Basic Health Promotion
Health promotion is a discipline that seeks to improve the health of individuals and communities through education, behavioral change, and environmental improvement. Health promotion draws from a number of complementary disciplines, such as psychology, sociology, the biological and clinical sciences, and business (marketing and management) to help individuals and communities change their behaviors and improve their environments. In short, health promotion is “the process of enabling people to increase control over and to improve their health.”
A key factor for the achievement of skills and community development is the empowerment of people, both in individuals and in communities, which is achieved mainly by health education and supportive environments.
Stages of change model
Helping patients change behavior is an important role for patient navigators. Change interventions are especially useful in addressing lifestyle modification for disease prevention, long-term disease management, and addictions. The concepts of “patient noncompliance” and motivation often focus on patient failure. Understanding patient readiness to make change, appreciating barriers to change and helping patients anticipate relapse can improve patient satisfaction and lower the health care provider’s frustration during the change process.
Stage in transtheoretical model of change
Incorporating other explanatory/treatment models
Not thinking about change
Locus of Control
May be resigned
Health Belief Model
Feeling of no control
Denial: does not believe it applies to self
Believes consequences are not serious
Weighing benefits and costs of behavior, proposed change
Health Belief Model
Experimenting with small changes
Taking a definitive action to change
Cognitive-behavioral therapy 12-Step program
Maintaining new behavior over time
Cognitive-behavioral therapy 12-Step program
Experiencing normal part of process of change
Motivational interviewing 12-Step program
Usually feels demoralized
Health belief model
The health belief model is a psychological model that attempts to explain and predict health behaviors by focusing on an individual’s attitudes and beliefs. It was first developed in the 1950s in response to the failure of a free tuberculosis health screening program. Since then, it has been adapted to explore a variety of long- and short-term health behaviors, including sexual risk behaviors and the transmission of HIV/AIDS.
The health belief model is a good model for addressing problem behaviors that evoke health concerns (e.g., high-risk sexual behavior and the possibility of contracting HIV).
The health belief model proposes that a person's health-related behavior depends on the person's perception of four critical areas:
1. Severity of a potential illness
2. The person's susceptibility to that illness
3. Benefits of taking a preventive action
4. Barriers to taking that action
By addressing the relationship between a person’s beliefs and behaviors, the model provides a way to understanding and predicting how clients will behave in relation to their health and how they will comply with health care therapies.
Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Health literacy is dependent on both individual and systemic factors:
- Communication skills of lay people and professionals
- Knowledge of lay people and professionals of health topics
- Demands of the health care and public health systems
- Demands of the situation/context
Health literacy is not simply the ability to read. It requires a complex group of reading, listening, analytical, and decision-making skills, and the ability to apply these skills to health situations. For example, it includes the ability to understand instructions on prescription drug bottles, appointment slips, medical education brochures, doctor's directions and consent forms, and the ability to negotiate complex health care systems.
Patients may need to:
- Evaluate information for credibility and quality
- Analyze relative risks and benefits
- Calculate dosages
- Interpret test results
- Locate health information
- Accomplishing those tasks requires
- Visually literacy (able to understand graphs or other visual information)
- Computer literacy (able to operate a computer)
- Information literacy (able to obtain and apply relevant information)
- Numerical or computational literacy (able to calculate or reason numerically)
Oral language skills are important as well. Patients need to articulate their health concerns and describe their symptoms accurately. They need to ask pertinent questions, and they need to understand spoken medical advice or treatment directions.
In an age of shared responsibility between physician and patient for health care, patients need strong decision-making skills. With the development of the Internet as a source of health information, health literacy may also include the ability to search the Internet and evaluate websites.
Prevalence of low health literacy
- People with low health literacy have a lower likelihood of getting flu shots, understanding medical labels and instructions, and a greater likelihood of taking medicines incorrectly compared with adults with higher health literacy.
- Individuals with limited health literacy reported poorer health status and were less likely to use preventative care.
- Individuals with low levels of health literacy are more likely to be hospitalized and have bad disease outcomes.
- In-patient spending increases by approximately $993 for patients with limited health literacy.
- After controlling for relevant covariates, lower health literacy scores were associated with high mortality rates within a Medicare managed care setting.
- The annual cost of low health literacy to the U.S. economy was $106 billion to $238 billion.
Reasons for limited literacy skills include:
- Lack of educational opportunity: People with a high school education or lower
- Learning disabilities
- Cognitive decline in older adults
- Use it or lose it: Reading abilities are typically three to five grade levels below the last year of school completed. As a result, people with a high school diploma, typically read at a seventh or eighth grade reading level.
Several recent federal policy initiatives address the issue of low health literacy. These initiatives raise importance of health literacy as a component in an effort to improve the health of the U.S. population, decrease costs, and reduce the number of medical errors.
Affordable Care Act (ACA) of 2010: The several ACA provisions address the need for greater attention to health literacy. There are provisions to clearly communicate health information, promote prevention, be patient-centered and create medical or health homes, assure equity and cultural competencies, and deliver high quality care.
National Action Plan to Improve Health Literacy: the Department of Health and Human Services (HHS) in collaboration with over 700 public and private sector entities, developed this framework for future research and action. The Plan includes seven goals and strategies that researchers and practitioners can use to design studies and interventions. (Released May 2010)
Plain Writing Act of 2010: requires all new publications, forms, and publicly distributed documents from the federal government to be written in a "clear, concise, well-organized" manner.
Health literacy and promotion resources
Health promotion resources
A “stages of change” approach to helping patients change behavior. Gretchen L. Zimmerman, Psy.D., Cynthia G. Olsen, M.D., and Michael F. Bosworth, D.O. Wright State University School of Medicine, Dayton, Ohio. American Family Physician. March 2000;61(5):1409-1416.
Health Belief Model (HBM).
In search of how people change. Applications to addictive behaviors. Prochaska JO, DiClemente CC, Norcross JC. Am Psychol. 1992 Sep;47(9):1102-14.
Motivational Interviewing: Preparing People to Change Addictive Behavior. William R. Miller Ph.d. and Stephen Rollnick Ph.D. New York: Guilford, 1991.
What is health promotion? Andrew Tannahill. Health Education Journal. December 1985 vol. 44 no. 4 167-168.
Health literacy resources
Health and Literacy Compendium.
Health Communication, Partners in Information Access for the Public Health Workforce.
Health Literacy: Accurate, Accessible and Actionable Health Information for All. Centers for Disease Control and Prevention (CDC).
Health Literacy. American Medical Association Foundation.
Health Literacy. Originally produced by Penny Glassman, former technology coordinator, National Network of Libraries of Medicine New England Region, Shrewsbury, MA.
The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy. Institute of Education Sciences. National Center for Education Statistics, U.S. Department of Education.
Proceedings of the Surgeon General's Workshop on Improving Health Literacy. September 7, 2006, National Institutes of Health, Bethesda, MD.