Health Promotion Principles within Health and Social Care The purpose of the study was to evaluate and validate the application of health promotion within the workplace. The following pages will focus on health and social care workers in promoting the oral health of individuals in their care. The study will also address policies relating to health promotion and public health.
The concept of health is complex, therefore health promotion draws upon many different strategies and disciplines to improve the health of individuals and communities and the population on the whole, these may include sociology, social psychology, education and communication, economics, ethics and epidemiology, (Bunton 1992).
The important factor in health promotion is the understanding of people’s lives and addressing appropriately the needs of the individual or target group.
The World Health Organisation defined health promotion as enabling people to gain control over their lives (WHO 1986). This approach helps people to identify their own concerns and gain the skills and confidence to act upon them.
It is unique in being based on a ‘bottom-up’ strategy and calls for different skills from the health promoter. Instead of the expert role adopted by the other approaches, the health promoter becomes a facilitator whose role is to act as a catalyst, getting things going, and then to withdraw from the situation.
Self-empowerment is used in some cases to describe those approaches to promoting health which are based on counselling and which use non-directive, client-centred approaches aimed at increasing people’s control over their own lives, (Nutbeam 2009).
For people to be empowered they need to: recognise and understand their powerlessness, feel strongly enough about the situation and want to change it, feel capable of changing the situation by having information, support and life skills.
A driving force in the world of health promotion was the “Ottawa Charter for Health Promotion” (1986). At the first international conference on the Health Promotion in Ottawa 1986, a charter to help achieve ‘Health for all by the year 2000’ was presented. The conference was primarily a response to growing expectations for a new public health movement around the world and it built on the progress made through the ‘Declaration on Primary Health Care’ at Alma-Ata and the world health organizations targets for ‘Health for All’ document.
It claimed that the health promotion is the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and to realise aspirations, to satisfy needs, and to change or cope with the environment, (Ewles, Simnett 2005). Health was, therefore, seen as a resource for everyday life, not the objective of living. 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. According to the Ottawa charter (1986), “action on health promotion means building healthy public policy, creating supportive environments, strengthening community actions, developing personal skills, reorienting health services, and moving to the future. ” Overall the outcome of this international movement is that successive governments have had to try to implement and or incorporate these nationally.
This paper now gives a brief overview of a health promotional campaign on an older person’s rehabilitation unit, the target of this health promotion being the staffs who work on the wards. A practitioner working at the hospital has been given a new role of oral hygiene champion for older people, this role had been devised and the intention to implement the programme across the trust. After an induction the practitioner is given the tools to implement an oral care regime within the workplace.
The role defined, facilitate change, promote and educate her colleagues about the programme, six weeks are proposed to collaborate with the team and get everyone on board. Implement assessment of all patients’ oral health on admission using the new documentation and follow up referrals, during which the champion would oversee and aim to overcome any barriers. In recent years a range of standards, statements and tools have been developed and evaluated. These can steer and support best practice in oral care.
Patients who are debilitated may need encouragement to maintain daily oral hygiene, and others with cognitive impairment or other medical problems in maintaining oral health will need support to do so. Nurses and practitioners have a vital role in the promotion of good oral health and hygiene, in preventing discomfort and inadequate nutrition, in detecting oral disease in the early stages and in improving outcomes for patients. In 2000, WHO reiterated the priority of health for older people through the programme Ageing and Life Course,’ which focussed on the concept of ‘active ageing. ’ In 2002, WHO issued a document entitled ‘Active Ageing – A Policy Framework’, which outlines the essential approaches towards healthy ageing. The proposed policy framework rests on three basic pillars: health, social participation and security. When risk factors for chronic diseases and functional decline are minimized and protective factors are maximized, people enjoy longer life and higher quality of life.
Where labour market, employment, education, health and social policies and programmes support full participation of the elderly in socio-economic and cultural activities, people will continue to make a significant contribution to society as they grow older. When policies and programmes address the social, financial and physical security needs and rights of people as they age, the elderly are ensured protection, dignity and care in the event that they are no longer able to care for themselves.
Oral health is an important component of ‘Active Ageing’ and is included in policy proposals related to health, one of the three basic pillars. The impacts of oral diseases on the general health and quality of life of elderly people and the significance of oral health promotion are also emphasized in the document. Oral care is recognised as a neglected area of practice, (Migel and Watchel 2009) and regarded as a key aspect of nursing in Essence of Care 2010: Benchmarks for Personal Hygiene (Department of health (DH) 2010).
Another element to health promotion and behaviour changes in social psychology is the locus control theory. Understanding of the concept was developed by Julian Rotter (1954), and has since become an important aspect of personality studies. Mackey (2006) explains “People with internal locus of control are more likely to seek out information and knowledge about their health problems” but people who have external locus of control, Nancarrow (2006) “are less likely to do this and are more likely to accept the information that is given to them. ” Locus of control has generated much research in a variety of areas in psychology.
The construct is applicable to fields such as educational psychology, health psychology or clinical psychology. The aim of this study was to assess the importance of applying public health policies and principles. By assessing models of health promotion and models of behaviour this essay critically examines what role these play in current practice and the ways they facilitate an individual or client groups to maintain a sense of well-being whilst addressing the dimensions of health these being physical, psychological, emotional, spiritual, social and vocational.
A range of models have surfaced in recent decades, these are useful in the fact they provide a framework showing how different parts of health promotion interact. For the purpose of the practitioners role Tannahills model (1985) could be applied. This model describes health promotion as three intersecting circles of health education, prevention and health protection, “Health promotion comprises efforts to enhance positive health and prevent ill-health, through the overlapping spheres of health education, prevention, and health protection,” (Downie 1990).
In planning the health promotion intervention a number of decisions were made, assessment of the present situation, so this involved evaluating the oral care regime already in place within the unit. The next stage the practitioner developed a strategy in where a health education program was made available to staff in order to set in place procedures for oral assessment and care of the patients, an e-mail was sent to all staff making them aware.
When all relevant training was been complete the new documentation and tools were trialled. Finally, surveillance systems targeted at the oral health of the elderly to help assess the attainment of goals for oral health of the elderly and provide data for analysis of the cost-effectiveness of oral health programme, this refers also to Tannahills (1985) “prevention” stage of the model to both the initial occurrence of disease and also to the progress and subsequently the final outcome.
Ajzen (1985) expanded upon the theory of reasoned action, formulating the Theory of Planned Behaviour, which also emphasises the role of intention in behaviour performance but is intended to cover cases in which a person is not in control of all factors affecting the actual performance of behaviour. As a result, the new theory states that the incidence of actual behaviour performance is proportional to the amount of control an individual possesses over the behaviour and the strength of the individual’s intention in performing the behaviour.
Self-efficacy was proposed by Bandura (1997), which came from social cognitive theory. According to Bandura (1986), expectations such as motivation, performance, and feelings of frustration associated with repeated failures determine affect and behavioural reactions. Bandura (1986) separated expectations into two distinct types: self-efficacy and outcome expectancy. He defined self-efficacy as the conviction that one can successfully execute the behaviour required to produce the outcomes.
The outcome expectancy refers to a person’s estimation that a given behaviour will lead to certain outcomes. He states that self-efficacy is the most important precondition for behavioural change, since it determines the initiation of coping behaviour. Nurses have developed many health models to understand the client’s attitudes and values about health and illness so that effective care can be provided. Healthcare must expand its efforts to design and implement interventions which support promotion of health and prevention of disease/illness or disability.
Preventing illness and staying well involve complex, multidimensional activities focused not only on the individual, but also on families, groups and populations. References Ajzen, I. (1985). From intentions to actions: A theory of planned behaviour. In J. Kuhl & J. Beckmann (Eds. ), Action control: From cognition to behaviour. Berlin, Heidelber, New York: Springer-Verlag Bunton, R. McDonald G. (1992) Health Promotion: disciplines and diversity. London. Routledge Bandura, A. (1997). Self-efficacy: The exercise of control. New York: Freeman. Bandura, A. (1986) cited in Bandura, A. 1997). Self-efficacy: The exercise of control. New York: Freeman. Downie, RS. Fyfe C & Tannahill, A. (1990) Oxford: Oxford University Press, Essence of Care, (2010): Benchmarks for Personal Hygiene (Department of health (DH) 2010) Ewles, L. Simnett, I. (2005) Promoting Health – a practical guide. Edinburgh: Balliere Tindall Mackey, H. Nancarrow, S. (2006) Enabling Independence: A Guide for Rehabilitation Workers. Oxford. Blackwell Publishing. (Migel, K. Watchel, T (2009) Improving the oral health of older people in long term residential care: a review of the literature.
International Journal of Older People Nursing 4, 2, 97-113 Nutbeam, D. (2009) Theory in a Nutshell: A practical guide to health promotion theories. Australia: McGraw Hill Professional Tannahill. (1985) cited in Papadopoulos, I. (2006) Transcultural health and social care. London: Churchill Livingstone Elsevier Ottawa charter, (1986), WHO/HPR/HEP/95. 1. Ontario, Canada World Health Organization. (2002) Active Ageing: a Policy Framework. Geneva, Switzerland: WHO WHO Europe. (1999) Health 21 – Health for all in the 21st Century. Copenhagen: WHO Europe
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