HEALTH PROMOTION

APPROACHES & METHODS

Compilated from many sources

APPROACHES IN HEALTH PROMOTION

1) Medical or Preventive
2) Behaviour Change
3) Educational
4) Empowerment
5) Social Change
 APPROACHES IN HEALTH PROMOTION -2

THE MEDICAL APPROACH

• Aim is freedom from medically-defined disease and
disability such as infectious diseases

• Involves medical intervention to prevent or ameliorate ill-

health

• Values preventive medical procedures and the medical

profession’s responsibility to ensure that patients comply
with recommended procedures
 APPROACHES IN HEALTH PROMOTION -3

THE BEHAVIOUR CHANGE APPROACH

• Aim is to change people’s individual attitudes and behaviour
so that they adopt a healthy lifestyle

• Examples include teaching people how to stop smoking,

encouraging people to take exercise, eat the right food, look
after their teeth etc

• Proponent of this approach will be convinced that a healthy

lifestyle is in the interest of their clients and that they are
responsible to encourage as many people as possible to adopt
a healthy lifestyle
 APPROACHES IN HEALTH PROMOTION -4

THE EDUCATIONAL APPROACH

• Aim is to give information and ensure knowledge and
understanding of health issues and to enable well-informed
decisions to be made

• Information about health is presented and people are helped

to explore their values and attitudes and make their own
decisions

• Help in carrying out those decisions and adopting new health

practices may also be offered
 APPROACHES IN HEALTH PROMOTION -5

THE EDUCATIONAL APPROACH (Cont’d)

• Proponent of this approach will value the educational
process and respect the right of the individual to choose
their own health behaviour

• Resposibility to raise with clients the health issues which

they think will be in their client’s best interests
 APPROACHES IN HEALTH PROMOTION -6

THE CLIENT-CENTRED APPROACH

(EMPOWERMENT)
• Aim is to work with clients in order to help them to identify
what they want to know about and take action on and make
their own decisions and choices according to their own
interest and values

• Health promoter’s role is to act as a facilitator in helping

people to identify their own concerns and gain the
knowledge and skills they require to make things happen
 APPROACHES IN HEALTH PROMOTION -7

THE CLIENT-CENTRED APPROACH

(EMPOWERMENT) (Cont’d)

• Self-empowerment of the client is seen as central

to this aim
• Clients are valued as equal who have knowledge,
skills and abilities to contribute, and who have an
absolute right to control their own health
destinies
 APPROACHES IN HEALTH PROMOTION -8

THE SOCIETAL CHANGE APPROACH

• Aim is to effect changes on the physical, social and economic
environment, in order to make it more conducive to good
health

• Focus is on changing society not on changing the behavior of

individuals

• Proponent of this approach will value their democratic right to

change society and will be committed to putting health on the
political agenda
 MODELS OF
HEALTH PROMOTION
HEALTH PROMOTION METHODS USING BEATTIE’S
TYPOLOGY (BEATTIE – 1991)
MODE OF INTERVENTION
Advice Legislation

Education
Authoritarian Policy making and
implementation
Behavior change
Health surveillance
Mass media campaign

Individual
Focus of
intervention
Counseling
Lobbying
Education
Action research
Group work
Skills sharing and training
Group work
Community development
Negotiated
 TANNAHILL’S MODEL OF HEALTH PROMOTION
(DOWNIE et al – 1990)

5 6. Positive health
1. Preventive services, Health education
e.g. immunization, protection, e.g.
cervical screening, workplace
2 7
hypertension case smoking policy.
1 4 6
finding, Health
developmental Prevention 3 protection 7. Health education
surveillance, use of aimed at positive
nicotine chewing gum health protection,
to aid smoking
3. Preventive health protection, e.g. e.g. lobbying for
cessation. a ban on tobacco
fluoridation of water.
advertising.
2. Preventive health 4. Health education for preventive
education, e.g. health protection, e.g. lobbying
smoking cessation for seat belt legislation.
advice and 5. Positive health education, e.g
information. life skills with young people.
HEALTH PROMOTION
INTERVENTIONS
INTERVENTION :-
WHAT DOES IT MEAN?
• Interventions are activities used by programme
planners to bring about outcomes identified in
the programme objectives
• These activities are sometimes referred to as
treatments
• An intervention may be made up of a single
activity but it is more common for planners to
use a variety of activities to make up an
intervention for a programme
SELECTING APPROPRIATE INTERVENTION
ACTIVITIES -1

• Selection should be based on a sound

rationale as opposed to chance and the
intervention should be both effective and
efficient. The following questions will serve
as a guide:
1. Do the intervention activities fit the goals and
objectives of the programme?
2. At what level(s) of influence will the
intervention be focused?
SELECTING APPROPRIATE INTERVENTION
ACTIVITIES -2
3. Is the intervention an appropriate fit for the
target population?

4. Are the necessary resources available to

implement the intervention selected?
SELECTING APPROPRIATE INTERVENTION
ACTIVITIES -3
5. What types of intervention activities are
known to be effective in dealing with the
programme focus?

6.Would it be better to use an intervention

that consists of a single activity or one that is
made up of multiple activities?
TYPES OF INTERVENTION ACTIVITIES -1

1. Communication activities
2. Educational activities
3. Behaviour modification activities
4. Environmental change activities
5. Regulatory activities
6. Community advocacy activities
TYPES OF INTERVENTION ACTIVITIES -1

7. Organizational culture activities

8. Incentives and disincentives
9. Health status evaluation activities
10. Social activities
11. Technology-delivered activities
1. COMMUNICATION ACTIVITIES

Useful in helping reach the many goals and

objectives of health promotion programmes
such as:
• Increasing awareness and knowledge
• Changing and reinforcing attitudes
• Maintaining interest
• Providing cues for action
• Demonstrating simple skills
2. EDUCATIONAL ACTIVITIES

• those usually associated with formal

education in courses, seminars and
workshops
• includes educational methods such as
lecture, discussion, group work,
computerised instruction etc
3. BEHAVIOUR MODIFICATION ACTIVITIES -1

• often used in intra-personal level

communication and include techniques
intended to help those in the target
population experience a change in behaviour

• systematic procedure for changing a

behaviour and process based on stimulus
response theory
3. BEHAVIOUR MODIFICATION ACTIVITIES -2

• emphasis placed on a specific behaviour

that one might want to increase or
decrease

• particular attention given to changing

the events that are antecedent or
subsequent to the behaviour that is to
be modified
4. ENVIRONMENTAL CHANGE ACTIVITIES -1

• measures that alter or control the

legal, social, economic and physical
environment
• changes are characterised by changes
in those things “around” individuals
that may influence their awareness,
knowledge, attitudes, skills or
behaviour
 4. ENVIRONMENTAL CHANGE ACTIVITIES -2

• activities to provide a “forced choice” situation (e.g.

selection of food and drinks in vending machines
and canteens changed to include only “healthy
food”

• activities to also include providing target population

with health messages and environmental cues for
certain types of behaviour
• (e.g. posting no-smoking signs, eliminating ash
trays, providing lockers and showers, using role-
modelling by others, food labelling
5. REGULATORY ACTIVITIES -1

• Include executive orders, laws, ordinances,

policies, position statements, regulations, and
formal and informal rules
• Classified as mandated or regulated activities
to guide individual or collective behaviour
• Intervention activity may be controversial as it
mandates a perticular response from an
individual and takes away individual freedom
5. REGULATORY ACTIVITIES -2

• regulatory activities do not allow for the

“voluntary actions” conducive to health
• this type of activity can get people to change
their behaviour when other strategies have
failed
• since these activities are mandatory, it is
particularly important to use good judgement
and show respect for others when
implementing them
6. COMMUNITY ADVOCACY ACTIVITIES -1

• are used to influence social change

• is a process in which the people of the community

become involved in the institutions and decisions that
will have an impact on their lives

• has the potential for creating more support, keeping

people informed, influencing decisions, activating
non-participants, improving services, and making
people, plans, and programmes more responsive
6. COMMUNITY ADVOCACY ACTIVITIES -2

• activities are not without cost - requires time

and effort as well as persistence
• techniques often used in advocacy activities
include:
• personal visits to educate or lobby the key people
• a community rally
• telephone call campaign to the office of decision makers
• TV or radio appearance to express your views
6. COMMUNITY ADVOCACY ACTIVITIES -3

• letter-writing campaigns to:

• the key-people who educate/influence
decision makers,
• newspaper editors, expressing concern
about the result of a vote by decision
makers on a particular issue,
• decision-makers, thanking them for their
support on a key issue
7. ORGANIZATIONAL CULTURE ACTIVITIES -1

• Closely aligned with environmental

change activities and that which affect
organizational culture
• Culture is usually associated with norms
and traditions that are generated by and
linked to a “community” of people
7. ORGANIZATIONAL CULTURE ACTIVITIES -1

• The culture expresses what is and what

is not considered important to the
organization

• It takes a long time to establish norms

and traditions and still change can
occur very quickly if the decision-
makers in the organization support it
 7. ORGANIZATIONAL CULTURE ACTIVITIES -3

• Some organizational culture activities

may include:
• Providing employees with extra 20 minutes
at lunch-time for exercise
• Use of common exercise facility by Senior
Managers
• Changing the type of food found in vending
machines
• Offering discount on health food
8. INCENTIVES AND DISINCENTIVES -1

• use of incentives and disincentives to

influence health outcomes is a common
type of activity
• activity is based on many health
behaviour theories - suggest that
anticipation of rewards increases the
probability of an individual engaging in
desired health behaviour
 8. INCENTIVES AND DISINCENTIVES -2

• an incentive can increase the perceived

value of an activity, motivate people to get
involved, and remind programme
participants of their commitment to and
goals for behaviour change

• for the activity to work, the planner needs

to match the incentives with the needs,
wants, or desires of the target population
8. INCENTIVES AND DISINCENTIVES -3

• two major categories of incentives – the first

group includes incentives called “social
reinforcers” and the second group called
“material reinforcers”

• just as incentives can be used to get people

involved in behaviour change, disincentives
can be used to discourage a certain
behaviour (e.g. tax on cigarettes, surcharge
on health insurance for smokers, fines for
not wearing safety-belts)
9. HEALTH STATUS EVALUATION ACTIVITIES

• aimed at making those in the target

population more aware of their current
health status
• part of multi-activity intervention
• activities involved the completion of a health
risk appraisal form, self-screening, clinical
screening
• settings for such activities - health fairs,
work-sites and health care facilities
10. SOCIAL ACTIVITIES
• social support important for behaviour change
• people find it much easier to change a
behaviour if those around them provide support
or are willing to be partners in the behaviour
change process
• social support could work as in incentive
• other social interventions could include support
groups or buddy support, social activities and
social networks
11. TECHNOLOGY-DELIVERED ACTIVITIES

• traditional delivery of many health

education and health promotion
programmes - face-to-face contact between
provider and target population
• with technology programmes are now
delivered through a variety of ways –
internet and computer-assisted instruction
• telephone-delivered intervention activities –
individual-initiated or outreach
AIMS AND METHODS
IN
HEALTH PROMOTION
 AIMS AND METHODS IN HEALTH PROMOTION
AIM APPROPRIATE METHOD
Health awareness goal Talks, group work, mass media, displays and
Raising awareness, or consciousness, exhibitions, campaign.
of health issues.
Improving knowledge One-to-one teaching, displays and exhibitions,
Providing information. written materials, mass media, campaigns, group
teaching.
Self-empowering Group work, practising decision-making, values
Improving self-awareness, elf-esteem, clarification, social skills training, simulation,
decision making. gaming and role play, assertiveness training,
counselling.
Changing attitudes and behaviour Group work, skills training, self-help groups, one-
Changing the lifestyles of individuals. to-one instruction, group or individual therapy,
written material, advice.
Societal/environmental change Positive action for under-served groups, lobbying,
Changing the physical or social pressure groups, community-based work,
environment. advocacy schemes, environmental measures,
planning and policy making, organisational
change, enforcement of laws and regulations.
 APPROACHES TO HEALTHY PROMOTION
(THE EXAMPLE OF HEALTHY EATING)

APPROACH AIMS METHODS WORKER/CLIENT

RELATIONSHIP
Medical To identify those at risk Primary health care Expert led. Passive,
from disease. consultation, e.g. conforming client.
measurement of body
mass index.

Behaviour change To encourage individuals Persuasion through one- Expert led.

to take responsibility for to-one advice, Dependent client. Victim
their own health and information, mass blaming ideology.
choose healthier campaigns, e.g. “Look
lifestyles. After Your Heart”
dietary messages.
APPROACH AIMS METHODS WORKER/CLIENT
RELATIONSHIP
Educational To increase knowledge Information. May be expert led
and skills about healthy Exploration of attitudes May also involve client in
lifestyles. through small group negotiation of issues for
work. Development of discussion.
skills, e.g. women’s
health group.
Empowerment To work with clients or Advocacy Health promoter is
communities to meet their Negotiation facilitator.
perceived needs. Client becomes
Networking
Facilitation e.g. food empowered.
co-op, fat women’s
group.
Social change To address inequities in Development of Entails social regulation
health based on class, organisational policy, and is top-down.
race, gender, geography. e.g. hospital catering
policy.
Public health
legislation, e.g. food
labelling. Lobbying.
Fiscal controls, e.g.
subsidy to farmers to
produce lean meat.