Interventions and Public Health

Question 1

Identify what is meant by a universal prevention intervention.

Answer 1

• Interventions aimed at everyone.
• Public health campaigns are usually universal (although they may have elements of being more selective).

Question 2

Identify what is meant by selective prevention interventions.

Answer 2

• aimed at groups who may be particularly at risk.

Question 3

Identify what is meant by indicated prevention interventions.

Answer 3

• aimed at people already showing early signs of symptoms.

Question 4

What are Public Health Campaigns?

Answer 4

• interventions that raise public awareness of important health issues.
• Encourage the public to adopt behaviours which promote good health
• Encourage the public to avoid behaviours which may be damaging to health.

Question 5

State examples of behaviours that may be damaging to health.

Answer 5

• Exercise
• Nutrition
• Stress reduction
• Health screening
• Using available health services appropriately

Question 6

What is the meaning of a policy?

Answer 6

Related to the goals of a government or society.
Outlines what a government intends to do (and what it does not intend to do) and what it wants to achieve.
Develops the methods and principles for achieving it’s goal.
Involves documents, not laws, although it may lead to new laws.

Question 7

What is meant by a Law?

Answer 7

A set of standards, principles, and procedures that must be followed in society.
Used for implementing and maintaining justice in a society.
Many different types including criminal law, civil law, international law etc

Question 8

Identify the advantages of Public Health Campaigns.

Answer 8

Reaches lots of people
Changing social norms
More targeted campaigns may miss people
Can be backed up by laws, policy etc.

Question 9

Identify the disadvantages of Public Health Campaigns.

Answer 9

Difficult to measure the effectiveness
Does it really reach everyone equally?
Difficult to change behaviour
Not individualised
Does education work?
Does fear arousal work?
Expensive

Question 10

Describe an example of a Public Health Intervention to change behaviour.

Answer 10

NHS Health Development Agency (2004)

Increasing knowledge and awareness of risks or knowledge and awareness of services to help prevent risks.

Changing attitudes and motivations

Increasing physical or interpersonal skills

Changing beliefs and perceptions

Influencing social norms

Changing structural factors and influencing the wider determinants of health.

Influencing the availability and accessibility of health services.

Question 11

What is most effective?

Answer 11

NHS Health Development Agency (2004)

Using theoretical models in developing interventions.

Intervening at multiple levels when appropriate.

Targeted and tailored, making use of needs assessment or formative research.

Providing basic, accurate information through clear, unambiguous messages.

Using behavioural skills training, including self-efficacy.

Joining up services with other community provisions.

Working with community members as advocates of appropriate services.

Providing alternative choices and risk reduction rather than simply telling people not to do something.

Addressing peer norms and social pressures

Question 12

Describe the Theory of Planned Behaviour (Ajzen, 1991) (Social Norms).

Answer 12

The core variables (attitude, subjective norms, and perceived behavioural control) shape an individuals intentions regarding whether or not to engage in a certain behaviour or not.

Our behavioural intentions are the thing most likely to determine whether or not we actually do engage in a behaviour or not.

Factors which impact on whether I will change my behaviour include my perceptions of whether valued others think I should perform the behaviour, as well as my own motivation to comply with the beliefs of others.

Question 13

Describe the Theory of Normative Social Behaviour (Rimal and Real, 2005) (Social norms)

Answer 13

Behaviour can be changed via normative mechanisms including:

An individuals belief about the prevalence of a behaviour (descriptive norms).

An individuals belief about what they feel they should do based on others expectations e.g. beliefs about the importance of social approval (injunctive norms).

Question 14

Outline the history behind the seatbelts (The Royal Society for the Prevention of Accidents)

Answer 14

1930s: Several US doctors equip their own cars with seat belts

1955: Society of Automotive Engineers (SAE) appoints Motor Vehicle Seat Belt Committee

Late 1950s – early 1960s: Car manufacturers started to offer seatbelts as optional extras in cars

1962: ‘Which?’ strongly advocated belt wearing, revealing that a “first survey” of their effectiveness in Britain showed they would reduce the likelihood of death and serious injury by 60%.

1965: compulsory to fit seat belts in the front of cars built in Europe BUT not compulsory to wear

1970s: first TV commercials

Question 15

Outline the history behind the seatbelts (The Royal Society for the Prevention of Accidents)
1970s - 2000

Answer 15

1970s: first TV commercials BUT no substantial increase in seat belt wearing

1983: compulsory for drivers and passengers to wear seat belts for a three-year trial period.

1986: Both Houses of Parliament vote overwhelmingly in favour of the requirement to wear seat belts becoming permanent at end of 3 year period

1987: cars having rear seatbelts becomes compulsory (but not wearing them)

1991: Wearing rear seat belts becomes compulsory

2000: Think! Was officially established as the governments road safety campaign

Question 16

What are the impacts of not wearing seatbelts

Answer 16

Department of Transport data shows the percentage of people who died in road traffic
accidents and were not wearing seat belts

rose from 19% in 2013 to 27% in 2017

Young people, rear seat passengers, short journeys still leading to lower seat belt wearing

Question 17

Has the introduction of seatbelts encouraged people to use them?

Answer 17

no, low seat-belt wearing rates (Dept of Transport, 2008):

Young men, and men in general

Rear-seat passengers

Goods vehicle and company car drivers

Journeys taken late at night or early in the morning

People driving in urban areas with relatively low speed limits.

Question 18

Define epidemiology

Answer 18

Research into the distribution (e.g. frequency or pattern) and causes of health-related states and events (not just diseases) in different populations.
Many psychologists conduct epidemiological research

Question 19

What do Think! Campaigns commonly target? (Targeted campaigns)

Answer 19

Wearing rear seat belts (Julie)
Young people (Backwards)
Short journeys in low speed limit areas
Men

Question 20

Psychological principles at work

Answer 20

Emotive
Social norms
Targeting

Question 21

Evaluate Think!

Answer 21

The Think! Campaigns aimed to meet 2010 objectives for reducing road deaths and injuries by 40% for adults 50% for children

Achieved target of reduction of road deaths and serious injuries by 40% (50% for children)

Compared with the 1994-98 average by 2010 number killed or seriously injured 44% lower (children 61%)

Question 22

Evaluate the Think! seatbelt campaign

Answer 22

Department for Transport (2009): Survey of 1956 people aged 15+

84% of respondents recognised at least one of the adverts used in the campaign.

41% of respondents reported that the adverts made them think they should always wear a seatbelt.

11% of respondents agreed the advert was aimed at ‘people like me’.

8% increase in the proportion of 17-34 year olds (19%) who spontaneously mentioned death as a likely consequence of not wearing a seatbelt.

5% increase in the proportion of 17-34 year olds (16%) who spontaneously mentioned serious injury as a likely consequence of not wearing a seatbelt.

70% of adults completely agreed that it was dangerous not to use a seatbelt in the front of a car – lower than at pre-campaign baseline.

85% of adults strongly disagreed that it is safe to travel at 30mph without a seatbelt in the rear of a car – 8% lower than at pre-campaign baseline.

Increase in the proportion of both front and rear seat passengers who said they did not always wear a seatbelt.

No change from pre-campaign baseline in the proportion of drivers who said they did not always wear a seatbelt when driving.

Question 23

What are confounding variables?

Answer 23

An outside influence which may alter the relationship between the variables you are trying to look at in your research (e.g. between your independent and dependent variable).

Question 24

What are confounding variables in the case of seatbelts and road safety?

Answer 24

Confounding variables are anything which might have affected road safety or seat belt wearing other than the Think! Campaign between 1994 and 2010.

Achieved target of reduction of road deaths and serious injuries by 40% (50% for children) between 1994 and 2010

BUT

although increases in some beliefs of the dangerousness of not wearing a seatbelt

Decreases in other areas AND more adults saying that they didn’t always wear their seatbelt

Difficulty of evaluation due to confounding variables

Too many things changing at once!

Question 25

What is Head Start?

Answer 25

A national intervention which provides comprehensive services to low-income children and families across the US

Launched in 1965 (just after Perry Preschool), expanded in 1981 and 2007

Not to be confused with UK Headstart programme

Early childhood education

Health

Nutrition

Parental involvement services

Question 26

Describe Zigler and Styfco (1994) (Head Start)

Answer 26

Is the Perry Preschool Better than Head Start? Yes and No

Programmes often confused with each other, even though one is a research project and one a public health intervention

Policy makers used research from the Perry Preschool to justify spending on Head Start, misattributing the success of Perry Preschool to Head Start; lack of transparency

After time this backfired and Head Start portrayed as a ‘scam’ living on borrowed fame (Hood, 1992)

Question 27

Evaluate Head Start

Answer 27

Clear, transparent evaluation politically important for survival of public health interventions.

Great that results of Perry Preschool were used to justify Head Start
We want public health campaigns to be based on good research

BUT

Need to be clear and transparent about where research results come from

The survival of public health programmes is political – one side of government may decide to scrap predecessors programmes

It is only be having excellent research and public support that programmes can survive.

Question 28

Further Evaluation of Zigler and Styfco (1994)
Head Start Evaluation

Answer 28

More recent research: Zigler and Styfco’s predictions were correct

If Head Start programmes incorporate best practice from new research evidence they can have long term impact

Welsh et al. (2020): increased social adjustment, academic engagement, and parent involvement throughout elementary school (age 10)

Morris et al (2018): substantial variation between head start sites

Question 29

Explain Free Early Years Provision

Answer 29

All 3 to 4-year-olds in England can get free childcare hours (usually taken as 15 hours a week for 38 weeks)

2 year olds also can access free childcare if
Parents/guardians are in receipt of benefits (e.g. income support)

They are looked after by a local authority
They have a statement of special education needs (SEN) or an education, health and care (EHC) plan

They get Disability Living Allowance

They have left care under an adoption order, special guardianship order or a child arrangements order

Question 30

Identify Complimentary intervention analysis types

Answer 30

Intention to treat:

The impact of offering the intervention
Analyse EVERYONE who was offered the intervention

As per protocol/as treatment:

The impact of receiving the treatment
Analyse only those who completed the treatment as intended/laid out in the intervention protocol