Health Promotion
and Education
B. MCKNIGHT, MSN RN
COLUMBUS STATE UNIVERSITY
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Health Promotion
“Any combination of health education and related organizational,
economic, and environmental supports for behavior of individuals,
groups or communities conducive to health (Green and Keuter, 1991).”
“that which is motivated by the desire to increase well-being and to
reach the best possible health potential (Parse, 1990)”
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Health Protection
“Behaviors in which one engages with the specific intent to prevent
disease, to detect disease in early stages, or to maximize health within
the constraints of a disease (Parse, 1990)”
an important step in maintaining health
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Defining Health
The way health is defined has shifted from a focus on the curative model,
to a focus on multidimensional aspects such as the social, cultural, and
environmental facets of life and health (Benson, 1996)
Health is viewed not only as an important goal, but as a resource for living
(WHO, 1986)
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Determinants of Health and
Disease
•The social determinants of health are the circumstances in which
people are born, grow up, live, work, and age, as well as the systems put
in place to deal with illness.
•These circumstances are in turn shaped by a wider set of forces:
economics, social policies, and politics.
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Determinants of Health and
Disease…Leading Health
Indicators
•Biology
•Behaviors
•Social Environment
•Physical Environment
•Policy and Interventions
•Access to quality health care
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Figure 4-1
From U.S. Department of Health
and Human Services.
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Healthy People 2020 …
… is the health promotion initiative for the nation.
… challenges individuals, communities, and professionals … to take
specific steps to ensure that good health, as well as long life, are enjoyed
by all.
– U.S. Department of Health and
Human Services, 2012
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Healthy People 2020 …
(Cont.)
Broad goals
◦ Attain high-quality, longer lives free of preventable disease, disability, injury,
and premature death.
◦ Achieve high equity, eliminate disparities, and improve the health of all groups.
◦ Create social and physical environments that promote good health for all.
◦ Promote quality of life, healthy development, and healthy behaviors across all
life stages.
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Determinants in Health…Leading
Health Indicators
Healthy People 2020 Topic areas as health indicators
• Access to Health Services
• Injury and Violence Prevention
• Adolescent health
• Maternal, Infant, and Child Health
• Cancer
• Mental Health
• Diabetes
• Nutrition, Physical Activity, and Obesity
• Chronic kidney disease
• Older Adults
• Disability and secondary conditions
• Oral Health
• Early and middle childhood
• Reproductive and Sexual Health
• Family Planning
• Sexually Transmitted Disease
• Food safety
• Social Determinants of Health
• Environmental Health
• Substance Abuse
• HIV
• Tobacco Use
• Heart Disease and Stroke
• Immunizations and Infectious Diseases
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Risk and Health
“The probability that a specific event will occur in a given time frame”
(Oleckno, 2002)
◦ Risk factors
◦ Modifiable
◦ nonmodifiable
◦ Risk assessment
◦ Risk reduction
◦ Risk communication
A risk factor is an exposure that is associated
with a disease (Friis & Sellers, 2004).
Risk Assessment is a systematic way of
distinguishing the risks posed by potentially
harmful exposures.
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Reviewing Issues in the
Community
•Major public health concerns.
•Helps measure the health of the community.
•For example tobacco use is linked to heart disease, stroke and cancer.
•Substance abuse is linked to accidents, injuries, violence, irresponsible sexual
behaviours, which can lead to unwanted pregnancies, STDs..
•Lack of access to health care can lead to poor healthcare outcomes because of
delayed treatment, untreated illness, and disability.
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Leading Causes of Death
Lifestyle Choices
◦ Tobacco usage – 20% of annual deaths in US
◦ Poor diet and physical inactivity 16.6%
◦ Alcohol consumption
◦ Associated with accidents, suicides, homicides, cirrhosis and chronic liver disease
◦
◦
◦
◦
◦
Toxic agents
Motor vehicle crashes
Firearms
Sexual behaviors
Illicit drug use
Life expectancy has increased because of the different changes in laws,
policies and/or efforts of health promotion.
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Group Think
Topic
Health Risks
Health Promotion
Activities
Tobacco
Alcohol Consumption
Diet
Physical Activity
Sleep
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Questions The Nurse Could Ask
Nurse should be aware of health patterns and health
indicators within their practice.
◦ What are the leading causes of death and disease among
various groups served?
◦ What are the most serious communicable disease threats
in the community or neighborhood?
◦ What are the most common risks in my city?
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Providing population-based care… a shift
in thinking
1.
Populations are not homogeneous; must address the
needs of special subpopulations.
2.
High-risk and vulnerable subpopulations must be
identified early in the care delivery cycle.
3.
Nonusers of services often become high-cost users;
essential to develop outreach strategies.
4.
Quality and cost of all health care services are linked
together across the health care continuum.
(Kaiser Family Foundation, 2013)
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Questions
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Defining the
Community
Defining the Community
Aggregate of people
◦ The “who”
◦ Share personal characteristics and risks
Location in space and time
◦ The “where” and “when”
◦ Physical location frequently delineated by boundaries and
influenced by the passage of time
◦ May be geographical boundaries
◦ Voting district, school district, fire and police protection precincts, neighborhoods
Social system
◦ The “why” and “how”
◦ Relationships that community members form with one another
◦ If there are cut backs in a health department, it effects the community
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Diagram of Assessment
Parameters
Figure 6-1
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Community Assessment Parameters
Geography
Public services
Population
Political organization
Environment
Community development or
planning
Industry
Education
Disaster programs
Health statistics
Recreations
Social problems
Religion
Health manpower
Communication
Health professional organizations
Transportation
Community services
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Healthy Communities
The nurse will assess the community’s
willingness or commitment to have a healthy
community
Interconnectedness between people and the
public and private sectors is essential to make
changes.
Each community has its unique perspective.
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Community as client or patient
Nursing focus is on the collective or common
good of the population instead of on individual
health
Nurse may work with individuals; families; other
interacting groups, aggregates, or institutions; or
within a population but the resulting changes are
intended to affect the whole community
Community Needs
Assessment
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Assessing the Community
Needs assessment
◦
◦
◦
◦
Used to understand the community’s perspective
Interview key community informants
Use community forums, focus groups, or surveys
12 Steps in a Needs Assessment
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Steps in the Needs Assessment Process
1. Identify aggregate for assessment
2. Engage the community in planning the assessment
3. Identify required information
4. Select method of data gathering
5. Develop questionnaires or interview questions
6. Develop procedures for data collection
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Steps in the Needs Assessment Process
(Cont.)
7. Train data collectors
8. Arrange for a sample representative of the aggregate
9. Conduct needs assessment
10. Tabulate and analyze data
11. Identify needs suggested by data
12. Develop an action plan
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Assessing the Community
Sources of data:
◦
◦
◦
◦
◦
Census data and other census reports
Vital statistics
NCHS survey data
Local, regional, and state government reports
Locally generated data collection
Analysis of demographic information provides descriptive information
about the population
Copyright © 2015, 2011, 2007,
2001, 1997, 1993 by Saunders,
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Data Gathering
Data gathering –existing readily available data
◦ Demographics – sex, social economic, racial distribution
Data generation – process of developing data that does not exist
◦ Direct data
◦ Informant interviews
◦ Focus groups
◦ Participant observation
◦ Windshield surveys
Collection of reported (indirect or secondary) data
◦ Secondary analysis – written minutes form community meetings
◦ Surveys –use sample of persons
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Assessing the Community
Sources of data:
◦ Census data and other census reports
◦ http://www.census.gov/
◦ Vital statistics –births, deaths, marriages, divorces, and adoptions
◦ NCHS (National Center for Health Statistics) survey data (CDC website)
◦
◦
◦
◦
◦
http://www.cdc.gov/nchs/
CDC quick facts
https://www.census.gov/quickfacts/fact/table/US/PST045217
Local, regional, and state government reports
http://dph.georgia.gov/
◦ Locally generated data collection
◦ http://westcentralhealthdistrict.com/
Analysis of demographic information provides descriptive
information about the population
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Informant interviews
Informants can be people who are familiar with and interact
with the population on a regular basis.
◦ Elected officials, health care providers, school principal, long
time residents
Some examples of questions that can be asked of key
informants are:
• Strengths/assets of the community
• Areas of improvement for the community
• Concerns of community members
• Access to health care
Community Reconnaissance
•Does the community have a web site?
•
How old is the information?
•
When was the last time site updated?
•
How credible is the source?
• Composite
database
•
Community health problems –need for action
•
Community health strengths – or abilities
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Focus groups
Helps gather community views
May be able to reach those in remote area and get their opinion
The nurse should have prepared questions
Surveys
Surveys may be used to collect data from the community.
Selecting a sample of the target population may prove
helpful in the collection of data that are easier to analyze.
It is important to ensure that the sample is representative of
the target population.
Survey Examples
•Health promotion activities
•Demographic information
•Status of employment
•Safety within community
•Stressors/stress
management patterns
•Risky behaviors
•Support systems
•Safety in environment
•Volunteer/community
activities
• Personal safety (seatbelts,
helmets, etc.)
•Rest patterns
•Nutrition
•Dental hygiene
Windshield Survey
Windshield survey
◦ Gain an understanding of environmental layout
◦ Locate possible areas of environmental concern through “sight, sense, and sound”
◦ Gives nurse an opportunity to observe people and their role in the community
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Windshield Survey
Drive or walk through and make
organized observations
Indicators of social and
economic conditions
Nurse can use sight, sense and
sound
Health resources
Observe people in their
environment
Community vitality
Environmental conditions
related to health
Social functioning
Attitudes toward health and
health care
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Windshield Survey
If you found childhood obesity in a community what would be some
things you would be looking for?
If there was poor patient outcomes or high disability rates in a
community?
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Key Observations and
Windshield Survey
Some examples of key observations to make when assessing the community through a windshield
survey are:
• Condition and age of the homes
• Location of parks and other recreational areas
• Amount of space between homes and businesses
• Neighborhood hangouts
• Modes of transportation used
• Quality of streets and sidewalks
• Stores and other businesses
• People out in the community
• Cleanliness of the community
• Billboards or other media displays
• Places of worship
Windshield surveys
https://www.youtube.com/watch?v=G1hUDk61LkY
Participant observation
By spending time observing the population, information can be learned
about the interactions within the community including the following:
• Developmental level of the population
• Effectiveness of peer-to-peer interactions
• Respect for peers and others
• Safety in the environment
Nursing Process
●The nursing process can be applied to the community as a
client.
 Needs assessment
 Diagnosing health
problems (actual
and potential)
 Planning
 Intervention
 Evaluation
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Format for Community Health Diagnosis
(See Case Study p. 104)
Figure 6-3 Redrawn from Mucked MA: Community health diagnosis in
nursing, Public Health Nurs 1:23-35, 1984. Used with permission of Blackwell
Scientific Publications.
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Case Study p. 104
Community Diagnosis
Increased risk of undetected testicular cancer (disability and/or disease)
among young men (community or population) related to insufficient
knowledge about the disease and methods for preventing and detecting
it at early stage (etiological statement), as demonstrated by rates of late
initiation of treatment (health indicators).
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Questions
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