: Models of Tannahill Beattie Tones French Stages of change model Health belief model Health action model Socio cognitive theory Theory of reasoned action 1. Tannahill 1985 process of enhancing health and reducing risk of ill-health through the overlapping spheres of health education, health protection, disease prevention:
Disease Prevention (3 types) primary prevention: prevent onset of disease e.g. vaccinate, lifestyle (exercise, smoking, diet) secondary prevention: early detection of disease, and reaction aiming to halt progression e.g. aspirin for people with I.H.D. tertiary prevention: seeks to minimise disability from disease that cannot be cured e.g. footcare for people with diabetes Health Education possible approaches: medical, behavioural, educational, empowerment, social change 3 phases importing knowledge changing attitudes altering behaviour good health promotion locally developed multifaceted i.e. different approaches to achieve similar aims involves multiple stakeholders e.g. statutory and community Health protection offered at a number of levels: national/governmental legislation (seat belts, alcohol and driving, safety at work fiscal control (cigarette tax) local/community, environmental control (work environment, speed ramps near schools, food industry, techniques to reduce communicable disease individual: medication, immunisation, cycle helmets for children Barriers to health protection neglect failure to prioritise clashes of interest e.g. between government departments vested interests over public policy or use mnemonic PE VAMP LIGHT to subdivide health protection levels:
Public Employers Voluntary Groups Advertising Media Primary Care Local Authority Industry Government Health Sector Training i.e. to deliver effective health promotion, need to involve people at each of these levels Individual 2. Beattie 1991 two dimensions, four paradigms Health persuasion e.g. behavioural approach, GP information on smoking Personal counselling e.g. empowerment approach, youth workers and kids Mode of Intervention Authoritative Legislative action e.g. social change approach, lobbying Community development e.g. empowerment Focus of Intervention Collective Negotiated NB: broader, socio/cultural framework 3. Tones 1995: The Health Action Model health promotion = health education and healthy public policy empowerment is the main aim highlights the important influence that self-esteem has on behaviour. The model assumes that someone with a high self-esteem is more likely to be motivated and find ways of healthier living. Many health promoters, especially those in the field of illicit drugs, use this model; by boosting people s self esteem they can help them resist peer pressure illustrates a variety of psychological, social and environmental influences that have been shown to be important in health related choices. concerned with empowerment and suggests that health promotion should not be focussed on providing information and the positive and negative aspects of particular behaviours, but more importantly on helping people
feel good about themselves and to learn the skills that they can use to assert themselves the model shows the stages a person goes through during the process of behaviour change it follows a holistic approach the health action model can be used: as a framework for a range of possible interventions by health promoters to describe the process that individuals go through when personally changing themselves The health action model 4. French 1990 four elements to health promotion disease management disease prevention: preventative services and behavioural change health education: information and empowerment politics of health: social change, policy development, economic and fiscal policy
5. Stages of change model Prochaska and Diclemente 1984 helps target advice basing health promotion strategies on the model has been shown to be effective in changing health related behaviours e.g. alcohol and drug abuse, smoking, exercise, weight control Stages person passes through: 1. pre-contemplation 2. contemplation 3. commitment (made a serious decision to change) 4. action (habit is actively being changed) 5. maintenance (difficulty to maintain change) 6. relapse 7. exit Prochaska and DiClemente stated that on average it took smokers three revolutions to successfully change Stages of change Model behaviour change strategies: used for someone in action/maintenance stage
education and awareness raising: used for someone in pre-contemplation stage client self empowerment: used for someone in contemplation stage this model is very useful in primary health care settings 6. Health belief model Janz and Becker 1984 health decisions influenced by individual perceptions perceived susceptibility perceived severity modifying factors demographic variables socio-economic variables likelihood of action perceived benefit perceived barriers cues to action mass media campaign advice from others illness of friend or family newspaper health protection reminder 7. Socio cognitive theory Bandura 1986 most comprehensive model of community interventions and changing behaviour the main concepts of socio cognitive theory are reciprocal determinism behaviour compatibility expectations self efficacy 8. Theory of reasoned action Azjen and Fishbein (1990) external variables influence beliefs which influence attitudes which influence intention which influences behaviour
Azjen I, Fishbein M, Understanding Attitudes and Predicting Social Behaviour. London: Engelwood Cliffs, 1990. Bandura A. Social foundations of thought and action. A social cognitive theory. Englewood Cliffs: Prentice-Hall, 1986. Beattie A, Jones J. Community Development and Health Education. Open University, Heath Education Unit, 1991. French J. (1990). Boundaries and horizons, the role of health education within health promotion. Health Education Journal 1990; 49, 7-10. Janz NK, Becker MH. The health belief model: a decade later. Health Education Quarterly 1984; 11:1-47. Prochaska JO, DiClemente CC. The Transtheoretical Approach: Crossing Traditional Boundaries of Therapy. Homewood, Illinois: Dow-Jones/Irwin, 1984. Tannahill A. What is health promotion? Health Education Journal 1985;44(4): 167-168. Tones BK. Making a change for the better: the health action model, Healthlines 1995; 27: 17-19. Tones K, Tilford S, Keeley Robinson Y. Health Education. Chapman and Hall, 1990. February 2005 Sarah Anderson, Specialist Registrar in Public Health, London/KSS Deanery