Learning Objectives
By the end of this section, you will be able to:
- Define the global strategies for health promotion
- Discuss levels of prevention and application to patient care
- Compare factors influencing a patient’s risk of illness
- Explain the impact illness has on health promotion
Health promotion is an essential aspect of nursing practice, and it involves the integration of global strategies, the application of prevention levels, and the consideration of factors that influence the risk of illness in patients. Health promotion aims to improve the overall well-being and health of individuals, families, and communities through a range of interventions and programs. Nurses play a vital role in health promotion, and they use a variety of strategies to prevent and manage illnesses and promote healthy behaviors. In this context, it is important to understand the levels of prevention and their application in patient care, the factors that contribute to illness, and the impact of illness on health promotion. This knowledge equips nurses to provide effective care and support to patients, enabling patients to make informed decisions about their health and well-being.
Strategies for Health Promotion
Global strategies for health promotion are comprehensive and coordinated efforts to improve health and wellness worldwide. The World Health Organization (WHO) has developed several global strategies for health promotion which focus on a variety of approaches, including improving access to healthcare services, promoting healthy lifestyles, addressing social determinants of health (SDOH), and advocating for policies and systems that support health and wellness. The goal of these strategies is to promote health equity, reduce health disparities, and empower individuals and communities to take an active role in their own health and well-being. The global strategies for health promotion include several key components, including governance for health, health literacy, and healthy cities. Overall, these global strategies for health promotion are aimed at creating supportive environments that enable individuals and communities to lead healthy and fulfilling lives. They emphasize the importance of collaboration and partnership among governments, organizations, and communities, as well as the need for a comprehensive and coordinated approach to promoting health and wellness worldwide. A recent example is the Healthy People 2030 initiative discussed earlier in this chapter.
Governance for Health
The process of developing and implementing policies, strategies, and actions that support and promote the health and well-being of individuals and communities is referred to as governance for health. Effective governance for health requires collaboration and coordination across various sectors and stakeholders, including government, civil society, and the private sector (WHO, 2023c). It emphasizes the importance of policies, laws, and regulations that support health and wellness. The role of governance in health promotion involves creating environments that support healthy behaviors, reducing health inequalities, and ensuring equitable access to health services. Good governance practices such as transparency, accountability, and participation are crucial to achieve these goals. Examples of actions that promote health and well-being include public service announcements and mass media campaigns, which provide communication to raise awareness. By prioritizing governance for health, policymakers and leaders can create the conditions necessary for individuals and communities to achieve optimal health and well-being.
Health Literacy
The ability of individuals to obtain, process, and understand basic health information and services needed to make informed decisions about their health is referred to as health literacy. It focuses on promoting knowledge and understanding of health and wellness among individuals and communities, which includes providing access to reliable health information, improving communication and decision-making skills, and promoting healthy behaviors and lifestyles (Centers for Disease Control and Prevention [CDC], 2023). In the context of health promotion, improving health literacy is essential to enable individuals to take an active role in their own health and well-being. People with low health literacy may have difficulty navigating the healthcare system, accessing appropriate health services, and making informed decisions about their health.
Link to Learning
Understanding health literacy is imperative for effective health promotion. The U.S. Department of Health and Human Services presents five facts to know about health literacy to improve health goals.
To improve health literacy, health promotion efforts should focus on providing clear, accurate, and accessible health information and services, using plain language and visual aids, breaking down information into small concrete steps, providing written information at or below sixth-grade reading level, limiting the objectives of a visit to three key points or tasks, and assessing for comprehension using the teach-back method (CDC, 2023). Community-based health education programs, health coaching, and digital health tools can also be used to support health literacy and empower individuals to take control of their health. By improving health literacy, individuals and communities can become more knowledgeable and engaged in making informed decisions about their health and well-being.
Healthy Cities
Healthy Cities is a strategy that focuses on creating environments that support the health and well-being of their residents. This includes designing cities and communities that promote physical activity, access to healthy food, clean air and water, and safe and affordable housing (WHO, 2023a). Healthy Cities recognizes that health is influenced by a range of factors, including the built environment, SDOH, and individual behavior. It prioritizes creating safe and accessible green spaces, promoting physical activity, and encouraging healthy eating habits (WHO, 2023a).
The Healthy Cities project was launched by the WHO in 1978. The goal was to promote public health and well-being as a result of the action of local government. The plan was to recognize the many determinants of health and to work collaboratively across all sectors to prioritize public health so that local governments work to improve public health. There are over seventy flagship cities that have expanded to form a national and global network. The WHO has created a resource for any city leader to utilize to improve health determinants specific to their locale or to work toward joining the Healthy City Network. By prioritizing health in their development and policies, healthy cities have the potential to improve the health and well-being of the residents and create a more sustainable future (WHO, 2023a). For example, in a healthy city, walking and biking are encouraged through the availability of pedestrian and cycling infrastructure. Residents have access to nutritious and affordable food options, and the city promotes local food production and farmers’ markets. The design of buildings and public spaces is inclusive and encourages social interaction, reducing isolation and promoting mental health.
Levels of Prevention
Different stages or approaches that can be taken to prevent the occurrence of a health condition or disease are referred to as levels of prevention. There are three levels of prevention: primary, secondary, and tertiary (Table 4.6). Understanding the different levels of prevention is essential to implementing effective and efficient healthcare strategies that can prevent the occurrence or progression of health conditions.
| Level of Prevention | Intent | Example |
|---|---|---|
| Primary prevention | First level of prevention that aims to prevent the onset of a disease or health condition before it occurs | Encourage exercise and healthy eating to prevent obesity |
| Secondary prevention | Second level of prevention that aims to detect and treat a disease or health condition in its early stages to prevent complications and progression | Check body mass index at wellness checkups to identify any changes to weight and potential for obesity |
| Tertiary prevention | Third level of prevention that aims to manage and treat the complications of a disease or health condition to prevent disability or death | Help patient who is obese to lose weight to prevent more severe consequences |
Primary Prevention
The first level of prevention is primary prevention. It aims to prevent the onset of a disease or health condition before it occurs (Kisling & Das, 2023). This approach involves promoting healthy behaviors and lifestyles as well as implementing vaccination programs (Baumann & Ylinen, 2020). Examples of primary prevention include regular exercise, healthy diet, avoiding tobacco and alcohol use, and practicing safe sex to prevent sexually transmitted infections. Vaccinations are also a vital part of primary prevention, such as immunizations for infectious diseases like measles, mumps, rubella, hepatitis B, and human papillomavirus. Additionally, community-based programs that promote healthy behaviors and lifestyles, such as antismoking campaigns or nutrition education programs, are also effective primary prevention strategies. By implementing primary prevention strategies, individuals can take proactive steps to reduce their risk of developing health conditions and improve their overall health and well-being.
Secondary Prevention
The second level of prevention is secondary prevention. It aims to detect and treat a disease or health condition in its early stages to prevent complications and progression (Kisling & Das, 2023). This approach involves implementing screening programs and early detection initiatives to identify the disease before the symptoms appear (Baumann & Ylinen, 2020). Examples of secondary prevention include regular health checkups, cancer screenings, mammograms, colonoscopies, and Pap smears. These screenings can detect the early signs of diseases like diabetes, heart disease, and cancer. Early detection allows for prompt treatment, which can prevent the progression of the disease, reduce the severity of symptoms, and improve outcomes. By implementing secondary prevention strategies, individuals can detect diseases early, which improves their chances of successful treatment and recovery.
Tertiary Prevention
The third level of prevention is tertiary prevention. It aims to manage and treat the complications of a disease or health condition to prevent disability or death (Kisling & Das, 2023). This approach involves implementing rehabilitation and chronic disease management programs to help individuals manage and cope with the consequences of the disease (Baumann & Ylinen, 2020). Examples of tertiary prevention include physical therapy, occupational therapy, and speech therapy for individuals who have experienced a stroke or a traumatic injury. Chronic disease management programs, such as diabetes management programs and cardiac rehabilitation programs, can help individuals manage the complications of their chronic condition and prevent further health issues. By implementing tertiary prevention strategies, individuals can improve their quality of life (QoL), manage their symptoms, and prevent complications associated with their disease.
Factors Influencing Risk of Illness
The risk of illness can be influenced by a range of factors, including inherent factors, lifestyle factors, and environmental factors (WHO, 2023b). Factors a patient cannot change or modify are inherent factors, also called nonmodifiable factors, such as age, gender, race, genetics, and family history. Factors the patient can change are lifestyle factors, also called modifiable factors, such as tobacco use, alcohol consumption, diet, and activity level. These can affect an individual’s risk of developing certain health conditions. Exposure to pollution, toxins, and infectious agents in the air, water, or surrounding environment are some of the environmental factors that can also increase the risk of illness (Rojas-Rueda et al., 2021). Understanding the various factors that influence the risk of illness can help individuals and healthcare professionals develop effective prevention and management strategies to reduce the risk of illness and promote optimal health and well-being (Table 4.7).
| Factor | Description | Examples |
|---|---|---|
| Inherent factors | Individual nonmodifiable characteristics that can influence the risk of illness | Genetics, age, and sex |
| Lifestyle factors | Individual modifiable behaviors and habits that can influence the risk of illness | Tobacco and alcohol use, diet, physical activity, and stress level |
| Environmental factors | Physical, chemical, biological, and social factors that affect the quality of air, water, food, and the general environment, which can eventually influence the risk of illness | Pollutants, sanitation, climate change, and access to health care |
Inherent Factors
Inherent factors are the individual nonmodifiable characteristics that can influence the risk of illness, which include genetics, age, and sex. Genetic factors can make an individual more susceptible to certain health conditions, such as cancer, heart disease, and diabetes (Johansson et al., 2021). Age is also an important inherent factor, as the risk of many diseases increases with age due to physiological changes and accumulated exposure to risk factors. For example, the risk of dementia, osteoporosis, and many types of cancer increases with age. Additionally, sex can also influence the risk of illness as females and males have different biological characteristics that make them more susceptible to certain conditions. For example, females are at a higher risk of developing breast cancer and osteoporosis, while males are more likely to develop prostate cancer. Understanding inherent factors that influence the risk of illness can help individuals and healthcare professionals develop personalized prevention and management strategies that address the unique risk factors of each individual.
Lifestyle Factors
Lifestyle factors, which include tobacco and alcohol use, diet, physical activity, and stress level, are individual modifiable behaviors and habits that can influence the risk of illness (Zaman et al., 2019).
Cultural Context
Cultural Considerations About Health
While assessing and discussing lifestyle factors with a patient, it is important for the nurse to consider cultural norms and expectations. For example, some cultures place great value on large meals to celebrate a lifestyle milestone and/or mourn a loss. While the food options at these events may be high in sodium, fat, and/or carbohydrates, thus making them not ideal for a patient struggling with obesity or diabetes mellitus type II, it is important to consider the social and familial factors in the decision to engage in these meals. The nurse should consider mental and emotional health and work with the patient to make a plan for engaging with and enjoying cultural traditions while keeping healthy choices in mind.
Tobacco use is a major lifestyle factor that increases the risk of respiratory illnesses, heart disease, and cancer. Alcohol consumption can also increase the risk of liver disease, cancer, and mental health disorders. Diet that is high in saturated fats, sugar, and salt can increase the risk of obesity, type 2 diabetes, and heart disease. Physical inactivity can increase the risk of obesity, heart disease, and stroke. Chronic stress can also affect the immune system and increase the risk of mental health disorders such as anxiety and depression. Adopting healthy lifestyle habits, such as regular exercise, a balanced diet, avoiding tobacco and excessive alcohol consumption, and managing stress, can help individuals reduce their risk of illness and promote optimal health and well-being (Zaman et al., 2019).
Patient Conversations
Discussing Lifestyle Changes to Improve Health
Scenario: This is a conversation between Nurse Luis DeSilva and Mr. Travis Butler, a 44-year-old male who was born and raised in the South. He has obesity and has high cholesterol and high blood pressure. Read what happens when Nurse Luis discusses lifestyle changes with Mr. Butler.
Nurse: Mr. Butler, the last time you were here, we talked about the changes you needed to make to improve your health.
Patient: Luis, I know we did, but I don’t know if I can do it. I was born in Texas and raised in Louisiana and Mississippi. Frying food is a part of who I am. I honestly don’t know if I can give that up.
Nurse: I understand that fried food is a part of your Southern culture. I do. My culture is Mexican, and we fry a lot of foods too. I get it. But when I became a nurse and learned about health and nutrition, I started trying ways to improve my traditional foods.
Patient: What do you mean? Like what?
Nurse: Well, for one thing, I use an air fryer now. So, I can still get the crispy coating on my food, but I don’t have to use all that oil.
Patient: An air fryer? I see them on TV sometimes. I’ve never tried it though. I always wonder if the food is actually crispy or if it’s fake for TV.
Nurse: It actually is. So, this is how I recommend you do this. Make gradual changes to your diet and exercise. Take small steps like trying your regular recipes in the air fryer instead of deep frying them. Do that first. Then we can try cutting back on your salt and increasing your fresh seasoning or even low sodium sauces and marinades. The key is to make small changes that will slowly improve your health without you having to abandon your traditional meals.
Patient: Ahhh, I see what you mean. I get it now. I don’t have to eat rabbit food. You know what, I think I’ll ask my daughter to lend me her air fryer this weekend. It’ll be cheaper without having to buy all that oil.
Environmental Factors
Environmental factors can significantly impact the risk of illness in individuals and populations. These factors can include physical, chemical, biological, and social factors that affect the quality of air, water, food, and the general environment (WHO, 2023b). Exposure to pollutants, such as particulate matter, formaldehyde, lead, and other toxic chemicals, can lead to respiratory problems, cancer, and other health problems. Poor sanitation, lack of access to clean water, and inadequate waste disposal can also increase the risk of infectious diseases. Climate change can worsen air quality, increase the frequency and intensity of extreme weather events, and lead to the spread of vector-borne diseases (WHO, 2023b). SDOH, such as poverty, education, and access to health care, can also influence the risk of illness. Understanding and addressing these environmental factors is critical in preventing and controlling illness and promoting public health.
Impact of Illness on Health Promotion
The impact of illness on health promotion can be significant, as an individual’s ability to engage in healthy behaviors may be hindered by their health condition. When someone is dealing with an illness, they may experience physical limitations, pain, fatigue, and emotional distress, which can make it difficult to adopt healthy habits such as exercise, eating a balanced diet, and managing stress. In addition, some medical treatments may also have side effects, such as dizziness, nausea, and vomiting, that can further impact an individual’s ability to engage in healthy behaviors. It is important for healthcare providers to take these factors into consideration and work with patients to create realistic and achievable health goals that take their illness and limitations into account. By working together to develop a personalized health plan, patients can still engage in health promotion activities that are appropriate for their condition and improve their overall well-being.
Emotions and Behavior
Illness can have a significant impact on a person’s emotions and behaviors (Levenson, 2019). Physical symptoms and limitations can lead to frustration, anxiety, and depression. Pain, fatigue, and discomfort can also make it difficult for individuals to engage in daily activities, leading to feelings of helplessness or hopelessness. These emotional states can further impact a person’s behavior, potentially leading to social withdrawal, decreased motivation, and changes in eating or sleeping habits. Additionally, illness can disrupt daily routines and responsibilities, leading to feelings of guilt or inadequacy (Levenson, 2019). It is important for healthcare providers to recognize and address the emotional and behavioral impact of illness on their patients. This may include providing emotional support, counseling, or referring patients to mental health specialists who can assist with the psychological and behavioral effects of illness.
Body Image and Self-Concept
Illness can have a significant impact on body image and self-concept. Physical changes resulting from illness or its treatment, such as hair loss, weight changes, and scars, can lead to negative body image and self-esteem issues (Cleveland Clinic, 2020). In addition, illness can disrupt daily routines and activities, which can affect a person’s sense of identity and purpose. This can be particularly challenging for those who have previously identified with their physical abilities or appearance. Illness can also lead to social isolation and decreased social support, which can further exacerbate feelings of low self-esteem and poor body image. Examples of how a change in body image can lead to social isolation can be found in the cases of amputees, burn patients, and patients with a colostomy bag. These patients have undergone medical procedures to save and improve their lives. When the body change is visible, as in the care of a burn victim or an amputee, the patient might retreat from social gatherings to avoid being gawked at or having to explain “what happened to me.” Therefore, healthcare providers should be aware of the potential impact of illness on body image and self-concept and provide support and resources to help patients cope and adjust to changes in their physical and emotional well-being.
Impact on the Family
The health of one family member can have a significant impact on the rest of the family. For example, if a family member is dealing with a chronic illness, it can be emotionally and physically taxing on everyone involved. Caregiving responsibilities can fall on other family members, which can add stress and strain to their lives. Additionally, if the ill family member requires frequent medical appointments or hospital stays, it can disrupt daily routines and create financial burdens. Furthermore, if the illness is genetic, other family members may be at a higher risk of developing the same condition, which can create anxiety and uncertainty. Overall, the health of one family member can have a ripple effect on the entire family unit.