Health education, behavioural change and social psychology: nursing's contribution to health promotion?

AIMS: To critically review the complex processes that underpin the modification of a client's health-related behaviour. This paper also seeks to contextualize the operational differences between health-educating and health-promoting activities - as a means of rationalizing current practice.
BACKGROUND: In "health promotional" encounters, there is a plethora of evidence that suggests that nurses work predominantly within a "traditional" preventative framework of practice. The prevalence of a culturally inherent biomedical framework, governing most nursing practice, tends to reduce health-related client interventions to little more than one-off, reductionist information-giving exercises. The expectation on clients to respond to and subsequently modify their health behaviour, when presented with such information, is unrealistic in most cases. Nurses are often unaware of the extremely complex human phenomena associated with modifying health-related behaviours and the resultant change processes. In nursing-related health encounters, the planned or unplanned intervention and the subsequent outcomes are mostly viewed within a too simplistic and superficial context.
DESIGN: A selective review of the relevant literature.
CONCLUSION: Where many nurses believe themselves to be health promotionalists, the likelihood is that they are instead more likely to be traditional health educationalists. Not that this is the main problem, in itself--but if nursing is to progress on this issue, it must first become more effective in delivering its current health education initiatives. Armed with further knowledge and understanding of their practices, health educators are far more likely to achieve a degree of success in their behavioural-change encounters as well as approach the intervention with a far more realistic expectation of outcome. Without this further understanding, it is argued that the integration of health educational initiatives into nursing practice will generally do little or nothing to change the health status of clients.