Category: Health Promotion

Statistics are directly relevant to the planning of health promotion interventions because they are paramount for identifying the groups that need such interventions in the first place. Learning more about a given group is actually one of the main uses of statistics in public health (Bruce, Pope, & Stanistreet, 2018). For example, if one aims to design a health promotion intervention against intimate partner violence (IPV), one needs to know which, if any, groups are disproportionally affected by it. Data from the Center for Disease and Control Prevention (CDC) demonstrate that women are approximately 2.5 times as likely to be victims of IPV as men (CDC, 2020). Thus, statistics demonstrate that intervention against IPV has to primarily target women as a more vulnerable demographic.

In terms of implementing a health promotion intervention, statistics are important as well. No intervention is entirely smooth and without its setbacks, and barriers to implementation are bound to arise in one form or another. Statistics are essential to identify these barriers and account for them. Using the example above, statistics may demonstrate that individualistic approaches to treating the victims of IPV prove unsuccessful in more collectivist cultures (Varcoe et al., 2019). In this respect, the implementation of health promotion intervention relies on statistics as much as planning.

Finally, statistics are indispensable for evaluating the outcome of an intervention. Virtually every criterion that allows designating an intervention as success or failure is statistical. Statistics gathered through the follow-up procedures provide information on the outcomes, such as the rate of improvement or its length (Varcoe et al., 2019). Administrative statistics demonstrate whether an intervention is economically feasible from the cost and effect perspective (Varcoe et al., 2019). If anything, statistics is even more important in evaluating an intervention than it is in planning and implementing it.

References

Bruce, N., Pope, D., & Stanistreet, D. (2018). Quantitative methods for health research A practical interactive guide to epidemiology and statistics (2nd ed.) Hoboken, NJ: John Wiley & Sons.

Center for Disease Control and Prevention (2020). Preventing intimate partner violence. 

Varcoe, C., Ford-Gilboe, M., Browne, L. G., Perrin, N., Bungay, V., McKenzie, H., Smye, V., Elder, I. P., Inyallie, J., Khan, K., & Atout, M. D. (2019). The efficacy of a health promotion intervention for Indigenous women: Reclaiming our spirits. Journal of Interpersonal Violence, 886260518820818.

Health promotion is a process that aims at attaining the full mental, physical and well-being of people in society. It enables people to have total control of their health and as a result of this improved their life. Health promotion enables people to increase control over their own health. Currently, within health, there are six different health promotion models.

The medical approach focuses on activity that aims to reduce morbidity and premature mortality. This activity is targeted towards whole populations or high-risk groups. This kind of health promotion seeks to increase medical intervention which will prevent ill health and premature death. It seems to have three levels of intervention.

Primary prevention – Prevention of the onset of disease through risk education e.g. immunisations, encouraging non-smoking.

Secondary prevention – Preventing the progress of disease e.g. screening.

Tertiary prevention – reducing further disability and suffering in those already ill; preventing recurrence of an illness e.g. rehabilitation, patient education.

The Behaviour change approach aims to encourage individuals to adopt healthy behaviours, which are the key to improved health. This approach is targeted towards individuals, although mass means of communication may be used to reach them. This can be seen on an individual, environmental and policy basis. These include changes in research showing the best ways to support people and make better health achievable wherever they are and whatever their individual circumstances.

The educational approach is to provide knowledge and information to develop the necessary skills so that people can make an informed choice about their health behaviour. The educational approach is distinguished from a behaviour approach in that it does not set out to persuade or motivate change in a particular direction. Education is intended to have the desired outcome.

The client-centred approach is not just about giving people whatever they want or providing information. It is about considering people’s desires, values, family situation, social circumstances and lifestyle seeing the person as an individual and working towards developing solutions. Encouraging people to speak about what they find important, helping to develop a shared understanding of what matters to them. (Health Education England (2017)

The societal-change approach is a specialised health promotion that aims to improve social, economic and environmental living conditions. This approach aims to change society not individual behaviour, it is targeted towards groups and populations – for example, the smoking in public areas ban that was introduced in 2007. This now makes it illegal to smoke in all public enclosed areas and workplaces. (Health innovations (2019)

The shock tactics approach is a strategy that uses violent or extreme action or imagery to shock someone into doing something. For example, the TV advert featuring a tumour growing on a cigarette as it is smoked, which is designed to make the invisible damage caused by cigarettes visible. This is a careful balancing act, there is a need to grab attention then get the person to interact with the warning but not feel victimized. (BBC (2003)

Although health promotion aims to improve well-being there are also ethical issues to consider. It is not the place of health professionals to make value judgments on the way others choose to live.

Looking at the different models of health approaches there seems to be many similarities and differences. The similarities between the behaviour change and educational change are that they both rely on providing information to the patient either via leaflets/booklets / visual displays or one piece of advice. The educational approach has assumptions about the relationship between knowledge and behaviour, by increasing knowledge, there will be a change in attitudes, which may lead to change behaviour. The educational approach helps provide information to help clients to make informed choices about their health behaviour. The behaviour change approach relies on campaigns to persuade people to desist from smoking, adopt a healthy diet and taking regular exercise. Both these approaches have the same method of delivering the information, both require individuals to listen and learn. Patient education about a condition or medication may seek to ensure compliance which leads to having behavioural change. The educational approach is linked to the medical approach as without education people wouldn’t realise the importance of screening and immunizations for the medical approach to work. Some of the major differences that come between the medical approach and the behaviour approach are, the medical approach is regarded as high status because it uses scientific methods and is expertly led. Prevention and early detection of disease are much cheaper than treatment of people who have become ill, an example of this would be the MMR vaccine, which made Britain have a measle free status until recently. The principle of preventive services such as immunisation and screening is that they are targeted to groups at risk from a particular condition. Whilst immunisation requires a certain level of uptake for it to be effective, screening is offered to specific groups for example cervical screening is offered every 3 to 5 years in women aged 25 to 64. Having screening or immunization facilities available is only effective if people can be persuaded to have them. This is the link to the educational approach. While the behaviour changes approach views health as the property of individuals. People can then make improvements to their own health by choosing to change their lifestyles. Changes in behaviour may be a response to the conditions in which people live, the cause of these conditions e.g. unemployment and poverty are outside an individual’s control. (Health innovation network.

Issues relating to funding and lack of resources are major problems in health promotion. Staff shortages mean nurses will be dealing with health promotion on top of dealing with direct care of patients. Health promotion will cut down costs for the economy by tackling health problems such as obesity, cardiovascular disease and cancer. Health promotion is prevention, it is the practice of preventing disease and promoting good health within groups of people from small communities to entire countries. Instead of telling a person what they must do to improve their health, promotion is about finding out what the person would like to see improve, how they think it can be improved and how ready they are to make the change. This is explained in the cycle of change model – pre-contemplation (shock tactics) not thinking seriously about the change, contemplate (educational) beginning to think about our behaviour, prepare / determination (behaviour change) now ready to change, action (medical approach) – we now want to change, maintenance (person-centred approach) – which is the aim of the whole change model to get to a position where we can maintain and relapse recognising a step back to pre-contemplation. The idea of making every contact count is a very effective way of promoting good health and exploring this with the patient. The medical approach overall aim is to reduce morbidity and premature mortality by targeting risk groups or risk behaviours with medical intervention – the main example of an effective medical approach is the measles elimination, up until September 2019 the UK had a measles elimination status due to the uptake of the MMR vaccination. Proving that the medical approach is effective health promotion, however without the educational approach making people aware of the dangers etc of measles the medical approach wouldn’t have been as successful.

Take the flu vaccination this year record numbers of people in England will be offered a flu vaccine this winter. For the first time, all primary school children will be offered the nasal spray It will be available to over 25 million people and the aim is to urge those at risk of suffering from or spreading flu to ensure they get their free vaccination. As it is estimated that around 10000 deaths last year were attributed to influenza infections (Seqirus UK limited leaflet 2019) This is a medical approach initiative however it needs the backing of the educational approach to spread the word and educate people on why they need to be vaccinated. It is targeted at those who are at higher risk such as the over 65, pregnant women and anyone with an underlying health condition from the age of 6 months. From this year 2019, the nasal spray vaccine will also be offered to any child at primary school age. It is also targeted at specific areas such as residential care homes and from line NHS staff. The main purpose of the initiative is to reduce the number of deaths from flu and to raise awareness of the dangers of catching influenza and how its spread. You will hear and see many campaigns for the flu vaccination on your GP surgery, you may receive a letter or phone call from your GP directly, it is also advertised on TV and in supermarkets. With the use of social media, campaigns are now been brought online and will be circulated via Facebook/Twitter / Instagram etc. How effective the campaign is depends on many variants such as the vaccination that must be given at the start of the flu season which is generally September to November. This is a free vaccination if you hit the above criteria or you can pay privately at a pharmacy. (NHS (2019) Reported end of season flu vaccine effectiveness for 2018 to 2019 against all strains was:

44.3 % across all ages, 48.6% for 2 to 17-year olds attenuated influenza vaccine (nasal spray) 44.2% for 18 to 64-year olds (any vaccine) 49.9% for those aged 65 and over and 62% for those aged 65 and over (adjuvanted trivalent influenza vaccine only) (Public health England (2019) There are a few campaigns for the flu vaccination such as Stay well in winter, NHS111, FLU its too big to ignore.

According to Public health matters.gov.uk, the new enhanced vaccine has the potential to lead to 30000 fewer GP appointments, 2000 fewer people needing hospital care and 700 fewer deaths from flu in England. Influenza infection can result in mortality and morbidity, especially in frail older populations and in residential settings. The flu vaccination is a powerful mechanism for prevention.

Change for life is a government campaign that involves eating well, move more, live longer. Alcohol focuses the UK – This is a UK national charity that works towards reducing the harm caused by alcohol. Drink aware – This aims to promote responsible drinking and find NSF ways to challenge the national drinking culture to help reduce alcohol misuse and minimise alcohol-related harm.

The NHS contribute a huge amount towards public health by offering a free national health service, offering free vaccinations such as the MMR and flu prevention. According to ‘health.org.uk’, the quality of and access to health care is estimated to account for 10-20% of what contributes to people’s health. There have been many changes to public health in recent decades some of the achievements include – Increases in life expectancy since 1981 life expectancy if men in England has increased from 70.9 to 79.4 years and for women has increased from 76.9 to 83.3 years. Reduction in numbers of people smoking e.g. ban on smoking in public places is estimated to have saved the NHS over £380 million a year. Putting fluoride into drinking water has resulted in reduced tooth decay and tooth loss. Fewer infectious diseases e.g. typhoid and tuberculosis.

Overview

As the profession of the Advanced Practice Registered Nurse (APRN) continues to evolve within the healthcare system, the utilization of theory-guided practice is imperative for the deliverance of purposeful and effective care to patients. The use of theory in nursing gives APRNs the ability to organize and structuralize knowledge to guide patient care (McEwen & Wills, 2019). Multiple nursing theories exist dating back to Florence Nightingale. A thorough examination of the literature revealed two theories of particular importance to an APRN’s role in health promotion and disease prevention. Nola J. Pender’s Health Promotion Model (HPM) and Icek Ajzen’s Theory of Planned Behavior (TPB) both focus on the factors influencing human behavior (Pender, 2011; Ajzen, 1991). Underpinning knowledge of these theories can benefit APRNs in practice by providing frameworks that facilitate recognition, comprehension, and modification of health behaviors.

Nola J. Pender is a nursing theorist that published the Health Promotion Model in 1982, which has since been revised in 2011 (Pender, 2011). The purpose of the HPM is to provide nurses with a framework to identify the determinants of patient behavior and influence health-promoting interventions (Pender, 2011). The model is based on the assumption that individuals can regulate their behaviors but are influenced by numerous personal and environmental factors (Pender, 2011). Behavioral specific cognitions such as perceived benefits, barriers, self-efficacy, activity-related affects, interpersonal influences, and situational influences can be assessed and modified (Pender, 2011). With the use of the HPM, APRNs can positively influence behavioral modification changes with counseling and education.

Icek Ajzen’s Theory of Planned Behavior was originally published in 1985 as an extension of the Theory of Reasoned Action (Ajzen, 1991). Although not identified as a nursing-specific theory, a substantial amount of nursing research has utilized the TPB as it relates to healthcare. The TPB proposes an individual’s intentions can be predicted through attitudes, subjective norms, and behavioral control to produce specific behaviors (Ajzen, 1991). An intention can be further described as the individual’s motivating factors. Ajzen proclaimed an understanding of an individual’s intentions and ability can support behavioral modification changes (Ajzen, 1991). Self-reflection of one’s personal beliefs, readiness, and willingness for change are the ultimate factors affecting the ability to control behavior. APRNs can utilize this theory in practice to identify unhealthy behaviors and support self-reflection.

Application of Theory

The Family Nurse Practitioner (FNP) plays a specific role in providing primary advanced nursing care to all age groups and promoting public health within the community. Continual health promotion and disease prevention is an essential role for FNPs working in any specialty. The ultimate health care goal is to improve the overall quality of life (Thomas et al., 2014). The use of both Pender and Ajzen’s theories in practice can assist FNPs in identifying the determinants for patient nonadherence to treatment regimens, poor health behaviors, and provide patient awareness of healthy versus unhealthy behaviors. The application of these theories can be used with every patient/family interaction from the pediatric population to the geriatric population. Family Nurse Practitioners can use theory-guided practice to promote health during the patient interview, goal setting, counseling, and follow-up visits (Thomas et al., 2014). Not only is provider awareness of patient behaviors imperative for developing a patient-specific plan of care, but also patient awareness of self-care, health behaviors, and willingness is significant for patients to accomplish and sustain long term goals. Utilization of these frameworks can provide patients with self-awareness of factors influencing their lifestyle choices. FNPs can then educate patients on the appropriate individualized lifestyle changes that are needed while working with the patient to set and evaluate goals. Therefore, the ultimate goal of implementing health-promoting behaviors to facilitate an overall improved quality of life can be met.

A multitude of research has been conducted using these theories as the theoretical framework to explain and alter situations such as smoking cessation, weight loss, patient safety, adherence with chronic illness, nutritional behaviors, HIV prevention and behaviors, diabetes self-management, breastfeeding duration, generalized health-promoting behaviors in everyday life, and much more (Thomas et al., 2014; Rich et al., 2015; Khodaveisi et al., 2017; Khani et al., 2020; Lee et al., 2017; Lau et al., 2018). For example, diabetic control relies on a treatment regimen consisting of lifestyle modifications and pharmacological treatment. Lee et al. (2017) suggests the use of the TPB to assess the patient’s personal beliefs, intentions, and expectations for diabetic self-management; identify healthy interpersonal and situational influences; and improve patient perception of behavioral control to meet long-term goals in diabetes management. FNPs can assess patient intentions related to maintaining a healthy diet, physical activity, weight reduction, and administration of medications. If the patient identifies a negative factor preventing appropriate diabetic self-management such as the affordability of healthy foods, FNPs can provide the patient with the appropriate resources to maintain a healthy diet (Lee et al., 2017). Following the theoretical frameworks in practice can, therefore, enhance adherence to the plan of care.

Theory Importance in Healthcare Practice

Often providers are caught up in the fast-paced nature of healthcare. A quick assessment of the patient’s condition followed by the diagnosis and treatment requirements cause patients to have low self-efficacy, poor motivation, and lack of self-control over their health. Providers expect the patient to adhere to suggestions before the patient’s health behaviors have been assessed appropriately. Ultimately, this leads to an increase in preventable illness, poor chronic condition management, and unhealthy behaviors.

Through my personal reflection, many examples utilizing these theories and lack thereof come to mind. When caring for pediatric patients, the parents are in control of the child’s fundamental health status. One example using the HPM in practice reflects a parent’s refusal of immunizations for their newborn infant. Working in a newborn nursery, it is common practice to obtain consent for the Hepatitis B vaccination at birth. The parents have the right to consent or refuse, however, providers strongly recommend and advocate for vaccination. During this time, we often learn of the parents’ intent to refuse all childhood vaccinations.

In this particular case, the parents of a newborn had been asked if they would like for their child to be immunized with the first dose of the Hepatitis B vaccine. They were provided with appropriate educational materials and verbally explained the importance of vaccination to obtain immunity and prevent unwanted illness. The parents refused without explanation and disclosed their intent to refuse all childhood immunizations. This being within the parents’ rights, the refusal papers were signed. Later when the newborn and parents were in the nursery, the Pediatric Nurse Practitioner (PNP) asked the parents why they refused the Hepatitis B vaccine. The parents once again disclosed their intent to not vaccinate their child. Instead of accepting their response, the PNP started asking about their beliefs, attitudes, and expectations of their child’s health. The parents stated that their families had strongly recommended against vaccination because of the potential for autism. The parents also expressed the belief that contracting these preventable childhood illnesses would provide future immunity and make their child’s immune system stronger. The final concern was of the parents’ financial status and the potential inability to maintain child wellness visits. The PNP intently listened to all of the parents’ concerns. He then asked the parents if they, themselves, had been vaccinated as children in which they had. By interviewing the parents, the PNP determined the negative factors influencing the health behavior decisions for their child as the lack of family support, personal beliefs related to the benefits and consequences of vaccination or lack of, and financial ability.

The PNP went on to educate the parents on the benefits and necessity of the immunization to prevent disease. He discussed and provided materials explaining the disease process, symptoms, and treatments of Hepatitis B and multiple other vaccine-preventable diseases. The next day, the PNP asked the parents if he could include the family members in the discussion of vaccine importance. The parents agreed and the PNP repeated immunization counseling to the entire family. Furthermore, the PNP called case management and was able to have the newborn placed on TennCare. By assessing the factors influencing their behaviors, the PNP was able to eliminate the concerns swaying the parents’ decision. Together, the PNP and the parents developed a plan to maintain child well visits and obtain vaccinations. By having an understanding of the HPM, the PNP followed the step by step approach to achieve health-promoting behaviors for the child’s well-being.

Conclusion

In conclusion, the application of Pender and Ajzen’s theories promote the recognition, comprehension, and modification of healthy behaviors. Theory-guided practice provides APRNs of any specialty with the appropriate framework to individualize the plan of care needed for health promotion and disease prevention. With an underpinning knowledge of theories useful to the APRN role, APRNs can provide care that is likely to achieve better outcomes and meet long-term goals.

“Survival of the fittest” a common phrase originated from the Evolutionary Theory of Darwin to describe the mechanism of natural selection. As humankind experience pandemic today, their physical health and mental health is being put into test on how to survive this disaster. Each day people are facing an invisible enemy that threatened them and their family. Hence, during this time of quarantine and people staying inside their homes to survive and try to find new ways to keep themselves healthy.

Lyons and Chamberlain (2017) said that Health Psychology aims to apply psychological knowledge to all aspects of physical health and illness. Conner and Norman (2019) stressed that in the topic of contemporary health psychology, the health behavior is the main concern. As Orlowski (2015) described health behavior as activity undertaken by an individual or group for the purpose of promoting, protecting and/or maintaining health. It is evident today that people are engaging to different behaviors.

Conner and Norman (2019) stated that there are four health behavior in the current issues that are widely studied. These are smoking, binge drinking, health diet and physical activity. In this paper, we will be covering these four health behaviors.

Smoking. In the study made by Bellew and his colleagues (2013), they described the tobacco industry of the Philippines as “the strongest tobacco lobby in Asia” which lands the country as one of the highest per capita on cigarette consumption despite the fact that tobacco is one of the leading cause of death. A study made in Bahrain indicated that people who are consuming tobacco increases their tolerance overtime hence requires higher dosage of nicotine to make an effect. They stressed that heavy tobacco consumption is correlated to stress, depression and several types of cancer specially lung cancer (Hamaden, Jamil, Kawari & Bucheeri, 2018). Valera, Bachman and Rucker (2016) had explained four main ideas regarding the smoking behavior. First is that people has been exposed to cigarette since they are little as secondhand smokers by their caregivers. Second is that people who are consuming cigarette find it as stress reliever and pleasurable. Third is that they have an easy access in acquiring cigarettes and lastly, there are many available programs in case they have decided to stop using cigarettes.

Philippines, being one of the highest consumer of cigarette also made necessary steps to reduce the consumption of cigarette such as the Smoking Cessation of Program of Department of Health. However, to make the smokers quit the habit of smoking, it must start to the change the belief of the person that smoking is not relevant to their life as well as it is dangerous and it must be stopped as mentioned in the Health Behavior Model. The practice of reducing their consumption would be better to improve their lifestyle as well as to the people surrounding them.

Binge Drinking. Another health behavior issue is binge drinking, drinking has been common to Filipinos as part of celebration. According to CNN News (2019), binge drinkers are those who consumes at least four bottles in a row, and Filipinos who are consuming that much alcohol are associated to different types of cancer and vehicular accidents. In the study of Furiscal, Pancharuniti & Keiwkarnka (2008), highschool students residing to Baguio City, ages 15-16, are already consuming alcohol due to easy access and affordable prices. Their study also showed that family and friends were also part of the contributing factors of student’s drinking behavior. However, the problem of binge drinking also extends to higher education students and to faculty members. Joris, and colleagues (2015) found out that male faculty members are more exposed to binge drinking than female faculty members. Moreover, they also found out that social drinking motivates monthly binge drinking to both female and male students and faculty.

There have been efforts to create interventions for the issue of binge drinking. It is evident that binge drinking is not a good health promotion for everyone and only damages our health. Hagger, Wong and Davey (2013) aimed to create a theory based intervention for undergraduate students using motivational and self-control intervention. Mindset plays an important role in Health Psychology because proper mindset can maximize even the smallest action a person is doing. Having a mindset of drinking alcohol only in proper occasions and does not need to drink it on excessive amount will be a good start to control drinking behavior.

Health Diet. People has been very conscious in their body image due to media presentation of beautiful and handsome. Diet is more common to women than men, since women often feel pressured to be thin and beautiful to be noticed. Mack (2008) said that healthy lifestyle of an adolescents was influenced by their primary caregiver. He emphasized that through Bandura’s Social Learning specifically modelling, a constant health behavior such as eating healthy diet can indicate the level of engagement a person has. In the Philippines, the Department of Health (n.d) stressed that healthy diet is the foundation of good health because diet can satisfy the energy and nutrients a person needs for the growth and development. However, diet does not always give us positive effects especially if engaging to a specific diet without proper consultation may cause a person to have insufficient nutrients and vitamins and worse can damage your internal organs. They also warned the people that joining a fad diet can lead to eating disorder (Geminiano,2018).

Anything about food perhaps is the Filipino’s greatest expression of their culture; from preparation to consumption of food is expressed in a very intimate way (Gallo-Crail & Hawkins,2012). However, due to low economic income, not all Filipino family were able to have a healthy diet that is sufficient to sustain their body energy. But despite the economic concern, the Philippines is still rich in vegetables and livestock which most of the people especially those who are living in the rural areas are consuming. It is important that people knows what they are eating so that they can fulfill the energy requirements and vitamins that is needed for them to survive.

Physical Activity. Motivation, self-efficacy and self-regulation are consistently correlated to the physical activity of a person. Regular Physical activity is effective preventive strategy against to chronic medical conditions (Rhodes, Janssen, Bredin, Warburton & Bauman,2017). In the United States, Strowger, Kiken, and Ramcharran (2018) said that only about half of the adult population meets the basic aerobic physical recommendation while the other are inactive. As mindfulness meditation gained popularity, US adults who practice this in the past were likely to engage in physical activity and mindfulness meditation showed stronger association rather than other types of meditation. In the Philippines, Sanchez Pituk and Cagas (2019) studied the physical activities of university students and showed that male students are more physically fit than female students and female students shows higher body fat than male students. They stated that physical activity is important not only to promote fitness but also to suffice the demands of the university.

Being in the country that demand skilled worker, most Filipinos’ body was molded to be always working physically rather than sitting in the chair working in the office. Physical activities in the Philippines has always been reinforced because in the primary to secondary school morning exercise is necessary. Nowadays, Zumba sessions are offered in all age brackets everywhere accessible to people, this is the kind of health promotion the Filipinos are extending to maintain the physical health of a person. Having constant physical activity such as exercises does not only limit its effect to the fitness of the body but also helps the brain gain oxygen to function properly.

In conclusion, the issues regarding health behaviors has both negative and positive effect to a person. These behaviors that a person choose will really start to the mindset the person has, their belief really plays a crucial part in the behavior they are doing. In this age of technology, the internet helps us gain access to different health promotions that can benefit our body positively especially today, during our fight to pandemic. Helping ourselves maintain healthy body and spreading positive vibes would encourage different people to act for a better life starting now.

What is health?

According to (WHO 2003) health is, defined as a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity. Health has characterized by conditions resulting from the body’s constant adjustment, adaptation in response to stresses, and changes in the environment for maintaining an inner equilibrium called homeostasis. Again, health is a resource for everyday life not the objective of living. It emphasizes the positive concept, social and personal resources as well as physical capacities.

What is health promotion?

Health promotion is a behavioral social science that draws from the biological, environmental, psychological, physical, and medical sciences to promote health. The process of enabling people to increase control over and to improve their health. It moves beyond a focus on individual behaviors towards a wide range of social and environmental interventions.

The importance of health promotion is that it improves the health status of individuals, families, communities, states, and the nation. Schools teach health as a subject to promote and implement school health programs, which include teachers, students, and parents. At the school district level, they develop education methods and materials, coordinate, promote and evaluate programs and write funding proposals Health educators are part of a team working to create an environment in which students feel empowered to make healthy choices and create a caring community. In addition, they also identify needs, advocate and community organizing, addressing issues related to disease prevention. They manage grants and conduct research. (University of Georgia Dr. Ph. admissions 2019).

In companies, they also help in promoting weight loss, controlling hypertension, nutrition, substance abuse, and physical fitness. They help companies meet health and safety regulations. In the health care sector, they educate patients about medical procedures and operations, also develop activities to improve patients’ participation in clinical processes, promote and .maintain their health.

A major transformation has been occurring in the health sector, this has contributed a lot to patients. These changes reviewed briefly for the benefit of those who do not work in the front line of care for those who have not had the opportunity to experience the changes

The opportunity for health promotion in primary health care legion and evidence from worldwide experimental sources reviewed to show how different levels of achievement can be demonstrated and monitored. The principles declared by (WHO) act were responsibility, empowerment, and participation. (Nigel CH Stott 1986)

Health promotions and preventions

Programs run by health promotions focus on keeping people healthy. The purpose of this program is to engage, empower individuals and communities to choose healthy behaviors and make changes that reduce the risk of developing chronic diseases, this process allows to increases control over and improve their health. Disease prevention differs from health promotion because it focuses on specific efforts to reduce the severity of chronic diseases and wellness is related to health promotion and prevention of diseases. It contributing to positive health and outcomes. While health promotion and prevention programs often address social determinants of health, which influence modifiable risk behaviors. (RHIHub 2019).

Health promotion preventing smoking

As l have stated that in the beginning that health promotion is the process of enabling people to increase control over and improve their health. Health is a positive concept highlighting social and personal resources, as well as physical capacities; this encourages life changes to society and supports strong social networks. Health promotion can make a huge difference to society.

Health promotion methods for smoking prevention and cessation. A comprehensive review of effectiveness and the way forward. Tobacco smoking is one of the greatest causes of mortality in the world, responsible for over 5 million deaths per annum. (Ottawa charter 1986)

Smoking is a serious public health challenge across the world; smoking harms nearly every organ of the body, resulting in enormous disability, diseases, and deaths. Cigarette smoking has claimed up to more than 5 million preventable deaths every year. Smoking causes about 90% of cancer deaths, in addition, ill health, reduced productivity, poverty to families, and damage to environments are effects caused by smoking. Smokers are more likely than non-smokers to develop heart diseases and stroke. The number of such deaths is expected to double by 2020. The leading causes of death caused by smoking are heart disease and stroke.

NHS smoking-free campaigns help people quit smoking by highlighting the damage it does to the lungs, heart, and brain. Every cigarette you smoke increases your likelihood of a heart attack or stroke. However, the risk to your heart health can be significantly out by quitting. NHS smoke-free helps thousands of people quit smoking every year through a range of free support and information. This campaign will graphically show how every time you smoke, thick dirty blood with toxins circulates through your body.

In the UK, about 78000 people die from smoking, with much more living with chronic diseases, due to related smoking illnesses. Smoking contains nicotine, which is highly addictive. This makes it more difficult for people who want to quit because they are addicted to the effects of smoking. Nicotine is already in their blood system, and nicotine affects your mood and changes your levels of concentration. Many people enjoy smoking because they feel like it helps them to reduce stress and anxiety. Yet it does not help but damages the body organ and leads to diseases, illness, and unpreventable deaths. The effects of quitting smoking can make you feel depressed and irritable. That is why NHS offers free smoking programs to help people quit smoking. NHS advises people to visit their GP when they feel the need to quit smoking. They will refer them to these NHS free programs for support, counseling, and advice. NHS programs can provide stop smoking treatment like nicotine patches, gums, or medical treatment on prescription. Statics states that four-time are more likely to quit smoking through these NHS programs.

Health promotion for preventing obesity

What is obesity? Obese is a term used to describe a person who is overweight and with many body fats. This is a challenging factor in the UK. They are many ways to classify obesity by using the method of calculating body mass BMI. BMI is measured according to weight over height.it is very important to tackle obesity because it can lead to a number of serious and potentially life-threatening conditions.

Risk of obesity. These include diseases such as type 2 diabetes, coronary heart disease, and stroke. Obesity can affect your quality of life and psychological problems such as depression and low self-esteem. Obesity is generally caused by consuming more calories, especially those fatty and sugary foods. It the more common in modern living people because many people eat cheap high-calorie foods and then spend lots of time sitting instead of exercising and burb those calories.

How to prevent obesity. Working with people managing overweight and obesity. NHS has programs that help with reducing weight and obesity. These are free programs also provide support, counseling, and advice on how to reduce your weight. Engaging people to be physical activity helps to maintain a healthy living. Therefore, everybody should engage in actives as it reduces poor health. About 150 minutes a week will change your life. In addition, food and nutrition eating high fat and sugary foods and increase the chances of having a heart attack or stroke. Reduces energy levels in the body contributing to overweight and obesity. NHS recommends that people should monitor what they consume in order to live a healthier life. A balanced meal consists of quarter protein, half vegetables, and quarter carbohydrates.

Evaluation – mass media campaigns, carried out to influence community standards around health behaviors, should include physical activity. Such campaigns can reach a large population at a relatively low cost to influence awareness. In smoking mass media, campaigns to promote quitting are important investments as part of comprehensive tobacco control programs to educate about the harms of smoking. Also, change smoking attitudes and beliefs. Increase quitting intentions and quit attempts.

Executive Summary

This report explores underage drinking among year nine students and what influences the drinking habits of these Australian teenagers. The data collected through this investigation suggests that peers have a significant influence in year nine students choosing to drink alcohol. This investigation aims to reduce alcohol consumption and encourage safe drinking habits within the year nine cohort. This was achieved with the use of stalls and games which educate the students on the dangers of alcohol and teach them strategies for safe drinking and dealing with peer pressure. This campaign is targeted at year nine students because many students start drinking at this age. Targeting this age group is strategic because this campaign is focused on the prevention of underage drinking, which should hopefully delay the age at which these children start drinking alcohol.

Social Cognitive Theory explains human behavior in a model of causation which involves triadic reciprocal determinism. The theory involves personal factors, environmental influences, and behavior continually interact and influence each other bidirectionally (Glanz, 2001). Within this, the ‘personal factors’ determinant aims to build knowledge and develop an individual’s attitudes, the ‘environmental factors’ determinant aims to change social norms and influence individual’s to change their own environment, and the ‘behavioral factors’ determinant develops skills and encourages self-efficiency (Johns Hopkins University, 2016).

This primary aim of this innovation is to teach year nine students’ skills for dealing with peer pressure and underage drinking. As well as this, the students learn about the negative effects of drinking alcohol and why delaying the age at which you start drinking is highly beneficial. After the participants were involved with the innovation, they completed a survey which is looking to see if behaviors have changed through this health innovation.

Introduction

Alcohol use amongst young Australians is has decreased significantly since 2013, with the number of teenagers abstaining from underage drinking in Australia having increased by 50% since 2013. This trend can be seen globally, with other high socio-economic countries including Canada, America, and England showing similar declining rates in underage drinking. Primary data collected shows that; of 61 surveyed year nine students, two drink daily, four drink monthly, two drink weekly, eight drink annually, and 45 have never drunk alcohol (International Alliance for Responsible Drinking, 2018). Despite the majority of these students having never tried alcohol, the remainder of students need to change their drinking habits. This health promotion aims to help these students identify these poor habits and establish new, healthier ones. The strategy aims to strengthen, maintain or adapt positive alcohol behaviors using peers as a resource. The World Health Organization’s Ottawa Charter includes five action areas to be used in any health promotion to address the determinants of health. These five action areas are: build healthy public policy, create supportive environments, strengthen community actions, develop personal skills, and reorient health services (Personal Development, Health and Physical Education, 2015). The area of personal skills aims to support personal development by providing information and enhancing an individual’s life skills (World Health Organisation, 1986). For this particular health promotion, the Ottawa Charter area of personal skills will be implemented to help achieve the aim. This health promotion aims to teach year nine students from Cavendish Road State High School strategies to abstain from underage drinking in an environment where they could potentially by victims of peer pressure. This was achieved with the use of an information video and fun, educational stalls.

Discussion

Context Analysis and Needs Assessment

National trends show that teenagers are consuming less alcohol than they were in 2011. Research by the Cancer Council conducted in 2011 shows that 11% of 12 to 15-year-old Australian secondary school students were current drinkers. The study also shows that 33% of 16 to 17-year-old Australians were current drinkers in that same year (White & Bariola, 2012). A similar study conducted in 2017 proves the recent decrease in underage alcohol consumption amongst Australian teenagers. This study revealed that 9% of 12 to 15-year-old, and 29% of 16 to 17-year-old Australian secondary school students were current drinkers in this year (Guerin & White, 2018). With this trend, it can be implied that the number of Australian secondary school students has, and will continue, to decrease.

This data supports survey data collected of students from Cavendish Road State High School in 2019, in that it is revealed that 6% of year nine students, and 30% of year twelve students, would be classified as ‘current drinkers.’

Key Findings

To collect primary data, year eleven students from Cavendish Road State High School conducted surveys before the health initiative to collect data about the current drinking habits of year nine and twelve secondary school students. The results show that 74% of year nine students, and 15% of year twelve students, have never tried alcohol. Both the year nine and year twelve cohorts predominantly identified ‘social reasons’ as the most influential reason for their consuming alcohol. One third of year nine students believed this health promotion was highly influential on their views of alcohol. 54% of year nine studently reportedly would stop their peers from consuming alcohol. Only 27% of year nine students believe this health promotion did not make them more aware of peer pressure. 6% of year nine students are ‘current drinkers’, and 30% of year twelve students are ‘current drinkers.’ This data can be used to show the influence that students can have on the drinking habits of their peers.

The survey questions which will assess the implementation of the intervention are: “do you think this experience has made you more aware of the influence peers have on your own alcohol consumption?” and “what is a fact or statement that you learnt on Friday that appeals to you the most?”. These questions determine implementation, as they encourage students to reflect on what they have learnt, which would futher reinforce their learning.

References

1. Glanz, K., 2001. Nutrition in the Prevention and Treatment of Disease. s.l.:Elsevier Inc.
2. Guerin, N. & White, V., 2018. ASSAD 2017 Statistics & Trends: Australian Secondary Students’ Use of Tobacco, Alcohol, Over-the-counter Drugs, and Illicit Substances, Victoria: Cancer Council.
3. Guerin, N. & White, V., 2018. ASSAD 2017 Statistics & Trends: Australian Secondary Students’ Use of Tobacco, Alcohol, Over-the-counter Drugs, and Illicit Substances, Victoria: Cancer Council.
4. International Alliance for Responsible Drinking, 2018. Trends Report Underage Drinking. Accessed 30 August 2019. http://www.iard.org/wp-content/uploads/2019/08/Trends-report-Underage-drinking-Working-together-to-deliver-change.pdf
5. Johns Hopkins University, 2016. Social Cognitive Learning Theory. Accessed 30 August 2019. https://sbccimplementationkits.org/sbcc-in-emergencies/social-cognitive-learning-theory/
6. Personal Development, Health and Physical Education, 2015. The Ottawa Charter in action. Accessed 30 August 2019. https://www.pdhpe.net/health-priorities-in-australia/what-actions-are-needed-to-address-australias-health-priorities/health-promotion-based-on-the-five-action-areas-of-the-ottawa-charter/the-ottawa-charter-in-action/
7. White, V. & Bariola, E., 2012. Australian secondary school students’ use of tobacco, alcohol, and over-the- counter and illicit substances in 2011, Victoria: Cancer Council.
8. World Health Organisation, 1986. Ottawa Charter for Health Promotion. Accessed 30 August 2019. https://www.healthpromotion.org.au/images/ottawa_charter_hp.pdf

Throughout all the body systems covered in PNUR 113 came with a lot of different ways to keep those systems, along with the tissues, organs, and cells that are involved, healthy. In this essay, I will discuss the five systems that stood out to me the most while learning about anatomy and physiology along with interesting promotion techniques and different health promotion strategies of each. The 2 systems are the Integumentary and Nervous systems.

The nervous system is the body’s main coordinating system that sends different types of sensory responses throughout the entire body. It is divided into two different divisions, the central nervous system; which contains the brain and spinal cord, and the peripheral nervous system; which contains the cranial and spinal nerves. When different areas of the nervous system are injured or even when mental health problems occur, it can be very difficult for the body to properly function. Health problems within the nervous system can occur suddenly, such as an accident, or can occur slowly, creating a loss of function. An example of a disease that can come on slowly and result in loss of function is Multiple Sclerosis (MS). Multiple Sclerosis affects the axons in the optic nerve, brain and spinal cord. It causes problems with vision, muscle control, balance and general motor coordination such as bladder control. The disease tends to be progressive causing more damage the longer you have it. Unfortunately there is currently no cure for multiple sclerosis or many of the other neurological diseases but most of them have medications that can help decrease severe attacks and make living with the disease a little bit easier. Preventing head injuries, such as a concussion is also key to maintaining a healthy nervous system; concussions can create an onset of mental health disorders such as depression, anxiety and even psychosis. Wearing helmets while doing activities that could potentially result in head injury, such as sports like hockey and football, can be very helpful.

The Integumentary system makes up a decent amount of your body weight and in my opinion is probably one of the most underappreciated systems in the body. It is constantly being worn away, attacked by microorganisms, irritated by the sun and other environmental chemicals. It is the body’s very first line of defense against antigens and providing physical protection from environmental hazards, essentially the first place where you and the outside world meet. The cutaneous membrane of the integumentary system consists of the epidermis and the dermis. The epidermis protects the dermis and helps prevent water loss and pathogens from entering. It also has sensory receptors that detect touch, pain and temperature. The dermis has two layers, the papillary layer which protects and supports the epidermis and the reticular layer, the blood vessels in this layer help with thermoregulation throughout the body. The accessory structures in the system are hair follicles, exocrine glands and nails. Protecting yourself from the sunlight is very important for your skin, too much sunlight will damage the epithelial cells and the deep tissues. People with fair skin who are constantly in the sunlight are at a higher risk of developing skin cancer, their melanocytes are not able to protect them from the UV rays. The sun usually has it most intense UV rays during the middle of the day, avoiding this and at the very most protecting yourself by finding shade and wearing sunscreen will help. Using sunscreen with a high SPF will also help as you get older will help with cosmetic problems such as wrinkling. Another health promotion strategy with the skin is stress management. When you become stressed out it causes your body to release more cortisol hormones into your body, this can result in oily skin making it more sensitive and contribute to more breakouts.

Introduction

I would like discuss about the most public concern health challenge, that is homelessness. It is the most experiencing challenge in India. It is also a social issue. Homelessness is defined as living in housing that doesn’t meet the minimum criteria or not even minimum secure. It is security of occupancy, services acceptability and so on. The major health challenge which I have found is homelessness in India. It is not referring to only the people who doesn’t have minimum requirements but also to people who live in public places such as platforms, temples, roadside, under the flyovers, open spaces, staircases, pipes and streets. Being in such places, they get infected to many diseases and they can lose their health.

Burden due to this health challenge

Based on 52% of city areas, it is estimated that around 1.8 million people in India are suffering with this health challenge. According to 2011 census, Delhi in India has a range of 150,000 to 200,000. Most of the people in this community are facing this problem. Due to this challenge whole population are affected and diseased in conjunction with this homelessness population. Due to this people get habituated to substances and offences. It can also lead to other diseases due to unavailability of facilities, lack of nutrition, hygiene and also by crowding in public places. In an article it was found that due to homelessness, there is increased risk in chronic diseases, respiratory infections, sexually transmitted infections and stroke of death. Due to this condition, along with physical and mental health problems, substance addiction and behavioural problems are also seen. Due to this, there is also chance of respiratory infections by inhaling toxic fumes and construction dust. Due to this condition, normal illness leads into a severe disease by increasing the burden. Many other linked conditions like malnutrition, dental diseases, joint disorders, venereal diseases are also observed. By being homeless they get easily receptive to many ranges of diseases. Mental illness is the main aspect and to control this many governmental and non-governmental schemes are introduced because as they have poor access to health care. With this population, mental illness is caused 20 times more than normal people. They also conducted a trail taking 140 people in India, they found vast people about 90% were from India when compared to others in this burden due to homelessness.

Determinants

There are many factors for this condition, they are like poverty, addiction to drugs, unhealthy relations between children and parents, violence, natural calamities, disturbance between people. One of article says that not only due to poverty but also expecting high amount, they rent it and get money. Even due to cheating, it is observed and also if crop is failure by farming, it also leads to homelessness. Also due to lack of education, people will be unaware of risk factors of homeless and causing factors. In adequate income, disputes and un healthy relationships, overcrowding in major cities, urbanization and so on are observed.

• Poverty: Both the poverty and homelessness are inter connected to each other as it was found that when housing people are compared to homeless people, they are under the poverty line and around 50% of people are found with this connection.
• Violence and war: In some places in India other than Delhi like Uttar Pradesh, Muzaffarnagar, Assam and bode tribes, there were riots and in that many of them lost their houses. It is a surprised factor observed. When compared to normal this is community violence, where many are affected.
• Joblessness: It is one of major causes in Delhi observing at present situation due to higher competition in jobs. So, that people are unable to spare the price of a house in addition. It is how they are unable to meet minimum housing or lack of houses.
• Natural calamities: Many of the natural disasters like tsunami, cyclones, thoofan are leading to destroying of houses. Recently, there are many cyclones observed in Uttarakhand in addition to Delhi where most of houses were destroyed.
• Drug and alcohol addiction: People due to addiction to alcohol, substance usage, tobacco smoking is of the most people in homeless condition. These addictions are mainly observed among homeless persons than persons containing home. When they are addicted and habituated to those all, they will be no balance between income, spending and savings. So, they can’t buy or rent a proper house as houses are more costly in Delhi and major cities.
• Disputes between children and parents: This is also important factor as children may mis behave and are irresponsible, their parents don’t give their property and children get evacuated from house. As they can’t earn money as much to afford house and so homelessness increases. If the relation between them is healthy, then this condition can be reduced.
• Family disputes like divorce: Then people in a family get separated and move to separate places and live separately. Then is there is risk for this parent with depending children.

Burden of homelessness

Data collected to represent the burden of homeless is done by professional workers from both government and non-governmental organizations. It was found that in India, around 78 million people are homeless in this developing world money making height. There is more burden of homeless in urban areas about 69,000 than in rural areas. In Delhi in 2010, there were 55,955 people are suffering with homelessness. In 2011, it was found 3,594 children out of total 46,076 people are homeless. There are also some conditions like they struggle due to homeless in particular time but not for longer times. As Delhi is a major city it has people suffering from this, central district about 25% where north district of it has 14.2% and north west side consists of 19.3%.

Critical analysis of new Health approaches

Focus on social support, social capital, behaviour and lifestyles: In this new this new public health approach, there is special support in behaviour wise or financially. While supporting this challenged people with financially can definitely afford a house and can lead a better life. Also guiding them good behaviour and lifestyles can decrease the burden of disease.

Legislation and policy: Under this approach all the public health workers must notify the issue in all policies and should create more awareness among people and also provide health care services. They need to argue about these issues and monitor. So, that homelessness can be reduced.

Philosophy and awareness: Philosophy plays an important in any health challenge. Because of their motivation, many changes in the public can be observed. However, in some articles it is said that, practically it lacks. These public health workers bring awareness and homeless can be decreased by maintaining relations in families and working properly.

Prevention and health promotion: Homelessness can be prevented in some cases like poverty by creating employment, in addiction to alcohol and substances whereas in some cases it cannot be prevented. Health promotion can apply in homelessness people by teaching them causes, risks of it and also burden of disease caused due to homeless.

Equity and social justice: In Delhi, this is the one of the major causes. All the people must be treated equally. There should be bias in gender, race, religion, community etc. due to these conditions people get effected and may not get houses. They remain homeless.

Also, according to Ottawa Charter example in those approaches, he presented two communities naming A and B. one is supportive and the other creative. Definitely, supportive approach community has more change than the community with creative. So, there should be some supportive approaches to avoid homelessness.

New approaches and recommendations

There are many new public health approaches to overcome the health challenge from which Indian community are suffering. It involves many schemes, government policies, non-governmental associations, legislations, easy access to health care services, awareness camps, welfare programmes and services, hosing interventions and so on. In this conditions, mostly mental illness is mostly observed, so to overcome, these must be supported with acts like revised persons with disability act, 2016 & mental health care act, 2017. So that these community population will have right to live in the community and also government should provide support to housing and also other services for their living. Also, guidelines are be developed to access and programmes developing must be comprehensive with all preventive components and immunization. Also, special care must be taken on homeless people by adopting schemes.

Intervention of housing: The main motto of this approach is to avoid disabilities, increased availability of houses, affordable and decrease the burden of diseases in support to homelessness people living, Indian government should introduce policies for their housing and those will be allotted to them. To meet their mandatory complex necessities, housing first is the best intervention as it is proof to talk about housing facilities, security. The National Mental Health Policy of India envisions prevention of disability, promotion of mental health, and facilitating recovery from psychiatric illness.

To support self-development: Homeless people stay far from the city. As they are illiterate, they live far and can’t get any schemes and policies that are provided. So, they are taken to open shelters and provide minimum shelter and motivate them to live better. In order to facilitate the key streaming of homeless people into society, shelters must ensure the design and implementation of different training programs, non-formal education projects and access to affordable services and rights.

Accessing to minimal services: Mostly, it is observed that people invest money for sanitation and water. Due to this, homeless people can’t even get provided with minimum requirements. They are getting exhausted with this. So, if action is taken and people in homes use them in less, homeless people can utilize from shelters and outside.

Conclusion

There are many issues and high burden of diseases due to homelessness. It is not only a single issue but it is a way to many of diseases. This is mostly being observed in Delhi in India. Many people in India are homeless and suffering with this issue. There are many causes, it may be due to poverty, illiteracy etc. Also, there are new public health approaches where those are applied to this community suffering with homelessness health challenge. Finally, homelessness can be decreases to minimum cannot be eradicated due to many factors.

Self-care is an essential mechanism to ensure heal regulation and monitoring health illness. According to the Middle Range Theory of Self-Care of Chronic Illness, self-care maintenance, self-care monitoring and self-care management were introduced and presented (Riegel et al., 2012). These concepts reiterate of how one distinguishes the symptoms and monitors it through rigid monitoring on one’s condition (Riegel et al., 2018). Nowadays, people are monitoring their health with the use of technology. With the advancement of technology, even clinicians are leaning towards adapting technology so as to actively monitor their status and progress (Reigel et al., 2019).

There are numerous studies that puts technological advancement on front as a way of promoting self-care towards end users. A study conducted by Bice, Wall, Hollman & Adkins (2019) students encounter difficulty in dealing with their academics to the point of lack of physical activity. These individuals give more attention to their educational activities rather than own needs of their own bodies which can lead to risk in health deterioration, possibly catching a disease or a chronic illness (cited in Elsawy & Higgins, 2010; Centers for Disease Control and Prevention, 2015). These instances are most likely to occur in incoming college freshmen on college or universities as they have to juggle their time in weighing down their options to their priorities at school. Needless to say, the activities of the students are compromising their health due to stress and fatigue and lack of active lifestyle which could help lessen their physical burden (cited in Ellis, Compton, Tyson, & Bohlig, 2002). Technology comes into play which is mostly incorporated and used throughout the day especially in the modern age where the advancement is increasing at a faster rate. Computer-based programs are as convenient amongst students especially smart technology such as mobile applications and smart watch that help them track their results. They may able to see, decipher and judge the results coming from these devices and integrate them in their healthy living. This, of course, is in limitation to their daily schedule (Bice et al., 2019).

Computing the body mass index (BMI) of the individual is one of the common and easy way to determine if one is on appropriate weight based on one’s height and weight (Stevens, Katz, & Huxley, 2010). The previously mentioned study had conducted 147 female college students and 71 male students to participate in relation to technology use in response to their physical behaviors. Out of 235 college students, 41.3% of them have utilized and assisted by technology to help them exercise and initiate to do physical activities. This is based on the students’ physical activity levels, number of days of physical activity and the amount of time during the day the activity was done. The researchers of the study deduced that technology use has a significant effect on vigorous physical activity. It can help promote and encourage not only young individuals but also individuals on all ages to track unhealthy lifestyle easily with the integration of technology, and thus correcting behaviors that one normally does. It does not only limit in physical activity but also eating habits that can contribute to one’s health. Using such mobile applications for health monitoring help boost self-confidence and satisfaction in physical change that can help an individual transition as a conscious with their own health and wellness (Bice et al., 2019).

Bucci, Schwannauer and Berry (2019) also supported the claim of beneficiaries of technology, this time, on mental health. In likelihood of technology use, it is mostly used as a medium for tracking self-assessment on their well-being. This includes social media, online blogs and forums (cited in Batterham & Calear, 2017; Berry, Lobban, Emsley, & Bucci, 2016). Digital assessments were then available to showcase online end-users to assist people who are experiencing mental problems and educate people on how to approach individuals suffering with mood disorders (Murray et al., 2015). Methods were also incorporated and informing through a digital platform to people who are reluctant to have personal meet-up treatments. The said examples mentioned are beneficial in the modern age especially that technology plays a huge role in engagement and communication. The digital tools also can help report educate the user on how they can able to regulate difficulties in such a way that, in one’s way, can cope challenging experience. Therapies, such as cognitive-behavioral therapy, are incorporated through self-monitoring apps and websites to further ascertain their condition, reduce severity and conduct self-assessments efficiently. Having said that, there are also downsides to this innovation. Some of those are the tendency of unvalidated material being used, which can be abused and be bound for tolerance, security of data, especially that transactions are through internet and the lack of contact between client since it is only limited on-screen and not in personal interaction (Bucci, Schwannauer and Berry, 2019). According to Berry et al (2017), Twitter is one of the social media websites which is notorious for people discussing mental health issues and promotions. It is convenient for them to share their experience without leaving the house and face other people. Disadvantage of using Twitter and other related social media sites is that the experience of others can be mirrored onto self. Referencing what other people have through can be a source of disapproval and shame, particularly prone on people who feel alone, rather than inspire to do better. Despite on the negatives, technology tremendously helped us in such a way that it gives support to those people who essentially needed much intervention which do not give threat to them.

A qualitative study discussed the perspective and experience of elderly towards using technology as an aid towards monitoring their mental health. With fifteen (15) participants, they round up with a deduction that usage of digital interface and gadgets help them understand their condition and minimizing their reluctance on using electronic devices that not only can reduce their loneliness, but can improve their mood such as watching online videos. The challenge identified by the participants was recognizing the symbols and the user interface of the gadget, especially when going to a website (Andrews, Brown, Hawley & Astell, 2019).

Internet-delivered psychological treatments had been advantageous in getting clients due to low consumption of money and people are now browsing to the internet conveniently and can book a clinician without going outside, however further studies are still needed to assess whether giving a psychological intervention to the affected person on screen can be effective all throughout the process (Andersson, Titov, Dear, Rozental, & Carlbring, 2019).

Mental health programs for young people can only be successful if it is flexible, culturally appropriate and more specifically centered on their needs and concerns. (Vranda, M.N., 2015). The ideal place for such programs is the school where there is ample opportunity to promote the mental health of young people. Stress, anxiety, and depression are the most frequently identified mental health problems among students. Psychoses, substance abuse disorders and self-harm tendencies, which are less common and are poorly addressed, but often much more serious and enduring (Roy 2019). Many of the mental, behavioral and psychological problems among children and adolescents can be prevented, if it is diagnosed and intervened at an early stage. School-based interventions possess great potential in reducing the risk factors and increasing the protective factors to promote the mental health and well-being of children and adolescents. A well-inclusive program has the potential to build efficiency among children and adolescents in schools if it incorporates teachers as facilitators and this yields long-term outcomes on investment. Good mental health is vital to children and adolescents’ success in school and social life. Researches confirmed that students who receive social-emotional and mental support always achieve better academically. It also improves the perception of healthy a School climate, classroom behavior, on-task learning, and students’ sense of connectedness and well-being as well (Thapa, Cohen, Guffey, & Alessandra, 2013). So, schools must recognize and respond to the diverse mental health and well being needs of students and thereby ensuring quality education to all through the appropriate curriculum, organizational arrangements, teaching strategies, and resource supports.

In this context, schools have a unique opportunity to improve the lives of students. Progressively, schools should expand their role in providing services for the overall child and adolescent development and well-being. As a powerful socialization agent, the school plays an important role in the transformation of cognitive, linguistic and psychosocial competencies. School is not just a place of educational learning, but also an important environment where children make friends, develop social networks and are introduced to adult role models. The school setting, being a place of learning and modeling, has the potential to contribute positively to students’ mental health and well-being. It is important to build happy, healthy and harmonious schools for students’ mental health welfare, which are significant demographic dividends and most important national assets. It is to be noted that India does not yet have a comprehensive approach and practices for school mental health promotion.

Existing policies and services for Mental Health Promotion in Schools: In India, there is no separate all-encompassing policy to deal with mental health issues in schools. Children’s mental health policy is limited, and the behavioral and emotional support needs and aspects of special students are completely ignored. In the five-year plans, the government has earmarked only a few crore rupees for the mental health of the entire country, in which mental health promotion of the child has received very little priority (Bhat, 2012). Many mental health or other disabilities programs and policies have lots of complications related to its nature, administration, or access to a targeted group of people. In a report by WHO (2011), mental health facilities are limited in India. And primary health care doctors and nurses have no official in-service training in the mental health sector. Mental health expenditure by the Indian government is less than 0.06% of the total health budget (Mishra & Galhotra, 2018). The existing policies such as the National Health Policy, Integrated Child Development Scheme and National Mental Health Program, etc. stress the need to be more comprehensive at various levels. India has adopted several national policies in different areas of child development, which include the National Policy for Children (1974), National Policy for education (1986), Mental Health Act (1987), Charter for Children (2004), National Mental Health Policy (2014) etc. But none of them have serious concern over the problem of mental health and wellbeing of children and adolescents in the school setting (Shastri, 2009). Some little steps are taken to improve the well being of students by various other institutions such as the ‘Happiness Curriculum’ that has been introduced by the Delhi government in over 1,000 schools between nursery to class 8. The entire curriculum is activity-based which includes yoga, meditation, exercises. It aims to stimulate a sense of self-concept, good mental health and reduce depression, anxiety among students (SCERT, 2019). School-based campaigns started by NIMHANS which aims to be increasing awareness about psychosocial disorders, self-awareness, and improvement in interpersonal relationships with peers and teachers (Vranda, 2015). CBSC has made it mandatory to have counseling services in every school but still, the most developed region of the country like NCR and other metropolitan cities, less than 3% of schools have counseling facilities. Schools charge hefty fees for services and are still not guaranteed whether the counselor is trained or not. They do not necessarily follow all the criteria for the recruitment of counselors (Thacker, 2018). On January 7th, 2014, the National Adolescent Health Action (RKSK) was recognized by the Government of India and implemented by the state government through the National Health Mission. Under such initiative of MHRD, recently the U.P. government has started the recruitment of school counselors in various KVS and other Navodaya schools (Johari, 2019). Although it has several limitations to address mental health issues, for instance, mental health is taken as taboo, and in reality; anxiety and depression are not taken as a serious concern in India (Roy et.al, 2019). Patients with severe mental disorders are stereotypically called Pagal (mad) here. So the people, especially students do not hold the courage to confront their situation in front of teachers, peers or even with family members. Counselors have the responsibility to identify such students and encourage them to share their feelings and problems. They should need continuous progression and training in their role and responsibility for school mental health promotion and special education for disabled children.

A solution as a Holistic School-based Approach

Mental health is the main concern in this study so it broadly emphasizes the approach that needs to be focusing on students’ psychological, emotional, social health and wellbeing. Schools play a large role in the holistic development of students and provide a room and scope for interventions at all levels of the schooling extent. There is a need to boost students’ mental health at various levels of school. As we have already discussed the importance of rounded development of students to ensure their positive mental health, so it is necessary to collaborate and cooperate with all school stakeholders to make sure that the counseling programs and mental health activities are successfully implemented (Low et al., 2013). This is called the Holistic Approach which means the involvement of every aspect of school and/or people related to school incorporates to accomplish certain goals (Argyros, 2012). It is a concept that acknowledges the social, political, economic and demographic contexts within which schools operate and influence students’ psychological health. Teaching resilience, safety, and health education, the involvement of parents and community services and working on comprehensive mental health policies are the most important contributing factors of a successful holistic approach across all years of the schooling system. This comprehensive approach is globally recognized as working holistically to promote student health and wellbeing. The Holistic school approach ensures that all aspects of the school community contribute positively to students’ health, safety, and well being. Several international initiatives from the WHO, UNICEF, UNESCO, and the International Union for Health Promotion and Education (IUHPE) use different terms to describe holistic, and comprehensive approaches address to the health and well-being issues among students, school staff and the wider school community. It is not just about what happens in the curriculum, but it is about the entire school day, it advocates that learning occurs not only through the traditional curriculum but also through students’ daily experience of life inside or outside of the school. It requires schools to address the health and wellbeing of their staff, students, parents/ guardians, and the wider community through the key components working in harmony to achieve improved health and wellbeing outcomes. It works on a theme that the good health of an individual cannot be attained just through their efforts, but health is also shaped by the surroundings within which he/she live, and work. By adopting this approach, schools can enhance the involvement of all stakeholders and increase the potential for sustainable development. Here are some recommendations to the school administrators and teachers to incorporate a holistic approach in their schools:

• The holistic school-based approach includes working together and being committed to all parts of the school. This requires teamwork among the government, school leaders, teachers and all school staff, as well as parents, and the wider community to achieve students’ overall health and development.
• The approach should encourage ongoing ‘comprehensive curriculum’ for the sensitization of principals, teachers, managers and all students towards the factors that can influence their mental health, like, Gender Issues, Substance Abuse Prevention, Anger management, Promotion of Emotional Health, and Safety as well.
• School systems must organize sequential age-appropriate programs and campaigns to spread awareness and responsibility about all dimensions of health and wellbeing.
• Life skills, health, and well being programs should be implemented for all students so that they become aware, accountable and empowered from all aspects of their personality and integrated with the standard of health and wellbeing.
• Trained counselors and special educators should be appointed to facilitate effective guidance and counseling for students as well as their families throughout their schooling. The right counseling and guidance help them to deal with their problems and also helps them to choose their academics and career effectively.
• There are a few most important things to consider for children with special needs i.e. early detection and intervention of the developmental problems and disorders are necessary as part of the specialized support to these children.
• The school should incorporate some parenting sessions in terms of child mental health, care and resilience training and awareness.
• Along with this, some capacity building programs for teachers and non-teaching staff should also be included to aware to the entire school about the sensitivity to child abuse and bullying.
• The mental health approaches should be designed to strengthen student abilities or skills using teachers as the facilitators in the schools in the following areas: promotion of positive mental health, enhancing resilience, handling academic stressors, practicing healthy lifestyles, prevention and handling sexual abuse, and bullying, developing healthy relationships, prevention of substance abuse, goal setting, prevention of suicide and developing values and life skills.
• Schools must have a measurable and sustainable Monitoring and Evaluation System (MES) for effective implementation of the life skills, mental health, values, behavioral and well being programs with dynamic indicators and the context of the changing scenario of the developmental, cultural and educational needs of the students.

Conclusion

Interactive and activity-based classroom sessions allow students to enhance their knowledge, attitudes, and skills essential for experientially promoting mental health and resilience, the results of which are expected to be sustained. Young people need to be taught how to regulate their emotions, deal with frustrations and failures, handle peer pressure and problems related to development, school and family in a healthier way which in turn would promote their mental health and resiliency. To support students in their mental health issues, it is important to reach all parts of the school community and beyond, because teachers, parents and other staffs all are integrated responsible for the development of students’ overall mental health and well being. A Holistic-school approach could be an ideal way to bring about changes to policy and practice to ensure everyone is fully on board, from governors to teaching assistants. Evidence suggests that schools with a whole school plan are more likely to have a positive impact on the mental health and wellbeing of pupils.

School-based interventions program has been increasingly recognized as an effective means of promoting the mental health of students and prevent the development of unhealthy behavior. Programs focused on competence enhancement of children and adolescents produced long-lasting positive effects on mental, social, and behavioral domains. Mental health problems among children and young people manifest in many ways, including emotional problems such as anxiety and depression, hyperactivity, conduct disorders, and peer problems. Not only do schools need to understand, and respond appropriately, to the wide range of symptoms displayed by children and young people, but they also need to understand the key role that gender plays in this.

Increased access to mental health services and supports in schools is vital to improve the physical and psychological safety of students, as well as academic performance and problem-solving skills at schools. School mental health supports that encompass social-emotional learning, mental wellness, resilience, and positive connections between students and adults are essential to creating a school culture in which students feel safe and empowered to report safety concerns, which is proven to be among the most effective school safety strategies. Additionally, school mental health professionals can provide supports that are sustainable, and can help to identify and work with students with their more intense or daily needs.