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Issues in promoting health.

Policymakers in many countries seek to contain health care costs over the long range by promoting health and more effective health behavior. Such efforts can be directed at entire populations, at members of a health plan, at defined risk groups or single individuals at risk. Many health risks are associated with socio-economic status and social inequalities but these are often difficult to address because of social and political conflicts. Health, also, is often a product of culture and other social circumstances. Health may be promoted through non-health interventions or through more targeted health efforts seeking to effect behavior change. Preventive screening is of growing importance but such efforts often out-pace evidence of efficacy or cost-effectiveness. Many opportunities exist to build on new clinician-patient partnerships to make patients better informed and to effect positive health behavior. New technologies, and particularly the internet, offer new ways to promote health and more constructive illness behaviors.

Cost-Benefit Analysis↗

It is time to move from health maintenance to health promotion.

The American health care delivery system has traditionally emphasized the treatment of illness instead of the promotion of wellness. Traditional Health Maintenance Organizations (HMOs) have attempted to reduce costs by controlling utilization, discounting and/or sharing risk with providers rather than promoting wellness and prevention. These efforts have, for the most part, been unsuccessful and health care costs and HMO premiums continue to rise. The authors propose it is time for a change and we must look again at what wellness programs can accomplish. It is time to move from an ineffective "health maintenance" approach towards one of "health achievement." Models for the proposed change already exist in the business community where companies have successfully used wellness programs as a tool to decrease health benefits expenditures. The changes proposed must be addressed on multiple levels. Perceptions, attitudes and approaches must be changed. The benefits of wellness must be individually marketed to target groups: blue and white collar workers, business executives and professionals, home makers, preschool and school age children, the elderly and the unemployable.

Attitude to Health↗

Obstacles to and future goals of ten comprehensive community health promotion projects.

Over 100 project staff, community coalition members, and other representatives from 10 comprehensive community health promotion projects in the western United States were surveyed two years into a three year funding cycle about: (1) the problems or obstacles they judged as preventing successful completion of their current goals and objectives, and (2) future goals and objectives they envisioned for their projects. The key issues confronting respondents were diverse, although issues around the process of implementing community health promotion programs were cited more frequently than issues related to the content of health promotion. When respondents were asked to prioritize Future Goals in the second survey, consensus across communities was obtained despite broad differences in the type of community surveyed and the health problem targeted. This study identifies the common organizational and community development problems faced by newly emerging community health promotion programs and has implications for other communities involved in designing, implementing, and evaluating community-wide health promotion programs.

Community Health Services↗

Using behavioral theory in computer-based health promotion and appraisal.

This article explores how behavioral theory can facilitate the development, implementation, and evaluation of health promotion software packages intended to influence personal health practices and/or assess health risks. Current behavioral theories and models are reviewed, and their relevance to developing health promotion software is discussed. A series of six steps is suggested for developing and evaluating health promotion and appraisal software within a behavioral theory framework. These steps should help to facilitate direct application of the theory-based process to health promotion software development.

Behavioral Sciences↗

Attitudes and reported practices of Korean primary care physicians for health promotion.

To examine attitudes and practice patterns of primary care physicians in health promotion and to probe factors associated with active involvement, a nationwide cross-sectional postal questionnaire survey of randomly sampled Korean family physicians and internists was performed. The areas of health promotion examined were; smoking, alcohol consumption, stress, exercise, and diet. Overall response rate was 38.0% and an interview survey of sub-samples of non-responders found no differences in socio-demographic characteristics or survey results versus original responders, except for the rate of collecting information on smoking and diet. Smoking cessation was considered important by 92% of responders, while other lifestyle factors were considered important by less than 70%. Approximately 80% of responders believed in effectiveness of lifestyle counseling, except for stress. The frequency of collecting information, providing counseling, and the level of preparedness to undertake counseling were higher for smoking and alcohol than for other factors. Beliefs in effectiveness of health promotion and preparedness to undertake counseling were positively associated with frequency of information collection and providing counseling, even after adjusting for socio-demographic factors. Efforts should be made to change the physicians perception of effectiveness and importance of health promotion, and to improve physician's preparedness to actively intervene.

Adult↗

The rural hospital as a provider of health promotion programs.

Although patient education has always been recognized as an essential function of a hospital, it was not until the health concerns of the nation focused on prevention that hospitals began to develop activities aimed at primarily healthy individuals. Hospital health promotion evolved from patient education about specific diseases to programs focused on modifying of lifestyle practices to prevent future debilitating conditions. Studies conducted in the early 1980s show hospital-based health promotion programs increasing in number and including such target populations as senior citizens, children, business people, and hospital employees. However, the extent of involvement of the rural hospital in offering health promotion programs has not been clearly established. The current study was conducted to determine the status of health promotion programs in rural North Carolina hospitals. Elements considered were types of programs, target audiences, methods of financing, staff use, and availability of specialized facilities for health promotion programs. The results indicate rural hospitals do offer health promotion programs, but their primary focus is on hospital employees. Most programs are offered at low or no cost, making those offered for the community readily accessible. If input from the community is used and programming is aimed at specific health needs of rural populations, the rural hospital could make a significant contribution to an overall primary prevention strategy, lowering community health care costs.

Community-Institutional Relations↗

Health, happiness and health promotion.

This article claims that health promotion is best practiced in the light of an Aristotelian conception of the good life for humans and of the place of health within it.

Coercion↗

[Disease prevention and health promotion. Distinct and complementary strategies].

Health maintenance entails interventions beyond the biomedical knowledge, regarding: economic matters, education levels, improvement of work conditions, nutrition, housing, and environment; that is to say, overall well-being. According to the World Health Organization, well-being is not a health determinant but is included in the health definition. This is good from a social point of view and consistent with some economic findings, but can be misleading. The two aspects identifiable in the definition are: disease prevention and health promotion, which operate at different levels. The first one is conditioned by the sciences' reductionistic methodology and its strategies can be economically appraised; the other one is holistic and the economic and scientific evaluation of its actions is difficult. Moreover, both offer solutions to different questions of public health ethic. Thus, both are necessary and synergetic.

Health Promotion↗

Internists' practices in health promotion and disease prevention. A survey.

OBJECTIVE: To estimate internists' use of disease prevention and health promotion activities, and to explore demographic, professional, behavioral, psychological, cognitive, and organizational factors associated with the use of such practices. DESIGN: Mail survey. SETTING AND SUBJECTS: A sample of 2610 members and fellows of the American College of Physicians (ACP) participated in the study. They engaged in patient care activities more than 20 hours per week and were stratified by gender and region. They lived in four geographic areas of the United States (Northeast, Southeast, Central, and West), comprising 21 ACP regions. MEASUREMENTS: A questionnaire requesting background information as well as information about personal health; record keeping; use of immunizations (pneumococcal, influenza, tetanus, hepatitis B); use of screening tests and procedures for detecting cancer (breast examination, Papanicolaou smear, stool occult blood test) and other diseases (electrocardiograms, cholesterol level tests, chest radiographs); and behavioral counseling to promote health (in the areas of smoking, exercise, and alcohol and seat belt use). MAIN RESULTS: Internists used effective preventive interventions less frequently and ineffective practices more frequently than experts recommend. Internists' use of health promotion and disease prevention activities is associated with habit, attitude, and a lack of adequate knowledge. Younger physician age, general internal medicine practice, and personal health promotion and disease prevention practices were strongly associated with more appropriate use of recommended practices (P less than 0.01). CONCLUSIONS: Internists' use of disease prevention and health promotion activities falls short of expert recommendations. Programs to improve the delivery of preventive services might be aimed at improving physicians' personal health practices, might be directed toward patients, and might include the development of effective systems to remind physicians.

Counseling↗

The ideological construction of risk: an analysis of corporate health promotion programs in the 1980s.

The nature of theoretical knowledge about health promotion and disease prevention programs at the worksite is examined in the context of knowledge as ideological construction. The emergence of the discourse about health promotion is linked to corporate attempts to reduce their share of medical expenditures and solve problems of productivity and absenteeism which plague the American workforce. Although not always evident, corporate managers choose selectively from a body of knowledge about medical costs and illness and disease in contemporary America. That knowledge reinforces the notion of risk: individual propensity to the risk of disease or the attempts of the firm to minimize risk. Three examples of ideological construction: (1) the corporate construction of the cost problem in terms of employee demand and overutilization; (2) the construction of disease etiology as individual risk; and (3) entrepreneurial activity in health promotion, all provide evidence for the dominance of the risk discourse.

Cost Control↗

Toward health promotion: physical and social behaviors in complete health.

OBJECTIVE: To examine the effects of physical and social behaviors on "complete health." METHODS: "Complete health" was constructed from measures of physical and mental health collected through the National Survey of Midlife Development in the United States (MIDUS; n = 3032). Multinomial regression models examined the association of complete health with physical and social behaviors. RESULTS: The odds of complete health were greatest among those who exercised, never smoked, attended church regularly, and had frequent contact with friends. Some "social" behaviors exerted effects comparable to "physical" behaviors. CONCLUSIONS: Interventions targeting social behaviors may yield similar gains to complete health as physical behaviors.

Adult↗

Characteristics of participants and nonparticipants in worksite health promotion.

PURPOSE: To identify demographic characteristics associated with worksite health promotion participation and to determine whether employees with high-risk health-related behaviors, as measured by a health risk appraisal, were participating in programs designed to address these behaviors. DESIGN: Descriptive. SETTING: A petrochemical research and development company where employees were offered a health risk appraisal questionnaire, a series of on-site wellness programs, and an on-site fitness center. SUBJECTS: All employees (n = 2290) working continuously from May 1, 1990, through February 28, 1992. MEASURES: Demographic and behavioral risk characteristics of participants and nonparticipants. RESULTS: Participation was 37% (health risk appraisal), 64% (all wellness programs), and 10% (fitness center), with women participating at higher rates than men in all programs. Most programs attracted 10% to 40% of the employees at risk for the particular behavior addressed by the program, although lower penetration (7% to 9%) was observed for the on-site fitness center and blood pressure education programs. With the exception of wellness programs for weight, smoking, and blood pressure, employees at lower behavioral risk tended to be more likely to participate than employees at high risk. CONCLUSIONS: Efforts to increase participation by all company employees, especially among those with high-risk behaviors, would benefit all health promotion programs, particularly the on-site fitness center.

Adult↗

Mexico: health promotion initiatives.

Mexico is currently undergoing a Health Sector Reform to address the country's epidemiologic and demographic changes, deep socio-economic inequalities and their consequences on health. The Government and a diversified set of actors, mainly NGOs, are taking up health promotion initiatives.

Health Care Reform↗

Health promotion behaviors of private practice dental hygienists.

Today, there is increased emphasis in oral healthcare on health promotion and disease prevention. This is consistent with the focus of the dental hygiene profession. The purpose of this study was to investigate the health promotion behaviors of private practice dental hygienists within the ADHA District X region (Colorado, Montana, Utah, Wyoming). Statistical analysis procedures (frequencies, tests of statistical significance, and factor analysis) were performed on the questionnaire responses of 817 respondents who were employed in private practice settings. The results indicated that most respondents spent approximately five to 10 minutes on oral hygiene instruction (OHI) during a prophylaxis appointment, and focused on a variety of "traditional instructional" activities (e.g., discussing brushing and flossing, plaque control, caries, and periodontal disease). The majority of the respondents were satisfied with the amount of time they spent on OHI. When asked what factors limited the amount of time spent on OHI, the respondents most often cited "lack of interest on the part of the patient." Most respondents indicated there was no separate fee charged for OHI, even if separate OHI appointments were scheduled. The factor analysis indicated that some low-frequency behaviors (e.g., use of disclosants) were related more strongly to the concept of health promotion than were some high-frequency behaviors (e.g., use of a periodontal probe). The results of this study indicate that although health promotion services are provided frequently by dental hygienists, these services may not be provided consistently in the most effective way. Future research efforts could investigate the health promotion behaviors of private practice hygienists across the nation with a revised questionnaire to determine more adequately the status of these behaviors.

Analysis of Variance↗

Understanding the multidimensional nature of health promotion for older adults through the application of a conceptual framework.

Over the next three decades, the proportion of Americans over age 65 will grow to exceed 25 percent of the population. Although research has shown that health promotion and disease prevention interventions for older adults can lead to positive health outcomes, our understanding of the effects of health promotion on the health and well-being of older people could be improved through the development and use of a conceptual framework. This article presents a conceptual model for understanding the determinants and consequences of engaging in health promotion activities for older adults, describes how to use the model to estimate the impact of health promotion programs on a variety of individual- and community-level outcomes, and then applies the model to two different health promotion programs for older persons: REACH II and the Senior Wellness Program.

Aged↗

The 'Health Promoting Schools' strategy: implications for nursing and allied health professionals.

In 1993, the Commonwealth government officially recommended that schools were excellent places in which to promote better health as part of the proposed National Health Strategy. The concept of Health Promoting Schools (HPS) has recently been endorsed by the Department of Education, with the result that teachers are now expected to further expand their role and responsibilities in this area. This paper outlines a survey of infant and primary school teachers in New South Wales (n = 350) which, amongst other factors, ascertained teachers' perceptions of the assistance they needed from school and community nurses in order to effectively implement the HPS strategy. Results demonstrated that teachers have a fundamental lack of understanding of child health issues and the HPS strategy, and that an overwhelming call by teachers for assistance from the nursing profession has implications not only for nurses but also for allied health agencies and the tertiary sector.

Allied Health Personnel↗