Health Promotion in Communities: Holistic and Wellness Approaches

HEALTH

PROMOTION IN COMMUNITIES Holistic and Wellness Approaches

Carolyn Chambers Clark, EdD, ARNP, FAAN, HNC, DABFN, FAAIM, is on the Health Services Doctoral Faculty at Walden University and has been on the graduate and undergraduate nursing faculty at several other universities. Dr. Clark is founder, The Wellness Institute, and Founding Editor, Alternative Health Practitioner: The Journal of Complementary and Natural Care (now called Complementary Health Practice Review). Her book, WeUness Practitioner: Concepts, Research, and Strategies, 2nd edition (Springer, 1996) won an American Journal of Nursing Book-of-the-Year Award, and The Nurse as Group Leader is now in its third edition (Springer, 1994) and has been published in German and Swedish. She has published widely on complementary and holistic topics for both academic and consumer audiences and is Editor-inChief of the Encyclopedia of Complementary Health Practice (Springer, 1999) and author of Integrating Complementary Health Procedures into Practice (Springer, 2000), both of which received AJN Book-of-the-Year Awards. Dr. Clark is certified as an holistic nurse by the American Holistic Nurses' Certification Corporation, is a Diplomate of the American Board of Forensic Nursing, an Advisory Board member and Fellow of the American Association of Integrative Medicine, and has been a Fellow of the American Academy of Nursing since 1980. She serves as a research grant reviewer for Sigma Theta Tau International, has maintained a wellness/ holistic private practice since 1976 and has provided community health and wellness consultation since 1973.

HEALTH

PROMOTION IN

COMMUNITIES Holistic and Wellness Approaches

Carolyn Chambers Clark, EdD, RN, ARNP, FAAN, HNC, DABFN, Editor

Springer Publishing Company

Copyright © 2002 by Springer Publishing Company, Inc. All rights reserved No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Springer Publishing Company, Inc. Springer Publishing Company, Inc. 536 Broadway New York, NY 10012-3955 Acquisitions Editor: Ruth Chasek Production Editor: J. Hurkin-Torres Cover design by Susan Hauley

02 03 04 05 06 / 5 4 3 2 1

Library of Congress Cataloging-in-Publication Data Clark, Carolyn Chambers. Health promotion in communities : holistic and wellness approaches / editor Carolyn Chambers Clark. p. ; cm. Includes bibliographical references and index. ISBN 0-8261-1407-5 1. Community health services. 2. Holistic medicine. 3. Health promotion. 4. Medicine, Preventive. I. Title. [DNLM: 1. Community Health Services—organization & administration—United States. 2. Health Promotion—methods—United States. 3. Holistic Health—United States. WA 546 AA1 C592h 2001] RA427 .C54 2001 362.1'2—dc21

Printed in the United States of America by Sheridan Press,

00-067911 CIP

This book is dedicated to my granddaughter, Morgaine, whose first word was "book."

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Contents

List of Tables

xi

List of Boxes

xiii

List of Figures

xvi

Contributors

xvii

Preface

xix Part I.

THEORY AND CONCEPTS

1. A Model for Health and Wellness Promotion in Communities Carolyn Chambers Clark

3

2. Health Promotion with Changing and Vulnerable Populations Grace Erickson

15

Part II.

DEVELOPING PROGRAMS IN THE COMMUNITY

3. Community Self-Assessment Carolyn Chambers Clark

35

4. Principles of Planning Effective Community Programs Elizabeth Erkel

47

5. Community Mobilization and Participation Carl O. Helvie

69

6. Marketing Community Health Promotion Programs Carolyn Chambers Clark

83

7. Evaluating Community Health Programs Sandra MacDonald

97

wi

viii

Contents

8. Health Promotion in Rural Settings Julia W. Aucoin and Sheilda G. Rodgers

111

9. Health Promotion on the Internet Judy L. Sheehan

121

Part III. STRATEGIES FOR WELLNESS 10. Nutrition and Weight Management Carolyn Chambers Clark

133

11. Fitness and Flexible Movement Barbara Resnick

183

12. Typical Childhood Communicable Diseases: Promoting Community Resiliency Margo A. Drohan

199

13. Stress Management Carolyn Chambers Clark

213

14. Smoking Cessation Charlene Long

233

15. Violence-Prevention Skills Carolyn Chambers Clark

247

16. Environmental Wellness Carolyn Chambers Clark

261

17. Complementary Health Care Practices Nancy Oliver

279

Part IV. INTERACTION SKILLS 18. Advanced Communication Skills with Individuals and Groups Carolyn Chambers Clark

297

19. Working with Groups Cynthia G. Johnson and Beth R. Keely

311

20. Working with Families Janice Unruh Davidson

331

Part V. HEALTH PROMOTION IN A CULTURAL CONTEXT 21. Health Promotion with African American Women Marua Mizell Price

355

Contents

ix

22. Establishing a Lay Health Promotion Program in a Hispanic Community Sandra K. Hopper

383

23. Diabetes Programs in Hawaii Chen-Yen Wang

401

24. Parish Nursing Susan MacLeod Dyess

409

Part VI.

LESSONS FROM SAMPLE HEALTH PROMOTION PROGRAMS

25. Conducting a Survey: The Example of a Youth Service Organization Robert W. Strack

421

26. Violence Prevention in Schools: A Model Violence-Prevention Center Pamela P. DiNapoli

433

27. Evaluating Small Community-Based Health Promotion Programs: Lessons Learned from Colorado Health Promotion Initiatives Kathryn A. Judge, Deborah S. Main, Carolyn Tressler, Douglas Fernald, Jill Parker, Kitty Corbett, and Jennifer Horton

439

28. Health Promotion in a Homeless Center Carl O. Helvie

461

Index

465

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List of Tables

Table Table Table Table Table Table

1.1 1.2 1.3 1.4 2.1 2.2

Table

2.3

Table Table

3.1 4.1

Table

4.2

Table 4.3 Table 4.4 Table 6.1 Table 10.1 Table 10.2 Table 10.3 Table 10.4 Table Table Table Table Table Table Table Table

11.1 11.2 11.3 12.1 13.1 13.2 13.3 13.4

Community Wellness Healthy People 2010 Objectives Cultural Beliefs About Health and Wellness Wellness Self-Assessment Factors Associated with Resilience and Vulnerability Factors That Increase Vulnerability for Adolescent Pregnancy and STDs Acute, Chronic, and Communicable Disease Associated with Childhood Homelessness Tasks and Timeline for a Participatory Community Survey Three-Year Budget Summary for "Shedding Pounds . . . Adding Years" Three-Year Budget Detail for "Shedding Pounds. . . Adding Years" Health Promotion Approaches by Modifiable Determinants Media for Engagement of Target Population Marketing Media Selection Factors Wellness-Enhancing Foods Vitamin Functions, Deficiency Symptoms, and Food Sources Recommended Amounts of Vitamin For Adults; Reasons Supplementation May Be Needed Reference to Minerals, Recommended Amounts, Functions, Sources, and Factors Leading to Insufficient Intake Maximum and Target Heart Rate Prescreening of Older Adults for Safe Exercise Exercise/Activity Resources Sample True Contraindications and Precautions Assessing and Reducing Stressful Life Changes Stress Symptom Assessment Basic Instructions for Self-Hypnosis Coaching Clients in Self-Hypnosis xi

7 9 10 11 17 20 27 38 59 59 63 65 87 137 140 144 147 184 186 194 205 215 216 220 220

List of Tables

Xtl

Table Table Table Table Table Table Table Table Table Table Table Table Table Table Table Table

13.5 13.6 14.1 15.1 16.1 18.1 19.1 19.2 19.3 19.4 19.5 20.1 20.2 20.3 20.4 20.5

Refuting Irrational Ideas Time Management Assessment Benefits from Stopping Smoking Emotional Intelligence Alternatives to Toxic Pesticides Blocks to Listening Comparison of Features of Five Types of Groups Three Types of Group Roles Group Maturity and Communication Factors Affecting Group Problem Solving Ten Major Evaluative Indicators of Group Functioning Determinants of Family Health and Wellness Factors Influencing Family Health Promotion Behaviors FAMCHAT—A Family Cultural Heritage Assessment Tool FAMTOOL—A Family Health Assessment Tool Family Empowerment Work Sheet for Planning to Meet Health Promotion Needs

227 228 237 249 271 298 317 320 321 322 329 332 337 341 342 343

List of Boxes

Box Box Box Box

1.1 2.1 2.2 2.3

Box 2.4 Box 2.5 Box 2.6 Box Box Box Box Box Box Box Box Box Box Box Box Box Box Box

3.1 3.2 3.3 3.4 4.1 4.2 6.1 6.2 6.3 7.1 7.2 7.3 7.4 7.5 7.6

Box 7.7 Box 7.8 Box 8.1 Box 9.1 Box 9.2

Holistic Health Promotion Assumptions Try This: Reflect on Factors to Lower Vulnerability Resources and Strategies to Promote Adolescent Health and Wellness Resources and Strategies to Balance Energy Intake and Energy Expenditure Teaching Parents How to Help Their Overweight and Obese Children Case Study: Teaching Parents of an Overweight Child Categories of Hope-Engendering Strategies with Brief Pragmatic Definitions Guidelines for Establishing Community Partnerships Services Available in One Community Data Sources for Your Community Assessment Community Assessment Program Objectives for "Shedding Pounds . . . Adding Years" Teaching Tips Media Release for Shape-up Program Radio PSA Creative Corner Examples of Community Self-assessment Information Community Self-assessment Information Marketing Services for Women Experiencing Menopause Formative and Summative Evaluation Questions Levels of Accountability for Program Evaluation Example Focus Group Evaluation Questions for a Cardiovascular Promotion Program Survey Questions for Program Evaluation Hypothetical Cost-Benefit Analysis for a High School Parenting Program Case Study: Cultural Competence with Rural Diversity Technological Assessment Sample Areas for Health Promotion Activity on the Internet xiii

4 20 22 24 25 25 28 37 38 39 41 56 64 90 92 93 98 99 100 102 103 106 108 109 116 123 124

xiv

Box Box Box Box Box Box Box Box Box Box Box Box Box Box Box Box Box Box Box Box Box

List of Boxes

9.3 10.1 11.1 11.2 11.3 11.4 11.5 11.6 11.7 11.8 12.1 12.2 14.1 14.2 14.3 15.1 15.2 16.1 17.1 17.2 17.3

Box 17.4 Box 17.5 Box Box Box Box Box Box Box Box Box Box Box Box Box Box Box Box Box Box Box Box

17.6 17.7 17.8 18.1 18.2 18.3 19.1 19.2 19.3 19.4 19.5 19.6 19.7 19.8 19.9 20.1 21.1 21.2 21.3 21.4

A Case Study Getting to Your Ideal Weight Physical Activity Readiness Questionnaire (PAR-Q) Definitions of Exercise Perceived Exertion Scale: Assessment Corner Evaluation of Exercise Using Heart Rate: Assessment Corner Definition and Examples of Stretching Activities Guidelines for Resistance Training in Adults Warning Signs to Recognize During Exercise Facing Your Barriers Sample Epidemiology of Communicable Diseases Breathing Exercise Reasons for Quitting Smoking Healthy Snacks Tips for Quitting Spotting an Abusive Relationship Threat-of-Violence Assessment and Decision-Making Process Nontoxic Household Cleaners Complementary Health Care Practices: Self-assessment NCCAM's Resources NCCAM's Classification of Alternative Medicine Practices for Mind-Body Medicine NCCAM Research Awards for Fiscal Year 1999 Resources for Information About Acupuncture, Chiropractic, and Homeopathy Imagery Exercise: "I Have All the Time I Need" Relaxation Resources Telephone Meditation Directions for Centering Case Study Focused on Listening Evaluation Example Factors Relating to Group Cohesiveness Evaluative Indicators of Group Cohesiveness Seven Purposes for Group Meetings Six Steps for Communicating with Groups Team-Building Activities: Take the Team-Building Test Characteristics of Group Leaders Characteristics of a Successful Decision-Making Process The POWER Listening Model Factors Causing Group Failure and Factors for Group Motivation Indications for Family Assessment BMI Calculation (Report of the U.S. Preventive Services Task Force) Barriers to Regular Physical Activity Criteria for Hypertension Healthy People 2010 Objectives for Hypertension Prevention and Control in African American Women

128 172 185 187 188 188 190 191 191 195 201 211 240 240 243 250 257 268 281 281 283 284 286 290 291 292 298 306 310 313 314 316 320 324 324 326 327 328 340 362 364 366 366

List of Boxes

Box Box Box Box Box Box Box Box Box Box Box Box Box Box Box Box Box Box Box Box Box Box Box

21.5 21.6 21.7 21.8 21.9 22.1 23.1 24.1 24.2 25.1 25.2 25.3 25.4 26.1 26.2 26.3 26.4 26.5 27.1 27.2 27.3 27.4 27.5

Stages of Change Model Antihypertensive Activities Personal Barriers for Breast Screening American Cancer Society BSE Guidelines Important Information about Breast Screening Checklist for Implementing a Lay Health Promoter Program Wisdom Box Parish Practitioner Functions Possibilities for Parish Practice Project Timeline Writing the IRB Research Plan Elements of an Informed Consent Form Data Collection Protocol for Youth Meeting Violence Among Adolescents Healthy People 2010 National Health Promotion Objectives: Adolescent Violence Assessment of Risk Factors for Violence Wisdom Box Wisdom Box Specific Health Issues Addressed by the Initiative Be an Anthropologist Qualitative Methods Used in the CAHPI Evaluation Periodic Mailings—A Special Case of Teamwork Lessons Learned through the Evaluation of a Statewide Initiative

xv

370 370 372 374 374 388 403 413 413 424 426 427 429 434 434 435 435 436 440 443 445 451 455

List of Figures

Figure Figure

1.1 4.1

Figure 4.2 Figure 7.1 Figure 7.2 Figure 20.1 Figure 20.2 Figure 20.3 Figure 21.1 Figure 22.1 Figure

22.2

Figure 22.3 Figure 23.1 Figure 27.1 Figure 27.2 Figure

27.3

Figure Figure Figure Figure

27.4 27.5 27.6 27.7

Wellness model. The PRECEDE-PROCEED model for health promotion planning and evaluation. Timeline for "Shedding Pounds ... Adding Years." Daily smoking by gender, community X versus community Y. Possible timeline for program evaluation. Family genogram. Family communication model. Family communication process diary. Factors influencing breast cancer screening. Agreement between Promotora and Promotoras de Salud Program

58 103 105 333 345 346 372 393

Sample year 1 budget income and expenditures.

394

Newsletter cover page. A proposed model for developing a community-based project. Contact summary form. Iterative process employed to focus and guide data collection efforts. Items from the annual CAHPI project director/coordinator self-assessment survey. Items from the periodic CAHPI technical assistance survey. Items from the annual CAHPI working with others survey. Components of the 6-month report summary form. Stakeholders as the pivotal point for information sharing that drives the iterative evaluation process.

398 401 444 446

xvi

6 49

447 449 452 457 459

Contributors

Susan MacLeod Dyess, RN, MS Director, Nursing through Faith Communities Christine E. Lynn Center for Caring College of Nursing Florida Atlantic University Boca Raton, FL and Coordinator, Health Ministry Parish Nurse Program St. Mary's and Good Samaritan Medical Centers West Palm Beach, FL

Julia W. Aucoin, DNS, RN, C Associate Professor School of Nursing Tennessee Technological University Cookeville, TN

Kitty Corbett, PhD, MPH Associate Professor of Anthropology University of Colorado Denver, CO

Grace Erickson, EdD, MPH, MSN, RN, BC University of South Florida College of Nursing Tampa, FL

Janice Unruh Davidson, PhD, RN, CS, CNAA, ARNP-FNP Professor Department of Nursing Fort Hays State University Hays, KS

Elizabeth Erkel, PhD, RN Associate Professor Medical University of South Carolina College of Nursing/FNP Program Charleston, SC

Pamela P. DiNapoli, RN, MSN, PhD Assistant Professor Department of Nursing University of New Hampshire School of Health and Human Services Durham, NH

Douglas Fernald, MA Department of Family Medicine University of Colorado Health Sciences Center Denver, CO

Margo Drohan, MSN, RN, CS, PNP Clinical Assistant Professor School of Nursing University of Massachusetts, Amherst Amherst, MA

Carl Helvie, RN, DrPH Professor Emeritus Old Dominion University School of Nursing Norfolk, VA xvii

xviii Sandra Hopper, RN, MSN Associate Director & Adjunct Faculty to Department of Nursing Blue Ridge Area Health Education Center James Madison University Harrisonburg, VA Jennifer Horton, DO Department of Family Medicine University of Colorado Health Sciences Center Denver, CO Cynthia G. Johnson, MSN, EdD, RN Associate Professor Division of Nursing California State University, Dominguez Hills Carson, CA Kathryn Allen Judge OMNI Research and Training & OMNI Institute Denver, CO Beth Keely, MSN, PhD, RN Director, Undergraduate Nursing Programs California State University, Long Beach Long Beach, CA Charlene Long, PhD, RN Professor Emerita College of Nursing University of South Florida St. Petersburg, FL Sandra MacDonald, RN, BN, MN, PhD Assistant Professor Memorial University of Newfoundland School of Nursing St. John's, Newfoundland Canada Deborah S. Main, PhD Department of Family Medicine University of Colorado Health Sciences Center Denver, CO Nancy R. Oliver, PhD, RN, HNC Associate Professor California State University Department of Nursing Long Beach, CA

Contributors Jill Parker, MPH Special Projects Coordinator for the Community Health Plan of the Rockies Denver, CO Marva Mizell Price, DrPh, MPH, RN, CS(FNP) School of Nursing Duke University Durham, NC Barbara Resnick, PhD, CRNP Assistant Professor University of Maryland School of Nursing Baltimore, MD Sheilda G. Rodgers, PhD, RN Associate Professor North Carolina Central University Durham, NC Judy L. Sheehan, RN Faculty, University of Rhode Island Educational Consultant, E.B. Tech, Inc. Educator, Westwood Pembroke Health Systems Rehoboth, MA Robert W. Strack, PhD, MBA Center for Adolescent Health Johns Hopkins University Baltimore, MD Carolyn Tressler, MPH Department of Family Medicine University of Colorado Health Sciences Center Denver, CO Chen-Yen Wang, PhD, APRN Assistant Professor University of Hawaii at Manoa School of Nursing Honolulu, HI

Preface

grams as well as principles for effective community health program marketing and program evaluation are provided. This book is organized into six parts. Part I presents theory and concepts and a model for health promotion in communities. Part II is devoted to skills needed to assist communities to assess, plan, mobilize, market, and evaluate programs. You will also find information about developing programs in rural settings and on the Internet. Although strategies for practice are presented in other sections, Part III specifically focuses on strategies for wellness, providing more specific approaches for nutrition, fitness and flexible movement, the environment, stress management, smoking cessation, holistic and complementary practices, and violence prevention. Part IV provides advanced interaction skills with individuals, groups, and families. Part V focuses on health promotion in cultural contexts and Part VI provides lessons learned from sample health promotion programs: youth service, schools, small community-based initiatives, and a homeless center. The goal of this book will be met if you develop a sense of what to do and how to do it when working as a community practitioner. Best wishes in your work with clients.

s hospital stays shrink and community residents demand more say in their health and wellness, new models for community practice emerge. This book is the culmination of an effort to provide one of those models. After working as a community health practitioner in many settings and striving to teach community health students at various levels, I have come to this book. It is a practical manual for the community practitioner. Although there is a strong conceptual framework and research studies are presented, the basic mission of this book is to help community practitioners practice. This book uses a unique holistic/wellness view of community practice with clients as full partners. Clients are viewed as whole persons and experts in their own wellness who collaborate with community practitioners to set goals, promote health, enhance wellness, and evaluate progress toward their goals. Although Healthy 2010 goals are provided, it is clients, not practitioners, who must decide which goals they wish to pursue. It is the practitioners' role to facilitate client dreams and goals. Giving up the expert role to work on one's own wellness is also unique. To role model wellness for clients, and to allow clients to make their own informed decisions (even when we disagree) is challenging. This book speaks directly to you, the reader, providing specific suggestions for working with clients, be they individuals, families, groups or communities. Ways to mobilize communities, and develop effective community health materials and pro-

A

Carolyn Chambers Clark Englewood, Florida

XIX

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PART I

Theory and Concepts

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CHAPTER

1

A Model for Health and Wellness Promotion in Communities Carolyn Chambers Clark

HOLISM, WELLNESS, AND COMMUNITY

• maximizing potential • looking beyond the needs of self to the needs of society • having a joy or zest for living

When you look at the community from a holistic point of view, patterns and processes begin to emerge and combine to form a unified whole. This whole is greater than the sum of its parts, and consciousness of self and others is an important factor in wellness (Dossey, 1997). From this view, health and disease are seen as a part of the total human experience. Both provide exceptional opportunities for learning and growth (Dossey, 1997). Box 1.1 lists the primary assumptions underlying holistic health promotion. Wellness is another part of the health promotion model you will be using for practice. Dunn (1961) coined the term "highlevel wellness." He described wellness not as an end or static goal but as an ongoing journey of self-creation, leading to ever higher levels of functioning. Key elements of his high-level wellness vision include:

Using this definition, you can see the difference between a community that is well and one that is not. Members of communities that strive for wellness look beyond themselves and can experience joy or zest for certain aspects of living. Using a holistic wellness model means to avoid focusing on risks and disease. Instead, community strengths and resilience become the focus. Community strengths can be physiological, psychological, social, or spiritual. They include such factors as education, coping skills, support systems, knowledge, communication skills, positive nutrition, coherent belief systems, problem-solving abilities, spirituality, fitness, ability to develop a supportive environment, and self-care skills. Resilience is the ability to avoid negative outcomes by doing well in the face of adversity. Using a wellness model, you can provide crucial information, energy, and

• having direction and purpose in life • meeting the challenges of the environment 3

4

Theory and Concepts

Box 1.1 Holistic Health Promotion Assumptions • • • • • •

•

• • • • • • • •

Patterns and causes of illness and wellness can be determined The whole community-as-client is the focus of concern Human values are important to wellness and illness Caring is an important component of healing Pain and disease are signals from our inner selves to change our lifestyles Noninvasive, self-care strategies (diet, exercise, movement, spiritual actions, environmentally sensitive actions, enhanced communication and support skills, and calming procedures) are combined to move toward wellness Individuals, composed of body-mind-spirit and electromagnetic energy, live in dynamic interaction with one another and with the environment, family, groups, and community Disease or disability is a process that can be perceived as a life lesson Increasing well-being and wellness is the focus of care The client is capable of self-assessment, wellness action, and self-evaluation The professional forms an alliance with the client to provide assistance in meeting wellness goals The mind is part of all illness and the province of all health care practice The placebo effect is evidence that the mind is a powerful element in disease and healing The client's subjective reports are of primary importance in assessment and evaluation Wellness involves wholeness in all things: work, relationships, goals, bodymind-spirit

materials to help raise communities to higher levels of wellness while promoting their resilience. Healing is a term that will come to have great importance in your repertoire if doesn't already. Healing in community terms includes a process of balancing and integrating community members by using a deep level of inner knowledge. The word heal comes from the Anglo-Saxon haelan meaning to be whole or to become whole. During the healing process, the physical, social, emotional, and spiritual aspects of both individuals and the community are as a whole given equal value and importance (Dossey, 1997). Dunn (1961) believed that high-level wellness is movement toward self-actualiza-

tion by means of reintegrating oneself with the social environment. This reintegration involves bringing together parts of the whole. Self-reintegration is really a creative process in which individuals develop new capabilities to reorganize the self and the environment so that there is meaning and purpose that transcends stress or suffering (Rosenow, 1997). In a community model, wellness is conceptualized as the process of achieving a greater awareness and deriving satisfaction from activities that move the community toward its goals for fitness, positive nutrition, positive relationships, peace, clear life purpose, consistent belief systems, commitment to self-care, and environmental sensitivity and comfort. From this perspective,

A Model for Health and Wellness

you and the community-as-client are dynamic systems that interact to exchange information, matter, and energy. Chaos can ensue when you or the community is greatly out of balance. A higher, more adaptive level of wellness can follow when wellness and health promotion interventions occur after such an imbalance. This change can lead to a new and often improved balance. In this model, environment refers to a changing field that is continuous and contiguous with communities. Environment can be modified by community and can modify the people within it. Self-care is defined as those activities and programs that the community performs for itself. In this model, you are involved in community self-care activities at times, but the decisions about goals, actions, and evaluation are the community's. Self-responsibility is a state of choosing to act in one's own behalf (Gaydos, 1997). Self-awareness comes first, opening the path and enabling a person to alter lifestyle patterns that will lead to wellness. Figure 1.1 exemplifies practitioner-community interactions from a wellness perspective. In this model, both you and the community move forward in your journey toward wellness. Communities are believed to evolve toward wellness by learning to do the following: • • • • •

manage life experiences seek out challenges self-assess level of wellness identify wellness self-care goals relate to others in a flexible, differentiated, assertive manner • use self-care strategies • examine and readjust beliefs and practices into an integrated whole • develop successful coping procedures

5

During the evolutionary process of moving toward wellness, communities interact with stressors more rationally and more efficiently by perceiving and managing situations differently. Although biological, historical, social, and cultural factors may be established, they can be readjusted. For example, perceptions or traumatic situations can be readjusted, and the immune system (a genetic given) can be strengthened by using self-care strategies. Table 1.1 shows a model of community wellness. Some assumptions underlying this model are that communities are capable of the following: • self-assessing their own wellness needs • setting their own wellness goals • setting up a process for moving toward wellness • taking action to meet their wellness goals • evaluating their progress toward wellness • displaying characteristics of wellness even when stressed • activating the self-healing process to enhance wellness • learning to move to a higher level of wellness • learning from peers and using clearly structured goals and constructive means to meet those goals. In this model for practice, motivation is intrinsic because the community chooses a goal that has meaning. Compliance becomes irrelevant because the community takes control over decision-making. The process of moving toward wellness assumes top priority over the outcome: wellness.

HEALTH PROMOTION ROLES As a whole person, you will be in a state of flux between the dimensions of wellness.

6

Theory and Concepts

INPUTS: « food *

energy, information, and materials exchanged

INPUTS: •

food

•

water

•

stressors

•

stressors

•

unique historical, social, cultural, psychological/emotional, spiritual, environmental, and biological factors

•

unique historical, social, cultural, psychological/emotional, spiritual, environmental, and biological factors

water

belief systems

belief systems

fitness

' INTERFACE

nutrition

fitness relationships

relationships Community

Practitioner

THROUGHPUTS

THROUGHPUTS

stress self-care

spirituality environment

<stress