Evidence base

Discuss About The Health Promotion Disease Prevention Theories.

The assignment states about thecase study discussing  the health condition of Jing, the issues of  Type 2 diabetes and the efforts of his wife towards resolving them. It states the importance of health and healthcare promotion and in Healthcare. Health can be defined as the condition of being sound in the mind, body, and spirit. Healthpromotion which is very relevant today explains theapproach that includes health education enabling people to change and exercise control over external influences (World Health Organization 2018). It includes the interventions at personal, social, organisational and political levels. The significance of health promotion in health care centres contributes to their success. As it provides knowledge and information to various individuals and communities to inculcate healthy behaviours and acts as a combination of learning experiences, ensures equity within the health care. The health sector includes the Department of health and The Hong Kong authority annual plan from the last three years (Hospital Authority, 2018). They address the situation by implementing the strategic and annual plans intended to improve the state of partnership with the clients, customers and the community and government.

The plan focuses on the betterment of the people helping them stay healthy through the employment of committed staff, professional services and teamwork. The authority strives to initiate the action plans such as Patient Partnership in Action Programme (PPIA) to enhance awareness of the HA. Another set up was the initiation of the Patient-centred care committee formed in the year 2011, to improve the communication between the patients and their senior managers. In this assignment, several areas will be discussed based on the scenario of the case study. Needs assessment,different approaches, levels to health promotion and the models areapplicable to the case (Royal College of Nursing 2016).

The case study represents the physical state of a 68 -year- old retired person Jing, with type-2 diabetes, who lacks physical exercise and is overweight. His inactive attitude towards his illness as he spends his day sitting at home watching television. Moreover, His wife helped him to take care of his health and focus towards physical exercises (NIH 2018).

The influence diet and physical health have on an individual is complex and differs from person to person. The study mentioned the link between obesity and HED diet. This relates to the case scenario to be discussed in this assignment as the man lack initiative in exercising, eating his favourite food most of the time. Also, it has been supported by various researches that obesity is correlated with health issues like Type 2 diabetes as represented in the case Jing had the same issue. As excessive weight gain leads numerous health issues such as heart diseases, strokes, cancer, and diabetes if not treated well on time. If the person does not changes his health behaviour, or poor dieting, up to a longer time, he/she tends to develop diseases or health issues because healthy diet or healthy eating includes intake of sufficient nutrients required to maintain health, or to gain energy (Ferrannini and DeFronzo, 2015). Hence, good health emphasizes eight aspects of the wellbeing of a spiritual and psychology. Accordingly, the patient Jing can take steps towards improving the state of his wellbeing by adopting healthy behaviour and by controlling over his poor diet. Also, Regular exercises prevent one from chronic diseases and keep the body healthy.

Needs assessment and levels of health promotion work

 Health needs assessment of the individual represented in the case is essential. The requirements of the Jing can be fulfilled by maximising his health potential and minimising the health inequalities. The Need assessment includes the normative need, felt, expressed and comparative needs. Normative needs are those, which are defined by professionals, and they arise when a particular individual or group fails to fit in with the established norms and standards. Felt needs to refer to what people actually want and how they feel about anything. The other kind of need, which is called expressed needs identifies the demands of the people arises when people converts want into actions. The last type of need is the comparative need which describes the presence of two groups with same characteristics. Analysing all needs, a normative need is only applicable in the case as with the person having type II diabetes doing regular 60minutes exercise may improve the insulin sensitivity and helps in decreasing the raised blood glucose level to the normal level. Therefore, Jing is advised to exercise regularly, instead of eating unhealthy food.

After the need assessment is done, health promotion levels should be determined. Three levels of health promotion are primary prevention focusing on prevention of illness, directed to the healthy individuals whereas secondary aims to help people dealing with their current problems or issues, tertiary focussing on the management of existing skills to improve the health of the individual. Accordingly, the tertiary level of health promotion is applicable with the case of Jing (Edelman, Mandle, and Kudzma, 2017).

SMART aim and objectives can be used for the case of Jing. The aim of this research for Jing is to increase awareness of Jing about his excessive weight gain. Another Aim can be introducing a Health Promotion Programme on ‘Quitting Smoke’ to help people know the harmful effects of smoking on health. The possible objectives to this case can be, first making sure that the Jing attend more health promotion programme and health education activities which will make him aware about the healthy habits; also by reducing the intake of food which lacks nutrition would help him maintaining the weight within body mass index (Issel and Wells, 2017).

Five approaches to health promotion are the Medical approach, behaviour change approach, educational, client- centred approach and societal change approach (Lewis, 2015). Medical or preventive approach refers to the approach focussing on the medical intervention for the prevention of ill health and premature death which means freedom from diseases (RHI Hub, 2018). Next, behaviour change approach aims to encourage people to adopt healthy eating habits and behaviour towards maintaining good health. It is one of the popular approaches as it mainly emphasizes towards enhancing the health of the individual. The objective behind the educational approach is to provide knowledge and information about health-related factors so that people can easily develop skills for the improvement of their choices such as educating diabetic person specifically about healthy behaviour and importance of exercising (Glanz, 2015). It can be done through teaching or with the help of mass media. Client centred approach insists on facilitating client’s to identify their problems or concerns and understand their needs thereby take decisions accordingly. Lastly, the societal change approach tends to recognise the importance of socio-economic environment on the health of being(Constand et. al., 2014). There can be certain limitations also to this such as it is long-term in nature and difficult to measure and people may not have necessary skills to change.

SMART aim and smart objectives

According to the case scenario given, the approaches applicable are behaviour change and educational approach as behaviour change approach will make Jing understand the impact of avoiding exercise on his health thus, enabling him to change his attitude towards maintaining good health. Also, the educational approach will create awareness and provide him necessary information to make informed choices about his health problems, as it directs the behaviour of the person towards improving health. For these health promoters can teach necessary skills for the change is to be carefully used.

 In order to apply the above -mentioned approaches to health promotion, it requires health promotion model, as they alone cannot promote behavioural change. Health action model is used in this case. It depicts the health promotion processes in such a way so that they can be implemented by the community members to achieve their actions (Sallis, Owen and Fisher, 2015). The Health action model is complex to use, but it carefully analyses the factors or influences which acts asa hindrance for the behavioural change. Using this model, the community tends to become responsible for their activities and their outcomes. There are two characteristics of the model which are to be given importance are as follows- First feature is the intention of the individual to focus and promote the behavioural change and secondly, converting that mere intention into actions so that change may take place. And besides the model, there has been an emphasis on the belief, and normative system. Since these factors influence or affect the choices made by the people and describe whether the people identified their problems well, translated into actions and the belief system tells us the way how well the information provided was received and understood by the receiver. Also, motivation system states whether a change in diet for the Jing, by his wife makes him happier. That means it seeks their motivation for anything they perceive. Therefore in the model applied in the above case, belief system and motivation system are interrelated. The way in which one understands the information will affect their belief system which indirectly depends on their motivation level.

Other than the systems, models approaches and activities applied the personality of each individual also affects their results. The Personality of an individual impacts him or her in every way and includes factors such as self-concept and self-sentiment. It means a person with high self-esteem tends to be more motivated towards making a change in their lives. For example, If Jing has high self- esteem, then the internal will or force to stop smoking or maintaining a healthy weight by exercising and taking a proper diet would be higher (Health Promotion Board, 2018).

Approaches

With the application of these approaches or activities to bring change, there are certain obstacles or barriers towards it. The barriers could be any such as physical, cultural, and socioeconomic.The activities for the case of Jing, to be applied for the improving the situation aims at changing the behaviour and attitude by the formation of self-help groups, teaching, group work, skills, giving advice. These act as guiding principles as a cure for the patient with type 2 diabetes (Chatterjee, Khuntis, and Davies, 2017). Other than the Health action model, another model can also be applied that is ‘Health belief model’ which guides the health promotion programmes, also predict the changes made in the health behaviours of a particular individual. It is one of the widely used models. The key elements of this model stress on the study of individual beliefs on health conditions and their improvement (RHI Hub, 2018). The above analysis of the information on the health of Jing, certain health promotion activities are possibly applicable. And particularly, for the behaviour approach applied, Jing could be provided with several counselling sessions or teaching. This would further help him develop an understanding of these sessions for the betterment of his health condition. Moreover, the educational approach also plays a major role in the improvement. So, Jing can access the websites which provide detailed information about improving health, getting a cure for his disease. Not, only this he can get easy tips or remedy for the healthy eating. Therefore, it all contributes to gaining proper information or knowledge. In addition, talking to people in the community would be beneficial as it will help in generating awareness about the negative effects of excessive weight gain and lack of exercising on his health (Azcentral, 2018). The advantages of societal change approach can also be used although not applied in this case. But advertising campaigns such as television ads or the media will also help in creating a general awareness about healthy eating and being healthy both mentally and physically (Getting Revising, 2018). Since the message will be conveyed in the case to the wife of Jing, through which she can easily make changes in his diet.

In health promotion, there are certainly ethical issues which should also be considered. Ethics defines the study of morals, values and beliefs (Neese, 2017). These ethical principles guide us in the decision making in the health promotion. Four principles of ethics are Autonomy, non-maleficence, beneficence, and justice which can be further described as follows. Autonomy – The term autonomy refers to the freedom to choose freely what behaviour or lifestyle an individual actually want, therefore they are responsible for their decisions. Non- maleficence means doing no harm, therefore promoters or physicians should not provide ineffective treatment because these lead to risks with no benefit which means harming the patient. Beneficence is defined as balancing the benefit of the intervention against any risks whereas justice involves equality, fair and equal distribution of risks, benefits and the costs (Holmes, 2016). According to the case of Jing, the possible ethical issue applicable is autonomy as he can change his poor eating habits, and lifestyle on his own. But, being manipulative towards him so that he can easily understand the effectiveness of maintaining good health.

The successfulness and effectiveness of the activities could be evaluated by different methods. Evaluation is considered as the last part of the health promotion program which helps in assessing what are the requirements and the value of policy, programs and projects. Therefore, evaluation is the process which brings out the information how the health promotion programme has been accomplished and whether the health promotion plan meets out the standards defined at the initial stage (Green et. al., 2015). For prevention of disease, it acts in a way to resolving the problems, analysing the availability of the resources and forming the evaluation questionnaire on the basis of data collected and gathered, and interpreting the results thereon (Windsor, 2015). The outcome can be measured by the use of interviewing Jing’s wife and observing his behaviour. There are evaluations on the basis of interventions done that means impact and outcome evaluation (Grembowski, 2015). Impact evaluation can be defined as an effect which is observed after several interventions have been done, which means it tells us whether the behaviour of the patients has been changed or not whereas outcome evaluation emphasizes on one major change only after an intervention (Toolkits, 2018). To gain an understanding of Jing’s perspective about exercising and healthy eating, the common measure in the outcome evaluation is questionnaires which can be used. Thus, this case involves the use of pre-questionnaire and post questionnaire. The use of questionnaire will help in evaluating the daily consumption of his meals, dietary habit, and time given to exercising and the physical activity or lifestyle. The use of more close-ended questions because people need to choose the answer among all the given options which is relatively easy and takes less time. On the contrary, acquiring in-depth information by the questions is always not beneficial as they could also lead to misinterpretations and bring false results. Therefore, it can be understood that the questionnaires prove to solve problems of the patient, in assessing his behaviour after giving him proper education or knowledge about health more than just taking interviews. These all are the footsteps towards initiating a change in the minds of the people having a certain issue to change their behaviour (Salazar, Crosby, and Diclemente, 2015).

Conclusion

To conclude the above discussion, it can be analysed that according to the case study which highlights about a 68 -year- old Jing being diabetic should focus on improving his health condition. But, he avoided healthy eating and lacks exercising to maintain his health. Therefore, the certain application of the models, activities and approaches to health promotion are used. Also, Approaches such as educational, or management contributed a lot towards resolving the issue. Creating awareness was another solution, which had a significant impact on improving his health. Since health depicts the physical and mental wellbeing. Health promotion began with identification or analysis of needs which individual faces in the different stages of life and then measuring the level of health promotion. The most significant change towards fostering the health promotion activities can be the individual’s behaviour towards oneself, self-esteem and the personality. These changes can be further initiated or implemented by implication of models such as health belief model or health action model. And these models are then implemented by setting up certain SMART aim and objectives, with respect to the case, can be applied with a proper and systematic manner to obtain positive results.

References

Azcentral (2018) The Effects of poor nutrition & Lack of exercise. [online] Available from: https://healthyliving.azcentral.com/effects-poor-nutrition-lack-exercise-2121.html [Accessed 21/06/18]

Chatterjee, S., Khunti, K. and Davies, M.J. (2017) Type 2 diabetes. The Lancet, nursing(10085), pp.2239-2251.

Constand, M.K., MacDermid, J.C., Dal Bello-Haas, V. and Law, M. (2014) Scoping review of patient-centered care approaches in healthcare. BMC health services research, 14(1), p.271.

Edelman, C.L., Mandle, C.L. and Kudzma, E.C. (2017) Health Promotion throughout the Life Span-E-Book. 9^th ed. London: Elsevier Health Sciences

Ferrannini, E. and DeFronzo, R.A. (2015) Impact of glucose-lowering drugs on cardiovascular disease in type 2 diabetes. European heart journal, 36(34), pp.2288-2296

Getting Revising (2018) Societal change approach to health promotion. [online] Available from: https://getrevising.co.uk/grids/societal-change-approach-to-health-promotion [Accessed 21/06/18]

Glanz, K. (2015)Health behaviour: Theory, research, and practice. 5^thed. San Francisco:  Jassey-boss.

Green, J., Tones, K., Cross, R., and Woodall, J. (2015) Health Promotion and Strategies. 3^rd ed. California: SAGE.

Grembowski, D. (2015) The practice of health program evaluation. 2^nd ed. California: Sage Publications.

Health Promotion Board (2018) Smoking Cessation Programmes. [online] Available from: https://www.hpb.gov.sg/workplace/workplace-programmes/smoking-cessation-programmes [Accessed 21/06/18]

Holmes, D. (2016) Critical interventions in the ethics of healthcare: Challenging the principle of autonomy in bioethics. London: Routledge.

Hospital authority (2018) Hospital Authority Annual Report. [online] Available from: https://www.ha.org.hk/ho/corpcomm/AR201516/HTML/en/ch6/index.html [Accessed 21/06/18]

Issel, L.M. and Wells, R. (2017) Health program planning and evaluation. Unites States:     Jones & Bartlett Learning.

Lewis, S. (2015) Qualitative inquiry and research design: Choosing among five approaches. Health promotion practice, 16(4), pp.473-475.

Neese, B. (2017) Ethical Issues in Healthcare [online] Available from https://online.alvernia.edu/ethical-issues-in-healthcare-2017/ [Accessed 21/06/18]

NIH (2018) Health Risks of being overweight [online] Available from https://www.niddk.nih.gov/health-information/weight-management/health-risks-overweight [Accessed 21/06/18]

RHI Hub (2018) Health Promotion and Disease Prevention theories and models. [online] Available from: https://www.ruralhealthinfo.org/toolkits/health-promotion/2/theories-and-models [Accessed 21/06/18]

RHI Hub (2018)The Health Belief Model. [online] Marketing from: https://www.ruralhealthinfo.org/toolkits/health-promotion/2/theories-and-models/health-belief [Accessed 21/06/18]

Royal College of Nursing (2016) Health promotion approaches. [online] Available from: https://rcni.com/hosted-content/rcn/first-steps/health-promotion-approaches [Accessed 21/06/18]

Salazar, L.F., Crosby, R.A. and DiClemente, R.J. (2015) Research methods in health promotion. United States: John Wiley & Sons.

Sallis, J.F., Owen, N. and Fisher, E. (2015) Ecological models of health behaviour. Health behaviour: Theory, research, and practice, 5, pp.43-64.

Toolkits (2018) Outcome and Impact Evaluation. [online] Available from: https://www.k4health.org/toolkits/measuring-success/outcome-and-impact-evaluation [Accessed 21/06/18]

Windsor, R.A. (2015) Evaluation of health promotion and disease prevention programs: improving population health through evidence-based practice. USA: Oxford University Press.

World Health Organization (2018) Health Promotion. [online] Available from: https://www.who.int/topics/health_promotion/en/ [Accessed 21/06/18]