Health promotion and personal behavior change strategies

Health Promotion is one of the most challenging areas in today's nursing environment. Today, encouraging individuals to make personal changes in health promotion is often built on the concept of enabling individuals to improve their own health. Theorists like Dorothea Orem and Nola J. Pender have contributed greatly to our understanding of self-care and its impact on health promotion. Specifically, Orem's self-care theories outline the importance of understanding an individual's ability for self-care, their societal context, and the health of the individual in health promotion. Similarly, Pender's theories focus on how the relationship between individuals, their peer group and families, and health care professionals can impact health-promoting behaviors. Taken together, the theories of Orem and Pender have had a large impact on health promotion that focuses on the combined interaction of the individual's ability for self-care, nursing professionals, individual health, and a complex variety of social and cultural factors.

Health promotion itself is a relatively simple concept that is built solidly on enabling individuals to improve their own health. The Ottawa Charter of Health Promotion notes, "Health Promotion is the process of enabling people to increase control over, and to improve, their health' (NWT Department of Health and Social Services).

Orem's Self-Care Deficit Theory and successful health promotion built on individual enablement are closely linked. Self-care, in Orem's analysis, is strongly related to the individual's initiative in becoming responsible for their own health care, whenever possible. Self-care is continuous through adult life, and involves the individual acting on their own behalf in health prevention, promotion, the detection of disease, and treatment. It contributes greatly to human development, and helps maintain human functioning and structural integrity (Parissopoulos and Kotzabassaki).

Orem's theories of self-care describe people as responsible individuals and adults that are fully capable of forming a contractual relationship with a nurse. Self-care is purposeful and deliberate, and strongly linked to well-being and health. It is achieved when "individuals are transformed from passive, dependent patients to active partners" (Parissopoulos and Kotzabassaki, p 6).

When the therapeutic self-care demands that arise out of known needs for care are not met, Orem notes that a self-care deficit is formed. At this point, a need for nursing may arise out of this deficit in self-care. The decision for nursing care is a joint decision between the nurse and the patient.

Ultimately, the nurse's role is to help the individual achieve self-care. The nurse must assess the care demands of the patient, and the patient's ability to meet these demands. As such, any nursing assessment in Orem's model includes an assessment of both health, and an assessment of an individual's ability to engage in self-care (known as the patient's self-care agency) (Parissopoulos and Kotzabassaki).

Self-care agency is a goal-oriented, and learned behavior. As such, self-care agency is a significantly complex behavior that is closely related to cultural values, and aided by an individual's intellectual curiosity and the availability of instruction and supervision. Motivation is also an important factor in a patient's ability to self-care agency (Parissopoulos and Kotzabassaki).

Health is closely related to the self-care behavior described by Orem. A healthy individual can meet their own developmental and health-care needs, and health becomes a resource that can help individuals meet their goals in life. As such, an individual's health beliefs are an important consideration for nurses planning nursing care (Parissopoulos and Kotzabassaki).

Health promotion is thus greatly impacted by the culture in which it takes place. Nurses must learn to see patient's beliefs, worldviews, and goals as a resource in order to effectively promote self-care. Further, they must consider factors such as the power disparity between the nurse and the patient in societal terms. For example, by helping older people achieve a better perception of power, nurses can assist these patients in performing more self-care (Parissopoulos and Kotzabassaki).

Thus, Orem's theories can play an important role in health promotion. The individual nurse faces the personal challenge of both understanding the individual patient's self-care agency, their personal health, and the culture and society in which the assessment takes place. A nurse is likely to be the most successful in enabling a patient's self-care agency only when a thorough and complete understanding of all of these diverse components is achieved. In simpler terms, health promotion must take into consideration a number of considerations, including the health of the individual, the individual's personal ability for self-care, and the society in which health promotion takes place.

Pender's research into health promotion was spurred by her observation that health professionals often only intervened after people became seriously ill. Given this observation, she focused on creating a proactive approach to the prevention of illness that is based on the " conviction that it is much better to experience exuberant well-being and prevent disease than let disease happen when it is avoidable and then try and cope with it" (Pender, Most Frequently Asked).

Pender's Theory of Health Promotion is focused on the assumptions that individuals have the capacity for self-awareness, and they have the ability and desire to create "their unique human health potential" (Pender, Assumptions). Pender sees health care professionals as part of an individual's interpersonal environment. Further, she argues that commitment to a health promotion plan of action is important in creating health-promoting behaviors. Pender also argues that families, peers and health care providers give interpersonal support that can play an important role in enabling a person to commit to health-promoting behaviors (Pender, Assumptions).