口腔健康促进与健康教育.ppt

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1、口腔健康促进与健康教育口腔健康促进与健康教育nOral Health Promotion&Health Education 大学口腔医学院大学口腔医学院 预防口腔医学教研室预防口腔医学教研室 The concept of health（1）n健康（health）：n健康不仅仅是没有疾病或衰弱，而是身心健康、社会幸福的完美状态。Health is a state of complete physical，mental，and social well-being and not merely the absence of disease or infirmity。World Health Orga

2、nization(1946)Basic Documents，5th ed.P.1.Understand the concept of health（2）n根据人类系统结构定义健康，n引入行为科学的方法研究健康问题。强调健康不仅与个体有关，还与社会，生态和经济方面的因素有关。What this definition recognizes relevant to health care is that the terms“physical，mental，and social”，conceptualize health according to human-system framework whic

3、h invites a behavioural science-oriented approach to the study of health.Furthermore，it emphasizes the idea that health goes beyond the individual to include social，ecological and economic facets of health.The dimensions of health个体健康（个体健康（inner circle）6 个方面个方面社会健康（社会健康（middle circle）环境健康（环境健康（out c

4、ircle）The concept of oral health（1）n口腔健康(oral health):牙齿清洁、无龋洞、无疼痛感、牙龈颜色正常、无出血现象。Teeth clean no caries cavities,no pains,gingiva with normal colure and no sign of bleeding.WHO 1981The concept of oral health（2）n口腔健康（Oral Health）：口腔健康是牙、牙周组织、口腔临近部位及颌面部均无组织结构与功能性异常。Dental health is concerned with the f

5、unctional efficiency not only of the teeth and supporting structures but also the surrounding parts of the oral cavity and or the various structures related to mastication and the maxilla-facial complex。WHO 1965 The concept of oral health（3）n口腔健康不再仅仅关系到对口腔疾病的治疗，而是与可预防的一系列口腔疾病危险因素有关，特别是社会心理、经济和文化因素。口

6、腔健康教育Oral Health Education健康教育定义健康教育定义Definition of Health Education：nAny planned combination of learning experiences designed to predispose，enable，and reinforce voluntary behaviour conducive to health，in individuals,groups,or communities.（Frazier，1992）健康教育定义健康教育定义Definition of Health Education：健康教育

7、（health education）：任何学习机会和教学活动的结合，其内容是为了促进人们自觉接受有益于健康的行为。nAny combination of learning opportunities and teaching activities designed to facilitate voluntary adaptations of behaviour that are conducive to health。Green，L.W.National policy in the promotion of health,1979口腔健康教育的最终目的口腔健康教育的最终目的 The objec

8、tive of dental health educationn口腔健康教育的最终目的是使人认识到并能终生保持口腔健康。The ultimate objective of all planned dental health education activities is to obtain and maintain optimum dental and oral health status for all individuals throughout life.（WHO 1970）口腔健康教育的基本概念口腔健康教育的基本概念（1）Basic Concepts of Oral Health Ed

9、ucationn口腔健康教育（Oral health education）：以教育的手段促使人们主动采取利于口腔健康的行为，以达到建立口腔健康行为的目的。n健康教育的一部分。口腔健康目标的实现要求运用健康教育有效的原则和程序。nDental health education is an integral part of general health education，the achievement of dental health goals will require the application of principles and processes that are effective

10、 in other aspects of health education。（WHO，1970）口腔健康教育的基本概念口腔健康教育的基本概念（2）Basic Concepts of Oral Health Educationn是通过行为改变来促进健康的科学：包括个人、集体和整个社会的改变。个体个体或或群体群体行为改变行为改变知识知识态度态度价值观价值观干预干预技能技能环境环境健康教育工作原理健康教育工作原理口腔健康教育的基本概念（口腔健康教育的基本概念（3）Basic Concepts of Oral Health Educationn健康教育不能代替预防服务措施，它是预防服务措施的教育部分，

11、为了使人们了解和接受这些措施的价值。nHealth education is not a substitute for a preventive serviceit is the educational component of such a service designed to develop understanding and acceptance of its value.（WHO 1984）口腔健康教育的基本概念口腔健康教育的基本概念（4）Basic Concepts of Oral Health Educationn“人民有权利和义务参加讨论制定健康计划以及如何贯彻等问题”n“针对

12、人群中流行的疾病进行健康教育，并教给人们确定、预防和控制这些疾病的方法”，是初级卫生保健八项任务的首位任务，n健康教育和促进在实现个人和社区的口腔健康中是必不可少的，两者不可分割，无论何时都应该成为所有保健项目策划、执行和评价的一部分。1978年阿拉木图宣言第四条款口腔健康教育的基本概念口腔健康教育的基本概念 Basic Concepts of Oral Health Educationn“the people have the right and duty to participate individually and collectively in the planning and imp

13、lementation of their health care”,“Education concerning prevailing health problems and the methods of identifying,preventing and controlling them”as the first of the eight recommended activities making up primary health care.WHO。Primary health care.Alma-Ata 1978.口腔健康教育的基本概念口腔健康教育的基本概念（5）Basic Concep

14、ts of Oral Health Educationn传递正确的信息 educating with correct information：例：刷牙不是预防龋齿的有效方法，只有使用含氟牙膏才能有效预防龋齿。因此针对龋病的预防，口腔健康教育应着重强调使用含氟牙膏（每天至少一次）而不是强调机械刷牙。但是，刷牙对预防牙周疾病是重要的。口腔健康教育的基本概念口腔健康教育的基本概念（5）Basic Concepts of Oral Health Educationn健康教育采用多种教育方法，要与项目直接或间接健康教育采用多种教育方法，要与项目直接或间接相关，保证向人们传达的知识的准确性，并使人们相关，

15、保证向人们传达的知识的准确性，并使人们正确理解，保持人们对项目的兴趣和积极参加。正确理解，保持人们对项目的兴趣和积极参加。nEducational efforts using many different educational methods should be directed towards those associated with the programme,directly or indirectly,to ensure accurate knowledge and understanding，and to maintain interest and participation。（

16、WHO，1984）口腔健康教育的原则口腔健康教育的原则 Health education principles1.口腔健康教育纳入综合健康教育计划中。Oral health education should be built into general health education programmes.(WHO,1984)国家或地方综合性的保健规划中都应明确规定口腔保健项目口腔健康教育的原则口腔健康教育的原则 Health education principles2.每项口腔预防措的实施都包括健康教育的内容。nEvery available preventive oral health p

17、rocedure includes educational components.(WHO,1984)口腔健康教育的原则口腔健康教育的原则 Health education principles3.对各类保健计划制定的相关人群都要进行健康教育：政策制定者、食品加工业人员、保健服务人员、家长、教师、参加预防措施的人员和学生。nEducation of a variety of different target groups：policy-makers，food manufacturing industry，all health care providers，parents，school pers

18、onnel，primary health care workers，programme participants，and school students.(WHO,1984)口腔健康教育的原则口腔健康教育的原则 Health education principles4.健康教育教材的设计要内容准确，及时更新知识，形式要有趣并有艺术性。n Educational materials should be designed to gain or focus attention,to provide new knowledge,to facilitate interpersonal and group

19、 discussion,and to reinforce or clarify prior knowledge and behaviour.Materials such as leaflets,news releases,posters,films,and slides series are appropriate educational aids.(WHO,1984)口腔健康教育的原则口腔健康教育的原则 Health education principles5.因地制宜，符合当地文化、教育和社会情况和目标。In all community and school-based settings,

20、oral health instruction should be consistent and compatible with scientific knowledge as well as with the local culture,the educational system,and social goals.(WHO,1984)社区健康教育方法社区健康教育方法the methods used in community health ducationn社区健康教育方法可分为四大类 divided into the following four broad categories：n1.个

21、别交流（个别交流（one-to-one communication）。）。n2.以组为单位报告、讨论、决定有关健康信息以组为单位报告、讨论、决定有关健康信息（group presentations of information and group discussion and decision-making）社区健康教育方法社区健康教育方法the methods used in community health educationn3.借助传播媒介（disseminating information through mass communication channels,including t

22、he use of pamphlets,posters,newspaters,newsletters,rediao and television.）n4.组织社区活动（community organizational strategies）项目实施的不同阶段，单个或联合应用。口腔健康教育计划Oral Health Education Programme口腔健康教育计划的目标口腔健康教育计划的目标 Objective of the oral health education programmesn目标在调查研究基础上，计划预定时间内可以实现的，也可以衡量的指标。n口腔健康教育目标应包括的四类内容

23、：n 改进口腔健康状况口腔健康状况的目标；n 减少危险因素危险因素的目标；n 改进服务与防护服务与防护的目标；n 提高公众与专业人员认识认识的目标；口腔健康具体目标口腔健康具体目标 Oral health goaln口腔健康具体目标四要素：n 特定人群；特定人群；n 具体指向；具体指向；n 可被测量的尺度；可被测量的尺度；n 目标预期实现的时间；目标预期实现的时间；口腔健康教育计划的设计口腔健康教育计划的设计n六个步骤：1.确定有待解决的问题；2.确定目标；3.评估本目标实施的条件；4.确定内容与选择方法；5.充分估计执行中的困难；6.评估效果；口腔健康教育的评价口腔健康教育的评价 Evalu

24、ationn对口腔健康项目的评价：1.是否完成了项目所提出的目标 2.项目的设计与执行是否合理有效 3.项目的投入效益（社会效益与经济效益）口腔健康教育的评价口腔健康教育的评价 Evaluationn对口腔健康知、信、行评价的内容：1.口腔健康意识的变化 2.口腔健康知识的变化 3.对口腔健康问题所持态度的变化 4.口腔健康行为的变化 5.社会环境的变化：口腔卫生方针、政策 口腔健康教育与促进的评价口腔健康教育与促进的评价 Evaluationn评价的目的保证资源的充分利用。n评价的时间在项目进行之前，计划阶段就要确定评价的方法。n直接评价通常采用标准指数，直接评价健康状况改善的程度，如DMF

25、T，CPITN。n间接评价同时也需要调查和衡量某些行动，以便鉴定项目某些方面是否合适或需修订或取消。口腔健康教育与促进的评价口腔健康教育与促进的评价 Evaluation1.取得评价用的资料有困难或经费上的问题但不容忽略，行政长官往往忽略这一步骤，应予以关注1.方法：在进行整个人群效果评价之前，可在一个局部地区进行不同方面的评价；同时，在方便的时候，定期进行评价。口腔健康促进Oral Health Promotion健康促进的起源健康促进的起源 The origins and development of health promotion(1)nInvest highly-After the

26、2nd World WarnEnsuring access to health services facilities(hospital&primary care)for those in neednThe National Health Service(UK,1948)nUniversal publicly managed health insurance schemes(Canada,60s-70s)nLegislation-health-related resources(USA)nMedicaid and Medicare-readily available to the old an

27、d poor(Green&Kreuter,1990)健康促进的起源健康促进的起源 The origins and development of health promotion(2)nResource development-After the 2nd World WarnThe original assumption:nBetter access to high-quality health service inevitably led to better health.?nThe challenging assumption:nSpending more money on health s

28、ervices will have limited impact on the health of the population.健康促进的起源健康促进的起源 The origins and development of health promotion(3)nThe facts:n免费医疗保健没有消除贫富人群的健康差异免费医疗保健没有消除贫富人群的健康差异nthe provision of free health care did not in and of itself eliminate the health gap between the wealthy and the poor.n死

29、亡率和发病率与社会经济状态成反比死亡率和发病率与社会经济状态成反比nThe mortality&morbidity vs socioeconomic status-inversely健康促进的起源健康促进的起源 The origins and development of health promotion(4)nThe consequence:n医疗费用限制政策出台nCost containment policyn推出健康教育措施以促进自我保健，减少就医nThe role of health education in promoting self-care and reducing utili

30、zation of services健康促进的起源健康促进的起源 The origins and development of health promotion(5)n新型保健机构诞生（健康维护机构）nNew forms of medical practice(health maintenance organizations)n医疗专业人员提供疾病预防服务可以收费nProfessionals were paid for prevention健康促进的起源健康促进的起源 The origins and development of health promotion(6)n疾病普改变：The ma

31、jor health problems of modern populations,particularly the poor,were and continue to be chronic degenerative diseasesnExpensive to manage but could not be cured nCould be prevented by changesnin personal behaviours nin social and physical environments健康促进的起源健康促进的起源 The origins and development of hea

32、lth promotion(7)nThe historical research of McKeown nimprovements in health of over the past 200 years were the product of rising standards of living,improvements in the social and physical environment in sanitation and water supplies.(1979)健康促进的起源健康促进的起源 The origins and development of health promot

33、ion(7)n TuberculosisnThe mortality from tuberculosis declined by 90%before chemotherapy and BCG vaccination became available.nhost resistancenThe improved environment decreased exposure to infectious diseases and increased host resistance to microorganisms.健康促进的起源健康促进的起源 The origins and development

34、of health promotion(8)nNew approach to population health health promotionnRejects much of the philosophy on which health service provision has been based.nInvolves the prevention of diseases and behviour change through health educationnAnd goes far beyond them新公共卫生 New Public Healthn阿拉木图初级卫生保健宣言1978

35、 n渥太华健康促进宪章1986n阿德雷德健康的公共政策建议1988n对健康的支持环境1991健康促进的定义健康促进的定义Defining health promotionn 运用行政或组织手段，广泛动员和协调社会各相关部门以及社区、家庭和个人，使其履行各自对健康的责任，共同维护和促进健康的一种社会行为和社会战略。口腔健康促进的发展口腔健康促进的发展 The development of oral health promotionn1990s-nThe discipline of oral health promotion has therefore emerged as a means of

36、improving oral health based upon the principles of the New Public Health movement。口腔健康促进的发展口腔健康促进的发展 The development of oral health promotionnA core element of oral health promotionthe recognition ofnThe importance of the determinants of oral healthnthe need to reduce oral health inequalities口腔健康促进的

37、发展口腔健康促进的发展 The development of oral health promotionnContemporary oral health promotion seeks to promote oral health by improving both：nThe ways people live 生活方式生活方式nThe condition of living that are relevant to oral health 生活条件生活条件健康的决定因素 the determinants of health n环境因素：环境因素包括自然环境与社会环境两个方面 n行为与生活方式

38、：行为与生活方式是指因自身行为所产生的影响健康的因素 n卫生保健服务因素：卫生保健服务因素是社会因素中直接与健康有关的一个重要方面，包括预防服务，医疗与康复服务 n生物遗传因素：已知人类的遗传性缺陷和遗传性疾病近三千种，约占人类各种疾病的15 口腔健康促进口腔健康促进危险因素策略危险因素策略 Risk Factor ApproachSocio-cultural risk factorsHealth system and oral health servicesEnvironmental risk factorsUse of oral health servicesOutcome:Oral he

39、alth statusImpairmentQuality of lifeGeneral healthRisk behavior:Oral hygieneDietTobaccoAlcoholWHO 2003健康促进的功能健康促进的功能五个工作领域五个工作领域1.促进制定有利于健康的政策 building healthy public policy2.促进建设和保护物质环境和自然环境 creating supportive environments3.促进提高个人和群体保健知识和技能 developing personal skills4.促进调整卫生服务方向 reorienting health

40、 services5.促进发展社区能力 strengthening community action Ottawa Charter for Health Promotion（WHO 1986）健康促进的原则健康促进的原则Principles of Health promotion（1）1、全社会参与，结合日常生活，不仅仅关注处于危险因素中的患病人群Health promotion involves the population as a whole in the context of their everyday lives rather than focusing on people who

41、 are sick or at risk for specific diseases.健康促进的原则健康促进的原则Principles of Health promotion（2）2、针对健康决定因素，社会多部门协同行动nIt is directed towards action on the determinants of health and requires close cooperation between many different sectors of society.3、采取多种联合措施，进行必要的组织机构调整，通过社区建设和地区行动确定并铲除健康危险因素It combines

42、 many different approaches and requires organizational change,community development and local activities to identify and remove health hazards.健康促进的原则健康促进的原则Principles of Health promotion（3）4、以切实有效的公众参与为目标，使个人和社区获得发现健康问题并正确抉择的生存技能Health promotion aims at effective and concrete public participation a

43、nd requires that problem-defining and decision-making life skills be developed further in individuals and communities.健康促进的原则健康促进的原则Principles of Health promotion（4）5、尽管不是医疗服务，但这是卫生和社会范畴的活动，卫生专业人员可以在教育和鼓动中发挥特殊作用While it is an activity in the health and social fields,it is not a medical service;healt

44、h professionals have a special contribution to make in the areas of education and advocacy.WHO 1984 口腔健康促进的策略与方法n群体策略 Community strategies n专业人力策略 Professional strategiesn个体策略 Individual strategiesWHO 2003群体策略方法群体策略方法Community strategies（1）nCommunity-wide health promotion interventions nCommunity wa

45、ter fluoridation,salt fluoridationnSchool-based fluoride mouthrinse,群体策略方法群体策略方法Community strategies（2）nfluoride tablet programmesnSchool-based or school-linked dental sealantnprogrammes,oral hygiene programmes,screening and referral 专业人力策略方法专业人力策略方法 Professional strategiesnPatient education and cou

46、nselling on risk factorsnProfessional plaque controlnTopical application of fluoridesnProvision of dental sealantsnIndividualized recall schedule个体策略方法 Individual strategiesnSelf-care practicesnOral hygiene measuresToothbrushing,flossing,traditional cleaning,dentifricenSelf-applied fluoride usenSelf-initiated use of dental services泰国一个小村庄口腔健康促进实例思考题n健康促进与健康教育的目的有什么不同?n如何评价健康教育的效果？n健康促进的途径有哪些？