Theories in CHN

Health Belief Model

• A psychological model that attempts to explain and
predict health behaviors.

• Based on the individual client’s perceptions of

seriousness or severity of the health problem,
susceptibility to or risk of the illness, benefits of
adopting the new behavior or changing the old behavior,
and barriers to changing or adopting the behavior.
 Health Belief Model
• Nurses can use the client’s locus of control (LOC) to
determine whether clients are likely to take action regarding
health.
• Locus of Control is a measurable concept that can be used to
predict which people are more likely to change their behavior
• Internal Locus – belief that the person has a major influence on his
own health
• External Locus – belief that health is controlled by outside forces and
it is beyond their control
 Health Belief Model

Perceived Perceived
Susceptibility Severity

Perceived Perceived
Benefits Barriers
 Health Belief Model
Concept Definition
Perceived Susceptibility One's opinion of chances of getting a
condition

Perceived Severity One's opinion of how serious a condition

and its consequences
Perceived Benefits One's belief in the efficacy of the advised
action to reduce risk or seriousness of
impact
 Health Belief Model
Concept Definition

Perceived Barriers One's opinion of the tangible and psychological

costs of the advised action

Cues to Action Strategies to activate "readiness”

Self-efficacy Confidence in one's ability to take action

 Health Belief Model
Concept Condom Use Education
Perceived Youth believe they can get STIs or HIV or create a
Susceptibility pregnancy.
Perceived Severity Youth believe that the consequences of getting STIs
or HIV or creating a pregnancy are significant enough
to try to avoid.
Perceived Benefits Youth believe that the recommended action of using
condoms would protect them from getting STIs or
HIV or creating a pregnancy.
Perceived Barriers Youth identify their personal barriers to using
condoms and explore ways to eliminate or reduce
these barriers
 Health Belief Model
Concept Condom Use Education

Cues to Action Youth receive reminder cues for action in

the form of incentives or reminder
messages

Self-efficacy Youth confident in using a condom

correctly in all circumstances.
Green’s PRECEDE-PROCEED Law
• Focuses on the community as the wellspring of health
promotion.

• Based on the epidemiological perspective on health

promotion to combat the leading causes of death.

• A comprehensive structure for assessing health needs for

designing, implementing, and evaluating health
promotion and other public health programs to meet
those needs.
Green’s PRECEDE-PROCEED Law

• The community is the center of gravity

Green’s PRECEDE-PROCEED Law
• PRECEDE provides the structure for planning a
targeted and focused public health program.

• PROCEED provides the structure for implementing and

evaluating the public health program.
Green’s PRECEDE-PROCEED Law
P • Predisposing
R • Reinforcing
E • Enabling
C • Constructs in
E • Educational/ Environmental
D • Diagnosis and
E • Evaluation
Green’s PRECEDE-PROCEED Law
P • Policy
R • Regulatory and
O • Organizational
C • Constructs in
E • Educational and
E • Environmental
D • Development
 Assumptions behind Precede-Proceed
Model
• Since behavior change is by and large voluntary, health
promotion (and, by extension, the promotion of other
community benefits) is more likely to be effective if it’s
participatory.
• Health and other issues must be looked at in the context of
the community.
• Health and other issues are essentially quality-of-life issues.
• Health is itself a constellation of factors that add up to a
healthy life for individuals and communities.
Four Phases of PRECEDE

Epidemiological
Social Diagnosis
Diagnosis

Educational & Administrative

Organizational & Policy
Diagnosis Diagnosis
 Social Diagnosis
• Determining what Focus Examples
the community Eliminating or reducing Homelessness
wants and needs a particular problem
to improve its Addressing an issue Race
quality of life.
Improving or Environmental
• What outcome maintaining certain protection
does the aspects of the quality
community find of life
most important? Improving the quality Increasing or creating
of life in general recreational and
cultural opportunities
 Social Diagnosis

Community Phone
Focus groups
surveys interviews

Face-to-face Questionnaires
interviews in public places
 Epidemiological Diagnosis
• Identify the health or other • Behavioral - needle-sharing among
drug addicts that increases their risk
issues that most clearly for AIDS
influence the outcome the
• Lifestyle - fondness for fatty foods
community seeks.
• Environmental (Physical, social,
political, and economic
Behavioral Lifestyle
environments.)
• Physical - water condition
• Social - childrearing practices).

Environmental
Precede
Phases 1 & 2 identify the goals of intervention
 Educational & Organizational
Diagnosis
• The nurse determines what to do in order to
change the factors identified in P2.

• The nurse identifies the predisposing, enabling,

and reinforcing factors that can affect the
behaviors, attitudes, and environmental factors
given priority in Phase 2.
 Predisposing Factors
• Tend to make individuals
more or less likely to adopt Knowledge Attitudes
healthful or risky behaviors
or lifestyles or to approve of
or accept particular Beliefs Values
environmental conditions.

Confidence
 Enabling Factors
• Are those internal and external
conditions directly related to the
issue that help people adopt and
maintain healthy or unhealthy Availability of Accessibility of
Resources Services
behaviors and lifestyles, or to
embrace or reject particular
environmental conditions. Community and/or
government laws, Issue-Related Skills
policies
 Reinforcing Factors
• Are the people and community attitudes that support or
make difficult adopting healthy behaviors or fostering
healthy environmental conditions.

• Attitudes of influential people: family, peers, teachers,

employers, health or human service providers, the
media, community leaders, and politicians and other
decision makers.
 Administrative & Policy
Diagnosis
• Focuses on identifying the administrative as well as internal and
external policy factors that can affect the success of what can
be implemented.

• This is important to avoid mismatches between an organization

and the proposed interventions.

• Organizational issues include organizational structure,

procedures, and culture; and the availability of resources
necessary for the intervention.
Four Phases of PROCEED

Process
Implementation
Evaluation

Impact Outcome
Evaluation Evaluation
Four Phases of PROCEED
IMPLEMENTATION PROCESS EVALUATION

• Carrying out the • Evaluating the

intervention. process of the
intervention .
 Four Phases of PROCEED
IMPACT EVALUATION OUTCOME EVALUATION

• Evaluating whether the • Evaluating whether the

intervention’s effects
intervention is having are in turn producing
the intended impact on the outcome(s) the
the behavioral and community identified in
environmental factors it Phase 1, and adjust
is aimed at, and adjust accordingly.
accordingly.
 Pender’s Health Promotion
Theory
Health Promotion
• Any activity undertaken to • Describes the
achieve a higher level of multidimensional nature
health and well-being of persons as they interact
within their environment
• Directed toward improving to pursue health.
well-being and actualizing the
health potential of
individuals, families, groups
and communities
Difference Between Health Promotion &
Disease Prevention

Health Promotion Health Protection

• Not disease oriented • Illness or injury specific
• Motivated by personal, • Motivated by avoidance of illness
positive approach to wellness
• Seeks to thwart the occurrence of
• Seeks to expand positive insults to health and illness
potential for health
Types of Health Promotion
Programs
Health Appraisal/ Lifestyle a
Information Wellness
Dissemination Assessment & Behavior
Programs Change Programs

Worksite Wellness Environmental

Programs Control Programs
 Information Dissemination
• Most basic type of HPP
• Aim to raise the level of
knowledge and awareness of
individuals about health habits
• Aims to educate the public
about the risks of particular
lifestyle choices and personal
behavior
 Health Appraisal/ Wellness
Assessment Programs
• Used to appraise individuals
of the risk factors inherent
in their lives in order to
motivate them to reduce
specific risks and develop
positive health habits.
• Focuses on more positive
methods of health
enhancement
• Some institutions have HRA
forms to determine risk
factors of their clienteles
Lifestyle & Behavior Change Programs
• Directed toward enhancing
the quality of life and
extending the lifespan.
• Requires active participation
of the individual
• Individual may consider
lifestyle change after they
have been informed of the
need to change their
behavior
 Worksite Wellness Programs
• Programs are developed to address the needs of individuals spending
a great deal of time in the work environment
• To promote health of workers in the area and other health
enhancement programs
Worksite Wellness Programs
• Making the workplace smoke-free
• Wellness Challenges that engage
and motivate on increasing
physical activity, proper nutrition
and better self-care.
• Implement healthy eating
guideline policies
 Worksite Wellness Programs
• Start a stairwell program.
• Implement an hourly over-head
chime reminder to promote
getting up to stretch, move or
change position.
 Worksite Wellness Programs
• Address air quality standards for the classroom, office or plant
• Accident prevention for the machine worker
• Programs to screen hypertension and health enhancement programs
such as fitness information and relaxation techniques
Environmental Control Programs
Environmental Sanitation
• The prevention and control of
diseases by eliminating or
controlling the environmental
factors which may form links in
disease transmission
• Control of air and water
pollution
Role of the Nurse in Health Promotion

Role Models
 Role of the Nurse in Health Promotion

Counselling • For the nurse, this activity

focuses on:
• Process of helping a client to • Healthy individuals with
recognize and cope with normal adjustment
stressful psychologic or social difficulties
problems, to develop improved • Development of new
IPR & to promote personal attitudes, feelings and
growth. behavior rather than on
• Emotional, intellectual and promoting intellectual
psychological support is growth.
provided through the use of
therapeutic communication skills
Multidimensional Nature of
Health Promotion

Individual Family Community

Wellness Wellness Wellness

Environmental Societal
Wellness Wellness
 Individual Wellness
• Individuals play a
critical role in the
determination of their
own health status
• Self-care represents
the dominant mode of
health care in our
society.
 Family Wellness
• The family plays a critical
role in the development
of health beliefs and
health behaviors
• Allows for family
members to become
engaged in the process of
helping and supporting
their loved one. Influence
of parents on the eating
pattern of children
 Community Wellness
• Achieved by multiple actions that improve the
conditions of family and community life.
• Is about the ability and willingness of people to act
together, in ways which benefit everyone.
 Environmental Wellness
• Affects the extent to
which individuals,
families and
communities achieve
their optimum
potential
• Being aware of the limits
of the earth's natural
resources
• Conserving energy (i.e.
shutting off unused lights)
• Recycling paper, cans, and
glass as much as possible
• Enjoying and appreciating
time outside in natural
settings
• Not polluting the air,
water or earth
• Creating home and work
environments that are
supportive and nurturing
 Societal Wellness
• Depends largely on the passage of laws and the establishment of
policies that protect the health and welfare of all age groups
• A well society is one in which all members have a standard of living
and way of life that enables them to meet basic human needs and
engage in activities that express their human potential.
Nursing Process in Health
Promotion

Assessment Planning

Implementation Evaluation
 Assessment

Health History and Physical Examination

Physical Fitness Assessment

Nutritional Assessment

Health Risk Appraisal(HRA)/Health Hazard

Appraisal (HHA)
 Risk Factor

Predisposing Precipitating
Factor Factor
 Risk Factors
Age

Genetic Factors

Biological Characteristics

Personal Health Habits

Lifestyle

Environment
 Assessment

Lifestyle Assessment

Life Stress Review

Health Care Beliefs

 Lifestyle Assessment
• Focus is on the lifestyle and
habits of the client as they affect
health.
• Increasing evidence indicates
that individuals can maintain
and enhance their well-being
and prevent the early onset of
disabling health problems by
engaging in health-promoting
lifestyle.
 Life Stress Review

• Stress has been identified

as a potential threat to
mental health and
physical well-being
 Health Care Beliefs
• Those concepts about health that the individual holds true which may
or may not be founded on facts.
 Diagnosing
• The nurse and client agrees on • Altered Nutrition: Potential for
potential nursing diagnoses that more than body requirements
will assist the client in • Potential for Altered Parenting
decreasing the risk of developing
specific diseases
 Planning

Identify health care goals

Identify possible behavior changes

Assign priorities to behavior changes

Make a commitment to change behavior

Identify effective reinforcements and rewards

Develop a schedule for implementing the behavior change

 Implementation
• Provide and facilitate
• “Doing phase” of the support
behavioral change
 Provide health education
• Emphasize “self-
 Enhance behavior
responsibility”
change
• Client is the primary decision-  Modeling
maker who seeks out the
expertise of the nurse
 Evaluation
• A collaborative effort between the nurse and the
client.

• Client may decide to continue with the plan,

reorder priorities, change strategies or revise HP
contract
 Milo’s Framework for Prevention
• Provides a complement to the HBM and provides a mechanism for
directing attention upstream and examining opportunities
for nursing intervention at the population level.
• Milo proposed that health deficits often result from an imbalance
between a population’s health needs and its health sustaining
resources.
• She stated that the disease associated with excess afflict
affluent societies, and the disease that result from inadequate
or unsafe food, shelter, and water afflict the poor.
 Milo’s Proposition
Population health deficit’s result from deprivation and or excess of critical resources.

Behaviors of population result from selection from limited choices. These arise from
actual and perceived options available as well as beliefs and expectations resulting from
socialization, education, and experience.
Organizational decisions and policies dictate many of eh options available to individuals
and populations and influence choices.
Individual choices related to health promotion or health damaging behaviors are
influenced by efforts to maximize valued resources.
Alteration in patterns of behavior resulting from decision making of a significant number
of people in a population can result in social change.
Without concurrent availability of alternative health-promoting options for investment of
personal resources, health education will be largely ineffective in changing behavior
patterns.