Developing Personal Skills

Nota:

• •Health promotion supports personal and social development through providing information, education for health, and enhancing life skills. By so doing, it increases the options available to people to exercise more control over their own health and over their environments, and to make choices conducive to health. •Enabling people to learn, throughout life, to prepare themselves for all of its stages and to cope with chronic illness and injuries is essential. This has to be facilitated in school, home, work and community settings. Action is required through educational, professional, commercial and voluntary bodies, and within the institutions themselves. - This means: •Provision of information • •Education • •Life skills • •Improved sense of control over health, improved  health outcomes for individuals

1. Info+education+life skills

   Nota:

   • •Life skills are abilities for adaptive and positive behaviour, that enable individuals to deal effectively with the demands and challenges of everyday life (HP Glossary, WHO 1998)
   1. Behaviour changes+ Health services knowledge
      1. Improved sense of control+ improved outcomes
   2. Decision making, Communication, Assertiveness, Time management, Problem solving
   3. Health education

      Nota:

      • •Aspect of health promotion most readily identified by the public • •Assumed by many to ‘be’ health promotion •Very prominent during the lifestyle era (1960s-1980s) • •Distinction between coercive and voluntaristic • •Underpinned by assumption –‘Unhealthy’ behaviour is a function of lack of information - e.g. •Patient education - health care settings •Public safety awareness campaigns •Leaflets and posters
      1. Definitions

         Nota:

         • •‘Health education is any intentional activity which is designed to achieve health or illness related learning, i.e. some relatively permanent change in an individuals capability or disposition…may produce changes in knowledge and understanding…. …may bring about shift in belief or attitude…may even effect changes in behaviour or lifestyle’ (Tones, 1997) • •‘Health education is any combination of learning experience designed to facilitate voluntary actions conducive to health.. Voluntary means without coercion and with the full understanding and acceptance of the purposes of the action.’ (Tones & Green, 2004)
      2. Ineffective strategy

         Nota:

         • •K-A-B too simplistic ? •Even more sophisticated models still have low predictive power •Criticized for failing to take account of social and environmental context in which choices are made •Increasing evidence that health-related behaviour are not enacted  (or avoided) in a vacuum –Socially conditioned –Culturally embedded –Economically determined - •Reinforcing health inequalities •Victim blaming •Underpinned by assumption of ‘rational man’ •People may reject advice •‘defensive’ rationalisations •Some behaviours involve addiction •For some behaviour, product companies engage in counter campaigns, and have more resources
         1. Yet may persist

            Nota:

            • –They are inexpensive –Belief that poor health is caused by personal lifestyle persists –Alternatives raise problems (what problems?) –Disciplinary base of many HP practitioners •Focus on healthy literacy and on empowerment • • •Both as processes and as outcomes •
2. Health Literacy

   Nota:

   • •WHO adopts following definition –The cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways that promote and maintain good health (WHO, 1998) – •Important differences (from earlier medicalised definitions) in emphasis, perspective • •Health literacy –Means more than being able to read pamphlets and make appointments –Is critical to empowerment –Is itself dependent upon more general levels of literacy - •‘health literacy is linked to literacy and encompasses people’s knowledge, motivation and competences to access, understand, appraise and apply health information in order to make judgements and take decisions in everyday life concerning healthcare, disease prevention and health promotion to maintain or improve quality of life during the life course’ (Sorensen, Van Den Broucke et al. 2012). - •Continuum (HL) (from Nutbeam, 2000) –Basic/functional - communicative/interactive - critical –Measured in absolute and relative terms –Issues of shame, embarrassment, stigma •Those who are functionally literate can participate better in society –How many ‘functionally illiterate ‘? •1997 International survey –25% at lowest level in Ireland, 17% at highest level (5 levels) –Poor compared to other states –Related to age, little gender difference •Programme for the International Assessment of Adult Competencies (PIACC 2012) (launched Oct 8 2013). –18% (1 IN 6) at/below level 1 on 5 point literacy scale –25% at/below level 1 on 5 point numeracy scale - •Relationships between low literacy and health outcomes •Evidence for low literacy linked to –Fewer preventative practices –Use of H information and of H services –Limited knowledge and u/s of medical treatments –Detection of disease –Lower levels of self managing disease •Planning and adjusting lifestyle •Making informed decisions •Knowing when and how to access appropriate health care services. • •Ethnicity, Income - socioeconomic factors - •Health Literacy as an asset (Nutbeam, 2008) •Consistent with principles of Health Promotion •Enabling individuals to exert greater control over their health and also over determinants of their health •An outcome of good Health education interventions  –lead to greater empowerment in health decision making, self efficacy in certain situations –Also awareness raising of social determinants of health –Ability to negotiate with HCPs, assertiveness  •More than reading leaflets, making appointments, complying with regimes….
   1. HLS-EU conceptual model of health

      Adjunto:

      • HLS-EU conceptual model of health
   2. Interactive health literacy framework

      Adjunto:

      • Interactive health literacy framework Parker 2009
   3. Conceptual model of health literacy as an asset

      Adjunto:

      • Conceptual model of health literacy as an asset Nutbeam 2008
   4. Measuring health literacy

      Nota:

      • •Various measures used for assessment in clinical settings but limited –Individual capacity measured, not ‘relationship’ between individual and setting –Focus on reading, not other aspects of communication •Need to develop –measures that incorporate wider skill set/capacity outside of health care settings –Measures of negotiation, advocacy –See the HLS-EU measure (Sorensen et al. 2012)
   5. Improving health literacy

      Nota:

      • •Need for strong, quality interventions that aims to empower and increase control, facilitate individuals to modify determinants of health • •How do you distinguish between ‘traditional ‘ H Ed and newer H Literacy approaches ? –See Silk et al. 2010 –Developing age and context specific interventions –Including self efficacy and support, assertiveness training –Focus on wider skill set, empowerment as goal –Use community facilitators, rather than HCPs