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Education for health promotion and disease prevention: convince them, don't confuse them.

Promotion of health and prevention of disease have become some of the most emphasized issues of the 1990s. The government, health professionals, and private organizations have made the primary prevention of disease a priority. Quality education is a major intervention by which prevention is realized. However, superior quality educational offerings entail significant pre-preparation via the development of clear and realistic teaching/learning plans, faculty knowledge of educational psychology, metacognition and cognitive processing, understanding of cultural diversity, incorporation of adult learning principles, the use of varied teaching/learning strategies, and astute application of program evaluation skills. Educators, like nurses, physicians, and allied health professionals, must work with people to mutually decipher their healthcare needs and plan educational experiences that learners can merge with their own life experiences and ethnocultural perspectives. In addition, educators should use health education materials that match learners' literacy levels. Most importantly, such programs must be thoughtfully evaluated in light of the achievable goals that were outlined during preplanning stages. Without outcomes assessment as part of health promotion/disease prevention education programs, health educators are less likely to produce interventions that learners value and from which they truly benefit. Optimally, education programs about health promotion/disease prevention should generate long-term critical thinking processes that produce positive health choices, behavioral change, and healthy life styles.

Adult↗

Predicting health-promoting lifestyles in the workplace.

A multivariate model proposed as explanatory and predictive of health-promoting lifestyles was evaluated in a sample of 589 employees enrolled in six employer-sponsored health-promotion programs. Perceived personal competence, definition of health, perceived health status, and perceived control of health accounted for 31% of the variance in health-promoting lifestyle patterns. Employees who reported more health-promoting lifestyles perceived themselves as competent in handling life situations, defined health as high-level wellness rather than merely the absence of illness, evaluated their health positively, and perceived their health as affected by significant others but not by chance or luck. Those who were female, older, and in the maintenance phase of the company fitness program also had healthier lifestyle patterns. These variables and the perception of health as internally controlled were predictive of health-promoting lifestyles three months later.

Attitude to Health↗

New health promotion movement: a critical examination.

In the last decade, a revolution has been occurring in the field of health promotion. Guided to a large extent by position papers disseminated by the World Health Organization (WHO) Europe Health Promotion Office, and furthered by the Ottawa Charter, the Epp Report in Canada, the Healthy Cities project, as well as by other efforts, this new health promotion movement has introduced new ideas, new language, and new concepts about what constitutes health and how health promotion efforts should be configured to achieve health. Punctuated by the terms like empowerment and community participation, this movement has generated a whole new discourse about the theory and practice of health promotion. This paper explores the multiple meanings that surround these terms, and the implications for practice, by addressing questions like: What does health mean in this new context? What is empowerment? What does participation look like? Has the tyranny of the professional been replaced by the tyranny of the community? Has anything changed about the practice of health promotion other than the language? Finally, it is argued that an acknowledgment of the multidimensionality of these concepts may facilitate their translation from rhetoric into health promotion practice.

Canada↗

Quality indicators for health promotion programmes.

Methods for systematically following up and auditing health promotion have been in demand for a considerable period of time. Quality assurance as an auditing method has opened up new opportunities in this area. On the basis of Donabedian's 'triad' of structure, process and outcome, the theoretical preconditions for and implementation of a number of successful health promotion programmes/ projects have been analysed with regard to their common characteristics. These characteristics have been generalized and then transformed into indicators of a successful health promotion programme/project. To ensure the practical applicability of the quality indicators, they were operationalized in what we call a 'question pro-forma'. Any negative response to a question on the pro-forma indicates quality defects in a programme, and any positive response the opposite. The 'template' can be employed for both the planning and auditing for quality assurance on health promotion programmes and projects. The question pro-forma has been tested successfully on a number of programmes and projects. The results from one study are shown in the article.

Health Promotion↗

Do only the healthy intend to participate in worksite health promotion?

Few companies or organizations involved in health promotion have addressed the major question of whether they are reaching the employees with the greatest health needs or those who could benefit most from these efforts. The popular view that only individuals who are already physically fit and healthy participate in worksite wellness programs was critically examined. Data from 523 survey respondents at the University of Oregon were analyzed to determine whether employees differed on health-related characteristics and their interest in attending a worksite health promotion program. Comparisons between program participant "intenders" and "nonintenders" revealed that both groups had similar lifestyle habits, preventive health practices, and health status profiles. Significant differences were more related to age and perceptions about their physical and emotional health status. Implications for health risk reduction program planning in the work setting are discussed.

Attitude to Health↗

[Assessing the quality of structures, concepts, and processes in prevention, health promotion, and education. Requirements and solutions].

The effectiveness of health promotion is determined by the foundation of evidence, the targeting of health problems, and the adaptation of interventions to specific social and organizational contexts. Methods for the implementation of these objectives must be able to balance interacting intervention goals, to account for the suitability of interventions for specific target groups and settings, and to integrate complex and divergent data. The core methodology underlying these conditions is peer review assessment. A quality assurance system based on this approach is presented: Two inventories elicit detailed self-descriptions characterizing either actors or activities within health promotion and education. Two assessment instruments instruct experts in reviewing these data according to primary and partial dimensions of quality. Thus, systematically structured and quantifiable quality profiles of organizational units or specific activities are produced. On this basis, comparative indicators for benchmarking purposes can be calculated. Quality profiles containing the strengths and weaknesses of organizations or activities, including indicators, benchmarks, and reviewers' recommendations, are communicated to participating organizations in order to stimulate continuous quality improvement by feedback. Moreover, the system offers a database of comparative indicators for monitoring and optimizing health promotion and education.

Germany↗

Personal health promotion at US medical schools: a quantitative study and qualitative description of deans' and students' perceptions.

BACKGROUND: Prior literature has shown that physicians with healthy personal habits are more likely to encourage patients to adopt similar habits. However, despite the possibility that promoting medical student health might therefore efficiently improve patient outcomes, no one has studied whether such promotion happens in medical school. We therefore wished to describe both typical and outstanding personal health promotion environments experienced by students in U.S. medical schools. METHODS: We collected information through four different modalities: a literature review, written surveys of medical school deans and students, student and dean focus groups, and site visits at and interviews with medical schools with reportedly outstanding student health promotion programs. RESULTS: We found strong correlations between deans' and students' perceptions of their schools' health promotion environments, including consistent support of the idea of schools' encouraging healthy student behaviors, with less consistent follow-through by schools on this concept. Though students seemed to have thought little about the relationships between their own personal and clinical health promotion practices, deans felt strongly that faculty members should model healthy behaviors. CONCLUSIONS: Deans' support of the relationship between physicians' personal and clinical health practices, and concern about their institutions' acting on this relationship augurs well for the role of student health promotion in the future of medical education. Deans seem to understand their students' health environment, and believe it could and should be improved; if this is acted on, it could create important positive changes in medical education and in disease prevention.

Adult↗

Comparison of recruitment strategies and associated disease prevalence for health promotion in rural elderly.

BACKGROUND: Although interest in health promotion for the elderly is increasing, the issues of recruitment into such programs and self-selection have not been well explored. While clinical studies require high participation levels and expensive recruitment, community efforts are satisfied with recruiting small numbers of volunteers from poorly defined populations. These small samples may not be representative of the populations at risk. METHODS: As part of the Rural Health Promotion Project, a Medicare demonstration, community-based recruitment methods were evaluated and participant characteristics were compared. A total of 3,884 individuals ages 65-79 were recruited in northwestern Pennsylvania, using four sequential recruitment strategies, varying in aggressiveness. The methods were: (A) mail only, (B) mail with phone recruitment follow-up, (C) mail with phone recruitment and scheduling, and (D) mail with aggressive phone recruitment and scheduling. RESULTS: Recruitment yields were Method A, 13.5%; B, 21.1%; and C, 31.6%. The most aggressive Method (D) yielded 37.0% participation. More aggressive methods (C and D) recruited more educated individuals. No other demographic or health status differences were noted. CONCLUSION: These data show that large numbers of the elderly can be recruited into a health promotion program using aggressive methods and professional interviewers.

Aged↗

Community-based senior health promotion program using a collaborative practice model: the Escalante Health Partnerships.

Recent research demonstrates that, although the risk of disease and disability clearly increases with age, poor health need not be an inevitable consequence of aging. A healthy lifestyle is more influential than genetic factors in assisting older adults avoid the decline and deterioration traditionally associated with aging. Many effective strategies for reducing disease and disability are widely underused. The Escalante Health Partnerships is a community-based, nurse-managed health promotion and chronic disease care management program for community-residing older adults. The program base supports a multidisciplinary, collaborative practice model, which has responded to the health needs of members of a community at high risk of having or developing chronic conditions. Preliminary comparisons of the health status of program participants with national norms demonstrate that these seniors report better general health, performance of roles, and social functioning, with the strongest correlations occurring between general health and vitality and between general health and role-physical. In addition, these participants have 4.2 doctor visits per year, in comparison with 7.1 office visits for a national comparison group and 1.6 hospital days per year, in comparison with 2.1 hospital days in the same referenced population. This collaborative partnership is a model that can be replicated cost-effectively in other communities.

Aged↗

Undergraduate nursing students' attitudes towards smoking health promotion.

Despite the fact that nurses have a key role in health promotion, many continue to smoke at much the same rate as the general population. This paper investigates the influence of smoking status, gender, age, stage of education, and smoking duration on undergraduate nursing students' attitudes towards smoking health promotion. The study took place in one university's School of Nursing in Victoria, Australia. Respondents completed the Smoking and Health Promotion instrument. Researchers obtained ethics approval prior to commencing the study. Smoking status was the main factor that affected respondents' attitudes towards smoking health promotion, with age and education stage having a minor effect, and gender and smoking duration not significant. Nurses have an important role in modeling non-smoking behaviors for patients. There needs to be consistency between personal and professional beliefs for nurses to properly engage in smoking health promotion. The findings have implications for undergraduate nursing education curricula, nursing practice and research, and these are discussed.

Adolescent↗

[Health promotion and a healthy workplace].

This study discusses approaches to a healthy working environment and presents the main lines in this theme area. A healthy workplace promotes good health, which is a basic resource for social, economic and personal development, as well as an important aspect of the working environment. The creation of a healthy workplace depends on promoting the participation of all parties involved, in order to monitor, improve and maintain employees' health and well-being, moving towards a healthy work environment that will improve the quality of life of the population in general, since good health is one of the most valued conditions by individuals, communities and countries. In this context, nursing professionals can encourage healthy workplaces by promoting good health, thus assisting in the development of individuals, families and society and, in this way, supporting the achievement of the goals set by employers and employees.

Health Promotion↗

Health promoting behaviors of African-American registered nurses.

The purposes of this study were: (1) to describe the health promoting behaviors of African-American nurses, (2) to add to the health promotion data base for African-American women, and (3) to pilot test a self-administered questionnaire developed by the investigators for use in a larger study of the health-promoting behaviors of middle class African-American women. The sample consisted of 49 African-American registered nurses recruited from members of a nursing sorority. Selected criteria for the subjects were female, college graduate, and a middle class standard of living. A self-administered questionnaire was used to assess the likelihood of engaging in health-promoting behaviors. Descriptive statistics were used to describe the findings in terms of frequency and percentage distribution. The results indicated that the African-American nurses had high percentages of adherence to the following health-promoting behaviors: minimal alcohol consumption, avoidance of smoking, cholesterol screening, assessment of blood sugar levels, monthly breast self-examination, pap smears, mammogram screening and regular measurement of blood pressure. Lower percentages of adherence were reported for two health-promoting behaviors: diet and exercise. Results of this study support the need for the incorporation of diet and exercise into all health promotion intervention programs for African-American women. Implications include additional research to validate the findings of this study.

Adult↗

Health promotion in minority adolescents: a Healthy People 2000 pilot study.

PURPOSE: The purpose was to evaluate the effects of a health promotion curriculum on health knowledge, behavior, cardiovascular fitness, and cardiovascular risk factors. METHODS: A multi-ethnic, multi-cultural sample (n = 54) of 10th grade males and females participated in a study of cardiovascular health promotion and coronary risk factor reduction. The sample was comprised of Asian-Americans (39%), blacks (33%), Hispanics (11%), whites (2%), and others (15%). Intervention consisted of a 10-week health promotion curriculum of classroom education modules in physical activity, nutrition, smoking cessation, stress management and personal problem solving, and an exercise program of walking and running. A nonintervention control group served as a basis for comparison. Classroom and exercise sessions met on alternate days. RESULTS: Following intervention, a significant treatment effect (P = .007) was observed in lowered total cholesterol, and significant within group improvements (P < .01) were observed in diet habits, percent body fat, and cardiovascular health knowledge. Comparisons of knowledge and social effects revealed higher cardiovascular health knowledge (P < .05) in subjects of nonsmoking compared to smoking parents, higher self-perception of health (P < .01) in more active vs less active subjects and better dietary habits (P < .07) in children whose parents were college educated compared to parents who did not attend college. CONCLUSIONS: Preliminary findings suggest that a health promotion curriculum consisting of health education, behavior modification, and regular aerobic exercise lowers cholesterol, improves health behavior and increases health knowledge.

Adolescent↗

Health promotion in community pharmacy: the UK situation.

Community pharmacies in the UK are an excellent setting for health promotion in the community; they see over 90% of the population per year. Pharmacy education and training is changing and health promotion is now part of the undergraduate curriculum. There is an increasing body of research about the effects of pharmacy health promotion and a number of examples of good practice. The UK research is reviewed and examples of good practice highlighted. The paper concludes with a discussion about the contribution of pharmacists can make and about some of the issues that will need to be overcome first. Pharmacists see healthy as well as sick people. They have a special relationship with many of their regular customers which enables them to promote health, they can also give population messages to passing trade. A number of issues such as training and remuneration must be addressed before health promotion becomes fully integrated into the pharmacist's role.

Community Health Services↗