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Health issues are always surrounding us nowadays. The different age group has their concerns to health. Health promotion is a platform allowing the public to know the health issues in deep.
Health is an abstract concept that is hard to explain by absolute term. World Health Organisation defined health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (WHO 1946). However, the definition of health was changing with time. A new definition was stated in the first International Conference on Health Promotion which was Ottawa Charter. Ottawa Charter indicated that ‘To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities.’(WHO 1986). The fundamental conditions and resources for health are peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice, and equity (WHO 1986).
Health promotion is one of methods to spread the importance of health. Health promotion is the process of enabling people to increase control over, and to improve, their health (WHO 1986).
Health promotion is important to build healthy public policy, create supportive environments for health, strengthen community action for health, develop personal skills and reorient health services (WHO 1986). Promoting health is one of the important part of nurses’ jobs. Nurses can use their professional knowledge to spread information of health such as how to prevent communicative and non-communicative diseases because an ounce of prevention is worth a pound of cure. Besides, nurses can introduce some basic home nursing for those who need to care for children or elderly which are very useful when an emergency. These actions can help create supportive environments, strengthen community action and develop personal skills (WHO 1986).
Overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health (WHO 2019). Body mass index (BMI) is a common measurement of obesity in which a person’s weight (in kilograms) is divided by the square of his or her height (in meters) (WHO 2019). A person with a BMI equal to or more than 25 is defined as overweight. Three common health consequences can be found which are cardiovascular diseases, musculoskeletal disorders and cancer (WHO 2018). Cardiovascular diseases were the leading cause of death in 2012 and musculoskeletal disorders are highly disabling degenerative diseases of the joints (WHO 2018).
Ru Shi is overweight with a BMI of 29 and was confirmed to have pre-diabetes after demonstrating a fasting blood sugar and HbA1C. Pre-diabetes may progress to type 2 diabetes if she did not take it seriously. Once pre-diabetes becomes diabetes, many diseases may be developed such as cardiovascular disease, eye disease, diabetic foot and so on (AHA, 2015).
Need is an important concept in public health. It is used in the planning and management of health services including health improvement, resource allocation, and equity (Steinbach 2009; Kwiatkowska 2016). Needs assessment consists of 4 types which are normative need, felt need, expressed need and comparative need (Bradshaw 1972).
The normative need is that experts or professionals using their standards to define the need (Scriven 2017). It is not suitable to Ru Shi case as she did not seek medical advice to lose weight before confirming having prediabetes.
Felt need is that people feel the need which is what they want (Scriven 2017).
After Ru Shi was confirmed to have prediabetes, she is worried about this and attend the outpatient clinic for advice about how to lose weight. This action showed that she felt the need to lose weight, so she attended the clinic actively.
The expressed need is the need that people say it out (Scriven 2017). It is not suitable to Ru Shi case as she did not attend the clinic by herself but after the advice of losing weight.
A comparative need for health promotion is comparing a similar group of patients in which some receive health promotion and some do not (Scriven 2017). It is not suitable to Ru Shi case as she did not have any comparisons with other groups.
Health promotion has three levels primary, secondary and tertiary (Hubley and Copeman 2013).
Primary health promotion focuses on preventing healthy people from suffering from an illness (Hubley and Copeman 2013). It would not be relevant for Ru Shi because she has already suffered from prediabetes.
Secondary health promotion means assisting people to handle current problems (Hubley and Copeman 2013). It would be relevant for Ru Shi because she is overweight and BMI is over the normal range which is 29.
Tertiary health promotion is preventing current problems from getting worse (Hubley and Copeman 2013). It would be relevant for Ru Shi because she is now suffering from prediabetes. We can teach her to have better control on prediabetes to reduce the risk of turning into type 2 diabetes.
By the end of 2019, the weight of Ru Shi will be reduced by 20%
By the end of 2019, Ru Shi will do at least 30 minutes of exercise every day.
By the end of 2019, Ru Shi will decrease his intake of snacks by 50%.
In Ru Shi’s case, she always eats snacks at work and works shifts that may not have a fixed meal hour. She travels to work on the bus also. These are the possible factors that led her to prediabetes.
Health promotion has five approaches including medical, behavior change, educational, client entered/empowerment and societal change (Scriven 2017).
The medical approach aims at freedom from medically defined illness and disability by reducing the live rate and death rate which targeted medical intervention that prevents illness (Scriven 2017). This approach is easily measurable about the effectiveness of treatment but it makes people rely on it rather than changing their unhealthy behavior.
The behavior change approach aims at persuading people to accept healthy behavior and campaigns and interventions are encouraging people to modify their behavior and accept a healthy lifestyle (Scriven 2017).
This approach could be used in Ru Shi case because is easy to evaluate, increases health knowledge and is based on the individual choice to change (Scriven 2017) in which she could have more motivation to do it. Ru Shi can participate in some fitness class such as yoga, gym and aerobics held by the fitness center as there will be coaches who can teach her properly and reduce the risks of sports injuries.
The educational approach aims at providing knowledge and information and develop skills allowing people to make a knowledgeable decision in which it provide information and learning including cognitive, affective and behavioral aspect to persuade discovery of attitudes towards behavior (Scriven 2017).
This approach could be used in Ru Shi case because it increases knowledge about health and is based on individual choice to change (Scriven 2017). She can join some classes that introduce how to eat healthily by explaining food nutrients and balanced diets to provide clear information and concept to her.
The empowerment approach focuses on individuals or community identifying their worries and helping them to handle it in which clients find out their needs of health through non-directive counseling (Scriven 2017). It can also base on the community by finding out worries and handle it together (Scriven 2017).
This approach could be used in Ru Shi case because it helps her to find out and express her worries and allows her to learn skills and develop the confidence to do for change (Scriven 2017). She can control her eating habits and keep doing exercise by finding a group that shared same problem which can have peer influence and support each other as well. This approach allows her to make decisions by herself and is suitable for Ru Shi because she has the determination to improve her health.
The societal change approach is to affect the socioeconomic factors that affect health and make changes in the physical, social and economic environment which will spread health importance by influencing policy at local and national level (Scriven 2017). However, this approach may be hard to manifest the direct relationship with health promotion because change is a long process (Louise, 2017).
Health promotion models can assist healthcare professionals to analyze present implementation. Health promoters can use them as a skeleton to assist them in the work of health promotion and the models can help health promoter to find out strategies and prioritize health promotion work (Scriven 2017). The common health promotion model has two types which are the Stages of Change Model and the Health Belief Model. I would like to use the Stages of Change Model in Ru Shi's case. The stages of Change Model has seven stages which are pre-contemplation, contemplation, commitment, action, maintenance, relapse and exit (Scriven 2017).
This is the stage that introduces entry into the change cycle (Scriven 2017). At this stage, an individual has no idea of a need of change or not willing to accept it and has no impulse to make changes of his or her lifestyle or habits (Scriven 2017).
Ru Shi is not at this stage as she now has the awareness to lose weight, so she attended an outpatient clinic after advice from a healthcare professional
This stage is the way into the looping door cycle of stages of change in which people come to this stage if they have plenty of impulses to contemplate solemnly modifying their habits (Scriven 2017).
Ru Shi is now at this stage. She takes action to attend the clinic and try to lose weight by following heath professionals’ instructions. As mentioned above, Ru Shi goes to work by bus and often eats snacks at work. She needs to do more exercise and change her eating habits focused on these two problems. She can choose to go to work by foot if the distance between home and workplace is not too far away. If the distance is too far away, she can get off the bus one or two stops before her destination and then walk to the workplace. This can increase the amount of exercise. Moreover, she has to do exercise at least 30 minutes a day. People always say they have no time to do exercise but 30 minutes occupied really a small part of a day. If you have the determination, you can do it. Besides, Ru Shi needs to eat less snacks at work. Snacks contain many chemicals and are always high content in sugar, sodium and fat which are not good for health. She may just want to get something to eat at work. Thus, I suggest she to choose some healthy food such as fruits. This kind of food can temporarily fill up the stomach and reduce the sense of hunger and reduce the desire of eating too.
This is the stage in which people take a cautious decision to modify the specific habit concerned (Scriven 2017). For example, doing more exercise and eating fewer snacks.
Ru Shi can set a goal for herself at this stage. She can set a goal by using SMART. SMART is the statement of the important results you are working to complete and plan in a way to encourages clear and a mutual comprehension of what constitutes expected levels of performance and successful professional development (University of California 2016). SMART refers to specific, measurable, achievable, relevant and time-bound (University of California 2016). Therefore, ‘doing 30 minutes of exercise a day and at least 3 times a week’ and ‘eating 50% less snacks than before’ are suitable goals for Ru Shi.
This is the stage where they start to change the habit actively (Scriven 2017). When Ru Shi entered this stage, she will start doing exercise regularly to lose weight and keep fit. Moreover, she will start eating less snacks such as use fruits to instead of snacks when she wants to eat something in between meals.
Ru Shi may be difficult to continue her goal alone. Therefore, I suggest she to find some people who shared the same problems or the same goal. She may find her husband and friends to do exercise with her. Friends gathering can be doing exercise but not only going out to have food inside cool area. They may discover an interest of doing exercise in the process.
Writing a keep-fit diary can be a good method as well. Ru Shi can record how long she do exercise and what she eat in a day in the diary. This can strengthen their determination to go on as she can see her progress clearly and she can review herself and then makes changes effectively.
This is the stage where people may have conflicts to maintain the change and may try many coping strategies (Scriven 2017).
Maintenance is the hardest stage in the cycle as goal takes time to reach. People may not have the patience to wait for the change. Thus, Ru Shi may join the fitness class which has other participants who can encourage her to keep going. This is the power of peers. Besides, the outpatient clinic nurses can review the progress of Ru Shi regularly by using the viewpoint of an observer to help her analyze the progress subjectively.
A large extent of people cannot quit the revolving door at the first round and they relapse although they gained the satisfaction of a modified lifestyle (Scriven 2017).
It is not rare to relapse as mentioned above. If Ru Shi really relapses, her family, friends and nurse have to show more support and review the reason together and then restart the cycle after tidying up the mind and mood.
This is the stage in which people are settled into a modified behavior such as keeping a regular exercise pattern (Scriven 2017). Ru Shi may exit the cycle when she decided to give up or reach the goal successfully.
‘Ethics is the study of morals, duties, values and virtues. Ethics can also be a mode of rules and understandings that has been worked out by the members of a profession to govern their own practice.’ (Hubley and Copeman 2008) Ethical principles include autonomy, non-maleficence, beneficence and justice (Beauchamp and Childress 2001).
Autonomy refers to the right of people (Beauchamp and Childress 2001). People can decide their behaviors and actions and also have their viewpoints, make decisions and take actions according to their values and beliefs (Beauchamp and Childress 2001). Respecting their autonomy is necessary. Ru Shi has the right to make decisions and she can choose her own plan to reach her goal. What we said was only suggestions but not rules.
Non-maleficence means not causing damage (Beauchamp and Childress 2001). It is improper to encourage Ru Shi to use incorrect methods to lose weight and keep fit such as refusing to eat and taking losing weight medication which do harm to her health.
Beneficence refers to doing good (Beauchamp&Childress 2001). Beneficence can be directed by those we know such as family and friends. In Ru Shi case, nurses can give good suggestions to Ru Shi and help her to lose weight healthily and reduce the risk of falling ill with type 2 diabetes.
Justice means fairness (Beauchamp and Childress 2001). Nurses should take all patients as the same and provide nursing care regardless their identities.
Evaluation is the assessment of the worth or value of something (Naidoo and Wills 2016). The purpose of the evaluation is to improve practice, give rise to a knowledge base of health promotion, help to determine the use of resources and analyze the efficacy of health promotion programs (Naidoo and Wills 2016). Evaluation includes three elements which are process, impact and outcome (Naidoo and Wills 2016).
The process aims at the strategies and actions of the program or project. This helps to find out the pros and cons of the program and then make improvements (WHO 2019)
Impact refers to a modification in the chosen population that has been selected by the program (WHO 2019). This will show whether the change is made by the program or not (WHO 2019).
This is where the results are evaluated to determine the success of the program (WHO 2019).
Holding an interview to review her results is considered in order to review the efficacy of this health promotion program and how much did Ru Shi gain from this program. Her exercise patterns, eating habits and weight reduction will be the evaluation criteria. Besides, knowing there is any improvements can be done for the health promotion program is necessary.
Health promotion is closely linked with health care. The public values health nowadays. Promoting public awareness of the significance of health by health promotion. Ru Shi is now 28 years old and suffers from prediabetes. This is a warning sign that we need to take health issues more seriously.
In Ru Shi’s case, she felt need to have this health promotion program as she was confirmed to have prediabetes. Moreover, secondary and tertiary health promotion would be relevant for her as she developed prediabetes (Hubley and Copeman 2013). Furthermore, behavioral, educational and empowerment approaches can help her to reduce the risk of developing type 2 diabetes (Scriven 2017). Also, the Stage of Change model could be used in this case to help her change their unhealthy lifestyle (Scriven 2017). Supports from family, friends and healthcare professionals are important to insist on changing. Finally, interviewing can be used to do an evaluation of this program.
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