Health-Promoting self-care Behavior in Adults Essay
Health-Promoting self-care Behavior in Adults Essay
Action, G. J., & Malathum, P. (2000). Basic need Status and Health-Promoting self-care Behavior in Adults (PDF). Western Journal of Nursing Research, 22(7), 796-811.(article attached)
Apply the selected model (highlighted) to Family Nurse Practitioner specialty, caring for a 45 years old male patient presenting with asthma exacerbation with heroin use. Describe how you would use the model in intervening with the patient-care problem focusing on assessment, counseling, and teaching Health-Promoting self-care Behavior in Adults Essay
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Embedded in the concept of health promotion is self-responsibility, or
accountability for actions (or nonactions) regarding health. That is, persons
are responsible for their health and health is largely self-determined through
self-care actions. For individuals to engage in health-promoting behavior,
they must be motivated to take personal responsibility for their health.
Little research, however, has focused on health-promoting self-care
actions to produce health-oriented outcomes and variables related to positive self-care decisions. One variable that may influence health-related decisions is the status of basic needs as described by Maslow (1970). According
to Maslow’s theory of human motivation, the actions one takes are largely
motivated by the needs of the individual. Basic needs are arranged in a hierarchy as physical, safety/security, love/belonging, esteem/self-esteem, and
self-actualization needs. The hierarchy implies that lower needs must be met
before higher needs emerge. For example, if the human being is deprived of
oxygen, then concerns about safety and belonging may not matter. Needs
actually exist in a quasi-hierarchy, and when the most urgent needs are partially or fully satisfied the next level emerges, ending with the search for
self-actualization. Unmet needs result in a state of tension or anxiety; as the
deficit increases, so does the tension, which ultimately leads to a state of perceived deprivation. There is always an inherent drive to relieve the tension
caused by unmet needs and achieve need satisfaction. When relief occurs,
the tension is decreased and the person can focus on other aspects of his or
her life, such as health promotion. Maslow’s theory of human motivation
suggests that persons experiencing higher levels of need satisfaction will
have lower levels of tension and will not be in a state of deprivation; thus,Health-Promoting self-care Behavior in Adults Essay
they might be motivated to make better decisions regarding self-care and
health promotion. Therefore, the purpose of this study was to (a) investigate
the relationships among basic need status, health-promoting self-care behavior, and selected demographic variables and (b) determine the best predictors (physical needs, safety/security needs, love/belonging needs, esteem/
self-esteem needs, or self-actualization needs) of health-promoting self-care
behavior in a sample of community-dwelling adults.
November 2000, Vol. 22, No. 7 797
Basic Needs and Health-Promoting Self-Care Behavior
Leidy (1994) found that a sample of healthy adults scored higher in basic
need satisfaction than a group of chronically ill adults; however, little
research has explored these variables. In one of the few studies of the variables, Laffrey (1985) examined the relationship between “promotiveness of
health behavior choice and self-actualization” (p. 290) in 95 adults ages 18
to 69 who were randomly selected from households in three midwestern
suburban cities. Laffrey used the Personal Orientation Inventory (POI)
(Shostrom, 1974) to measure values and behaviors important to the development of the self-actualized person and the Health Behavior Choice Scale
(HBCS) to measure participants’ reasons for engaging in sleep/rest, relaxation,
physical exercise, nutrition, and dental care. Laffrey’s findings, however,
failed to support her hypothesis that there would be a significant relationship
between self-actualization and promotiveness of health behavior choice.
In a study similar to Laffrey’s (1985), Petosa (1984) examined the relation between self-actualization and health practices in 421 college students.
Like Laffrey, Petosa used the POI to measure indicators of self-actualization;
however, unlike Laffrey, Petosa used the Health Practices Inventory (Baum,
1972) to measure actual health practices related to personal and dental
health, rest and sleep, relaxation, chronic disease, family living, environmental health, safety and accident prevention, nutrition, physical activity,
recreation, communicable disease, mental health, consumer health, and drug
use. Petosa found a significant relationship between self-actualization and
health promotion practices.
Whereas Laffrey’s (1985) and Petosa’s (1984) results may appear to conflict, the difference may be explained by differences in the study measures.Health-Promoting self-care Behavior in Adults Essay
Laffrey’s study evaluated the reasons for engaging in a limited scope of
health-promoting behaviors (sleep, relaxation, exercise, nutrition, and dental care), whereas Petosa measured the actual practice of a wide variety of
health-promotion behaviors. Thus, the studies were evaluating two different
conceptions of health promotion behavior. In addition, neither Petosa nor
Laffrey examined the relationships among physiological needs, safety/
security needs, love/belonging needs, esteem/self-esteem needs, and health
behaviors. The present study examined the links between all of Maslow’s
(1970) basic needs, including self-actualization and health-promoting selfcare behavior.
798 Western Journal of Nursing Research
Demographic Variables and
Health-Promoting Self-Care Behavior
Support for the relationships among the demographic variables and healthpromoting self-care can be found in several studies. Researchers found that
increased self-care activities were related to higher social class (Dean, 1989;
Hanucharurnkul, 1989; Weerdt, Visser, Kok, & van der Veen, 1990) and higher
income (Ahijevych & Bernhard, 1994; Ailinger, 1989). Several researchers
(Ahijevych & Bernhard, 1994; Ailinger, 1989; Gottlieb & Green, 1984;
Muhlenkamp & Sayles, 1986; Segall & Goldstein, 1989; Weerdt et al., 1990)
found that more education and increasing age (Ailinger, 1989; Bausell, 1986;
Gottlieb & Green, 1984; Muhlenkamp & Sayles, 1986; Prochaska, Leventhal,
Leventhal, & Keller, 1985; Walker, Volkan, Sechrist, & Pender, 1988) were
also related to increased self-care activities. Regarding employment and
self-care, Frank-Stromborg, Pender, Walker, and Sechrist (1990) found
employment to be a significant predictor of a health-promoting lifestyle in
persons with cancer, and Duffy, Rossow, and Hernandez (1996) found
employment to be a significant predictor of a health-promoting lifestyle in
Mexican-American women. Taken collectively, the research indicates that
employed persons of higher social class and income who had more education tended to engage in more health-promoting self-care behavior. In addition, as persons age, their health-promoting self-care behavior tends to
increase.Health-Promoting self-care Behavior in Adults Essay
METHOD
Procedure
Permission to conduct the study was granted by the appropriate human participants review committee. The sample for the study consisted of communitydwelling adults recruited from a conference for lay persons and professionals interested in issues concerning older adults. Attendees received the survey
questionnaires in their packet of registration materials. A cover letter explained
the study and stated that return of the questionnaires to the researcher indicated consent to participate in the study. The participants completed the
November 2000, Vol. 22, No. 7 799
questionnaires during breaks and/or at lunchtime during the conference and
returned them to the researcher at a centrally located display table.
Sample
Eighty-four adults completed the questionnaires. The ages of the participants ranged from 21 to 79 years, with the average age being 48.49 years. Of
the sample, 87% were female. Most were White (84.5%), 7.1% were Black,
3.6% were Hispanic, and 3.6% of the sample reported another unspecified
ethnicity. Sixty-eight percent had a college education. Of the sample, 69%
were employed and 53.6% reported their family annual income as $36,000
or more (see Table 1).
Instruments
Basic needs. Basic needs status was measured by the Basic Needs Satisfaction Inventory (BNSI) developed by Leidy (1994). The BNSI contains
subscales analogous to Maslow’s (1970) theoretical description of the basic
needs categories: physical, safety/security, love/belonging, esteem/self-esteem,
and self-actualization. Five subscale scores and a total scale score can be
computed reflecting an individual’s need satisfaction status in each category
and overall need status. The BNSI contains 27 items. The stem for each item
asks how one feels about various aspects of life. Participants respond on a
Likert-type scale ranging from 1 (terrible) to 7 (delighted). The ratings are
summed for a possible range of scores from 27 to 189. Extensive validity and
reliability testing of the BNSI has been described elsewhere by Leidy (1994).
Cronbach’s alphas have been reported to range from .90 to .94 (Irvin &
Acton, 1996; Leidy, 1990, 1994). Reliability coefficients in this study were
.90 for the total scale and .82, .85, .85, .82, and .88 for the physical, safety/
security, love/belonging, esteem/self-esteem, and self-actualization subscales,
respectively.
Health-promoting self-care behavior. The Health-Promoting Lifestyle
Profile II (HPLP II) (Walker, Sechrist, & Pender, 1995) was used to measure
health-promoting self-care behavior. The HPLP II is a revision of the original
Health-Promoting Lifestyle Profile (Walker, Sechrist, & Pender, 1987) used
extensively in health promotion research. The HPLP II was revised to better
reflect current practice related to health promotion activities. The HPLP II
measures health-promoting self-care behavior conceptualized as a multi800 Western Journal of Nursing Research
dimensional pattern of self-initiated actions that maintain or enhance the
level of wellness and health potential of the individual. The 52-item instrument employs a 4-point response scale to measure the frequency of
self-reported health-promoting behaviors in the areas of health responsibility, physical activity, nutrition, spiritual growth, interpersonal relations, and
stress management. Thus, the HPLP II represents a holistic evaluation of
NOTE: The percentage columns may not total 100% due to missing data.
health-promoting self-care behaviors. Cronbach’s alphas are reported by
Walker and colleagues (1995) as follows: health responsibility (.86), physical activity (.85), nutrition (.80), spiritual growth (.86), interpersonal relations (.87), stress management (.79), and total scale (.94). Cronbach’s alphas
in this study were .90 for the total scale and .88, .86, .83, .90, .85, and .85 for
the health responsibility, physical activity, nutrition, spiritual growth, interpersonal relations, and stress management subscales, respectively.
Demographic data. Participants completed a form containing questions
concerning age, gender, ethnicity, marital status, education, income, and
employment status. Research has shown these variables to be linked to health
promotion activities.
RESULTS
With a possible range of 27 to 189 on the BNSI, the group mean score of
137.71 (SD = 23.80) indicates that the participants in this study were experiencing moderately high levels of basic need satisfaction. The group mean of
138.90 (SD = 27.08, range = 52 to 208) on the HPLP II shows that the participants were engaging in moderate numbers of health-promoting self-care
behaviors (see Table 2).Health-Promoting self-care Behavior in Adults Essay
The correlations between the BNSI subscales and the HPLP II are displayed in Table 3. Those persons who reported greater physical (r = .66),
safety/security (r = .64), love/belonging (r = .68), esteem/self-esteem (r =
.62), and self-actualization (r = .76) need status reported more healthpromoting self-care behaviors. In addition, correlations among the subscales
of the BNSI ranged from .48 to .76 (p < .001).
Stepwise regression analyses were used to examine the ability of the
basic need subscales to predict health-promoting self-care behavior. Tests
for violations of the multiple regression assumptions were negative (Munro,
1997). Multicolinearity tests revealed that no correlation coefficient
exceeded .80 and variance inflation factors for the regression analyses
ranged from 1.000 to 2.506, far below the caution point of 10 (Stevens,
1996).
Data reporting the ability of the basic need subscales to predict healthpromoting self-care behavior are displayed in Table 4. Self-actualization
was the first variable to enter the equation, and it accounted for 58% of the
variation in health-promoting self-care behavior. Physical need satisfaction
increased the variance by 5% and love/belonging satisfaction increased
802 Western Journal of Nursing Research
November 2000, Vol. 22, No. 7 803
TABLE 2: Descriptive Data for the Basic Need Satisfaction Inventory (BNSI)
Subscales and the Health-Promoting Lifestyle Profile II (HPLP II)
Scale M SD Range
BNSI total 137.71 23.80 27 to 189
Self-actualization 31.15 6.04 6 to 42
Esteem/self-esteem 20.79 3.82 4 to 28
Love/belonging 26.99 5.28 5 to 35
Safety/security 29.90 6.14 6 to 42
Physical 28.88 6.39 6 to 42
HPLP II total 138.90 27.08 52 to 208
TABLE 3: Correlations Among the Health-Promoting Lifestyle Profile II (HPLP II)
and the Basic Need Satisfaction Inventory (BNSI) Subscales
Safety/ Love/ Esteem/ Self- HPLP
Physical Security Belonging Self-Esteem Actualization II
Physical 1
Safety/
security .73 1
Love/
belonging .65 .72 1
Esteem/
self-esteem .54 .48 .75 1
Selfactualization .66 .76 .71 .66 1
HPLP II .66 .64 .68 .62 .76 1
NOTE: All variables are correlated at p < .001, two-tailed.
TABLE 4: Stepwise Regression Predicting Health-Promoting Self-Care Behavior From the Basic Need Satisfaction Inventory (BNSI) Subscales
Variable R2 Overall F Sig F R2 Change F Change Sig Change
Self-actualization .58 113.26 .000 .58 113.26 .000
Physical .63 67.66 .000 .05 9.84 .002
Love/belonging .64 48.13 .000 .02 4.03 .048
the variance by 1%. Together, these three variables accounted for 64% of
the variance in predicting health-promoting self-care behavior. Thus, selfactualization, physical, and love/belonging need satisfaction predicted
engagement in health-promoting self-care behavior.
Because there was some concern about overlap between the selfactualization subscale of the BNSI and the spiritual growth subscale of the
HPLP II, the spiritual growth subscale was removed from the HPLP II and
the stepwise regression analysis was repeated. The results indicated that
self-actualization was still the first variable to enter (R2 = .52, p < .01) the
regression equation; thus, concerns about the overlap were allayed.
The relationships among the categorical demographic variables (ethnicity, marital status, education, employment, and income), health-promoting
lifestyle, and basic need satisfaction were examined using t tests and ANOVA.
Chi-square statistics were used to examine the relationships among the categorical demographic variables. The categorical demographic variables were
dichotomized as follows: White or other ethnicities, married or unmarried
(divorced, separated, single, or single living with another), and high school
education or college education. The income variable was divided into three
groups—low income (less than $15,000), medium income ($15,001 to
$50,000), and high income (greater than $50,000)—as was the employment
variable (employed, retired, or unemployed). Relationships among age,
health-promoting self-care behavior, and basic need satisfaction were examined using Pearson product-moment correlation.Health-Promoting self-care Behavior in Adults Essay
Participants with a higher family income were more likely to be married
(χ2
= 23.00, p < .001), had a higher educational level (χ2
= 6.40, p < .05), had
a higher basic need satisfaction (ANOVA: F(2, 79) = 3.39, p < .05), and
engaged in more health-promoting behaviors (ANOVA: F(2, 79) = 4.99, p <
.05). Participants who were currently married had a higher education level
(χ2
= 6.40, p < .05) and higher basic need satisfaction (t test = –.50, df = 80,
p < .05). Participants with higher education engaged in more healthpromoting behaviors (t test = –3.26, df = 81, p < .05) and had higher basic
need satisfaction (t test = –2.26, df = 81, p < .05). Participants who were currently employed performed fewer health-promoting behaviors (ANOVA:
F(2, 80) = 3.39, p < .05). Post hoc tests indicated that those participants who
were retired engaged in more health-promoting behaviors than those who
were employed. Participants who had higher basic need satisfaction were
more likely to engage in health-promoting behaviors (r = .79). There
were no significant associations between age, gender, ethnicity, and healthpromoting self-care behavior or basic need satisfaction. In addition,
there were no significant associations between marital status and health804 Western Journal of Nursing Research
promoting self-care behavior or between employment status and basic need
satisfaction.
DISCUSSION
Basic Needs and Health-Promoting Self-Care Behavior
The significant relationship between basic need satisfaction and healthpromoting self-care supports Maslow’s (1970) theory of human motivation.
Maslow hypothesized that unmet needs and the desire to grow and move forward in life are the stimuli for human motivation. Maslow proposed that
higher levels of need satisfaction may lead to the development of more
resources and increased motivation for individuals to make better decisions
(e.g., healthy lifestyle choices). In contrast, Maslow argued that unmet needs
may contribute to increasing anxiety and tensions that theoretically might
lead to unhealthy practices and perhaps even increased illness. The findings
of this study support Maslow’s hypothesis that need satisfaction results in
positive behavior motivation. Results show that persons with higher scores
on basic need satisfaction engaged in more health-promoting self-care
behavior and those with lower levels of need satisfaction reported fewer positive health-related behaviors. In addition, Maslow theorized that basic need
satisfaction is positively associated with psychological health. Better psychological health might free people to make better decisions about their
health. Findings that college students who reported higher basic need satisfaction had lower levels of anxiety (Kalliopuska, 1992) support Maslow’s
theory, and although the study reported here did not measure psychological
health, future research could test the relationships among need satisfaction,
anxiety, and health-promoting self-care behavior.Health-Promoting self-care Behavior in Adults Essay
Self-actualization is at the top of the basic needs hierarchy and in this
study it emerged as the best predictor of health-promoting self-care behavior. Self-actualization is defined as the “ongoing actualization of potentials,
capacities and talents, as fulfillment of mission (or call, fate, destiny, or
vocation), as a fuller knowledge of, and acceptance of, the person’s own
intrinsic nature” (Maslow, 1968, p. 25). Maslow (1970) says that “what a
man can be, he must be” (p. 46) and suggests that self-actualizing persons
are motivated to be the best they can be in multiple aspects of their lives;
thus, data from this study indicate that they may be better able to make
healthy lifestyle choices. Maslow also argues that self-actualizing people
tend to be able to accept themselves—therefore, they might have a better
November 2000, Vol. 22, No. 7 805
attitude toward themselves and their lives, so their ability to engage in
health-promoting self-care may be increased. Laffrey (1985) states that
health promotion behavior is indicative of a person’s striving to attain highlevel health or increased general well-being. This is consistent with increased
self-actualization need satisfaction when persons are continually striving to
go forth in life, grow, develop, and be the best they can be. Findings that selfactualization was the best predictor of health-promoting self-care behavior
is also consistent with Petosa’s (1984) finding that persons with higher levels of self-actualization were more likely to engage in healthier lifestyle
behaviors. Persons who are more fulfilled and content with themselves and
their lives may be better able to carry out health-promoting self-care behaviors.
Maslow (1970) says that the physiological needs are usually the starting
point for human motivation and that at least partial satisfaction of physical
needs is necessary for an individual to move toward satisfaction of higher
needs. Physical need satisfaction predicted engagement in health-promoting
self-care behavior in this study. That seems logical because when one does
not have to worry about physical needs, it may be easier to focus on a healthy
lifestyle. Physical need satisfaction may free the person from anxieties about
things such as hunger or finding shelter that might occupy the mind and
reduce health-promoting actions.Health-Promoting self-care Behavior in Adults Essay
Maslow (1970) states that persons have a need to love and be loved and to
feel like they belong to a group or an organization larger than the self. Persons deprived of love/belonging needs may feel alone and isolated, unable to
seek assistance and support that might facilitate better health-related decisionmaking. In this study, love/belonging need satisfaction predicted engagement in health-promoting self-care behaviors. It may be that persons who
feel more supported are better able to make good decisions and maintain a
healthier lifestyle. Findings that social support (connections with others)
(Cohen & Syme, 1985; Dean, 1989) and family support (Rakowski, Julius,
Hickey, & Holter, 1987) may enhance health strengthen this conclusion.
Maslow (1970) states that as needs are met and persons do not feel in a
state of deprivation, they are motivated to move toward more social goals.
Health promotion may be considered a social goal. The publication of
Healthy People 2000 is evidence of increased emphasis on healthy lifestyles
in this country. Findings from this study show that as needs are met, especially the higher needs, more attention may be paid to social goals such as
health-promoting self-care behavior and perhaps healthier lifestyles.
806 Western Journal of Nursing Research
Demographic Variables
Persons who were currently married and had higher incomes and more
education had greater basic need satisfaction, which is not surprising because being married and having a higher income and more education may
mean that one has more resources to satisfy basic needs. The results are consistent with Laffrey’s (1985) finding that education and income were positively related to self-actualization. In addition, participants in the study who
had higher levels of basic need satisfaction engaged in more health-promoting
self-care behaviors. This is consistent with Leidy’s (1994) finding that
scores on basic need satisfaction could discriminate between healthy and
chronically ill individuals. Persons with higher levels of basic need satisfaction may have more resources and may be able to engage in more healthpromoting self-care behaviors than other individuals. As needs are satisfied,
persons may be able to more easily move forward in life and engage in
behavior that is growth motivated (Maslow, 1968).Health-Promoting self-care Behavior in Adults Essay
Age was not related to either basic need satisfaction or health-promoting behaviors. This is comparable to Laffrey’s (1985) finding that self-actualization
was not significantly correlated with the age of the participants. Leidy (1994)
also found that age was not significantly correlated with basic need satisfaction. Differing from the findings of this study, Walker and colleagues (1988)
found that older persons had higher scores on health-promoting self-care
behavior than did young or middle-aged adults. These conflicting results
may be explained by the fact that 77% of the participants in this study were
employed and engaged in fewer health-promoting self-care behaviors, but
those persons who were retired engaged in more positive health behaviors.
Perhaps those persons who were older but still employed obscured a potential positive relationship between increased age and health-promoting selfcare behavior.
Gender and ethnicity were not associated with either basic need satisfaction or health-promoting self-care behavior. This may be due to the characteristics of the sample, which was overwhelmingly female, White, well educated, and with adequate incomes, thus obscuring the variability that might
have been found in a more diverse sample.
Education was also related to health-promoting self-care behavior, as in
the work of others (Ahijevych & Bernhard, 1994; Ailinger, 1989; Gottlieb &
Green, 1984; Muhlenkamp & Sayles, 1986; Segall & Goldstein, 1989;
Weerdt et al., 1990). Uitenbroek, Kerekovska, and Festchieva (1996) found
November 2000, Vol. 22, No. 7 807
that persons who were better educated and employed engaged in healthier
behaviors in regard to cigarette smoking, diet, alcohol consumption, and
exercise than those who were less educated and employed. Conversely, participants in this study who were employed tended to engage in fewer healthpromoting behaviors than those who were retired. One possible reason may
be that employed persons have less time or are too tired to perform
health-promoting activities.
Findings from this study demonstrate the importance that need satisfaction may have on the decisions people make about lifestyle, particularly
health-promoting self-care behavior. Generalizations from these results
must be made cautiously because random sampling was not employed and
the design was descriptive. The sample was recruited from persons interested in issues concerning older adults and thus may be more likely to be
concerned about health issues because health is particularly important to
older adults. Also, because this sample reported relatively high levels of
need satisfaction, those persons who might score lower on Maslow’s (1968)Health-Promoting self-care Behavior in Adults Essay
hierarchy of needs are left underrepresented. More research (using random
sampling) is needed to confirm and clarify the findings of this study. Samples from lower socioeconomic levels and minority populations might also
enhance the findings.
Despite the limitations of the study, the relationship between basic need
satisfaction and health-promoting self-care behavior is intriguing and may
be helpful in designing interventions to facilitate health-promoting self-care
behavior. Nurses should assess basic need status and intervene to assist persons to meet their basic need requirements, especially with higher needs such
as self-actualization. Persons have an inherent ability to grow and develop to
their highest capacity. To do so, however, they need connections, support,
and good information regarding the changes they are seeking to make.
Nurses can facilitate these needs and help persons grow, develop, and realize
their potential, especially in the area of positive, healthy lifestyles.
One other area of particular importance involves employed persons who,
in this study, reported fewer health-promoting self-care behaviors. Health
care professionals, particularly those working in occupational health, must
help working adults build resources needed to engage in activities to promote
health. Occupational health nurses may be able to suggest health-promotion
strategies to employers. Activities such as health-related support groups,
exercise time, health-related seminars, health fairs, and other health-related
activities might assist working adults in increasing health-promoting
self-care behavior.
808 Western Journal of Nursing Research
Nurses are educated to assist persons in meeting basic need requirements.
Nurses may be able to help clients elevate themselves in the basic need hierarchy moving toward self-actualization and increasing the likelihood that
they will perform health-promoting self-care behaviors. Maslow (1970) states
that needs are satisfied through others by support, reassurance, acceptance,
protection, willingness to listen, and kindness. Leidy (1994) points out that
“these actions are the therapeutic essence of nursing practice” (p. 279). As
nurses assist persons in achieving need satisfaction, they may be helping
them move toward healthier lifestyles. More attention must be directed
toward health promotion and ways to help people engage in positive lifestyle
choices. This study indicates that one’s basic need status may be related to
the choices and decisions one makes regarding health-promoting self-care
behavior. Nurses and other health care professionals are in a good position to
assess and intervene to influence positive need satisfaction and thus healthy
lifestyle choices.Health-Promoting self-care Behavior in Adults Essay
This essay will explore the success of health promotion in providing individuals with information that either changes their health behaviours or prevents them from developing health behaviours that may put them at risk of experiencing negative health outcomes in the future.Health-Promoting self-care Behavior in Adults Essay
The Cancer Research UK leaflet will be reviewed and evaluated within this essay as well as the campaigns that have been run in the attempt to address the rising numbers of individuals who suffer from skin cancer in the UK will be investigated, while skin cancer does not account for the majority of cancer-related deaths, it is the most common form of cancer. The leaflet Cancer Research UK, (2009), states “Being Sun Smart can reduce your cancer risk” and this leaflet has been distributed to GP surgeries, schools, colleges, hospitals and also online.
Health behaviour has been defined by Kasl and Cobb (1966) as ‘any activity undertaken by a person believing his self to be healthy for the purpose of preventing disease or detecting it at an asymptomatic stage’. According to the World Health Organisation, (1948) health is ‘a complete state of physical, mental and social well-being and not merely the absence of disease or infirmity’. Whilst Medics would define health as the absence of disease, illness and injury and the social scientist state, it is the ability to function in a normal social role (cited in Albery and Munafo 2007).Health-Promoting self-care Behavior in Adults Essay
The social cognitive theory looks at cognitive processes of beliefs and attitudes in relation to individuals making decisions of their health, whilst self efficacy looks at an inviduaulas self belief of their ability to control health behaviours, some of the other theories are health belief model, protection motivation theory, unrealistic optimism and habit (Albery and Munafo 2007).
Health psychology is the academic discipline that aims to identify psychological processes in the experience of health and illness looking closely at the causes of health and illness as well as the consequences. Psychologists are interested in the factors involved in acceptance, change adaptive or maladaptive response to health behaviour (Albery and Munafo 2007).Health-Promoting self-care Behavior in Adults Essay
Skin cancer caused by overexposure to the sun is a topic most vastly spoken of in health promotions especially in regards to how people should protect them-selves from the disease. The ultra-violet type B (UVB) in sunlight damages the DNA in the skin cells, this damage could occur before cancer develops (Cancer Research UK, 2009). There are two types of cancer, non melanoma skin cancer – basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), a history of sunburn or leisure exposure to sunlight increases the risk of BCC, risk is particularly high when individuals in childhood have had over exposure to the sun (Research UK, 2009). The risk of SCC is related to sun experience during the period of an individual’s life, this could also result in people who work outdoors such as farm workers, gardeners and building site workers having an increased risk (Research UK, 2009).
Rogers, Weinstock, Narris, Hinckley, Feldman, Fleischer and Coldiron, (2010) research study revealed that UVB is the key risk for skin cancer, Ultraviolet Light (UVA) generated in sun beds causes damage to the skin and there is growing evidence that UVA possibly causes skin cancer their research found that sun beds could increase the risk of non melanoma skin cancer and a strong link was found relating to sun beds and squamous cell skin cancer.Health-Promoting self-care Behavior in Adults Essay
In the UK, 84,500 non-melanoma skin cancers were recorded in 2007 even though other studies have shown that approximately at least 100,000 cases are diagnosed every year (Rogers et al, 2010). According to the British Association of Dermatologists children, from 0 to 14 years, and teenagers, from 15 to 19 years, show the most rates of skin cancers of any European country. Besides this the number of melanoma raised four times in UK teenagers from 1978 to 1997 and Australia has the highest rate of skin cancer diagnosis in the world, approximately four times the rates recorded in the United States, the UK and Canada (Rogers et al, 2010).Health-Promoting self-care Behavior in Adults Essay
The aims and objective of the leaflet is for people to be sun-smart, the leaflet calls attention to the risk of dangerous daily sun exposure and recommends sun protection to be made a daily habit, for individuals and their families by becoming aware that too much sun exposure can lead to damage or cause skin damage. Thus when individuals are being sun smart they prevent themselves from skin diseases, by means of gaining knowledge through health promotions of skin cancer, people are more likely to reduce their risk of getting skin cancer.Health-Promoting self-care Behavior in Adults Essay
Rosenstock’s (1974) health belief model (HBM) provides evidence in how individuals cognitively signify the part of their behaviour that is more important for predicting self-protective health behaviour. HBM was formerly developed by Rosenstock, (1974) and combined by Becke, Drachman, & Kirscht, (1974); the HBM was created for description of the part of belief-based psychological issue in health-related decision making and health behaviour. Jackson and Aiken (2006) conducted a study on appearance-based sun-protective intervention for young women; the study included the women approving paleness image norms of female media figures and fashion models, women were shown these images as well as the advantages tanning carries, health beliefs of photo-aging and skin cancer and self efficacy for sun protection results showed an instant raise in sun protective awareness, the tendency to be emotionally affected if not protected, benefit and intention for protection was high and reduced inclination to sunbathe and few hours sunbathing.Health-Promoting self-care Behavior in Adults Essay
Jackson and Aiken findings are reliable with previous research targeting advantages of tanning (Hill et al., 1993; Hillhouse & Turrisi, 2002; Jones & Leary, 1994) and past study which aims more at personal threat of photo-aging (Mahler et al., 2003). Mermelstein & Reisenberg, (1992); Miller et al., (1990); Rodrigue, (1996) suggested that earlier sun protective usage maintains the function of health beliefs in sun protection, their study supported Ronis’s (1992) who argued that apparent vulnerability to severity of a health threat is necessary in order for health behaviours to be undertaken. However, the message in the leaflets has not such threaten message that could make someone to undertaken healthy behaviour.Health-Promoting self-care Behavior in Adults Essay
The leaflets main target group is families, but the leaflet should also be developed to take into account different groups of users as it mentions those most at risk, such as fair skin people who are more likely to get sun burn, red or fair hair people, people with lots of moles or freckles, individuals or family history of skin cancer and a history of sunburn, but the presentation of the leaflet being more family orientated due to the pictures it employs seems as if it is more directed to appeal to families, but the fact that the people most at risk that it notes do not only fall under the family target group, this leaflet should also be made to appeal to the general public as well as young single people who may love sun bathing but have the hair and skin colour that may put them at risk and individuals who may have skin conditions that put them at risk (Rogers, et al. 2010).Health-Promoting self-care Behavior in Adults Essay
Rogers, et al. (2010) study found individuals with pale skin, coloured eyes and hair are more likely to get burn than tan, and have a higher risk of sun damage than dark skinned people, in addition Albinism people also have high risk of sun damage, due to albinism being an innate genetic form in which the skin creates no melanin at all. Albino individuals have extremely white skins and pale blonde hair which puts them at greater risk than any normal individual to getting skin cancer as their skin has no natural protection against the sun. These people should be more informed on how to prevent themselves from skin disease caused by over exposure to the sun. One way of them being informed is by implementation intention, which will help them to plan and take action about their health more importantly.Health-Promoting self-care Behavior in Adults Essay
Gollwitzer, (1993) states that implementation intentions are formed when a response is recognised by an individual which leads to the achievement or successful completion of the goal whilst also identifying situations where this response can be successfully applied, people then plan possible ways of how to undertake behaviours.
Studies have shown and established that the configuration of an implementation intention have the outcome of making the prospect that somebody will undertake behaviours, and put into practice their goal intentions when a situation arises, considerably better then with control subjects (Koestner et al., 2002; Sheeran, 2002). Through this way people that are more at risk will use this method of information to change their health, because the threat is more convincing and so it will result high self efficacy increase the probability of adaptive behaviour being undertake.Health-Promoting self-care Behavior in Adults Essay
The leaflet takes into account peoples different perceptions of their likely hood of getting skin damage due to overexposure to the sun as it provides information of types of people most at risk, times of the day exposure is more damaging, the adverse affects of using sun beds, the need to report any unusual changes in the skin that people may ignore, the fact that sunscreen alone is not enough protection to use as a means to stay in the sun for long periods. In addition the language used were every straightforward for anybody to understand, but persuasive communication may have not evokes fear for individuals to adapt behaviour change.Health-Promoting self-care Behavior in Adults Essay
Weinstein (1982) emphasized that the motive for people’s persistence practise of unhealthy behaviours is due to incorrect perceptions of risk and susceptibility with their unrealistic optimism. In another words people believe that nothing bad will happen to them so they fall short of doing something. Weinstein (1982) conducted a study where participants had to compare their probability of experiencing different forms of health problems presented to them to their peer’s probability of getting them. The findings indicated majority of the participants assumed that they were less likely to get health problems, which Weinstein (1982) implied was due to the phenomenon of unrealistic optimism, Weinstein (1987) explained four cognitive aspects that add to unrealistic optimism; lack of personal experience with the problem, the conviction that the problem is avoidable by protective action, the conviction that if the crisis has not yet become visible, it will not emerge in the future, and the belief that the dilemma is infrequent, all these factors show that individuals perception of risks is not a rational process.Health-Promoting self-care Behavior in Adults Essay
Ouellette and Wood, (1998) state why some people might undertake health behaviours and others not may be put down to habits, this consists of repetitive behaviours conducted in similar environmental situation where people consistently undertake certain behaviours without consciously thinking or planning them. Also Verplanken, (2005) stated that when a behaviour becomes a habit or habitual in nature it is the most excellent predictor of future behaviour. Verplanken and Aart (1999) defined habits as ‘learned sequences of acts that have become automatic responses to specific cues, and are functional in obtaining certain goals and end-states (cited in Albery and Munafo 2007).Health-Promoting self-care Behavior in Adults Essay
The information in the leaflet takes into account threatening messages can lead to change in behaviour, for example the leaflet states take extra care with children, young skin is delicate and it also highlights skin cancer is very common in the UK. Self-affirmation studies have shown people lessen the tendency to refuse to accept threat information, Narris and Napper (2005) carried out a study using information on alcohol, smoking and breast cancer in young women. The finding revealed that participants who had self affirmed were more knowledgeable of the health message to change their behaviour, moreover the precaution adoption process model (PAPM) has discovered how people take decision to undertake health protective action into behaviour (Albery and Munafo 2007).Health-Promoting self-care Behavior in Adults Essay
PAPM develops in stages from individuals making decision which they are unaware of the health threats, to engaging in behaviours that maintain the removal of the threat. People usually compare themselves with others even when they know the health risk (Conner and Norman 2009). For example individual who smoke may have a belief that they have a reduced risk of disease because they do not smoke as much as other stereotypical smoker by relative assessment of other from themselves (Weinstein and Sandman 2002). Beck and Lund (1981) study on protection motivation theory (PMT) manipulated dental students’ viewpoint about tooth decay using persuasive communication, their findings showed that the knowledge that they have raised fear of the severity tooth decay terrible costs, their self-efficacy was associated to behavioural intentions.
5) How can leaflet be improved to take account of your critical evaluation?Health-Promoting self-care Behavior in Adults Essay
In conclusion the leaflet can be improved by taking into account individuals more at risk of getting cancer, for example fair skin individuals that tends to get more burned in the sun are at greater risk than any other group and young adults should be focused on as well. The leaflet was more focused on families and children; however the leaflet on a whole, is very informative about cancer and were to go for more information. By implementing and improving the leaflet which could be done through using protection motivation theory (Rogers, 1975), PMT is famous and most practiced form of modern health psychology in individuals attitudes and consequently their behaviour, this can be done with fear appeal, through persuasive communication with the role of threat and fear experience of things that individuals have knowledge of, their attitude will be changed and belief acceptance. Also with the individual self-efficacy belief in his or her ability to succeed in this particular situation, their response could be a defence mechanism of self-protection which can decrease the health threat or a high level of efficacy which means their behaviour may change.Health-Promoting self-care Behavior in Adults Essay
Norman, Boer and Seydel, (2005) studies on (PMT) has shown to be very effective in predicting health-related cognitions and behaviour for example, breast self-examination, smoking, and sexual risk behaviours how it helps individuals to be motivated to take self protective action toward their health when been threaten with their life. Rippetoe and Rogers (1987) presented women with information regarding breast cancer and looked at the outcome of this information on the mechanism of the PMT and their association to the women’s intentions to carry out breast self-examination (BSE). Their finding showed that the most excellent predictors of intentions to pursue BSE is the response efficiency, participants considered that BSE could help them establish cancer early on, participants severity in thinking that Breast cancer is unsafe and complicated to treat in its highly developed stages and self-efficacy, (belief in one’s ability ) caused participants to carry out BSE effectively.Health-Promoting self-care Behavior in Adults Essay
Nevertheless, there is limitation with this study although PMT is less criticized then the HBM, still other criticisms of HBM is connected to the PMT. The PMT believes people are based on reason information processors, but it does not take into account some part of illogicality in fear factor. Also it does not provide a description for habitual behaviours. Schwarzer (1992) disapproved of the PMT for not undertaking how attitudes could change.
PAPM offers several contributions to health psychology; it proposes a range of explanations tailored for each stage. PAPM only simply needs a particular question to measure a person’s stage thus its development is appropriate for application for individual as well as group situations (Weinstein & Sandman, 2002). PAPM is a useful model for explaining any alteration or modification of individuals behaviour, these kind of changes can happen deliberately, with no intention, or change quickly in circumstances of mental illness (Weinstein & Sandman, 2002).Health-Promoting self-care Behavior in Adults Essay
However PAPM has some limitation to the model, predominantly to health behaviours it has not been tested mostly, also mainly the empirical evidence is limited to limited behaviours. The model does not provide itself easily to actions that need slow growth of behaviour like diet or exercise (Weinstein & Sandman, 2002). Other weakness with PAPM is that it makes equivalents to every stage of the model that need to be tailored for succession, beside the stages are not described well. Lastly, the stage on interventions is very expensive and resource demanding once measured up to a standard intervention it is geared towards the entire population.Health-Promoting self-care Behavior in Adults Essay
The HBM has some limitation as well; it is very particular on the conscious processing of information, but ignores emotional issue such as fear and denial and it has been recommended that substitute factors probably will predict health behaviour, like outcome expectancy and self-ef¬cacy Seydel, Taal, & Wiegman, 1990; Schwarzer (1992). Also Schwarzer (1992) has further criticized the HBM for its static approach to health beliefs and suggests that within the HBM, beliefs are described as going on simultaneously with no space for change, and development or process. Health-Promoting self-care Behavior in Adults Essay
