PREVENTION AND HEALTH PROMOTION
Table of Contents
LECTURE 1: INTRODUCTION ............................................................................................ 3
WHAT IS PREVENTION SCIENCE? ............................................................................................. 3
LIFE AND ILLNESS ....................................................................................................................... 3
DEFINITIONS ............................................................................................................................. 4
WHAT CAN WE PREVENT? ............................................................................................................. 5
LECTURE 2: DETERMINANTS OF BEHAVIOUR AND BEHAVIOUR CHANGE ............................ 7
WHAT ARE HEALTH BEHAVIOURS? ............................................................................................ 7
DETERMINANTS OF BEHAVIOUR:.............................................................................................. 7
EXAMPLE OF THE VITAMIN E CASE: .................................................................................................. 7
INTERVENTIONS ARE POSSIBLE FOR ALL DETERMINANTS: ..................................................................... 8
THEORIES FOR BEHAVIOUR CHANGE ......................................................................................... 8
SOCIAL NETWORK AND SOCIAL SUPPORT:................................................................................ 14
CHANGING PERSONAL VS. ENVIRONMENTAL DETERMINANTS ........................................................ 14
LECTURE 3: PLANNING, IMPLEMENTATION, DISSEMINATION .......................................... 15
EVIDENCE BASED PRACTICE ................................................................................................. 16
THEORETICAL DOMAINS FRAMEWORK: DO IDENTIFY THE TARGET BEHAVIOR AND ITS DETERMINANTS ....... 17
BEHAVIORAL CHANGE TECHNIQUE: TO CHANGE THE TARGET BEHAVIOR ........................................... 18
STANDARDS OF EVIDENCE IN PREVENTION: .............................................................................. 19
HOW TO DEVELOP AN INTERVENTION ...................................................................................... 20
DIFFERENT IMPLEMENTATION MODELS .......................................................................................... 24
LECTURE 4: GUEST LECTURE - HEALTH LITERACY (PROF VAN DEN BROUCKE) .................. 26
WHAT IS HEALTH LITERACY? ................................................................................................. 26
WHERE DOES HEALTH INFORMATION COME FROM? .......................................................................... 26
EXPANDING SCOPE AND MEANING OF HEALTH LITERACY .................................................................... 27
WHAT IS THE LEVEL OF HEALTH LITERACY IN THE POPULATION? ..................................................... 28
WHY IS HEALTH LITERACY IMPORTANT? ................................................................................... 29
HOW CAN LOW HEALTH LITERACY BE TAKEN INTO ACCOUNT? ........................................................ 31
FUTURE PERSPECTIVES ....................................................................................................... 32
LECTURE 5: PRIMARY PREVENTION ................................................................................ 35
LEVELS OF PREVENTION ...................................................................................................... 35
TYPES OF INTERVENTIONS FOR RISK AVOIDANCE OR REDUCTION: ......................................................... 36
1
,HEALTH PROMOTION .......................................................................................................... 37
STRATEGIES FOR PRIMARY PREVENTION AND HEALTH PROMOTION.................................................. 38
EDUCATIONAL STRATEGIES (DOWNSTREAM): ................................................................................... 38
ENVIRONMENTAL INTERVENTIONS (MIDSTREAM): ............................................................................. 39
POPULATION STRATEGY (UPSTREAM): ............................................................................................ 41
LECTURE 6: GUEST LECTURE - PREVENTION IN PRACTICE: CANCER SCREENING ............. 42
THE BURDEN OF THE DISEASE OF CANCER ................................................................................ 42
CANCER SCREENING: PRINCIPLES AND PRACTICE...................................................................... 42
WHY DO WE SCREEN CANCER? ................................................................................................... 43
HARMS OF CANCER SCREENING ............................................................................................ 43
OTHER POTENTIAL HARMS AND CONSIDERATIONS: .......................................................................... 44
THE PSYCHOLOGY OF CANCER SCREENING .............................................................................. 44
FACTORS INFLUENCING PARTICIPATION: ........................................................................................ 44
HOW DO THESE FACTORS INFLUENCE REAL-WORLD DATA ON SCREENING PARTICIPATION AND CANCER
INCIDENCE? ........................................................................................................................... 45
HEALTH PROMOTION STRATEGIES .......................................................................................... 45
REAL-WORLD EXAMPLES AND ONGOING RESEARCH ................................................................... 46
FUTURE RESEARCH ............................................................................................................ 47
LECTURE 7: SECONDARY AND TERTIARY PREVENTION .................................................... 48
DEFINITIONS .................................................................................................................... 48
CRITICAL CONSIDERATIONS ON SECONDARY PREVENTION (SCREENING: PRO’S/CONS) ....................... 50
DO THE HARMS OF CANCER SCREENING OUTWEIGH THE BENEFITS? ..................................................... 50
MODELS AND STRATEGIES IN TERTIARY PREVENTION................................................................... 51
DOES SHARED DECISION MAKING WORK? ...................................................................................... 53
SELF-STUDY: PLANNING AN INTERVENTION WITH THE IM (POWERPOINT) ....................... 55
STEP 1: ANALYSIS OF THE PROBLEM ....................................................................................... 55
AIM: SPECIFIC HEALTH PROBLEM IN A SPECIFIED TARGET GROUP.......................................................... 55
RESULTS OF STEP 1: IDENTIFICATION AND DESCRIPTION OF… ............................................................. 56
PITFALLS ................................................................................................................................ 56
A COVID-19 EXAMPLE .............................................................................................................. 56
FURTHER STEP 2: SELECT RELEVANT RISK FACTORS AND FORMULATE THE GOALS OF YOUR INTERVENTION 57
FURTHER STEP 3: SELECT METHODS & TECHNIQUES TO CHANGE THE DETERMINANTS OF BEHAVIOUR AND
MEET THE CHANGE OBJECTIVES ............................................................................................. 57
HOW SELECT METHODS (STEP 3) ................................................................................................. 58
WHICH TECHNIQUES (STEP3) ..................................................................................................... 59
PITFALLS ................................................................................................................................ 59
STEP 4: DEVELOPING PROGRAM CONTENT ............................................................................... 59
STEP 5: PLANNING ADOPTION AND IMPLEMENTATION ................................................................. 60
STEP 6: SETTING UP AN EVALUATION PLAN ............................................................................... 60
2
,Lecture 1: Introduction
What is prevention science?
It is an interdisciplinary specialty that requires integration from multiple disciplines including
psychology, counseling, social work, education, health sciences, economics, and public aYairs.
Psychological prevention science tries to prevent psychological and physical illnesses and to
promote overall health and wellbeing through evidence base practice at individual and systemic
levels
Imagine you want the public to quit smoking: which disciplines do you need to reach? Think of the economy
for example
It is an evidence-based discipline with two general aims: Advancing health and the individual
and societal levels by informing policymakers => How we will complete these aims, we will see
in this course
Other aims of prevention:
1. Reduce preventable deaths
2. Reduce the number of lost years
3. Increase the healthy life years
4. Increase quality of life
5. Reduce the economic impact of diseases
Life and illness
The diYerences in life expectancy across the world are a result of lifestyle and genetics:
• Defining the problem and area of intervention: what are the causes of death?
• Top ten global causes: vascular disorders, COPD, respiratory infections, dementias,
cancers, diabetes, road injury,…
• Overall the life expectancy age has grown over time in all countries
Causes of death depends on where you live:
• In high income countries the top causes of death are heart disease,
stroke, dementia, lung cancers, diabetes and COPD
• In low-income countries they are lower respiratory infections,
diarrhoeal disease, heart disease, AIDS, stroke and malaria
Communicable diseases are diseases spread between humans
(contact sick) and hold a higher place in the cause of death list in low-
income countries => diYerent type of prevention needed > Examples:
lower respiratory infection, AIDS, malaria, tuberculosis, birth
complications
<-> non-communicable diseases cannot be passed to someone else
(ex. Stroke, COPD, Alzheimer, cancer…)
Means you have to know: background when planning an intervention, the target population,
target age group and target environment
3
, Definitions
Preventable deaths: Number of deaths that could be potentially prevented either by
prevention, or by medical intervention (treatable)
ex. An infection is treatable
Premature deaths: Deaths occurring before the expected age of death (also used as a synonym
for preventable death)
ex. In Europe before 70 years of age (regional diYerences)
Years of Life Lost: Number of years that people loose due to death/illness (if someone is expected to
live to 80y and she dies at 60, then the YLL equals 20) -> YLL=Reference life expectancy-Age at death
Year of life lost rate: adjusted for the size of the population -> YLL rate=(total
YLL/Population)*100 000 (is often used to compare countries)
Age-specific YLL rate: YLL rate for a certain age group (0-14 years)
Years Lost to Disability (YLD): Number of years that a person lives with a illness, disability,
health impairment – weighed by severity
Prevalence: measure of frequency of a disease calculated as existing cases/total
population, includes old and new cases and reflects overall disease burden
Incidence: also measure of frequency of a disease but only new cases in a given period
of time
- Incidence proportion (risk): calculated as new cases during a period/population at
risk
- Incidence rate: takes into account how long a person was observed before
developing the disease (new cases/total person time at risk)
Healthy life expectancy: Life expectancy in good health
Disability-Adjusted Life Years (DALY): Years lost by being sick or premature death
> DALY = YLL + YLD
Quality-Adjusted Life Years (QALY): Improvement in quality of living after an intervention
> combines length of life and quality of life
> years lived * health-related quality weight ex. 10 perfect years is 10 QALY, 10 years with migraines
can be 5 QALY
Disability: an umbrella term, covering impairments, activity limitations, and participation
restrictions.
> An impairment is a problem in body function or structure
> An activity limitation is a diYiculty encountered by an individual in executing a task or action
> Participation restriction is a problem experienced by an individual in involvement in life
situations.
Disability is thus not just a health problem. It is a complex phenomenon, reflecting the
interaction between features of a person’s body and features of the society in which he
or she lives
Disability is always chronic – it is diYerent from a temporary health restriction like a
broken bone for several weeks versus a disability being paralysed from a car crash
4
Table of Contents
LECTURE 1: INTRODUCTION ............................................................................................ 3
WHAT IS PREVENTION SCIENCE? ............................................................................................. 3
LIFE AND ILLNESS ....................................................................................................................... 3
DEFINITIONS ............................................................................................................................. 4
WHAT CAN WE PREVENT? ............................................................................................................. 5
LECTURE 2: DETERMINANTS OF BEHAVIOUR AND BEHAVIOUR CHANGE ............................ 7
WHAT ARE HEALTH BEHAVIOURS? ............................................................................................ 7
DETERMINANTS OF BEHAVIOUR:.............................................................................................. 7
EXAMPLE OF THE VITAMIN E CASE: .................................................................................................. 7
INTERVENTIONS ARE POSSIBLE FOR ALL DETERMINANTS: ..................................................................... 8
THEORIES FOR BEHAVIOUR CHANGE ......................................................................................... 8
SOCIAL NETWORK AND SOCIAL SUPPORT:................................................................................ 14
CHANGING PERSONAL VS. ENVIRONMENTAL DETERMINANTS ........................................................ 14
LECTURE 3: PLANNING, IMPLEMENTATION, DISSEMINATION .......................................... 15
EVIDENCE BASED PRACTICE ................................................................................................. 16
THEORETICAL DOMAINS FRAMEWORK: DO IDENTIFY THE TARGET BEHAVIOR AND ITS DETERMINANTS ....... 17
BEHAVIORAL CHANGE TECHNIQUE: TO CHANGE THE TARGET BEHAVIOR ........................................... 18
STANDARDS OF EVIDENCE IN PREVENTION: .............................................................................. 19
HOW TO DEVELOP AN INTERVENTION ...................................................................................... 20
DIFFERENT IMPLEMENTATION MODELS .......................................................................................... 24
LECTURE 4: GUEST LECTURE - HEALTH LITERACY (PROF VAN DEN BROUCKE) .................. 26
WHAT IS HEALTH LITERACY? ................................................................................................. 26
WHERE DOES HEALTH INFORMATION COME FROM? .......................................................................... 26
EXPANDING SCOPE AND MEANING OF HEALTH LITERACY .................................................................... 27
WHAT IS THE LEVEL OF HEALTH LITERACY IN THE POPULATION? ..................................................... 28
WHY IS HEALTH LITERACY IMPORTANT? ................................................................................... 29
HOW CAN LOW HEALTH LITERACY BE TAKEN INTO ACCOUNT? ........................................................ 31
FUTURE PERSPECTIVES ....................................................................................................... 32
LECTURE 5: PRIMARY PREVENTION ................................................................................ 35
LEVELS OF PREVENTION ...................................................................................................... 35
TYPES OF INTERVENTIONS FOR RISK AVOIDANCE OR REDUCTION: ......................................................... 36
1
,HEALTH PROMOTION .......................................................................................................... 37
STRATEGIES FOR PRIMARY PREVENTION AND HEALTH PROMOTION.................................................. 38
EDUCATIONAL STRATEGIES (DOWNSTREAM): ................................................................................... 38
ENVIRONMENTAL INTERVENTIONS (MIDSTREAM): ............................................................................. 39
POPULATION STRATEGY (UPSTREAM): ............................................................................................ 41
LECTURE 6: GUEST LECTURE - PREVENTION IN PRACTICE: CANCER SCREENING ............. 42
THE BURDEN OF THE DISEASE OF CANCER ................................................................................ 42
CANCER SCREENING: PRINCIPLES AND PRACTICE...................................................................... 42
WHY DO WE SCREEN CANCER? ................................................................................................... 43
HARMS OF CANCER SCREENING ............................................................................................ 43
OTHER POTENTIAL HARMS AND CONSIDERATIONS: .......................................................................... 44
THE PSYCHOLOGY OF CANCER SCREENING .............................................................................. 44
FACTORS INFLUENCING PARTICIPATION: ........................................................................................ 44
HOW DO THESE FACTORS INFLUENCE REAL-WORLD DATA ON SCREENING PARTICIPATION AND CANCER
INCIDENCE? ........................................................................................................................... 45
HEALTH PROMOTION STRATEGIES .......................................................................................... 45
REAL-WORLD EXAMPLES AND ONGOING RESEARCH ................................................................... 46
FUTURE RESEARCH ............................................................................................................ 47
LECTURE 7: SECONDARY AND TERTIARY PREVENTION .................................................... 48
DEFINITIONS .................................................................................................................... 48
CRITICAL CONSIDERATIONS ON SECONDARY PREVENTION (SCREENING: PRO’S/CONS) ....................... 50
DO THE HARMS OF CANCER SCREENING OUTWEIGH THE BENEFITS? ..................................................... 50
MODELS AND STRATEGIES IN TERTIARY PREVENTION................................................................... 51
DOES SHARED DECISION MAKING WORK? ...................................................................................... 53
SELF-STUDY: PLANNING AN INTERVENTION WITH THE IM (POWERPOINT) ....................... 55
STEP 1: ANALYSIS OF THE PROBLEM ....................................................................................... 55
AIM: SPECIFIC HEALTH PROBLEM IN A SPECIFIED TARGET GROUP.......................................................... 55
RESULTS OF STEP 1: IDENTIFICATION AND DESCRIPTION OF… ............................................................. 56
PITFALLS ................................................................................................................................ 56
A COVID-19 EXAMPLE .............................................................................................................. 56
FURTHER STEP 2: SELECT RELEVANT RISK FACTORS AND FORMULATE THE GOALS OF YOUR INTERVENTION 57
FURTHER STEP 3: SELECT METHODS & TECHNIQUES TO CHANGE THE DETERMINANTS OF BEHAVIOUR AND
MEET THE CHANGE OBJECTIVES ............................................................................................. 57
HOW SELECT METHODS (STEP 3) ................................................................................................. 58
WHICH TECHNIQUES (STEP3) ..................................................................................................... 59
PITFALLS ................................................................................................................................ 59
STEP 4: DEVELOPING PROGRAM CONTENT ............................................................................... 59
STEP 5: PLANNING ADOPTION AND IMPLEMENTATION ................................................................. 60
STEP 6: SETTING UP AN EVALUATION PLAN ............................................................................... 60
2
,Lecture 1: Introduction
What is prevention science?
It is an interdisciplinary specialty that requires integration from multiple disciplines including
psychology, counseling, social work, education, health sciences, economics, and public aYairs.
Psychological prevention science tries to prevent psychological and physical illnesses and to
promote overall health and wellbeing through evidence base practice at individual and systemic
levels
Imagine you want the public to quit smoking: which disciplines do you need to reach? Think of the economy
for example
It is an evidence-based discipline with two general aims: Advancing health and the individual
and societal levels by informing policymakers => How we will complete these aims, we will see
in this course
Other aims of prevention:
1. Reduce preventable deaths
2. Reduce the number of lost years
3. Increase the healthy life years
4. Increase quality of life
5. Reduce the economic impact of diseases
Life and illness
The diYerences in life expectancy across the world are a result of lifestyle and genetics:
• Defining the problem and area of intervention: what are the causes of death?
• Top ten global causes: vascular disorders, COPD, respiratory infections, dementias,
cancers, diabetes, road injury,…
• Overall the life expectancy age has grown over time in all countries
Causes of death depends on where you live:
• In high income countries the top causes of death are heart disease,
stroke, dementia, lung cancers, diabetes and COPD
• In low-income countries they are lower respiratory infections,
diarrhoeal disease, heart disease, AIDS, stroke and malaria
Communicable diseases are diseases spread between humans
(contact sick) and hold a higher place in the cause of death list in low-
income countries => diYerent type of prevention needed > Examples:
lower respiratory infection, AIDS, malaria, tuberculosis, birth
complications
<-> non-communicable diseases cannot be passed to someone else
(ex. Stroke, COPD, Alzheimer, cancer…)
Means you have to know: background when planning an intervention, the target population,
target age group and target environment
3
, Definitions
Preventable deaths: Number of deaths that could be potentially prevented either by
prevention, or by medical intervention (treatable)
ex. An infection is treatable
Premature deaths: Deaths occurring before the expected age of death (also used as a synonym
for preventable death)
ex. In Europe before 70 years of age (regional diYerences)
Years of Life Lost: Number of years that people loose due to death/illness (if someone is expected to
live to 80y and she dies at 60, then the YLL equals 20) -> YLL=Reference life expectancy-Age at death
Year of life lost rate: adjusted for the size of the population -> YLL rate=(total
YLL/Population)*100 000 (is often used to compare countries)
Age-specific YLL rate: YLL rate for a certain age group (0-14 years)
Years Lost to Disability (YLD): Number of years that a person lives with a illness, disability,
health impairment – weighed by severity
Prevalence: measure of frequency of a disease calculated as existing cases/total
population, includes old and new cases and reflects overall disease burden
Incidence: also measure of frequency of a disease but only new cases in a given period
of time
- Incidence proportion (risk): calculated as new cases during a period/population at
risk
- Incidence rate: takes into account how long a person was observed before
developing the disease (new cases/total person time at risk)
Healthy life expectancy: Life expectancy in good health
Disability-Adjusted Life Years (DALY): Years lost by being sick or premature death
> DALY = YLL + YLD
Quality-Adjusted Life Years (QALY): Improvement in quality of living after an intervention
> combines length of life and quality of life
> years lived * health-related quality weight ex. 10 perfect years is 10 QALY, 10 years with migraines
can be 5 QALY
Disability: an umbrella term, covering impairments, activity limitations, and participation
restrictions.
> An impairment is a problem in body function or structure
> An activity limitation is a diYiculty encountered by an individual in executing a task or action
> Participation restriction is a problem experienced by an individual in involvement in life
situations.
Disability is thus not just a health problem. It is a complex phenomenon, reflecting the
interaction between features of a person’s body and features of the society in which he
or she lives
Disability is always chronic – it is diYerent from a temporary health restriction like a
broken bone for several weeks versus a disability being paralysed from a car crash
4
