Welcome Back Students

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Welcome Back Students!

• HEALTH PROMOTION/PROTECTION DISEASE PREVENTION
• Week 1 63-173

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Importance of Illness and Injury Prevention
(Statistics Reported in Sept. 2006)

• There were more than 4,000 deaths and 570,000
  injuries. In other words, every hour of every
  day, 65 people in Ontario are injured and roughly
  11 people die from their injuries each day
• The total costs of intentional and unintentional
  injuries in Ontario amounted to more than 5.7
  billion annually. These include direct costs such
  as health care and indirect costs including lost
  productivity
• Falls were the most costly unintentional injury,
  totalling more than 1.9 billion. Motor vehicle
  collisions were the second most costly, at more
  than 1.1 billion http//www.smartrisk.ca/Content
  Director.aspx?tp4044

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Importance of Illness and Injury Prevention
(contd)

• Of the total cost of intentional injuries,
  suicide and self-inflicted injury accounted for
  nearly 886 million, while interpersonal violence
  represented 230 million
• Alcohol-related injuries had a total cost of 440
  million for the four leading causes of injury
• Injuries resulting from physical activity cost
  655 million http//www.smartrisk.ca/ContentDirect
  or.aspx?tp4044

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Importance of Illness and Injury Prevention
(contd)

• The rates and economic burden of injury vary
  widely across Ontario. For example, residents of
  northwestern Ontario experience the highest
  death, hospitalization and injury rates, along
  with the highest per capita injury costs. The
  lowest death rates and per capita injury costs
  were found in the Mississaugua-Halton area
  http//www.smartrisk.ca/ContentDirector.aspx?tp40
  44

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At Risk Populations

• 40 in pre-contemplation
• 40 in contemplation
• 20 in preparation
• Example of High Risk Populations
• University/College students Drug and Alcohol
  Use, Drinking and Driving
• Children high risk population for falls,
  poisoning, suffocation, drowning and obesity
• Teenage Pregnancies
• Elder Falls
• Depression/Suicide in Aboriginal populations

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Human Potential for Change

• Individuals/groups have tremendous potential for
  change
• Have capacity for self-knowledge,
  self-regulation, decision-making and creative
  problem solving 
• Willingly undertake to achieve self-selected goals

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Human Potential for Change

• Nurses create/promote positive environments, may
  serve as catalyst and assist with various steps
  of change process
• Promote behavioural change by having positive
  regard for culture and and socioeconomic
  conditions
• Health behaviours with cultural fit more likely
  to be maintained over time as an integral aspect
  of lifestyle

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Use of Multidisciplinary Theories

• Successful approaches to behaviour change address
  multiple levels of influence on the behaviour and
  their interaction/influence across all levels of
  care
• Ecological approach uses intrapersonal,
  interpersonal, institutional, community and
  public policy factors which all represent levels
  of influence on human health behaviour

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A Model of Health Protection The Health Belief
Model (HBM)

• Viewed as potentially useful to predict those
  individuals who would/would not use preventive
  measures and to suggest interventions that might
  increase predisposition of resistant individuals
  to engage in health-protecting behaviours

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A Model of Health Protection The Health Belief
Model (HBM) (contd)

• Main variables perceived threat to personal
  health and the conviction that the benefits of
  taking action to protect health outweigh the
  barriers that will be encountered

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Health Belief Model


Individual Perceptions

Modifying Factors

Likelihood of Action





Demographic variables
(age, sex,

race,
ethnicity, etc.)





Perceived benefits
o
f
Sociopsychological variables


preventive action

(personality, social class, peer

minus

reference group pressure, etc.)



Perceived barriers
to


preventive action

Structural variables
(knowledge


about the disease, prior contact

Perceived susceptibility
to
with the disease, etc.)


disease X





Perceived
seriousness

Likelihood of taking

Perceived threat
recommended preventive

(severity) of disease X

of disease X


health action




Cues to action



Mass media campaigns


Advice from others


Reminder postcard from


physician or dentist

Illness of family member or
friend

Newspaper/magazine article

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Focused areas of criticism about the HBM

• Perception of threat is the only time modifying
  factors (demographics, social, psychological and
  structural variables) are addressed in the model
  and only indirectly
• Health Belief Model model for disease
  preventing behavior but is clearly an
  inappropriate as a model for health promoting
  behavior (Pender et al, 2006)

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Explaining or Predicting Preventive Behavior

• Research suggests that perceived barriers is the
  most powerful dimension in explaining or
  predicting various preventive behaviors.
• Perceived susceptibility important
• Perceived benefits of taking action and perceived
  severity of illness lacked power to explain or
  predict preventive behavior

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Criticisms of the Health Belief Model

• Only two component variables in the model are
  supported by research
• This is relevant to designing preventive
  interventions ( Pender et al, 2006)
• HBM Model was to be applied to one time behaviors
  (i.e. immunization)
• Application to more complex behavioral risks
  i.e. smoking, unsafe sexual practices
  necessitates attending to the individual
  perceptions of competence or self efficacy to
  repeatedly engage in preventive behaviors over a
  long period of time. (Pender et al, 2006)

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Health Promotion Model (HPM) Pender, N.,
Murdaugh, C. Parsons, M. (2006). Health
promotion in nursing practice. 5th ed. Upper
Saddle River, N.J Pearson Prentice Hall.

• Focuses on promotion of healthy behaviours, not
  on disease prevention  
• Competence or approach-oriented model does not
  include fear of threat as a source of motivation
  for health behaviour 
• Potentially applicable across the lifespan

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Theoretical Basis for HPM

• Attempt to depict multidimensional nature of
  persons interacting with their interpersonal and
  physical environments as they pursue health 
• Integrates constructs from
• Expectancy-Value Theory - Behaviour is rational
  and economical
• Social Cognitive Theory - Interactive dynamic
  model of causation, environmental events,
  personal factors, affect, cognitions and
  behaviours themselves interact to influence and
  cause each other

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Health Promotion Model
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Research Evidence for the HPM

• Variables that were significant in highest of
  previous studies were perceived self-efficacy,
  perceived barriers and prior behaviour 
• Demographic characteristics, perceived benefits,
  interpersonal and situational influences and
  perceived health status were significant in
  majority of studies 
• Better measures of interpersonal and situational
  influences are needed to provide more rigorous
  test of their explanatory and predictive value
  for health-promoting behaviour

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Role of the Professional andSelf Care

• The nurse helps the client shape a positive
  behavioral history for the future by focusing on
  the benefits of a behavior, teaching clients how
  to overcome hurdles to carrying out the behavior
  and engendering high levels of efficacy and
  positive affect through successful performance
  experience and positive feed back. ( Pender et
  al, 2006)

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Usefulness of the HBM and the HPM

• Models provide a coherent and organized framework
  for intervening with clients to increase health
  protection and health promotion behaviours
• HBM for use in examining health protection
  behaviours

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• HPM e.g.s
• Regular exercise - 20 minutes, 3 x/week
• Regular daily intake of proper servings of 4 main
  food groups - Canadas food guide
• Regular rest relaxation/ leisure activities
• Maintenance of wt within suggested parameters
  based on Ht age.

• HBM e.g.s
• Monthly BSE for early detection of breast cancer
• Smoking cessation to reduce risk of lung cancer
• Intake of sufficient dietary fibre to reduce risk
  of stomach cancer
• Regular use of seatbelts to minimize serious
  injury in car accident

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Transtheoretical Model of Change

• Prochaska and Diclemente
• Provides a framework for understanding the
  process of how people change
• Recognizes that different stages require
  different types of interventions in order to make
  the change process relevant to the client

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The Transtheoretical Model

• Health behavior change involves progress through
  six stages of change
• 1. Pre-contemplation Not intending to make a
  change
• 2. Contemplation Seriously considering next 6
  months
• 3. Preparation Next 30 days
• 4. Action Involved in the behavioral
  change for 6 months
• 5. Maintenance Works to prevent reverting- 6
  months after action has started and
  continuing indefinitely.
• 6. Termination Integrated change behaviors
  into ADLs- activities of daily living

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Spiral of Change
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What Helps People Change?

• Processes of Change
• Decisional balance
• Self-efficacy

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Processes of ChangeRole of Professional and Self
Care Facilitated Change

• Experiential Process
• Consciousness Raising
• Self reevaluation
• Environmental Re-evaluation
• Self- re-evaluation
• Social Liberation

• Behavioral Process
• Counterconditioning
• Helping relationships
• Reinforcement Management
• Self Liberation
• Stimulus Control

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Role of the NurseStage Matched
InterventionsProchaska, J.O., DiClemente, C.C.,
Norcross, J.C. (1992). In search of how people
change Applications to addictive behaviors.
American Psychologist. 47(9)1102-1114.
Pre contemplation Contemplation Preparation
Action Maintenance Termination
Consciousness raising Dramatic relief Environmenta
l Re evaluation
Self-liberation
Reinforcement management Helping
relationships Counter conditioning Stimulus
Control
Self- Re-evaluation
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Decisional Balance Across the Stages of Change
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Self-efficacy

• Represents a persons confidence in their ability
  to change a behavior
• Confidence to resist temptations varies across
  the stages of change. It is lowest in the
  pre-contemplation and highest in the maintenance
  stage

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Application of Change Theories

• Ten minutes Group Activity
• In groups of 3
• Using TTM
• Develop 3 questions that would assist you, the
  nurse, in ascertaining the stage of a clients
  readiness for behavioral change
• Choose a spokes person to present your questions