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ParentingEducation:
ThePublicHealthApproachDr.ShirleyLeungFRCP(Glasg),FHKAM(Paed),MPH(Auckland)FamilyHealthServiceDepartmentofHealthParentingEducation:
ThePublOutlineTheParentingProgrammeintheFamilyHealthServicePublichealthconcepts&principlesThepublichealthapproachtothedevelopmentoftheParentingProgrammeOutlineTheParentingProgrammeTheFamilyHealthService(DH)Ourbusiness:Toprovideacomprehensiverangeofhealthpromotionanddiseasepreventionservicesforchildrenfrombirthto5years,andwomen
below65yearsofage.throughanetworkof
Maternal&ChildHealthCentres(MCHCs),&WomanHealthCentres(WHCs).TheFamilyHealthService(DH)The
“IntegratedChildHealth
&
DevelopmentProgramme”
“Parenting”asamajorcomponentThe
“IntegratedChildHealthWhatis“parenting”?Parentingmeansfulfillingtherolesofaparentinmeetingtheindividualneedsofthechild,andnurturingthechild’sphysical,cognitive,social-emotional,moral&personalitydevelopment.Whatis“parenting”?ParentingPhysicalexaminationGrowthmonitoringDevelopmentalsurveillanceHearingandvisionscreeningParentingProgrammeBreastfeeding
NutritionHomesafetyOralhealthOthernewborn&childcareissuesPreparationforparenthoodBuildingpositiverelationshipPromotingchilddevelopmentManagingchildbehaviourImmunizationprogrammeVaccinationagainst9infectiousdiseasesChildHealth&DevelopmentalSurveillanceProgrammePhysicalexaminationGrowthmonitoringDevelopmentalsurveillanceHearingandvisionscreeningPhysicalexaminationParentinParentingProgrammeAim:Equippingparentswiththenecessaryknowledgeandskills&supportingthemtofulfilltheirparentingroles,tobringuphealthyandwell-adjustedchildrenParentingProgrammeAim:EquippPsychotherapy/familysupport/familytherapy/drugtreatmentUniversalProgrammeIntensiveProgrammeSpecialistReferralTargetclientAllAtriskgroupMild/EarlyproblemsSignificantbehavioural&otherpsycho-socialproblemsServiceProviderMCHCsMCHCsCACsCACsHASWDResourcesLeafletsWorkshopsCounsellingPrimarycareTriplePGroupTriplePPsychotherapy/familysupport/familytherapy/drugtreatmentPsychotherapy/familysupportUniversalProgrammeForexpectantparentsandparentsofallchildrenattendingMCHCs(>90%newbornbabiesregisterwithMCHCs)Addressarangeofparentingissues,includingphysical,cognitive,socialandemotionalissues.ProvideanticipatoryguidancetoparentstoincreasetheirconfidenceinparentingactivitiesGiveninstagedformatUniversalProgrammeForexpectaAN012346121824364860AgeinMonths
Keys:
ImmunizationPhysicalExaminationGrowthMonitoring
ComprehensiveObservationServiceOAEHearingScreeningParentingProgrammeAntenatal
AN
AN012346121824364860AgeinMonAN0123469121824303642485460年齡(月)AgeinMonths
Keys註解
:Immunization免疫注射
PhysicalExamination身體檢查
GrowthMonitoring生長監察/DevelopmentalSurveillanceProgramme發展綜合觀察服務
OAEHearingScreening
聽力普查VisionScreening視力普查ParentingProgramme親職教育計劃Ifindicated如有需要Antenatal產前()
AN
()
()
()
()
(2006)AN0123469121824303642485460年齡(FormatSeriesofinteractiveworkshops共享育兒樂IndividualcounsellingHealtheducationalresourcesStageddevelopmentalleaflets:
ChildDevelopment兒童發展Specificparentingissueleaflets:
Childcare&Parenting育兒及親職系列Videoonchilddevelopment0-3:
TheBuddingYears寳寳成長路Videoonparenting:
ParentingDoReMi親子三點式FormatSeriesofinteractivewoIntensiveProgramme:
PositiveParentingProgramme(TripleP)Target:Families/Parentsatriskofchildrenwithearly/mildbehaviourproblemsinchildrenwithparentingdifficultiesIntensiveProgramme:
PositiveSummary(1)TheParentingProgramme(asamajorcomponentoftheIntegratedChildHealth&DevelopmentProgramme)inMCHCsaimstoequipandsupportparentstofulfilltheirrolesinbringinguphealthyandhappychildrenSummary(1)TheParentingProgrPublicHealth
Concepts&PrinciplesPublicHealth
Concepts&PrinPublicHealthThescienceandartofpreventingdisease,prolonginglife,andpromotinghealththroughorganizedeffortsofsociety(AchesonReport:PublicHealthinEngland,1988)AddresshealthatthepopulationlevelMulti-disciplinaryPublicHealthThescienceandaEpidemiologyThestudyofthedistributionanddeterminantsofhealth-relatedstatesoreventsinspecifiedpopulations,andtheapplicationofthisstudytocontrolofhealthproblems.EpidemiologyHealthHealthisastateofcompletephysical,mentalandsocialwell-beingandnotmerelytheabsenceofdiseaseorinfirmity(1948)Healthistheextenttowhichanindividualorgroupisabletorealiseaspirationsandsatisfyneeds,andtochangeorcopewiththeenvironmentHealthisaresourceforeverydaylife,notanobjectiveofliving;itisapositiveconcept,emphasisingsocialandpersonalresources,aswellasphysicalcapabilities(1984)HealthHealthisastateofcomEnvironmentalSocietalSocialEmotionalPhysicalMentalSpiritualSexualDimensionsofHealth
(Aggletonetal,1987&Ewlesetal,1999)EnvironmentalSocietalSocialEmoTheMainDeterminantsofHealth(Dahlgren&Whitehead1991)GeneralSocio-Economic,CulturalandEnvironmentalConditionsLivingandWorkingConditionsSocialandCommunityNetworksWorkenvironmentUnemploymentEducationWaterandsanitationAgricultureAndfoodproductionHealthCareservicesHousingAge,Sex&HereditaryFactorsIndividualLifestyleFactorTheMainDeterminantsofHealtLife-courseapproachEarlylifeexperiencesarerelatedtolaterlifeoutcomes(childhealthadulthealth)BiologicalprogrammingSocialdeprivationEarlycare&nurtureLife-courseapproachEarlylifeLevelsofpreventionPrimordialprevention–Establishment&maintenanceofconditions(social,economic,environmental,cultural&behavioural)thatminimizehazardtohealth(publichealthpolicy&healthpromotion)Primaryprevention–Protectionofhealthbypersonal&communalefforts,suchasenhancingnutritionalstatus,immunization,andeliminationofenvironmentalrisksLevelsofpreventionPrimordialLevelsofpreventionSecondaryprevention–asetofmeasuresavailabletoindividuals&communitiesforearlydetection&promptinterventiontocontroldisease&minimizedisabilities,e.g.byuseofscreeningprogrammeTertiaryprevention–Measuresaimedatsofteningtheimpactoflong-termdiseasebyeliminatingandreducingdisability&handicap;minimizingsuffering&maximizingpotentialyearsofusefullife(medicaltreatment&rehabilitation)(Last,2001)LevelsofpreventionSecondaryDiseasePreventionEnvironmentalRiskFactorsGeneticDiseaseClinicalOnsetPresentationPrimarySecondary
PreventionPreventionDiseasePreventionEnvironmentaPrimaryPrevention:
High-riskvsPopulation-basedApproachPrimaryPrevention:
High-riskPrimaryPrevention:
High-riskvsPopulation-basedApproachHigh-riskapproachMoreefficient;BUT“Risk”areimpreciselydefinedProblemofdevelopinga“screening”tooltoidentifythehighriskgroupLabelingeffectMissthecasesgeneratedbyalargenumberofpeopleatlowerriskPrimaryPrevention:
High-riskPrimaryPrevention:
High-riskvsPopulation-basedApproachPopulation-basedinterventionaimsto:Shifttheriskdistributioncurvetowardsthefavourabledirectioneveryoneenjoysalowerrisk;high-riskindividualsareshiftedoutofthe“danger”zoneReversethe“riskparadox”AlargenumberofpeopleexposedtoasmallriskmaygeneratemorecasesthanasmallnumberexposedtoahighriskPrimaryPrevention:
High-riskPrimaryPrevention:
High-riskvsPopulation-basedApproachPrimaryPrevention:
High-risk
Addressingarangeof
HealthIssues&RiskFactors:HealthPromotionHealthPromotionistheprocessofenablingpeopletoincreasecontrolover(thedeterminantsofhealth)and(thereby)improvetheirhealth
(WHO1986;Nutbeam,1985)
Addressingarangeof
HealthTheOttawaCharterfor
HealthPromotion(WHO1986)
BuildhealthyPublicPolicyCreateSupportiveEnvironmentStrengthenCommunityActionsDevelopPersonalSkillsReorientHealthServicesAdvocateEnableMediateTheOttawaCharterfor
HealthTheJakartaDeclaration(WHO,1997)Thereisclearevidencethat….Comprehensiveapproaches(usingcombinationsof5strategies)arethemosteffectiveParticularsettingsofferpracticalopportunitiesforimplementationofcomprehensivestrategies(e.g.schools,workplaces,localcommunities)ParticipationfrompeopleisessentialtosustaineffortsHealthlearning(accesstoeducation&information)fostersparticipation&empowermentofpeople&communitiesTheJakartaDeclaration(WHO,Summary(2)Health–multi-dimensionalDeterminantsofhealthBio-genetic/Life-style/Eco-systemLife-courseapproach
PreventionPrimordial/Primary/Secondary/TertiaryPrimary(Populationvshigh-riskapproach)HealthPromotionEmpowerment(individual/community)MultiplestrategiesInter-disciplinary&inter-sectoralcollaborationSummary(2)Health–multi-dimeTheDevelopment&DiffusionoftheParentingProgramme-ThePublicHealthApproach-TheDevelopment&DiffusionofCommunityDiagnosisNeedsassessment:3approachesEpidemiologicalComparativeCorporateCommunityDiagnosisNeedsassesEpidemiologicalNeedsAssessmentEffectivenessofinterventionsPopulation’shealthstatusAvailabilityofservicesEpidemiologicalNeedsAssessmeTheproblem:
ChildhoodbehaviourproblemsChildhoodbehaviourproblemslikelytodevelopintoadolescentemotional&behaviourdisordersLinksbetweenadolescentemotional&behaviourdisorderstodepression,anti-socialbehaviourandmajorphysicalillnessinadulthoodInter-generationallinks–psychologicallytroubledchildrenwillbecomepsychologicallytroubledparents
Theproblem:
ChildhoodbehaviTheDeterminantsTheBio-socio-ecologicalFramework(Bronfenbrenner,1979)4interactingdomainsThebiologicalchildThefamily*Theschool/communityThewiderworldChildFamilySchoolCommunityWiderworldTheDeterminantsTheBio-socio-ChildbehaviourproblemandParentingdifficultyChildBehaviourproblemParentingDifficultyAViscousCycleChildbehaviourproblemandPaLocalsituation(1)PrevalenceofbehaviourproblemsPreschoolersMild=17.9%,Moderate=4.6%,Severe=0.8%(Luketal,1991)
Childrenunder18yrsInternalizingbehaviour=10.3%,Externalizingbehaviour=18.9%(Tangetal,SWD1999)Localsituation(1)PrevalenceLocalsituation(2)Parentingdifficulty55.2%indicatedgreatorextremelygreatdifficultiesinparenting(preschoolers)(HongKongCouncilofSocialServices,1999)Parentingstressinrelationto:(childrenunderage15)Children’sacademicperformance–51.7%Children’sdiscipline–49.5%Beingagoodparent–47.4%(HKBoys’andGirls’ClubsAssociation,2000)18%fulfilledresearchcriteriadefinedforchildabuse(Tangetal,SWD1999)Localsituation(2)ParentingdLocalSituation(3)Familyadversity:Increasingnumberoffamilieswithchildrenunder5onComprehensiveSocialSecurityAssistanceJanuary2002–11379December2002–14183Increasingnumberofnewlyreportedcasesofdomesticviolence1999–1679cases2001–2433casesIncreasingnumberofsingleparentfamilieswithchildrenunder51991–45532001-8832(SWD2003)LocalSituation(3)FamilyadveLocalsituation(4)AcommunitysurveyonpatternsofparentingpracticesconductedbyFHSin2002942parentsof4-year-oldchildrenregisteredwithMCHC10.5%(n=99)intheclinicalrangeforbehaviourproblems(ECBI)ParentingstressmeasuredbyPSI(FamilyHealthService,DepartmentofHealth,2003)Localsituation(4)AcommunityParentingstressandchildbehaviourproblems
Parentingstressandchildbeh
Prevalenceoftheproblem(10-20%)StabilityovertimePoorprognosisHighhuman,economic&socialcostsBehaviourProblemsinChildrenandAdolescentsNeedforearlyinterventionMajorpublichealthissue
BehaviourProblemsinChiEpidemiologicalNeedsAssessmentEffectivenessofinterventionsPopulation’shealthstatusAvailabilityofservicesEpidemiologicalNeedsAssessmeSystematicreviews(RCT)
(Barlow,1999;Webster-Stratton&Taylor,2001;CochraneReviews-Barlow&Parsons,2003&Barlow&Coren,2003)
Parent-trainingprogrammesareeffectiveinimprovingparentalattitudes,selfesteemandemotionalhealthParent-trainingprogrammescanleadtoreductioninparentalanxiety,depression,stressandmaritalconflict
Behaviourally-orientedparent-trainingprogrammesarebetterthanotherapproachesinproducingbehaviourchangeinchildrenGroupprogrammehasbetterlong-termeffectthanindividualprogrammeSystematicreviews(RCT)
(BarlTypesofparentingprogrammeBasedonbehaviouralprinciplesPositiveParentingProgramme(TripleP)IncredibleYearsBasedonhumanistic&relationshipprinciplesParentEffectivenessTraining(PET)SystematicTrainingforEffectiveParenting(STEP)TypesofparentingprogrammeBaEpidemiologicalNeedsAssessmentEffectivenessofinterventionsPopulation’shealthstatusAvailabilityofservicesEpidemiologicalNeedsAssessmeServiceDevelopmentTopilot&evaluatethe“PositiveParentingProgramme”(TripleP)inHongKongServiceDevelopmentTopilot&TripleP(TP):TheoreticalBasisAformofbehaviouralfamilyintervention(BFI)basedonsociallearningprinciplesResearchinchild&familybehaviourtherapyandappliedbehaviouranalysisDevelopmentalresearchonparentingineverydaycontextDevelopmentalpsychopathologyresearchPublichealthperspectiveTripleP(TP):TheoreticalBasTP:AimsIncreaseparentalcompetenceandconfidenceinraisingchildrenIncreasepositiveparent-childcommunicationImproveparents’skillsinmanagingbehaviourproblemswiththeuseofnon-coerciveandnon-punitivemethodsReduceemotionalandbehaviourproblemsinchildrenTP:AimsIncreaseparentalcompPrinciplesofPositiveParentingEnsuringasafe&engagingenvironmentCreatingapositivelearningenvironmentUsingassertivedisciplineHavingrealisticexpectationsTakingcareofoneselfasaparentPrinciplesofPositiveParentiTP:TheEvidenceDocumentedEfficacyofBFIintreatment&preventionofchildbehaviouralproblems,usingRCTEvidenceofEffectivenessofdifferentlevelsofintervention,andwitharangeoffamilytypesTP:TheEvidenceTP:LocalEvidenceImplementationinlocalChineseCommunityParticipants-69parentswithchildrenbetween3to7yearsoldRecruitmentbyhealthprofessionalsinMCHCandCACRandomassignmenttointerventionandcontrolgroupsMeasures-Completionofpre-interventionandpost-interventionquestionnairesonChildbehaviourproblemsParentingsenseofcompetenceParentingpracticesMaritalrelationship(Leung,Sanders,Leung,Mak&Lau,2003)TP:LocalEvidenceImplementatiTP:LocalEvidence(2)ResultsDecreaseinchildbehaviourproblemsDecreaseindysfunctionalparentingpracticesIncreaseinparentingsenseofcompetenceIncreaseinmaritalrelationshipsatisfactionTP:LocalEvidence(2)ResultsPreandpostchangesindifferentchildbehaviorproblemsandparentingstressscalesPreandpostchangesindifferPreandpostchangesindifferentparentingandmaritalrelationshipscalesPreandpostchangesindifferServiceDevelopmentProgrammeDiffusionTraining&AccreditationQualityManagementEvaluationServiceDevelopmentProgrammeDTraining&AccreditationSystematic&structuredKnowledge&skillbasedAttentiontoprocessissuesAccreditationOver300medicalandnursingstafftrainedandaccreditedtodeliverTriplePTraining&AccreditationSystemContinuousProfessionalSupportCentralprofessionalteamsupportFrontlinepeersupportnetworkStructuredsupervisionschemeTriplePwebsiteContinuousProfessionalSupporEvaluationDatabaseonpre-andpost-TriplePgroupmeasuresofchildbehaviourandparentingskillsofparticipantsEffectivenessoftheprogrammeonthewholeEffectivenessofindividualgroups/facilitatorsEvaluationDatabaseonpre-andSummary(3)NeedsassessmentHealthstatusEffectivenessofinterventions(Evidence-based)AvailabilityofservicesServicedevelopmentPilotprogrammewithevaluation(process&outcome)–Evidence-basedProgrammediffusionTraining&accreditationQualitymanagementEvaluation(outcome)Summary(3)NeedsassessmentParentingEducation:
ThePublicHealthApproachDr.ShirleyLeungFRCP(Glasg),FHKAM(Paed),MPH(Auckland)FamilyHealthServiceDepartmentofHealthParentingEducation:
ThePublOutlineTheParentingProgrammeintheFamilyHealthServicePublichealthconcepts&principlesThepublichealthapproachtothedevelopmentoftheParentingProgrammeOutlineTheParentingProgrammeTheFamilyHealthService(DH)Ourbusiness:Toprovideacomprehensiverangeofhealthpromotionanddiseasepreventionservicesforchildrenfrombirthto5years,andwomen
below65yearsofage.throughanetworkof
Maternal&ChildHealthCentres(MCHCs),&WomanHealthCentres(WHCs).TheFamilyHealthService(DH)The
“IntegratedChildHealth
&
DevelopmentProgramme”
“Parenting”asamajorcomponentThe
“IntegratedChildHealthWhatis“parenting”?Parentingmeansfulfillingtherolesofaparentinmeetingtheindividualneedsofthechild,andnurturingthechild’sphysical,cognitive,social-emotional,moral&personalitydevelopment.Whatis“parenting”?ParentingPhysicalexaminationGrowthmonitoringDevelopmentalsurveillanceHearingandvisionscreeningParentingProgrammeBreastfeeding
NutritionHomesafetyOralhealthOthernewborn&childcareissuesPreparationforparenthoodBuildingpositiverelationshipPromotingchilddevelopmentManagingchildbehaviourImmunizationprogrammeVaccinationagainst9infectiousdiseasesChildHealth&DevelopmentalSurveillanceProgrammePhysicalexaminationGrowthmonitoringDevelopmentalsurveillanceHearingandvisionscreeningPhysicalexaminationParentinParentingProgrammeAim:Equippingparentswiththenecessaryknowledgeandskills&supportingthemtofulfilltheirparentingroles,tobringuphealthyandwell-adjustedchildrenParentingProgrammeAim:EquippPsychotherapy/familysupport/familytherapy/drugtreatmentUniversalProgrammeIntensiveProgrammeSpecialistReferralTargetclientAllAtriskgroupMild/EarlyproblemsSignificantbehavioural&otherpsycho-socialproblemsServiceProviderMCHCsMCHCsCACsCACsHASWDResourcesLeafletsWorkshopsCounsellingPrimarycareTriplePGroupTriplePPsychotherapy/familysupport/familytherapy/drugtreatmentPsychotherapy/familysupportUniversalProgrammeForexpectantparentsandparentsofallchildrenattendingMCHCs(>90%newbornbabiesregisterwithMCHCs)Addressarangeofparentingissues,includingphysical,cognitive,socialandemotionalissues.ProvideanticipatoryguidancetoparentstoincreasetheirconfidenceinparentingactivitiesGiveninstagedformatUniversalProgrammeForexpectaAN012346121824364860AgeinMonths
Keys:
ImmunizationPhysicalExaminationGrowthMonitoring
ComprehensiveObservationServiceOAEHearingScreeningParentingProgrammeAntenatal
AN
AN012346121824364860AgeinMonAN0123469121824303642485460年齡(月)AgeinMonths
Keys註解
:Immunization免疫注射
PhysicalExamination身體檢查
GrowthMonitoring生長監察/DevelopmentalSurveillanceProgramme發展綜合觀察服務
OAEHearingScreening
聽力普查VisionScreening視力普查ParentingProgramme親職教育計劃Ifindicated如有需要Antenatal產前()
AN
()
()
()
()
(2006)AN0123469121824303642485460年齡(FormatSeriesofinteractiveworkshops共享育兒樂IndividualcounsellingHealtheducationalresourcesStageddevelopmentalleaflets:
ChildDevelopment兒童發展Specificparentingissueleaflets:
Childcare&Parenting育兒及親職系列Videoonchilddevelopment0-3:
TheBuddingYears寳寳成長路Videoonparenting:
ParentingDoReMi親子三點式FormatSeriesofinteractivewoIntensiveProgramme:
PositiveParentingProgramme(TripleP)Target:Families/Parentsatriskofchildrenwithearly/mildbehaviourproblemsinchildrenwithparentingdifficultiesIntensiveProgramme:
PositiveSummary(1)TheParentingProgramme(asamajorcomponentoftheIntegratedChildHealth&DevelopmentProgramme)inMCHCsaimstoequipandsupportparentstofulfilltheirrolesinbringinguphealthyandhappychildrenSummary(1)TheParentingProgrPublicHealth
Concepts&PrinciplesPublicHealth
Concepts&PrinPublicHealthThescienceandartofpreventingdisease,prolonginglife,andpromotinghealththroughorganizedeffortsofsociety(AchesonReport:PublicHealthinEngland,1988)AddresshealthatthepopulationlevelMulti-disciplinaryPublicHealthThescienceandaEpidemiologyThestudyofthedistributionanddeterminantsofhealth-relatedstatesoreventsinspecifiedpopulations,andtheapplicationofthisstudytocontrolofhealthproblems.EpidemiologyHealthHealthisastateofcompletephysical,mentalandsocialwell-beingandnotmerelytheabsenceofdiseaseorinfirmity(1948)Healthistheextenttowhichanindividualorgroupisabletorealiseaspirationsandsatisfyneeds,andtochangeorcopewiththeenvironmentHealthisaresourceforeverydaylife,notanobjectiveofliving;itisapositiveconcept,emphasisingsocialandpersonalresources,aswellasphysicalcapabilities(1984)HealthHealthisastateofcomEnvironmentalSocietalSocialEmotionalPhysicalMentalSpiritualSexualDimensionsofHealth
(Aggletonetal,1987&Ewlesetal,1999)EnvironmentalSocietalSocialEmoTheMainDeterminantsofHealth(Dahlgren&Whitehead1991)GeneralSocio-Economic,CulturalandEnvironmentalConditionsLivingandWorkingConditionsSocialandCommunityNetworksWorkenvironmentUnemploymentEducationWaterandsanitationAgricultureAndfoodproductionHealthCareservicesHousingAge,Sex&HereditaryFactorsIndividualLifestyleFactorTheMainDeterminantsofHealtLife-courseapproachEarlylifeexperiencesarerelatedtolaterlifeoutcomes(childhealthadulthealth)BiologicalprogrammingSocialdeprivationEarlycare&nurtureLife-courseapproachEarlylifeLevelsofpreventionPrimordialprevention–Establishment&maintenanceofconditions(social,economic,environmental,cultural&behavioural)thatminimizehazardtohealth(publichealthpolicy&healthpromotion)Primaryprevention–Protectionofhealthbypersonal&communalefforts,suchasenhancingnutritionalstatus,immunization,andeliminationofenvironmentalrisksLevelsofpreventionPrimordialLevelsofpreventionSecondaryprevention–asetofmeasuresavailabletoindividuals&communitiesforearlydetection&promptinterventiontocontroldisease&minimizedisabilities,e.g.byuseofscreeningprogrammeTertiaryprevention–Measuresaimedatsofteningtheimpactoflong-termdiseasebyeliminatingandreducingdisability&handicap;minimizingsuffering&maximizingpotentialyearsofusefullife(medicaltreatment&rehabilitation)(Last,2001)LevelsofpreventionSecondaryDiseasePreventionEnvironmentalRiskFactorsGeneticDiseaseClinicalOnsetPresentationPrimarySecondary
PreventionPreventionDiseasePreventionEnvironmentaPrimaryPrevention:
High-riskvsPopulation-basedApproachPrimaryPrevention:
High-riskPrimaryPrevention:
High-riskvsPopulation-basedApproachHigh-riskapproachMoreefficient;BUT“Risk”areimpreciselydefinedProblemofdevelopinga“screening”tooltoidentifythehighriskgroupLabelingeffectMissthecasesgeneratedbyalargenumberofpeopleatlowerriskPrimaryPrevention:
High-riskPrimaryPrevention:
High-riskvsPopulation-basedApproachPopulation-basedinterventionaimsto:Shifttheriskdistributioncurvetowardsthefavourabledirectioneveryoneenjoysalowerrisk;high-riskindividualsareshiftedoutofthe“danger”zoneReversethe“riskparadox”AlargenumberofpeopleexposedtoasmallriskmaygeneratemorecasesthanasmallnumberexposedtoahighriskPrimaryPrevention:
High-riskPrimaryPrevention:
High-riskvsPopulation-basedApproachPrimaryPrevention:
High-risk
Addressingarangeof
HealthIssues&RiskFactors:HealthPromotionHealthPromotionistheprocessofenablingpeopletoincreasecontrolover(thedeterminantsofhealth)and(thereby)improvetheirhealth
(WHO1986;Nutbeam,1985)
Addressingarangeof
HealthTheOttawaCharterfor
HealthPromotion(WHO1986)
BuildhealthyPublicPolicyCreateSupportiveEnvironmentStrengthenCommunityActionsDevelopPersonalSkillsReorientHealthServicesAdvocateEnableMediateTheOttawaCharterfor
HealthTheJakartaDeclaration(WHO,1997)Thereisclearevidencethat….Comprehensiveapproaches(usingcombinationsof5strategies)arethemosteffectiveParticularsettingsofferpracticalopportunitiesforimplementationofcomprehensivestrategies(e.g.schools,workplaces,localcommunities)ParticipationfrompeopleisessentialtosustaineffortsHealthlearning(accesstoeducation&information)fostersparticipation&empowermentofpeople&communitiesTheJakartaDeclaration(WHO,Summary(2)Health–multi-dimensionalDeterminantsofhealthBio-genetic/Life-style/Eco-systemLife-courseapproach
PreventionPrimordial/Primary/Secondary/TertiaryPrimary(Populationvshigh-riskapproach)HealthPromotionEmpowerment(individual/community)MultiplestrategiesInter-disciplinary&inter-sectoralcollaborationSummary(2)Health–multi-dimeTheDevelopment&DiffusionoftheParentingProgramme-ThePublicHealthApproach-TheDevelopment&DiffusionofCommunityDiagno
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