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Community Health and Wellness Promotion CH06100

Community Health and Wellness Promotion CH06100. Session 1 Concepts, History, Determinates & more May 10, 2011 David Beavers, M.Ed., D.C., M.P.H. Determinants of Health Major Categories. Physical factors Social & Cultural factors Community organization Individual behaviors

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Community Health and Wellness Promotion CH06100

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  1. Community HealthandWellness PromotionCH06100 Session 1 Concepts, History, Determinates & more May 10, 2011 David Beavers, M.Ed., D.C., M.P.H. Session 1

  2. Determinants of HealthMajor Categories • Physical factors • Social & Cultural factors • Community organization • Individual behaviors • Biological factors Session 1

  3. Determinants of Health Individual Non-Modifiable Biological host Modifiable Health habits Diet Physical activity Tobacco use Use of health care • Environmental • Ambient • Infectious • Crime • Stress • Family Social Determinants Income Poverty & Inequity Education Race & Ethnicity Community & Social cohesion Health Care Access Quality Session 1

  4. Themes in Public & Community Health History Plagues & Contagious Diseases War & Conflicts Exploration & Expansion Scientific Progress The Industrial Revolution 19th Century Reforms (beginnings of modern PH) 20th Century Achievements Recurring themes: Science & Social Values Session 1

  5. Early Christian Period:30 - 300 AD • Order of Deaconesses • Organized visiting of the sick • Forerunner of community nursing concept • Rise of monasteries • Tended to be built near reliable water source • Fed the hungry • Cared for the sick (forerunner of hospitals) • Repositories of learning Session 1

  6. Middle Ages: 500 AD – 1400 AD Ships docking at the Lazzaretto Vecchio, Venice, 14th century Quarantine: as a control measure, started in Venice, the chief port of entry from the Orient Session 1

  7. Renaissance & Enlightenment: 1300 - 1700 Public Health administration is becoming a city council responsibility Gradual transfer of responsibility for institutional health care from the church to civil authorities By the 1600s towns in Europe had standards for cleanliness and rules for personal responsibility Late 1600s hospitals started became places not only to treat disease but to train doctors Session 1

  8. The Sanitary Movement:1830-1875 • Growth in scientific knowledge • Connection between poverty and disease • Importance of water supply & sewage removal Session 1

  9. British Reformers Sir Edwin Chadwick 1800-1890 “Good economics to prevent the evils” Assistant to Bentham 1834 report led to reform of England’s Poor Laws 1842 Report on the Sanitary Conditions of the Labouring Population – “Sanitary Report” 1847 - first Medical Officer of Health appointed in Liverpool 1848 Public Health Act established the principle that health care should be administered at a local level Session 1

  10. Four Phases of the Development of Modern Public Health • Addressing infectious diseases related to “urbanization, poverty and squalor” (1840s to the late 19th century) • Added personal preventive medical services related to immunization, family hygiene, health education and family planning which began with the development of vaccines (late 19th century until the 1930s) • Focus is on improving population health through the provision of organized medical services deploying effective therapeutic technologies (antibiotics) • Recognition that the ‘environment’ is also social, economic and psychological and needs to be considered as part society's health policy Session 1 Source: Ashton (1990)

  11. Part I: Understanding & Improving Health • History • Determinants of health model • How to use a systematic approach • Leading Health Indicators (LHI) Session 1

  12. Community HealthandWellness PromotionCH06100 Session 2 Dimensions, Risks, Levels of Prevention, Professional Literature, Related Theories & “Flags” May 17, 2011 David Beavers, M.Ed., D.C., M.P.H. Session 2

  13. Wellness Review • Wellness is an active process of becoming aware of and making choices toward a more successful existence • Wellness is a multidimensional state of being describing the existence of positive health in an individual as exemplified by quality of life and a sense of well-being Session 2

  14. Six Major Dimensions ofHealth & Wellness • Emotional – continuum of feelings, managing stress, transitioning major changes, work-life balance • Intellectual – stimulating mind & mental capacity, reasoning & creatively, continuing education • Occupational – contributing, using vocational skills/abilities, hobbies 4. Physical – taking action to maintain health, exercise, nutrition, ADLs, self-care Session 2

  15. Six Major Dimensions ofHealth & Wellness 5. Social – connecting & interacting with family, friends, co-workers & others 6. Spiritual – life purpose, seeking spiritual centered beliefs, nature, religion Session 2

  16. Health Problems &Intro to Risk Factors • Health problem • a condition that can be represented in terms of measurable • health status, or • quality of life indicators • To intervene in a health problem requires ability to identify • risk factors • pathways of causation • Risk factors in general: • Causative factors that increase likelihood of a condition or disease • Direct Contributing Factors - affect the level of the condition • Indirect Contributing Factors - likely to be controllable and basis for intervention Session 2

  17. Analyzing Health Problemsfor Risk Factors Source: Definitions adapted from Centers for Disease Control and Prevention Public Health Practice Program Office • Determinant - scientifically established factor that relates directly (most proximal) to the level of the health problem. A health problem may have any number of determinants identified for it. Example: Low birth-weight is a prime determinant for the health problem of neonatal mortality • Direct Contributing Factor - scientifically established factor that directly affects the level of the determinant. Example: Use of prenatal care is one factor that affects the low birth weight rate • Indirect Contributing Factor – individual or community-specific factor that affects the level of a direct contributing factor. Such factors can vary considerably from one individual or community to another. Example: Availability of day care or transportation services within the community may affect the use of prenatal care services NOTE: Work sheet example on later slide (#21) Session 2

  18. Health Problem Analysis Worksheet Example Session 2

  19. Ten Leading Causes of Death • Depends on age group • Observable patterns • Overall age group ranking • #1 = heart disease • #2 = malignant neoplasms • #3 = cardio-vascular Session 2

  20. Three Levels of Prevention • Primary • Stop or delay onset • Secondary • Early diagnosis & prompt treatment • Tertiary • Retrain, re-education & rehabilitate Session 2

  21. Health “Flag” System • Flags help explain risk factors • Guidelines to help make clinical decision(s) • Evaluation, triage & augmentation of treatment • Five types of flags Session 2

  22. Community HealthandWellness PromotionCH06100 Session 3 Behavioral Health May 24, 2011 David Beavers, M.Ed., D.C., M.P.H. Session 3

  23. Importance & Responsibilities of Health & Wellness Promotion • For prevention or reduction of morbidity, mortality, injury & disability • Lifestyle causes nearly 80% of health issues • Musculoskeletal conditions are a leading cause of disability (Chiropractors are uniquely qualified) • Need competency in use of evidenced-base theories, models, knowledge & skills • Wellness concepts to promote patient self-efficacy Session 3

  24. Definition of Terms • Counseling • The act of giving advice about issues, challenges or health problems • Attempts to clarify patient’s own thinking about a health problem rather than solve the health problem • Coaching • The act of directing, instructing and training with the aim to achieve a specific health goal • Such as addressing health and adjusting lifestyle for wellness Session 3

  25. Theory vs. Model • Theories comprise principles devised to explain a group of facts or phenomena; used to make predictions • Health behavior theories provide broader understanding of behavior & its links to the general human condition • Models comprise representations of structures or processes & the interactions among these; logically links phenomena together • Health models provides a framework for targeting system, structural & process changes Session 3

  26. Ecological FrameworkBrief Introduction • Ecology (“environment”) is the space outside the person • Five levels of concentric influence: • Intrapersonal (“self/individual”) factors • Interpersonal (“primary groups”) processes • Institutional factors • Community Factors • Public policy Session 3

  27. Models of Intrapersonal or IndividualHealth Behavior • Health Belief Model • Theory of Reasoned Action & Planned Behavior • Transtheoretical Model • With Stages of Change Session 3

  28. Models of IndividualHealth Behavior • Health Belief • Constructs • Perceived susceptibility, severity, benefits & barriers • Self-efficacy – confidence • Cues to Action – strategies, reminders, push to take action, phone a friend, postcard Session 3

  29. Models of IndividualHealth Behavior • Theory of Reasoned Action & Planned Behavior (two separate theories work together) • Foundation • Individual motivational factors • Motivation • Internal state activates & directs behavior • Desire energizes & directs goal orientation • Needs influence intensity & direction Session 3

  30. Models of IndividualHealth Behavior • Theory of Reasoned Action & Planned Behavior (two separate theories work together) • Foundation (continued) • Behavior is result of one’s intention • Intent is result of beliefs & attitudes • Suggests that attitude is better predictor of behavior • Assumes people are rational Session 3

  31. Models of IndividualHealth Behavior • Theory of Reasoned Action & Planned Behavior (two separate theories work together) • Constructs • Behavioral intention • Attitude toward behavior • Positive - strong beliefs that positively valued outcomes will result • Negative - strong beliefs that negatively valued outcomes will result Session 3

  32. Models of IndividualHealth Behavior • Theory of Reasoned Action & Planned Behavior (two separate theories work together) • Constructs • Subjective norms • Normative beliefs • Referent others • Approval-Disapproval • Sum & Neutral • Think – “Intention & Individual Intention” Session 3

  33. Models of IndividualHealth Behavior • Theory of Reasoned Action & Planned Behavior(two separate theories work together) • Foundation – similar to TRA • Constructs • Volitional control – large degree of control • Perceived behavioral control • Influences of outside factors • Assumes person will exert more effort when perception of control is high Session 3

  34. Theory of Reasoned Action (grey) & Planned Behavior (white) Session 3

  35. Models of IndividualHealth Behavior • Transtheoretical Model & Stages of Change • Foundation • People are generally in 1 of 5 stages of change (total of 6 stages) • Used often with addictive behaviors Session 3

  36. Models of IndividualHealth Behavior • Transtheoretical Model & Stages of Change • Six stages (only 5 are “active”) • Pre-contemplation – not intending • Contemplation – intending within 6 months • Preparation – intending/planning within 30 days • Action – currently & within last 6 months • Maintenance – actively doing/preventing relapse • Termination – no temptation, integrated into lifestyle, “non-active” Session 3

  37. Models of InterpersonalHealth Behavior • Social Cognitive theory • Foundation • Principles of reinforcement & punishment • Learn by watching others = observational learning/modeling • Cognitive process mediates social learning • R & P affect motivation, not behavior itself • Assumptions • Learning internal process – may/may not affect behavior • Behavior is directed toward particular goals • Behavior becomes self-regulated Session 3

  38. Models of InterpersonalHealth Behavior • Social Cognitive theory • Constructs • Reciprocal determinism • Personal factors (P) • Behavior (B) • Environmental (E) • Environment • Physical-Social-Cognitive • Observational learning • Attention-Retention-Motor Reproduction-Motivation Session 3

  39. Models of InterpersonalHealth Behavior • Social Cognitive theory • Constructs (continued) • Behavioral capacity • Must have knowledge/skill of a behavior before one can perform behavior • Reinforcement • Positive = reward • Removal of reward -> behavior reverts • Reduce barriers Session 3

  40. Models of InterpersonalHealth Behavior • Social Cognitive theory • Constructs (continued) • Outcome expectations • Belief will lead to certain outcome • Maximize positive and minimize negative • Learned four ways • Previous experience in similar situations • From observing others • Hearing about situations • From emotional/physical responses Session 3

  41. Models of InterpersonalHealth Behavior • Social Cognitive theory • Constructs (continued) • Self-efficacy = self-confidence that one can do the behavior • Confidence in performing • Enhancing – similar to four ways of learning • Verbal persuasion for incremental changes • Physiological state Session 3

  42. Models of InterpersonalHealth Behavior • Social Cognitive theory • Constructs (continued) • Self-control • Evaluation of internal standards & external perceptions (“reality”) • Emotional Coping Responses • Have control over emotions • Psychological defenses of repression, denial • Cognitive techniques – restructuring, CBT • Treatment of symptoms – relaxation, stress Session 3

  43. Models of InterpersonalHealth Behavior • Social Networks & Social Support • Social Support (continued) • Important function of social relationships • Categories of supportive behaviors • Emotional – empathy, love, trust, caring • Instrumental – tangible aid, service • Informational – advice, suggestions, information • Appraisal – information for self-evaluation Session 3

  44. Models of Community& Group Behavior • Diffusion of Innovations • Adoption process – follows bell curve • Innovators • Early adopters • Early majority • Late majority • Think – iPad Session 3

  45. Models of Community& Group Behavior • Communication Theory & Health Behavior Change “To make common to many” on many levels: • Individual – persuasion theories, social cognitive theory • Organization – news gate-keeping • Communities & Social systems – diffusion of innovations, knowledge gap • Mass society & culture/Cross-level analysis – framing problems, agenda setting, risk communication Session 3

  46. Application of Models & Theoriesfor Patient Health & Wellness • PRECEDE-PROCEED Planning Model – how to apply theories • PRECEDE part • Predisposing, Reinforcing & Enabling constructs in educational/environmental diagnosis & Evaluation • Just as a diagnosis precedes a treatment plan, so should educational diagnosis precede an intervention plan Session 3

  47. Application of Models & Theoriesfor Patient Health & Wellness • PRECEDE-PROCEED Planning Model – how to apply theories • PROCEED part • Policy, Regulatory & Organizational constructs in Educational & Environmental Development • Adds determinants of health & health behaviors/lifestyle factors Session 3

  48. Application of Models & Theoriesfor Patient Health & Wellness • Stages of Change • 1. Pre-contemplation – usually uninformed or under-informed; tried change but demoralized; provide facts and general information • 2. Contemplation – acutely aware of cons, so ambivalent, chronic contemplation; provide information about pros • 3. Preparation – have a plan of action; recruit for action-oriented programs, such as weight loss clinic Session 3

  49. Application of Models & Theoriesfor Patient Health & Wellness • Stages of Change (continued) • 4. Action – have taken some action, still have not obtained sufficient level to reduce risks; encourage continued progress • 5. Maintenance – for example 12 months of not smoking has 43% relapse, 5 years has only 7%; strive to prevent relapse • 6. Termination– total self-efficacy; less than 20% reach this stage; encourage life-time of “maintenance” with continued check-ups Session 3

  50. Community HealthandWellness PromotionCH06100 Session 4 Epidemiology May 31, 2011 David Beavers, M.Ed., D.C., M.P.H. Session 4

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