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Promoting participation: evaluation of a health promotion program for low income seniors.

This article describes a qualitative evaluation of the Seniors Active Living in Vulnerable Elders (ALIVE) program, a 10-month health promotion program for low income seniors. Program interventions delivered in seniors' apartment buildings included exercise classes, health information sessions (i.e., health corners), and newsletters. The evaluation examined program participation, program impacts, and how the program worked. The most frequent reason for joining the program was recognizing the benefits of exercise, and the most frequent reason for not attending the program was having other priorities. The main participant impact was "feeling better." Specific impacts were also noted in physical, mental, and social domains. Fun, program delivery adaptations, autonomy, social interactions, and staff-participant relationships were discovered to be important program processes. These processes all contributed to participant's "comfort" in the program. How and why the program worked is examined in relation to Pender's (1996) revised health promotion model and implications for nursing are indicated.

Aged↗

Revisiting the Health Belief Model: nurses applying it to young families and their health promotion needs.

The Health Belief Model (HBM) was reviewed with the aim of modifying it so that it reflected a health promotion stance for young families. Since this model's inception, health professionals like nurses have been involved in using the HBM to guide their practice. It is argued that to assist families, nurses now need a model that is focused on "health." In support of this approach, reorienting the HBM and basing it on "positive" health definitions associated with health promotion, by modifying it through adding the constructs "perceived behavioral control" (representing health locus of control) and "behavioral intention" from Ajzen will provide nurses with a more appropriate and useful model for interacting with families and their preschool children. A summary of positive and negative aspects of the modification of the HBM is presented, followed by a strategy for the process of validating the revised HBM for young families.

Adult↗

Health promotion--caring concern.

'Health promotion' has unfortunately come to mean different things to different people. Interpretations have frequently been left implicit and where spelt out have often been too diffuse or too limited to be useful. Nevertheless the term can be usefully employed to define a set of health-enhancing activities in which the focus is deflected from current disease- and cure-oriented power bases. Used in this way health promotion can come to include the best of the developing theory and practice from a wide range of 'experts' but can also place due emphasis on community involvement. To reject health promotion on the basis of selected, inadequate interpretations is to discard past successes, current developments and future possibilities in important fields of activity and to preserve an inappropriate status quo.

Behavior Control↗

The health promotion of aging workers from the perspective of occupational health professionals.

OBJECTIVES: This study defines and describes, from the perspective of occupational health professionals, (a) the aging worker, (b) health promotion for aging workers, (3) employees' health-promoting activities, (4) workplace health promotion factors, (5) occupational health promotion activities, (6) co-partners supporting the health promotion, and (7) the impact of health promotion activities for older workers. A model is proposed, based on these issues. DESIGN: A cross-sectional, qualitative design was used to analyze e-mailed essays. Content analysis of the essays yielded themes that were validated by an independent research colleague. SAMPLE: Ten group essays from 16 occupational health professionals who had participated in the Health Promotion Project of Aging Workers in Northern Karelia, Finland were received. RESULTS: An aging employee was defined as a mature worker. Health promotion was defined as early prevention of the influence of health hazards. Workers can improve their health through living habits, positive attitude, personal relationships, and education. Individual work arrangements, good work atmosphere, and appreciative leadership were essential factors for the health of workers. Occupational health professionals supported workers by health examinations, workplace visits, counseling, and organizing activities. CONCLUSIONS: The impacts of health promotion activities were better health, productivity, and work satisfaction.

Adult↗

What students bring to medical school: attitudes toward health promotion and prevention.

INTRODUCTION: Health care providers' positive attitudes toward prevention and health promotion are important in achieving national health care goals. Limited studies of incoming medical students have been conducted that measure predictors of positive attitudes toward health promotion and prevention. METHODS: Data were obtained from a 1993 curriculum evaluation survey of first-year students at five different medical schools in California. Attitudes toward health promotion and prevention were measured using a nine-question Prevention Attitude Scale (PAS). We developed 2 multivariate linear regression models using demographics, education choices, and personal social values and beliefs to predict PAS scores. We also performed bivariate analysis. RESULTS: Five hundred ninety-nine completed surveys were analyzed, with a response rate of 95%. Mean PAS score was 36.47 +/- 3.7 on a 0 to 44 scale. Female gender, Democratic party preference, and a planned specialty choice in preventive medicine or primary care predicted the highest PAS scores on bivariate analysis (p < 0.002). Significant correlation ( p < 0. 001) was shown between PAS scores and 2 additional scales regarding beliefs in associations of social factors and illness and in the importance of caring for the poor. Linear regression model using personal social values and beliefs explained 34% of the variance, as opposed to the demographic model that explained only 9% of the variance. CONCLUSIONS: In the schools studied, participating first-year medical students had moderately positive attitudes toward health promotion and prevention, as measured by PAS scores. In designing curriculum to improve medical students' attitudes toward health promotion and prevention, medical educators may need to consider other personal and social values held by medical students and to address the "political" aspects of health promotion and prevention. Future studies are needed to longitudinally follow medical student attitudes.

Adolescent↗

School health promotion--good effort, but could do better; keep up the good work!

There are many reasons to focus on schools as a setting to promote the health of young people, including the inter-relationship between health and education, the commitment to health and synergy between the health and education sectors, the existence of evidence to support school health promotion, and the access to large numbers of students that schools provide. There remain, however, many challenges for school health promotion, including the potential to overcrowd the curriculum, the difficulty of engaging parents and community partners, issues of school or health ownership of programs and the practical dilemmas of evaluation. It is argued that rather than being reasons to avoid work in this setting, these challenges should inform intervention and broader program design.

Adolescent↗

The opportunities and effectiveness of the health promoting primary school in improving child health--a review of the claims and evidence.

School health programs have been part of schooling for most of this century. The health promoting school is a recently developed concept which seeks to provide a multifaceted approach to school health. Will it provide a better frame-work to assist schools address the health issues of their students? This paper examines the development of the health promoting school and identifies its structural components. It reviews the claims and evidence which have emerged from the school health research literature which focus on primary schools. Findings indicate health gains for primary school students are difficult to assess, and will most likely occur if a well-designed program is implemented which links the curriculum with other health promoting school actions, contains substantial professional development for teachers and is underpinned by a theoretical model. The paper concludes by discussing how improvements can be made in more accurately assessing the effectiveness of the health promoting primary school in improving school health.

Child↗

Occupational mental health promotion: a prevention agenda based on education and treatment. The American Psychological Association/National Institute for Occupational Safety and Health, Health Promotion Panel, 1990 Work and Well-Being Conference.

PURPOSE OF THE REVIEW. Psychological disorders are one of the 10 leading work-related diseases and injuries in the United States according to the National Institute for Occupational Safety and Health. This article addresses occupational metal health and preventive stress management in the workplace. The individual and organizational costs are briefly considered with concern for reducing the burden of suffering associated with these problems. SEARCH METHOD. As an American Psychological Association interdisciplinary panel, we searched the psychological, medical, public health, and organizational literature. We selected articles relevant to the problem of psychological disorders in the workplace and to enhancing occupational mental health and preventive stress management. IMPORTANT FINDINGS. The panel proposed a national agenda of education and treatment, combined with a program of evaluation research, for addressing these issues. Target populations are identified, and the need for collaboration among a variety of national constituencies is considered. Advancing occupational mental health and promoting skills in preventive stress management is considered in the context of comprehensive health promotion. MAJOR CONCLUSIONS. The panel concluded that there is a pressing need to: 1) set a 'gold' standard concerning the current state of knowledge in the domains of occupational mental health and stress management; 2) identify Diagnostically Related Groups (DRGs) which are stress-related; 3) establish assessment standards for stress and mental health; 4) set guidelines for reasonable interventions; and 5) establish acceptable post-outcome criteria.

Health Education↗

Health promotion in pregnancy: the role of the midwife.

Health promotion is of particular importance to midwives who promote health rather than manage disease and ill health. Although the midwife has always had a role in public health, there is now an explicit need for the profession to direct its attention to teenage pregnancy, smoking cessation, drug awareness and domestic violence. Much of the role of the midwife during pregnancy is in health promotion and a more explicit application of such may carry benefits in meeting Government policy on public health. Some activities undertaken by midwives may not be identified as health promotion, though there is evidence that the interaction generated by routine examinations is of benefit to the mother's health. Midwives should work in partnership with women and families, facilitating decisions about the care that they feel they may require. Social disadvantage may impede participation where formal education was not valued or ethnic background or language impaired access to traditional childbirth education. Tackling this is at the heart of current public health policy around childbirth and child care. Education can take place during any interaction and this gives midwives huge scope to provide an educational experience for women each time they meet. For the pregnant teenager the extended family may need to be included in health promotion activities particularly if breastfeeding targets are to be met. A united health and education policy to inform and educate children and teenagers about the benefits of pre-conceptional care and breastfeeding may be needed. In this way young women come into contact with midwives before they are pregnant, before attitudes to breastfeeding are established and before the concept of pre-conceptional care is lost. Although breastfeeding improves health for women and their infants it can become another burden and expectation which they fail to achieve. Professionals need to be sensitive to the possible negative impact on a woman's health, which could be reduced if the emphasis was moved from individual behaviour change to the inequalities within society. Midwives should seek to respond positively to service changes to achieve the goal of multidisciplinary, non-hierarchical patient-centred services. In facilitating change midwives seek to use their influence to the benefit of the pregnant woman.

England↗

Workplace health promotion: the role and responsibility of health care managers.

The World Health Organization's (WHO) Ottawa Charter for Health Promotion in 1986 provided the catalyst from which the Health Promoting Workplace movement emerged. Here, an extensive review of the available workplace-related health literature provides the basis for critical discussion and recommendations for health care managers. The findings suggest that health care managers, who practice in all health service settings, should be aiming to initiate and promote radical health promotion reform as set out in the WHO settings-based movement. Developing and implementing sustainable health promotion-orientated and organization-wide healthy workplace policy initiatives represent the most effective way for health care managers to directly benefit from the desirable outcomes that come from creating and maintaining a healthy workforce.

Health Promotion↗

Health promotion in general practice.

Health promotion is accepted as a desirable and increasingly necessary component of contemporary general practice. Discussion of health promotion in the family medicine setting has neglected to seek the views of General Practitioners. Their contact with patients places them in a unique position to observe the health promotion needs of their patients, and assign priorities to these. A sample of practitioners in the Eastern Sydney Area Health Service was interviewed to ascertain the major areas of preventive medicine needed by their patients. Information was also sought on the General Practitioners' use and views on health promotion services already available in the Eastern Sydney Area Health Service. General Practitioners were receptive to discussion of health promotion and disease prevention activities. Cardiovascular disease was clearly identified as the major area for preventative work for GPs. The large scope for health promotion in general practice ranged from women's health to parent effectiveness training. Although GPs generally viewed favourably the health promotion services provided by the ESAHS limitations on their use were cited.

Attitude of Health Personnel↗

Improving delivery of a health-promoting-environments program: experiences from Queensland Health.

The purpose of this paper is to outline the key components of a statewide multisite health-promoting-environments program. Contemporary health-promotion programs in settings such as schools, workplaces and hospitals use organisational development theory to address the health issues of the setting, including the physical environment, the organisational environment, and the specific health needs of the employees and consumers of the service. Program principles include management of each project by the participant organisation or site (for example, a school or workplace), using resources available within the organisation and the local community, voluntary participation, social justice and participant-based priority setting, and evaluation and monitoring. Adoption of these principles implies a shift in the role of the health worker from implementer to facilitator. Based on the experience of Queensland Health, it is proposed that the essential building blocks of the health-promoting-environments program are an intersectoral policy base, a model for action, training and resources, local facilitators, support from local organisations, a supportive network of sites, marketing of the program, and a state-based evaluation and monitoring system. The program in Queensland was able to develop a significant number of these components over the 1990-1996 period. In regard to evaluation, process measures can be built around the program components; however, further research is required for development of impact indicators and benchmarks on quality.

Community Health Services↗

Heart Partners: a strategy for promoting effective diffusion of school health promotion programs.

Heart Partners uses a straightforward, interpersonal approach to increase acceptance and use of innovations in school health promotion. In accord with the linkage model of innovation diffusion, developers of a new program or technology (i.e., resource system) simply designate and train selected members to be recruiters and allies of individual advocates at the campus-level (i.e., user system). Linkage is supported by supplying advocates and allies with guidelines and materials that encourage ongoing, interactive, interpersonal partnerships to promote effective implementation of the new technology at the school. Empirical assessment of this simple strategy implemented by the Texas Affiliate of the American Heart Association showed a twofold to fourfold increase in actual use and reach of school health promotion packages, with an average reported volunteer time of less than three hours per month.

American Heart Association↗

Health policy implications of health promotion and disease prevention for allied health.

Regardless of the direction health policies in this country may take, allied health professionals seem uniquely positioned to meet the health promotion needs of a variety of clients, such as patients, families, other providers, employees, and members of communities. If allied health professionals choose to respond to health promotion as an area of clinical expertise, they will have to accept the challenge presented by the numerous complex issues associated with implementing a new discipline. However, the successful application of energy and resources to resolving these problems would allow allied health professionals to provide significant interventions in meeting national health goals. This article reviews the history of health promotion in the United States, discusses current practices in health promotion, and suggests some future trends.

Allied Health Personnel↗

Facilitating the involvement of Canadian health care facilities in health promotion.

Following a brief background of Canadian health promotion policy efforts, the Canadian health care system, and a discussion of the reasons for increased interest in the area, two health promotion and health care facility initiatives undertaken by the Canadian Hospital Association are presented. The first describes the findings of a 1986 survey of Canadian hospitals (n = 732) in terms of the level of commitment to health promotion, the future priority of health promotion for four target groups, the types of programs and activities, and the perceived obstacles to implementing health promotion. The results suggest that although health promotion is considered an important role for hospitals, most health promotion activities in Canadian hospitals can be classified as ad hoc. The second initiative presents the summary of a focus group meeting which was established to further the organized involvement of health care facilities in health promotion. Findings are described as follows: a shared vision of health and health promotion; the role of health care facilities in health promotion; and the implementation of health promotion in health institutions. These efforts culminated in the striking of a national working group by Health and Welfare Canada to develop a document which will serve as a framework for health promotion in health care facilities.

Canada↗

Health promotion at the workplace.

Health promotion encompasses those activities undertaken to improve the quality of one's life, thereby moving the individual forward toward a state of wellness or optimal health. Occupational health nurses are in a prime position to impart knowledge and change attitudes and behaviors and thus are uniquely qualified to plan, develop, implement, and evaluate workplace health promotion programs. Employee health promotion programs are based on the theory that it costs less to educate workers about controllable lifestyle health risks than to pay for the cost of ill health. Comprehensive workplace health promotion programs should be targeted at three levels: awareness, lifestyle/behavior change, and supportive environments, if long-term success is to be achieved. Occupational health nurses may use the Model for Workplace Health Promotion to assist them in planning, developing, implementing, and evaluating programs that provide health and cost benefits for both employees and employers.

Cost-Benefit Analysis↗