8: Health Promotion and Health Communication

Health Promotion and Health Communication

Beverly Isman, RDH, MPH, ELS

Opening Statements

Challenges to Promoting Oral Health

• Despite years of research on prevention of oral diseases, very little is known about how best to promote oral health.1

• More community-based participatory research, in which community members are involved at all stages, and more interdisciplinary research, with nondental behavioral scientists, might shed more light on effective strategies.

• More evidence is needed to document that changes in attitudes and beliefs about oral health lead to improved oral health outcomes.

• Improved knowledge levels alone rarely translate into healthy behaviors, so approaches need to be designed around proved behavioral theories.

• Most behavioral change that occurs after oral health education or promotion is short term and not sustained without periodic reinforcement. What does it take to create sustainable changes?

• Today, dental hygienists have unique and unlimited opportunities to become involved in community health activities and research and to contribute to the development of a better understanding and application of effective oral health promotion and communication approaches.

The main goal of this chapter is to help dental hygienists incorporate a thought process for assessing needs, forming evaluation questions, and planning communication strategies before jumping to implement what seems like a “good idea.”

Health Promotion

The World Health Organization defines health as a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. Health is a personal resource that permits people to lead productive lives.2 Health promotion is a broad concept that refers to the process of enabling people and communities to increase their control over various determinants of health (see Chapter 3) and therefore to improve their own health. Health promotion introduces the role of behaviors, not just attitudes and knowledge, into the health equation and goes beyond a focus on individual behavior toward a wide range of social and environmental interventions. Health promotion goes beyond health education and links oral health to other health issues. Thus this chapter focuses on the concepts of oral health promotion, strategies to effect behavioral and community changes, and the dental hygienist’s role in communicating health messages to other health professionals and the public.

The Ottawa Charter, a global health promotion imperative, identifies three basic health promotion strategies: (1) advocating for health, (2) enabling people to achieve their full health potential, and (3) mediating different societal interests in pursuit of health. The following five action steps can help achieve these strategies:

All of these steps have direct relevance to oral health, the health promotion theories enumerated in this chapter, and health care reform efforts in the United States and other countries.

Oral health promotion efforts can increase use of oral health and wellness services and preventive self-care measures. The anticipated outcome of these efforts is a reduced incidence and severity of oral diseases with improved oral health and overall health. Yet, as we see in the challenges in the Opening Statement, applied research relating to oral health promotion is still in its infancy and not yet well integrated or coordinated with research and theories developed by other health disciplines.

Health Promotion Theories

When promoting health and preventing disease, theories help us analyze and interpret health problems and then plan and evaluate interventions. What is a theory? A theory is a set of interrelated concepts, definitions, and propositions that present a systematic view of events or situations by specifying relations among variables to explain and predict the events or situations.3

A theory is an abstract notion that comes to life only when it is applied to specific topics and problems. Sometimes, theories are called conceptual frameworks or models. The best way to remember each theory is to focus on key concepts such as readiness to change, susceptibility to health risks, or how innovations are adopted.

How can theories be applied to dental hygiene practice and public health practice? Every day, dental hygienists face challenging situations that result in oral health problems such as families who feed their babies cariogenic liquids in baby bottles, athletes who sustain oral injuries because they refuse to wear a mouth guard, adults who say they are too busy to follow oral care recommendations, or administrators who eliminate school-based dental sealant programs but retain orthodontic screening programs. Theories can help us analyze these situations and apply solutions that have been effective in similar circumstances.

Traditionally, dental hygienists have viewed oral health problems primarily as the “patient’s” problem and have proceeded to “educate” the patient about how to improve oral health. This approach is doomed to failure because it skips directly to a generic intervention and does not assess or validate the patient’s point of view or health beliefs and does not consider the environmental, literacy, or cultural circumstances that have influenced the person’s attitudes, beliefs, or health practices. It is important to analyze oral health problems from more than one perspective and to understand how each perspective affects the others.

Behavior that leads to improved oral health can be affected at three levels:

The following section describes selected health promotion theories that relate to these three levels and that have the most relevance to oral health issues. An overview of the six selected theories is provided in Box 8-1. A narrative of each theory, including an oral health example, is accompanied by a table that contains key concepts, definitions, and general applications. For easier reading and to select theories that are most relevant to situations you may encounter, there is an overview table of additional theories with their focus and key concepts in Glanz and Rimer, which is available online.3

Intrapersonal Level

Stages of Change Theory (Transtheoretical Model)

Initially developed by Prochaska and DiClemente, the Stages of Change Theory views change as a process or cycle that occurs over time rather than as a single event. This theory allows the dental hygienist to assess a person’s readiness to change a behavior toward a more healthful lifestyle such as daily brushing to prevent gingivitis. The theory assumes that at any point in time everyone is at a different stage of readiness to make lifestyle changes and that people cycle through the various stages over time, depending on the behavior to be changed and whether the environment is supportive. The major stages of this model with definitions and applications are outlined in Table 8-1.

Table 8-1

Stages of Change Theory (Transtheoretical Model)

Concept Definition Application
Precontemplation Being unaware of problem; not having thought about change. Increase awareness of need for change; personalize information on risks and benefits.
Contemplation Thinking about change in the near future. Motivate and encourage to make specific plans.
Decision/determination Making a plan to change. Assist in developing concrete action plans or setting gradual goals.
Action Implementing specific action or plans. Assist with feedback, problem solving, social support, and reinforcement.
Maintenance Continuing desirable actions or repeating periodic recommended steps. Assist in coping, using reminders, finding alternatives, avoiding slips or relapses.

Adapted from Glanz K, Rimer BK. Theory at a Glance: A Guide for Health Promotion Practice. Bethesda, MD: National Institutes of Health; 2005.

Health Belief Model

Originated by Rosenstock and others in the 1970s to explain people’s use of preventive health services, the Health Belief Model allows us to assess perceptions of how susceptible one is to a health risk and whether one believes that recommended preventive behaviors will result in less susceptibility.

One application of the Health Belief Model is to develop messages that are likely to persuade people to make decisions to improve their oral health. The components of the model and some applications are shown in Table 8-2. The primary hypothesis is that increased perception of severity and susceptibility to a disease results in an increased probability of taking action. Perceived ability to take action and cues to action are important factors.

Table 8-2

Health Belief Model

Concept Definition Application
Perceived susceptibility One’s opinion of chances of getting a condition Define population at risk and risk levels; personalize risk based on a person’s features or behavior; heighten perceived susceptibility if too low.
Perceived severity One’s opinion of how serious a condition and its sequelae are Specify consequences of the risk and the condition.
Perceived benefits One’s opinion of the efficacy of the advised action to reduce risk or seriousness of impact Define action to take: How, where, when; clarify the positive effects to be expected.
Perceived barriers One’s opinion of the tangible and psychologic costs of the advised action Identify and reduce barriers through reassurance, incentives, and assistance.
Cues to action Strategies to activate readiness Provide how-to information; promote awareness, send reminders.
Self-efficacy Confidence in one’s ability to take action Provide training and guidance in performing action.

Adapted from Glanz K, Rimer BK. Theory at a Glance: A Guide for Health Promotion Practice. Bethesda, MD: National Institutes of Health; 2005.

Interpersonal Level

Social Learning Theory

The Social Learning Theory posits that people learn primarily in the following four ways:

The basic premise of this theory, developed by Bandera and sometimes known as the Social Cognitive Theory, is that people learn through their own experiences, by observing the actions of others, and by the results of these actions. Behavioral change is accomplished through the interaction of personal factors, environmental influences, and individual behaviors. Self-efficacy and self-confidence are important concepts. Table 8-3 lists the relevant definitions and applications of the major concepts.

Table 8-3

Social Learning Theory (Social Cognitive Theory)

Concept Definition Application
Reciprocal determinism Behavioral changes result from interaction between the person and the environment; change is bidirectional Involve the individual and relevant others; work to change the environment, if warranted.
Behavioral capability Knowledge and skills to influence behavior Provide information and training about action.
Expectations Beliefs about likely results of action Incorporate information about likely results of action in advance.
Self-efficacy Confidence in ability to take action and to persist in action Point out strengths; use persuasion and encouragement; approach behavioral change in small steps.
Observational learning Beliefs based on observing others like oneself and/or visible physical results Point out others’ experience and physical changes; identify role models to emulate.
Reinforcement Responses to a person’s behavior that increase or decrease the chances of recurrence Provide incentives, rewards, praise; encourage self-reward; decrease possibility of negative responses that deter positive changes.

Adapted from Glanz K, Rimer BK. Theory at a Glance: A Guide for Health Promotion Practice. Bethesda, MD: National Institutes of Health; 2005.

Community Level

Community Organization Theory

Community Organization Theory is the process of involving and activating members of a community or subgroup to identify a common problem or goal, to mobilize resources, to implement strategies, and to evaluate their efforts. People usually refer to this process as empowerment. This is a grassroots approach to health promotion, rather than an effort that is initiated and conducted by health professionals. Table 8-4 outlines the key components.

Table 8-4

Community Organization Theory

Concept Definition Application
Empowerment Process of gaining mastery and power over oneself or one’s community to produce change Give individuals and communities tools and responsibility for making decisions that affect them.
Community competence Community’s ability to engage in effective problem solving Work with community to identify problems, create consensus, and reach goals.
Participation relevance Learner should be active participant and work starting “where the people are” Help community set goals within the context of preexisting goals, and encourage active participation.
Issue selection Identifying winnable, simple, and specific concerns as focus of action Assist community members in examining how they can communicate the concerns and whether success is likely.
Critical consciousness Developing understanding of root causes of problems Guide consideration of health concerns in broad perspective of social problems.

Adapted from Glanz K, Rimer BK. Theory at a Glance: A Guide for Health Promotion Practice. Bethesda, MD: National Institutes of Health; 2005.

Oral Health Example

Consider the role of a church pastor and a congregation in oral health promotion. Church members notice that many of the elders have stopped coming to church suppers because they have lost their teeth and are embarrassed to eat in public. The pastor calls the dental school for help, and the congregation raises money to help defray the cost of examinations and dentures for the elders. Dental and dental hygiene student teams work together to assess each elder’s needs and to fabricate and fit the dentures. They also discuss oral health, denture care, and the challenges of eating with dentures. Gradually, the elders become comfortable eating and speaking with the dentures, and they resume their attendance at church suppers. The following year, the church leaders continue to work with the student teams to promote oral health to people of all ages within their parish.

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Jan 1, 2015 | Posted by in Dental Hygiene | Comments Off on 8: Health Promotion and Health Communication

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