Family Nurse Practitioner as Health Promoter based on the Health Promoter and Disease Prevention Theoretical Model
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HealthPromotionandDiseasePreventionTheoriesandModels1.pptxHealth Promotion and Disease Prevention Theories and Models.
Facilitator: Sarai Fernandez.
Health Promotion and Disease Prevention Theories and Models.
There are several theories and models that support the practice of health promotion and disease prevention.
Theories and models are used in program planning to understand and explain health behavior and to guide the identification, development, and implementation of interventions.
When identifying a theory or model to guide health promotion or disease prevention programs, it is important to consider a range of factors, such as the specific health problem being addressed, the population(s) being served, and the contexts within which the program is being implemented.
Health promotion and disease prevention programs typically draw from one or more theories or models.
Selected theories and models that are used for health promotion and disease prevention programs include:
Ecological Models.
The Health Belief Model.
Stages of Change Model (Transtheoretical Model)
Social Cognitive Theory.
Theory of Reasoned Action/Planned Behavior.
Ecological Models
Theory at a Glance: A Guide for Health Promotion and Practice frames the ecological perspective as
“...the interaction between, and interdependence of, factors within and across all levels of a health problem. It highlights people’s interactions with their physical and sociocultural environments.”
Ecological models recognize multiple levels of influence on health behaviors, including:
Intrapersonal/individual factors, which influence behavior such as knowledge, attitudes, beliefs, and personality.
Interpersonal factors, such as interactions with other people, which can provide social support or create barriers to interpersonal growth that promotes healthy behavior.
Institutional and organizational factors, including the rules, regulations, policies, and informal structures that constrain or promote healthy behaviors.
Community factors, such as formal or informal social norms that exist among individuals, groups, or organizations, can limit or enhance healthy behaviors.
Public policy factors, including local, state, and federal policies and laws that regulate or support health actions and practices for disease prevention including early detection, control, and management.
Examples of Ecological Models.
Project HEART (Health Education Awareness Research Team) used an ecological model to design a health promotion and disease prevention program to address cardiovascular disease risk factors.
The project uses a community health worker (CHW) promoter model to provide services.
CDC's Colorectal Cancer Control Program (CRCCP) was designed to address multiple factors of influence on colorectal cancer prevention, using ecological model components.
Rural networks and coalitions often acknowledge multiple factors of influence and may be designed using theoretical components of ecological models. More information is available in the Rural Health Networks and Coalitions Toolkit.
Considerations for Implementation
The ecological perspective is a useful framework for understanding the range of factors that influence health and wellbeing.
It is a model that can assist in providing a complete perspective of the factors that affect specific health behaviors, including the social determinants of health.
Because of this, ecological frameworks can be used to integrate components of other theories and models, thus ensuring the design of a comprehensive health promotion or disease prevention program or policy approach.
The Healthy People 2020 framework addresses the importance of ecological models in health promotion and disease prevention. Programs are most likely to be effective when they are designed to address the multiple levels of influence on health behaviors
The Health Belief Model.
The Health Belief Model is a theoretical model that can be used to guide health promotion and disease prevention programs.
It is used to explain and predict individual changes in health behaviors.
It is one of the most widely used models for understanding health behaviors.
Key elements of the Health Belief Model focus on individual beliefs about health conditions, which predict individual health-related behaviors.
The model defines the key factors that influence health behaviors as an individual's perceived threat to sickness or disease (perceived susceptibility), belief of consequence (perceived severity), potential positive benefits of action (perceived benefits), perceived barriers to action, exposure to factors that prompt action (cues to action), and confidence in ability to succeed (self-efficacy).
Health Belief Model Examples.
The Michigan Model for Health is a curriculum designed for implementation in schools.
It targets social and emotional health challenges including nutrition, physical activity, alcohol and drug use, safety, and personal health, among other topics.
This model adapts components of the Health Belief Model related to knowledge, skills, self-efficacy, and environmental support.
Considerations for Implementation.
The Health Belief Model can be used to design short- and long-term interventions. The five key action-related components that determine the ability of the Health Belief Model to identify key decision-making points that influence health behaviors are:
Gathering information by conducting a health needs assessments and other efforts to determine who is at risk and the population(s) that should be targeted.
Conveying the consequences of the health issues associated with risk behaviors in a clear and unambiguous fashion to understand perceived severity.
Communicating to the target population the steps that are involved in taking the recommended action and highlighting the benefits to action.
Providing assistance in identifying and reducing barriers to action.
Demonstrating actions through skill development activities and providing support that enhances self-efficacy and the likelihood of successful behavior changes.
These actions represent key elements of the Health Belief Model and can be used to design or adapt health promotion or disease prevention programs.
The Health Belief Model is appropriate to be used alone or in combination with other theories or models.
To ensure success with this model, it is important to identify "cues to action" that are meaningful and appropriate for the target population.
Stages of Change Model (Transtheoretical Model)
The Stages of Change Model, also called the Transtheoretical Model, explains an individual's readiness to change their behavior. It describes the process of behavior change as occurring in stages.
These stages include:
Pre-contemplation: There is no intention of taking action.
Contemplation: There are intentions to take action and a plan to do so in the near future.
Preparation: There is intention to take action and some steps have been taken.
Action: Behavior has been changed for a short period of time.
Maintenance: Behavior has been changed and continues to be maintained for the long-term.
Termination: There is no desire to return to prior negative behaviors.
Stages of Change Examples.
Michigan's Healthy Workplaces Resource Guide presents guidelines for implementing a worksite wellness program. The guide includes information and resources related to the Stages of Change and the varying levels of employee readiness to change.
The Alliance of Black Churches Health Project implemented a self-help smoking cessation intervention called Call it Quits. The intervention was designed to address the Stages of Change. The short-term outcomes from the intervention were increased awareness of smoking cessation programs and increased progress along the Stages of Change.
CDC provides a Talking about Fall Prevention with Your Patients Fact Sheet that describes how to use the Stages of Change Model for fall prevention education
Considerations for Implementation.
The Stages of Change Model describes how an individual or organization integrates new behaviors, goals, and programs at various levels.
At each stage, different intervention strategies will help individuals progress to the next stage and through the model.
Individuals within a population will likely vary in their readiness to change. In addition, it is important to recognize that movement through this model is cyclical – individuals may progress to the next stage or regress to a previous stage.
The Stages of Change model can be applied to health promotion and disease prevention programs to address a range of health behaviors, populations, and settings.
It may be an appropriate model for health promotion and disease prevention programs related to worksite wellness, tobacco use, weight management, medication compliance, addiction, and physical activity, among other health topics.
Social Cognitive Theory.
Social Cognitive Theory (SCT) describes the influence of individual experiences, the actions of others, and environmental factors on individual health behaviors.
SCT provides opportunities for social support through instilling expectations, self-efficacy, and using observational learning and other reinforcements to achieve behavior change.
Key components of the SCT related to individual behavior change include:
Self-efficacy: The belief that an individual has control over and is able to execute a behavior.
Behavioral capability: Understanding and having the skill to perform a behavior.
Expectations: Determining the outcomes of behavior change.
Expectancies: Assigning a value to the outcomes of behavior change.
Self-control: Regulating and monitoring individual behavior.
Observational learning: Watching and observing outcomes of others performing or modeling the desired behavior.
Reinforcements: Promoting incentives and rewards that encourage behavior change.
Social Cognitive Theory Examples:
Healthy Relationships, a program implemented by Chattanooga CARES, is a small-group intervention for people living with HIV/AIDS. The program is based on the Social Cognitive Theory and uses skill-building exercises to increase independence and develop healthy behaviors among participants. Additional information about this program is available in the HIV/AIDS Prevention and Treatment Toolkit.
Hombres is a community-based intervention designed to reduce the risk of HIV and other sexually transmitted diseases among Latino men living in rural areas of the United States. Based on the Social Cognitive Theory, the program trains “Navegantes” (Navigators) who provide information and risk reduction materials to the target population.
Considerations for Implementation.
The SCT can be applied as a theoretical framework in different settings and populations. It is frequently used to guide behavior change interventions.
It may be particularly useful in rural communities for examining how individuals interact with their surroundings.
The SCT can be used to understand the influence of social determinants of health and a person's past experiences on behavior change.
Theory of Reasoned Action/Planned Behavior.
Two closely associated theories – The Theory of Reasoned Action and the Theory of Planned Behavior – suggest that a person's health behavior is determined by their intention to perform a behavior. A person's intention to perform a behavior (behavioral intention) is predicted by:
a person's attitude toward the behavior, and
subjective norms regarding the behavior.
Subjective norms are the result of social and environmental surroundings and a person's perceived control over the behavior. Generally, positive attitude and positive subjective norms result in greater perceived control and increase the likelihood of intentions governing changes in behavior.
Theory of Reasoned Action/Planned Behavior Examples:
SIPsmartER is a health promotion program implemented in rural southwest Virginia. The goal of the program is to decrease sugar-sweetened beverage consumption among adults. The intervention strategy is based on the Theory of Planned Behavior and includes education through small-group classes and teach back methods.
A cervical cancer prevention program was designed for women in rural, Appalachian Kentucky. 1-2-3 Pap: Easy Steps to Prevent Cervical Cancer is a cervical cancer prevention program designed for women in rural, Appalachian Kentucky. The program components include strategies to increase knowledge and modify attitudes, beliefs, and behaviors, using the Theory of Planned Behavior as a guide.
Considerations for Implementation.
The Theory of Reasoned Action/Planned Behavior provide useful information for predicting health behaviors and for planning and implementing health promotion and disease prevention programs.
Subjective norms can be used to describe the behaviors of healthcare providers, patients, care providers, and others in the community.
These theories have been used to guide health promotion and disease prevention asthma counseling and treatment compliant, tobacco use interventions, and anti-drug media campaigns, among other topics.
