Health promotions model evaluation

 

Name of the Model	Target: Individual or Community	Strengths of the Model	Limitations of the Model	Identify situations/circumstances where the model would be appropriate. Include rationale for use.
Health belief	This model attempts to predict public attitudes around a health issue. It target individuals and communities (Pender, Murdaugh, & Parsons, 2011).	This model helps educate individuals on risk and health complications that can be changed with modification in behavior (Pender, Murdaugh, & Parsons, 2011). It helps people dispel misconception and denial about health (Pender, Murdaugh, & Parsons, 2011). The model gives ways to overcome barriers both physical and psychological (Pender, Murdaugh, & Parsons, 2011). Positive outcomes often occur when individual understand behavior influence outcomes. Consequences come with it Gives individual the cue to take action and take responsibility for behavior.	The model relies on an individual’s perception of the education received (Pender, Murdaugh, & Parsons, 2011). The physical and psychological barriers at times are difficult to overcome despite support, financial, and emotionally (Pender, Murdaugh, & Parsons, 2011). Likelihood that people will make changes based on a perceived threat (Pender, Murdaugh, & Parsons, 2011). Longstanding habits that must be overcome (Pender, Murdaugh, & Parsons, 2011). Plan often times does not give very personalized descriptive ways to change behavior (Pender, Murdaugh, & Parsons, 2011).	Development of nutrition programs for minority groups with low income and education levels. Example in SC with a 3.5% population of low income Hispanics, a nutrition program was developed to combat the growing epidemic of obesity (Gamboa, 2015). A survey was sent out into the community to find out what meals were commonly served in the home (Gamboa, 2015).  Healthier versions of the recipes were created (Gamboa, 2015). Classes on cooking and nutrition were given for free in the community. Follow up results included improved nutrition knowledge and decrease in overall family weights one year after attendance (Gamboa, 2015).
Health promotion	Targets the individual through the promotion of healthy behavior (Pender, Murdaugh, & Parsons, 2011).	By changing behaviors the individual experiences positive health outcomes which in turn promotes future constructive behaviors and overall better health. The nurse’s therapeutic relationship and planning has been scientifically proven to improve health outcomes in patients (Alligood & Medford, 2011). Health is not the absence of disease but rather the positive management of health and the best possible quality of health for the individual (Pender, Murdaugh, & Parsons, 2011). This make the plan very individualized.	An often time requires long-term commitment by the individual without seeing the immediate effects (Pender, Murdaugh, & Parsons, 2011). Require planning and commitment by the health care professional (Pender, Murdaugh, & Parsons, 2011). Individual are more likely to make positive health changes if the behaviors are demonstrated by roles modes i.e. health care providers (Pender, Murdaugh, & Parsons, 2011). Situations in the external and internal environment can have effects on overall behavior (Pender, Murdaugh, & Parsons, 2011).	An area that the health promotion model has been used successfully is the care of pre-term infants. The survival of pre-term infants depends greatly on the engagement and relationship between the family of the child and nurse (Alligood & Mefford, 2011). The education and support provided by the nursing staff to the family are vital in the outcome of this very vulnerable population. The crisis of the survival of the preterm infant is the perfect storm to provide motivation by the family to engage in health promoting factors (Alligood & Mefford, 2011). With therapeutic and encouraging interaction with the goal that the family will provide optimal care to the pre-term infant in the future the nurse is in symbiosis with the family to help them create the best health  outcome for the infant (Alligood & Mefford, 2011).
Theory of Reasoned Action	Individuals and community.	That behavior that is linked to change is broken down in six stages to help the health care provider and the individual better understand actions (Pender, Murdaugh, & Parsons, 2011). The five stages are pre -contemplation, contemplation, pre-preparation, action, and maintenance (Pender, Murdaugh, & Parsons, 2011). The greater the persons perceived control the more likely they are to complete the action (Pender, Murdaugh, & Parsons, 2011). Caregivers and society in general can be positive influences for change Pender, Murdaugh, & Parsons, 2011). Some of the most successful models of positive health changes are based on theory of reason action (Thrush & Plant, 2013).	People who believe they have little control over their behavior (Pender, Murdaugh, & Parsons, 2011). A person who as negative attitudes towards a healthful behavior (Pender, Murdaugh, & Parsons, 2011). Certain personality traits (Pender, Murdaugh, & Parsons, 2011). All behavior is not one hundred percent voluntary and under control (Pender, Murdaugh, & Parsons, 2011). Requires long-term commitment and relapses often occur (Pender, Murdaugh, & Parsons, 2011).	This model could be useful in improving communication strategies (Pender, Murdaugh, & Parsons, 2011). Items that could be researched using this model include: wearing a seat belt, use of condoms to prevent transmission of HIV, smoking cessation, drug and alcohol addiction. Another area that would be helpful is the study of social influence on overall behavior beliefs of individual and communities (Thrush & Plant, 2013). It has been proven through research that social networks have a strong correlation to behavior and health (Thrush & Plant, 2013).
Social Cognitive	Individuals and community	People learn through observing others. Good and bad behaviors can be cultivated by identifying and copying behaviors from individual in our social networks (Pender, Murdaugh, & Parsons, 2011). People often decide on behaviors unconsciously and consciously based on perceive or actual consequences witnessed when observing others (Pender, Murdaugh, & Parsons, 2011). The more emotionally attached a individual is to a role model the more likely they are to learn from them (Pender, Murdaugh, & Parsons, 2011). The more likely a person believes they can achieve a goal the more successful they will be (Pender, Murdaugh, & Parsons, 2011). By mastering skills people become more self efficiency and repeat behaviors with positive experiences (Pender, Murdaugh, & Parsons, 2011).	Peer groups can often have a negative effect on behavior and be poor role models (Pender, Murdaugh, & Parsons, 2011). Situations such as poverty, illness, drug abuse, norms, education and mental illness can effect perceptions of how a individual interpreters their environment (Pender, Murdaugh, & Parsons, 2011).	Social cognitive models are often used in advertising to try to get people to identify with their product. Advertising agencies target specific demographic groups so that you will relate to their product and want to purchase it. Social cognitive theory could be used to close gaps in health disparities see throughout the United states due to lack of education, positive health influence and poverty. By prompting healthy behaviors nationally society beliefs can be changed collectively to have better health outcomes (Frishman, 2012).
Trans-theoretical	individuals	Helps health care workers identify areas the area of change the individual is at. Breakdowns change into  five levels and support that can be given at each level Five levels include 1)      Pre-contemplation 2)      2) contemplation 3)      Preparation 4)      Action  5)      Maintains During stage one and two need conscious raising and liberation Stage three and four emotional and self regulation  Stage five commitment and reward (Pender, Murdaugh, & Parsons, 2011). Helps the person and health care provider identify barriers at each stage of change.	False beliefs of individual and the social network of the individual (Pender, Murdaugh, & Parsons, 2011). Lack of social support systems (Pender, Murdaugh, & Parsons, 2011). Behavior change is difficult and may require multiple attempts and approaches (Pender, Murdaugh, & Parsons, 2011).	Obesity epidemic in Mexican American women. Mexican American women have one of the highest obesity rates in the country (Hoke& Timmerman, 2011).  Surveys were sent out to a demographic of Mexican American women to determine which stage of change they were in to lose weight (Hoke & Timmerman, 2011). The majority of the women where in the contemplation stage (Hoke& Timmerman, 2011). This information would be valuable in identifying with population in order to cause a emotional connection to bring about positive change (Hoke& Timmerman, 2011).
Social Ecological The goal of this model is create society and policy changes that create a healthier society (Pender, Murdaugh, & Parsons, 2011).	The approach Focuses on changing physical and social environments to modify society behavior for a more positive outcome rather than just the individual (Pender, Murdaugh, & Parsons, 2011). This model consists of interplay between a individual relationship and the community (Pender, Murdaugh, & Parsons, 2011).	Individuals and Groups can create positive change in society by modeling positive healthful behavior and it can overflow into other parts of society (Pender, Murdaugh, & Parsons, 2011). Individuals can help create policy changes and environment to decrease violence and victimization (Pender, Murdaugh, & Parsons, 2011). Mentoring, life skills training, education and substance abuse prevention have all shown to decrease violence within society (Pender, Murdaugh, & Parsons, 2011).	Negative Behaviors of groups can also overflow into society (Pender, Murdaugh, & Parsons, 2011). Behavior can be influence negatively by income and social, cultural and physical dimensions within an environment (Pender, Murdaugh, & Parsons, 2011). With the introduction of increased technology society is more integrated and influence by a much greater sphere (Pender, Murdaugh, & Parsons, 2011).	The social ecological health model was used successfully in the Arboreal tribes in Australia to promote positive health outcomes (Reily, Cinotta, Doyle, Firebrace, Curgo, VanDental, Morgan-Builed & Rowley, 2011). The improvement of chronic conditions related to longstanding beliefs, economic disadvantage, and lack of education where changed with change in government policy using the social ecological model (Reliy, e.t.al, 2011).
PRECEDE-PROCEED This model has to involve actions that communities want to change (Pender, Murdaugh, & Parsons, 2011). This model asserts health is a community issue (Pender, Murdaugh, & Parsons, 2011). This model believes that health is not just the absence of disease but the quality of life of those in the community (Pender, Murdaugh, & Parsons, 2011). Health can be affected by economical, social and political factors (Pender, Murdaugh, & Parsons, 2011). Five phases o f the model 1)      Social diagnosis 2)      Epidemiological diagnosis 3)      Behavior and environmental diagnosis 4)      Educational and organizational Diagnosis 5)      Administrative and policy diagnosis Precede stands for predisposing, reinforcing, enabling, constricts in education and environment, diagnosis and evaluation. Proceed stands for: policy, regulation, organizational constraints, education and environment (Pender, Murdaugh, & Parsons, 2011).	This is a community intervention to promote healthy conscious behavior (Pender, Murdaugh, & Parsons, 2011).	This model helps improve the stability of families (Pender, Murdaugh, & Parsons, 2011). This model encourages the promotion of the arts (Pender, Murdaugh, & Parsons, 2011). This model promotes the safety and wellbeing of the community (Pender, Murdaugh, & Parsons, 2011). This model values children and cultural diversity (Pender, Murdaugh, & Parsons, 2011).	Lack of available resources and funding (Pender, Murdaugh, & Parsons, 2011). Influencing others is the community to engage in the model (Pender, Murdaugh, & Parsons, 2011). Working through the government bureaucracy to make meaningful changes in policy to improve health (Pender, Murdaugh, & Parsons, 2011). Ethical leadership to use funding wisely in the community (Pender, Murdaugh, & Parsons, 2011).	The precede proceed health model was very useful framework to provide researchers with a way to promote health education to breast cancer survivors (McCarthy& Yates, 2011). It also helped nurse researcher identify healthy behaviors that survivors engaged in that non-survivors did not (McCarthy& Yates, 2011). In was a very helpful model to create a plan for health promotion for cancer survivors(McCarthy& Yates, 2011)
Diffusion of Innovation	Diffuse innovation target individuals and society.  This is a study of why information and ideas spread (Pender, Murdaugh, & Parsons, 2011). Areas that effect the spread of innovation include; communication channels, time, and social systems (Pender, Murdaugh, & Parsons, 2011). Five stages: Adoption of knowledge. Persuasion. Decision Implementation confirmation Rejection or acceptance.	Electronic media and social networking are making social networks closer.  Ideas are conveyed at a rapid pace. The diffusion innovation theory has been successful in many areas to include communications, agriculture, public health, and criminal justice (Smith &Findeis, 2013).  This theory has proven to accelerate the adoption of public health programs aimed at changing behavior and social systems (Pender, Murdaugh, & Parsons, 2011).	Without a solid understanding of the world view of the demographic population adoption of change is very difficult (Pender, Murdaugh, & Parsons, 2011). When given a choice people choose to interact with others similar to themselves (Smith &Findeis, 2013). This model relies heavily on the influence of others. People are finicky and change their minds easily. This model work well with adoption of behavior rather than cessation of a behavior (Findeis, 2013).	The department of agriculture used the diffusion innovation health model to design campaigns to combat hunger in Mozambique (Smith &Findeis, 2013). Research was done to investigate ways to demographic chosen would best be influence to adopt suggested changes (Smith &Findeis, 2013). The research demonstrated ways to improve influence on early majority and late majority to influence change in societies norms (Smith &Findeis, 2013).   By the adoption of new ideas, education and technology famine was decreased and health improved (Smith &Findeis, 2013).
Social Marketing Applies marketing tools and techniques to communicate positive health messages in order to influence target audiences to make better health choices (Pender, Murdaugh, & Parsons, 2011).	Influences both the individual, community and society (Pender, Murdaugh, & Parsons, 2011).	Social marketing research creates better understanding of people and environments (Pender, Murdaugh, & Parsons, 2011). This model allows individuals to weigh the cost and benefit of behavior (Pender, Murdaugh, & Parsons, 2011). Helps to change society norms by appealing to emotion which has been proven to help people identify with messages (Pender, Murdaugh, & Parsons, 2011).	Model is based on the research and observation of individuals research and is only as good as the research conducted (Pender, Murdaugh, & Parsons, 2011). Promoting healthy behaviors through social marketing has to compete against highly competitive markets such as alcohol and tobacco industry, which promote unhealthy behavior. Messages must be different for each demographic group (Pender, Murdaugh, & Parsons, 2011).	In Europe research was done on the value of social marketing to improve the health of those with chronic illness (Zainuddin, Bennette, Previte, 2013). Through social marketing research demonstrate health behaviors and beliefs can be impacted by emotionally appealing to audience and providing education (Zainuddin, Bennette, Previte, 2013).

 

Part 2

     Disease management and practice redesign have been created in the last ten years to better manage chronic health conditions in the population (Coleman, Mattke, Perrault, and Wagner, 2009). Disease management model and practice redesign have often been portrayed as competing models (Pender, Murdaugh, & Parsons, 2011). The goal of both DM and PR is to provide effective, safe affordable health care to the entire population (Pender, Murdaugh, & Parsons, 2011). Dm goal was to utilize education, technology, and health care teams to improve patient outcomes, decrease cost, decrease hospitalization while improving safety and patients long term health (Pender, Murdaugh, & Parsons, 2011). Practice redesign was created for the same purpose but, looked at creating new processes within health care to address the need for chronic disease management due to the ageing population of baby boomers (Coleman, et.al, 2009).

     Research has demonstrated that DM improves the management of chronic illness, patient satisfaction and hospitalization (Pender, Murdaugh, & Parsons, 2011).  Problems that the DM model faces such as low income individuals, substance abuse, mental illness that require extensive management and  lack of health care staff, all contribute to the fact research shows it is not always cost effective (Coleman, et.al, 2009).  The health care industry is often slow to adopt major process changes due to cost, time and proven incentive; this is why process design in health care is slow to occur (Coleman, et.al, 2009). Research has proven the combination of the two models is most effective in improving patient health, decreasing the cost of health care and improving patient satisfaction (Coleman, et.al, 2009).

     The problem lies in the fact that at this time in the United States that goal is not possible for all it citizens (Coleman, et.al, 2009). The objective of all health care policy that serves the public is it should be obtainable by all members of society. Under the current health care system disadvantage individual receiving Medicaid often receives medical benefits on month to month biases, with gaps and caregiver changes in-between (Pender, Murdaugh, & Parsons, 2011). This fact makes it difficult for providers to manage chronic illness effectively and frugally (Coleman, et.al, 2009). The combination of the two models at first may be costly but, the long –term change would provide safe, effective cost efficient care. This will only occur with policy change on how medical care is provides to the disadvantaged.