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[Health promotion in adolescents in Latin America].

The First International Conference on Health Promotion (Ottawa 1996) consolidated and developed the interest of Latin American countries in the amelioration of the health of their populations. Initiatives such as the International Conference for Health Promotion in Columbia in 1992 and the adoption in 1993 of the Caribbean Charter for Health Promotion show the efforts that have been carried out by different American countries to work toward the principles of the Ottawa Charter and to adapt them to their realities. This article focuses on the state of health of adolescents in Latin America as well as different actions that have been, and continue to be, carried out. The authors first discuss the peer approach to health education, which has been used in many health promotion actions throughout Latin America because of its effectiveness. Often in developing countries, the oldest children care for the younger ones. This approach therefore provides a way to reach not only peers of the adolescent involved, but also other youth in his/her entourage. Also, the participation of youth in health education allows them to develop relations with adults outside of their families, to improve their self-perceptions and to acquire a sense of responsibility and belonging within a social group. Examples from several countries are provided by the authors. What the authors call "classic" approaches to health promotion and education are also still used in many countries of Latin America and many of these programmes are concerned with sexual education and managing adolescent parenthood. Also, programmes using in approach specific to problems such as alcoholism, drug abuse, and violence have been developed in many countries. Finally, training programmes for health personnel focusing on the specific health needs of adolescents have been developed in Brazil, Peru, Costa Rica, and Uruguay for a large range of health professionals (psychologists, social workers, etc.). In conclusion, the authors state that although there is an increasing number of health promotion actions for adolescents in Latin America, there is still much work to be done. One of the elements that is priority for managing the health of adolescents is the integral approach of the adolescent, considering the psychological, social, and environmental factors that influence his/her well-being. Multi-disciplinary and intersectoral approaches are also considered as important, as is the participation of adolescents in the development and implementation of actions concerning them.

Adolescent↗

Parish nursing. Addressing the significance of social support and spirituality for sustained health-promoting behaviors in the elderly.

Literature about the significance of health promotion for the elderly and identification of various determinants of health-promoting activities contains numerous inconsistencies. From a review of nursing and health-related literature over the past decade, it is possible to draw only limited conclusions about the commitment of the elderly to health-promoting behaviors. Despite this, the importance of the roles of social support and spirituality for the empowerment of older adults to practice health-promoting activities is a consistent research finding in this population. Parish nurse programs expand home health and public health provider roles and use the faith community as a cooperative means for sociocultural implementation of successful health promotion. Significance for nursing education, practice, and research is discussed.

Aged↗

The first years of implementation of the Swiss National Environment and Health Action Plan (NEHAP): lessons for environmental health promotion.

The National Environment and Health Action Plans (NEHAPs) are a novel attempt to integrate environmental protection and health promotion in political programmes. Throughout Europe, about 40 NEHAPs have been developed so far. The Swiss NEHAP was among the first to be developed in an industrialised country. We discuss strength and weaknesses of the Swiss NEHAP and draw first conclusions on the development and implementation process of such programmes, illustrated by examples of other European NEHAPs. The strengths of the Swiss NEHAP lie in the formulation of specific targets in selected areas, its approach as a environmental health promotion programme, and its comprehensive evaluation. Weaknesses in most NEHAPs are the lack of involvement of the general public and of the economic sector, and the absence of an implementation strategy along with adequate financing.

Conservation of Natural Resources↗

Involving students in learning and health promotion processes--clarifying why? what? and how?

The concept of student participation is currently a popular notion in health promoting schools as well as in general education. However, phrases such as 'involvement', 'participation', 'co-determination' and 'influence' are frequently used without careful definition. In this article two models, developed in the context of health promoting schools in two different cultures, are presented and discussed. The first model makes a fundamental distinction between token and genuine participation. Token participation in health promotion is characterised by focusing on prescribed knowledge, closed and convergent outcomes and targeting individuals isolated from the surrounding environment. In contrast, genuine participation stresses students' own construction of knowledge, open and divergent outcomes and targeting individuals in their context. Genuine participation is in accordance with a democratic health promoting school aiming at students' empowerment and action competence. The second model clarifies a number of different categories of students' participation in health promotion. The different categories illustrate how the teacher in various ways can play an active role in participatory approaches as a responsible professional. The more the students are involved in health projects, the more important it will be for the teacher to provide support, insight and knowledge to facilitate the learning processes. Furthermore, the different participation categories have to be related to a number of decisions which are normally included in a school health project. The model illustrates that participation should always be viewed in relation to the context and that it makes no sense to establish a single ideal way of working with participation in a health promoting school. The theoretical models are illuminated by concrete examples from health promoting schools. The overall conclusion is that participation is a complex term and rather than providing definitive answers, the models can be used as a framework for discussion among all stakeholders in planning, implementation, evaluation and managing projects involving student participation. Finally, specific implications and challenges for future health promoting schools are outlined. These are as follows: a participatory approach does not imply that health content should be regarded as vague or superfluous; teachers need flexible educational models and resources to manage participatory projects in health promoting schools; schools have to be acknowledged as cultural systems with firmly rooted rules and routines that are often difficult to change; a participatory approach has to influence all aspects of a democratic health promoting school rather than solely the teaching strategies.

Cooperative Behavior↗

[Attitudes of occupational medicine physician towards health promotion].

The objective of the survey was to judge the attitudes of occupational medicine physicians towards health promotion in the workplace. To this end, a special questionnaire has been developed. In total, 142 physicians qualified in preventive medicine were surveyed. Some of them have been working as occupational physicians for six years and some were in the course of specialisation in occupational medicine (the 1st and the 2nd grades). The survey yielded the following results: 84.5% of respondents considered that occupational medicine physicians should be involved in health promotion in the workplace, but only 37.1% of them were ready to undertake individual actions in this area; a large majority of respondents listed the following factors as the main obstacles in initiating health promotion activities: (a) the lack of interest in health promotion among employers (27.5%), (b) the lack of interest in health promotion among employees (25.5%), (c) the lack of time (25.5%), (d) the ack of sufficient financial means for health promotion in the workplace. Only 2.8% of persons reported no problems encountered in their health promotion work in the workplace. In addition, 39.4% of respondents were interested in the organisation and coordination of health promotion programmes in conditions existing nowadays in Poland. To sum up the results of the survey, it is necessary to emphasise a positive observation that the majority of respondents want to participate in health promotion programmes, although they feel that 'know-how' knowledge, professional publications and medical equipment are still far from being satisfactory. Thus, it is deemed necessary to develop further health promotion programmes to encourage positive attitudes towards health promotion among employers and employees.

Attitude of Health Personnel↗

Commitment of national resources to health promotion: the Canadian experience.

The article "Federal Initiatives in Health Education in Canada" which was featured in the first issue of Hygie reviewed the historical developments and the federal-provincial co-operative efforts in health education. It described the events and aspirations leading to the establishment, in 1978, of the focal point on health promotion. The current paper by R.A. Draper, Director General of Health Promotion in the Department of National Health and Welfare, addresses itself to the modes of resource allocation and policy development. It outlines the programmatic considerations of health promotion which reflect the current status of health education and promotion in Canada.

Canada↗

Predictors of health-promoting behavior of African-American and white caregivers of impaired elders.

Several longitudinal studies have examined declines in health of caregivers, but few have explored the health-promoting behavior Because caregivers neglect their health, they are at risk for developing a number of physical and psychological problems. What is not well known are the factors that contribute to increased health-promoting behavior ultimately preventing poor health and premature death. Therefore, the purpose of this study was to explore the predictors and the change in predictors of health-promoting behavior in African-American and White caregivers over a 3-year period. Pender, Murdaugh, and Parsons' (2002) health promotion model guided the study. This present study is a secondary data analysis of a larger study aimed at examining predictors of health-promoting behavior among 66 African-American (n=66) and 110 (n=110) and White caregivers of impaired older adults recruited primarily through random digit dialing. The larger data set consisted of 391 (N=391) subjects (n=136 African-American; n=255 White). The larger prospective study was based on face-to-face interviews. In the original study, trained interviewers collected data on depression, psychological distress, self-perceived health, religiosity, number of chronic conditions, and demographic characteristics using well-established instruments. Data in this present study were collected at three time points over a three-year period with one-year intervals at Time1 (T1), Time2 (T2), and Time3 (T3). Analysis of the data in this present study suggested that, although, the number of health-promoting behaviors significantly differed for African-American and White caregivers at T1, T2, and T3, no predictors were significantly associated with a change in health-promoting behavior over time. Nonetheless, this finding suggests that nurses can develop useful information in helping to focus more attention on the health of caregivers in the future.

Adult↗

Multilevel health promotion research: conceptual and analytical considerations.

Health promotion research is often conceptualized through the use of socioecological frameworks. This results in data or variables associated with multiple levels such as individual, community, and provincial. These data are nested, or clustered. In other words, multilevel health promotion research is based on the idea that community influences health, above and beyond one's individual characteristics or behaviours. These contextual effects can be analyzed rigorously using multilevel modelling (MLM), thus determining whether contextual effects are truly derived from context or are the result of residents' social profile. MLM also facilitates examination of cross-level interaction effects. The authors discuss conceptual and methodological issues related to multilevel research. While multilevel pathways to health outcomes have been suggested at the conceptual level, analytical techniques that produce only average overall effects fail to reveal the various other influences on health behaviour.

Data Interpretation, Statistical↗

Health promotion: a life-long spectrum for health care facilities.

Although many traditional health care facilities were not called upon to contribute to health promotion and prevention in two statements from ministers of National Health and Welfare, many have well-established programs that complement treatment. As it is important to be able to measure the effectiveness of these activities, the author proposes that a Promotion and Prevention Index (PPI) be created within the health care system. The PPI, a percentage factor, would be applied to services and programs and, hopefully, provide a scale for formal recognition among traditional institutions.

Abstracting and Indexing↗

Occupational therapy education in health promotion and disease prevention.

Educational experiences and didactic materials on health promotion are necessary for occupational therapists to remain current in the profession. This paper reviews health promotion learning experiences to determine the "state of the art" in this important area. It was found that few papers or workshops have been given at recent AOTA Annual Conferences; five universities received Allied Health Grants, which included occupational therapists, to develop health promotion learning materials; and occupational therapy educational curricula for the most part do include something on health promotion. The AOTA Special Interest Sections have shown interest in health promotion.

Curriculum↗

Economic evaluation of health promotion: friend or foe?

It is commonly believed that economic evaluation is hostile to health promotion and that the requirement for health programs to be cost effective will result in a biased allocation of funds in favour of programs that can demonstrate short-run benefits as defined by inadequate outcome measures. The paper is concerned with the validity of this perception. It is argued that economic evaluation has the potential for treating health promotion activities on an equal basis with other health interventions. The major obstacle to this does not arise from the theory of economic evaluation, which is discussed, but from a lack of information about outcomes. Without this information any evaluation--economic or otherwise--is flawed. Three problems relating to the economic evaluation of health promotion activities are considered. These are: the discounting of future health benefits; the potential for economic evaluation to be counter-productive if applied to 'immature' projects; and the practical problems encountered in the measurement of the outcomes of health promotion programs. A four-fold classification which is based upon a distinction between disease cure, individual health promotion, community welfare and systemic change designed to promote either individual health or social well-being. The capacity of economics to incorporate these objectives is discussed.

Cost-Benefit Analysis↗

[An introduction of the concept of social capital into health promotion activities].

Social factors, such as networks, institutions, trust, and social norms, are currently known as "Social Capital", the concept of which seeks to provide a basis for visualization and measurement of phenomena stemming from such factors. As a considerable amount of research has demonstrated that collective actions may be established with a greater degree of ease in communities with well-accumulated social factors, we can promote collective actions of Health Promotion activities through the concept of Social Capital and thereby establish more effective intervention. It is to be expected that theoretical research and operational experience using Social Capital may contribute to enhancing the effectiveness of Health Promotion activities, improving various health determinants through collective action.

Community Networks↗

The health promotion needs of older people.

The health promotion needs of older people, including optimising quality of life in chronic illness, are inadequately represented in The Health of the Nation. Tertiary health promotion is an integral part of district nursing but must be enhanced through goal-oriented care and skills development. Service policies should ensure that older people have access to appropriate care to meet their rehabilitation and emotional needs.

Aged↗

Community health behavior change through computer network health promotion: preliminary findings from Stanford Health-Net.

Computer-based health education has been employed in many settings. However, data on resultant behavior change are lacking. A randomized, controlled, prospective study was performed to test the efficacy of Stanford Health-Net (Stanford, CA, U.S.A.) in changing community health behaviors. Graduate and undergraduate students (N = 1003) were randomly assigned to treatment and control conditions. The treatment group received access to Health-Net, a health promotion computer network emphasizing specific self-care and preventive strategies. Over a 4-month intervention period, 26% of the treatment group used Health-Net an average of 6.4 times each (range 1-97). The most commonly cited reasons for use were curiosity, general health education, evaluation of current symptoms and anonymity of information. Users rated Health-Net favorably. The most commonly reported reasons for non-use were related to lack of health problems, limited time and lack of access to computer facilities. The mean number of ambulatory medical visits decreased 22.5% more in the treatment group than in the control group (P less than 0.05), while hospitalizations did not differ significantly between groups. In addition, perceived self-efficacy for preventing the acquisition of a sexually transmitted disease (STD) and herpes increased 577% (P less than 0.05) and 261% (P less than 0.01) more, respectively, in the treatment group than in the control group. These findings suggest that access to Stanford Health-Net can result in significant health behavior change. The advantages of the network approach make it a potential model for other communities.

Adult↗

Creating a health-promoting group for elderly couples on a home health care program.

The hospital home care social worker has a unique opportunity to develop a home-keeping, health-promoting group for frail elderly couples within his or her caseload. Through home visits, working as a filial professional, the worker enters, then strengthens the couples' pre-illness formal and informal support networks, and then goes on to create an additional informal peer support group, that meets in each other's homes. The group is capable of decreasing the chance of nursing home placement for all its members. It is proposed that home health care agencies within hospitals incorporate such groups into their regular programs.

Aged↗

Breastfeeding as health-promoting behaviour for Hispanic women: literature review.

AIM: This paper reports a literature review to synthesize the evidence that breastfeeding is a health-promoting behaviour for Hispanic women and to demonstrate the usefulness of the Health Promotion Model in understanding and increasing breastfeeding behaviours in Hispanic women. BACKGROUND: While breastfeeding has been shown to promote the health of both mother and infant, it has not been widely viewed from the perspective of the Health Promotion Model. METHODS: The CINAHL and MEDLINE databases were searched using the terms 'Hispanic' or 'Latina', 'breastfeeding' and concepts specific to the Health Promotion Model (interpersonal relationships, social support, acculturation, self-efficacy, barriers, benefits, and commitment). Only papers in the English language from 1990 to 2003 (except for classic papers) that used research techniques were reviewed. Only those addressing breastfeeding intention, initiation or duration were included. The reference lists of each paper were examined for additional empirical papers that linked any of the determinants of the Health Promotion Model to breastfeeding among Hispanic women. Papers were organized using the ten determinants as headings: prior related behaviour, personal factors, perceived benefits, perceived barriers, perceived self-efficacy, activity-related affect, interpersonal influences, situational influences, immediate competing demands, and commitment to a plan of action. The review was conducted in 2003. FINDINGS: The literature verifies that each of the 10 determinants of health-promoting behaviour also promotes breastfeeding for Hispanic women, particularly through the constructs of acculturation, interpersonal support, self-efficacy and immediate competing demands. Breastfeeding is not consistently defined in all studies, nor are Hispanic population groups uniformly classified according to country of origin. Specific interventions to promote breastfeeding have been implemented for women of Latin American origin, but randomized designs to measure outcomes have not been consistently employed with Hispanic women in the United States of America. Further intervention research is needed to confirm breastfeeding as a health-promoting behaviour and to inform breastfeeding education for this group.

Affect↗

Collective lifestyles as the target for health promotion.

The last five years have witnessed intense debate among health researchers in Canada regarding the overlap of the health promotion and population health discourses. Meanwhile, strong currents within health promotion have attempted to move the field beyond a focus on individual behaviour towards the influence of social environments on health, although the tendency is often to fall back on individual behaviour modification as the primary lever for change. The Population Health research agenda bypasses behavioural determinants of health and explores instead social determinants. This body of knowledge provides useful insight for addressing some of the tensions in the health promotion discourse. This paper explores two of these tensions: whether individuals at risk or general populations should be targeted for change; and whether lifestyle is an individual or a collective attribute. We propose the notion of collective lifestyles as a heuristic for understanding the interaction between social conditions and behaviour in shaping health.

Canada↗

[Health promotion development as the basis for an effective health policy].

Health promotion and development are an essential part of modern and effective health care. It is based on the awareness of social health priority, it tries to develop and apply adequate methods, it is the motive for the promotion of nation-wide activities which foster health. It promotes individual efforts to improve health and contributes to the concretization and implementation of a health policy, the aim of which is to resolve basic health problems of society as a whole.

Czechoslovakia↗