Health Promotion

Abstract

Health promotion is one the major interventions employed in healthcare delivery generally and primary care in particular. Health promotion enables individuals, families, populations and communities to adopt and/or adapt lifestyles that promote and improve health. It helps the community members to make the right choices that can improve their health. Each individual, population and community have factors that influence their health either positively or negatively. Health promotion enables everyone in their context to identify these factors and increase control over these factors to empower them live a life that improves and promotes their health. This chapter explained health promotion actions, health promotion approaches, health promotion strategies and steps for effective implementation of health promotion programme.

1. Introduction

According to the Ottawa Charter, health promotion is ‘the process that enables people to increase control over their health and improve their overall health’. This can be achieved through education, building skills, and advocating change at the individual, family, and community levels. The responsibility for health promotion extends beyond the health sector and includes wellbeing. Health promotion activities focus on promoting good health and preventing illness, rather than focusing only on people who are at highest risk of developing certain diseases [1, 2, 3].

Promoting health is a series of actions; it is not promotion in the usual sense. Promoting health involves more than just telling people how they can take care of themselves. It also involves:

• informing individuals, families, and populations about what they can do to be healthy

• identifying characteristics of communities that influence people’s health or wellbeing

• supporting those who are most in need, so they can be helped

• assisting people in improving their control and health

• including all the people in the contexts of their daily lives

• activities that promote health and prevent ill health instead of focusing on specific groups at risk for disease

‘Health’ is defined by the World Health Organization as ‘complete physical and mental well-being, not only the absence of illness or infirmity’. To achieve a state that is complete in terms of physical, mental, and social wellbeing, an individual or group must have the ability to recognize and realize their aspirations, satisfy their needs, and adapt to changing environments.

Therefore, health can be described as:

• a resource for everyday living, not the goal of life

• a positive concept that stresses the importance of personal and social resources along with physical abilities

• being created and lived in daily lives; where one learns, works, and plays

• being capable of taking care of oneself and having control over one’s own life.

2. Prerequisite for health

To be healthy, each person, family, and community must have the right conditions and resources. A solid foundation is essential for health improvement and should include:

• peace

• shelter

• education

• food

• income

• a stable ecosystem

• sustainable resources

• social justice and equity

3. Fundamental principles for health promotion

3.1 Advocate

To advocate is to promote good health as a resource for personal, financial, and social development. All factors, including those that are political, economic, social, and cultural, as well as those that affect behavioral and biological behavior, can have a positive or negative impact on health. Through advocacy for health, stakeholders for health promotion make these conditions favorable.

3.2 Enable

Health promotion focuses on equity in health. Health promotion aims to reduce health disparities and provide equal opportunities and support to all people so that they can reach their full potential. This includes a safe foundation and supportive environment that provides information, life skills, and opportunities to make healthy choices. If people are not able take control of the factors that influence their health, they will not be able achieve their fullest potential. This is true for all people.

3.3 Mediate

Without the involvement of all stakeholders, the health sector cannot ensure that there are adequate health conditions and prospects. Importantly, health promotion requires coordination by all stakeholders, including the government, the health sector, other sectors and nongovernmental organizations, industry, local authorities, and media. Individuals, families, communities, and all walks of society are involved. The role of professionals and health personnel, as well as social and professional groups, is to help people reach common goals in the pursuit for health [1, 2, 3].

4. Health promotion action

According to the Ottawa Charter (1986), health promotion actions consist of:

1. Building healthy public policy

2. Creating supportive environments

3. Strengthening community actions

4. Developing personal skills

5. Reorienting healthcare services

4.1 Build healthy public policy

Being healthy is much more than being without sickness. Health promotion places health on the agenda of those that make policies in all sectors, directing them to be aware of the burden of diseases on individuals, families, populations, and communities. The consequences of policies on health should be well thought out before these policies are enacted.

Health promotion encompasses legislation, economic measures, taxation, and organizational structure. It is coordinated in a way that results in fitness, profits, and social regulations that foster fairness. Healthy public policies contribute to making sure there are securer and healthier items and offerings, healthier public services, and cleaner, more pleasurable environments.

Health promotion involves identifying limitations to the adoption of healthy public regulations in non-health sectors and approaches to removing them. The goal is to make the healthier choice more attractive to policymakers.

4.2 Create supportive environments

Our societies are complicated and interrelated. The inextricable connections among human beings and their surroundings constitute the premise for a socioecological approach to health. A guiding principle for communities worldwide is to take care of each other and the natural environment. Protecting and conserving natural resources as well as built environments is a global responsibility integral for promoting health.

Lifestyle, employment, and leisure have a sizable effect on health, and all of these facets of a person’s life should be a source of health. Health promotion should provide living and working conditions that are secure, stimulating, pleasurable, and fun. The world is currently experiencing rapid change in technology, urbanization, and energy use and production and thus systematic evaluation of how a rapidly changing environment affects individual health is critical.

4.3 Strengthen community actions

Health promotion works through concrete and powerful action among all actors in a community in identifying priorities, making decisions, choosing techniques, and implementing strategies to enhance health. At the centre of this process is the empowerment of groups and communities to understand their autonomy and control over their personal pursuits and destinies.

Community improvement calls for the use of existing human and material sources within the community network to improve and broaden flexible structures for strengthening public participation in health matters. This requires complete access to information, health education, and financial investment.

4.4 Develop personal skills

Health promotion helps individual and community development by providing information about health and illness and how to improve life skills. This increases the choices available to people to help them take more control of their personal wellbeing as well as their environments and to make good choices that benefit their health.

It is essential to enable individuals to prepare for all of life’s stages and the possibility of chronic illness and injuries. This must be facilitated in all settings of a person’s life, including at home, at work, and in community settings. Action is needed through instructional, expert, industrial, and voluntary bodies as well as in the establishments themselves.

4.5 Reorient health services

Health promotion is a shared responsibility among people, networks, corporations, health experts, healthcare providers and institutions, and governments. Everyone should work collectively to develop a healthcare service that contributes to the pursuit of full health. The function of the healthcare sector is not only to provide medical services but also to promote health and wellbeing. Health care should be sensitive to and respectful of cultural wishes to support individuals in the pursuit of a healthier life and open channels among the healthcare sector and broader social, political, economic, and physical institutions.

Reorienting health services additionally calls for more interest in health studies as well as adjustments in health curriculums and training. This will create a mindset and lifestyle of health services that focuses on the individual as a whole person [4, 5, 6].

5. Pillars of health promotion

The three pillars of health promotion, as declared at the 9th global conference for health promotion in Shanghai in 2016, are:

1. Good governance

2. Healthy cities

3. Health literacy

5.1 Good governance

Good health policies and equity are highly advantageous to society. Failures in governance are too regularly unfavorable to the pursuit of optimal health both for countrywide and globally. The United Nations Sustainable Development Goals (SDGs) provide universal recommendations for investing in all determinants of health. Governments have an essential duty to deal with the harmful outcomes of unsustainable manufacturing and consumption at local, national, and international levels. This consists of getting rid of economic regulations that create unemployment and dangerous working environments, and allowing advertising, funding, and legislation that enhance health. In addition, business leaders need to be cognizant of health in making company policies that do not value income over employee wellbeing. This is fundamental for disease prevention and health maintenance.

Mechanisms for promoting health include:

• public regulations

• strengthening legislation, regulations, and taxation of dangerous commodities

• implementing economic regulations as an effective device to allow new investments in fitness and health

• creating robust public fitness structures and introducing general fitness insurance as a green way for individuals to attain fitness and economic safety

• ensuring transparency and social duty and allowing the extensive engagement of civil society

• strengthening international governance to manage diseases of international importance

• strengthening and institutionalizing informal and traditional healthcare services for improving health outcomes

A key method for achieving the SDGs is to consider health in all policies. This is possible by having a vision for development without leaving anybody behind, that is, a world that is fair to all, prosperous, peaceful, and exists in a “green” sustainable environment. This situation requires transformed politics and governance through participatory governance, social mobilization, and community participation.

Actions to ensure governance include:

1. Integrating health as a central factor in all regulations and prioritizing regulations that contribute to promoting wellness.

2. Addressing all—social, fiscal, and environmental—determinants of health, implementing city plans and regulations that lessen poverty and inequity, and dealing with person rights and social inclusion.

3. Promoting robust community engagement, integrating health promotion activities in schools, workplaces, and other settings, creating an environment that promotes health literacy, and providing access to health information in communities.

4. Re-positioning health and other social services to the direction of fairness, ensuring unselective access to public services including health services to achieve health for all.

5. Conducting epidemiological studies and monitoring and evaluating evidence on health states and health determinants and disease burden, and using this information to inform policies, guidelines, and programme implementation.

5.2 Healthy cities

More than half of the world’s population lives in cities and this number is expected to grow. More now than ever people rely on urban amenities and infrastructure for living a healthy lifestyle.

Health is created within the settings of ordinary lifestyles, within neighborhoods and groups in which people live, work, and play. It is one of the only markers of a city’s sustainable improvement and contributes to making cities inclusive, secure, and resilient. As such, there is an urgent need for city leaders and authorities to deal with the adverse effects of rural-to-urban migration, economic stagnation, excessive unemployment and poverty, and environmental deterioration and pollution. People residing in cities are at greater risk of experiencing loneliness, unhappiness, stress, and mental health disorders.

Creating healthy cities calls for collaboration in promoting fitness and health and preventing disease. Cities are on the front line of sustainable improvement.

Urban ‘greening’ is an example of a transformative approach that promotes health and contributes to the implementation of the SDGs. Examples of greening include planting trees and creating parks, community gardens, living plant walls, and the like. Thus, it is crucial to prioritize regulations that:

• make policies that will be beneficial to the health and wellbeing of people in all sectors

• help cities promote fairness and social inclusion, harnessing the information, capabilities, and priorities of populations through robust network engagement

• re-organize social systems, including heath care, in a way that allows individuals and communities access to needed services

Actions to take to ensure healthy cities include:

1. providing citizens with schooling, housing, employment, and protection

2. implementing measures to remove pollutants from the air, water, and soil

3. investing in younger generations (No Child Left Behind) by offering education, health, and social programmes

4. ensuring the safety of vulnerable populations (migrants, refugees, homeless, etc.), protecting them from violence and harassment and providing them with housing and health care

5. dealing with all forms of discrimination

6. implementing vaccination programs, managing waste and vectors, and providing safe drinking water to prevent infectious disease

7. building cities with infrastructure that promotes walking, biking, and other healthy activities

8. providing access to low-cost healthy meals and safe drinking water, reducing sugar and salt consumption, and decreasing the dangerous use of alcohol through regulations, pricing, education, and taxation

9. banning smoking in indoor, public spaces and limiting or prohibiting tobacco advertising

5.3 Health literacy

Health literacy empowers people and encourages their engagement in collective health promotion. Health literacy is based on inclusive and equitable access to high-quality education.

Health literacy allows people to make more informed decisions about their health and the health of their families and empowers them to make recommendations to their political leaders and authorities. In this era of the Internet, many people regularly obtain their health information online. However, not all online information is accurate or reliable. As such, it may be helpful to consider policies to test unreliable or disputable facts.

It is crucial to:

• understand health literacy as a vital determinant of wellbeing and invest in its improvement

• broaden, enforce, and display intersectoral countrywide and local techniques for strengthening health literacy in all populations and in all instructional settings

• improve residents’ management of their personal health and its determinants

• ensure that business environments provide healthful alternatives through business regulations including commodities, standard regulations, consumer rights, and so on

Actions to enhance health literacy include:

• Expanding health promotion actions: One health promotion action can be used as a platform for other health activities thereby broadening the scope of the programme. This is an integrated approach to solve different health problems under a programme.

• Changing health promotion thinking: Connecting health promotion with activities of daily living is integral for health promotion. It entails linking peoples’ norms, culture, and responses to health promotion. Making people see health promotion as a way of everyday life is the whole essence.

• Sharing knowledge and information: Exchange of new knowledge and information helps in quality health planning and healthcare delivery across all levels of care. There are better opportunities for healthy living when new knowledge is shared with stakeholders and community members.

• Using new technologies: Use of innovative Information Technology (IT) facilities will help to reform health promotion activities in a way that target populations will be more interested in the programme. Such a transformative approach will increase access to health promotion activities leading to high heath literacy across population groups.

6. Strategies for health promotion

Caring, holism, and ecology are critical factors to consider when developing techniques for health promotion. Therefore, the ones worried must take as a guiding precept that, in every segment of making plans, implementation and assessment of health promotion activities, men and women must emerge as identical partners. The following are techniques for promoting health:

1. Health communication

2. Health education

3. Policy development

4. Systems change

5. Environmental change

6.1 Health communication

Conversations about health consist of verbal and written techniques to persuade and empower people, populations, and groups to make healthy choices. Effective health communication is related to social marketing and includes the following components:

• Use of evidence-based techniques to develop materials and products and to identify channels through which to deliver these products to individuals

• Understanding the traditional wisdom, concepts, language, and priorities for specific cultures and settings

• Consideration of health literacy, Internet access, media exposure, and cultural competency of target populations

• Development of brochures, billboards, newspaper articles, TV broadcasts, radio commercials, public provider announcements, newsletters, pamphlets, videos, digital tools, and other media

Using a variety of communication channels allow the dissemination of health messaging to individuals, communities, and institutions at both the local and national levels. Radio, television, newspapers, flyers, brochures, the Internet, social media, and so on can all be used to communicate health messages. Health communication can be used to alert people to health risks and dangers, reinforce healthy behaviors, influence social norms, increase availability of help and services, and empower people to improve their health.

6.2 Health education

Health education is a social science approach that integrates physical, medical, and other sciences to promote health and prevent illness. It can be delivered in a variety of ways, including through lectures, courses, seminars, workshops, webinars, classes, and so on. Characteristics of health education techniques include:

• Participation of the target population

• Carrying out a community needs assessment to identify community capability, resources, priorities, and wishes

• Planned educational activities that increase participants’ information and capabilities

• Using lessons and materials to implement a programme that participants can easily access

• Presentation of facts via multimedia such as videos, websites, software, and so on

• Training staff to ensure they adhere to the programme

6.3 Policy improvement

Policy is a device for promoting and supporting health and preventing disease. Policy decisions are made by organizations and stakeholders. Policy methods consist of legislative advocacy, economic measures, taxation, and regulatory oversight. Examples of health policies include:

• Establishing regulations for smoke-free zones

• Regulating food vendors to provide healthy options to the public

• Taxing unhealthy foods

• Requiring the use of safety equipment in work settings

6.4 Systems change

Systems change refers to an essential shift in the manner in which problematic issues are solved. Within a business enterprise, systems change impacts organizational intent, function, and connections through addressing organizational culture, beliefs, relationships, protocols, and objectives.

Examples of systems change in health promotion include:

• Developing plans for imposing new interventions and strategies

• Adapting or replicating tested and proven health promotion models

• Employing innovative technology

• Creating education, training, or certification programs that align with regulations and policies

6.5 Environmental change

Environmental techniques for promoting health involve fiscal, social, and environmental aspects that influence human health. Examples of environmental health promotion techniques include:

• Increasing the number of parks, greenways, and trails within a community

• Putting up signage that promotes the use of walking and biking paths

• Increasing the supply of fresh, nutritious food in schools, restaurants, and cafeterias [7]

7. Health-promoting approaches

Health promotion methods are primarily based on the idea that health and wellbeing encompass myriad complicated and interrelated elements, including a person’s behaviors, beliefs, practices, environment, community, and culture, as well as broader socioeconomic elements like legislation and economics.

There are several different approaches to promoting health. These include medical, behavioral, educational, empowerment, and social approaches.

7.1 Medical approach

This approach focuses on reducing morbidity and mortality. Activity is focused on whole populations or high-risk groups. This type of health promotion seeks to increase clinical interventions to prevent disease and early death.

The clinical method focuses on treatment of diseases to prevent complications and premature death. It targets individuals or groups who are exposed to diseases or those who are already sick. This approach is basically targeting people that are sick to ameliorate their sickness as such it is the center of medical intervention. In the approach, the professional has the responsibility to ensure people adhere to treatment regimens. In most instances, sick people do not have full information of the reasons for their actions, they carry out the health promotion actions because of the directives of the health professionals.

The clinical method to health promotion is unique because:

• It combines scientific evidence through epidemiological studies and medical strategies to manage diseases.

• Prevention and the early detection of sickness are more cost effective than treatment of existing diseases.

• It is a professional-led, or top-down, kind of intervention. This type of health promotion method reinforces the authority of clinical and health experts who are identified as having the professional knowledge about the disease and its management.

• There is enormous evidence on efficacious strategies for disease prevention and management used in health promotion.

The medical approach to health promotion has three levels of intervention:

1. Primary prevention – preventing the onset of illness and disease

2. Secondary prevention – preventing the progression of illness and disease

3. Tertiary prevention – mitigating further illness and suffering in those already ill

The principle of preventive services such as immunization and screening is that they target at-risk groups. Immunization only works if people get their vaccinations. Disease screening is offered to certain groups of people, for example, prostate screening is offered to men who are 55 to 69 years of age. Screening is only effective if the following conditions are met:

• The disease must have an extended preclinical stage so that screening will not miss the symptoms

• Earlier treatment will improve patient outcomes

• The screening test is sensitive, specific, and cost-effective

Preventive strategies should be based on epidemiological proof. The medical approach is predicated on having an infrastructure able to support screening and immunization programmes. This consists of educated personnel, laboratory facilities, information systems, and in the case of immunization, an effective and safe vaccine. It is obvious that the medical approach to health promotion is complicated procedure and may rely on national programmes or guidelines.

7.2 Behavioral approach

Making healthy choices can be complicated and requires self-motivation. A behavioral approach to health aims to inspire individuals to adopt healthy lifestyle behaviors, to use preventive health services, and to take responsibility for their own health. The behavioral approach is popular because it views health as an individual asset and, as such, it can be assumed that people have the ability to make good decisions to improve their health and make healthy lifestyle choices. This approach also assumes that people have only themselves to blame if they do not take steps to look after their health.

It is apparent that the relationship between people’s behavior and social and environmental factors is complicated. A person’s behavior may be outside of their control due to the conditions in which they live. For example, a person may be unemployed or living in poverty and thus unable to make healthy choices.

The behavioral approach has been undertaken by many health promotion agencies. For example, health campaigns promote quitting smoking, adopting a healthy diet, and regularly participating in physical activities. This method is focused on individuals although mass communication means may be used to reach them. The behavioral approach is typically a professional-led, top-down method, which highlights the divide between the health professional, who knows how to enhance fitness and wellbeing, and the general public who requires education and advice [8, 9].

In some instances, interventions can be directed to clients’ needs although these needs will also be identified by the health provider. The behavioral change method is primarily based on trying to change a person’s attitudes and behaviors so that they undertake a healthful way of life. For instance, health professionals teach clients how to take care of their teeth, how to prepare their daily food menu, how to lose weight, and so on. This approach underscores the importance of health workers to seize every opportunity to teach healthy lifestyles. However, while it is the duty of health workers to teach, people should also see living a healthy life as their responsibility.

Many healthcare professionals teach their clients about health and wellness via education and individual consultation. Patient education about a health condition or treatment may be used to ensure patient compliance to a certain regimen and thus is focused on the individual and providing them with useful and reliable information.

7.3 Educational approach

The purpose of the educational approach is to provide information and facts, and to develop relevant skills so that individuals can make knowledgeable choices about their health. This approach is different from the behavioral approach. It is not intended to motivate people to move in certain directions, although it does hope to lead them to an outcome. It is based on personal choice regardless of whether the choices made are agreeable to the healthcare promoter.

The goal of the educational method is to offer people facts and encourage them to make their own decisions about their health behavior. Educational interventions require the promoter to understand the concepts the person is studying as well as any factors that assist or preclude the studying.

Psychological theories of learning identify three aspects:

1. Information and understanding (cognition)

2. Attitudes and feelings (affect)

3. Skills (behavior)

The educational method is based on the premise that access to information can help change and modify behavior. When a person is knowledgeable, they are capable of making clear choices acceptable to both health experts and the public.

The educational approach to health promotion involves offering facts to assist people in making informed decisions about their health behavior. This can be accomplished through distribution of materials that contain health information, presentation of health topics, and counseling.

Education offers possibilities for individuals to discuss and discover their attitudes about their personal wellness. Educational programmes may broaden individuals’ decision-making capabilities through drama or program designed to discover alternatives. In the educational method, individuals may have the opportunity to role play real-life situations to solidify what they are learning. Educational programmes are typically led through a trainer or facilitator.

7.4 Empowerment approach

Within the context of health promotion, empowerment may be understood as a procedure through which human beings are allowed to control and manage their health and things affecting their health. An empowerment method seeks to allow people as individuals as well as collectively to develop their ability to control their own health status and make their own health decisions. This method focuses on helping people develop decision-making and problem-solving skills and encouraging them to engage in critical thinking and critical action.

In this method, the health expert works with individuals or groups to assist them in identifying what they need to recognize and act on in their body and environment. Then, based on their knowledge and wishes, to make decisions. The function of the health expert is to behave as a facilitator. They assist individuals in identifying their concerns and help them acquire the information and capabilities needed to make adjustments. Empowerment of individuals and communities is vital in health promotion. Individuals or groups have information, capabilities, and competencies to make contributions and decisions. They also have an absolute power to govern their personal health.

7.5 Social change approach

Rather than changing the conduct of individuals, the social change approach focuses on changing societal behavior (physical, economic, and social environments).

The social change approach is concerned with adjusting the physical, social, and fiscal environment to create enabling environment for building health promotion capacity.

Rather than changing the conduct of individuals, the social change approach focuses on changing societal behavior (physical, economic, and social environments). Those that wish to use this method will cause their democratic principles and processes to change the society. The policy makers would place health at the political timetable at all levels in a way that there will be concerted effort to significantly improve the environment where people reside, work, and play to be healthy. This method assumes that if the healthier option is made the less complicated option, people will be more likely to make the healthy choice. Therefore, health promotion is consequently a social and political procedure that regards health as a human right and considers the protection of population health to be a prerequisite for social progress.

8. Health promotion in medical settings

It is essential for all health professionals to integrate health promotion goals and principles in their practice. This section uses the field of nursing as an example of how to incorporate health promotion in medical settings.

8.1 Medical or preventive approach

As previously discussed, the medical approach to health promotion has three levels of intervention:

• Primary prevention – preventing the onset of illness and disease

• Secondary prevention – preventing the progression of illness and disease

• Tertiary prevention – mitigating further illness and suffering in those already ill

Nurses work very closely with sick persons in medical facilities and sometimes even with entire populations or groups who are at risk of sickness. In communities, schools, and industries, nurses have the platform to apply the clinical or preventive method to reduce mortality. It is imperative for nurses to use nursing capabilities in prevention and control of disease.

Nurses who work in this method of health promotion can be involved in immunization programmes, screening for diseases like cancers, or administering medication to individuals in palliative care settings. This method of health promotion also assumes the clinical version of health, which adopts a systematic view of the body whereby the part of the body system can be affected to disorganize the system. This systemic effect can be seen as signs and symptoms of the diseases and the medical approach will just target those signs and symptoms of the diseases. Additionally, sick people are expected to adhere to the instructions of the health expert and conform to treatment regimen for this approach to be effective. This method is in support with a conventional clinical hierarchy that regards the healthcare professional as an expert and the affected person as a clinical subject.

8.2 Behavioral approach

In this approach, nurses are engaged in sensitization and education of people and groups about healthy lifestyles. The behavioral approach makes the essential assumption that the way an individual lives in terms of eating, sleeping, exercising, and so on is critical to being and staying healthy. Nurses who undertake the behavioral method of health promotion offer sick people information about lifestyle and how it affects health, and they encourage individuals to make healthy choices.

8.3 The educational approach

Nurses can also help sick people to broaden their health literacy capabilities and allow them to make significant adjustments to enhance their wellness. The educational method to health promotion assumes that providing people with information about their health will cause more healthy behavior. Nurses who undertake an educational method to health promotion offer individuals and groups information and facts concerning their health, allowing them to make informed decisions. In this method, the information about health is detailed and robust to allow the individual or group to have a clear understanding of the whole situation. This differs from the behavior change method in that the nurse does not try to encourage the person to change their behavior to a pre-determined pattern, but rather supports the individual to make an informed decision based on available information. One crucial result of the educational method is health literacy, which refers to personal, cognitive, and social capabilities that decide the capacity of people to access, comprehend, and use health information to promote and maintain good health.

8.4 The empowerment approach

Nurses are trained to offer nursing services in diverse settings including health facilities, communities, schools, businesses, and so on. The first step in the nursing process in all levels of care is assessment. As such, nurses have information of the socio-cultural background and wishes of individuals and groups, which positions them to empower people in improving their health. For instance, the community health nurse empowers community members to manage their health using what they have in their community. This is possible because nurses will first undertake community assessment and identify their strengths, weaknesses, opportunities, and threats. With this robust data from the community, the nurse will show the community members how to be healthy within their context, and community members are able to live their lives within the community without being sick. Moreover, even at the facility level, by enhancing open conversation with sick persons and their families, nurses are capable of eliciting expressed wishes and available resources that help to broaden personalized care plans. Through therapeutic communication and empathy, nurses can enhance the intellectual wellness of sick people. Nurses are also engaged in industries and schools where they empower management, staff, and students to live healthy lives.

8.5 The social change approach

Nurses recommend for social change that is informed by individual/community assessment and epidemiological reports. Social change includes adjustment of the physical, social, and economic surroundings where people live, work, and play to promote human health. For instance, an occupational health nurse advocates for safe work environments, including provision of personal protective equipment. This method also entails advocacy for the community, which will be taken to the public as well as policy makers.

This method assumes that that if the systems where people live, work, and play are structured for healthy living, people are more likely to make the right choices for healthy lifestyles. Health promotion is a social and political procedure that regards fitness as a human property and considers the protection of population health to be a prerequisite for social progress. Nurses can successfully cause social change for health promotion through advocacy and collaboration. Assessment, which is the first step, provides the platform to obtain complete records that may be informative for social change [8, 9].

9. Developing a health promotion programme for the community

There are eight steps to developing and implementing a health promotion programme:

• Step 1: Manage the plan

• Step 2: Assess the community

• Step 3: Identify goals, population of interest, outcomes, and objectives

• Step 4: Identify strategies, activities, outputs, process objectives, and resources

• Step 5: Develop indicators

• Step 6: Review the programme plan

• Step 7: Implement the plan

• Step 8: Determine results and impact

9.1 Step 1: management of the plan

The objective of this step is to develop a plan to control stakeholder participation, timelines, and resources, and decide strategies for gathering and interpreting data and making decisions. It involves interacting with stakeholders, establishing a timeline, planning allocation of funds and other resources, obtaining records and data for decision-making, and establishing a decision-making procedure through consensus or committee.

9.2 Step 2: conduct a situation analysis

This step examines the current situation of the community and its characteristics, population, trends, and problems that can influence implementation of the programme. It consists of identifying the wants, wishes, strengths, and weaknesses of the community. This step entails the use of records and data obtained through a variety of means, including interviews, surveys, testimonials, guidelines, regulations, polls, research, literature reviews, and so on, to determine the following:

• the present state of the community

• what’s making the state of the community better and what’s making it worse

• what viable moves can be made to deal with the situation

9.3 Step 3: identify goals, populations of interest, outcomes, and outcome objectives

The purpose of this step is to apply situational evaluation to identify the goals, target population, desired outcomes, and results of the programme. This step consists of:

• Identifying achievable goals: This is price statements outlining what the programme will achieve both at short term and long term.

• Identifying target population: this is a population groups like women of child bearing age, the adolescent, university students and so on that needs the specified health promotion programme.

• Outlining expected outcomes: this refers to short statements specifying the preferred changes that could be due to this program.

• Ensuring that program goals, target populations and expected outcomes of the health promotion programme are aligned with strategic plans of your institution.

These will assist to contextualize the health promotion programme to make sure that it is applicable and sustainable for the community.

9.4 Step 4: identify strategies, activities, outputs, process objectives, and resources

This step involves choosing strategies through brainstorming and situational analysis. At this point, having a clear picture of ‘where you want to go’ (see Step 3) will help you ‘how to get there’. This entails outlining techniques, methods, and activities that will contribute to achieving the goal and objectives of the programme.

• Use of brainstorming techniques. For instance, asking team members to suggest strategies such as health education, health communication, organizational change, and policy improvement for accomplishing goals.

• Use of situation analysis reports to prioritize thoughts from team members.

• Identify unique activities for every approach, including when to start the activity, how long it will run, and when to end each activity.

• Determine outputs (both targets and final outputs) and establish process objectives that you will assess during process evaluation.

• Consider economic, human, and material resources available for the programme.

9.5 Step 5: develop indicators

This step involves developing a list of variables that may be tracked to evaluate the degree to which results and goals are met. To accomplish this, goals should be tested to make sure they are legitimate, reliable, and attainable. Certain goals may need to be subdivided into individual tasks. As such, the indicators that will be used to check the process and outcome of the programme must be clearly described and the validity, reliability, and accessibility of the proposed indicators checked.

For every final result and process goal, there is a need to consider the following:

• the expected end result

• whether or not the expected end result may be divided into separate components

• if the expected end result can be measured

• if there will be suitable time to achieve the end result

• if the required records will be available and accessible

• if the resources needed for checking these results are available

9.6 Step 6: review the programme plan

In this step, the plan for the programme is reviewed and assessed. The reason for this step is to make clear the contribution of every aspect of the plan to the overall programme’s goals, to identify any gaps, and to ensure the programme’s efficiency and applicability. It is crucial to apply good judgment at this stage.

The plan is reviewed to decide whether:

• techniques successfully contribute to predetermined goals and objectives

• short-term goals contribute to long-term goals

• the most appropriate activities have been selected

• activities are suitable for the audience

• resources are good enough to enforce the activities

9.7 Step 7: implement the plan

This in the step in which the programme is implemented. For a community health programme, it is crucial to make sure community participation is embedded within the programme throughout all stages of implementation. Community participation is the active involvement of human beings from groups and/or communities to ensure acceptance and utilization of the programmme. True community participation entails the involvement of community members in all phases of programme planning and implementation, including community analysis, decision-making, and programme implementation.

9.8 Step 8: Results and impact

This step assesses the programme for its effectiveness, efficiency, fairness, and acceptance. The consequences and effects of the programme are critical benchmarks for assessing programme planners and managers. The programme planners will propose and choose the techniques for assessment to examine the status of the health promotion programme. The results and effects will decide whether the programme is sustainable and can be adapted to other groups [10, 11].

10. Conclusion

Health promotion is a primary technique for ensuring health for all regardless of socioeconomic and geographic status. There is a need to enhance health promotion activities in all areas of healthcare services.