HEALTH PROMOTION

1. HEALTH PROMOTION Banyard: Psychology in Practice: Health Chapter 6

2. HEALTH PROMOTION In this module we will be looking at • Methods of promoting health • Health promotion in schools, worksites and communities • Key issues in Health Promotion We will also discuss WHY we need health promotion and what makes a promotion successful!

3. HEALTH PROMOTION HEALTH PROMOTION can be defined as 1. “ the process of enabling people to increase control over, and to improve, their health” Health promotion is “Not just the responsibility of the health sector but goes beyond healthy life styles to well being” Ottawa Charter for Health Promotion, W.H.O 1986 2. “an activity aimed at informing people about the prevention of disease and ill health and motivating them to change their behaviour” Naidoo and Wells, 2000

4. HEALTH PROMOTION HEALTH PROMOTION ACTIVITIES. Three overlapping activities HEALTH EDUCATION PROTECTION PREVENTION The aim of health promotion is EMPOWERMENT, i.e. enabling the individual to act in a healthy way. Tannahill, A. 1985

5. PREVENTION • PRIMARY PREVENTION means attempts to combat risk factors before illness occurs

6. PREVENTION • SECONDARY PREVENTION means identifying and treating an illness early on with the intention of curing it

7. PREVENTION • TERTIARY PREVENTION Focuses on slowing down the damage of serious disease and trying to rehabilitate the patient. Which category does health promotion come into? What are the benefits of this?

8. Health promotion is termed as PRIMARY PREVENTION – getting people to change their lifestyles before they become ill. This type of promotion has been underused until recently for three main reasons. Can you think what they might be?

9. HEALTH PROMOTION Methods of Health Promotion: A fear appeal is...... a persuasive message which emphasises the harmful physical/social consequences of failing to comply with the recommendations of the message

10. The HEALTH BELIEF MODEL and the THEORY OF PLANNED BEHAVIOUR both suggest that perceived threat is necessary for a person to change their behaviour. The most obvious way to introduce this threat is through FEAR APPEALS. Think about recent anti-smoking campaigns, healthy eating, and drink driving…. The list is endless! What we need to ask ourselves is how EFFECTIVE these appeals are. CEOPS here

11. What do you think of the following?.............. Consider whether each one is a mild, moderate or strong fear appeal. Why? Would it alter your behaviour? Why or why not? What emotions does it arouse for you?

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18. OR HOW ABOUT THESE VIDEOS.............. • Seat belt campaign • Kill your speed campaign 7 8

19. HEALTH PROMOTION A classic study into the use of fear in health promotion was carried out by Janis and Feshbachin 1953 who devised a study looking at promoting oral hygiene.

20. METHOD: 4 groups of Ps. 3 were given a 15 min lecture on tooth decay and oral hygiene. • AIM: • To study the motivational effects of fear arousal in health promotion • PARTICIPANTS • The entire freshman year of a large Connecticut high school, average age 15 years.

21. GROUP 1 were given a Strong fear appeal They received pictures and descriptions of diseased mouths, including explanations about the pain of tooth decay and gum disease and awful consequences like cancer and blindness.

24. GROUP 2 were given a moderate fear appeal They received similar pictures and descriptions but they were much less disturbing and dramatic.

25. GROUP 3 were given a lecture about teeth and cavities - But without referring to very serious consequences and using diagrams and x-rays rather than emotive pictures. This is a MINIMAL FEAR APPEAL

28. Janis and Feshbach 42 % increase 24 % increase 0% increase No difference No difference No difference No difference Highest appraisal BUT “horrible” Lowest appraisal 8% increase 27 % increase 36% increase 0 % increase

29. HEALTH PROMOTION CONCLUSIONS; The strong fear appeal created the most worry in the students and was rated as more interesting. BUT The overall effectiveness of a health promotion campaign is likely to be REDUCED by the use of strong fear appeal. It produced the least change in behaviour.

30. Why do you suppose this is?

31. HEALTH PROMOTION REBELLION HEALTH PROMOTION CAMPAIGN USING FEAR APPEALS AND SHOCK TACTICS DENIAL FATALISM RECALCITRANCE

32. Now evaluate this study

33. HEALTH PROMOTION Yale Model of Communication: A good health promotion must have clear and effective communication for it to reach a wide audience. Hovland, 1953,working with other researchers investigated the features of good communication that make it persuasive and effective. The general findings were summarised by Zimbardo in 1977 but the model is named after the university, hence the YALE MODEL OF COMMUNICATION.

34. List some things you think are important when trying to put across a persuasive message • Think about adverts. What elements make a difference to their effectiveness?

35. Yale Model of Communication SITUATION TARGET MESSAGE M E D I U M SOURCE Credible One / two Personal Audience School/ work Expert sided General knowledge community Trustworthy Clear, direct, Print, t.v sympathy In home, vivid radio public.

36. Now its YOUR turn! I would like you to evaluate TWO examples of Health promotions. • For EACH promotion you will need to decide if it a) Follows the Yale model; b) Uses fear arousal; c) Increases perceived susceptibility; d) Increases self efficacy; e) Highlights the BENEFITS of a particular behaviour. • Give a mark out of 10 for how well the health promotion uses each of these concepts. Which health promotion is the most effective?

37. FOOD AND HEALTH PARTNERSHIP , UK Produced and evaluated a “Healthy Eating” programme for pre-school children. PROGRAMME • Series of three minute videos, shown at snack time in nurseries. • Children given the foodstuff featured in the video as a snack. Those that ate the food given a wall-chart as a reward. • Child receives a prize when wall chart complete. • (Operant conditioning)

38. HEALTH PROMOTION in SCHOOLS, WORKPLACE and COMMUNITY Food and health partnership evaluated the effectiveness of the programme on two classes in a multicultural school within an area of high poverty. EXPERIMENTAL GROUP: Received above programme CONTROL GROUP: No intervention. DATA COLLECTION: interviews and questionnaires with nursery workers and anecdotal evidence from parents. Children’s eating habits before, during and after intervention were studied. Teachers reported day to day improvements in eating in the exp group but not the control group. Parents reported children in exp group more adventurous in their eating habits at home.

39. HEALTH PROMOTION in SCHOOLS, WORKPLACE and COMMUNITY Johnson and Johnson “LIVE for LIFE”, 1978 Aim: Programme to improve employees health knowledge, stress management, encourage health behaviours. Sample: 31,000 employees Programme: Health screen for EACH employee, lifestyle seminar, action group, follow up contacts. J&J also provided a gym, no smoking areas and healthy eating options. Evaluation of Johnson and Johnson “LIVE FOR LIFE” campaign. (Stanford University HEALTH PROJECT, 1983) J&J employees from various sites, divided into three groups. Group 1: Employees from sites with LFL programme running for 30+ months in by Dec 31 1983. Group 2: Employees from sites with LFL programme starting between 1 Jan 1979 to 30 March 1981. Group 3: Employees from sites with no LFL programme running. OUTCOME MEASURES: Mean inpatient costs, Hospital Admissions / 1000 employees, Hospital days / 1000 employees, Outpatient costs. RESULTS: 92% higher average inpatient hospital costs for group 3. Average 20.4 more hospital days / year / 1000 employees for group 1 and 2 compared to 35.4 more hospital days / year.

40. Stanford three-city project ‘What three cities?’ I hear you cry........

43. wATSONVILLE

44. HEALTH PROMOTION in SCHOOLS, WORKPLACE and COMMUNITY STANFORD THREE CITY PROJECT AIM: To promote health behaviours to reduce heart disease. SAMPLE: Residents from three cities in the USA PROGRAMME: CITY 1: Promotion of behaviours to reduce heart disease including a mass media campaign, school based health education and screening programmes in the work place to provide early warning CITY 2: All of the above + one to one counselling for individuals identified as being at risk CITY 3: No intervention (control) EVALUATION (Farquhar et al, 1985) Residents interviewed before, during and after two year project. Researchers assessed health knowledge and risk of heart disease. Initial evaluation showed factors linked with heart disease INCREASED in control city and DECREASED in other two. Further evaluation showed residents in City 1 showed increases in health knowledge BUT little change. Residents in City 2 showed dramatic increase in actual health behaviour. Researchers found intervention particularly helpful in minority groups.

45. HEALTH PROMOTION YALE MODEL OF COMMUNICATION Useful when designing a health promotion CONDITIONING Do any of the promotions involve reward? i.e. use POSITIVE REINFORCEMENT KEY CONCEPTS: SELF EFFICACY ALL effective health promotions aim to INCREASE self efficacy HEALTH BELIEF MODEL How does the promotion fit in with HBM? Does changing our perceptions actually change our behaviour?

46. USEFULNESS How useful / effective was each promotion? ETHICS Do we have the right to impose health behaviours on individuals? ISSUES SCREENING Problems and issues? INTERNET Mass access to medical info DATA COLLECTION Which studies use self reports/ were any other methods used?