Finally, the transtheoretical model proposes five stages of change: precontemplation, contemplation, preparation for action, action, and maintenance. These five stages illustrate health behavior. The transtheoretical model can be viewed more as an outcome of health promotion rather than a theory underlying health promotion strategies. However, the theoretical model can inform best practices in health promotion by nurses who work directly with clients. The theory helps health care workers evaluate the effectiveness of health promotion programs.
While each of these four theories should ultimately be integrated and synthesized into a model for health promotion, I will focus on the Health Belief Model and the Motivational Interviewing Model to demonstrate direct, specific ways nurses can contribute to health promotion in their practices.
Integration of Theory with Nursing Practice
The Health Belief Model shows why individuals make the health-related choices they do. For example, young people are far less likely to perceive the long-term threats from behaviors like smoking, doing drugs, drinking, engaging in unprotected sex, and eating junk food. Similarly, an individual who believes that diabetes does not run in their family and therefore fails to eat properly might be making choices that impact personal health and well-being. I perceive the Health Belief Model as a means of understanding client behavior and client choices rather than as a suggestion for direct intervention. In keeping also with the Motivational Interviewing model, I would incorporate the Health Belief Model into my practice by simply listening to and understanding client beliefs. From this compassionate perspective, it is likely that clients may at least come to embrace their choices and take responsibility for any possible health-related consequences.
Barriers to Health Promotion
Barriers to health promotion include financial, communications, and legislative issues. Financial barriers to health promotion are among the most significant. Many health promotion organizations lack the requisite funding to achieve intended public or personal health objectives. Health care institutions and clinics likewise lack unlimited funding by which they can produce publications, implement free programs for clients, or hire health promotion specialists. These barriers are especially relevant in terms of social and economic class issues. Clients who are poor have less access to health promotion materials, making health an important political issue.
The media must be recruited for health promotion. If no media outlets are available or if available outlets are uninterested in promoting health, then barriers to communication prevent health promotion. A lack of qualified health promotion specialists can also pose a communication barrier. Finally, legislative and legal issues can prevent health promotion. Legislation should ideally be promoting health, but often the interests of business trump the best interests of public health.
Evaluating and Assessing
Evaluating and assessing the effectiveness of any chosen theory or health promotion strategy requires both research and careful observation. As a nurse, I can observe changes in my clients. Working with the Transtheoretical Model, I even have a means of observing stages of change in individuals as well as whole communities. Researchers can gather statistical data that can be used to inform public policy and guide legislation.
When the financial, legal, and practical barriers to health promotion are removed, achieving public health goals becomes much easier. Health promotion is an ethical imperative. While improved funding and legislation is helpful, health promotion can begin right now: with a solid commitment to creating and maintaining healthy lifestyles and healthy communities. Nurses are at the forefront of health promotion, because we interact directly with clients as well as with health care administrators and health educators.
Center for Health Communications Research at the University of Michigan (2009). "Health Behavior Theories." Retrieved online: http://chcr.umich.edu/how_we_do_it/health_theories/healththeories4/chcr_document_view
"Health Literacy." (2010). Health Service Executive. Retrieved online: http://www.healthpromotion.ie/health/health_literacy
Health Promotion Agency (2009). What is health promotion? Retrieved online: http://www.healthpromotionagency.org.uk/Healthpromotion/Health/section2.htm
O'Donnell, M.P. (n.d.). Tobacco killed my little brother. American Journal of Health Promotion. Retrieved online: http://www.healthpromotionjournal.com/publications/journal/en2010-11.htm
Public Health Promotion Agency of Canada (2010). Health promotion. Retrieved online: http://www.phac-aspc.gc.ca/hp-ps/index-eng.php
World Health Organization (WHO 2006). Constitution of the World Health Organization. Retrieved online: http://www.searo.who.int/EN/Section898/Section1441.htm