Health Promotion Program: Planning, Design and Evaluation

1. Define theory in your own words and explain why it is important to use theory in planning, implementing, and evaluating Health Promotion Programs.
2. How doe behavior and the environment influence health and how does health promotion take both into account?
3. Briefly describe three theories used in health promotion.
4. What is the ecological perspective in health promotion?

Introduction

One of the roles of public health is to promote and protect the health of the people in the communities in which they live, work, go to school, and play.  Public health improves the health of communities through implementing health programs. This is achieved by compiling the research data, selecting the appropriate theory to support the identifying, developing, and implementing of health promotion and disease prevention programs (Cdcfoundation.org., n.d.).   

Role of Theory in Health Promotion

Theory is a group of hypotheses which are formulated on limited data as a starting point to further the investigation. Theory is not the end result, but rather, theory is the tool which brings us to the end result. We can observe “the risky lifestyle behaviors, but theory provides the framework in which to build upon as we develop health promotion programs” (Simpson, 2015). 

The Importance of Using Theory in Health Promotion

 “Theory helps us to understand the behaviors, recognize what causes the behavior, and develop strategies to address those health behaviors. Planners can use theory to increase the effectiveness of their program design, implementation, and evaluation” (Simpson).   ‘Healthy People’ is a report published by the U.S. government and is an example of using theory to bring about change; specifically the relationship between the American people and their health. ‘Healthy People 2030’ is in the planning stage, but as in past decades, it will focus on “those aspects of health that are the most critical to overall health and well-being and can be improved using our available knowledge” (Healthypeople.gov, 2019). 

Influence of Behavior and Environment on Health and Accounting For Both

Our behavior has a direct impact on our health.  Stress has been linked to cardiovascular disease and compromised immune system, so if we are in a high-stress job but do nothing to decompress, we are increasing our risks for those health problems.  If we partake in activities such as unprotected and promiscuous sex, tobacco and alcohol use, poorly balanced diet, and lack of exercise, our risk of developing health problems related to these behaviors increases.  A high-fat, high sugar, low-fiber diet, and no exercise increase our risk of developing heart disease and type 2 diabetes.   Unprotected and promiscuous sex increases our chances of getting a sexually transmitted disease (Institute of Medicine (U.S.) Committee on Health and Behavior: Research, Practice, and Policy (2001). 

The environment can influence our health by exposing us to pollutants found in the air, water, and soil. Air pollution and pollens can affect our breathing. Toxins like Perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA) can be found in our public water systems (Fifield, 2019) and can have a negative effect on a community’s health.   In Arizona, we have mining operations which the runoff from these industrial processes can enter the soil, contaminating it, making the soil unfit for farming (The University of Arizona, n.d.).

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Health promotion must take into account our behavior and environment to effectively address the health issue and prompt change. Our health is profoundly affected by such things as our social habits, where we live and work, economics, culture, and genetics.  We know that amongst low-income Hispanic communities, there is a higher chance of developing type 2 diabetes (T2D) than there is in a high-income Caucasian community.  A successful health promotion program must seek to improve personal behavior, but also improve a community's access to affordable, wholesome, healthy foods, and tailor the program to also take into account Hispanic culture with regards to diet and exercise (American Diabetes Association, 2014).  

Three Theories Used In Health Promotion

Three theories used in health promotion are Ecological Model, Health Belief Model, and Theory of Reasoned Action/Planned Behavior.  The Ecological Model is described as “the interaction between, and interdependence of, factors within and across all levels of a health problem. It recognizes multiple levels of influence on health behaviors. Those influences are intrapersonal/individual factors, interpersonal factors, institutional/organizational factors, community factors, and public policy factors” (U.S. Department of Health and Human Services, 2005).   The next theory is the "Theory of Planned Behavior, and it started as the  Theory of Reasoned Action and was used to predict an individual’s intention to engage in a behavior at a specific time and place.  This theory takes into account six constructs, and they are attitudes, behavioral intention, subjective norms, social norms, perceived power, and perceived behavioral control. Collectively these constructs represent a person's actual control over the behavior" (Boston University School of Public Health, 2018).  The Health Belief Model is based on the health behaviors of the "desire to avoid illness and the belief that a specific health action will prevent or cure an illness. It takes into account the six constructs of perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cue to action, and self-efficacy"

(Jones et al., 2015).

The Ecological Perspective In Health Promotion

The ecological perspective in health promotion is “the theoretical context meant to draw attention to individual and environmental determinants (or causes) of behavior (McLaren & Hawe, 2005).  The emphasis is focused on the individual and socioenvironmental factors as the reasons for the behavior(s) and becomes the targets for the health promotion intervention.

References

• American Diabetes Association (2014).  Diabetes Among Hispanics: All Are Not Equal. Retrieved from http://www.diabetes.org/newsroom/press-releases/2014/diabetes-among-hispanics-all-are-not-equal.html
• Boston University School of Public Health (2018). The Theory of Planned Behavior. Retrieved from http://sphweb.bumc.bu.edu/otlt/MPH-Modules/SB/BehavioralChangeTheories/BehavioralChangeTheories3.html
• Cdcfoundation.org (n.d.). What is Public Health?. Retrieved from https://www.cdcfoundation.org/what-public-health
• Fifield, J. (2019). AZCentral.com. Water in 9 Arizona systems has tested high for toxins found at Luke. Retrieved from https://www.azcentral.com/story/news/local/tempe/2019/05/02/water-9-arizona-systems-have-tested-high-toxins-found-luke-air-force-base/3485082002/
• Healthypeople.gov (2019). Healthy People 2030 Framework | Healthy People 2020. Retrieved from https://www.healthypeople.gov/2020/About-Healthy-People/Development-Healthy-People-2030/Framework
• Institute of Medicine (U.S.) Committee on Health and Behavior: Research, Practice, and Policy (2001). Health and Behavior: The Interplay of Biological, Behavioral, and Societal Influences. Washington, D.C.: National Academy Press.
• Jones, C.L., Jensen, J.D., Scherr, C.L., Brown, N.R., Christy, K., & Weaver, J. (2015). The Health Belief Model as an Explanatory Framework in Communication Research: Exploring Parallel, Serial, and Moderated Mediation. Health Communication, 30(6), 566–576. doi:10.1080/10410236.2013.873363
• McLaren, L., & Hawe, P. (2005). Ecological perspectives in health research. Journal of Epidemiology & Community Health,59(1), 6-14. doi:10.1136/jech.2003.018044
• Simpson, V. (2015). Extension.purdue.edu. Models and Theories to Support Health Behavior Intervention and Program Planning. Retrieved from https://extension.purdue.edu/extmedia/HHS/HHS-792-W.pdf
• The University of Arizona (n.d.). Toxic Soil and Public Health. Retrieved from https://mphdegree.arizona.edu/blog/how-toxic-soil-has-become-a-public-health-issue-at-home-and-abroad/
• U.S. Department of Health and Human Services (2005). Theory At A Glance: A Guide For Health Promotion Practice.  Retrieved from https://www.sbccimplementationkits.org/demandrmnch/wp-content/uploads/2014/02/Theory-at-a-Glance-A-Guide-For-Health-Promotion-Practice.pdf