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Health Promotion Cycle

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In my last lecture, I gave a brief overview of some of the elements of health promotion. What I wanted to do now is continue the exploration of the health promotion cycle with some specific commentary around planning. And really, planning is about making sure you’ve done your homework. There are many different models you could use in the planning phase and I’ve just presented two. One of which is a model which I wrote many many years ago. And this model came out of practice. It came out of observing what people were doing when they were doing health promotion, and the steps they had to go through to sometimes get support for their programs.
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It’s a very simple model called PABCAR and it asks a number of very simple questions. It asks,” Is there a problem? “. And then asks, “Is it amenable to change?”. And if so, “Are the benefits from that change greater than the costs?”. It asks aspects around acceptance for the change and then it makes recommendations for action. So, the model actually contains elements around cultural appropriateness, equity, that are really important when we think about the strategies and methods that we might be choosing to do. It asks about their acceptability and all within the context of the problem. Now, this is rather an imposing diagram.
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But what it does is it just asks you to think about some of the ways that you might know there’s a problem. And then think about the range of options you have to deal with them and the appropriateness of each of those. In particular, it’s about understanding the nature of the problem. Not just from an academic sense, not just from an epidemiological sense, not just from a clinical sense. Though all of those things may be important. But if you’re really going to do health promotion, and if you’re really going to hold true to the aspects of the Ottawa Charter, then it’s absolutely important that you understand the problem from the perception of those that are facing it.
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So at the very beginning, you should understand to be able to articulate the problem from the perception of those that are experiencing it. That means you need to go out and talk to people, spend time with people, observe people, not just look at a data set.
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Everything else then flows quite logically. The model asks you to think about your range of options and for each of those you would assess whether or not they’re the most appropriate thing to be doing. Ideally, if you’re following a participatory approach, you would actually be checking on those strategies with those that are most effective. So with the emphasis about trying to understand the problem, you can sometimes get interesting results. A little while ago, I was presented with a community group or a group of schools that were saying, “Our children are not walking to school.”. This is a problem. They’re not participating in enough physical activity. This is a problem. And indeed it may be.
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But I thought it would be worth investigating, “Why are children not walking to school?”. And this is the image of one of those children. Here is the boy who is carrying his backpack and also his computer bag. He has to carry this load every day. But on some days, he also has to carry his sports bag, and that’s the one in front. And then, on yet other days, he also has to carry his music equipment.
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This boy looks like a group of bags with a couple of legs coming out from underneath. It is small wonder when a child has to carry this much luggage just to get to school that they don’t want to walk to school. It’s by understanding that we stopped from going down an intervention of trying to educate children to walk to school to understanding an actual fact, this was an issue about how much they had to carry, not an issue about being lazy or not wanting to walk to school.

Dr. Bruce will continue the exploration of the health promotion cycle with some specific commentary around planning. He will introduce a simple model, PABCAR, first. This model requires the practitioners to answer five questions:

  • What is the problem and is it significant?  
  • Is it amenable to change?  
  • Are the intervention benefits greater than costs?  
  • Is there acceptance for the interventions?  
  • What actions are recommended?

He will use an example of “Why are children not walking to school?” with this model.

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Capacity Building: Core Competencies for Health Promotion

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