Module 5

Question 1

disease prevention

Answer 1

non-communicable diseases account for 70% of deaths globally
there is a greater need to focus on disease first rather than treatment because most of the burden of non communicable diseases is preventable

Question 2

disease prevention stages

Answer 2

1. Primordial prevention: prevents the development of risk factors by targeting underlying social and environmental conditions
2. primary prevention: identification and modification of risk factors to prevent disease onset
3. secondary prevention: early detection and treatment of disease before symptoms appear
4. tertiary prevention: treatment of disease to stop its progression and control its negative consequences

Question 3

primordial prevention on the disease progression pathway

Answer 3

used when there is no disease

Question 4

primary prevention on the disease progression pathway

Answer 4

used when there is no disease
ex: getting vaccinated

Question 5

secondary prevention on the disease progression pathway

Answer 5

occurs after the disease onset, but the disease is asymptomatic
ex: regular mammograms and Pap smears

Question 6

tertiary prevention on the disease progression pathway

Answer 6

clinical onset of disease
ex: cardiac rehabilitation for people with myocardial infarction

Question 7

health promotion

Answer 7

Primordial prevention is often considered synonymous with health promotion, but that is not entirely accurate. Primordial prevention consists of risk factor prevention/reduction through social and environmental changes for the entire population. These changes tend to be accomplished through policy and law changes. In addition, health promotion helps individuals increase their control over their health, by promoting skills development and healthy habits.

Question 8

2 approaches to effective health promotion

Answer 8

1. identification risk: identify susceptible individuals to a risk factor and intervening to reduce the development of risk
2. reducing average risk: reducing risk level for the whole population, usually through legislative/policy changes
   ex: mandating all companies display nutritional facts on their food products to promote healthier eating

Question 9

Ottawa Charter of Health Promotion

Answer 9

developed after the International Conference on Health Promotion was held in 1986
it called for several important actions to facilitate health promotion, including:
- building healthy public policy
- creating supportive environments
- strengthening community actions
- developing personal skills
- reorienting health services

Question 10

health promotion and the SDHs

Answer 10

Health promotion at the individual and population levels targets the behaviours, environmental conditions, social conditions, and any other factors that could lead to the development of risk factors. These factors are often grouped into three categories: environmental, social, and other factors.

Question 11

health promotion: environmental factors

Answer 11

occupation
housing/living conditions
school or work

Question 12

health promotion: social factors

Answer 12

education
family
SES
war/conflict
culture
race/racism

Question 13

health promotion: other factors

Answer 13

internal/external factors that impact health
healthy/unhealthy behaviours
availability of quality services

Question 14

the need for behaviour change

Answer 14

the healthy behaviours one chooses to engage in are arguably the most significant factors in determining an individual’s health. The behaviours we choose to engage in also happen to be the most easily modifiable SDH, as the remaining ones we are either born into, or they are beyond our immediate control.
Given that personal health behaviours are a critical aspect of one’s health, modifying such behaviours (tobacco use, diet, physical activity) is a large and effective component of health promotion.
Yet, behavioural change tends to be a difficult aspect of health promotion as there is often a disconnect between knowledge and behaviour.

Question 15

barriers to changing healthy behaviours: intrapersonal

Answer 15

Mostly situated within the control of an individual. Some of these factors related to this level include knowledge, attitude, skills, self-efficacy, motivation, age, and socioeconomic status
Examples of barriers:
- Lack of knowledge about safe sexual practices, dental hygiene, etc.
- Flawed risk perception of unhealthy eating, drinking habits, and sleeping habits
- Cost (time or money) of switching to healthy foods, joining a gym, getting proper medical advice, etc.

Question 16

barriers to changing healthy behaviours: interpersonal

Answer 16

Involve social relationships, including those with friends, family, peers, partners, and coworkers
Any one of these relationships may influence an individual’s behaviour positively or negatively
Ex:
-Lack of connection and social integration with peers
- Unsupportive family or peer environment
- Social norms within the peer group that promote negative behaviours like smoking

Question 17

barriers to changing healthy behaviours: community/institutional barriers

Answer 17

Includes the social and physical environments and setting individuals engage with daily, including schools, workplaces, neighbourhoods, and healthcare facilities
Encompasses social and gender norms, a sense of empowerment within the community, and the policies that influence the social environment of schools and workplaces
Ex:
- Lack of economic and housing opportunities
- Inflexible work environment
- Lack of healthy food options at school
- Inaccessible parks and other recreational areas

Question 18

barriers to changing healthy behaviours: public policy barrier

Answer 18

Involves the broad, structural factors such as local, state, and federal policies, that either enable or hinder an individual’s ability to take control over their health
Ex:
- Unfair trade and labour laws that increase prices and access to care products and services
- Lack of funding to the healthcare system and other social services
- Punitive drug policies
- Lack of a comprehensive health curriculum at school

Question 19

the health belief model

Answer 19

Is one of the best known and most widely used theories about health behaviour change. It was first developed by a group of social psychologists in the 1950s, who were trying to understand the widespread failure of TB screening programs. It involves modifying factors (age, gender, ethnicity, personality, SES, and knowledge), individual beliefs, and action

Question 20

HBM: individual beliefs

Answer 20

includes perceived seriousness, perceived susceptibility, perceived benefits, and perceived burdens, and self efficacy (person’s confidence in their ability to change successfully)

Question 21

HBM: action

Answer 21

cues to action include specific triggers needed to prompt the decision making process to engage in a health behavioural change
ex: pre-existence of a health condition, physician recommendation, or the illness of a family member

Question 22

trans-theoretical model of a health behaviour change (TTM)

Answer 22

Outlines the process of intentional behaviour change
Understanding this process can facilitate the development of successful interventions. The TTM posits that individuals move through six stages of change: precontemplation, contemplation, preparation, action, maintenance, and relapse

Question 23

TTM: precontemplation

Answer 23

individuals in this stage are unaware of the need to change
they are often uninformed about the consequences of their behaviour
ex: a person is smoking

Question 24

TTM: contemplation

Answer 24

the getting ready stage, individuals are often ambivalent or behavioural procrastinators
ex: smoker thinking about quitting, but has not made plans to do so

Question 25

TTM: preparation

Answer 25

individuals have motivation and a plan of action, some steps have been made to change their behaviour ex: a smoker has set a quit date

Question 26

TTM: action

Answer 26

individuals are actively trying to modify their behaviour and lifestyle

Question 27

TTM: maintenance

Answer 27

individuals have sustained their behavioural change for at least 6 months and work towards preventing relapse

Question 28

TTM: relapse

Answer 28

individuals have abandoned the idea of changing due to difficulty in maintaining their new behaviour

Question 29

health promotion levels: individual

Answer 29

happens through one-on-one interactions and is suitable when there is a lot of individualized information and knowledge to be transferred These interactions provide an opportunity for personal clarification and adaptation, however, individual level health promotion can be labour intensive and costly ex: discussing strategies for smoking cessation

Question 30

health promotion levels: peer or group

Answer 30

this level can include small groups, institutions, or entire communities, and can occur in many spaces (classrooms, field trips, etc.) This interaction is suitable when social interaction is helpful and may be a more efficient method to transfer information because one individual can teach a large group of people ex: prenatal class

Question 31

health promotion level: population

Answer 31

there are 2 main types at this level: legislation and policy, and social marketing

Question 32

population health promotion: legislation and policy

Answer 32

promotion is effective but often an overlooked approach as it requires political will and public support This type of promotion helps change environments and sets the community standard for behaviour Since individuals are forced to change, this can cause a massive shift in attitude and behaviour

Question 33

population level health promotion: social marketing

Answer 33

relies on 'selling' health like businesses that sell products This approach leverages a target niche market. Often this approach can influence acceptability of social norms and attitudes

Question 34

need for Indigenous voices in Health Promotion

Answer 34

Many Indigenous communities are disproportionately affected by health related issues compared to non-Indigenous populations. A space needs to be created for Indigenous voices to be heard when developing Indigenous health promotion strategies. When Indigenous voices are not heard, colonial health promotion strategies are left unchecked and can result in the continuous and damaging perpetuation of neocolonialism.

Question 35

need for Indigenous voices in Health Promotion: researcher perspective

Answer 35

Many Indigenous health researchers and practitioners do not come from an Indigenous background, or do not identify as Indigenous This can be problematic and oftentimes results in a contradiction between the Indigenous community's priorities and common goals and researcher's perspectives in how they identify and address these issues

Question 36

need for Indigenous voices in Health Promotion: intervention evaluation

Answer 36

There is an evident lack of research on evaluating the effectiveness of health promotion interventions for Indigenous Peoples. Even when research is conducted, program effectiveness is regularly measured based on westernized individualistic methods that do not align with Indigenous holistic community measures.

Question 37

BC Cancer Prince George Centre for the Northern

Answer 37

has taken on various initiatives that are aimed at improving the healthcare and experiences of Indigenous Peoples they have implemented strategies to combine Western and Traditional medicines, like having an Aboriginal Case Coordinator and a Healing Garden

Question 38

amplifying Indigenous Voices in Health Promotion

Answer 38

researchers must genuinely collaborate with, and work alongside chiefs, elders, and leaders By creating a safe space for Indigenous voices to be heard, health promotion strategies can be developed that reflect Indigenous cultures, values, and traditional knowledge

Question 39

Indigenous health promotion factors:

Answer 39

- Protective Factors: self government, land control, and control over cultural activities - Prevention: community based approaches, gatekeeper training, and peer support groups - Spirituality: using Indigenous concepts of well-being and spiritual practices: pow-wows, sweetgrass ceremonies, and sweat lodges

Question 40

Indigenous Suicide Prevention: successful program

Answer 40

Focus on community and family connectedness, community empowerment, and Indigenous cultural affinity. Programs developed with these components in mind have been proven to be effective in lowering rates of suicide - Ex: to treat substance abuse issues, a treatment would involve community healers utilizing spiritual practices, dances, and ceremonies In many Indigenous communities, culture is viewed as treatment and it is understood that all healing is spiritual

Question 41

Indigenous Suicide prevention: unsuccessful

Answer 41

There have been cases where westernized suicide prevention programs and strategies have failed in Indigenous communities As the programs lacked Indigenous perspective, they created incongruences in culture and resulted in further disruption of Indigenous communities In some situations, the implementation of these suicide prevention programs has actually resulted in higher rates of suicide

Question 42

health promotion in practice

Answer 42

As a whole, health promotion focuses on encouraging people to improve their health in one of two ways: either by increasing their frequency of healthy behaviours, or by reducing or eliminating their unhealthy behaviours

Question 43

increasing frequency of healthy behaviours

Answer 43

One practice focuses on increasing the frequency of healthy behaviours by identifying healthy behaviours and implementing programs to make these behaviours easier to achieve ex: OMama for pregnancy healthcare

Question 44

eliminating unhealthy behaviours

Answer 44

Health promotion also focuses on empowering the population to identify and reduce behaviours that are detrimental to a healthy lifestyle, and designed interventions which will effectively alter those behaviours ex: smoking cessation programs

Question 45

Indigenous considerations with smoking cessation: First Nations

Answer 45

Have traditionally used tobacco for prayer, purifying the body and mind, providing spiritual strength, guidance, and as a symbol of respect in First Nations gatherings However, most practices do not include inhaling tobacco directly

Question 46

Indigenous considerations with smoking cessation: Metis

Answer 46

Metis use of tobacco has historically been influenced by First Nations as a medicinal plant and for social uses. Early Metis were known for being voyageurs, and during long canoe journeys they would frequently stop for rest and to pipe Eventually, this way of life became so important they would measure their distance travelled by the number of pipes smoked

Question 47

Indigenous considerations with smoking cessation: Inuit

Answer 47

From a traditional perspective, Inuit typically do not use tobacco for ceremonial or other practices because tobacco could not grow in the colder climate of traditional land

Question 48

Sacred Smoke Program

Answer 48

an initiative that was developed to support and promote being tobacco wise in two communities: Batchewana First Nation and Garden River First Nation. The program was based on traditional Anishinaabe practices and shares smoking cessation information in a culturally respective manner This cessation program involved both western medicine nicotine replacement therapies and support groups in conjunction with traditional Anishinaabe medicines and cultural resources

Question 49

Sacred Smoke Program: elders and coping strategies

Answer 49

Elders: Led by elders, participants were shown how to make kinikinik (traditional tobacco) and taught traditional methods for smoking cessation, such as tobacco offerings, quitting on a new moon, and selecting traditional medicines Coping Strategies: Participants were shown how to incorporate adaptive coping strategies into their daily routines to help distract from cravings and avoid relapse Some strategies were exercise, drumming, crafts, and cultural ceremonies.

Question 50

primary prevention information

Answer 50

Strategy: the identification and modification of risk factors for disease Aim: to prevent occurrences of disease Disease stage: there is no disease present, but the individual is susceptible to the disease due to risk factors Ex: quitting smoking

Question 51

secondary prevention information

Answer 51

Strategy: the early detection and treatment of diseases Aim: to stop the progression of the disease, or to either cure, prevent complications, and death, or to stop or limit its spread Disease stage: subclinical or early clinical, pathological changes but no signs or symptoms Ex: regularly schedules mammograms

Question 52

tertiary prevention information

Answer 52

Strategy: the treatment and rehabilitation of the person with the disease Aim: to limit disability, prevent relapse, and restore function Disease Stage: signs and symptoms of the disease, potential complications/disabilities Ex: early rehabilitation for people who suffered a stroke

Question 53

primary prevention of HPV related cancers

Answer 53

Aims to reduce the occurrence of a disease by identifying and modifying risk factors. Globally, HPV infections are the most common sexually transmitted infections and can lead to 6 types of cancer. Without vaccination, it is estimated that 75% of sexually active Canadians will have an HPV infection in their life HPV vaccination is most effective when administered before becoming sexually active. HPV vaccines are federally funded and administered in schools.

Question 54

secondary prevention of cervical cancer

Answer 54

Screening plays a critical roe in secondary prevention because it enables early detection and treatment of disease. One example of effective secondary prevention is the screening for cervical cancer Although highly curable, cervical cancer kills thousands of women annually, especially in low income countries

Question 55

tertiary prevention for PD

Answer 55

Tertiary prevention involves the treatment and control of disease. PD is a progressive disease of the NS. This diseases usually effects adults ages 50-60, and is 50% more common in men than women. The cause of PD is attributed to a combination of genetic mutations, which can be hereditary, and environmental factors

Question 56

health interventions

Answer 56

Aim to address a health need or gap within a given population. Often, interventions are developed around 3 main criteria: the target (entity on which the action is carried out), the action (a deed done by an actor to a target), and the means (the processes and methods by which the action is carried out)

Question 57

developing an intervention step 1

Answer 57

identify and assess the level of the problem This can be done using a needs assessment Common needs assessments include questions like: - What is the extent of the problem - What are potential root causes for the health problem - What are barriers and enablers to addressing the root cause through intervention

Question 58

developing an intervention step 2

Answer 58

develop a solution to the problem After identification and assessment of the problem, a solution is developed. Solutions can be built upon existing interventions/best practices

Question 59

developing an intervention step 3

Answer 59

describe the action plan for the intervention This step involves determining the details of the implementation of the proposed solution. Questions that are addressed at this stage include: - What specific change or aspect of the intervention will occur? - Which groups will benefit from this intervention? - Who will carry it out? - When will the intervention be implemented? How long will it be maintained? - What resources are needed, what resources are available? - What is the feasibility of the plan?

Question 60

developing an intervention step 4

Answer 60

assess the potential impact Once the action plan has been described, the potential impact must be assessed. Questions asked: - What are the intended and unintended outcomes of this intervention? - How will 'success' be measured? Will the impact be positive or negative?

Question 61

interventions: from theory to practice

Answer 61

despite rigorous planning that occurs in developing an intervention, it is important to understand that once implemented in reality, the intervention might now always be as effective as anticipated. Therefore, it is important for researchers to investigate any intended or unintended consequences of their proposed intervention plan.

Question 62

quaternary prevention

Answer 62

Quaternary prevention is defined as "action taken to identify patients at risk of overmedicalization, to protect them from new medical invasion, and to suggest to them interventions which are ethically acceptable". This type of prevention is important so that doctors are conscious of the harm they may cause to their patients, even unintentionally. One relevant example involves the current opioid crisis, which was initially caused by the over-prescription of opioids for patients with chronic pain. The opioid crisis has historically burdened marginalized and racialized people disproportionately, including Indigenous people.

Question 63

community input in needs assessment

Answer 63

Conducting a needs assessment of the community is the most critical component developing an intervention. It informs health promoters of the most pressing needs within a community, as described by its own members, and it also ensures that the intervention being planned is aligned with the needs that are perceived by the community. One of the biggest benefits of involving community members throughout this process is a higher likelihood that the community will support the process and engage with the intervention, resulting in improved chances of a successful intervention.

Question 64

the importance of consultation and practice

Answer 64

Community input and participation during a needs assessment is central to the success of an intervention. However, if this step is not taken into consideration, the intervention might be unsuccessful at best, and at worst, have unintended consequences within the community.

Question 65

curating an intervention

Answer 65

Successful interventions are often the result of effective collaboration between people, departments, and disciplines.

Question 66

problematic attitudes when providing aid

Answer 66

Paternalistic and patronizing attitudes when carrying out an intervention can be extremely dangerous, as they may be disguised as a well-intentioned approach to take while it is actually doing harm. These complexes are often found in the white saviour complex, and it serves to build a helpless and demeaning image of marginalized and vulnerable communities, which further disempowers them.