I am a full time specialist nurse in mental health, currently working for a large NHS mental health trust as a nurse consultant in the department of old age psychiatry and social care. My previous nursing experience has been in adult psychiatry, older people’s psychiatry and in the health and social care of older people. I am a qualified registered mental health nurse with over 15 years experience and I also have Bsc in community health, a specialist Practitioners Award in Community Mental Health and a Masters degree with Merit in Dementia Care. My current responsibilities also include teaching and training student nurses, social workers and junior doctors in association with the Trust and the local university. I have a particular interest in health research and have recently had some of my work published in a nursing and health journal.
Theoretical and Methodological Perspectives of Health Promotion
Health promotion includes a wide range of strategies for improving the health of individuals, (Naidoo and Wills, 2001) therefore it is important to primarily define what health is.
A universally-accepted definition of health is provided by the World Health Organisation and is defined as ‘a complete state of physical, mental and social wellbeing rather than the absence of disease or infirmity’ (Mahler, 1981).
Health is a resource for everyday life, not the object of living. It is a positive concept emphasising social and personal resources as well as physical capabilities (WHO, 1986).
There are several definitions of the word ‘promotion’; dictionary definitions include ‘to help forward’ and ‘to further’ (Chambers Dictionary, 1989).
Maben and Macleod-Clark (1995) suggest that based on the definitions of ‘health’ and ‘promotion’ described above it could be suggested that the term health promotion would mean ‘to help forward’ or ‘to further wellbeing’.
Health promotion is the science or art of helping people change their lifestyle to move towards a state of optimal health. Lifestyle change can be facilitated through a combination of efforts to increase awareness, change behaviour and create environments that support good health practices (Viner and Macfarlane, 2005).
Other definitions suggest that health promotion is the process of enabling people to exert control over the determinants of health and thereby improve their health (Health Promotion Agency, 2008).
To explore further it is suggested that health promotion is a process that is directed towards enabling people to take action and that health promotion is not something that is done on or to people; it is done with and for people, either as individuals or as groups. The purpose of this activity is to strengthen the skills and capabilities of individuals to take action to exert control over the determinants of health and achieve positive change (Health Promotion Agency, 2008).
It has been identified that health is not just a physical matter but has social and mental components and therefore health promotion should be based on holistic accounts of health (Young, 1996).
Tannahill (1985) suggests that health promotion is a multifactorial process operating on individuals and communities and that the process of promoting health falls into three categories, described as prevention, protection and health education, and these categories overlap to provide the basis for health promotion activity.
Prevention would include such things as screening for hypertension or immunisation against influenza. Protection would include no smoking policies for public places or seat belt legislation (Young, 1996). Health education is an act of communication which might include information about the body and how to look after it or information about national, regional or local policies, structures and processes in the wider environment that influence health (Draper et al, 1980).
Prevention has become a key aspect of health policy in most developed countries, using the term prevention suggests that it is possible to intervene in a causal process and that there are particular risks to health that can be detected and managed (Naidoo and Wills, 2001).
Health promotion combines different approaches and topics and thus draws upon many academic disciplines and knowledge bases (Naidoo and Wills, 2001).
The concept of health promotion incorporates perspectives from epidemiology, sociology, social policy, economics, education, marketing, communication and psychology, using these different perspectives to build a more complete picture of health needs and the appropriate strategies to promote health (Bunton and MacDonald, 1992).
The prevention of disease and the relief of ill health in those who are ‘sick’ are core aspects of health promotion, but the process also is concerned with improving quality of life.
Naidoo and Wills (2001) suggest that rather than the ‘clinical gaze’ of medicine that focuses on the body with disease, health promotion utilises a biographical approach viewing the individual a whole person, embedded in his or her gender, culture and society.
Health promotion, in essence, seeks to effect changes in the health behaviour of individuals and the centrepiece of the health promotion paradigm is the concept of empowerment – enabling individuals to increase control over and improve their own health (Oliver and Peersman, 2001).
Theoretical and Methodological Perspectives of Health Promotion
MacDonald (1998) infers that the strength of health promotion is the lack of a unitary discipline or underlying theory, it is suggested that health promotion cannot be called a discipline as it draws parasitically on several existing disciplines.
Bunton and MacDonald (1992) suggest that health promotion has its own integrating framework that is informed by the social science disciplines of sociology and psychology; however Naidoo and Wills (2001) suggest that health promotion takes place in a context of epidemiology and medicine which sets the scene by identifying health risks and some preventative strategies.
There has been some doubt as to whether health promotion is an entity in its own right and in an attempt to develop a robust health promotion identity a range of models and frameworks have been developed (Naidoo and Wills, 2001).
Rawson and Grigg (1988) identified 17 published health education models in the United Kingdom and since this time there have been a number of newly proposed models (Naidoo and Wills, 2001).
Models provide a way of mapping health promotion and identify the underlying theoretical perspectives. There are two main approaches to the development of health promotion models and they are identified as descriptive or analytical.
Descriptive models identify the diversity of existing practice but make no judgement about what kind of practice is preferable, and analytical models are explicit about the values underpinning practice and often prioritise certain kinds of practice over others (Naidoo and Wills, 2001).
Health promotion models are a subclass of a theory; they provide a plan for investigating or addressing a phenomenon and provide a vehicle for applying the theories (Health Promotion Agency, 2008).
Health promotion theory can be divided in to three components; firstly theories that attempt to explain health behaviour and health behaviour change by focusing on individuals; secondly theories that explain change in communities and community action for health and finally models that explain changes in organisations and the creation of health supportive organisational practices.
As previously identified, there have been numerous theoretical concepts and models developed as vehicles for the delivery of health promotion. However, Ewles and Simnett (1999) identify that there is no one right aim for health promotion and no one right approach or set of activities. We need to work out for ourselves which aim and which activities we use in accordance with our own professional code of conduct, our own carefully considered values and our own assessment of our clients needs.