Health Promotion
Models and levels
Health promotion is the process of enabling people to increase control over their health (Ottawa Charter, 1986). Know the five Ottawa action areas (healthy public policy, supportive environments, community action, personal skills, reorienting services) and three health promotion strategies (enable, mediate, advocate). Distinguish primary, secondary, tertiary prevention and primordial prevention.
Behaviour change
High-yield models: Transtheoretical (stages of change) - precontemplation, contemplation, preparation, action, maintenance; Health Belief Model; motivational interviewing (OARS: open questions, affirmations, reflections, summaries; rolling with resistance). Questions often ask which stage a patient is in and the matching intervention: precontemplation → raise awareness; action → support and relapse prevention.
Screening principles
Wilson and Jungner criteria: important condition, accepted treatment, facilities for diagnosis, latent stage, suitable test, test acceptable, natural history understood, agreed policy, cost-effective, continuous case-finding. Sensitivity, specificity, PPV/NPV, lead-time bias, length-time bias, and overdiagnosis are classic traps.
Traps
- Confusing health promotion (empowerment, upstream) with health education (information transfer).
- Applying a screening test to a low-prevalence population and misjudging PPV.
- Mistaking length-time bias for true survival benefit.
Rule of thumb
PPV rises with prevalence; NPV falls. If prevalence is low, even a specific test yields many false positives - the basis for targeted screening.
Worked example
A smoker in 'contemplation' is ambivalent. Best response: motivational interviewing to explore pros/cons, not a lecture or immediate nicotine prescription.