Behavioral Model of Health Promotion - Essay Example

BEHAVIOURAL MODEL OF HEALTH PROMOTION 2007 Behavioural Model of Health Promotion Introduction Increasingly serious attention to a wide range of health related factors and issues is the distinct trend observed in the developed countries over the last decades. Perhaps the key reason for this trend is the newly emerged health threats and risks associated with living in the modern globalised technological world which require new forms of actions and approaches to successfully address them. Therefore, the challenge for the coming years will likely be to fully realise the potential for health promotion inherent in many sectors of society, among local communities, and within families. The ability to effectively cope with this challenge will largely depend on the extent to which modern health professionals are aware of the whole range of factors, both overt and covert, that influence human health and affect effectiveness of efforts intended to improve health of individuals and populations. The existing models of health stress different constituents and contributing factors of health: consequently, the views adopted by representatives of various approaches on the nature and methods of improving individual and public health vary too. For example, the biomedical model of health views health as the absence of diseases or disorders. Such view implies that development of health care facilities and methods to help people cope with their health problems and improving the quality of health care in every possible way is the most effective way to promote better individual and public health. On the contrary, the socio-environmental model of health views health as the sum of certain social, economic and environmental determinants which provide either barriers or incentives to the health of individuals and groups. Consequently, identifying and removing the barriers while identifying and reinforcing the incentives is likely to be adopted as the primary goal within this approach. And finally, the behavioural model views health as the outcome of correct healthy lifestyle choices: the primary goal of health promotion within the framework of behavioural model is to help individuals and groups change their lifestyle to reach a state of optimal health which can be defined as "...a balance of physical, emotional, social, spiritual, and intellectual health" (O'Donnel 1989: 5). The change can be facilitated through a variety of actions to increase the population awareness and create an environment that supports good health practices. Rationale The problem of using various models for maximizing health of individuals and communities is not new to the scholarly literature. A growing body of empirical evidence is available to support the notion that effectiveness of health promotion initiative or campaign largely depends upon the correct choice of model. The existing literature in the field supports the assumption that there is probably no universally applicable framework: each has its own limitations and strengths. This paper will provide a helpful insight into the behavioural model, namely the variation of behavioural model known as the Transtheoretical Model of Change (TMC). The choice is determined by several factors. Firstly, TMC is the most widely used and popular model in the psychology of health and the literature exploring various aspects of this model is abundant (Horwath, 1999). Secondly, practical effectiveness and applicability of TMC to a wide range of complex/simple contexts and health behaviours (e.g. weight control, smoking cessation, reduction of dietary fat, increasing physical activity levels, quitting drugs, ect) is well documented (Prochaska, et al., 1994). Thirdly, TMC is relatively simple model to understand as compared to many other models. Main discussion The definitions of 'health' fall into three major groups: Cultural: health is a standard of physical and mental well being appropriate to a particular society; Normative: health as an fixed level, or an ideal physical and mental state; Functional: health is a state of being necessary to perform certain physical and mental activities (Townsend, Davidson & Whitehead 1990) However, none of the existing definitions or groups fully reflects the essence of this highly complex and multilateral concept. One common definition of health is the following: "health is positive concept that emphasises social and personal resources, as well as physical capabilities. It involves the capacity of individuals - and their perceptions of their ability - to function and to cope with their social and physical environment, as well as with specific illnesses and with life in general" (WHO, 1984). The broadness of this definition implies that the factors influencing health are multiple and complex. In 2006, a group of U.S. researchers conducted an interesting qualitative study in order to find out which definition of health better reflects the opinion of health care professionals. The study involved 73 practitioners most of whom viewed health as the interrelatedness of physical, mental, and spiritual factors. However, none of the participants adopted a single model or definition of health described in the literature: they freely combined elements from several definitions and models (Julliard, Klimenko & Jacob, 2006). Therefore, attempts to identify such definition or model of health that would fully reflect the variety of determinants and aspects associated with this concept are doomed to failure. What is really important is that both the theorists and practitioners agree on the fact health represents a complex amalgam of factors perfectly summarised in one of the most popular definitions of health provided by the World Health Organisation: "Health is a state of complete physical, psychological, and social well-being and not simply the absence of disease or infirmity" (Wright et al, 1998: 1312). Health promotion, in its turn, is the process of enabling people to increase control over the determinants of health and thereby improve their health (Nutbeam, 1986: 116). It is a reflecting approach serving to facilitate physical and emotional well-being of individuals and groups. Although the actions undertaken within the broad framework of health promotion may take different forms and employ a variety of tools, the most common form of health promotion efforts is a programme targeting a specific population in a unique setting. Thus, in schools and other educational institutions, health promotion approach may include a range of physical and mental health practices to target to educational goals such as improved cardiovascular fitness, non-utilization of potentially hazardous chemical substances, social skills proficiency, affective development, and enhanced motoric functioning (Zins et al 1985). However, there are many alternatives available to contemporary health professional in terms of planning and implementation of such a programme. The TMC is on the list of such alternatives. The TMC represents an integration of theories and concepts from clinical psychology with the focus on promoting behavioural change, but several of the constructs employed (e.g., pros, cons, self-efficacy) imply a model for understanding behaviour. Although T did not originate the concept of stages of change (SOC), a major contribution of T has been heavy emphasis on the extent to which behavioural change occurs in stages and the explanatory concepts used to show differences in influence across stages (Prochaska et al, 1994). The most commonly used set of stages within the TMC includes five steps: precontemplation (not thinking about change or suppressing thoughts of change); contemplation (considering change but taking no action); planning or preparation (anticipating making efforts to change and considering what behaviour one will do); action (actually engaging in efforts to change); maintenance (expending effort to retain the changes made during action) (Baranowski et al, 2003). The motivational mechanism in TMC is an important concept: people are believed to change their behaviours to attain desired ends and to avoid undesired ends. Behavioural change, as a process, is initiated by changes in cognitions, that is, the pros and cons, across the first three stages. In much research, the perception of the benefits of the new behaviour exceeds the costs of the existing behaviour between the first two stages , although this crossing may occur between the second and third stages for diet (Ling & Howarth, 2001) and physical activity (Sarkin et al, 2001). Some recent studies demonstrate that the stage-based structure of TMC is likely to result in substantial positive outcomes in promoting changes in fish and fruit and vegetable consumption (Siero et al, 2000). Although majority of modern health promotion efforts adopt increasingly integrated approach to human health attempting to take into consideration as many known determinants as possible, the basic underpinning of these efforts is predominantly behavioural with the emphasis being placed of changing life-styles of the targeted populations. Practical application of the behavioural model in health promotion can be illustrated using the famous 5 A DAY campaign in the UK. Nowadays the 5 A DAY initiative is the core element of the government's framework for prevention of ill health. The promotional materials and all products with no added sugar, salt or fat may carry the 5 A DAY logo including fresh, frozen, cooked, chilled, canned and dried fruits and vegetables as well as 100% fruit and vegetable juice. A set of nutritional criteria for composite foods to enable products that contain non-harmful levels of added sugar, salt or fat to carry the logo was published by the Department of Health in 2004 (DH, 2007). It is empirically demonstrated that taking 5 portions of fruit and vegetables can reduce the risk of premature death by 20 per cent (DH 2000). Moreover, it will decrease the possibility of colorectal and breast cancer as the intake of fruits and vegetables increases. These cancers represent in 18 per cent men and nearly about 30 per cent women in UK (DH, 1998). Another advantage of higher consumption of fruit and vegetables is that it reduces coronary heart disease and chances of stroke. Moreover, it is also very helpful in reducing blood pressure (Appel, Moore & Obarzanek, 1997). Other benefits of increasing intake of fruit and vegetables are delaying the development of cataracts, reducing symptoms of asthma and very helpful in managing diabetes (Taylor, Jacques & Epstein, 1995). Availability of convincing evidences forced public health policy makers pay adequate attention to controlling and preventing chronic diseases with 5 A DAY programme being at the core of the effort. The programme brought some positive results already in the short-term perspective. Thus, in the beginning of this decade awareness of the 5 A DAY message was gradually increasing. The Expenditure and Food Survey shows that total fruit and vegetable consumption increased 2.5% by volume from 2001/2 to 2002/3, with consumption of fresh fruit up by 5.8% (Marriott & Buttriss, 2004). However, the room for further improvement is huge because many members of the targeted population still lack encouragement to eat 5 portions of a fruit and vegetables a day. For example, a survey by the Food Standards Agency into consumer attitudes to food found that almost 60% of people said they knew they should eat 5 portions a day compared to 43% in 2000, but despite the noticeable increase in awareness, in 2003 only 28% actually achieved this target, which is only a 2% increase as compared with 2000 (FSA, 2003). Evidently, some of the barriers which prevented UK population from increasing the consumption of natural healthy food (e.g. poverty, unavailability of good quality fresh fruits and vegetables) can barely be addressed within the framework of the 5 A DAY initiative. However, the programme itself seems to lack some essential features that distinguish a highly effective health intervention from a moderately effective or ineffective one. Adequate level of attention paid to cooperation and partnership on the lower levels is one of such features. The 5 A DAY initiative employs a combination of strategies focusing primarily on the partnership with the food industry partners and large media organisations in order to generate and communicate the information related to the programme. As a result, the 5 A DAY effort nowadays bears more resemblance to an average advertising campaign that to an accurately planned and implemented health promotion initiative. In order to reach the target population the most effective manner, the best method is establishing a lasting good faith partnership between local healthcare organisations, local governments and media, voluntary organisations, and public. In the local community level such a concerted effort in partnership, with highly specialised agencies, is the best option in order to face the menace of chronic diseases and boost the results of such initiatives as 5 A DAY. Although the 5 A DAY initiative matches the basic assumptions underlying the TMC model, it still lacks certain characteristics common to interventions carried out within the framework of this model. Thus, an important strength of TMC is the availability of a clear and effective structure which can be used to sequentially describe the process of behaviour change during or after the intervention. This strength, in its turn, makes the model flexible and easy to apply as compared to other models. The view that health is the product of making healthy lifestyle choices incorporated in the TMC and other behavioural models greatly increases the potential of the behavioural model in terms of preventing health problems. For example, the biomedical model does not have the same potential in terms of preventability of diseases (it rather focuses of effective treatment) which is a serious drawback as compared with the behavioural model that seeks to prevent health problems in the first turn. This advantage is exceptionally important because a large share of premature deaths in the UK and other developed countries (up to 50 percent) are estimated to be caused by issues related to quality of life (O'Donnel 1989). Many of these deaths can be prevented by addressing the wide range of lifestyle patterns such as physical activity and exercising, tobacco and excess alcohol use, stress behaviour, nutrition, participation in social networks and economic underpinning, adjustment of lifestyle values, etc. On the other hand, application of the TMC to maximizing health requires extremely accurate planning and intensive cooperation between different institutions, and substantial time and resources. Furthermore, it is likely that the behavioural model will be useless in addressing such determinants as the conditions in which people live and work that play an important role in spreading, treatment and prevention of communicable as well as non-communicable diseases (Farmer, 1999). And finally, some methodological concerns have been expressed in regard to the structure of TMC (Whitelaw et al, 2000). Conclusion The behavioural framework of health promotion is a highly effective instrument to improve health of individuals and communities via changing of their lifestyle choices. Perhaps the most essential advantage of this approach is its effectiveness in the short-term perspective: for example, any attempt to address the wide range of contributors within the socio-environmental model will require incomparably more resources and time, and effectiveness of such campaign will be practically impossible to measure in the short-term. The TMC is one of the most widely applied and popular models within the behavioural perspectives. This model has a number of advantages such as clear structure, flexibility, it is relatively simple to apply and its high effectiveness in changing negative health-related behaviours is well documented, although some concerns have also been raised. However, further research is needed in order to better understand the mechanisms of behaviour change: increasingly huge body of knowledge about the role of behavioural factors in aetiology of serious chronic diseases emphasize the fact that behaviour-based issues require adequate behaviour-based solutions. References Appel, L., Moore, T. and, E. Obarzanek 1997. 'A clinical trial of the effects of dietary patterns on blood pressure'. New England Journal of Medicine, 336: 1117-23 Baranowski, T., Cullen, K. W., Nicklas, T., Thompson, D., & Baranowski, J. (2003). 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