WHITE PAPER
BY
KATIE BOWERS
DECEMBER 2013
Table of Contents Table of Contents ..................................................................................................................... 2 Introduction .............................................................................................................................. 3 The Theory of Passion ..................................................................................................................... 3 Taking a New Approach ......................................................................................................... 4 Non-­‐traditional Approach .................................................................................................... 6 Exploring the New Approach ............................................................................................... 7 Concepts and Constructs ................................................................................................................. 7 Practical Implications ......................................................................................................... 10 References .............................................................................................................................. 11 2
Introduction The Theory of Passion When a problem presents itself, a solution is required in order to solve the
problem. Sometimes the answer is found by relating the problem to a theory. A theory
is a set of concepts, definitions, and propositions that explain or predict these events or
situations by illustrating the relationships between variables (Services, 2005). With my
future in wellness management I hope to implement wellness programs for populations of
people in need of a behavior change. Therefore, I need creative, innovative approaches
to solving the problems I will encounter in the wellness world. “Like an artist, a program
planner who grounds health interventions in theory creates innovative ways to address
specific circumstances. He or she does not depend on a “paint-by-numbers” approach, rehashing stale ideas, but uses a palette of behavior theories, skillfully applying them to
develop unique, tailored solutions to problems” (Services, 2005). It is overwhelming,
however, to think about all the different theories that are out there that could help me
with any potential problems I run into. So why just choose one theory? If I can take the
concepts I like from different ones to fit with my worldview, I can create an innovative
method for problem solving.
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Taking a New Approach Research supports that our country’s wellbeing has gotten worse over the decades.
Chronic sleep problems effect as many as 70 million people (Institute of Medicine,
2006). In 2000, no state in the U.S. had an obesity prevalence of 30% or more. In 2010,
12 states had an obesity prevalence of 30% (Ogden, Carroll, Kit, & Flegal, 2012). More
than 50% of adults do not get the recommended 150 minutes of exercise per week
(Sapkota, Bowles, Ham, & Kohl, 2005). Less than a third of adults in the U.S. eat the
recommended amount of fruits and vegetables. That rate has not changed since 1994
(Blanck, Gillespie, Khan, Serdula, & Mokdad, 2005). These problems in wellbeing are
not caused because there is a lack of information about health promotion and disease
prevention. “Reinforcing this staggering data of ineptitude, results of one survey found
that while many people are aware of the health benefits of physical activity and weight
management, they don’t typically respond to that information with a change in health
behavior” (Kimiecik, 2011). For example, one study found that 90 percent of heart
attacks worldwide are caused by nine “easy-to-measure”, modifiable risk factors (Yusuf
et al., 2004). “But prevention, no matter how sophisticated and elegant the
biopsychosocial models guiding it, has fallen far short of making significant inroads into
helping people live healthier lives through the avoidance of disease” (Kimiecik, 2011).
Most professionals have a way of looking at our bodies as a machine. “Briefly, in
relation to health and wellness, the mechanistic worldview seeks to identify and isolate
the causal sequences that lead to illness and ultimately to death” (Nicholas & Gobble,
1991). It is time to look at approaching holistic wellbeing from a different angle. I’m not
saying that a different approach will dramatically improve an individual’s holistic
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wellbeing. I only suggest that a new approach is worth exploring. If professionals want
to change behavior, then they should spend more time exploring why people develop
wellbeing risks.
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Non-­‐traditional Approach An approach that focuses on people’s inner resources for thriving and flourishing
rather than prevention and disease-risk reduction was is called the third revolution of
health (Breslow, 2004). Concepts brought from salutogenesis, self-determination theory,
and eudaimonic wellbeing support this type of focus for long-term behavior change in
regards to holistic wellbeing. In other words, finding meaning in your life can contribute
to improved wellbeing and long-term success of behavior change. “One potential
explanation for the short-lasting effects of these interventions [health promotion and
disease risk reduction] is that they may not be addressing deeper meanings as to why
people may or may not perform health-related behaviors, such as physical activity, in the
first place. This possibility suggests that for sustainable, long-term behavior change, the
meaning or lived experiences of the individual needs to be taken into account” (Fahlberg
& Fa, 1997; Fahlberg & Fahlberg, 1994; Kimiecik, 2011). “And without considering
meaning or the lived experiences of individuals and the communities in which they live,
the effects of most change attempts will be short-lived because the starting point is
flawed” (Kimiecik, 2011). “Focusing on health issues without addressing deeper human
experience, such as life meaning and purpose, will achieve limited long-term success”
(Robison, 2004). The theory I made up from concepts from salutogenesis, selfdetermination theory, and eudaimonic wellbeing is not a traditional theory because it
challenges the mechanistic worldview of health and wellbeing.
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Exploring the New Approach Concepts and Constructs Aaron Antonovsky came up with a theoretical model for Salutogenesis in the late
1970s. “The concept of Salutogenesis aims on finding and examining factors, which are
responsible for the formation and the maintaining of health, as the healthy pole of a
health-disease continuum” (Buch, 2006). More specifically, I focused on the Sense of
Coherence model of Antonovsky’s. Sense of Coherence can be defined as The extent to
which one has a pervasive, enduring though dynamic, feeling of confidence that one’s
environment is predictable and that things will work out as well as can reasonably be
expected (Buch, 2006). The Sense of Coherence model is composed of the three
concepts comprehensibility, manageability, and meaningfulness. Within the
manageability concept I have added the subconcepts of needs (competence, relatedness,
and autonomy) and motivations (intrinsic and extrinsic). Also within the meaningfulness
concept I have added the subconcept of eudaimonic wellbeing (pleasures,
meaningfulness, engagement in life).
Helping an individual move towards a stronger Sense of Coherence ultimately
will improve their holistic wellbeing. The concept of comprehensibility is the extent of
how clear, structured, and understood one’s environment or problem is. The concept of
manageability explains the extent to which a person believes they can cope with the
resources that they have. The stronger Sense of Coherence they have the better the
individual can cope with stressors in their life. This is where the needs and motivations
of an individual are involved. “According to Ryan and Deci, three basic psychological
needs are essential for optimal growth, social development and personal well-being—
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competence, relatedness, and autonomy. Experiencing these needs provides an
energizing state that facilitates health and well-being” (Kimiecik, 2011). The concept of
meaningfulness describes the extent to which one believes their life has meaning and is
worth living. “Without meaningfulness, respectively without the life attitude, which
makes life seem worth living, all mobilization of resources won’t do anything”
(Brieskorn-Zinke, 2002). Meaningfulness is one of the main concepts professionals
should take a closer look at for the people they are trying to reach and help. “And
without considering meaning or the lived experiences of individuals and the communities
in which they live, the effects of most change attempts will be short-lived because the
starting point is flawed” (Kimiecik, 2011). Eudaimonic wellbeing is an approach to
obtaining happiness that has dimensions: pleasure, engagement, and meaning. These
dimensions attribute to happiness for an individual. Pleasure is the process of
maximizing positive emotion and minimizing negative emotion in one’s life.
Engagement is the process of being involved and actively participating in the
requirements and demands of one’s life. This process is also known as the good life.
The good life is a result from one cultivating and investing their strengths and virtues into
their relationships, work, and leisure (Seligman, 2002). Meaning is the process of having
a higher purpose in life than our selves. One should perceive and use their strengths and
virtues to serve a higher purpose in life. As one finds meaningfulness in their life their
chance at improving their holistic wellbeing improves. “It is this life of becoming, of selfdiscovering, of experiencing that is missing in so much of the mainstream biomedical,
prevention, wellness offerings. Eudaimonic well-being may be a new road to travel on to
move past neutral and experience optimal health” (Kimiecik, 2011).
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Living your life in accordance to these concepts suggests that improving one’s
wellbeing is a result from a continuous process of finding meaning in their life. If people
develop a deeper meaning in their life they are more likely to apply resources in order to
better cope with stressors in their life (Antonovsky, 1987). “They propose that people
high in subjective vitality may be better equipped to mobilize their resources to more
actively participate in health-relevant activities” (Ryan, Huta, & Deci, 2008). Subjective
vitality in this case is interchangeable with meaningfulness in one’s life. In a study of
older women, results showed that those with higher levels of eudaimonic well being had
lower levels of daily salivary cortisol, pro-inflammatory cytokines, cardiovascular risk,
and longer duration REM sleep. These factors are positively linked to long-term physical
health (Deci & Ryan, 2008). This suggests that people do not change their minds and
behavior based off what they know, they change their minds and behavior based of what
they feel.
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Practical Implications As a professional this theory complies with my worldview. I want people to
improve their holistic wellbeing. They can do this by making behavior changes. These
behavior changes, however, must have a chance at being long-term. If I look to this
theory for guidance when doing my job, then people will have a chance at long-term
behavior change. For example, I can provide a supportive environment that fosters
positive feedback for extrinsic motivation. Positive feedback could include rewarding the
person or supporting autonomy. Providing positive feedback for extrinsic motivation
helps a person move towards positive intrinsic motivation. Intrinsic motivation for
somebody could include relatedness, self-regulated and autonomous motivation,
competence, and confidence. “This idea of autonomous self-regulation is very relevant to
health behavior such as physical activity because the more an individual is guided by
autonomous self-regulation, the more likely she or he will engage, persist, and enjoy
these behaviors” (Patrick & Williams, 2012). I just need to remember that this type of
theory is subjective in terms of wellbeing, and in order for an individual to get the full
effect I cannot be too directive, to encourage one to strengthen their Sense of Coherence,
and find meaningfulness in their life. This theory is a fresh, new approach to the
problems the health and wellbeing world is facing. Professionals should try
implementing some of these concepts into their work.
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References Antonovsky, A. (1987). Unraveling the mystery of health. San Francisco: Jossey-Bass.
Blanck, H., Gillespie, C., Khan, L., Serdula, M., & Mokdad, A. (2005). Fruit and
vegetable consumption among adults. Morbidity and Mortality Weekly Reports,
(56), 213–217.
Breslow, L. (2004). Perspectives: the third revolution in health. Annual Review of Public
Health, (25), xiii–xviii.
Brieskorn-Zinke, M. (2002). The role of nursing in public health/health promotion-attempt at a systematic approach, 16(2), 66–74.
Buch, B. (2006). Salutogenesis and Shamanism.
Deci, E., & Ryan, R. (2008). Hedonia, eudaimonia, and well-being: An introduction.
Journal of Happiness Studies, (9), 1–11.
Fahlberg, L. L., & Fa. (1997). Wellness re-examined: A cross-cultural perspective.
American Journal of Health Studies, (13), 8–17.
Fahlberg, L. L., & Fahlberg, L. A. (1994). A human science for health: An overview.
Health Values, (18), 3–12.
Kimiecik, J. (2011). Exploring the Promise of Eudaimonic Well-Being Within the
Practice of Health Promotion: The “How” is as Important as the “What.” Journal of
Happiness Studies, 12(5), 769–792. doi:10.1007/s10902-010-9226-6
Nicholas, D., & Gobble, D. (1991). World views, systems theory, and health promotion.
American Journal of Health Promotion, (6), 30–34, 54.
Ogden, C. L., Carroll, M. D., Kit, B. K., & Flegal, K. M. (2012). Prevalence of obesity in
the United States, 2009-2010. NCHS data brief, (82), 1–8. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/22617494
Patrick, H., & Williams, G. (2012). Self-determination theory: its application to health
behavior and complementarity with motivational interviewing. Internation Journal
of Behavioral Nutrition and Physical Activity, 9(18), 1–12.
Robison, J. (2004). Reinventing the profession. Absolute Advantage, (6), 7–11.
Ryan, R. M., Huta, V., & Deci, E. L. (2008). Living well: A self-determination theory
perspective on eudaimonia. Journal of Happiness Studies, 139–170.
11
Sapkota, S., Bowles, H., Ham, S., & Kohl, H. (2005). Adult participation in
recommended levels of physical activity: United States 2001 and 2003. Morbidity
and Mortality Weekly Reports, (54), 1208–1212.
Seligman, M. (2002). Authentic Happiness: Using the new positive psychology to realize
your potential for lasting fulfillment. The Free Press. New York.
Services, U. S. D. of H. and H. N. C. I. (2005). Theory at a Glance: A Guide For Health
Promotion Practice (2nd ed.).
Yusuf, S., Hawken, S., Ounpuu, S., Dans, T., Avezun, A., & Lanas, F. (2004). Effects of
potentially modifable risk factors associated with myocardial infarction in 52
countries (the INTERHEART study): case-control study. Lancet, (364), 937–952.
Antonovsky, A. (1987). Unraveling the mystery of health. San Francisco: Jossey-Bass.
Blanck, H., Gillespie, C., Khan, L., Serdula, M., & Mokdad, A. (2005). Fruit and
vegetable consumption among adults. Morbidity and Mortality Weekly Reports,
(56), 213–217.
Breslow, L. (2004). Perspectives: the third revolution in health. Annual Review of Public
Health, (25), xiii–xviii.
Brieskorn-Zinke, M. (2002). The role of nursing in public health/health promotion-attempt at a systematic approach, 16(2), 66–74.
Buch, B. (2006). Salutogenesis and Shamanism.
Deci, E., & Ryan, R. (2008). Hedonia, eudaimonia, and well-being: An introduction.
Journal of Happiness Studies, (9), 1–11.
Fahlberg, L. L., & Fa. (1997). Wellness re-examined: A cross-cultural perspective.
American Journal of Health Studies, (13), 8–17.
Fahlberg, L. L., & Fahlberg, L. A. (1994). A human science for health: An overview.
Health Values, (18), 3–12.
Kimiecik, J. (2011). Exploring the Promise of Eudaimonic Well-Being Within the
Practice of Health Promotion: The “How” is as Important as the “What.” Journal of
Happiness Studies, 12(5), 769–792. doi:10.1007/s10902-010-9226-6
Nicholas, D., & Gobble, D. (1991). World views, systems theory, and health promotion.
American Journal of Health Promotion, (6), 30–34, 54.
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Ogden, C. L., Carroll, M. D., Kit, B. K., & Flegal, K. M. (2012). Prevalence of obesity in
the United States, 2009-2010. NCHS data brief, (82), 1–8. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/22617494
Patrick, H., & Williams, G. (2012). Self-determination theory: its application to health
behavior and complementarity with motivational interviewing. Internation Journal
of Behavioral Nutrition and Physical Activity, 9(18), 1–12.
Robison, J. (2004). Reinventing the profession. Absolute Advantage, (6), 7–11.
Ryan, R. M., Huta, V., & Deci, E. L. (2008). Living well: A self-determination theory
perspective on eudaimonia. Journal of Happiness Studies, 139–170.
Sapkota, S., Bowles, H., Ham, S., & Kohl, H. (2005). Adult participation in
recommended levels of physical activity: United States 2001 and 2003. Morbidity
and Mortality Weekly Reports, (54), 1208–1212.
Seligman, M. (2002). Authentic Happiness: Using the new positive psychology to realize
your potential for lasting fulfillment. The Free Press. New York.
Services, U. S. D. of H. and H. N. C. I. (2005). Theory at a Glance: A Guide For Health
Promotion Practice (2nd ed.).
Yusuf, S., Hawken, S., Ounpuu, S., Dans, T., Avezun, A., & Lanas, F. (2004). Effects of
potentially modifable risk factors associated with myocardial infarction in 52
countries (the INTERHEART study): case-control study. Lancet, (364), 937–952.
13