The Open Public Health Journal




ISSN: 1874-9445 ― Volume 14, 2021
PERSPECTIVE ARTICLE

The Connection between Health Promotion, Prevention, and Psychosocial Health: An Innovative Action Model



Tannys Helfer1, *, David Faeh2, Eefje Luijckx3, Sibylle Frey4, Annemarie Berg5, Karin Anne Peter1
1 Department of Health Professions, Applied Research & Development in Nursing , Bern University of Applied Sciences, Bern, Switzerland
2 Department of Health Professions, Division of Nutrition and Dietetics, Bern University of Applied Sciences, Bern, Switzerland
3 Department of Health Professions, Division of Physiotherapy, Bern University of Applied Sciences, Bern, Switzerland
4 Department of Health Professions, Division of Nursing, Bern University of Applied Sciences, Bern, Switzerland
5 Department of Health Professions, Division of Midwifery, Bern University of Applied Sciences, Bern, Switzerland

Abstract

The promotion of psychosocial health among individuals, groups, and society is becoming an increasingly important task and research topic in the field of public health. Psychosocial health is a complex interaction between the psyche of an individual and the social environment in which that individual lives. Promoting psychosocial health is often challenging and complex for health care professionals. Therefore, an important question of public health significance is: how can we address and improve the psychosocial health of individuals, groups, as well as society in general?

An interdisciplinary team of specialists at the Department of Health Professions at the Bern University of Applied Sciences, Switzerland, focused on the connection between health promotion, prevention, and psychosocial health. This team newly defined these topics in relation to how they could be synergistically combined to promote psychosocial health. Additionally, they presented an action model to graphically depict their connection.

The proposed action model is based upon already well-established concepts, models, frameworks in health promotion, and prevention practice. In a further step, they have depicted them in a way that clearly integrates and combines their core concepts for their practical application in promoting psychosocial health. As these topics are overlapping, their clear illustration is important in promoting their systematic and planned usage.

This new and innovative approach encourages the systematic usage of health promotion and prevention for the promotion of psychosocial health. The next step would be the implementation and evaluation of this action model, especially the measurement of the outcome (psychosocial health). The integrative and intentional use of health promotion and prevention is an innovative approach for the promotion of psychosocial health in public health practice.

Keywords: Health promotion, Prevention, Psychosocial health, Action model, Public health, Systematic health promotion.


Article Information


Identifiers and Pagination:

Year: 2020
Volume: 13
First Page: 850
Last Page: 855
Publisher Id: TOPHJ-13-850
DOI: 10.2174/1874944502013010850

Article History:

Received Date: 18/06/2020
Revision Received Date: 29/10/2020
Acceptance Date: 17/11/2020
Electronic publication date: 31/12/2020
Collection year: 2020

© 2020 Helfer et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


* Address correspondence to this author at Department of Health Professions, Applied Research & Development in Nursing , Bern University of Applied Sciences, Bern, Switzerland; Tel: +41318483760; Fax: +41318483501; E-mail: tannys.helfer@bfh.ch





1. INTRODUCTION

The promotion of psychosocial health among individuals, groups, and society, is becoming an increasingly important task and research topic in the field of public health. Issues potentially affecting one’s psychosocial health include, for example, workload and competition at work, demanding family life, rising health care costs, along with social inequality and insecurity [1Larson JS. The World Health Organization’s Definition of Health: Social Versus Spiritual Health. Soc Indic Res 1996; 38: 181-92.
[http://dx.doi.org/10.1007/BF00300458]
]. Psychosocial health is a complex interaction between the psyche of an individual and the social environment in which a person lives [2Martikainen P, Bartley M, Lahelma E. Psychosocial determinants of health in social epidemiology. Int J Epidemiol 2002; 31(6): 1091-3.
[http://dx.doi.org/10.1093/ije/31.6.1091] [PMID: 12540696]
, 3McCubbin M, Labonte R. Toward psychosocial theory for an integrated understanding of the health and well-being of populations. Ethical Hum Sci Serv 2002; 4(1): 47-61.]. See video (Definition of psychosocial health) in the Supportive/Supplementary Material section of this article. A number of factors that have a major impact on the health of individuals/groups are social in nature. For instance, the neighborhood in which one lives, a change in occupation, or having to migrate to a new country could all have an impact on one’s health. These factors are often out of an individuals’ direct control; however, they can either positively or negatively affect one's health. Promoting psychosocial health is often challenging and complex [4Siegrist J, Marmot M. Health inequalities and the psychosocial environment-two scientific challenges. Soc Sci Med 2004; 58(8): 1463-73.
[http://dx.doi.org/10.1016/S0277-9536(03)00349-6] [PMID: 14759690]
]. Therefore, an important question of public health significance is: how can we address and improve the psychosocial health of individuals, groups, as well as society in general? Healthcare professionals and public health authorities can positively influence the psychosocial health of individuals, groups, and communities who they are supporting.

2. MAIN TEXT

An interdisciplinary team of specialists at the Department of Health Professions at the Bern University of Applied Sciences, Switzerland, focused on the connection between health promotion, prevention, and psychosocial health. This team newly defined these topics in relation to how they could be synergistically combined to promote psychosocial health. A practical E-learning program was developed to promote their integration at this university. In this article, these newly established definitions, as well as an action model, will be introduced.

2.1. Definitions

The proposed definitions (Table 1) delineate that health promotion and prevention can be distinguished conceptually, as their approaches to health and illness differ from one another. While health promotion aims at improving/promoting health and resources (salutogenesis), prevention focuses on avoiding disease and its associated risk factors. In practice, however, health promotion and prevention often have the same goal, which is to improve or maintain the health and health competencies of the population. Consequently, they have been combined in the targeting of psychosocial health. Health promotion focuses on strengthening the personal resources of individuals and groups as well as improving the resources present in the social environment. Primary prevention targets detecting and reducing the risk of an illness from occurring (e.g. from unhealthy behavior or detrimental environments). Secondary and tertiary prevention focus their interventions on reducing the negative consequences of symptoms or diseases. The aim of quaternary prevention is the identification of patients’ risk for over-medicalization. Primordial prevention focuses on the avoidance of the development of risk factors, which have not yet occurred (e.g. early childhood health programs to avoid disease later in life). The combined support of health promotion and prevention positively impacts the psychosocial health of individuals, groups, and societies.

Table 1
Defining psychosocial health, health promotion and prevention for health professions (including the relationship between them).


Fig. (1)
Health promotion, prevention, and psychosocial health: An innovative action model, Bern University of Applied Sciences, Switzerland, 2020.


2.2. Action Model

In order to depict how health promotion and prevention could be systematically utilized to promote the psychosocial health of individuals, groups, and society, a novel action model was developed (Fig. 1). This action model is designed to guide health professionals and authorities in promoting psychosocial health amongst their target groups. In this graphic, health promotion and prevention are encircled together with a dotted line, which depicts that they are meant to be utilized jointly. Situated between health promotion and prevention are two grey triangles. They represent the interdependence that salutogenesis has with health promotion and prevention. The triangle connected to health promotion illustrates that it focuses on what makes people healthy; whereas, the triangle connected to prevention symbolizes that it focuses on avoiding what makes them ill.

The sun-like symbol in the middle of the graphic depicts the significance and interconnectedness that the Determinants of Health have in relation to health promotion, prevention, and psychosocial health. The Determinants of Health are often social in nature, and therefore, impact the health of all individuals living in the surrounding environment [5Dahlgren G, Whitehead M. Policies and strategies to promote social equity in health. Background document to WHO-Strategy paper for Europe. Institute for Futures Studies 2007; 69.]. Examples of the social Determinants of Health include the physical environment, social network, education and health literacy, employment opportunities, and the healthcare system [6World-Health-Organization. Social determinants of health: The solid facts. Centre for Urban Health WHO, Regional Office for Europe 1998.]. Thus, improvement in these social determinants of health are a key focus of health promotion and prevention strategies. The circles surrounding the graphic portray how this action model can be utilized at all population health levels (individual, group, community, global).

The arrow with “outcome” written inside is the “action” part of the model. It depicts how health promotion and prevention actions, strategies, models, etc., can be used to promote psychosocial health. Thus, the improved psychosocial health of individuals, groups, etc., is seen as an outcome. The arrow with “resource” written inside represents that if an individual has adequate resources (through her/himself and her/his environment) and sufficient psychosocial health, it is likely that she/he will be more motivated and able to maintain health and to avoid illness. Importantly, a lack of resources may make it more difficult to undertake health-promoting or preventive measures.

The proposed action model is based upon already well-established concepts, models and frameworks in health promotion and prevention practice. In a further step, we have depicted them in a way that clearly integrates and combines their core concepts for their practical application in promoting psychosocial health. As there is a lot of overlap present among these topics, this clear illustration is important to promote their systematic and planned usage. It will now be highlighted in more detail how this action model is intended to be applied (Fig. 2).

2.3. Core Concepts Essential to Health Promotion

Ottawa Charter: A key component in health promotion practice is the advocating, enabling, and mediating action strategies delineated in the Ottawa Charter: developing personal skills, strengthening community action, creating supportive environments, reorienting health services, and building healthy public policy [7World-Health-Organization. The ottawa charter for health promotion 1986.]. Additionally, there are specific principles that guide health promotion practice. The principles of participation, empowerment, and a holistic and positive conceptualization of health, are the basis for the relationship which will be formed between the health professional and the individual/group [8Ippolito A, Smaldone F, Ruberto M. Exploring patient empowerment: The link between satisfying physician relationship and patient involvement. TQM J 2019; 32(1): 92-109.
[http://dx.doi.org/10.1108/TQM-04-2019-0096]
,9Israel BA, Checkoway B, Schulz A, Zimmerman M. Health education and community empowerment: conceptualizing and measuring perceptions of individual, organizational, and community control. Health Educ Q 1994; 21(2): 149-70.
[http://dx.doi.org/10.1177/109019819402100203] [PMID: 8021145]
]. Other health promotion principles, such as advocacy and social justice and equity in health [10Falk-Rafael A, Betker C. Witnessing social injustice downstream and advocating for health equity upstream: “the trombone slide” of nursing. ANS Adv Nurs Sci 2012; 35(2): 98-112.
[http://dx.doi.org/10.1097/ANS.0b013e31824fe70f] [PMID: 22429948]
], reflect that the health professional is focused upon reducing inequities in health. The remaining principles, such as intersectoral collaboration, building upon existing strategies, and usage of multiple strategies, guide health professionals in the broadening and systematic usage of their targeted interventions/projects [11Lin V, Kickbusch I, editors. Progressing the Sustainable Development Goals through Health in All Policies: Case studies from around the world. Department for Health and Ageing 2017.]. The use of a settings approach, which denotes taking action in the settings in which everyday life takes place (e.g. workplace, schools, hospitals, cities, etc.), is also core to health promotion strategies [12Green J, Tones K. Health Promotion lanning and Strategies 2012.]. There is a specific focus on the organizational structures and systems within the settings approach, as these affect the health of all involved individuals. The settings approach is also connected with an ecological model of health promotion, as it acknowledges that health is “determined by a complex interplay of environmental, organizational and personal factors” (Dooris, 2006, p. 55).

2.4. Core Concepts Essential to Prevention

Differentiated usage of the five main types of prevention (primordial, primary, secondary, tertiary, quaternary (see previous description) are important in the development of strategies/interventions /projects, as they target different persons/groups at varying stages of health/disease [13Kisling LA, Das JM. Prevention strategies: Stats 2020.]. Prevention strategies can either focus directly on the behavior of individuals/groups/society (e.g., with information & education), or they can target the structure which indirectly affects behavior. Structural (environmental) prevention measures enable health-promoting behaviors and deter potentially hazardous behaviors, by making them more difficult to engage in. Examples of such structures are the built environment (sidewalks, green space, bike paths) or legislation /policies (food composition and labeling, advertisement, seatbelt legislation) [14Blankenship KM, Bray SJ, Merson MH. Structural interventions in public health. Aids 2000; 14: S11-21.
[http://dx.doi.org/10.1097/00002030-200006001-00003]
, 15Hughes R. Practical public health nutrition 2010.].

2.5. Usage of Health Promotion and Prevention to Impact Psychosocial Health (As An Outcome)

There are numerous, more specific models and frameworks which guide health professionals in planning and implementing interventions/projects/ programs. Family-centered Care [16Wright LM, Leahey M. Familienzentrierte Pflege: Lehrbuch für Familien-Assessment und Interventionen 2nd ed. 2014.], Theory of Planned Behavior [17Ajzen I, Lange PAM, Kruglanski AW, Higgins ET. Handbook of theories of social psychology: The theory of planned behavior 2012; 438-59., 18Kan MPH, Fabrigar LR, Zeigler-Hill VST. Encyclopedia of personality and individual differences: Theory of planned behavior 2017.], Transtheoretical Model of Behavioral Change [19Hashemzadeh M, Rahimi A, Zare-Farashbandi F, Alavi-Naeini AMD, Daei A. A. Transtheoretical model of health behavioral change: A systematic review. Iran J Nurs Midwifery Res 2019; 24(2): 83-90.
[http://dx.doi.org/10.4103/ijnmr.IJNMR_94_17] [PMID: 30820217]
, 20Robinson LM, Vail SR. An integrative review of adolescent smoking cessation using the Transtheoretical Model of Change. J Pediatr Health Care 2012; 26(5): 336-45.
[http://dx.doi.org/10.1016/j.pedhc.2010.12.001] [PMID: 22920775]
] and Self-efficacy [21Bandura A. Self-Efficacy: The exercise of control 1997.-24Puschmann AK, Drießlein D, Beck H, et al. Stress and self-efficacy as long-term predictors for chronic low back pain: A prospective longitudinal study. J Pain Res 2020; 13: 613-21.
[http://dx.doi.org/10.2147/JPR.S223893] [PMID: 32280264]
], are examples of more focused models, which, in addition to the broader, core concepts of health promotion and prevention, offer more specific guidance to health professionals. Models, such as the Integrated Model of Population Health Promotion Model [25Government-Canada. Population health promotion: An integrated model ofpopulation health and health promotion CanadaDate modified: 2001-12-08.], the Public Health Action Cycle [26Ruckstuhl B, Somaini B, Twisselmann W, et al. Förderung der Qualität in Gesundheitsprojekten: Der Public Health Action Cycle als Arbeitsinstrument 2008.], and the Precede-Proceed Model [27Green LW, Kreuter MW. Health Program Planning: An Educational and Ecolological Approach 4th ed. 2005., 28Tramm R, McCarthy A, Yates P. Using the Precede-Proceed Model of Health Program Planning in breast cancer nursing research. J Adv Nurs 2012; 68(8): 1870-80.
[http://dx.doi.org/10.1111/j.1365-2648.2011.05888.x] [PMID: 22142482]
], are tools that can be utilized during project/program planning to ensure more systematic usage of health promotion and prevention.

Fig. (2)
Health promotion, prevention, and psychosocial health: An innovative action model (with pop-ups, based on contents in the E-learning program from the SALUTE Project), Bern University of Applied Sciences, Switzerland, 2020.


It is also important to integrate more general, public health-related concepts when introducing change among various population health levels. Integration of constructs, such as epidemiology, ethics in public health, healthcare systems, and policies, along with study design (quantitative, qualitative or mixed methods), is also important when planning interventions/projects/programs in health promotion and prevention.

2.6. Conceptualization of the Action Model

The definitions and action model are based upon core aspects from health promotion and prevention practice, along with expert knowledge from an interdisciplinary team of specialists. To the authors’ knowledge, such an action model does not exist in the international literature. This new and innovative approach encourages the systematic usage of health promotion and prevention in the promotion of psychosocial health. The next step would be the implementation and evaluation of this action model, especially the measurement of the outcome (psychosocial health).

CONCLUSION

The integrative and intentional use of health promotion and prevention is an innovative approach for the promotion of psychosocial health in public health practice. The proposed action model guides health professionals in utilizing health promotion and prevention to promote psychosocial health among their target groups. Internationally, such a model does not exist. Therefore, it offers a new and systematic approach to promote psychosocial health among various population health levels.

SUPPORTIVE/SUPPLEMENTARY INFORMATION

Video: Definition of Psychosocial Health

Peter, K.A., Golz, C., Hahn, S. & Richter, D. (2018). Definition of Psychosocial Health. Bern University of Applied Sciences, Department of Health Professions: Bern, Switzerland. Video. https://www.youtube.com/watch? v=0_0olJf-1H0&feature=youtu.be

CONSENT FOR PUBLICATION

Not applicable.

FUNDING

This work was financially supported (non-grant) by Bern University of Applied Sciences (through the SALUTE Project), Bern, Switzerland.

CONFLICTS OF INTEREST

The authors declare no conflict of interest, financial or otherwise.

ACKNOWLEDGEMENTS

Declared none.

REFERENCES

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[http://dx.doi.org/10.1007/BF00300458]
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[http://dx.doi.org/10.1108/TQM-04-2019-0096]
[9] Israel BA, Checkoway B, Schulz A, Zimmerman M. Health education and community empowerment: conceptualizing and measuring perceptions of individual, organizational, and community control. Health Educ Q 1994; 21(2): 149-70.
[http://dx.doi.org/10.1177/109019819402100203] [PMID: 8021145]
[10] Falk-Rafael A, Betker C. Witnessing social injustice downstream and advocating for health equity upstream: “the trombone slide” of nursing. ANS Adv Nurs Sci 2012; 35(2): 98-112.
[http://dx.doi.org/10.1097/ANS.0b013e31824fe70f] [PMID: 22429948]
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[14] Blankenship KM, Bray SJ, Merson MH. Structural interventions in public health. Aids 2000; 14: S11-21.
[http://dx.doi.org/10.1097/00002030-200006001-00003]
[15] Hughes R. Practical public health nutrition 2010.
[16] Wright LM, Leahey M. Familienzentrierte Pflege: Lehrbuch für Familien-Assessment und Interventionen 2nd ed. 2014.
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[18] Kan MPH, Fabrigar LR, Zeigler-Hill VST. Encyclopedia of personality and individual differences: Theory of planned behavior 2017.
[19] Hashemzadeh M, Rahimi A, Zare-Farashbandi F, Alavi-Naeini AMD, Daei A. A. Transtheoretical model of health behavioral change: A systematic review. Iran J Nurs Midwifery Res 2019; 24(2): 83-90.
[http://dx.doi.org/10.4103/ijnmr.IJNMR_94_17] [PMID: 30820217]
[20] Robinson LM, Vail SR. An integrative review of adolescent smoking cessation using the Transtheoretical Model of Change. J Pediatr Health Care 2012; 26(5): 336-45.
[http://dx.doi.org/10.1016/j.pedhc.2010.12.001] [PMID: 22920775]
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[http://dx.doi.org/10.2147/JPR.S223893] [PMID: 32280264]
[25] Government-Canada. Population health promotion: An integrated model ofpopulation health and health promotion CanadaDate modified: 2001-12-08.
[26] Ruckstuhl B, Somaini B, Twisselmann W, et al. Förderung der Qualität in Gesundheitsprojekten: Der Public Health Action Cycle als Arbeitsinstrument 2008.
[27] Green LW, Kreuter MW. Health Program Planning: An Educational and Ecolological Approach 4th ed. 2005.
[28] Tramm R, McCarthy A, Yates P. Using the Precede-Proceed Model of Health Program Planning in breast cancer nursing research. J Adv Nurs 2012; 68(8): 1870-80.
[http://dx.doi.org/10.1111/j.1365-2648.2011.05888.x] [PMID: 22142482]
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