Friday, September 01, 2006

Methods of Promoting Health

Health promotion is any event, process or activity which facilitates the protection or improvement of the health status of individuals, groups, communities or populations. Its objective is to prolong life and to improve quality of life, that is to prevent or reduce the effects of impaired physical and/or mental health on those individuals who are directly (e.g. patients) or indirectly (e.g. carers) affected. Health promotion includes both environmental and behavioural interventions.

Environmental interventions target the built environment (e.g. fencing around dangerous sites) and involve legislation to safeguard the natural environment (e.g. maximum water pollution targets) as well as the production of goods (e.g. the ban on certain beef products). Behavioural interventions are primarily concerned with the consequences of individuals' actions. Behavioural interventions include raising awareness and knowledge about health hazards, teaching technical (e.g. how to floss one's teeth; how to use a condom) and social skills (e.g. how to say no to drugs; how to negotiate condom use), as well as cognitive behavioural techniques (e.g. how to practise progressive muscle relaxation; how to re-focus one's thoughts). All of these measures require the active co-operation of those who benefit from them and the use of persuasive and effective communication.

There are three main approaches to promoting health, all of which use a number of methods to aid in this process-

Behaviour change approach

  • Objective: To bring about changes in individual behaviour through changes in individuals' cognitions.
  • Aim: To increase individuals' knowledge about the causes of health and illness.
  • Process: Provision of information about health risks and hazards.
  • Assumption: Humans are rational decision-makers whose cognitions inform their actions.

Methods used -

Provision of information: The central idea here is that if people are provided with accurate information they will make informed and rational decisions concerning their health behaviours. A good example of how this can work is provided by Cowpe (1989). He reported how, when asked about chip pan fires, people claimed that they always adopted safe practices, although fire brigade statistics, and the ideas which the survey uncovered, showed that this was not always the case. Consequently, the television advertising campaign which was developed took a different tack, showing a dramatic sequence of pictures which showed exactly how these fires develop and how people should deal with them. The adverts ended with a simple statement, such as, 'Of course, if you don't overfill your chip pan in the first place, you won't have to do any of this.' By comparing fire brigade statistics for the areas which had received the advertisements and those for the areas which had not, the advertisers found that the advertisements had produced a 25% reduction in the number of chip pan fires in some areas, with a 12% reduction overall. Surveys taken after the series of advertisements showed that people had more accurate knowledge about what they should do in the event of a chip pan fire than before.

Fear campaigns: According to the health belief model, people are likely to practise healthful behavior if they believe that by not doing so they are susceptible to serious health problems. In other words, they are motivated by fear to protect their health. How threatening should the warning be? There is some controversy about this. Irving Janis (1984) has argued that each person and circumstance has an optimal level of fear arousal to motivate a change in attitude or behavior. Too much fear may stimulate the person to use intrapsychic processes to cope—by ignoring, minimizing, or denying the threat. For example, Janis and Feshbach (1955) divided college students into three groups and gave them messages designed to produce low, medium or high fear about the relationship between teeth brushing and gum decay. The most effective message was moderate fear appeal when accompanied by instructions on effective tooth brushing. High fear, it would appear, tends to have a negative effect on behavioural change.

In two more recent studies. Job (1988), and Self & Rogers (1990) explored the use of fear in health promotion. Job's report concluded that fear-provoking messages detailing the unpleasant consequences of a behavior are unlikely to change it. Self and Rogers found that attempts to frighten people, without reassuring them about their ability to cope, had a negative effect on their health behaviors. Job contended that fear can be useful under the following certain circumstances: the people are fearful before they receive the health communication; the fear-arousing event appears imminent; specific guidelines are provided on what behaviors one should perform to reduce the fear; the people begin with a low level of fear that can realistically be reduced by performing a desirable health-related behavior; and a strong possibility exists that reducing fear and a strong possibility exisis. Carefully designed campaigns can include these elements, but Job concluded that positive reinforcement is probably more effective than the use of fear.

Changing behaviours: Behavioral methods focus directly on enhancing people's performance of the preventive act itself. These methods include providing specific instructions or training for performing the behavior, calendars to indicate when to perform infrequent preventive actions, and reminders of appointments. Research has shown that these techniques enhance the effectiveness of programs for health promotion (Kegeles, 1983; Winett, King, & Altman, 1989). Behavioral methods in health promotion also include manipulating the consequences of people's health-related behavior, particularly by providing reinforcers for practicing preventive action, such as giving praise for adopting healthy behaviours in school.

Self-empowerment approach

  • Objective: To empower individuals to make healthy choices.
  • Aim: To increase control over one's physical, social and internal environments.
  • Process: Participatory learning techniques.
  • Assumption: Power is a universal resource which can be mobilized by every individual.

Methods used: These can include role play, social skills training, and self-awareness raising. Examples of these are seen in a range of HIV-preventive interventions for young people that have been informed by a self-empowerment rationale (Abraham and Sheeran, 1994). These include rehearsal of communication and interaction sequences which might be involved in condom purchase or sexual negotiation, questioning and challenging sexual scripts which do not allow space for negotiation of contraceptive use, peer education programmes, as well as group-based cognitive-behavioural programmes aiming to identify and then modifv personal obstacles to HIV prevention.

Collective action approach

  • Objective: To improve health by addressing socio-economic and environmental causes of ill health.
  • Aim: To modify social, economic and physical structures which generate ill health.
  • Process: Individuals organize and act collectively in order to change their physical and social environments.
  • Assumption: Communities of individuals share interests which allows them to act collectively.

This is a very different approach to health promotion than those outlined above, because it works on a community rather than individual level, thus the methods employed are varied and not easy to encapsulate. However according to Raeburn and Rootman (1998), the process of community development contains seven steps, which for our purposes can be viewed as a series of methods:

  1. Participatory formulation of a philosophy of action and overall objectives.
  2. Participatory planning of action through community needs assessment.
  3. Consensual setting of time-limited goals.
  4. Consensually agreed resource plans.
  5. Allocation of tasks and actions to as many participants as possible.
  6. Regular review of all major project goals and processes in a public forum.
  7. Periodic assessment of outcomes.

A good example of this process in operation is the Junkiebonden, a federation of Dutch self-help groups, who's aim is to initiate community change through campaigning for the modification of local and national drug policy. The Junkiebonden was involved in the setting up of the first syringe exchange in the Netherlands in 1984. Since then, it has distributed education and prevention materials to drug users and sex workers through outreach techniques. The Junkiebonden was set up from within the drug-using community and is run predominantly by current drug users. This was a grass-roots initiative which did not require external facilitation. Evaluation of the needle exchange programme in Amsterdam has been positive. Since the establishment of the needle exchange network, the number of injectors has remained constant whilst the number of people joining treatment schemes has increased. The rate of infections decreased.

(Marks et al, 2000)


Blogger aliena josph said...

Health promotion is the process of enabling people to increase control over, and to improve, their health. It moves beyond a focus on individual behaviour towards a wide range of social and environmental interventions.

12:14 AM

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3:52 PM


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