Week 1 Flashcards
Primary prevention
Preventing disease/ injury before it occurs
-immunisation programmes
- laws enforcing safety equipment at work
Secondary prevention
Reducing the impact of disease/ injury
- screening programme
- low dose aspirin/ diet exercise programmes to reduce risk of further health problems
Tertiary prevention
Softening the impact of long term health effects
- rehabilitation programmes
- support groups
Quaternary prevention
Avoiding over-medicalisation- protection from unnecessary interventions/ medical harm
Definitions of health
Health as “absence of disease”: medical model of health, can be traced as far as the ancient Greeks
Health as “well being”: ‘health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’ WHO 1948
Health as “ a resource”: health is a resource for everyday life, not the object of living. It is a positive concept emphasising social and personal resources as well as physical capabilities
“Complete wellbeing” is no longer fit for the purpose given the rise of chronic disease, Huber and colleagues propose changing emphasis towards the ability to adapt and self manage in the face of social, physical and emotional challenges
What determines our health
Range of interactive factors and our expectation of health is fluid, changing based on our experiences and characteristics
Factors include:
- social and economic environment: financial status, social and cultural factors, employment status, quality of relationships
-physical environment: level of hygiene, pollution levels, access to healthcare etc
- personal characteristics and behaviours: genetic makeup and lifestyle choices
Prevention vs promotion
Prevention: medical model, tends to focus of specific disease, target at risk group
Promotion: positive, holistic model, general and benefits are wider, whole population approach
Most interventions target both- i.e prevent disease and promote health
Most health promotion interventions are the same as primary prevention but health promotion can also impact on secondary and tertiary prevention
Examples of health promotion
Drink driving campaigns
Tobacco control
Immunisation programmes
Screening programmes:
- BP monitoring
- NCMP- national child measurement programme
-water fluoridation
- self management of disease
-healthy eating campaigns
Health promotion definitions
Health promotion is the process of enabling people to increase control over and to improve their health
HP is the combination of educational and environmental supports for actions and conditions of living conducive to health
Three approaches to health promotion
Medical (traditional)- absence of disease/ disability, target high risk individuals, strategy= surgical/ medical therapy etc, actors= doctors and other HCPs
Behavioural - public health/ lifestyle, target= high risk groups, individuals and population, strategy= health education, public health policies, actors= public health, patient groups, governments
Socio-environmental - structural, poverty, isolation loneliness etc, target= high risk societal conditions, communities/ collective responsibility, strategy= community development, political action for societal change, actors= citizens, social organisations, political movements
Target for health promotion: high risk vs population approach
High risk approach: identify few at high risk, target intervention on these, large benefit to individuals at greatest risk, limited benefit at population level.
Population approach: target whole population for intervention, modify risk in small community, small changes at individual level but affecting large numbers- substantial population benefit
Behaviour change theory BCT individual level
Health belief model: perceptions of threat, benefits avoiding the threat, perceived susceptibility, severity, benefits, barriers, self efficacy
Stages of change model: readiness to change behaviour, pre contemplation, contemplation, action, decision, maintenance
Theory of planned behaviour: attitudes and norms, intention, subjective norm, behavioural control
Precaution adoption process model: journey from lack of awareness to action and maintenance, unaware, unengaged, deciding about acting, acting, maintenance
Behaviour change theory BCT interpersonal and community level
Interpersonal:
Social cognitive theory: personal, environmental factors and behaviour, capability, expectations, self efficacy, reinforcements
Community level:
Community organisation: community driven, empowerment, community capacity
Diffusion of innovations: how new ideas and practices spread within society, compatibility, complexity, trialability, observability
Communication theory: how different types of communication affect behaviour, agenda setting, problem identification
The behaviour change wheel
Developed from review of behaviour change frameworks
At the heart of the model: capability, opportunity, motivation
Which influence your behaviour
In order to change behaviour we need to modify one or all of those functions
The intervention ladder
Do nothing or monitor current situation
Provide information
Enable choice
Guide choice through disincentives e,g taxes on cigs
Guide choice through incentives
Guide choice through changing default policy
Restrict choice
Eliminate choice
