👨🏽‍🤝‍👨🏾Intro to Community Psychology Unit 5 – Prevention and Health Promotion

Key Concepts and Definitions

• Prevention focuses on reducing the incidence, prevalence, and severity of health problems before they occur
  • Includes primary, secondary, and tertiary prevention levels
• Health promotion involves enabling people to increase control over and improve their health
  • Encompasses a wide range of social and environmental interventions
• Risk factors increase the likelihood of developing a health problem (poverty, lack of education)
• Protective factors decrease the likelihood of developing a health problem or reduce its impact (social support, access to healthcare)
• Evidence-based prevention strategies have been rigorously evaluated and shown to be effective in preventing health problems
• Community engagement involves actively collaborating with community members in the planning, implementation, and evaluation of prevention programs
• Social determinants of health are the conditions in which people are born, grow, live, work, and age that shape health outcomes (housing, employment, education)

Historical Context of Prevention

• Early prevention efforts focused on reducing the spread of infectious diseases through sanitation and hygiene measures (handwashing, quarantine)
• In the mid-20th century, prevention shifted towards chronic diseases as major causes of death and disability
  • Emphasis on individual behavior change (smoking cessation, diet modification)
• The 1974 Lalonde Report in Canada recognized the importance of social and environmental factors in shaping health
• The Ottawa Charter for Health Promotion (1986) outlined key strategies for promoting health, including building healthy public policy and creating supportive environments
• Recent decades have seen a growing focus on health equity and addressing social determinants of health in prevention efforts
• The Affordable Care Act (2010) in the United States included provisions for expanding prevention and public health initiatives
• Global initiatives like the United Nations Sustainable Development Goals (2015) have prioritized prevention and health promotion as key strategies for improving population health

Levels of Prevention

• Primary prevention aims to prevent the onset of health problems before they occur
  • Targets the general population or high-risk groups
  • Examples include vaccination programs, health education campaigns, and policies to reduce exposure to health risks (tobacco taxes)
• Secondary prevention focuses on early detection and treatment of health problems to prevent progression and complications
  • Targets individuals with early signs or symptoms of a health problem
  • Examples include screening programs for cancer, diabetes, and hypertension
• Tertiary prevention aims to manage and rehabilitate individuals with established health problems to prevent further disability and improve quality of life
  • Targets individuals with chronic or severe health conditions
  • Examples include cardiac rehabilitation programs, diabetes self-management education, and support groups for mental health conditions
• Primordial prevention is a newer concept that focuses on preventing the emergence of risk factors themselves
  • Targets the social, economic, and environmental conditions that give rise to health risks
  • Examples include policies to reduce poverty, improve education, and promote healthy urban planning

Health Promotion Models

• The Health Belief Model suggests that individuals' health behaviors are influenced by their perceptions of susceptibility, severity, benefits, and barriers
  • Interventions aim to increase perceived benefits and reduce perceived barriers to healthy behaviors
• The Transtheoretical Model (Stages of Change) proposes that behavior change occurs through a series of stages (precontemplation, contemplation, preparation, action, maintenance)
  • Interventions are tailored to individuals' readiness to change
• The Social Cognitive Theory emphasizes the interplay between individual, behavioral, and environmental factors in shaping health behaviors
  • Interventions focus on improving self-efficacy, modeling healthy behaviors, and modifying the environment to support healthy choices
• The Socio-Ecological Model recognizes multiple levels of influence on health behaviors (individual, interpersonal, organizational, community, policy)
  • Interventions target multiple levels simultaneously to create comprehensive change
• The Community Organization Model involves empowering communities to identify and address their own health needs
  • Emphasizes community participation, capacity building, and social change
• The Diffusion of Innovations Theory describes how new ideas and practices spread through social networks over time
  • Interventions aim to accelerate the adoption of health-promoting innovations by targeting key opinion leaders and early adopters

Risk and Protective Factors

• Risk factors for chronic diseases include unhealthy diet, physical inactivity, tobacco use, and excessive alcohol consumption
  • Modifiable through lifestyle interventions and policy changes (e.g., increasing access to healthy foods, creating smoke-free environments)
• Adverse childhood experiences (ACEs) such as abuse, neglect, and household dysfunction increase the risk of numerous health problems throughout the lifespan
  • Preventing ACEs and promoting resilience can have long-term health benefits
• Social isolation and loneliness are risk factors for poor mental and physical health outcomes
  • Interventions that promote social connectedness and support can be protective
• Protective factors for mental health include positive coping skills, strong social support, and a sense of purpose and meaning in life
  • Can be strengthened through individual and community-level interventions (e.g., mindfulness training, peer support programs)
• Neighborhood and built environment factors such as access to green space, walkability, and safety can influence health behaviors and outcomes
  • Improving the built environment can promote physical activity and social interaction
• Health literacy, or the ability to obtain, understand, and use health information, is a protective factor for health outcomes
  • Interventions that improve health literacy can empower individuals to make informed health decisions

Evidence-Based Prevention Strategies

• The Nurse-Family Partnership program provides home visits by nurses to low-income, first-time mothers during pregnancy and early childhood
  • Has been shown to improve maternal and child health outcomes, reduce child maltreatment, and increase economic self-sufficiency
• The Diabetes Prevention Program is a lifestyle intervention for individuals at high risk of developing type 2 diabetes
  • Includes dietary changes, physical activity, and behavior modification
  • Has been shown to reduce the incidence of diabetes by 58% compared to placebo
• School-based prevention programs for substance use and violence have been shown to be effective in reducing risk behaviors and promoting healthy development
  • Examples include the Life Skills Training program and the Good Behavior Game
• Community-wide campaigns to promote physical activity, such as the Stanford Five-City Project, have been shown to increase physical activity levels and reduce cardiovascular risk factors
• Policy interventions such as tobacco taxes, smoke-free laws, and restrictions on alcohol sales have been effective in reducing tobacco and alcohol use and related health problems
• Screening and brief intervention for alcohol misuse in primary care settings has been shown to reduce risky drinking and alcohol-related problems
  • Involves assessing alcohol use, providing feedback and advice, and referring to treatment if needed

Community Engagement in Prevention

• Community-based participatory research (CBPR) involves equitable partnerships between researchers and community members in all phases of the research process
  • Ensures that research is relevant, culturally appropriate, and beneficial to the community
• Community coalitions bring together diverse stakeholders to address health issues of concern to the community
  • Can mobilize resources, coordinate activities, and advocate for policy change
• Peer education and outreach programs involve training community members to provide health education and support to their peers
  • Can be effective in reaching marginalized or hard-to-reach populations
• Community health workers (CHWs) are frontline public health workers who are trusted members of the community they serve
  • Can provide health education, navigation, and advocacy services to improve health outcomes and reduce disparities
• Youth engagement in prevention programs can increase their relevance, acceptability, and effectiveness
  • Examples include youth-led research, peer education, and advocacy campaigns
• Faith-based organizations can be important partners in prevention efforts, particularly in communities where religion plays a central role in daily life
  • Can provide social support, promote healthy behaviors, and mobilize resources for health initiatives

Challenges and Future Directions

• Health disparities persist despite advances in prevention science, with certain populations experiencing disproportionate burdens of disease and risk factors
  • Addressing social determinants of health and promoting health equity are critical challenges for the field
• The COVID-19 pandemic has highlighted the importance of public health preparedness and the need for robust prevention infrastructure
  • Has also exacerbated existing health disparities and created new challenges for prevention efforts
• The rise of chronic diseases and an aging population require a shift towards prevention and management of long-term conditions
  • Integrating prevention into primary care and other healthcare settings is a key strategy
• Advances in technology, such as mobile health (mHealth) interventions and wearable devices, offer new opportunities for prevention and health promotion
  • Must be balanced with concerns about privacy, equity, and unintended consequences
• Climate change poses significant threats to human health, particularly for vulnerable populations
  • Preventing and mitigating the health impacts of climate change is an urgent priority for the field
• Implementation and dissemination of evidence-based prevention strategies remain a challenge, particularly in low-resource settings
  • Requires investment in capacity building, technical assistance, and sustainable funding mechanisms
• Interdisciplinary and cross-sectoral collaboration is essential for addressing complex health challenges and promoting population health
  • Requires breaking down silos and building partnerships across fields such as healthcare, education, housing, and transportation