Health Promotion and the Gamification of Health

HEALTH PROMOTION AND THE GAMIFICATION OF HEALTH

Health Promotion

  • Definition (WHO): Health promotion is the process that enables people to increase control over, and improve, their health. It emphasizes a move beyond individual behavior, addressing a broad range of social and environmental interventions.
  • Objectives:
    • Reduce excess mortality
    • Address leading risk factors and underlying determinants of health
    • Strengthen sustainable health systems
    • Place health at the center of a broad development agenda
  • Focus: Health promotion is primarily concerned with the prevention of disease and empowering individuals to manage their diseases through healthy living and behaviors (WHO; WHO Health Promotion).

Values of Health Promotion

  • Health promotion is based on several implicit values:
    • Equity and Social Justice: Promotes fairness and justice in health opportunities.
    • Holistic Definition of Health: Considers physical, mental, and social well-being.
    • Full Range of Health Determinants: Acknowledges multiple factors influencing health.
    • Environmental Influence: Recognizes the role of the environment in health outcomes.
    • Empowerment: Builds individual and collective capacity for health improvement.
    • Social Participation: Enhances engagement and involvement of communities in health-related initiatives.
    • Intersectoral Collaboration: Involves collaboration with non-healthcare sectors to address health outcomes.

Downstream vs Upstream Interventions

  • Concept: The metaphor of upstream and downstream interventions relates to how health promotion seeks to influence health.
  • Downstream Interventions:
    • Example: A passer-by sees a body floating in a river and calls for help. Firemen and paramedics provide immediate care.
    • Focus: Reactive approach that handles immediate health crises.
  • Upstream Interventions:
    • Example: After rescuing one person, it is found that others are falling into the river due to a broken bridge. Fixing the bridge reduces future emergencies.
    • Focus: Proactive approach aiming to correct root causes of health issues by modifying social determinants of health.

Health Promotion and Healthcare Levels

  • Scope of Health Promotion:
    • Health promotion activities occur before various levels of healthcare:
    • Quaternary care
    • Tertiary care
    • Secondary care
    • Primary care.

History of Health Promotion in Canada

  • 1947 - Lalonde Report:
    • Conceptualized the health field, highlighting two main goals: healthcare system and prevention of health problems.
    • Critiqued the biomedical model, stressing that traditional treatment approaches are insufficient.
    • Acknowledged that health determinants extend beyond the healthcare system, advocating for public health focus on populations facing health inequalities.
  • 1978 - Health Promotion Directorate Established:
    • Federal government expresses commitment to health promotion.
  • 1979 - University of Toronto:
    • Established the first Canadian post-secondary degree program in health promotion.
  • 1986 - Ottawa Charter for Health Promotion:
    • Developed as a framework for health promotion globally, promoting strategies to achieve health for all by 2000.
    • Identified seven prerequisites for adult health:
    • Peace
    • Shelter
    • Education
    • Food
    • Income
    • A stable eco-system
    • Sustainable resources.
  • 1989-1991:
    • Expansion of health promotion initiatives through provincial government funding.
  • 2003:
    • Creation of separate provincial ministries with public health/health promotion mandates and the Public Health Agency of Canada.
  • 2011 - Declaration on Prevention and Promotion:
    • Ministers of Health acknowledge the importance of population health as a measure of societal well-being.

Ottawa Charter for Health Promotion

  • Building Healthy Public Policy:
    • Puts health on the agenda for policymakers, urging them to consider health outcomes in decision-making.
  • Creating Supportive Environments:
    • Example: Encouraging families to support members in health-related behavior changes.
  • Strengthening Community Action:
    • Emphasizes community empowerment and participation in health strategies.
  • Developing Personal Skills:
    • Supports personal and social development by enhancing life skills and providing necessary information.
  • Reorienting Health Services:
    • Advocates for an equitable distribution of health resources focusing on prevention alongside traditional care.

Declaration on Prevention and Promotion

  • Core Agreements:
    • Emphasizes that population health contributes to societal well-being.
    • Defines health as complete physical, mental, and social well-being, not merely the absence of disease.
    • Recognizes disparities in health among populations such as First Nations, Inuit, and Métis; and those with lower education and income.
  • Determinants of Health:
    • Health is influenced by various factors including environmental, social, economic, cultural conditions, and individual behaviors.
    • Identifies that many influencing factors extend beyond the healthcare system, necessitating collaborative societal efforts to address health disparities.

Approaches to Health Promotion

  • Strategies Include:
    • Change risk factors and conditions beyond health sector control.
    • Provide community support through population health initiatives.
    • Ensure access to effective clinical prevention services.
    • Promote healthy behavior through education.
    • Utilize research to inform and improve health outcomes.

Models of Change in Health Promotion

  • Learning Theory:
    • Concepts: Positive reinforcement, negative reinforcement, extinction, and modeling healthy behaviors.
  • Consensus Model:
    • Sequence of steps for change:
    1. Intention
    2. Absence of environmental constraints
    3. Necessary skills
    4. Benefits outweigh costs
    5. Social support
    6. Self-efficacy
    7. Consistent with self-standards
    8. Positive affect (positive mood).

Health Belief Model

  • Components:
    • Modifying Variables
    • Perceived Benefits vs. Perceived Barriers
    • Perceived Seriousness
    • Likelihood of Engaging in Health-Promoting Behavior
    • Perceived Threat
    • Perceived Susceptibility
    • Self-Efficacy
    • Cues to Action.

Theory of Reasoned Action

  • Components:
    • Behavioral Beliefs:
    • Belief strength and outcome evaluation affecting attitude toward the behavior.
    • Normative Beliefs:
    • Belief strength and motivation influencing perceived norms.
    • Behavior Control Beliefs:
    • Impact on perceived behavioral control, capacities, and autonomy.

Gamification of Health

  • Definition: Gamification involves applying game elements (point scoring, competition, rules of play) to non-game activities, including health initiatives.
  • Purpose: Employed as a tactic to encourage healthy behaviors through game-like incentives.
  • Mechanisms of Change:
    • Rewards for healthy behaviors
    • Increase perceived benefits
    • Use of competition for social support
    • Bridge the gap between intention and behavior
    • Enhance self-efficacy.

Examples of Health Gamification

  • Nutrition, Fitness, and Weight Loss:
    • Fitbit: A device tracking steps, heart rate, and encouraging messages to promote activity; significant outcomes noted in trials (16 weeks).
    • Findings: 96% of users found it helpful for increasing activity, vs 32% for standard pedometers.
    • Pokémon Go: An augmented reality mobile game that promotes walking while playing; anecdotal evidence suggests increased physical activity and community interaction.
    • Other Applications:
    • Mango Health: Reminders for medication compliance paired with a point system.
    • QuitNow!: Aids in smoking cessation by tracking habits and savings.
    • Didget: A device linking gaming and health monitoring for diabetes management.

Non-technological Gamification

  • Gamification does not require technology:
    • Engage in friendly competitions or challenges, such as workplace walking contests, communal swimming goals, or gym attendance challenges.

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