Public Health in Ghana a cue from Penders Health Promotion Model

Public health is the science and art of preventing disease, prolonging life, and promoting physical health and efficiency, through organized community efforts, for the sanitation of the environment, the control of community infections, the education of the individual in the principles of personal hygiene, the organization of medical and nursing service for the early detection and preventive treatment of disease, and the development of the social machinery which will ensure to every individual in the community a standard of living adequate for the maintenance of health (winslow 1923).

Pender’s framework purported that the acquisition and maintenance of health-promoting behavior depends upon three components: cognitive/perceptual actors, modifying factors and cues to action. The framework supports the theory that attaining and maintaining health depends on actions and behaviors undertaken by the individual threatened by real or potential disease.

The theory hypothesizes that some individuals or groups develop life styles and patterns of behavior which are aimed at the attainment of higher levels of wellness and positive health states, not just the avoidance of disease. The model contains cognitive-perceptual factors, modifying factors and cues to action. Each category addresses an aspect of human behavior (Pender, 2005).

The Health Promotion Model (HPM) categorizes the factors influencing behaviors similar to the HBM. Modifying factors, cognitive-perceptual factors and variables influencing the likelihood of action, are delineated. The health belief model (HBM) is a health protective model whereas the HPM is focused more on achievement of higher levels of well-being and self-actualization.

Modifying factors include behavioral and situational factors, interpersonal influences, and biological and demographic characteristics.

Behavioral factors describe the person's prior experiences with a given activity. The activity and associated information previously learned may influence the person's self-efficacy in resuming participation in the activity.

Situational factors may influence behavior as it relates to the surrounding environment. For example, if a person desires to lose weight, but only has high calorie or high fat food/meal options available they will be more challenged.

Interpersonal influences relate to social support and expectations of others. A respected clinician that advises a client to quit smoking can provide the impetus for the client to quit. Families and work colleagues are other sources of encouragement or discouragement toward a change of behavior.

Age, gender, income, ethnic, racial and educational background comprises the demographic characteristics associated with the model. For example, as an individual's income increases there is a greater likelihood the participant will engage in preventive services. This aspect provides meshing of the HPM with the concept of self-actualization.

Cognitive/perceptual factors, for example perceived self-efficacy, perceived health, definition of health and perceived barriers are considered to be the primary mechanisms directly affecting the chance of adopting health-promoting behavior.

Modifying factors, for example demographic characteristics, biological characteristics and interpersonal influences, are mediated through the cognitive perceptual factors.

Cues to action may be internal or external and serve to stimulate behavior actions such as feeling of elation after exercise, peer encouragement and mass media (Pender, 2005).
Basic needs must be met before the client aspires to higher levels of self-actualization. These modifying components are suggested to indirectly affect health behaviors; however, cognitive-perceptual factors are the primary motivating mechanisms for acquisition and maintenance of health promoting behaviors.

The cognitive-perceptual elements include items such as, importance of health and perceptions of control of health, self-efficacy, and definition of health, health status, benefits of and barriers to health-promoting behaviors. The importance of health is clearly within the client's value scale; however, if health is not a priority or highly valued, the client may be less likely to act. It is at this juncture that a spiritual component could possibly be inferred given the definitions of spirituality and the relatedness to sense of purpose and values.

Different types of programs will be required for individuals with an internal versus external locus of control. The locus of control determines the individual's program expectations and outcomes. Externally controlled participants may not do well with an individual or self-directed program, and consequently require a group format. Research has demonstrated that locus of control can be accounted for by the perceived control of health, which directly relates to the client's confidence in their personal ability to accomplish the task.

Conclusion
The writers think that if below listed practices are taken, then in no time the public health service in Ghana would be a model to many other developing countries

(a) The use of indigenous knowledge in primary health care will let the community understand completely what is been done.

(b) Promotion and respecting the culture of our communities will let the community to embrace public health and this could act as a health tool and determinant


(c) strong and regular mass education on other public health issues like sanitation, water purification system, waste disposal system will help public health to achieve its aim apart from disease control through immunization, vaccinations etc.

(d) Assimilation and community involvement in health promotions, campaigns etc will improve the public health system.


(e) Policy makers on public health should involve district health officers and other sector leaders in order to get an integrated policy.

(f) There should be a good understanding and openness between community traditional healers and the orthodox practitioners in order to promote good and safety health


(g) There should be more research and publications on community health and policy makers should also use their finding in their draft


(h) There should be management information systems, monitoring and evaluation on all public health programs.


The writers are: Owusu Nyarko Richard, B.Sc., MHCM, MBA, Senior health practitioner, health research scientist and Graduate entry medical student in Accra

Owusu Boateng Paul, B.Sc., MBBS (Medicine and Surgery) - Jinzhou Medical University, China.
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