Health Promotion in International Documents: Strengths and Weaknesses from the Perspective of Community Empowerment

Informed by a community psychology perspective, which takes an integrated and systemic, or holistic view of health and health promotion, this study presents quali‐quantitative analysis of health documents, produced by the World Health Organization (WHO) over the last 30 years. Textual analysis facilitated the identification of the typical specificities of international WHO health promotion documents, highlighting the lexical contexts of health promotion, particularly in relation to responsibilities for health and the concept of community health. Further, this textual analysis demonstrated how these understandings of health and health promotion have evolved over the last 30 years. Drawing on theory from within the field of community psychology, the changes proposed throughout international WHO documentation in conceptualizations of health and health promotion and in defining strategies to achieve the stated goals of health promotion are discussed critically. Copyright © 2011 John Wiley & Sons, Ltd.     

Post-Traumatic Growth After a Myocardial Infarction: A Matter of Personality,Psychological Health,or Cognitive Coping?

The aim of the present study was to focus on the relative contributions of personality, psychological health and cognitive coping to post-traumatic growth in patients with recent myocardial infarction (MI). The sample consisted of 139 patients who had experienced a first-time acute MI between 3 and 12 months before data assessment. Multivariate relationships were tested by means of Structural Equation Modeling. The results showed that besides the contribution of personality and psychological health, a significant amount of variance in growth was explained by the cognitive coping strategies people used to handle their MI. As cognitive coping strategies are generally assumed to be mechanisms that are subject to potential influence and change, this provides us with important targets for intervention.     

Health promotion--science or ideology?

This article is the author's American Psychological Association Division 38 Presidential Address, which was delivered at the 1987 APA meetings. It challenges health psychologists to be wary of becoming zealots in health promotion activities without continuing to recognize that health promotion programs should be anchored in sound science. This is discussed in terms of the biomedical research support for a recommended health practice or in terms of the psycho-socio-behavioral research support for techniques applied or advocated in intervention programs. To illustrate this problem in health promotion, the research foundations for recommendations of cholesterol control programs and the "Say No to Drugs" campaigns are explored. Other concerns relating to the appropriate role for the health psychologist in health promotion activities are also discussed.     

Understanding body image disturbance in the promotion of mental health: a discourse analytic study

Health care interventions in the area of body image disturbance and eating disorders largely involve individual treatment approaches, while prevention and health promotion are relatively underexplored. A review of health promotion activities in the area of body image in Australia revealed three programmes, the most extensive and longest standing having been established in 1992. The aims of this programme are to reduce body image dissatisfaction and inappropriate eating behaviour, especially among women. Because health promotion is concerned with the social aspects of health, it was hypothesized by the authors that a social understanding of body image and eating disorders might be advanced in a health promotion setting and reflected in the approach to practice. In order to examine approaches to body image in health promotion, 10 health professionals responsible for the design and management of this programme participated in a series of semi‐structured interviews between 1997 and 2000. Three discursive themes were evident in health workers' explanations of body image problems: (1) cognitive‐behavioural themes; (2) gender themes; and (3) socio‐cultural themes. While body image problems were constructed as psychological problems that are particularly experienced by women, their origins were largely conceived to be socio‐cultural. The implications of these constructions are critically discussed in terms of the approach to health promotion used in this programme. Copyright © 2001 John Wiley & Sons, Ltd.     

悦纳访谈——健康适应不良行为的纠治艺术

动机访谈是目前西方国家行业协会推荐给广大非心理治疗专业医务人员或健康工作者的一种简单有效的治疗性沟通方法,可以广泛应用于心身医学关注的健康适应不良行为的纠治。悦纳访谈是在动机访谈的基础上,结合作者的临床和教研经验,引入太极推手等中国文化元素,以“知己知彼,反应适当,真实和谐,悦纳选取”十六字诀为访谈基本原则,统领并整合动机访谈的基本精神、基本技术和基本程序,形成的具有中国文化特色的或中国化的动机访谈。     

Barriers to Learning Motivational Interviewing: A Survey of Motivational Interviewing Trainers' Perceptions

Trainers reported that motivational interviewing (MI)–inconsistent behaviors were frequently perceived during training and believed to create barriers to learning. More barriers were perceived in corrections than in mental health training audiences. Strategies to facilitate unlearning MI‐inconsistent behaviors may accelerate acquisition of MI.     

心理预防概念的更新及其对实践的指导意义

继Caplan的“公共卫生预防模型”之后,Gordon提出另一个综合性预防模型;美国国家科学院医学研究所绘制了“心理健康干预光谱”; 美国国家研究所和国家科学院医学院则进一步将“心理健康促进”正式纳入心理预防概念。“心理健康促进”是针对消极被动的传统预防而提出的积极主动的预防。心理预防概念的发展与更新,特别是将“心理健康促进”纳入心理预防体系,要求树立预防的全局观念,提高预防的针对性,将消极心理预防与积极心理健康促进结合起来。     

Changes in smoking behavior after a myocardial infarction

Among 383 participants in a longitudinal study of myocardial infarction (MI) patients, 230 smoked at the time of the MI. Posthospital smoking status was based on self-report for the day of follow-up, whereas information about length of continuous cessation was not available. Six months after the heart attack, 40.6% of the smokers had resumed smoking, whereas 49.4% smoked at a 3- to 5-year (M = 43-month) follow-up. Resumption of smoking within 6 months after the heart attack was associated with an increase in anxiety and depression during the first weeks after discharge, less cardiac health knowledge, and a less severe MI. In patients who relapsed at a later point, resumption of smoking was associated with a subsequent decline in general cardiac health knowledge, as well as in correct understanding of smoking at a risk factor. Long-term changes in smoking status were also related to previous heart disease, premorbid work instability, age, and severity of the MI. The results indicate that antismoking counseling of MI patients should not be limited to the health risks associated with smoking and that training in coping with negative affects without smoking may be valuable in promoting smoking cessation.     

Health promotion from the perspective of social cognitive theory

Abstract

This article examines health promotion and disease prevention from the perspective of social cognitive theory. The areas of overlap with some of the most widely applied psychosocial models of health are identified. The models of health promotion and disease prevention have undergone several generational changes. We have shifted from trying to scare people into health, to rewarding them into health, to equipping them with self-regulatory skills to manage their health habits, to shoring up their habit changes with dependable social supports. These transformations have evolved a multifaceted approach that addresses the reciprocal interplay between self-regulatory and environmental determinants of health behavior. Social cognitive theory addresses the socio structural determinants of health as well as the personal determinants. A comprehensive approach to health promotion requires changing the practices of social systems that have widespread detrimental effects on health rather than solely changing the habits of individuals. Further progress in this field requires building new structures for health promotion, new systems for risk reduction and greater emphasis on health policy initiatives. People's beliefs in their collective efficacy to accomplish social change, therefore, play a key role in the policy and public health approach to health promotion and disease prevention.     

The Role of Interdisciplinary Teams in the Promotion of Physical and Mental Health

This article delineates important issues to be considered using special services professionals to develop and implement health promotion programs by means of a school-based interdisciplinary team approach. The current status of interdisciplinary teams is discussed and an expanded role for such teams in health promotion activities is advocated. Specific issues pertaining to interdisciplinary team organization and integration into school systems are reviewed in the context of health promotion program development.     

腰椎间盘突出症患者MED术前心理状态调查与分析

为了研究腰椎间盘突出症患者行MED微创治疗前的心理状况,对442例行MED手术治疗的患者应用焦虑自评量表（SAS）、抑郁自评量表（SDS）进行术前心理评估。结果显示MED微创治疗前患者SAS、SDS测量分明显高于常模组。患者性别、年龄、婚姻状况、文化程度、病程长短等都与心理状况的改变相关。有34.9%的患者SAS得分和36.7%的患者SDS得分显示阳性。因此,临床骨科医师应重视心理因素的作用,在MED术前应对患者进行心理状况评估,并对心理状况较差的患者进行术前干预,才能取得更好的临床疗效。     

Establishing and maintaining healthy environments. Toward a social ecology of health promotion.

Earlier research on health promotion has emphasized behavior change strategies rather than environmentally focused interventions. The advantages of integrating lifestyle modification, injury control, and environmental enhancement strategies of health promotion are substantial. The author offers a social ecological analysis of health promotive environments, emphasizing the transactions between individual or collective behavior and the health resources and constraints that exist in specific environmental settings. Directions for future research on the creation and maintenance of health promotive environments also are examined.     

Parent-adolescent health conversations as action: Theoretical and methodological issues

Abstract

A qualitative research method based on action theory is proposed and illustrated for use in health psychology and health promotion research. Action refers to the goal-directed and intentional behaviors of individual and groups. Action theory has the advantage of using the perspectives provided by manifest behavior, internal processes, and social meaning in the analysis of action. In this article, the actions under consideration are the health-related conversations of parents and their adolescent children. The approach is premised on an understanding of health promotion as a family task constructed through actions such as conversations between family members. Health conversations in two parent-adolescent dyads are used to illustrate the method. The analysis includes the identification of goals, functional steps, and elements and their relation to the family health promotion project. Specific attention is paid to data gathering and analysis issues and their implications for health promotion research.     

A systematic review of motivational interviewing within musculoskeletal health

Motivational interviewing (MI) has been investigated within a range of healthcare environments though to date no studies have systematically assessed its application and effectiveness within musculoskeletal health. The aim of this study is to identify interventions that have utilised MI to create change within musculoskeletal healthcare, evaluate quality and effectiveness, as well as identify the level of training received by those utilising the approach. The search strategy identified both published and unpublished or grey literature through electronic resources, reference list and content searches. Five studies were identified for quality assessment. Due to variations in delivery modality, musculoskeletal condition and type of MI application it was not possible to provide direct comparative interpretations for these factors. A data synthesis was used to provide a summary of study characteristics, a narrative overview and conduct a quality assessment as well as considering authors comments on study limitations. The results of the quality assessment highlighted a number of methodological issues which supported and expanded upon those expressed by the studies authors. None of the studies contained children or young people and in terms of training there were variations in training provider, duration and competency, as well as variation in the fidelity of MI. The findings have highlighted the need for well designed randomised controlled trials that are suitability powered to measure the effectiveness of MI within musculoskeletal health. Future studies may consider the application of MI within musculoskeletal conditions in terms of self-management and its application to creating lifestyle changes (e.g., diet, exercise) for adults, as well as children and young people. Research currently being conducted may expand upon the evidence, feasibility and validity of MI within areas such as fibromyalgia, osteoporosis, arthritis, understanding of knee replacement and rehabilitation.     

Effect of brief mindfulness and relaxation inductions on anxiety,affect and brain activation in athletes

The mindfulness-based intervention and psychological skills training are often used for maintaining the mental health or reducing undesirable mental states in athletes. However, their differences in acute effects on mental health and underlying neural mechanism are not well understood. Therefore, the purpose of the current study was to examine the differential effects of brief mindfulness induction (MI) and relaxation induction (RI) on state anxiety, affect and brain activation. Thirty-five track and field athletes were recruited for this study. Using a within-subjects crossover design, participants underwent three conditions that incorporated two 30-min experimental conditions (i.e., MI or RI) and a control condition. State anxiety and affect were assessed before and after intervention, and brain activation (i.e., theta, alpha bands) were recorded by electroencephalography (EEG) during each 30-min condition. Repeated measures analysis of variance revealed that MI and RI similarly reduced state anxiety and negative affect from pre-test to post-test compared to the control condition. In terms of positive affect, there were no significant differences among the three conditions across times. Furthermore, participants exhibited higher frontal theta power during the MI and RI than control condition, whereas no differences in alpha power were observed among conditions. The current study provides initial evidence from an electrophysiological perspective that brief MI and RI both improve the negative psychological states in individual sport athletes through similar neural mechanisms. Nevertheless, the moderating effects of training experiences and long-term interventions on mental state and EEG activity in athletes need further investigation in future studies.     

Finding new ways to practise critically: applying a critical reflection model with Australian health promotion practitioners

Greater support is required in health promotion for practitioners to adopt critical approaches to their practice. Despite recognition of the role that critical reflection can play in supporting critical practice, it is underdeveloped in health promotion. This pilot study aimed to explore the use of critical reflection with health promotion practitioners. Critical postmodernism provided the theoretical perspective and critical reflection methodology guided the study. The data collection method involved the application of a critical reflection model via in-depth semi-structured interviews with two health promotion practitioners who were recruited using purposive sampling. Critical postmodernism and critical health promotion values and principles were the thematic frameworks used to analyse the data. Four types of assumptions were identified across both participants’ narratives: binary opposites and dichotomous thinking; identity and othering; professionalism; and power. Two key themes that evidenced these assumptions were conceptualising power as a commodity, and identity in the Aboriginal and Torres Strait Islander context. Both traditional and critical health promotion practice approaches were evident in participants’ practice. The process of engaging in critical reflection resulted in positive outcomes for the practitioners, including the identification of new, more critical ways of practising. Critical reflection provides a process for developing critical health promotion practice. The designation of critical reflection as a core health promotion competency may enhance the development of critical health promotion. Further research is needed to develop and test a critical reflection model incorporating the values and principles of health promotion with a larger sample of practitioners.     

Motivational Interviewing in the Reciprocal Engagement Model of Genetic Counseling: a Method Overview and Case Illustration

Motivational Interviewing is a well-described counseling method that has been applied to a broad range of health behavior encounters. Genetic counseling is an emerging area of utilization for the method of Motivational Interviewing. The relational and technical elements of the MI method are described within the context of genetic counseling encounters. Case excerpts will be used to illustrate incorporation of MI methods into the Reciprocal Engagement Model of the genetic counseling encounter.     

Knowledge and expectations: Perceived illness in myocardial infarction patients

In a study of 367 patients with myocardial infarction (MI), questionnaires were developed to assess two central aspects of perceived illness: factual and consensual illness knowledge and subjective expectations for the personal consequences of the MI. In a factor analysis, these two aspects of perceived illness were found to load on separate factors, and the patients views of the personal consequences of the MI were only moderately associated with their general cardiac health knowledge. Among a series of sociodemographic, medical, and psychological variables, including a standardized in-hospital patient education programme, the two aspects of perceived illness also proved to have different determinants. Differences in factual and consensual illness knowledge were mainly related to differences in formal education, and this aspect of perceived illness was influenced by the standardized education programme. In contrast, differences in subjective expectations were associated with levels of hopelessness. The implications for psychosocial interventions in the rehabilitation of MI patients are discussed.     

The relationship between shame and perceived biological origins of mental illness among South Asian and white American young adults

Mental illness (MI) affects one in four people in their lifetime and a failure to seek help for MI can have grave consequences. To decrease stigma and increase help seeking, prior campaigns have promoted the biological origins of MI. Even though some research supports the efficacy of this approach, other research does not. We propose cultural differences as a partial explanation for these inconsistent results. The current study assessed ethnic differences in the relationship between perceived causes of MI, shame associated with MI and perceived family support for help seeking. White and South Asian American (SAA) undergraduate students completed an online survey (n = 177). Results indicated that SAAs were significantly more likely than whites to perceive character deficits as the cause of MI. Further, among those who had sought help for MI, ethnic differences emerged in perceptions of MI based on perceived cause. SAAs who believed that MI had biological origins perceived more shame and less family support for seeking help compared to SAAs who believed MI was due to character deficits. The converse was true for whites – those who believed that MI had biological origins perceived less shame and more family support for help seeking compared to whites who believed MI was due to character deficits. The results of the current study illuminate the role that culture plays in perceptions of MI. Further, these results have implications for interventions targeting South Asian populations and for mental health outreach in general.