Introduction

Some of the most prevalent health issues with the highest mortality are non-communicable conditions such as diabetes, cardiovascular disease and respiratory conditions (Pan American Health Organization, 2023). The World Health Organization (WHO, 2023) estimates that 41 million people die from non-communicable conditions globally each year. Many of these conditions are caused and exacerbated by lifestyle choices and behaviours, for example:

• alcohol use
• tobacco use
• physical inactivity
• poor dietary choices

All nurses have a regulatory expectation and requirement to promote health (Nursing and Midwifery Council (NMC), 2023). This article explores how nurses can make vital contributions to a person-centred approach to health promotion. To do this, nurses must be aware of the causes of risks and health outcomes, known as the social determinants of health (Braveman and Gottlieb, 2014), when they are having conversations with people about lifestyle changes.

What is health promotion?

The term ‘health promotion’ first emerged in 1974, in a Canadian report calling for collaborative work between health professionals, government organisations and the public to manage illness and prevent the root causes of ill health (Phillips, 2019). The Ottawa charter defined health promotion as ‘The process of enabling people to take control over their health’ (WHO, 1986).

However, there is no universal consensus about what health promotion is. Scriven and Ewles (2017) discussed that some authors define health promotion in relation to actions and activities, while others describe a range of values and principles. Nonetheless, health promotion is fundamentally a form of empowerment to enable individuals and communities to take control of and improve their health. The foundations of health promotion are underpinned by human rights and person-centred approaches linked to participation and empowerment. Illness, whether chronic or acute, is disempowering, and nurses must be aware of this to allow people to be confident in reclaiming control. Tvieten (2021) explained that empowerment in relation to health promotion is underpinned by active participation, identifying issues that people themselves define as important and increasing their capabilities through the attainment of knowledge, making the process person-centred.

Poor health is inextricably linked to inequalities and poverty. Evidence suggests societal factors such as employment, education, income, gender, ethnicity and access to healthcare have a significant influence on the health status of a person (WHO, 2018). These inequalities manifest in the prevalence of behavioural risks such as alcohol intake, illicit substance use, smoking and poor diet (National Institute for Health and Care Excellence, 2023). It is important to acknowledge that the socioeconomic determinants of health are often beyond the control of individuals and communities (Scriven and Ewles, 2017).

The nurse’s role in health promotion

Nurses have a duty to actively promote health and reduce inequalities (NMC, 2018). Darch et al (2017) found that some nurses and nursing students were not aware of their role in health promotion. They also suggested it was difficult to be a role model in health promotion when nursing, as a career, prevents them from living to the standards and advice they would be delivering to their patients, as a result of missed breaks, staff shortages and burnout. A systematic review by Zhang et al (2020) found that nurses working night shifts were at greater risk of developing obesity. Taking care of one’s own health while also promoting healthy practices among patients would have a significant effect on patient health outcomes and reduce the burden on healthcare systems.

Nurses make up the largest proportion of health professionals in the NHS, so are ideally placed to contribute to health promotion (Newton, 2015). This is an expectation set out by the Nursing and Midwifery Council (2023), where one of the seven platforms of the Standards of Proficiency for Registered Nurses is ‘Promoting health and preventing ill health’.

How to be person-centred during health promotion

While benefitting from modern medical practices, certain life events such as pregnancy, childbirth, menopause and ageing have arguably been medicalised, causing the public to relinquished control over these to the medical profession (Scriven and Ewles, 2017). Nurses are tasked with not only supporting people to regain control over their health, but changing the culture and expectation around this. Person-centred care is a central tenet of health policy across the UK. It is key to enabling individuals to acquire the knowledge, skills and confidence to make informed decisions in relation to their health needs and ensuring that people are treated with compassion, dignity and respect (Health Foundation, 2016; NMC, 2018).

Downey et al (2021) highlighted that by prioritising mutual respect and person-centred discussions, healthcare providers can contextualise care and motivate individuals to take greater control of their health. Nurses are well-positioned to empower patients through effective communication strategies that promote healthy lifestyle behaviours (Phillips, 2019). NHS England (2019) state that person-centred health promotion can be achieved through:

• shared decision making
• facilitating choice
• increasing the knowledge, skills and confidence of people through interventions such as:
  • health-coaching
  • self-management education
  • peer support

Nurses are well placed to offer health education, which is the cornerstone of health promotion (Green et al, 2019). Health education at an individual level is arguably best delivered opportunistically through conversation. Examples of offering interventions to reduce risky behaviours might involve signposting to sources of support, such as smoking cessation, delivering workshops on healthy eating or making recommendations to increase physical activity (Woods, 2022).

However, nurses must understand potential barriers, such as language and literacy levels, if health inequalities are to be reduced and health promotion interventions are to be effective. While resources are available to support people who speak other languages, literacy levels are a more complex barrier. Around 42% of working-age adults in the UK are unable to comprehend health information, rising to 61% when numeric data is included (Public Health England, 2015). Poor literacy is linked to poor health outcomes, so strategies to support people to take control of their health where literacy is reduced might include teach-back methods to check understanding or peer-support approaches to enable health literacy through social networks (Public Health England, 2015).

Where does lifestyle medicine fit into health promotion?

Approaches and modifications to a person’s way of living, often termed lifestyle medicine or lifestyle approaches, are gaining increased recognition and popularity. Lifestyle medicine is defined as:

There are various ways in which nurses can approach health promotion, depending on the needs and preferred approach of the patient (Table 1). Alterations in lifestyle can positively influence multiple health conditions and wellbeing (Schwappach, 2014), leading to a growing endorsement of such strategies in global policy and research (Razavi et al, 2014; Harvey et al, 2020). Lifestyle interventions may encompass modifications in:

• physical activity routines
• alcohol and caffeine consumption
• dietary habits

These changes can enhance overall health. Lifestyle interventions do not have to involve major changes, but can be minor and manageable, giving the person a sense of purpose, accomplishment and achievement. Simple lifestyle changes such as to dietary intake and habits (Webster, 2022) or even a change in eating times and eating patterns (Webster, 2023), are manageable and may significantly improve health outcomes.

Motivational interviewing

There is a strong argument for more health ‘coaching’ as part of health promotion. Motivational interviewing was initially developed by Miller and Rollnick (1991), and is a widely recognised approach to health coaching (Lindson et al, 2019).

Motivational interviewing aims to enhance self-efficacy and self-empowerment. It provides an alternative communication style, particularly effective for patients who typically do not benefit from intensive interventions. Growing evidence supports the effectiveness of motivational interviewing, especially concerning outcomes in patients with a disadvantaged background. However, further research is needed to better understand the impact of motivational interviewing in health promotion (Ammentorp et al, 2013).

Conclusions

Nurses must embrace health promotion activities at every opportunity to improve the overall health of the population. Building high-quality person-centred relationships with people is a fundamental means of empowering them to assume control over their health. One method often used is motivational interviewing, but nurses must keep in mind the social determinants of health when delivering any health promotion activities to people. Lifestyle medicine approaches have the potential to reduce the rates of non-communicable diseases and even reverse the damages caused.