Health Promotion for Clinicians

1.0 Introduction:

Health promotion interventions in the context of sexual health are carried out not only to spread awareness about the use of modern contraceptive methods, but also to diminish the desire of engaging in sexual activities at an early, unsuitable age. The strategies employed for intervention integrate decision-making, motivational control, planning, and setting goals to decrease the number of teenage pregnancies and mitigate the risk of contracting sexually transmitted diseases (STD’s) such as HIV/AIDS. This report will discuss the educational, social, and behavioral strategies to improve sexual health by discussing the various perspectives and theoretical models that are applied in each dimension. It is unlikely for adolescents to partake in unprotected sexual intercourse if they have developed the social skills to dealing with romantic and sexual relationships. However, due to a variety of social pressures, the relevant social skills may be rendered ineffective; as a result, different programs applicable in the context of schools, national policies, civil society, and individual behavior will be discussed in this report.

1.1 The use of interventions:

In the case of STD prevention and the reduction of the rate of teenage pregnancies, ‘interventions’ constitute an integrated approach towards the incorporation of theoretical models and strategies that are supported by a body of research and that have been proven to effectively encourage sexual health and promote behavioral change (Allen, 1987). The following are the different strategies employed to design and implement sexual health programs on the basis of findings and assessments about the current state of sexual health:

Educational: Informational, Motivation, and Behavioral Skills (IMB) Model and the Social Learning Theory;
Social change: Social Cognitive Theory;
Behavioral: Transtheoretical Model and Theory of Planned Behavior.

2.0 – Educational:

2.1 – The Informational, Motivation, and Behavioral skills Model (IMB):

In the context of education, i.e. high school or college education that introduces the aspects of sexual health in a learning atmosphere, the IMB model has been used as an effective strategy towards improving sexual health (Allen, 1987). Within the sexual health programs that may be employed to promote sexual health, evidence supports that the inclusion of the elements of information, motivation, and behavior greatly improve the effectiveness of the considered program. These three elements form the foundations for behaviorally improving the perception towards sexual health and making individuals realize the need for sexual health (Allen, 1987). This is done through communication of basic concepts that can be easily understood by both educators and audiences alike. Specific terms applicable to IMB are discussed as follows:

Information: In order for sexual health programs to be effective, information needs to be given in the form of evidence so that the individual can translate this information into behaviors that induce them to realize the importance of sexual health;
Motivation: Once the individual has been provisioned with relevant and effective information regarding their sexual health, they need to be sufficiently motivated to act upon what they have learnt. Accordingly, the IMB model discusses the various forms of motivation that can be used in the context of education to provoke individuals to set goals and priorities regarding sexual health themselves.
Behavioral: Having acquire information and the necessary motivation to act upon it, individuals must enact the specific behaviors that enable them to prioritize their sexual health and abstain from negative sexual outcomes.

Acquiring information regarding the use of contraceptives in a learning atmosphere that is devoid of bias and prejudice, individuals can acquire information about how birth works and how the chances of contracting an STD can be reduced (Allen, 1987). They are given information about where they can acquire modern contraceptives, how they can pay for them, how they work, and how they may discuss the use of contraceptives with their partners. In the friendly environment of a learning institution, IMB focuses on educating both the youth and their parents so that an overall orientation towards improving sexual health can be developed (Family Planning Association, 1991).

2.2 – Social Learning Theory:

The Social Learning Theory has been applied to sexual education along with various other areas of health promotion campaigns. This theory aims to change educate participants on the need for sexual health and is therefore applicable to the context of educational strategies. By promoting sexual health through education, the Social Learning Theory attempts to change behavior in participants by using a mixture of personal knowledge, skills, interpersonal relationships, environmental influences, and attitudes. Educational methods in the classroom are used to provide a model of positive sexual behavior to students so that they are given an idealized view of sexual health (Bandura, 1977). This is done to counter the effects of the media, which has popularized sexual activity through movies, music, and magazines. The majority of this modeled behavior, i.e. through the media, has little or no mention of sexual health, contraceptive methods, and the danger associated with engaging in sexual activities at an early age (Family Planning Association, 1991).

The Social Learning Theory, as a method of intervention, therefore attempts to provide the youth with practice in exercising their social and behavioral skills through education. Students are taught to practice the ability to say “no” to the pressure of having sex (Bandura, 1977).

3.0 – Behavioral Change:

3.1 – Transtheoretical model:

The Transtheoretical model forms the basis of an effective intervention strategy that inspires social change to contribute towards an attitude that values and prioritizes sexual health. The model focuses on behavioral change and inducing the attitudes that encourage the individual to focus on their sexual health (Bandura, 1977). According to the Transtheoretical model, behavioral change is a process rather than an isolated event. Behavioral change occurs incrementally, and through a five-stage process which is as follows:

Precontemplation: the individual has little or no intention to change their behavior or attitude in the near future at this stage;
Contemplation: the individual now intends to change their behavior in the near future, i.e. in the coming six months;
Preparation: the individual now has the intention to take steps and is motivated to change their behavior in the coming six months;
Action: the action stage sees the individual engaging in behavior that improves sexual health;
Maintenance: this is the consistent practice of the desired behavior and working to prevent any form of relapse to old habits and behaviors.

The Transtheoretical model therefore holds promise for adolescents, in that it is a planned approach towards changing behaviors regarding sexual health (Kirby, 1987). In a particular study, it was also discovered that having a partner or an older person looking after you made it more likely for the individual to pass through the five stages of behavioral change (Kirby, 1987).

With respect to the Transtheoretical model, the set timeframes that define the time gradual stages the individual undergoes to transform their behavior, it has been argued that the time periods are largely arbitrary (Massey, 1990). This casts doubt on whether the stages are necessarily distinct or different from another and not just a random mixture of different processes occurring simultaneously (Massey, 1990). Moreover, the use of arbitrary timeframes fails to appreciate the changes in behavior that occur over several years or from a daily routine of an attempt to change, rather than a gradual though out plan of changing. Furthermore, for some individuals, a bad experience or an epiphany is enough for a permanent change in their behavior (Kirby, 1987).