Theories of Health Promotion

The following essay is a comparative analysis of two theories of health promotion, one which is a theory of and the other a theory for health promotion. Beattie’s model will be used as theory of and transtheoritical stages of change model as a theory for health promotion. An example from area of work practice will be used to demonstrate the differing aspects emphasised by each Theory. Furthermore the essay will seek to suggest an explanation of current health promotion.

This assignment will therefore aim to achieve a greater comprehension of what health promotion actually is and to understand what is meant by ‘Theories of and for…’.

Difference of theories and models will also be given. Being able to state what health promotion actually is will be the first priority and by looking at its origins and influences will aid this task. An exploration of health promotion is envisaged on understanding of health. Like health promotion health is difficult to define as it means different things to different people.

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Health has two common meanings in day to day use, one negative and one positive. The most commonly quoted definition of health is that formalized by Ottawa Charter for Health Promotion. WHO, (1986) “a complete state of physical, mental and social well-being, and not merely the absence of disease or infirm. In keeping with the concept of health as a fundamental human right, the Ottawa Charter emphasises certain pre-requisites for health which include peace, adequate economic resources, food and shelter, and a stable eco-system and sustainable resource use.

Recognition of these pre-requisites highlights the inextricable links between social and economic conditions, the physical environment, individual lifestyles and health. These links provide the key to a holistic understanding of health which is central to the definition of health promotion Trying to define Health promotion is not an easy task. The term health promotion is quite recent first used in the mid 1970s (Lalonde 1974) It has been presented in different guises since the 19th century where it was initially created to improve sanitation in industrial towns when it was nown as the ‘Public Health Movement’.

It then targeted different diseases until 1927 when the concept of ‘Health Education’ was thought to be more beneficial, by providing education and information to improve the health behaviours resulting in disease. Education has a vital role in the empowerment process and it thus central to health promotion Whitehead and Irvine (2005. ) Some writers criticized health education for being a series of individualised focused campaigns designed to change lifestyles, and which therefore disempowered people by ‘blaming the victim’.

Where confusing descriptions of health education and health promotion existed Oakley (2001),’stated this is not merely a matter of semantic difference: what is at stake is the very practice of health education/promotion and the positions it adopts based on a particular view of the world. A change of terms is far more than a semantic shi ft. It is an imposition of one position over the other’. Bunton and McDonald (2000) adds on to say ‘health education and health promotion tend now to be seen as overlapping spheres’

Health promotion advanced this idea to allow health practitioners to work with communities to target specific health needs within certain populations Naidoo and Wills, (2000) increasing the concept to include access, class, gender, age, ethnicity, sexuality and disability as important sociological influences upon health, healthcare and health behaviours (Bunton and MacDonald, 2002). As health promotion now appears to target populations rather than individuals there is a greater push towards a New Public Health focus Naidoo and Wills, (2000).

There is no singularly accepted definition of health promotion. Health promotion draws from many different disciplines sociology, psychology, bio-medical whitehead and Irvine (2010). Authors such as Tannahil 1985 cited in Nadoo and wills 2009 described health promotion as a meaningless concept because it was used so differently. Seedhouse (1997) described the field of health promotion ‘as muddled, poorly articulated and completely lacking of clear philosophy’. Wills (2007) argues, conceptualizing health promotion is also problematic because there are many ifferent approaches to promoting health.

Burton and McDonald (2000) asks whether or not health promotion can legitimately be thought of as a discipline but suggest that recent changes in knowledge base and practice of health promotion are characteristics of a paradigmatic and disciplinary development. However the purpose of Health Promotion is to enable people to increase control over, and to improve, their health and its determinants. This is embodied in the Ottawa Charter for Health Promotion (WHO 1986) and in the Bangkok Charter for Health Promotion in a globalized World (WHO 2005) ….

Health is a positive concept emphasizing social and personal resources, as well as physical capacities. Therefore, health promotion is not just the responsibility of the health sector, but goes beyond healthy lifestyles to well-being. Contemporary health promotion draws on a range of theoretical and disciplinary perspectives and operates at many levels to facilitate conditions and opportunities for personal, community and organisational empowerment, effective partnerships. and alliances, healthy public policy and reoriented, sustainable environment.

A theory according to the National Institute of cancer (2005)’presents a systematic way of understanding events or situations’. It is a set of concepts, definitions, and propositions that explain or predict these events or situations by illustrating the relationships between variables. A commonly used definition of theory is that of Van Ryn and Heany (1992) which states theory as ‘systematically organised knowledge applicable in relatively wide variety of circumstances devised to analyse, predict, or otherwise explain the nature of behaviour of a specified set of phenomena that could be used as the basis for action’.

A theory for health promotion adopts a sociological approach and attempts to be more client/population sensitive focussing on a wider range of healthcare requirements (Bunton and MacDonald, 2002). A more analytical means of indentifying types of health promotion is to develop models of practice. Nadoo and Willis (2005) notes that all models be they building models seek to present reality in some way and try to show in a simplified form how different things connect. National institute of cancer (2005) describe a model as a subclass of theory which provides a plan for investigation of phenomenal.

A model seeks to provide the vehicle for applying theories. Nadoo and wills (2009) state that using a model can be helpful because it encourages one to think theoretically, and come up with new strategies and ways of working. Beattie’s model of health promotion has been chosen because it is a model used within the HIV Clinical Nurse Specialist in promoting health. The nature of the job provides multiple experiences of dealing with vulnerable service-users in need of this intervention. The Health Protection Agency (HPA) reported an increase of HIV infections (HPA, 2007).

As a model of health promotion it is useful for promoters because it identifies a clear framework for deciding a strategy and reminds the promoter the choice is influenced by social and political perspective Naidoo and Wills (2000). Beattie (1991) suggests that there are four paradigms for health promotion and focuses on interventions. These are generated from the dimensions of mode of interventions which ranges from ‘authoritative’ (top down and expert led) to ‘negotiated’ (bottom up and valuing individual autonomy) Whitehead and Irvine (2010).

Much of the health promotion work involving advice and information is practitioner lead, as well policy is determined by practitioners using epidemiology data. Diementions such as focus intervention range from individual to community led. Beattie (1991) terms the quadrants health persuasion, personal counselling, legislative action and community development. Applying the model for utilisation in the field of hiv the four specific target areas would be as follows:- Health persuasion would be to persuade clients to change risk sexual behaviour to avoid onward transmission, persuade clients to adhere with treatment and partner notification.

This intervention is directed to the individual but is expert led. Personal counselling would include clients adjusting to HIV diagnosis, condom use post exposure prophylaxis, HIV transmission law and clients about to start HIV treatment. These interventions are client led and the promoter is facilitator. Legislative action led by practitioners but aimed at community protection an example lobbing for normalization of HIV testing with General practice. Community developments like counseling these interventions seek to empower and enhance the skills of a community, example working with target group for HIV prevention.

Critiques argue that if Beattie’s model is used in isolation, attempts to persuade patients to change behaviors that are expert driven and medically approved, are likely to be limited in their effectiveness whitehead (2005). it has been argued that this type of approach fails to assess and explore how ready and skilled a patients is in changing their behavior. In addition it is argued that focus on the individual to change their behavior does not take into account the inability of some and the lack of choice owing to societal circumstances (Lavarack (2005).

The model fails to address some of the social and economic detriments of health. The transtheoretical model, more commonly known as ‘Stages of Change Theory’, was originally developed in 1982 to aid smoking cessation (Prochaska et al, 1992) and is a theory for health promotion. Theories for health promotion are applicable unlike theories of which provide a framework. It is a widely used stage theory in health psychology, however, is regularly applied to safer sex for health promotion purposes (Straub, 2002).

This ‘stage’ model was designed to adjust promotion strategies depending on an individual’s willingness to change through five stages: Pre-contemplation; Contemplation; Preparation for Action; Action and Maintenance (Prochaska et al, 1992). The stages are based on health behaviours and intentions for change with an ultimate goal of improving health (Straub, 2002) through a dynamic and gradual process (Lauby et al, 1998). This model posits that individuals move through a series of motivational stages before achieving particular target behaviour.

The five stages of change are pre contemplation, in which an individual shows no intention to adopt the health behaviour; contemplation, in which an individual shows awareness of personal risk and the need to change; preparation, in which an individual expresses intention to change; action, in which an individual has actively adopted the behaviour for a period of less than six months; and maintenance, in which the behaviour is sustained for more than six months . At each stage emotional, cognitive, and behavioural processes influence forward movement.

Behavioural change can be facilitated by the use of intervention strategies tailored to an individual’s readiness to stage (Prochaska et al, 1992; Straub, 2002) When associating the Stages of Change Model with safer sex education it has been found to adopt a practical approach, using motivational interviewing to move an individual from one stage to the next. According to Shrier et al (2001), it is most effective when a diagnosis of an HIV has been made as the individual is more likely to consider change.

Initial findings of Shrier et al’s (2001) research found that those who received intervention had greater perception of risk relating to hiv, positive attitudes towards condom use and were more likely to use condoms with a non regular partner compared with those in a control group. Using the stages of change model did appear to have a positive effect on sexual health promotion and found that participants were less likely to re-acquire an STI as a result (Shrier et al, 2001).

Lauby et al (1998) go on to point out that the crucial point for behaviour change is when the pros outweigh the cons. Prochaska et al (1994) felt that by increasing the perceived advantages would have a better effect on change than reducing the perceived disadvantages giving a more positive spin, therefore, improving the risky behaviour. Beattie’s model covers a variety of circumstances and can be utilised for individuals, groups or on a public health scale (Naidoo and Wills, 2000). However, it is not obvious where sociological influences would be addressed Bunton and MacDonald, (2002).

On the other hand, the ‘stages of change’ model’s main limitation is its focus on individuals rather than groups or communities. As a result, it wouldn’t prove a very useful tool on a public health promotion basis as the process of motivational interviewing is labour and time intensive, only benefiting a few rather than the many (Shrier et al, 2001; Bell et al, 2004). Beattie’s model has been critised for making the health promoter push their personal opinion of ideal health onto their patients/clients (Bunton & MacDonald, 2002) and with so many ways to express sexuality (Bell et al, 004) who is to say they are necessarily correct.

The stages of change model would accommodate itself for clients to express individual preferences on the health promoter and allow for goals to be created in a client-led direction rather than a top down one (Naidoo and Wills, 2000). As can be seen both models have made positive effects on improving sexual health promotion, but both have limitations; mainly they either focus too heavy on groups of people rather than the individual or vice versa.

Due to the current trends in STI acquisition it is important that effective health promotion strategies are put in place to stop further spread (HPA, 2007). A model that can be utilised for an individual as well as groups; incorporates different sexual, social and cultural needs while allowing for influences from a public health arena has been created by Bean et al (2002) in the form of the ‘Sexual Health Model’ and aims to provide a holistic approach to sexual health.