Health is defined by the World Health Organization (WHO) as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” and it promotes the attainment of "highest possible level of health" by all people. Moreover, one’s health and well- being are affected by both the inner and outer dimensions and their impact to us can be fully understood on how we perceive and deal with these dimensions.
Louise Harms’ book entitled “Understanding Human Development: A Multidimensional Approach” reiterates that social ecology of human behavior and adaptation examines the role of social networks in building social capital, adaptation in traumatic situations, risk and resilience in the face of adversity, and the influences of human development, gender, culture and social class. Moreover, how one adapts in this world is dictated by the fact that one’s perception and attitude is a mere outcome of these inner and outer dimensions. An inner or innate behavior is determined by the "hard-wiring" of the nervous system. It is usually inflexible, a given stimulus triggering a given response while an outer or learned behavior is more or less permanently altered as a result of the experience of the individual organism. (RCN Available at users.rcn.com .Accessed 24/01/2008).
Furthermore, both the internal and external variables influence health as they can increase the risk of certain diseases or serve as warning signals of impending medical conditions. Internal variables are composed of biologic (genetic makeup, race, sex; age, developmental level), psychological (mind-body interactions & self-concept; conscious versus unconscious) and Cognitive (spiritual & religious beliefs; lifestyle choices may) while environment, standards of living, family & cultural beliefs and social support networks comprise the external variables. The presence or absence of these factors functions either initiate or restrain healthy behaviors. For example, perceived personal susceptibility to a particular disease within the internal factor of attitudes, beliefs and core values augments the probability that the individual will engage in a health relevant behavior. On the other hand, lack of perceived seriousness of the threat would not serve as a motivation to change risky behaviors. (Cole et al., 1992).
To cite an example, certain types of cancer are hereditary in nature and its impact may vary from one person to another. One person although aware of the familial tendency may continue to engage in detrimental activities that may predispose him to develop cancer while another person will keep in mind his vulnerability of developing cancer and this knowledge will serve as a warning sign to him to be more meticulous with his health condition. Aside from this, some illnesses also are caused by external factors such as the environment. "The environment can operate as a stressor, evidenced by the physical debilitation resulting from chronic exposure to uncontrollable environmental demands." (Stokols, 1992).
However, Coates (1988) cited that information is necessary, but is not sufficient to effect and sustain behavioral change in large segments of the population. One’s attitude is also important since one’s ability to deal with issues concerning health affects how we promote or prevent them from occurring. Meanwhile, there are individuals who believe that they themselves influence their health and there are others who think that outer variables control their health. No matter what one believes, it is important that an individual will participate in disease prevention and health promotion. It is therefore important that the health care system is well implemented. "The individual's attitudes toward health care and accessibility to health services suggest a relationship in which access factors affect and/or are affected by one's evaluation of health care." (Cummings, 1980)
On the other hand, one’s well- being is one’s responsibility and to keep it functioning in optimal condition is one’s revered goal. Thus, health promotion and disease prevention is very essential and these are just two of the WHO’s pillars in attaining the goal of achieving a highest possible health by all people. Furthermore, many awareness drives and campaigns are being initiated by the Government especially by the health department to ensure that the proper information dissemination is implemented even in the remotest regions.
An old adage says that an ounce of prevention is better than a pound of cure thus the three levels of prevention strategy is initiated namely: primary, secondary and tertiary. Primary prevention dwells on protection against certain diseases. An example of this is vaccination. Early detection such as doing self breast examination is categorized under secondary level of prevention and tertiary level of prevention is geared towards rehabilitation and restoration. An example of this includes rehabilitation of a post stroke patient. Ewart (1991) stressed that prevention must strive to promote individual self-protective activity by altering laws and policies, rendering environments conducive to personal action, and educating the public." In addition to this, different health promotions are established. These are activities directed toward increasing level of well being (Pender, 1996); Individual & community activities to promote healthy lifestyle.
Furthermore, a nurse plays a major role in inculcating the importance of health and how one can optimally maintain it within the inner and outer dimensions and since health is viewed as a whole component, holistic nursing is then initiated. Holistic Nursing is defined as “all nursing practice that has healing the whole person as its goal.” Holistic Nursing is further defined as practice that draws on nursing knowledge, theories, expertise and intuition to guide nurses in becoming therapeutic partners with clients in strengthening clients’ response to facilitate the healing process and achieve wholeness. The practice of Holistic Nursing is grounded in nursing theory -- fully recognizing that there are two views in the profession regarding holism (the view that defines the whole in terms of component parts -- bio-psych-social-spiritual -- believing that the whole is greater than these parts; and the view that defines the whole as an irreducible unit). Different from other nursing practice, the practice of Holistic Nursing requires the nurse to integrate self-care and self-responsibility into his or her own life and to strive for an awareness of the interconnectedness of individuals to the human and global community.
The nurse institutes the nursing process in dealing with this. Moreover, assessment is important as it gauges the clients’ ability to cope health issues concerning him. The nurse then is able to identify the client’s health history, risk factors, social support system, strengths and weaknesses. With this, the nurse will be able to give his nursing diagnosis appropriate for the client and planning follows. In this process, the nurse guides the client in making his short term as well as his long term goals that are systematic, measurable, attainable, and realistic and time- bounded. With plans in hand, the nurse together with the client can now implement the necessary actions catered for the client within the level of his ability. Lastly, to measure effectiveness, evaluation is done and continuous revision is instituted.
However, aside from the medical professionals like the nurses, the community in general has a role to fulfill. According to Ewart (1991), systems of production, distribution, and promotion, together with government regulatory policies, affects exposure to settings, products, and messages that influence health choices. It is the function of the Government to ensure that the public is well informed and guided with different health choices available. Stokols (1992) believes that as incremental health promotion and environmental protection efforts are adopted in local communities, they can exert a positive, albeit gradual, influence on the quality and healthfulness of the global environment. Stokol (1991) further emphasized that environmental impact assessment regulations are intended to protect public health and environmental quality and opportunities for designing health-promotive environments at local levels will be more and more influenced by the regulatory and economic policies implemented in municipal, regional, and international contexts.
Unfortunately, it is still up to the individual to change his behavior for the better and perception since one’s well- being is highly personal. Thus, people's belief that they can motivate themselves and regulate their own behavior plays a crucial role in whether they even consider altering habits detrimental to health. (Bandura, 1990). Different attempts to focus on health issues will be useless if the people will not cooperate and what the government or the medical professionals are doing will be put to waste if no mobilization from the people will take place. Bandura (1990) cited that neither intention nor desire alone has much effect (on self-regulation) if people lack the capability for exercising influence over their own motivation and behavior and according to Becker (1990) intention to perform a behavior can be accounted for by a combination of attitudes about an action and perceptions of likely normative reactions to that action.
In conclusion, what the people need to maintain a healthy life within the inner and outer dimensions are the combination of proper attitude and perception towards health, sufficient knowledge concerning health issues, right amount of self- directed motivation, continued and proper guidance from the concerned institutions and direct support from the Government for sustenance. Becker (1988) accounts that knowledge regarding (the disease), and the perceived value of behavioral change in reducing one's risk of (infection), were both consistently related to various measures of risk reduction, appropriate knowledge and attitudes are prerequisites for alteration of behavior and knowledge and attitudes are generally supportive of behavioral risk reduction.
Lastly, performance of a behavior is a function of the strength of a person's attempt to perform a behavior and the degree of control the person has over that behavior. The harder the person tries, and the greater his or her control over personal and external factors that may interfere with the behavior, the greater the likelihood that the behavior will be performed and the more favorable an individual's attitude toward attempting a behavior, and the more he or she believes that significant others are in favor of his or her trying, the stronger will be his or her intention to try. (Becker, 1990)
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