Exploring the aims of health promotion and discussing the various theories and models that will empower clients and help them to improve their sexual health
Barnes, J. (2009) Health promotion in sexual health 1: different theories and models of health promotion. Nursing Times; 105: 18, early online publication.
This is the first in a two-part unit on health promotion in sexual health care. It discusses the aims of health promotion and various models and theories. It considers the importance of building empowerment, autonomy and self-efficacy.
This article has been double-blind peer-reviewed
Keywords: Sexual health, Health promotion, Behaviour change
Health promotion delivered without people’s participation (a ‘top-down’ approach) is not seen as an ideal framework because recipients are not involved in the process (Jones et al, 1997).
To achieve initial and sustainable success in health promotion, it is vital that work is driven from the bottom by including recipients (Naidoo and Wills, 2005). Health promotion in sexual health has three aims, outlined in Box 1.
Box 1. Aims of health promotion in sexual health
That clients use appropriate contraception effectively to avoid unwanted pregnancies – for this to be successful, it is vital that individual clients find the contraceptive method acceptable and usable for them.
To prevent STI transmission by using effective barrier methods, especially with new sexual partners.
For clients to make autonomous, non-regretted choices about their sexual activity. Autonomy is defined as ‘the possession of the right of self-government’ or ‘freedom of action’ (Pearsall, 2002). It is therefore linked to individual self-determination.
Rising STI rates (Health Protection Agency, 2008) and increasing termination rates (Department of Health, 2008) indicate there is now a real need to address both issues through progressive work in sexual health care.
Indeed, the Medical Foundation for AIDS and Sexual Health (2008) highlighted a clear need for people to be aware of how they can protect themselves from unplanned pregnancy and STIs, and the importance of sexual health promotion.
It is important, therefore, that practitioners not only seize the opportunity but also that they carry out health promotion to the highest level of skill and expertise. The manner in which consultations are carried out has some impact on the success of the health promotion opportunity.
It is worth considering the best way of delivering health promotion within sexual health care. The focus on preventing unwanted pregnancy and STIs suggests potential for a medical approach, as defined by Jones and Naidoo (1997). However, this could lead to a top-down approach. It is important to include clients in any health promotion intervention to ensure there is an individual focus.
An alternative approach to health promotion could focus on clients’ behaviour, for example on condom use. However, there is a danger that focusing purely on behaviour change could mean taking an approach centred on the professional agenda and therefore not engaging fully with clients.
As discussed, health promotion is likely to be more successful if it involves clients. Jones and Naidoo (1997) suggested that health-promotion strategies intended to change behaviour may not sit comfortably with health promotion aimed at empowering clients and enabling them to make autonomous choices.
Empowerment is a concept that has become popular in health promotion and policy (DH, 2004; Tones, 1997).
A definition of empowerment is ‘to give authority or...