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Lecture notes HEP4210 (complete!)
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This document contains all the lecture notes of lectures given during the course HEP4210 at Maastricht University.
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Introduction & lecture 1 – Understanding Health BehaviorAim of the course: understanding why individuals and groups do or do not adopt healthy (and
unhealthy) behaviors. In other words, it is about trying to understand why people do what
they do regarding (un)healthy behavior. Health behavior are related to; nutrition, physical
activity, alcohol consumption, smoking, protecting against harms in workplace, use of
condom, use of sunscreen, use of vaccination, adherence to what the doctor prescribes.
Central question: Why do we engage in unhealthy behavior? And how can we make people
engage in healthy behaviors?
- Focus on determinants as they determine the behavior (most important ones are the
environment around you (ex. friends, family, supermarket), social economic status
(educational level, income), self-efficacy (has to do with the confidence we have, our
perception. For instance, if we think that we cannot do something it has a negative
effect on our behavior even though we may perfectly be able to do so). If
determinants are know, you can try to change the behavior.
- Most important changeable determinants: for instance, different products in
someone’s fridge.
- How do determinants interrelate? What is in your fridge is probably related to your
social economic status for instance. Models and theories help to see how they are
related.
- How can we execute determinants research? Interviews (qualitative research),
literature, correlation between determinant and outcome (quantitative research).
What is Health Education and Promotion?
Ottawa Charter, 1986 (health promotion started to get attention as from the ‘80s)
Many researchers gave attention to improving people’s health. They developed the
Ottawa Charter which is a basic overview on what you can do to improve the health
of people. In the first place, the focus was on telling people (educating them) on what
is good for their health. Afterwards, the focus shifted to health promotion (facilitate
people to make healthy choices). It was mostly focused on developing personal skills,
supportive environments, health services.
Based on this model, the Planned Health Promotion steps were developed. These
steps should be taken if you want to tackle a health problem:
1. Identify the (health) problem
2. Identify the behaviors and environmental factors involved
3. Identify the determinants: why do people do what they do? (HEP)
4. Develop intervention(s) & policy measures
5. Implementation of intervention(s) & policy measures
Evaluation comes across all the steps, not only the last step. If evaluation is ignored in all
steps, you can create a solution for the wrong thing. Therefore, systematic approach is
needed.
Precede-Proceed Model are the steps of Planned Health Promotion transformed into a model.
Phase 1 is about the quality of life. It may be that people do not sleep enough but if it does
not affect their quality of life, is there a problem? Do we have to address it? This model can
help to systematically go through all the steps for Health Promotion.
,Determinants of health behaviors:
- Cognitive (intentions, knowledge, attitudes “What do I think about drinking”,
preferences, risk perceptions “It is just a flu, I will not get sick”, expectations “Do I
think it will help to get a vaccination?”, motivation.)
- Environmental (availability of facilities “what is in your fridge”, prices, neighborhood
characteristics “can you walk to the vegetable stores?”, climate, culture “in the South
we drink more, we eat unhealthier”, policies “for instance if bicycling in prohibited”,
peer support, norms, social media “many people believe everything that is online”).
But everything (all determinants) is interconnected so only creating bicycle lines will not
solve the problem.
Causal mechanisms:
- What leads to what?
- Which factors are interrelated?
Therefore, we use models and theories to find out how all factors are interrelated.
Some models are:
1. Health Belief Model (sociocognitive model)
2. Theory of Reasoned Action (sociocognitive model)
3. Theory of Planned Behavior (sociocognitive model)
4. Self-Determination Theory (sociocognitive model)
5. Ecological models – the environment and its’ influence
6. Habit theory – many behaviors is a habit and not planned
7. Dual-process models – combine all the information into one model
Always re-think your theoretical approach, based on the “problem” at hand. For different
behaviors different models and theories should probably be used (smoking is not the same
model as eating a bag of chips daily for instance).
Lecture 2 – Understanding Health Behavior
Public health =
the art and science of preventing disease, prolonging life, and promoting health
through the organized efforts of society. Thus, this definition shows that promoting
health is very important in public health.
Activities in the field of public health aim to provide conditions under which people
can maintain to be healthy, improve their health and well-being, or prevent the
deterioration of their health. Thus, the perspective of health is very broad. Not only
about health promotion, but also on prevention of disorders.
Public health focuses on the entire spectrum of health and well-being, not only on the
eradication of disease. Thus, it had been different than before. After the second world
war, it was specifically focused on the absence of a disease, but that focus is broader
nowadays.
Health promotion =
the process to enabling people to increase control over and to improve their health.
Another definition is: a combination of health education and environmental changes
that together promote healthy behaviors and healthy living circumstances.
Health education =
, the combination of learning experiences designed to help people and communities
promote their health.
This has been under debate as people argue that only educating people will not help
them to change their health, the focus is too much on individuals being responsible for
their own health behavior. A healthy environment is also needed.
Major health improvements are achieved by:
- Quarantine and insolation – that are known for quite some time
- Sanitation
- Hygiene
- Social reforms (housing and working conditions)
- Vaccination
These measures have improved public health due to their high effectiveness. These measures
are still very relevant today (e.g., vaccination in COVID-19) but all these measures also have
to do with behavior of people (as they have the choice to take a vaccine, to be in isolation
etc). However, nowadays we are also facing non-communicable disease (e.g., cancer,
cardiovascular disease) for which these measures are not effective. From the 1970’s on the
idea arose that these non-communicable diseases are rooted in behaviors of people and the
environments in which they live. The increase in non-communicable disease cannot be
treated by the medical field only. Taking away their causes is very important by focusing on
behavior.
In 1986 the First International Conference on Health Promotion was organized in Ottawa
were ideas like what is health and how can it be promoted were discussed. The conference
resulted in the Ottawa Charter for health promotion. This charter is still very useful and
important. Nowadays, what is very prominent is that health promotion can only be achieved
if we focus on the 5 actions areas:
1. Health Promotion can only take place if there are health public policies.
2. It is important to reorient health services so that they are not only focused on treating
diseases but much more on promotion of health (preventing instead of curing).
3. Create supportive environments is important for health promotion.
4. Develop personal skills of the target audience to improve health. Not only adopting
the environment.
5. Strengthen community action – positive health is stimulated in communities so that
makes it important to strengthening community action in reaching positive health.
This can be achieved by the following strategies:
- Enable: helping people to get the skills, tools, environment, whatever it takes to make
them able to achieve their fullest health potential. It focuses on equity in health, health
for all. People need different support what should be provided.
- Mediate: health promotion demands coordinated action by all concerned: by
governments, by health and other social and economic sectors, by non-governmental
and voluntary organization, by local authorities. Mediate between differing interests
in society for the pursuit of health. This collaboration is needed to achieve good
health for all.
- Advocate: political, economic, societal, cultural, environmental, behavioral, and
biological factors can all favor health or be harmful to it. Health promotion action
aims at making these conditions favorable through advocacy for health. If we will
achieve health for all, broader action is needed.
After this Conference, other conferences were organized:
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