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Flashcards in Health Promotion And Adult Education Deck (154):
1

When did emphasis on health promotion begin?

With the nineteenth century epidemiologic revolution

2

Nineteenth century focus of health promotion

1. Hygiene
2. Sanitation
3. Housing
4. Working conditions

3

Twentieth century focus of health promotion

Disease prevention and health

4

1970s focus of health promotion

Recognition that more than half of premature deaths were preventable by lifestyle changes

5

Early 1980s focus of health promotion

Comprehensive workplace health promotion programs instituted to help people change their behaviors

6

1990s focus of health promotion

Concept of workplace health broadened to include not only behavioral and lifestyle change, but also organizational strategies that supported healthy work environments

7

Twenty-first century and beyond focus of health promotion

As healthcare costs continue to soar, adding a significant burden to the industry, the major thrust becomes one of cost containment

8

Health promotion activities are conducted by and draw upon expertise from the following fields

1. Nursing
2. Health education
3. Medicine
4. Psychology
5. Nutrition
6. Occupational and physical therapy
7. Safety
8. Ergonomics

9

Health promotion focuses on

1. Prevention of illness and injury with return to work strategies to prevent relapse
2. Promotion of personal health accountability while partnering with the employer for enhanced outcomes
3. Development of strategies for behavioral change
4. Movement to optimal health by balancing physical, emotional, social, spiritual and intellectual health
5. Creation of a supportive work environment through policy, programs and culture

10

Consumerism

Used to describe the provision of education to consumers of healthcare so that they become more prudent users of healthcare services and can advocate for better care

11

Self-care

Refers to individuals, each taking responsibility for his or her own health

12

Percent of GDP spent on healthcare by large companies in 2004 and projected estimate for 2013

15.5%

18.4%

13

Business goals of health promotion

1. Improved employee productivity
2. Improved employee morale
3. Reduced health care costs
4. Recruitment and retention of employees

14

Personal health goals of health promotion

1. Identification and reduction of major health risks
2. Maintenance and improvement of health and health conditions
3. Improved energy and resilience
4. Balanced work and personal life

15

Recommended guidelines for physical exams

One per year

Have an established relationship with a provider and schedule appropriate preventative care

16

Recommended guidelines for tetanus diphtheria

Every 10 years

Evaluate need for booster after injury

17

Recommend guidelines for influenza vaccine

Annual vaccination

18

High risk patients for influenza

Heart problems
Lung problems
Over 65
Diabetes
Kidney dysfunction
Lowered immunity
Care takers if high risk persons

19

Recommended guidelines for travel immunizations

Consult with personal provider with each trip and as soon as you know you will be traveling

20

Recommended guidelines for blood pressure

Goal

21

Recommended guidelines for fecal occult blood testing

Start at age 40

Annually

22

Recommended guidelines for colonoscopy

Start at 50

Flexible sigmoidoscopy every 3-5 yrs
Colonoscopy every 5-10yrs

23

Recommended guidelines for oral exam and cleaning

Every 6 months

24

Recommended guidelines for eye exams

20-29: one complete eye exam
30-39: at least 2 exams
40-64: exams every 2-3yrs
65+: exams every 1-2yrs

25

Recommended guidelines for PAP smear and cervical exam

Every 1-3yrs after age 18 to screen for cervical cancer

26

Recommended guidelines for clinical breast exam

Every 1-3yrs
Annually after age 40

27

Recommended guidelines for mammography

40-49: every 1-2yrs
50+: annually
At risk women consult with healthcare provider for frequency

28

Recommended guidelines for prostate cancer screening

Start at age 40: at risk personal or family history and if African American- annual digital rectal exam

Age 50: annual digital rectal exam

Discuss PSA blood testing with healthcare provider

29

Recommended guidelines for testicular exam

Annual healthcare provider exam

30

Ways health promotion programs reduce unnecessary health cre utilization

1. Encourages appropriate use of health care delivery services
2. Prevents acute illness and injury and delaying development of chronic illness
3. Reducing symptom severity, discomfort and disability

31

Items that may be included in a health promotion program

1. Awareness and support programs
2. Screening programs and services
3. Lifestyle behavior change services and programs
4. Work-culture enhancement

32

Examples of awareness and support programs

1. Newsletters
2. Flyers
3. Posters
4. Seminars
5. Health fairs

33

Examples of lifestyle behavior change programs

1. Regular exercise
2. Good nutrition
3. Stress management
4. Smoking cessation

34

Examples of work/culture enhancement

1. Work/life programs
2. Organizational change efforts
3. Flexible work alternatives

35

Contributions of occupational and environmental health nurses to heal promotion

1. Keeping healthy people healthy
2. Identifying high risk populations and developing targeted interventions
3. Developing interventions for the management of disease conditions
4. Contributing to the comprehensive healthcare strategy for the organization

36

Healthy People 2010

-Objectives for improving health
- 467 objectives
- 28 focus areas
- seek to increase life expectancy and quality of life and to eliminate health disparities

37

To meet these goals, the implementation plan:

Supports gains in knowledge, motivation, and opportunities for better decision making

38

Healthy People 2010 encourages local and state leaders to accomplish the following:

1. Develop community and state efforts to promote healthy behaviors
2. Create healthy environments
3. Increase access to high quality health care

39

Areas of Healthy People 2010 of interest to occupational and environmental professionals

1. Physical activity
2. Obesity and weight loss
3. Tobacco use
4. Substance use
5. Mental health
6. Injury
7. Violence
8. Immunizations
9. Sexual behavior
10. Environmental quality
11. Improved access to health care

40

Occupational and environmental health nurses use Healthy People 2010 objectives to:

1. Benchmark with national norms
2. Justify program and service needs in discussions with management
3. Focus interventions
4. Develop site-specific population health goals and outcomes based on population data

41

Examples of Healthy People 2010 goals for a company population

1. Increase proportion of workers who exercise regularly
2. Increase the proportion of workers and their families who are at their desired weight
3. Increase the proportion of workers and their families who do not smoke tobacco

42

Example of strategy to " Increase proportion of workers who exercise regularly" and impact of strategy

Strategy: Employer will improve walking paths near the worksite and will allocate space for after hours exercise class

Impact: workers will have more energy, better weight control, less mental stress, and fewer disability claims

43

Example of strategy to "Increase the proportion of workers and their families who are at their desired weight" and impact of strategy

Strategy: company nurse will provide lunchtime nutrition courses

Impact: workers will generally feel better, they will have more energy, less mental stress and fewer disability claims

44

Example if strategy to "Increase the proportion of workers and their families who do not smoke tobacco" and impact of strategy

Strategy: at least one smoking cessation lecture series will be offered each quarter

Impact: workers will generally feel better, they will have more energy, less mental stress and fewer disability claims

45

Health models are developed as...

A means of explaining the concept of health and it's relationship to people's health decisions

46

Health Belief Model

-Developed by Godfrey Hochbaum, Stephen Kegeles, Howard Leventhal and Irwin Rosenstock
-Developed in 1950s

47

Major components of Health Belief Model

1. Perceived susceptibility
2. Perceived severity
3. Perceived benefits
4. Perceived barriers
5. Cues to action
6. Self-efficacy
7. Likelihood of an action being taken is driven by the positive difference between the perceived barriers and the perceived benefits

48

Perceived susceptibility

An individual's subjective estimation of his or her own personal risk of developing a specific health problem

49

Perceived severity

Refers to an individual's own personal judgement of how serious a health condition may be

50

Perceived susceptibility and perceived severity are often combined into....

Perceived threat

51

Perceived benefits

An individual's estimation of how effective a health recommendation may be against removing a threat

52

Perceived barriers

An individual's estimation of the obstacles to the performance of a health-related behavior

53

Cues to action

Strategies to activate one's readiness for action

54

Self efficacy

Refer's to one's confidence in one's own ability to take action

55

Health Promotion Model

-Pender
-2002
-Derived from social learns theory (Section IV.C)
-Organized like the Health Belief Model

56

Health Promotion Model is based on the following premises:

1. Health promotion is directed at increasing the level of well being and self actualization of an individual or group
2. Health promoting behaviors are continuing activities that must be an integral part of an individual's lifestyle
3. Health promoting behaviors are viewed as proactive rather than reactive

57

Health Promotion Planning Model

-known as PRECEDE
-used to help plan and evaluate health promotion activities

58

PRECEDE Model consists of:

1. Predisposing factors
2. Reinforcing factors
3. Enabling factors

59

Predisposing factors

1. Attitudes
2. Knowledge

60

Reinforcing factors

1. Rewards
2. Positive feedback

61

Enabling factors

Resources that facilitate or hinder performance of desired outcome

62

Health Promotion Planning a model considers multiple factors that shape health such as:

1. Behavior
2. Lifestyle
3. Environment

63

In the Health Promotion Planning Model ------ and ------ are viewed as important influences on the quality of life

Health promotion education
Policy

64

Expected outcome of Health Promotion Planning Model

Quality of life

65

Application of Health Promotion Planning Model begins with

The determination to work on controllable behaviors

66

Model of Health Promotion Behavior

Proposes that self efficacy beliefs play a central role regarding health beliefs and behavior

67

Basic premises of Model of Health Promotion Behavior

1. Optimal health represents a balance between physical, emotional, social, spiritual and intellectual health
2. Programs and services are targeted at three levels

68

Targeted three levels of Model of Health Promotion Behavior

1. Awareness
2. Lifestyle and behavioral change
3. Supportive environments

69

An expanded version of the Model of Health Promotion Behavior includes a dimension labeled....

Occupational/Environmental

70

Expanded version of Model of Health Promotion Behavior

-more comprehensive model
-includes the concept of work
-draws attention to the importance of work and how work is integrated into the fabric of our lives

71

Harm Reduction Model

Assumes that health risks can be decreased by asking clients:
1. What is healthier, safer or less risky than what I am doing now?
2. What steps am I willing to take in order to be healthier, safer or less risky?

72

Basic principles of Harm Reduction Model

1. Most people are competent to make informed decisions about health behaviors
2. Needs are diverse, so it is better to offer numerous behaviors rather than one solution
3. Incremental changes in steps will work better than making large, difficult changes
4. People need social support, eduction, referrals and assistance to make changes

73

An analysis of psychotherapy theories for behavior change was performed to.....

Identify psychotherapeutic principles that relate to helping people change their behavior

74

Types of psychotherapy theories for behavior change:

1. Verbal theories
2. Action or behavioral theories

75

Verbal theories

Use language and emotion to guide changes in behavior

76

Types of verbal theory

1. Consciousness raising
2. Catharsis
3. Choosing

77

Conscious raising

Uses the individual's personal experience feedback to stimulate responses

78

Catharsis

Allows individuals to express emotions, which produces personal relief and improvement

79

Choosing

Gives alternatives responses for individuals, and self liberation occurs when they choose an alternative

80

Action or behavioral theories

Use stimuli outside the individual to evoke an action or behavior

81

Types of action or behavioral theory

1. Conditional stimuli
2. Counter-conditioning
3. Stimulus control
4. Contingency control
5. Reevaluation

82

Conditional stimuli

Refers to critical changes made in the stimuli that influence responses

83

Counter-conditioning

Occurs when an individual changes his or her response to a stimulus

84

Stimulus control

Occurs when the environment is changed

85

Contingency control

Refers to managing change by making changes in the environment to cause individuals to change

86

Reevaluation (action or behavioral theory)

Occurs when individuals change in response to consequences without contingency changes in the environment

87

Transtheoretical theory- stages of change model

- Prochaska & DiClemente
- 1983
- describes interventions tailored to individual responses at specific levels or stages

88

Transtheoretical theory- stages of change model was formulated by......

Using numerous psychotherapy theories to develop the stages of change model to produce sustained behavioral change

89

The content of the Transtheoretical theory- stages of change model theory varies from client to client depending on the client's......

1. History of actions
2. Present environment
3. Personality

90

The stages of change in the Transtheoretical theory- stages of change model include the following:

1. Precontemplation
2. Contemplation
3. Planning
4. Action
5. Maintenance

91

Precontemplation stage of Transtheoretical theory- stages of change model

Clients are not considering making a change

92

Contemplation stage of Transtheoretical theory- stages of change model

Clients are beginning to explore or think about making a change

93

Planning stage of Transtheoretical theory- stages of change model

Clients are determined to stop and begin developing a plan

94

Action stage of Transtheoretical theory- stages of change model

Clients modify their behavior, which may also mean they change their environment

95

Maintenance stage of Transtheoretical theory- stages of change model

Continues as the new behavior continues to be practiced

96

Central premise of Transtheoretical theory- stages of change model

That people progress through a series of stages when they attempt to change behaviors

97

---- different processes are used to enhance progression through the stages of change

Ten

98

Processes used to enhance profession through stages of change include:

1. Consciousness raising
2. Dramatic relief
3. Environmental reevaluation
4. Self-reevaluation
5. Self-liberation
6. Relationships
7. Social liberation
8. Counterconditioning
9. Stimulus control
10. Reinforcement management

99

Consciousness raising

Transtheoretical theory- stages of change model

Increasing awareness

100

Dramatic relief

Transtheoretical theory- stages of change model

Experiencing and expressing feelings

101

Environmental reevaluation

Transtheoretical theory- stages of change model

Assessing how environment affects the situation

102

Self-reevaluation

Transtheoretical theory- stages of change model

How person feels about the situation

103

Self-liberation

Transtheoretical theory- stages of change model

Belief in ability to change

104

Relationships

Transtheoretical theory- stages of change model

Support

105

Social liberation

Transtheoretical theory- stages of change model

Assessing social changes that support changes

106

Counterconditioning

Transtheoretical theory- stages of change model

Substituting healthier behaviors

107

Stimulus control

Transtheoretical theory- stages of change model

Restructuring the environment

108

Reinforcement management

Transtheoretical theory- stages of change model

Getting rewards

109

Identifying and classifying the population into the stages of change should guide.....

1. Program planning
2. Interventions

110

Behavior change tools developed using the stages of change......

Provide a comprehensive framework to move more behaviors towards maintenance

111

Stages of change theory using psychotherapy theories examples of processes in contemplation stage to facilitate change

1. Consciousness raising
2. Feedback

112

Stages of change theory using psychotherapy theories examples of processes in planning stage to facilitate change

1. Choosing
2. Self-liberation
3. Catharsis

113

Stages of change theory using psychotherapy theories examples of processes in action/maintenance stage to facilitate change

1. Contingency control
2. Reevaluation
3. Conditional stimuli
4. Stimulus control

114

Stages of change theory using health promotion activities examples of processes in precontemplation stage to facilitate change

1. Posters
2. Invitation classes
3. Buddy system

115

Stages of change theory using health promotion activities examples of processes in contemplation stage to facilitate change

1. Health fairs
2. Newsletters
3. Brochures
4. Pamphlets
5. Health education classes
6. Buddy system
7. HRA

116

Stages of change theory using health promotion activities examples of processes in planning stage to facilitate change

1. Health education classes
2. Counseling
3. Health planner

117

Stages of change theory using health promotion activities examples of processes in action/maintenance stage to facilitate change

1. Follow-up contact
2. Environmental supports
3. Health education

118

Social learning theory

Proposes that people's thoughts have a strong effect on their behavior, and their behavior affects their thoughts

119

Social cognitive-self-efficacy theory

- Bandura, 1986
- describes the factors involved in making decisions related to healthy behavior

120

Factors involved in making decisions related to healthy behavior according to social cognitive-self-efficacy theory

1. Personal efficacy
2. Social support
3. Environmental support
4. Behavioral experiences

121

Self-efficacy

Social cognitive-self-efficacy theory

An individual's confidence in his or her ability to perform

122

An individual's efficacy expectation determines:

1. His or her choice of activity
2. How much effort he or she will expend
3. How persistent he or she will be

123

Supporting an individual's --------- may be the single st important factor in a person's success in changing personal health behaviors

Self efficacy efforts

124

According to the Locus of Control Theory types of locus of control

1. Internal locus of control
2. External locus of control

125

Internal locus of control

An individual's belief (outcome expectation) that his or her own behavior determines reinforcement (outcomes)

126

External locus of control

An individual's belief (outcome expectation) that reinforcements (outcomes) are controlled by others

127

Theoretically, individuals with --------- locus of control are rode likely to take control of their health and engage in health promotion activities that are those with ------- locus of control

Internal

External

128

Ways to motivate individuals for improved internal locus of control

1. Intrinsic motivation
2. External stimulus applied to to intrinsic motivation
3. Extrinsic motivation

129

Example of intrinsic motivation to improve internal locus of control

Increase participants' perception of success

130

Example of external stimulus applied to intrinsic motivation to improve internal locus of control

Reinforce positive actions

131

Examples of extrinsic motivation to improve internal locus of control

1. Provide incentive for participation and accomplishment of goals
2. Involve family support
3. Reinforce health messages in the environment, for example, vending machines, cafeteria, work spaces, and management communications

132

Transactional theory

Is characterized by "reciprocal determinism", in which individuals change behavior then begin to actively participate with others in the new behavior

133

Reciprocal determinism strengthens the individual's......

Desire to continue that new behavior or find the need to change the environment

134

Efficacy and support can....

Modify behavior

135

Direct experience with e new behavior increases....

The level of efficacy and support

136

Actions the occupational and environmental health nurse can take to reinforce the principles of transactional theory

1. Recreational leagues
2. Teams
3. Buddy systems
4. Support groups

137

The Theory of Reasoned Action

Proposes that behavioral intentions are the result of one's attitudes and subjective norms

138

Attitudes

The Theory of Reasoned Action

Are determined by beliefs regarding the consequences of a behavior and one's positive or negative evaluation of those consequences

139

Subjective norms

The Theory of Reasoned Action

Refer to a person's beliefs or perceptions about what others think he or she should do

140

Intentions

The Theory of Reasoned Action

The immediate determinant of behavior

141

Theory of Planned Behavior

- builds on the Theory of Reasoned Action
- the element added to that theory is the belief that one has the resources to perform the behavior
- Ajzen, 1988

142

Theory of Goal Setting

States that setting goals can help people change health-related behaviors by focusing effort, persistence, and concentration

143

The steps to setting goals include:

1. Determination of commitment to change
2. Analysis of tasks required to make changes; breaking complex tasks into smaller tasks
3. Assessment of the client's self-efficacy for performing required behaviors
4. Establishment of reasonable goals
5. Feedback for continued success

144

Theory of Social Behavior

States that the probability that an act will occur in a specific situation is equal to the sum of the person's habit and intention

145

Protection Motivation Theory

Combines features of the Health Belief Model with self-efficacy theory and other social psychologic constructs such as fear, arousal, appraisal and coping

146

Health Action Process Approach

States that health behavior change takes place over time

147

Levels of prevention

1. Primary prevention
2. Secondary prevention
3. Tertiary prevention

148

Primary prevention

Is aimed at eliminating or reducing risk of disease through specific actions

149

Examples of primary prevention

1. Immunizations
2. Stress management
3. Smoking avoidance
4. Risk factor appraisal
5. Seat belt use
6. Work-site walk-throughs
7. Use of personal protective equipment

150

Secondary prevention

Is directly aimed at early case-finding and diagnosis of individuals with disease in order to institute prompt interventions

151

Examples of secondary prevention interventions

1. Screening programs
2. Health surveillance
3. Monitoring health and illness trend data
4. Preplacement examinations
5. Periodic examinations

152

Tertiary prevention

Is directed at rehabilitating and restoring individuals to their maximum health potential

153

Examples of tertiary prevention interventions

1. Disability case management
2. Early return to work
3. Chronic illness monitoring
4. Substance abuse rehabilitation

154

Health promotion

A process that supports positive lifestyle changes through corporate policies, individual efforts to lower risk of disease and injury and the creation of an environment that provides a sense of balance among work, family, personal health and social concerns

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