Health Promotion Planning

1. Health Promotion Planning WinterschoolHAAGA-HELIA University of Applied Sciences Kurt.Debaere@howest.be

2. New years eve Countdown …. 10 9 8 7 6 5 4 3 2 1 2011

3. Goodintentions? • I wish you … • What can I wish you? • Why? Qualityof LifeIndicators BehavioralFactors HealthProblems

4. Top 10 New Year Resolutions (from the website newyearresolutions.com.au) 1. Spend more time with family 2. Exercise regularly 3. Lose weight 4. Quit smoking 5. Enjoy life more 6. Quit drinking 7. Get out of debt 8. Learn something new 9. Help others 10. Get organised

5. Fastforward … We’renowmidfebruary … • Howfar are youwithyourgoodintentions? • Howcome? Qualityof LifeIndicators HealthProblems BehavioralFactors Determinants

6. Phase 5 Administrative & policy assessment Phase 4 Educational & ecological assessment Phase 2 Epidemiological assessment Phase 1 Social assessment Phase 3 Behavioral & environmental assessment Predisposing Health Promotion Health education Behavior Reinforcing Quality of life Health Policy regulation organization Environment Enabling Precede – Proceed (Green & Kreuter) Phase 6 Implementation Phase 7 Process evaluation Phase 8 Impact evaluation Phase 9 Outcome evaluation Input Process Short-term social impact Output Short-term impact Longer-term health outcome Long-term social impact

7. Health promotion • All activitiesmotivatingpeople to changebahavior to healthybehavior • Multidisciplinary • Focus on free will • Combination of education, behaviorchange & evironmentactions

8. Objectives • Positivehealth = promoting health (happy healthylife …) • Primaryprevention = preventingspecifichealthproblem • Secundaryprevention = earlydetection and treatment • Tertiaryprevention = cure & care, adherence, preventingfurtherinvalidity

9. How? • Forced: Law, controle & sactions • Tabaco, helmet, … • Offer • Screening • School health • Workhealth • Motivation • Health promotion • Health education

11. HEALTH PROMOTION METHODS USING BEATTIE’S TYPOLOGY (BEATTIE – 1991) MODE OF INTERVENTION Legislation Policy making and implementation Health surveillance Authoritarian Individual Collective Focus of intervention Counselling Education Mass media campaign Skills sharing and training Group work Community development Lobbying Negotiated

12. Levels:

13. Pose the question Brainstorm a provisional list of answers Review the literature related to the topic at hand(Some of the findings will be strictly empirical; others will be based on theory) Review the literature for theory using the concept and general theories approaches Assess and address needs for new research Formulate a working list of answers to the posed question Six core processes

14. Phase 5 Administrative & policy assessment Phase 4 Educational & ecological assessment Phase 2 Epidemiological assessment Phase 1 Social assessment Phase 3 Behavioral & environmental assessment Predisposing Health Promotion Health education Behavior Reinforcing Quality of life Health Policy regulation organization Environment Enabling Precede – Proceed (Green & Kreuter) Phase 6 Implementation Phase 7 Process evaluation Phase 8 Impact evaluation Phase 9 Outcome evaluation Input Process Short-term social impact Output Short-term impact Longer-term health outcome Long-term social impact

15. Problemanalysis • Social • Epidemiological • Behavior • Environment • Sometimes: preconditionssuch as finance, methodortechnique • Why? • Maximalisingintervention • Eventuallychanging the precondition • Pre-measurement (evaluation of effectivenes) Behaviourof at-risk groups HealthProblems Qualityof Life EnvironmentalFactors (including behavior of “environmental agents”

16. Socialanalysis • lessspecified • Inventarisation of psycho-social and/orsocio-economicconsequences • Social indicators: fex. • Unemployement • Discrimination • Social services • Housing • Divorce • …

17. Epidemiologicalanalysis • Health problems: inventarisation of the (most) important healthproblems • Frequencysuch as incidence and prevalence (scale), consequences (severity), difference in figures (spread)

18. Analysis of behavior & environment • Causes of the healthproblems • Causality • Differencebetweenbehavior and environment • Changeability • Objectives • Behavior: who, what, howmuch, when? • Environment: behavioranalysis of decision makers

19. What needs to change? Phase 4 Phase 3 Phase 2 Phase 1 Qualityof LifeIndicators BehavioralFactors HealthProblems Determinants Determinants EnvironmentalFactors

20. Planning the needs assessment with a logic model adapted from Green & Kreuter’s PRECEDE-PROCEED MODEL Phase 4 Phase 3 Phase 2 Phase 1 Personal and External Determinants (Predisposing, enabling and reinforcing factors) Qualityof LifeIndicators BehavioralFactors HealthProblems Personal and External Determinants (Predisposing, enabling and reinforcing factors) EnvironmentalFactors

21. Determinants • Why do peoplebehave as theybehave? • Behavior most of the time severalbehaviors … • Determinants of wantedbehavior, unwantedbehaviororbehaviorchange? • Who’sbehavior? • Do peopleknowthey have anunhealthybehavior?

22. Health believe model (Rosenstock)

24. Protectionmotivationtheory(Rogers)

26. Sociallearningtheory(Bandura)

27. How to put on a condom

28. Theory of reasonedaction(Ajzen & Fishbein)

31. Peer pressure to drink

32. ASE-model(Kok & De Vries)

34. Phase 5 Administrative & policy assessment Phase 4 Educational & ecological assessment Phase 2 Epidemiological assessment Phase 1 Social assessment Phase 3 Behavioral & environmental assessment Predisposing Health Promotion Health education Behavior Reinforcing Quality of life Health Policy regulation organization Environment Enabling Precede – Proceed (Green & Kreuter) Phase 6 Implementation Phase 7 Process evaluation Phase 8 Impact evaluation Phase 9 Outcome evaluation Input Process Short-term social impact Output Short-term impact Longer-term health outcome Long-term social impact

35. Interventionmapping

37. Theories and methods of change • Stages of change model • Elaboratedlikelyhood model (Petty & Cacioppo) • Riscperception • …

38. Stages of change(Prochaska & DiClemente)

40. Phase 5 Administrative & policy assessment Phase 4 Educational & ecological assessment Phase 2 Epidemiological assessment Phase 1 Social assessment Phase 3 Behavioral & environmental assessment Predisposing Health Promotion Health education Behavior Reinforcing Quality of life Health Policy regulation organization Environment Enabling Precede – Proceed (Green & Kreuter) Phase 6 Implementation Phase 7 Process evaluation Phase 8 Impact evaluation Phase 9 Outcome evaluation Input Process Short-term social impact Output Short-term impact Longer-term health outcome Long-term social impact

41. Evaluation • Why? • Accountability, learningfor the future, ethics • Effect: outcome, impact • Proces

42. Phase 5 Administrative & policy assessment Phase 4 Educational & ecological assessment Phase 2 Epidemiological assessment Phase 1 Social assessment Phase 3 Behavioral & environmental assessment Predisposing Health Promotion Health education Behavior Reinforcing Quality of life Health Policy regulation organization Environment Enabling Precede – Proceed(Green & Kreuter) Phase 6 Implementation Phase 7 Process evaluation Phase 8 Impact evaluation Phase 9 Outcome evaluation Input Process Short-term social impact Output Short-term impact Longer-term health outcome Long-term social impact

43. Stillawake? Thankyouforyourattention! Questions? Kurt.debaere@howest.be