2h Principles and Practice of Health Promotion Flashcards
What is the Dahlgren and Whitehead (1991) ‘Policy Rainbow’?
The Dahlgren-Whitehead rainbow is a model for determining health inequalities that maps the relationship between the individual, their environment and health
GIve an example of a document that suports the concept of social detemrinants of health, and which factors does it mention.
The WHO Solid Facts document (2003).
Commented on key social determinants, giving health policy suggesitons of how to manage them.
The Global Strategy of Health for all by the Year 2000 (HFA 2000).
All citizens of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life
What is the Commission on Social Determinants (CSDH)?
A 2005 WHO initiative that aimed to assemble and promote effective, evidence based models and practices; to support countries in placing health equity as a shared goal across governments and other sectors of society, and to build a sustainable global movement. ‘A major thrust of the commission is turning public health knowledge into political action’.
I.e. It aimed to enable governments to practically act on the social determinants of health.
What are the methods of behaviour change?
The medical model is based on the prevention of disease (illness/’negative health’) as an entity of the host individual with a focus on the biomedical model of health combined with a philosophy of compliance with professionals’ diagnosis and prognosis - usually the doctor.
The educational model is based on the view that the world consists of rational human beings and that to prevent disease and improve health you merely have to inform or educate people about the remedies and healthy lifestyles and as rational human beings they will respond accordingly.
The social model is based on a view that health is determined by the social/cultural and physical environment and hence the solutions are more fundamental and political, and people need to be protected from health disabling environments.
For example, a professional strictly following the medical model, will determine hyperlipidaemia and hypertension as causes of heart disease, whereas a social epidemiologist may consider stress, poor living and working conditions as main contributory factors for heart disease.
What are the key principles of health promtoion and give an example of a document/legislation that details these?
The WHO (1984) document on concepts and principles of health promotion, and the Ottawa Charter (1986) define the principles of health promotion as:
Involving the population as a whole in the context of their everyday life, rather than focusing on people at risk for specific disease.
Directed towards the action on the determinants or causes of health; requiring co-operation between sectors and government responsibility
Combining diverse, but complementary, methods or approaches; including individual communication and education as well as legislation and fiscal measures, organisational and community development
Effective and concrete community participation
Involvement of health professionals, particularly in primary health care
What are the WHO’s priorities for 21st century health promotion (Ottowa Charter)?
Promote social responsibility for health
Increase investment in health development
Consolidate and expand partnerships for health
Increase community capacity and empower the individual
Secure an infrastructure for health promotion
Why should you use a model or theroy when designing a behaviour change intervention?
There is substantial evidence that the use of theory in designing and implementing health promotion programmes improves the effectiveness of interventions.
Which behaviour change models relate to the theories that explain health behaviour and health behaviour change by focussing on the individual
Health Belief Model
Theory of Reasoned Action / Planned Behaviour
Transtheoretical (Stages of Change) Model
Social Learning Theory
Which behaviour change models relate to the theories that explain the change in communities and community action for health
Community mobilisation
Diffusion of Innovations
Which behaviour change models relate to the theories that guide the use of communication strategies for change to promote health
Communication for behaviour change
Social marketing
Which behaviour change models relate to the models that explain changes in organisation and the creation of health-supportive organisational practices
Theories of organisational change
Models of intersectoral action
Which behaviour change models relate to the models that explain the development and implementation of healthy public policy
Ecological framework for policy development
Determinants of policy making
Indicators of health promotion policy
What is the Health Belief Model (HBM)?
Explains how the likelihood of taking action on a particular health problem is dependant on four different types of beliefs or perceptions. It predicts that protective or health promoting actions depend on the extent to which individuals:
Believe they are susceptible to the problem (susceptibility)
Believe that the problem has serious consequences (severity)
Perceive the benefits of the specified actions (benefits)
Believe that the benefits to action outweigh the perceived costs (barriers)
Disadvantages:
A psycho-social model and so can only account for those aspects of behaviour that can be explained by attitudes and beliefs.
Advantages:
Shown to be useful in certain types of interventions i.e. uptake of screening and immunisation,
What is the Theory of Reasoned Action?
The Theory of Reasoned Action was developed to explain behaviours under voluntary control and assumes that people are rational and that the intention to act is the most immediate determinant of behaviour.
This was later updated to the theory of planned behaviour.
What is the theory of planned behaviour?
Follows on from the Theory of Reasoned Action. Predicts that a person is more likely to change behaviour if they believe the behaviour will improve their health, is socially desirable and there is social pressure to change, and that they feel they have personal control over the behaviour and the ability to change.
What is the Stages of Change (Transtheoretical) model?
A model that describes different stages of motivation to change behaviour and indicates the need for different processes of change to support movement between stages. Behaviour change is not seen as a result of a single cognitive decision, but a series of steps.
Precontemplation
Contemplation
Determination, or preparation
Action
Maintenance
Relapse
It also recognises that individuals may relapse and go back around the cycle again.
Advantages:
Influential in the design of smoking cessation programmes.
Practical for clinicians in clinical settings
Recognises relapse is not a failure
Disadvantages:
Further refinement of change processes and how they are operationalised in stage-matched interventions is needed.
What is the social cognitive theory?
Social Cognitive Theory (also known as Social Learning Theory) attempts to embrace the subtle and complex relationships between people and their environment, and the social and environmental influences on their actions. Identifying the role of role models and social influences on health promotion.
For example, in the absence of legislation about smoking, if non-smokers are sufficiently assertive about not smoking it becomes more likely that a smoker will modify their behaviour. Thus the social influence has impacted on the individual’s choice.
Advantages:
Shows that the modification of social norms is a powerful health promotion tool.
WHat is motivational interviewing?
An approach to behavioural counselling aimed at fostering the individual’s desire to change.
It uses the Stages of Change model, recognising that at different stages people are in a different frame of mind about the behaviour concerned and have different motivations to change.
There are 5 key principles:
Create a warm, comfortable and relaxing atmosphere
Give clear and concrete feedback to the patient about his behaviour, motives and personal situation
Structure and provide choice alternatives concerning the risk behaviour and its related problems
Stay in contact with the patient
Actively listen to the patient
It has 3 main phases:
The ‘eliciting phase’ - Aims to get the individual to state their concerns and see that change is necessary.
The ‘information phase’ - When the patient is actively interested in their health and is seeking further information.
The ‘negotiation phase’ - Focuses on what the patient wants to change, the means of achieving it and where to begin.
What is the evidence base for motivational interviewing?
There is little evidence for the specific efficacy of ‘motivational interviewing’ as a technique.
Although there is evidence that a structured interviewing approach is more effective than an ad hoc one, (Dunn et al , 2001 and Maguire et al, 2001: cited in West et al, 2003)
When is motivational interviewing most effective?
Motivational interviewing is most appropriate for people at the contemplation stage when they are in conflict with their behaviour and are weighing the balance of ‘to change or not to change’.
Motivational interviews may end with the individual feeling more motivated to think more about changing a behaviour, for others it may lead to making a decision to change, dependant on how ready they are.
What are the key communication techniques used in motivational interviewing?
Motivational interviewing uses four key communication techniques:
Open questions
Reflection
Summarising/restructuring
Provoking / devil’s advocate
What is the Diffusion of Innovation Theory?
The diffusion of innovation theory looks at the way that new ideas are adopted by communities. It notes that different innovations will take different times to disseminate through a population, and some may never penetrate fully. It describes five factors that determine the speed of innovation diffusion:
* The characteristics of the potential adopters
* The rate of adoption
* The nature of the social system
* The characteristics of the innovation
* The characteristics of change agents
It classifies people (Adopters) by the time it takes them to adopt the innovation and their distribution in the population matches the normal probability distribution curve.
* Innovators are the 2-3% of the population quickest to adopt new ideas
* Early adopters are the 10-15% of the population who may be more mainstream within the community but are most amenable to change.
* The early majority are the 30-35% of the population who are also amenable to change and have become persuaded of the benefits of adopting the innovation. The late majority, (30-35%) are sceptics and are generally reluctant to adopt new ideas until the benefits have been established.
* Laggards are the 10-20% who are most conservative and may be actively resistant to new ideas. However, of course it may also be that these are the least able to change due to poor financial, social and personal circumstances. This can be plotted as a classic S-shaped diffusion curve.
Example:
Many western countries have reached a stage where the majority of the public are in favour of a ban on indoor smoking. The idea of the non-acceptability of smoking in public places has therefore reached the ‘late majority’ stage.
In health promotion terms, attention needs to be paid to ways of maximising diffusion rates, and utilising appropriate strategies to engage and sustain different groups at different times.
What is the communication-behaviour change model?
A model aiming to guide public education campaigns.
It is based on communication inputs and outputs designed to influence attitudes and behaviour and can be helpful in conceptualising and designing mass communication strategies. Focusing on 5 criteria:
* Source - the person or organisation from whom the message is perceived to have come. The source can influence the credibility, clarity and relevance of the message.
* Message - what is said and how it is said eg using fear or humour for different audiences
* Channel - medium through which it is delivered eg TV, radio print, or more recently email and text messaging
* Receiver - the intended target audience. Matching the right message to the right segment of the audience
* Destination - desired outcome of the communication, change in attitudes, beliefs or behaviour.
Disadvantages:
The model focuses on mass education campaigns, which should be used as part, but not the whole, of a behaviour change campaign.
What is social marketing?
The use of marketing principles and techniques to advance a social cause, idea or behaviour
What are the differences between social and commericial marketing?
Commericial:
What does it sell - goods or services
Primary aim - Financial gain
Target - Those that will provide greatest profitable volume of sales
Competition - Other organisations offering similar goods or service
Social:
What does it sell - Behaviour change
Primary aim - Individual or societal gain
Target - Segments selected on basis of prevalence of social problem, ability to reach audience, readiness for change
Competition - The current or preferred behaviour
What are the similiarities between social and commericla marketing?
Customer orientation - the offer (4Ps - product, price, place and promotion) needs to appeal to target audience
Exchange theory fundamental - benefits must equal or exceed costs
Marketing research used throughout
Audiences are segmented according to wants, needs, resources and current behaviours
All 4Ps considered, not just relying on advertising
Results are measured and used for improvement
What criteria should be met for effective social marketing?
Behavioural goals
Interventions should seeks to impact an individual or group behaviour. Behavioural goals need to be measurable and related indicators identified
Consumer research and pre-testing
Requires formative market research to identify audience characteristics and needs. Pre-testing and development integrated and range of sources used
Insight driven
Based on identifying and developing actionable insights rather than just data/intelligence. Focus on deep understanding of what motivates the consumer/citizen
Theory-based and informed
Theory drawn from different disciplines, and used to inform selection and development of appropriate intervention
Segmentation & targeting
More than simple demographic or epidemiological targeting, use of psycho-graphic data. Interventions tailored directly to audience segments
Marketing mix
Range of methods and approaches used to enhance impact
Exchange Full analysis of costs/benefits to consumer. Attention to incentives and barriers, and maximising benefits of behaviour change
Competition
Consideration given to internal and external competition, including personal appeal of competing behaviours and external reinforcement. Consideration of impact of other interventions competing for attention of audience.
What are the key components of a communication?
Tones and Green (2004):
A sender (communicator or source)
A message - this may take three forms, ‘symbolic’ meaning spoken or written language; ‘iconic’ referring to pictorial or diagrammatic representations, and ‘enactive’ describing situations where communication requires the active involvement of the audience
A receiver (audience)
Which factors of a risk impact whether someone will see it as “risky”
Whether the risk is:
Voluntary vs. coerced (eg working in a nuclear plant vs. living in a nearby village)
Natural vs. industrial (eg sun radiation vs. telephone antennas)
Familiar vs. not familiar (car driving vs. canoeing)
Not dreaded vs. dreaded ( eg high blood pressure vs. cancer)
Chronic vs. catastrophic (car accidents vs. airplane accidents
Fair vs. unfair (riding a motorcycle at high speed vs. a pedestrian being hit by the same motorcycle)
What is the prevention paradox?
Many interventions that aim to improve health have relatively small influence on the health of most people. Thus for one person to benefit, many people will have to change their behaviour and receive no benefit from these changes.
What are the types of health promotion?
High-risk approach - Aims to identify those at highest risk and intervene to lower individual risk
Popultion approach - Aims to lower the mean level of risk in the population and shift the distribution of risk
What are the advantages and disadvantages of the high risk approach to health promotion?
Disadvantages:
Difficulties and costs of screening
Not radical, does not address causes
Limited potential for population health improvement
Does not address social norms that frame health behaviour
Advanatages:
Intervention appropriate for individual
Patient motivation high
Staff motivation also high
Can be cost-effective
Benefit-risk ratio higher for individual
What are the advantages and disadvantages of the population approach to health promotion?
Disadvantages:
Only a small benefit for the majority of individuals - (prevention paradox)
Poor motivation to comply
Possibly poor motivation of professionals due to less perceived effect
Individual benefit-risk ratio may be a concern
Advantages:
Seeks to remove root causes
Large potential for whole population improvement
Seeks to shift population norms
What are community interventions?
There is a distinction between ‘community-wide interventions’ and ‘interventions-in-community’.
community-wide interventions generally attempts to make changes that affect individuals through population wide interventions, if using multiple approaches these would be complex community interventions.
Interventions- in-community tend to operate on sub-groups within specific settings and may employ simpler methods.
What is Transfer evaluation?
Assesses the replicability of a project’s mechanisms/processes and outcomes, can they be transferred to another setting or population and achieve the same effects?
What are the principles of good healthcare promotion evaluation?
4 key points:
* Participation - at each stage of evaluation those with an interest should be involved. These can include policy-makers, community members and organisations, health and other professionals, etc.
* Multiple methods - evaluations should draw on a variety of disciplines and employ a broad range of information gathering procedures
* Capacity building - evaluations should enhance the capacity of individuals, communities, organisations etc
* Appropriateness - evaluations should be designed to accommodate the complex nature of health promotion interventions and their long term impact
Other suggestions:
Health promotion initiatives should be evaluated in terms of their processes as well as their outcomes.
The use of randomised controlled trials to evaluate health promotion initiatives is, in most cases, inappropriate, misleading and unnecessarily expensive.
What are the steps in planning a health promotion evaluation?
1) What are the aims and objectives of my project? (Are these evaluable, what about the wider impact)
2) What are my research questions? (These will determine the indicators and methods used)
3) How is the project expected to work? (The theory base)
4) What do I want my evaluation to do? (Process/formative evaluation or outcome/summative evaluation?)
5) Who are the main groups and individuals involved in this project?
6) Who is my evaluation for? (The ‘audience’ may the project funders or community members, and this may affect choice of evaluation measures.)
What models can be used to assess health promotion interventions?
An outcome model for health promotion (Nutbeam, 1998).
Gives all key areas where a health promotion intervention may have an impact, allowing for a better understadnign of the benefits gained overall.
What frameworks can be used to assess a health promotion intervention?
Wimbush & Watson (2000)
What is the theory of realistic evaluation?
Outcomes = Mechanisms + Context
What is the theory of change and how can it be used in healthcare promotion evaluations?
It suggests that all programmes have explicit or implicit ‘theories of change’ about how and why they will work (Weiss, 1995) Once these theories have been made explicit they can influence the design of the evaluation to ensure that it assesses whether the theory is correct when it is implemented.
Why is evidence based behaviour change difficult?
It is very hard to assess the effectiveness of a behaviour change intervention. This is because traditional gold standard studies (such as RCT and systematic reviews) are less effective at this type of assessment.
This is particularily true for upstream interventions.
What are the evidence based health promotion interventions in relation to smoking cessation and what are their sources?
Source:
Task Force on Community Preventive Services (2005) The Guide to Community Preventive Services - what works to promote health? New York, OUP
Reducing tobacco use initiation:
Increasing the unit price for tobacco products
Mass media education campaigns when combined with other interventions
Restricting minors’ access to tobacco products
Community mobilisation when combined with additional interventions
Active reinforcement of retail laws, retailer education with reinforcement
Increasing tobacco use cessation:
Increasing the unit price for tobacco products
Mass media education campaigns when combined with other interventions
Healthcare provider reminder systems, and with provider/client education
Reducing client out-of-pocket costs for effective cessation therapies
Multicomponent interventions that include telephone support
Reducing exposure to environmental tobacco smoke
Smoking bans and restrictions
What are the evidence-based health promotion interventions in relation to Food-support programmes for low-income and socially disadvantaged childbearing women in developed countries and what are their sources?
Sources:
NICE (2006) Food-support programmes for low-income and socially disadvantaged childbearing women in developed countries.
Food-support programmes aim to improve key maternal and perinatal outcomes. The lack of any significant impact on low birth weight (LBW), pre-term birth and other perinatal outcomes along with the favourable impact on maternal weight gain and nutrient intakes provide a basis both for re-thinking the aims and objectives of current food-support programmes. Setting out-of-reach goals for food-support programmes such as reduction in rates of LBW and pre-term birth is probably not useful until there is strong evidence of what works to improve those outcomes.
With respect to the primary outcome of interest, LBW, the results of this review do not provide evidence that food-support programmes have any impact. However, there are favourable impacts on other outcomes. There is indicative evidence of an increase in mean birth weight of babies born to heavy smokers, and of the beneficial impact of food support on maternal weight gain and dietary intake in a woman’s first pregnancy.
Childbearing women in the UK have diets deficient in key nutrients and those on low incomes face difficulties in feeding themselves and their children. In this respect, teenage mothers are perhaps the most vulnerable group. Programmes providing women with food supplements are likely to help them and their children to eat healthier diets. This in itself is a desirable outcome for any programme.
What are the evidence-based health promotion interventions in relation to Food-support programmes for low-income and socially disadvantaged childbearing women in developed countries and what are their sources?
Sources:
NICE (2006) Food-support programmes for low-income and socially disadvantaged childbearing women in developed countries.
Food-support programmes aim to improve key maternal and perinatal outcomes. The lack of any significant impact on low birth weight (LBW), pre-term birth and other perinatal outcomes along with the favourable impact on maternal weight gain and nutrient intakes provide a basis both for re-thinking the aims and objectives of current food-support programmes. Setting out-of-reach goals for food-support programmes such as reduction in rates of LBW and pre-term birth is probably not useful until there is strong evidence of what works to improve those outcomes.
With respect to the primary outcome of interest, LBW, the results of this review do not provide evidence that food-support programmes have any impact. However, there are favourable impacts on other outcomes. There is indicative evidence of an increase in mean birth weight of babies born to heavy smokers, and of the beneficial impact of food support on maternal weight gain and dietary intake in a woman’s first pregnancy.
Childbearing women in the UK have diets deficient in key nutrients and those on low incomes face difficulties in feeding themselves and their children. In this respect, teenage mothers are perhaps the most vulnerable group. Programmes providing women with food supplements are likely to help them and their children to eat healthier diets. This in itself is a desirable outcome for any programme.
What are the evidence-based health promotion interventions in relation to Drug use prevention amongst young people and what are their sources?
Source:
McGrath Y, Sumnall H, McVeigh J, Bellis M (2006) Drug use prevention among young people: a review of reviews Evidence briefing update. London, National Institute for Health and Clinical Excellence, January 2006
Interventions:
Programme delivery should incorporate interactive methods and include peer-led interventions.
Design and content of programmes should be based on the social influence model, include booster sessions, be delivered to those aged between 11-14 years and involve family members.
What are the evidence-based health promotion interventions in relation to Increasing physical activity and what are their sources?
Source:
Task Force on Community Preventive Services (2005) The Guide to Community Preventive Services - what works to promote health? New York, OUP
Informational approaches:
Community-wide campaigns
Point-of-Decision prompts
School-based physical education
Behavioural and social approaches:
Individually-adapted health behaviour change programmes
Social support interventions in community settings
Environmental and policy approaches:
Creation of new or enhanced access to places for physical activity, combined with informational outreach activities
Point-of-Decision prompts
What are the evidence-based health promotion interventions in relation to Preventing skin cancer by reducing exposure to UV radiation and what are their sources?
Source:
Task Force on Community Preventive Services (2005) The Guide to Community Preventive Services - what works to promote health? New York, OUP
Interventions:
Educational and policy interventions in primary schools
Educational and policy interventions in recreational and tourism settings
What are the evidence-based health promotion interventions in relation to Motor vehicle occupant injury and what are their sources?
Source:
Task Force on Community Preventive Services (2005) The Guide to Community Preventive Services - what works to promote health? New York, OUP
Increasing child safety seat use:
Child safety seat laws
Distribution and education programmes
Community-wide information and enhanced enforcement campaigns
Incentive and education programmes
Increasing safety belt use:
Safety belt laws, and enhanced enforcement
Reducing alcohol-impaired driving:
0.08% blood alcohol concentration laws
Minimum legal drinking age laws
Sobriety checkpoints
Lower blood alcohol limits for younger or inexperienced drivers
Intervention training programmes for servers (under certain conditions)
Mass media campaigns (under certain conditions)
What are the evidence-based health promotion interventions in relation to accidental injury to young people aged 15-24 and what are their sources?
Source:
Errington G, Athey K, Towner E et al. (2006) Interventions to prevent accidental injury to young people aged 15-24 London, NICE
Interventions:
Legislation and enforcement have been effective in preventing accidental injury to young people in this age range.
Interventions that use environmental measures and protective equipment have also been shown to be effective.
Stand-alone educational interventions have not been shown to be effective, but when combined with other approaches such as legislation and engineering, may be successful. However, with multi-factorial intervention programmes it is difficult to attribute the degree of success to any single element.
Road interventions such as raising the legal drinking age from 18 to 21, random breath testing, seat belt legislation, compulsory protective helmets for motor-cyclists and bicyclists, lowering the drink-driving limit (blood-alcohol concentration) and graduated driver licensing schemes have been shown to be successful.
Within the sports and leisure setting, legislative measures, such as the mandatory use of mouthguards and face protectors, and modifications to the rules of games, have been shown to be effective in reducing injuries.
What are the evidence-based health promotion interventions in relation to housing and public health and what are their sources?
Source:
NICE (2005) Housing and public health:
a review of reviews of interventions for improving health
Rehousing and neighbourhood regeneration:
Medical priority rehousing - Anxiety and depression scores are reduced in people who are rehoused on the basis of medical need.
Rehousing plus relocation from slum or socially isolated areas - rehousing people from slum areas can improve self-reported physical and mental health outcomes in the longer term (18 months), and can adversely affect self-reported health outcomes in the short term (9 months)
Housing subsidy programmes for low-income families e.g.
US rental voucher programmes can improve household safety by providing families with the choice to move to neighbourhoods with reduced exposure to violence.
Refurbishment and renovation:
Improvement in housing energy efficiency measures - housing interventions involving improvements to energy efficiency measures, such as installation of new windows, can positively affect health outcomes.
Accidental injury prevention:
Home visits to people in lower socio-economic areas plus provision of advice on home hazards, combined with health education and media campaigns, are effective in encouraging parents to make physical changes to the home environment to ensure their homes are safer.
Provision of free or discounted home safety equipment and/or educational campaigns may lead to behavioural and environmental change.
Home hazard modification interventions that seek to remove and repair safety hazards are effective in reducing falls in older people. This effect was strongest for people with a history of falling prior to intervention and men aged ≥75 years.
Community based provision of free smoke alarms (with or without installation) may reduce fire-related injuries.
Prevention of allergic respiratory disease:
Use of physical (intensive home cleaning, vinyl mattress covers, daily wet cleaning of floors, boiling of top bedding covers and removal of soft furnishing) and/or chemical measures (air filters loaded with Enviracaire and acaracide spray and cleaning products) may lead to a reduction in allergen load for those with house dust mite-provoked respiratory disease when combined with maintenance drug treatments.
What are the evidence-based health promotion interventions in relation to breastfeeding and what are their sources?
Source:
Dyson L et al (2006) Promotion of breastfeeding initiation and duration. Evidence into practice briefing.
Renfrew MJ, Dyson L, Wallace L et al. (2005) The effectiveness of health interventions to promote the duration of breastfeeding: systematic review.NICE
Interventions:
Implementation of the Baby Friendly Initiative in all maternity and community services.
Routine delivery of education and support programmes by professionals and peers
Changes to policy and practice to include effective positioning, unrestricted feeding, and supportive care
Changes to policy and practice to abandon restrictions on feeding and contact, provision of supplemental feeds
Complementary telephone peer support
Education and support from one professional
One-to-one support for the first year
Media programmes
What are the evidence-based health promotion interventions in relation to empowerment and what are their sources?
Source:
Wallerstein N (2006) What is the evidence on effectiveness of empowerment to improve health? Copenhagen, WHO Regional Office for Europe’s Health Evidence Network (HEN).
Interventions:
Increasing citizen’s skills, control over resources and access to information
Using small group efforts which enhance critical consciousness to build supportive environments and a deeper sense of community
Most effective empowerment strategies are those that build on and reinforce authentic participation ensuring autonomy in decision-making, sense of community and local bonding, and psychological empowerment of the community members themselves.
What are the key steps in implementing a health promotion intervention?
Assess need
Interrogate the evidence base for effective interventions
Identify resources
Clarify Aims
Set Targets
Set Objectives -(actions to achieve the aim)
Decide on methodology
Evaluation
Resource allocation and budget setting
Give an example of a health promotion framework that can be used to design an intervention.
European Quality Instrument for Health Promotion (EQUIHP)
Recently produced quality improvement tool based on review of existing tools and European consensus. Combines checklists and guidelines.
Getting to Outcomes (GTO)
Action steps and checklists facilitate planning. Incorporates ‘cultural competence’ throughout. Requires attention to environmental context, inc examination of relevant research and evidence. Strong focus on implementation, continuous improvement and sustainability.
Interactive Domain Model Approach (IDM) to Best Practices in Health Promotion
Structured tables for programme planning allow for individual specificity. Encourages reflection to facilitate process of ongoing programme revision. Emphasis on ethics renders it suitable for more sensitive areas of health promotion.
PRECEDE-PROCEED
‘Backwards’ approach leads to thorough problem analysis. Detailed evaluation process. Good for community-based intervention due to emphasis on individual engagement.
Preffi 2.0 Health Promotion Effect Management Instrument
Detailed explanations with support from evidence. Very strong assessment methods allowing for programme reflection and revision. Includes useful planning recommendations, esp. for large-scale programmes. Allows for flexibility, useful in variety of settings.
What is the Precede-Proceed Model?
A model based on the recognition of the multiple determinants of health.
It starts with an assessment of the quality of life and social problems, as ultimate goals, of which health is a contributory factor. It proposes a sequence of diagnostic phases that emphasise the environmental and organisational factors that influence health behaviour.
It considers the predisposing factors, those personal factors such as motivation, knowledge attitudes and beliefs; reinforcing factors, the attitudes and behaviours of role models, peers etc; and enabling factors, resources and skills etc that either support or hinder change in behaviour or environment.
The fifth phase also pays attention to the capacity for implementation of the programme of the delivery agent and its context. An interesting aspect of this model is its incorporation of evaluation steps and clear association of evaluative phases with the diagnostic phases, demonstrating the appropriate distinctions between process, impact and outcome evaluation.
This is similar to the more recent ‘theory of change approach’, which aims to clarify to those planning and evaluating community-based interventions, how the proposed actions will lead to the anticipated outcomes by making explicit the links between programme components and outcomes, that is articulating their theory of change.
What is the European Quality Instrument for Health Promotion (EQUIHP)?
A model supporting development of interventions, benchmarking and evaluation, drawn from a thorough review of existing frameworks and tools and consensus testing to facilitate cross-national comparisons and collaboration in enhancing quality (Bollars et al, 2005).
Steps:
1) Framework of health promotion principles
* This approach embraces the principles of health promotion, including a positive and comprehensive approach to health, attention for the broad determinants of health, participation, empowerment, equity and equality.
2) Project development and implementation
* Analysis - the project is based on a systematic analysis of the health problem and its determinants and of the context in which it will be implemented.
* Aims & Objectives - the aims and objectives of the project are clearly defined.
* Target Group - the group of people the project intends to influence is clearly defined
* Intervention - the strategies and methods for an effective intervention are clearly outlined.
* Implementation strategy - there is a clear description of the way the intervention will be carried out.
* Evaluation - the effects (effect evaluation) and quality (process evaluation) of the intervention will be assessed.
3) Project Management
* Leadership - a person has been designated who is ultimately responsible for and capable of managing the project
* Planning and documentation - the working plan and organisation of the project are firmly established.
* Capacity & resources - are the expertise and resources available that are necessary to implement the project successfully?
* Participation and commitment - the ways in which various parties will be involved and committed to the project is clearly outlined.
* Communication - the way in which all the participants (target group and stakeholders) will be informed about the project is clearly established.
4) Sustainability
The continuation of the project is ensured.
What is a “setting” in health promotion?
The place or social context in which people engage in daily activities in which environmental, organisational, and personal factors interact to affect health and well-being…A setting is also where people actively use and shape the environment and thus create or solve problems relating to health. Settings can normally be identified as having physical boundaries, a range of people with defined roles, and an organisational structure’
