Health Promotion Work Research Articles

An epidemic of orthodoxy? Design and methodology in the evaluation of the effectiveness of HIV health promotion

This paper examines the epidemic of orthodoxy affecting the evaluation of current health promotion work. This has resulted in the privileging of certain methods, in particular, experimental method and the randomized control trial. Problems identified by public health researchers are discussed but the major focus of our critique concerns the ways in which the experimental method and, especially, the randomized control trial, assume that the audience of any health promotion message comprises a number of asocial individuals who occupy non-discursive space in ahistorical time. An alternative approach is advocated which focuses attention on the programme of health promotion and education rather than on any one individual health promotion initiative or intervention. Attention is also given to educational and health promotion practices; it is here, we argue, that some of the answers to ‘what works’ are to be sought. We illustrate our argument with reference to a number of recent Australian health promotion campaigns, including ‘Condoms Every Time’ and ‘Negotiated Safety’ .

Stages of Change training for opportunistic smoking intervention by the primary health care team. Part II: qualitative evaluation of long-term impact on professionals' reported behaviour

This paper presents and critically evaluates data on the long-term impact of brief training for the primary health care team in facilitating smoking behav iour change with patients. Semi-structured interviews were carried out with one third ( n = 23) of training participants one year after taking part in a brief, one-day workshop to enhance the abilities of the primary care team in facilitating smoking behaviour change. The impact of brief training for the primary care team is premised on the health professionals' acceptance of the content and relevance of the training, the enhancement of professional self- efficacy, their definition of their role in health promotion work, their own smoking status, and their readiness to change clinical practice/behaviour. It is also dependent on professionals' capacity to refrain from using ineffective methods which may cancel out the benefits gained by learning and using more effective strategies. Future training workshops or courses for primary health care professionals in health promotion work should be tailored to individual participants' needs as their readiness to change clinical practice must be acknowledged rather than using a global approach which can result in a diluted impact.

The ecological approach in health promotion programmes: the views of health promotion workers in Canada

The purpose of this study was to explore attitudes, beliefs, and values related to the ecological approach among health education and health promotion workers. Data were collected using self-administered questionnaires. The sam ple consisted of 157 health education/promotion workers involved in Canadian regional public health organisations. The response rate was 79 per cent. Respondents tended to know the ecological approach, perceived it as effective, and acknowledged a need for interventions aimed at modifying people's environment. However, many respondents perceived that they had insufficient competencies to operationalise the ecological approach. A sizeable proportion of respondents seemed to hold values inconsistent with the ecological approach. Compared to doctors/dentists, nurses expressed a higher satisfaction with interventions targeting individuals. In general, respondents' cognitive profile was favourable to the ecological approach. It is hypothesised that the particular patterns of response obtained for some scales might be related to the respondents' previous training.

Let’s hear it for the boys!

Shares initial results of a two‐year project commissioned by the Department of Health to support the needs of boys and young men in sex education and sexual health care. Draws on expertise provided via questionnaire responses from 130 sex educators; a series of consultations with boys and young men aged five to 16, primary and secondary school teachers, health promotion workers, youth workers and those working in community settings with boys and young men. Offers principles of practice for working with boys and young men. Provides a training exercise which examines some of the influences and attitudes to boys and young men which may affect a professional’s work with them.

Health promoting schools: learning from the European project

Reports on the evaluation of the European Network of Health Promoting Schools project in England, which concluded in March 1997. The Europe‐wide initiative aims to develop schools as settings for the promotion of young people’s health, encouraging innovative approaches and opportunities for pan‐European working. In England the project has been managed by the Health Education Authority, which commissioned an independent research agency, the National Foundation for Educational Research (NFER), to carry out the evaluation. Reports on the NFER’s evaluation of the impact of a co‐ordinated whole school approach to health education in 16 pilot and 32 reference schools. Presents highlights from the Final Research Report and accompanying Management Summary, including a case history of health promotion work carried out by special schools which took part in the project.

Working Invisibly: Health Workers Talk About Capacity-Building in Health Promotion

SUMMARY A series of six focus groups was held with health promotion workers to explore the meaning and experience of ‘capacity-building’, a term which is used variously in the literature. The research is part of a participatory, practice-based project to develop outcome indicators in capacity-building. Capacity-building was defined as seeking to develop health promotion skills and resources, and also problem-solving capability, at five levels: the individual; within health care teams; within health organisations; across organisations; and within the community. While workers had little difficulty in identifying outcomes of capacity-building, indicators of quality or good process were more difficult to articulate. This was partly because capacity-building was described as an invisible, even secret process. Capacitybuilding is hidden from funders and administrators because it is not generally regarded as a legitimate project activity; that is, it is not directly linked to risk factor behaviours in priority areas such as cancer, heart disease and injury control. Capacity-building is also hidden from other workers in order to make it more effective. This is particularly the case with health promotion workers working within what they perceive to be hostile climates, such as health care settings experiencing funding cut backs. The invisibility of practitioners’ capacity-building work has implications for quality control, guiding theory, practice ethics, peer support, worker morale and funding mechanisms in health promotion.

The impact of social inequalities in child health on health visitors' work.

Preventive and health promotion work by health visitors ought to reduce social inequalities in child health. However, the increased health and developmental problems among disadvantaged children may constrain health visitors' ability to carry out effective preventive work. This paper measures the impact of socioeconomic inequalities in children's health on the work of health visitors and the amount of preventive work they can provide, with emphasis on 'parenting' programmes. Data collected for health visitors' profiles were analysed in an ecological cross-sectional study. Individual caseloads were classified according to the proportions of families in social class IV or V and families headed by an unemployed person. A range of measures of young children's health and development indicated the demands on health visitors' time. Preventive work was divided into post-natal support, parenting programmes, special clinics and other preventive work. All the outcome measures were poorer in the most disadvantaged caseloads. Odds ratios between the most and least disadvantaged 20 per cent of caseloads were 0.6 for breast feeding at birth, and at seven months, 1.9 for post-natal depression, 3.2 for mothers under 18, 10 for lone parent families, 2.6 for families needing high intervention, 4.5 for families with a smoker, 11 for domestic violence, 4.4 for parents with a chronic health problem, 2.7 for children on the child protection register and 2.8 for children with developmental problems. There was 30 per cent greater health visitor time provided in the most disadvantaged caseloads than in the most advantaged. There was no consistent difference in the amount of preventive work carried out; in particular, parenting programmes were delivered at a similar rate in all caseloads. Large differences in demands on health visitors' time exist between affluent and disadvantaged caseloads which are barely reflected in the provision of extra time to poorer caseloads. There is no consistent pattern to the delivery of preventive programmes designed to ameliorate the effects of disadvantage on children's health and development.

Peer‐led sexual health promotion with young gay and bisexual men ‐ results of The HAPEER Project

Presents the results of an investigation into effective methods of peer‐led sexual health promotion work with young gay and bisexual men. The study recruited a group of young gay and bisexual men from Southampton who underwent training to participate in a peer‐led sexual health intervention in which they conducted one‐to‐one interviews with a selection of their peers. Reports briefly on the key learning to arise from the process of recruiting and training peer educators, and in greater depth concerning the quasi‐experimental evaluation of the intervention the peer educators participated in to promote sexual health. The study found that rapport and familiarity between project workers and potential recruits aided the recruitment process, and that informal, confidence‐building activities were key factors in the effectiveness of the peer educators’ training. The peer educators were most effective in terms of information provision, but weaker on the exploration of attitudes and beliefs, or the encouragement of safer sexual behaviour. The advantages associated with the intervention included its ability to target individuals in a range of community settings, to stimulate in‐depth discussion about sexual health, to identify individual needs and to facilitate outcome evaluation over time.

Do the homeless get a fair deal from general practitioners?

Many studies have indicated the health status of homeless people to be typically poorer than that of the general population, with various studies indicating a high prevalence of psychiatric illness, drug or alcohol misuse and associated socio-medical problems. The Bristol Primary Healthcare Project is an agency which was established to provide a local health care service tailored to the needs of people who are homeless. The present study was carried out as part of an evaluation of the service offered locally to homeless people by General Practitioners (GPs). A postal questionnaire survey of 155 general practices within the Avon FHSA area was carried out. Both fundholding and non-fundholding practices were included, within an area including inner city, urban and rural/semi-rural locations. One hundred and seventeen completed questionnaires were returned, providing a response rate of 75%. Twenty-seven percent of practices would fully register a homeless person who seeks to register at the practice, 24% would treat as immediate and necessary and 33% would treat as a temporary resident. Four percent of fundholding practices surveyed would fully register homeless persons and 55% of inner city practices would do so. Seventy-nine percent of doctors indicated that homeless patients were more difficult to treat than other patients. The most frequent problems associated with registering homeless persons were perceived to be the associated social problems (90% of respondents agreed), the lack of medical records (88% agreed), the complex health problems (79% agreed) and the associated alcohol or substance misuse (78% agreed). The study has highlighted a need for government to consider providing incentives to GPs to register homeless people without resulting in adverse effects on their contract targets. The reluctance of some practices to register these patients varied by area and type of practice with doctors at fundholding practices being the most reluctant. There is an identified need for further health education and promotion work and initiatives exemplified by the Bristol Primary Healthcare Project for people who are homeless.

Multiplying Health Gains: the critical role of capacity-building within health promotion programs

Health outcomes in populations are the product of three factors: (1) the size of effect of the intervention; (2) the reach or penetration of an intervention into a population and (3) the sustainability of the effect. The last factor is crucial. In recent years, many health promotion workers have moved the focus of their efforts away from the immediate population group or environment of interest towards making other health workers and other organisations responsible for, and more capable of, conducting health promotion programs, maintaining those programs and initiating others. ‘Capacity-building’ by health promotion workers, to enhance the capacity of the system to prolong and multiply health effects thus represents a ‘value added’ dimension to the health outcomes offered by any particular health promotion program. The value of this activity will become apparent in the long term, with methods to detect multiple types of health outcomes. But in the short term its value will be difficult to assess unless we devise specific measures to detect it. At present the term ‘capacity-building’ is conceptualised and assessed in different ways in the health promotion literature. Development of reliable indicators of capacity-building which could be used both in program planning and in program evaluation will need to take this into account. Such work will provide health-decision makers with information about program potential at the conclusion of the funding period, which could be factored into resource allocation decisions, in addition to the usual information about a program's impact on health outcomes. By program potential, we mean ability to reap greater and wider health gains.

Knowledge and beliefs about health and cancer prevention: the views of young people

Reports the findings from a study of young people’s knowledge of and attitudes towards cancer, and their understanding of health and health‐related behaviours, the aim of which is to inform future health promotion work in this area. Finds, from the study of three inner city, suburban and rural schools involving 226 young people aged 15‐16, that young people know most about lung cancer, but there is also some understanding of other cancers, particularly breast and skin cancer and leukaemia. Reveals that smoking, pollution and other environmental factors are seen as the dominant causes of cancer, and the latter are more often mentioned by the inner city samples. Shows that young people appear to be more worried about unemployment than ill health, and that happiness comes before health as a priority in their lives. Finds television and the media to be the most important sources of information. Considers the implications of these findings for traditional approaches to health education and health promotion.

Public perceptions of a health visitor

This paper outlines the views of a random sample of 175 members of the public on the role and function of the health visitor. Those who had previous contact with a health visitor were more likely to know † † In the absence of a generic term the health visitor is referred to in the female gender, although the author recognises that health visitors may be male or female. her employer but not necessarily her qualifications. They also had a greater knowledge of the type of clients a health visitor may see and the advice she is able to give. Although many people were aware of the health visitor's work in health promotion, very few would contact a health visitor for health advice, the vast majority choosing to see their GP. Health visitors should be aware of this and the way in which their profession is viewed by those whose health they aim to influence and may also consider a change of name and/or direction if the profession is to continue to develop and be more responsive to the needs of the 90s.

It makes you bald: children’s knowledge and beliefs about health and cancer prevention

Reports results from a study concerning children’s knowledge of and attitudes towards cancer, and their understanding of health and health‐related behaviours, with the specific aim of informing future health promotion work. Using “draw and write” techniques, the findings indicate that these children possessed considerable health‐related knowledge. Exercise and healthy eating were seen as the most important factors in keeping healthy, whereas smoking and bad diet were cited most often as representing unhealthy behaviour. However, both categories also included more general items, embracing both environmental and “individualistic” factors. Similarly, children appeared to possess considerable knowledge about cancer, particularly about lung cancer, but there was also some understanding of other cancers such as breast and skin cancer and leukaemia. Concerning sources of information, most of the children’s knowledge about cancer appeared to derive from television and other media; in particular, soap operas appeared to exert a considerable influence on these young children. Considers the implications of these findings for traditional approaches to health education and the methodological issues involved in researching children’s health.

A STUDY TO MEASURE KNOWLEDGE AND AWARENESS OF PHYSICAL ACTIVITY AMONG HEALTH AND LEISURE PROFESSIONALS 192

Health and leisure professionals play key roles in the promotion of physical activity and in the dissemination of advice in England. A survey of these professionals was conducted to obtain baseline data and to provide indicators to assess their awareness and knowledge of a new physical activity message which recommends participation in at least moderate (with an energy cost of >=5 kcal/min) physical activity of at least 30 minutes on five or more occasions a week. The survey was a nationally representative random sample of Family Doctors (FDs), Primary Care Nurses, Health Promotion workers and Leisure professionals (n=800), which was conducted on CATI (Computer Assisted Telephone Interviewing). The results of the survey showed that only Leisure professionals (53%) regarded physical activity as the most important factor to improve the average person's health. Whereas the rest of the professional groups regarded smoking as the most important factor (87% of FDs, 70% of Primary Care Nurses, and 67% of Health Promotion workers). All four groups stated they were reasonably confident about their knowledge of physical activity, (71% of FDs, 78% of Primary Care Nurses, 63% of Health Promoters and 73% of Leisure Professionals). However, knowledge levels of the new message were low in each professional group (1% of FDs, 1% for Primary Care nurses, 2% of Health Promotion workers and 3% of Leisure professionals). The results have informed the design of a national campaign, which targeted health and leisure professionals to increase their knowledge of the new physical activity message. A repeat survey will be conducted in one year to evaluate the effectiveness of the campaign.

Evaluation of a national health promotion program in South Australia

This paper reports the findings of the evaluation of the South Australian component of the National Better Health Program. The evaluation used analysis of focus-group interviews and key documents to assess the value of the state program. The evaluation demonstrated that for a relatively small investment ($2.4 million was allocated to the project over four years, representing only 0.5 per cent of the annual budget for teaching hospitals in South Australia), much can be achieved by harnessing the energy of local communities. The evaluation concluded that more attention should be directed to structural change, with an emphasis on collaboration across sectors, and community participation. Some key issues for the planning and implementation of health promotion were highlighted: the challenge of marrying local initiatives based on community development with national health promotion objectives; the importance of dedicated and assured funding; the need for increased training and support for health promotion workers; and the importance of continuing a focus on equity in the implementation of health promotion. The paper concludes by questioning the value of the current Australian goals, targets and strategies for health, given the findings from this evaluation.

Mental health promotion - visualisation as a method for communication

The project “Lofoten - fit for living” was carried out in Northern Norway from 1990 to 1993. The aims were threefold: to prevent health damage and initiate health-promoting work in a region in crisis, to gather knowledge on psychosocial health promotion in a rural area, and to induce an understanding of the fact that psychosocial health promotion has to engage several sectors of administration. In order to reach all the different groups of people in question, we developed a method of simple visualisation of what we were doing to overcome cultural differences within various sectors of public life. Since the aim of mental health promotion is to reach the population on a broad scale, it has to engage a broad public. The problems faced in this process are also visualised. It is too early to present the results of the project as a whole, but we found that this simple method of communication worked surprisingly well in initiating the discussions we wanted.

A Study of Youth Workers as Health Promoters on Sex-Related Issues and HIV/AIDS in a British City

ABSTRACT This study investigates the capacity of youth workers in a British city to undertake health promotion work on sex-related issues and HIV/AIDS. Forty five youth workers completed a semi-structured questionnaire which examined their current work on sex-related issues and HIV/AIDS. Over half had been asked about sex-related issues by young people in the previous month, most frequently about HIV/AIDS. Over half had run formal sessions on these issues but few had received training except on HIV/AIDS. Half requested further training. It is concluded that the youth service has considerable potential for conducting effective health promotion work in this area.

Survey of health promotion organisational arrangements and levels of service for health promotion

This study was promoted by the Executive Committee of the Association of Directors of Public Health when faced with the need to examine the organisation of and quantify health promotion arrangements in the Health Districts of England and Wales, resulting from the concerns of many of the members of the Association. These concerns were based on the views that health promotion is a key purchasing function of the District Health Authorities and must be appropriately and effectively structured and adequately resourced if the requirements of The Health of The Nation are to be fulfilled. There are many aspects to health promotion work and the delivery of health promotion services which will need addressing in the new commissioning environment of the NHS. A need was recognised for up-to-date data about health promotion services to inform a necessary debate about future arrangements, since it appeared that organisational change was being driven by influences unconnected with the possibly most appropriate structure of health promotion departments and which relate to a contemporary view of health promotion. Reducing the size and cutting the cost of commissioning authorities was perceived as one of the most important influences. A postal questionnaire survey to all Health District and Regional Health Authorities in England and Wales was conducted covering questions about the present organisational arrangements and levels of service, and soliciting the opinions of those canvassed. A total of 185 District and Regional Health Authorities, effectively reduced to 171 because of mergers, was sent questionnaires, of which 141 were completed and returned, giving a response rate of 82.5%. Most Health Promotion Units are currently purchaser-only based or split betweenpurchaser and provider bases. The majority of Districts have an establishment for a Director of Health Promotion, who is likely to be based at the purchaser level, Most directors have support staff. The median staff level in this survey is 7 WTEs (whole-time equivalents), and the level for the population served is 2.74/100,000. A little over 50% of respondents felt that health promotion should be a split purchaser and provider function, and there is evidence that this opinion has changed in recent years. This reflects concern expressed in comments made by respondents about the practical problems inherent in the separation of the purchaser and provider elements of health promotion activities, resulting from the ostensible requirements of the purchaser/provider reorientation in the NHS. The survey provides a picture of the present organisational arrangements in health promotion across the country and forms a basis for discussion of future developments. It highlights the problems of integrating all health promotion functions under a single management umbrella, purchaser or provider, and of the perceived importance of ensuring an adequate health promotion structure at the commissioning level.

The potential application of social marketing techniques in health promotion

Health promotion is increasingly considered to be the guiding principle of contemporary health care strategies. As a concept, health promotion concerns the development, implementation and evaluation of a realm of health enhancing activities. The composition and distribution of information on health, lifestyle and related services is crucial to the development of such activities. Social marketing is concerned with the application of marketing techniques to influence the acceptability of social ideas and practices.It is the aim of this article to draw out the potential advantages of employing social marketing techniques in the development of information campaigns, as a component of health promotion work. The article opens with the definition of health promotion and social marketing and then considers the application of marketing techniques to health information work. In the final section the relationship between social marketing and health promotion is illustrated and assessed. The authors conclude that with due recognition of the differing value systems and cultures of social marketing and health promotion, information campaigns might benefit from the application of skills and techniques from both perspectives in the design and implementation of projects.

'Sell your cost-effectiveness'.

Nurses must now grab pivotal roles in the shift towards primary care by selling the cost-effectiveness of their health promotion and prevention work, RCN General Secretary Christine Hancock declared.