Health Promotion and Models

1. Introduction

It is widely recognised that disease prevention and the associated mortality is vastly dependent on the behavioural and psychological factors (Berkman & Kawachi, 2000) Health promotion stems from these factors whereby focussing on the individual’s behaviour by influencing changes in variety of aspects such as families, communities work places and eventually encouraging individuals to adopt healthy practices (Green, 1984). The role of a nurse in health promotion and education is considered as a key by numerous researchers and policy initiatives from the government to promote health comprehending the essentiality of health promotion (Norton, 1998). The present essay elucidates the effectiveness of health promotion within the context of health belief model (HBM) and behaviour change model (BCM) and critically analyzes it with the Whiteheads model (2001), where the nurse plays a role as a traditional health educator.

2. Case Study As a student nurse, I have been actively involved in promoting it to my patient Duggie Snowdon, aged 21, the patient on appearance was substantially obese, and on examination it was found out that he had a BMI of 26. (See appendix 1.1 for full case study).

3. Health Belief Model (HBM) The health professionals should focus on catering the needs of the patient beyond their practical tasks therefore, efforts to better understand the patients and their conditions are crucial, in order to provide effective care (Grainger, 2008).Furthermore, Harsmen et al. (2005) points that mutual understanding between a practitioner and patients is key in rendering quality care. Kleinman’s theory states that, it is important to account the patient and practitioner views on a decisive clinical agreement on patient’s health. As a practitioner the visual and engaging problem that I observed in my patient was obesity which may lead to detrimental effects in the future. In enumerating health education and health promotion to my patient the apt model to choose and comprehend personal belief or perceptions about his condition is HBM.

The HBM identifies the factors involved in the individual’s health behavior and the likelihood of performing those behaviors (Gammage et al., 2009). Taking into account the H.B.M. (During the first appointment with the patient) I started to understand my patients eating behaviors by using the four perceptions of the model. The primary task within the HBM is assessing the patient understanding of his health condition (perceived susceptibility) and their understanding of the severity of their conditions (perceived severity).

The patient’s initial perceived susceptibility and its severity towards his eating behavior was effectively high. Haisch et al. (2005) states that an individual perceived severity and susceptibility determines the strength of their belief that their own health is in jeopardy. Moreover the patient’s personal perception towards his obese condition has changed when his uncle expired owing to coronary disease associated with obesity and his friend’s rancid comments on his obesity. The patient’s realization of his obesity has provided with effective cues of action to alter his eating behavior. Stretcher & Rosenstock, 1997 comments that cues of action influence perceived risks eventually motivating individuals to alter their health behavior.

Haisch et al.,, 2005 states if an individual perceived risks are greater, and then the individual is more likely to engage in behaviors which would decrease the risk.. He further reports that an individual tend to develop an unhealthy behavior, when they believe they are at low risk of associated problems. Wright, 1986 states that change in appearance and function of any part of body can lead to stigma in obese individuals and may lead to psychological consequences (Friedman & Brownell, 1995). However, the patient considered him-self big and strong rather than obese. Wardle & Johnson, 2002 points that obese individuals are complacent about their weight and are less likely to seek any medical advice.

The next stage in promoting health would be enumerating the perceived barriers and benefits to the patient. The centre for disease control and prevention 2004 address that in adopting any new health behavior in a patient, the key would be understanding its benefits which would overweigh the consequences of the past health behavior. However, for a patient to alter his behavior it is crucial to believe in their own ability to do change them. Therefore, in order to achieve this, an individual need to possess self- efficacy. Bandura, (1977) indicates that self- efficacy is a belief in which an individual is able to change his behavior to achieve a positive outcome. In the present situation the patient’s socio- economical factors such as, lack of basic educational qualifications and society’s unhealthy behaviour were seen as effective barriers to his obesity (weight loss program).

Research states that socio-economic factors such as income ( William, 2002), wealth (Duncan et al., 2002) the quality of physical environment such as housing and population (Blane et al., 2000) and psychological factors such as social support, control over work and life circumstances (Hemingway & Marmot, 1999) are likelihoods of influencing an individuals health. Blane et al. (1996) comments that lower the income quotient or status, the least the probability that individuals engage themselves in healthy behaviors such as routine exercises and consumption of healthy food (fruits and vegetables). Moreover, Irabrren et al, (1997) asserts that individuals with adequate schooling and qualifications are aware of health promotion activities, however, this was not the case with my patient because on communication with him it was found that he lacked basic knowledge about healthy behaviors.

Furthermore, he reports that his friends engage themselves in the similar act of unhealthy eating. Therefore it was evident that my patient had inadequate psychological support from his family and friends, consequently forming a major barrier towards his unhealthy behavior. Christakis et al, (2007) implies that social network of friends have an impact on spreading obesity in adults, by imitating or modeling a particular individual who play an important role in their life’s such as a friend (Bandura, 1986).

On the other note, it was imperative for me as a nurse to recognize the benefits involved in the patients weight loss. According to Cohen, (1997) perceived benefits describes an individual’s opinion and the usefulness of their new behavior. One of the major benefits that the patient reported about his dietary change is reduction in body weight. Moriotte et al. (2004) points that individuals with the low BMI are less prone to be affected by diabetes, Hypertension and dyslipidemia and are less likely to develop risk factors of coronary artery disease and congestive heart failure (CHF).

4. Behavioral Change Model (BCM) The behavior change model developed by Prochaska & Diclemente (1986), is used as a belief intervention for patients by providing them appropriate advice and counseling (Carpenter, 1998). Behavioral change model shows that an individual’s change in behavior occurs gradually and involves six series of change (Prochaska, 2005). According to Carpenter (1998), an individual can lie at any stage of the cycle of change during the first appointment with the practitioner, therefore it is the practitioner’s duty to correctly identify where the individual lies within the cycle.

On communicating with the patient during the (2nd appointment) it was found that he was in the contemplation stage, a stage where individual intends to take necessary action within a short period. I recognized this by his ambivalent attitude towards changing his unhealthy behavior. Zimmermen et al. (2000) states that a person feels a loss within themselves when they give up their enjoyable behavior. During the patient’s visit to clinic I enumerated him the weight loss readiness tool questionnaire (1-5) which was based on Procheska & Diclemente (1986), stages of change to evaluate the patient’s readiness to change his behavior on a scale of total agreement and disagreement and as a result he was aware of the costs of changing his eating habits.

Engberg et al. (2007) states that asking relevant questions is a key to find information needed for any clinical practice and it also increases the likelihood of finding right quality of evidence based practice, which is incorporated to make decisions about patients care. While conversing with the patient, he reported that he wanted some time to think whether to take up the challenges involved in his behavior change. Therefore I gave the patient some time to reflect, before proceeding to the next stage on the cycle. During the stages of health behavior some patients can be stuck at a particular stage for a long period of time (Zimmerman et al., 2000).

This stage is characterized as procrastination stage, where an individual is not ready to take any action oriented programs (Procheska, 2005) therefore empathy, validation, praise and encouragement are necessary during the contemplation stage (Zimmerman et al, 2000). During the next appointment the patient reported that he was ready to take up the challenges involving his behavior which led to progression towards the next stage of the cycle called the preparation stage. Procheska ,2005 states that preparation stage is a stage where an individual intent to take action in immediate future. This led to develop an action plan for the patient where he could experiment minor changes by planning a lifestyle intervention program of weight loss, diet and exercises. Learman et al, (1998) states that increasing level of activity is crucial element in a long term weight loss program.

Patient involvement in planning and monitoring their health increase patient satisfaction reduces anxiety and increase control over their life and health (Farrell, 2004). Once the preparation, the next aim was to maintain and act upon the action plan prepared for the patient and in-order to achieve this, I appointed the date to begin the exercise program for several weeks, implemented dietary requirements and encouraged to check his weight every week.

However the patient reported in the next meeting that he fell into a relapse stage where he is not ready to move on further with the action plan and was ready to quit owing to his eating behavior and living environment .Procheska (2005), indicates that that an individual relapse in an early stage when they are not prepared for the prolonged efforts needed for the progress maintenance. Norton (1998), states that a health professional should recognize that the individual has the freedom to choose other priorities other than their health. Therefore, as a nurse my main duty was to pursue the patients from failure to the successful part of the plan and promote problem solving and offer encouragement. And acknowledge their positive step towards changing behavior.

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