Health promotion strategies and implementation

Health Promotion

At the interface between nursing practice and public health is the concept of health promotion. Health promotion is defined in the literature as "the process of enabling people to exert control over the determinants of health and thereby improve their health," (Health Promotion Agency 2009). That process includes a practical, hands-on dimension in which healthcare workers and policy makers actively raise awareness and facilitate health via information dissemination and accessible health care services. O'Donnell (2009) defines health promotion as "the science and art of helping people change their lifestyle to move toward a state of optimal health." Thus, health promotion addresses both curative and preventative issues. The World Health Organization suggests in its constitution that health promotion has an ethical component: " the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition." Health promotion combines public relations, political empowerment, and public policy initiatives with daily nursing practice.

Definitions of health promotion show that health promotion can be broken down into four distinct areas. First, health behavior theory illustrates the underlying methods by which health promotion can be achieved. Ideally, theory is supported by empirical evidence and practice. Second, health promotion depends on healthy interfaces between public policy and health care financing, and between the law and health care practice. Third, health promotion is a communications field within the broader rubric of nursing practice. Good public relations and communications skills are required, as well as partnerships with media and the private sector. Finally, health promotion must have measurable or at least observable outcomes. Measuring the effectiveness of health promotion strategies does not depend on statistical analyses. However, quantitative and qualitative data can both be helpful in assessing program merits and designing new strategies for the future.

Underlying Theories of Health Behavior

Health promotion strategies are rooted in a few core health behavior theories. Four of these theories are outlined by the Center for Health Communications Research at the University of Michigan (2009). Those four theories include the Health Belief Model, Social Cognitive Theory, Motivational Interviewing, and the Transtheoretical Model. Each of these theories can be drawn upon for advice and support for best practices in health promotion.

The Health Belief Model focuses on the attitudes and beliefs of individuals, showing how those factors impact behavior (Center for Health Communications Research 2009). The two most important cognitive factors in the Health Belief Model are perceived threats and perceived susceptibility to those threats. Perceived susceptibility in turn includes issues such as perceived severity of the problem (who cares if I get heartburn?); perceived benefits (I will look better as well as feel better if I exercise); and perceived barriers (I won't be able to hang out with my friends if I stop drinking). Self-efficacy and other variables also form the basis of individual decision-making with regards to health and lifestyle choices. Health promotion depends on an understanding of the Health Belief Model. Nurses, health care workers, and public health administrators can all take perceived threats and perceived susceptibilities into account when designing communication strategies.

Social cognitive theory combines social learning with behaviorism. The theory holds that "response consequences of a behavior are used to form expectations of behavioral outcomes," (Center for Health Communications Research 2009). Social cognitive theory "suggests that the mind is an active force that constructs one's reality, selectively encodes information, performs behavior on the basis of values and expectations, and imposes structure on its own actions," (Center for Health Communications Research 2009). Therefore, social cognitive theory takes into account environmental factors that impact behavioral choices. Those environmental factors and related symbols and sensory input can be used to design effective health promotion programs.

Motivational interviewing is an especially fruitful theory in that it offers nurses and other health care professionals practical steps by which to help clients achieve optimal health. The underlying theory is that clients need to be motivated from within, and not told what to do from an external authority. "Direct persuasion is not an effective method for resolving ambivalence" towards change (Center for Health Communications Research 2009). The counselor forms a partnership with the client rather than acting as an authority figure. Because of its practical advice, motivational interviewing serves as both fundamental health promotion theory and strategy.

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.