1.2 Health Promotion

Health promotion is defined by the World Health Organization as “the process for enabling people to increase control over and improve their own health. It moves beyond a focus on individual behavior towards a wide range of social and environmental interventions. As a core function of public health, health promotion supports governments, communities, and individuals to cope with and address health challenges. This is accomplished by building healthy public policies, creating supportive environments, and strengthening community action and personal skills.”^[1]

Social Determinants of Health

As previously mentioned in the World Health Organization’s definition, health promotion moves beyond a focus on individual behavior towards a wide range of social and environmental conditions, also referred to as social determinants of health. Social determinants of health (SDOH) are the conditions in which people are born, grow, work, live, and age. SDOH have a major impact on people’s health, well-being, and quality of life. Examples of SDOH are as follows^[2]:

• Safe housing, transportation, and neighborhoods
• Racism, discrimination, and violence
• Education, job opportunities, and income
• Access to nutritious foods and physical activity opportunities
• Polluted air and water
• Language and literacy skills

Research shows that the SDOH can be more important than health care or lifestyle choices in influencing health and account for 30-55% of health outcomes. See an illustration of SDOH in Figure 1.1.^[3] SDOH can contribute to health inequities, defined as avoidable differences in health status seen within and between communities.^[4] When providing health teaching, nurses must consider clients’ SDOH and build on their strengths, as well as address potential barriers for health and learning.

Healthy People 2030

Healthy People 2030 is published by the United States Department of Health and Human Services Office of Disease Prevention and Promotion and addresses the most current national public health priorities. Health literacy is a central focus of Healthy People 2030 with an overarching goal of, “Eliminating health disparities, achieving health equity, and attaining health literacy to improve the health and well-being of all.”^[5]

Healthy People 2030 defines personal health literacy as the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.^[6]

Health information can be difficult to understand, and the health care system is complex. Nurses can provide health teaching that is easier to understand for clients by completing the following actions^[7]:

• Use proven strategies, such as answering questions in simple, nonmedical language and using written materials designed for the intended audience.
• Realize that while everyone can have trouble understanding complex health information, certain populations are at higher risk for difficulty understanding. The elderly, English-language learners, and those who have difficulty with math and reading comprehension are at even greater risk for lack of understanding that can result in poor health outcomes. Health teaching and client understanding can be improved if the nurse teaches with the assumption that everyone is at risk for misunderstanding.
• Use health literacy strategies to encourage health care consumers to take part in decisions about testing, treatment, and procedures. This helps people make health care decisions that fit their values, goals, preferences, and circumstances.
• Take time to listen with respect and make information easy to understand. Checking to make sure the information is understood is vital for making sure the health care consumer is informed.
• Help people achieve their personal health goals, whether that means engaging in a healthy lifestyle, managing a chronic health condition, or taking precautions to avoid getting sick.

Health Promotion Topics

Health promotion focuses on primary prevention (i.e., preventing illness and injury), secondary prevention (i.e., early detection of disease), and tertiary prevention (i.e., helping clients reduce the severity of disease and/or altered functioning, also referred to as “rehabilitation”).^[10] Examples of health teaching topics for these categories that are provided by nurses include the following:

• Prevent illness/injury (primary prevention)
  • Preventing illness with good nutrition, physical activity, stress management, immunizations, lifestyle modifications to reduce risk, parent education about children’s growth and development, fertility control, and resources within the community to maintain wellness
  • Teaching about cardiac risk factors
  • Teaching specific protective measures such as seat belts, helmets, car seats, condom use, and sunscreen use
  • Providing preoperative and postoperative teaching to prevent complications and enhance recovery

• Early detection of disease (secondary prevention)
  • Providing information about diagnostic testing, medical diagnoses, treatment, and medication
  • Encouraging screening tests such as a mammogram, PAP smear, and colonoscopy
  • Promoting preventive health screening (blood glucose, cholesterol)

• Adapt to altered health and functioning (tertiary prevention)
  • Promoting self-care skills to manage chronic diseases at home
  • Sharing community resources like support groups
  • Teaching about assistive devices
  • Teaching strategies to manage current medical problems (for example, diabetic education, colostomy care, and wound care at home)
  • Encouraging coping strategies (for example, coping with fear and/or anxiety related to terminal cancer, future surgeries, or other invasive medical treatments)
  • Providing grief and bereavement counseling