1-4, 6, 18, 24, 31. Health Promotion, Wellness, Disease Prevention & Religion
Criteria for screening programme
*Disease criteria*: -Serious disease -High prevalence of pre-clinical stage -Natural history of disease well understood -Long period b/w 1st signs & overt disease *Diagnostic test criteria*: -Sensitive & Specific -Simple & cheap -Safe & acceptable -Reliable *Diagnosis/Treatment criteria*: -Adequate facilities -Effective, acceptable & safe treatment available
Factors influencing individual response to Health promotion: REINFORCING FACTORS & Appropriate Health promotion response
*Inter*personal (between self and others) factors negatively or positively influencing behaviour -relationships w/ significant others -health literacy among sig. others *Response* -Cultural competence -Involving families -Peace and Security initiatives -Social support network and services -Educational opportunities -Community organisation
Factors influencing individual response to Health promotion: PREDISPOSING FACTORS & Appropriate Health promotion response
*Intra*personal (within self) characteristics influencing behaviour -knowledge -attitudes -beliefs -perceptions -health literacy *Response* -Continual assessment of what these are & how they change based on interventions -Understand and apply behaviour change theories -Build capacity for change & coping
Prenatal & Newborn screening tests
*Prenatal* (antenatal): HIV/HBV, Ultrasound *Newborn*: Sickle cell disease, thyroid disease
Health Literacy dimensions: Cultural Literacy
-Abilities to recognize, understand and use collective beliefs, customs and social identity of diverse individuals to interpret and act on information. -Important at the individual patient provider level eg. Understanding that Hispanics have lowest levels of Flu vaccine, and this can affect entire family. Tell Hispanic patient 'protect your entire family'
Mental health
-Also called psychological health, may include emotional health; may make explicit reference to intellectual capabilities; the subjective sense of well-being -Growth in understanding, reasoning, memory and communication -Emotional growth, involving accepting yourself, making room for others, and having a sense of purpose in life -Ability to cope with the good and bad experiences of life by showing appropriate emotional and practical responses
Health Literacy dimensions: Civic Literacy
-Awareness of public issues and ability to discuss these issues -Judging the sources of information -Judging the quality of information -Knowing when and where to access information -Knowing how to advocate for oneself and others eg. The parent who understands that keeping a child with chicken pox at home is for the greater good of the class and school even though it may be inconvenient to do so.
Common examples of Medical Norms in: Christian Science, Catholicism, Judaism, Jehovah's Witness
-Christian scientists may choose to pray for healing rather than medical treatment. -Jehovah Witnesses do not accept blood transfusion, but non-blood alternatives instead. -Roman Catholics are averse to fertility treatment such as in vitro fertilization. -For some Jewish families, the question of circumcising boys is one of faith and tradition as well as a medical decision.
Primary approach to Health Education
-Effective communication to improve health literacy -Foster motivation, skills & confidence to take action -Mobilize & organize participation in activities that impact health outcomes
Model of Health & Illness: Health Promotion Model
-Emphasises actualisation of health potential and an increase in the level of wellbeing rather than avoidance of disease; -Has been primarily used in nursing -Describes major components and variables that influence health promoting behaviours 3 major components: 1.individual characteristics and experiences 2.behaviour-specific cognition and affect 3.behavioural outcome
Multidimensional Model of Health Literacy: 4 central domains
-Fundamental literacy -Scientific literacy -Civic literacy -Cultural literacy
Health Literacy dimensions: Scientific Literacy
-Skills and abilities to understand and use science and technology -->Basic concepts -->Change in accepted science is possible eg. Woman on Hormone replacement therapy reads that studies have linked HRT to increased risk of ovarian cancer. Poor scientific literacy: She thinks it's no big deal and continues on the therapy Good scientific literacy: She inquires about this with her doctor
Social Health
-The ability to interact effectively with other people and the social environment; satisfying interpersonal relationships; role fulfilment -Ability to integrate and to interact acceptably with others -Optimal social health includes knowing self; establishing, maintaining healthy boundaries and respecting the boundaries of others
Health Literacy dimensions: Fundamental Literacy
-The ability to read, write, speak and work in numbers -Is the cornerstone to health literacy -->Written and spoken health info contains complex language -->Finding the right educational materials to reinforce learning is often difficult
Disease Classification according to Duration or Onset (Acute)
-Usually has a short duration and severe. -The signs and symptoms appear abruptly, are intense and often subside after a relatively short period. -Following an acute disease process a person may return to normal level of functioning
Disease Classification according to Aetiology
1. Hereditary 2. Congenital. Due to a defect in the development, hereditary factors, or prenatal infection; present at birth. (e.g. cleft lip, cleft palate) 3. Metabolic 4. Deficiency. Results from inadequate intake of absorption of essential dietary factors. 5. Traumatic. Due to injury. 6. Allergic 7. Neoplastic. Due to abnormal or uncontrolled growth of cells. 8. Idiopathic. Cause is unknown; Self-originated; of spontaneous origin. 9. Degenerative. Results from the degenerative changes that occur in tissue and organs. 10. Iatrogenic. Results from the treatment of a disease.
Stages of Illness
1. symptom experience 2. assumption of sick role 3. contact medical care 4. dependent patient role
Leavell's 3 levels of disease prevention
1° - Before person gets disease → *Lower incidence & prevalence of disease* 2° - Disease process started, but asymptomatic → Find & treat disease early; reduce morbidity; may be able to cure 3° - Person has symptoms → Cure disease; slow disease; prevent complications; treat disability; rehabilitate; *prevent death*
Health Education Defn.
A combination of learning experiences designed to achieve VOLUNTARY actions supportive of health; Any combination of planned learning experiences based on sound theories that provide individuals, groups and communities the opportunity to acquire information and the skills needed to make quality health decisions.
Complication
A condition that occurs during or after the course of an illness
Cultural awareness
A deliberate recognition of cultural beliefs, practices and values as a necessary part of the approach health care providers need to possess, in order to be more sensitive to their patients
Disease Classification: Pandemic
Epidemic diseases which is extremely widespread involving an entire country or continent.
5 Models of Health and Illness
Agent-Host-Environment Health/Illness Continuum High-Level Wellness Model Health Belief Model Health Promotion Model
Common major childhood illnesses: Adolescent
Accidents & injuries STI / HIV Teenage pregnancy Depression - suicide Substance abuse
Spiritual Health
Also called "personal health"; associated with the concept of self-actualization; sometimes reflects a concern for issues related to one's value system; alternatively ,may be concerned with a belief in a transcending, unifying force.
Disease Classification: Epidemic
Attacks a large number of individuals in a community at the same time
Sensitivity vs Specificity
Both *measures of accuracy* of tests *Sensitivity* is proportion of people *with disease* who correctly *test positive*; [THINK: Sensitive enough to detect the disease] *Specificity* is proportion of people *without disease* who correctly *test negative*
Based on the information given about Dawn and in light of the stages of change theory at what stage would you say she is, in her readiness to change her behaviour A. Pre-contemplation B. Action C. Preparation D. Contemplation
C. preparation She has already made plans to make the changes. She now is preparing to follow through with these plans.
Health Education Operative Words: Voluntary Actions
Change is more lasting when it is self imposed
Disease Classification according to Duration or Onset (Chronic)
Characterized by: Remission - Period during which the disease is controlled symptoms are not obvious Exacerbation - The disease becomes more active again at a future time, recurrence of pronounced symptoms; -Slow onset. -Persists, usually longer than 6 months and can also affect functioning in any dimension. -The client fluctuates between maximal functioning and serious relapses that may be life threatening
Behavioural Change (Basic factors)
Communication strategies Building relationships
Morbidity & Morbidity rate
Condition of being diseased; The proportion of disease to health in a community
Public Health Policy by World Health Organization
Defines a vision for the future Outlines priorities and expected roles of different groups Builds consensus and informs people
Common major childhood illnesses: Infant
Diarrhoeal illnesses Respiratory infections Nutritional problems Injuries
Disease vs Illness
Disease: Biological and/or physiological malfunctioning (the 'clinical' perspective); Illness: The experience and perception of disease within the sociocultural context; includes spirituality and religion; a personal or subjective state in which the person feels unhealthy or unwell; Illness may or may not be related to disease; Illness is a state in which a person's physical, emotional, intellectual, social, developmental or spiritual functioning is diminished or impairment compared with previous experience.
Disease (defn.)
Disturbance of structure or of function of the body or its constituent parts; Lack of or inadequate adaptation of the organism to his environment; Failure of the adaptive mechanism to adequately counteract the stimuli or stresses to which it is subject, resulting in disturbances in function and structure of any part, organ or system of the body
Declaration of Human Rights Article 25(1)
Everyone has a right to a standard of living adequate for the health and wellbeing of himself, and of his family , including food, clothing, housing and medical care and necessary social services
Factors influencing individual response to Health promotion: ENABLING FACTORS (*Health Services & Social Conditions*) & Appropriate Health promotion response
Factor: *Health Services* -Activities organized for *p*romoting health, *p*reventing disease and restoring or maintaining *p*opulation health. {*P*'s} Factor: *Social conditions* -Income and social status -Equity -Employment and working conditions *Response* -Know population & needs -Plan with communities -Promote services -Include non-traditional services -Use modern technology -Public Education -Supportive actions
Factors influencing individual response to Health promotion: ENABLING FACTORS (*Natural & Man Made environment*) & Appropriate Health promotion response
Factor: Natural/Made-made Environment -Environmental Engineering -air, water, soil -vectors -natural hazards, waste -road signs *Response* -Impact assessments & interventions -Public education and protective measures -Community Services
Challenges of preventative care that persist in Jamaica
HIV/AIDS Violence & its impact
Examples of 1° prevention of common illnesses/injuries in children
Hand washing Wearing seatbelt Pool fences Stairway gates Keep guns/weapons in secure location
WHO Definition of Health (1948)
Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
Health on a Continuum
Health on a continuum is [a person's] degree of wellness at any point in time, ranging from: an optimal wellness condition, with available energy at its maximum to: death, which represents total energy depletion
Multiple risk reduction strategies (Behavioural)
Identify knowledge, attitudes & risk behaviours Understand effects on health Plan change
Key successes in childhood illness preventative initiatives so far in Jamaica
Immunisation Breastfeeding initiative Use of oral rehydration solutions Fluoridation - decrease tooth decay Seatbelt legislation Antiretroviral prophylaxis
Health engineering strategies for behaviour change
Include activities that seek to change the structure or types of services or system of care to promote health • Referrals to specialists for focus on educational inputs (eg nutritionists, counselors, health educators) • Changes in the environment to influence awareness, knowledge, attitudes (eg posters, videos, pamphlets, no smoking signs, removal of ash trays, placement of bins, food choices) • Lower prices on healthy snacks • Combination of strategies
Wellness (Ministry of Health of New Zealand defn. & National Wellness Association of Singapore)
New Z: A dimension of health beyond the absence of disease or infirmity, including social, emotional and spiritual aspects of health Singapore: Wellness is an active process of becoming aware of and making choices toward a more successful existence.
Incentives and Disincentives for health promotion
Often used in workplace health programmes to encourage or discourage behaviours; *Social reinforcers*: • Attention or recognition • Praise/verbal reinforcements • Encouragement *Material reinforcers*: • Tokens • Certificates etc • Cost sharing eg reduced fees for engaging in some activities *Health Insurance*
Etiologic Agent
One that possesses the potential for producing injury or disease (eg virus or bacteria etc)
Disease Classification: Sporadic
Only occurs occasionally
Community services & organisational strategies for Health promotion
Outreach programmes to: *Remove barriers to obtaining service*; *Help persons who do not use the health services*: • screening • Provide follow-up/referrals • Explain or demonstrate alternatives in treatment *Support groups*: • Having a knowledge of existing groups • Establishing groups • Encourage networking • Encourage family support
Examples of 2° screening
PAP smear Mammogram Penicillin prophylaxis for RHD
Common major childhood illnesses: Child
Poisoning Accidents & injuries Infections Nutritional problems
Health Belief Model
Predicts likelihood of individual health behaviour change; People more likely to comply with recommended health behaviour if: 1.*they perceive themselves vulnerable to a condition they consider to be severe* 2.They perceive the effects of non-compliance to be severe 3.the benefits to be derived from recommended action outweigh the cost of engaging in the behaviour 4.*Barriers to carrying out the action are minimal/ manageable* 5.*There is Self efficacy for performing the behaviour before starting the behaviour* 6.Other sociocultural factors
Common major childhood illnesses: Newborns
Prematurity Jaundice Respiratory distress Congenital anomalies Infection
Disease Classification: Endemic
Present more or less continuously or recurs in the community.
2 Tests for Health Literacy
Rapid Estimates of Adult Literacy in Medicine [REALM] Test Of Functional Health Literacy in Medicine [TOFLA]
Virulence
Relative power or the degree of pathogenicity of the invading microorganism, the ability to produce poisons that repel or destroy phagocytes
Why study health literacy? / Issues with low healthcare literacy?
Research shows that low health literacy increases health expenditures -->Patient provider communication -problems leading improper use of medications & other procedures -->Applications for health care benefits require paper work so benefits are often not accessed by low literate persons. Low literate persons: -->Think in concrete/immediate terms -->Often interpret information literally -->Have insufficient language fluency needed to comprehend and apply information from written materials -->Have difficulty with information processing such as medical instructions, reading labels
Syndrome
Set of symptoms, the sum of which constitutes a disease; a ground of symptoms which commonly occur together; a group of signs and symptoms which when considered together characterise a disease
Stages of Illness: Symptom Experience
Stage 1: believe something is wrong -some symptoms -transition stage 3 aspects: -physical (fever, ache, etc) -cognitive (believing you have the flu) -emotional (worry about consequences)
Stages of Illness: Assumption of Sick role
Stage 2: -Acceptance of the illness -Seeks advice, support for decision to give up some activities.
Stages of Illness: Contact Medical Care
Stage 3: Seeks advice to health professionals for the following reasons: - validation of real illness - explanation of symptoms - reassurance or prediction of outcome
Stages of Illness: Dependent patient role
Stage 4: -The person becomes a client dependent on the health professional for help. -Accepts/rejects health professional's suggestions. -Becomes more passive and accepting. -May regress to an earlier behavioral stage.
Epidemiology
Study of the patterns of health & disease, its occurrence and distribution in man, for the purpose of control and prevention of disease
Symptom vs Sign
Symptom: Any disorder of appearance, sensation or function experienced by the patient indicative of a certain phase of a disease. Manifestation of perceptible changes in the body which indicate the presence of a disease or disorder; Sign: An objective symptom or objective evidence or physical manifestation made apparent by special methods of examination or use of sense
Inadequacy (basic factors)
Tendency to blame the victim Many actions difficult due to lack of resources and opportunities
Physical Health
The absence of disease and disability; functioning adequately from the perspective of physical and physiological abilities; the biological integrity of the individual
Biopsychosocial Definition of Health
The biopsychosocial model is a general model or approach that posits that biological, psychological (which entails thoughts, emotions, and behaviours), and social factors, all play a significant role in human functioning in the context of disease or illness
Susceptibility
The degree of resistance the potential host has against the pathogen
WHO Revised description of Health (1984)
The extent to which an individual or a group is able to realize aspirations and satisfy needs, and to change or cope with the environment; health is a resource for everyday life, not the objective of living; it is a positive concept, emphasizing social and personal resources as well as physical capabilities
Model of Health & Illness: Health Belief Model Basis
This is built on the premise: that disease prevention and curing regimens will eventually be successful and; the belief that health is highly valued. Both premises need to be present in the model to be relevant in explaining health behaviour
Health Education Operative Words: Sound theories
Understanding the process of change for better planning of health behaviour change
Screening
Unrecognised disease identified by tests that can be rapidly applied on a large scale
Disease Classification: Venereal
Usually acquired through sexual relation (HIV/AIDS, gonorrhea)
Health Education Operative Words: Planned learning experiences
Versus incidental or occasional and based on relevant assessment
Dimensions of Wellness
Wellness = optimal health and vitality Dimensions of wellness: 1.Physical wellness 2.Emotional wellness 3.Intellectual wellness 4.Spiritual wellness 5.Interpersonal and social wellness 6.Environmental, or planetary, wellness
Secondary screening (PAP smear, cervix cells tested for cervical cancer)
What level of screening is this?
Secondary screening (Prostate cancer already developed.)
What level of screening is this?
Religion
a matter of faith-belief anchored in conviction rather than scientific evidence. It is founded on the idea of the sacred, that which is set apart as extraordinary and demands submission
Cultural knowledge
a responsibility to develop a culturally sensitive approach to patient care interactions, and to take measures to educate self about the worldview of various cultures.
*Case*: Dawn believes she is vulnerable to diabetes. She believes diabetes is a serious life threatening disease. Risk behaviours: • She likes to eat a lot of sweet foods • She is not physically active Other risk factors: • Her mother and two aunts on her mothers side died from complications of diabetes • She is obese (Thinks this is more appealing to her spouse) She knows she is at risk and plans to reduce her risk. She plans to exercise and has made arrangements with her friend Pam to go walking in the mornings at 5:30. For the last year she has been putting off starting the walking programme. *Question*: What educational approach is more likely to help Dawn modify her bahaviour? a. Give Dawn some reading materials about diabetes and its prevention b. Encourage Dawn to develop a behaviour contract and negotiate for a strong support system c. Have a variety of educational materials displayed in the waiting area of the clinic where Dawn visits for medical care d. Engage in reflective listening and offer material incentives for change
b. Encourage Dawn to develop a behaviour contract and negotiate for a strong support system Dawn already is knowledgeable about her risks. She understands what needs to be done. She needs support in actually starting her new healthy habits.
Web of Causation
de-emphasizes the disease agent and allows for multifactorial causes
Health Policy (define)
decisions, plans, and actions that are undertaken to achieve specific health care goals within a society
Health Promotion Operative words: Social & Environmental
economic, cultural, regulatory, organizational factors which interact with behaviour to influence health status
Culture
learned, shared and transmitted values, beliefs, norms and life practices of a particular group that guides the thinking, decisions and actions in patterned ways
Disease Classification: Functional
no anatomical changes are observed to account for the symptoms, may result from abnormal response to stimuli.
Disease Classification: Familial
occurs in several individuals of the same family (e.g. hypertension, cancer)
Health Promotion Operative words: Educational
provision of learning experiences to facilitate voluntary actions
Disease Classification: Organic
results from changes in the normal structure, from recognizable anatomical changes in an organ or tissue of the body.
Disease Classification: Occupational
results from factors associated with the occupation engaged in by the patient (e.g. cancer among chemical factory workers).
Cultural skills
the ability to collect data and perform physical histories that are both thorough and culturally sensitive
Health Promotion Operative words: Combination
the importance of matching determinants of health with multiple interventions
Health Education Operative Words: Combination
the importance of using a variety of approaches & engaging the senses
Cultural encounter
this refers to direct interactions between the provider and patient, despite their different cultural backgrounds. The more providers interact with patients of different cultures, the more they get the opportunities to refine their approaches to these groups
Sources of resistance to change of health behaviour
• *Ignorance* • *Mistrust* • *Disbelief • *"Power-Cut"*: a fear that sources of influence and control will be eroded. • *Loss*: change has unacceptable personal costs • *Inadequacy*: the benefits from the change are not seen as sufficient • Anxiety • *Comparison*: the way forward is disliked because an alternative is preferred • *Demolition*: change threatens the destruction of existing social networks.