Opposing Models in Health Promotion
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Published: Tue, 27 Mar 2018
HND Health, Diet & Nutritional Studies – Unit Four
Health promotion is provided by various organisations working together towards the same goal – overall health and wellbeing for everyone. It aims to prevent and reduce the risk of disease, manage illness, recovery and rehabilitation. Its objectives are to involve the public in their own quest for a healthier life through education and awareness, to improve services, support and continuity of care and provide a safe environment for people to live and work in with equal opportunities giving everyone the means to achieve, wherever possible, optimum health.
We know children learn from parents and teachers but if parents fail to educate their children to make healthy choices at home in an informal setting, even if teachers do so to a preset curriculum in a formal setting, it may not happen. I recall a report on a TV news channel some years ago where Jaime Oliver introduced healthy meals in schools but the parents were against the idea so they squeezed Macdonald’s burgers to them through the school fence at lunchtime because that is the type of food they had grown to know. In social learning theory Albert Bandura suggests “behaviour is learned from the environment through the process of observational learning” (Bandura A. (1977)), we all know this to be true.
Children often refuse vegetables etc when they are young but perseverance is a necessity if they are to receive the nutrients they require for a healthy, disease free life. According to the BBC Breakfast news this morning (31.05.14) researchers say that if a variety of foods are introduced to a child from a very early age and it is repeated at least ten times the child will grow up liking that particular food. Another story that springs to mind was when a friend’s husband claimed to be vegetarian, in reality as a child he could not be bothered to chew meat but his parents gave in to him and let him have what he wanted so his meals consisted mainly of egg and chips. How is it possible to teach children right from wrong when parents act this way?” The answer must be to educate them as well?”
Health education and promotion requires repeatedly conveying the message to those at risk, through media advertising, health and welfare campaigns and organised frameworks to promote change. No smoking zones, for example, takes away the freedom to participate in harmful actions in public places making people stop and think about what they are doing to themselves and others. If people understand the consequences of their actions and believe that the changes will make a difference to them and those around them they are more likely to change their habits which in turn will reduce the associated social and economic costs.
Making these practices illegal may sound like the individuals rights, liberty and freedom of movement are being taken away however the rights of their “victims” are of equal importance and it would be unethical for them to have to suffer as a consequence of another’s ignorance or selfishness e.g. second hand smoke or the cost of medical treatment for the driver of the vehicle injured as a result of an accident where he was not wearing a seatbelt.
RESEARCH AND EVALUATION
Researchers are constantly gathering information, from population surveys and health statistics etc, about people’s habits and behaviour, the environment they live in and how it affects them, their attitudes, where specific incidences are occurring, to whom and how often, they do not however, include ideas, opinions or the observations of the individual. This is known as quantitative research as it is deals with quantity i.e. the number of individuals affected and the causes contributing to health problems. Once collected the data can be divided into smaller categories e.g. demographic, lifestyle, education, ethnicity etc then used to identify where health promotion needs to be directed. This is an ongoing evaluation method with set criteria allowing statistical analysis and dissemination of informative data regarding the adequacy of service provision, number of incidences of certain diseases or where new trends are manifesting etc. and gives a “flavour” of a given situation at any one time.
Other researchers gather data from healthcare facilities and charity organisations etc based on one to one or small group contact where people and things can be observed and where changes can be made, if necessary, to try to reach the desired outcome, this is known as qualitative data. Hospital wards, clinical trials etc record the effect and outcome of “tests”, their aim is to research holistically allowing results to be seen and patterns evaluated in the short term. Once the outcome of qualitative research has been determined the results can be built upon to further improve i.e. one thing can lead to another or the what if scenario, it has been seen where researchers look for a cure for one thing then stumble across another.
Both these types of research are valuable in different ways e.g. for comparison or effect but can often be used together however, one important consideration before carrying out any research is that the researcher is competent in what his is aiming to achieve, that research will be carried out under a strict code of ethics and follows the legal guidelines laid down by the relevant authorities e.g. ensuring that there is no danger to the patient, he is fully informed about what to expect and that he is informed as to how the data will be utilised etc.
By showing people the detrimental effects of unhealthy lifestyles versus the benefits of healthy lifestyles it is possible to change their views. They have to go through what is known as the “Stages of Change” (Prochaska J.O. & DiClemente C.C. (1983)) whereby the individual has no wish or interest in changing (pre-contemplation) until an idea is sown in his mind, he begins to think about how he would benefit from change and realises the sense of it so decides to try (contemplation) he puts a plan into place (preparation). Day one arrives and he discontinues the habit (action), he is enthusiastic, he begins to see and feel the benefits encouraging him to continue (maintenance). At some stage he may falter so seeks help and support from others to keep him motivated during the difficult times. Intervention like this can come from many sources, often depending on the circumstances e.g. smokers decide they want to quit so they visit their local GP who prescribes a course of nicotine patches, he suggests contacting a local support group where individuals, who understand and have experienced the same situation, can advise and help him reach his goal and help prevent relapse, once a person sees that success is possible he will be motivated to continue.
Some of the barriers encountered in changing behavioural habits are down to individual beliefs. If someone believes he is insusceptible to a particular disease, perhaps because no family member has been affected by it he is unlikely to feel threatened but if he sees a family member suffering he is more likely to want to avoid the disease himself. On the other hand, he sees someone living with a disease who looks fine he may do nothing, this could be because he may not fully understand or believe the severity of the disease to worry about it, but when that person dies he realises the implications and decides to take preventative action because he sees living longer is better than the alternative. Again the person may require help and support to maintain the new regime because without any visible signs it can seem pointless.
Both of these models are similar in that they happen in stages, from pre-contemplation through to maintaining change, often without actually “seeing” immediate benefits and this is where continued reinforcement of the message is necessary. Individual and group methods are both effective ways for promoting health whether they are in supporting e.g. helping to overcome barriers and providing feedback or educating roles e.g. explaining and influencing ways to change behaviour but the main point is that the person must want to and believe he can change otherwise he will always find reasons not to try.
Social and Community Models
Promoting health in groups and communities relies on the collaboration of individuals to work towards the same goals within their particular environments where they can prepare for and react to situations that affect them all e.g. the recent flooding on the Somerset Levels brought everyone together to help strengthen barriers and limit damage to themselves and their properties. Their situation encompassed the social learning theory in that personal and environmental factors led to interaction by everyone affected to prevent further disaster and they came together on a community level to evaluate and plan effective strategies to solve and improve their situation. Together they organised themselves and put forward their ideas to government bodies responsible for keeping them safe and demanded policy changes to help prevent similar situations in the future along with financial funding for their loss of businesses and income.
No single model or theory is better or worse it depends entirely on the particular situation e.g. the thoughts, feelings and beliefs of individuals or the structure, regulations and policies that exist in groups, organisations or communities.
There are many other methods for communities and organisations to support, educate and effect positive change e.g. mother and toddler groups, wellness centres, school and workplace participation programmes, social networking etc. where peer and professional knowledge can be exchanged and support provided.
Many years may pass before we can confirm whether health education and promotion has helped us reach our goals because the outcomes will not be immediately apparent e.g. mortality rates due to obesity or the recent flood disasters however, we can measure if our objectives are being met through quantifying whether people have learned from the messages being conveyed by e.g. evaluating their lifestyle changes; are there fewer deaths due to heart attack or stroke? Are people safe in their environment? Has public policy changed to address the floodwater problem so that lives or property are not again put at risk in the event of heavy rains and have the measures proved satisfactory?
We must carryon educating people about the benefits of a healthy lifestyle, continue research and development and anticipate future problems in order to reduce these leeches on our society and utilise the funding in a better more rewarding way.
Health education and promotion helps people to take control of and improve their own health and wellbeing. The idea is to teach people how to prevent disease and make improvements to attain that (primary level), to understand and manage current illnesses and aid recovery and rehabilitation (secondary level) and in the case of the terminally ill to help them and their families cope with the illness and provide counselling and care services that will alleviate some of the strain (tertiary level). Health education and promotion not only deals with illness but attempts to ensure that all factors relating to overall health and wellbeing are being achieved e.g. an end to poverty.
Health education and promotion can be passed on formally or informally through a variety of sources e.g. schools, workplaces, NHS services, charities or voluntary organisations.
HEALTH PROMOTION AND EDUCATION
Teachers convey messages in a formal way by following a preset curriculum and involving students in the learning and practice with measured outcomes e.g. teaching children road safety. In the 1960’s The Society for the Prevention of Accidents “invented” a squirrel character, named Tufty, to help teach children road safety. It became so popular that there were 24,500 Tufty Clubs formed in the UK during that decade (http://www.rospa.com/about/history/tufty.aspx). Certificates and badges were awarded to children after they successfully completed the course, I will always remember the slogan (and the lesson) from those school days.
A voluntary organisation known as Hope UK (http://www.hopeuk.org) train volunteers to educate and promote the dangers of drug, alcohol and smoking addiction to all ages. Their training techniques are planned to appeal to different ages of society so volunteers attend school assemblies or youth clubs to relay their message in a fun, interesting and interactive way while adults may be taught in an informative way highlighting signs and symptoms etc. followed by a Q&A session.
Informing parents and teachers of the pitfalls of addictions, or whatever the subject may be, can strengthen the understanding of children and young people when they ask them informal questions. Sometimes it can work the other way e.g. if a child learns at school that smoking is bad for you and can affect other people he may then relay that message to a parent who is a smoker and this has been seen to make the parent stop to think about the damage it is doing to himself and his children and decide to give it up.
Schools, workplaces and hospitals are all being encouraged to offer balanced, healthy meals in their eateries and introduce a variety of social activities to help people keep moving. I watched a television programme recently where they were testing a new invention where a school or office desk can be raised so that the operator can work alternately sitting or standing as sitting for long periods is known to be detrimental to health; research and innovation I believe it is called.
It is becoming more and more fashionable nowadays to eat well and exercise more and a prime example of this is the number of sales Jamie Oliver has achieved with his books on 15 and 30 minute meals and his new one “Save with Jamie”, written in response to popular demand, which is aimed at eating healthily on a budget. We own two of these at home, we did not buy them because we do not know what to eat, but the inspiration and ideas they provide and the speed in which meals can be prepared as well as the pre-calculated nutritional balance has the hard work done for you. Celebrities are often advertising their exercise DVDs, endorsing exercise equipment and taking part in charity sporting events to encourage followers to take part.
These are examples of health education and promotion aimed at prevention and improvement but there are people who are currently suffering and recovering from disease and illness who also need educating in its management and ways of reducing further risk. To do this we must ensure they are aware of how and why these diseases occur and what can be done to help them during its course while securing funding to enable further treatment research to help eliminate them altogether e.g. Cancer and Alcoholism. Most people will have seen the advertising campaigns for Drink Awareness and the fund raising campaign “Race for Life” (raceforlife.cancerresearchuk.org) held each year in support of Cancer Research UK. The NHS and many charities are continually drumming into people what signs and symptoms to regularly check for e.g. breast or testicular lumps or sexual dysfunction and advising them where to go for screening and advice, the sooner these signs are detected the better chance there is of survival. Practically every week of the year there is an awareness campaign for one or more disease or illness that can affect anyone.
Terminally ill people will require care of some description as will their families who can also suffer indirectly due to the situation. Either of these parties may need to talk to someone about it, terminally ill people can become depressed while their families find it difficult to get through their lives due to the strain and heartache, just having someone to listen can help immensely. There are many organisations that can help e.g. The Macmillan Cancer Support (www.macmillan.org.uk) can arrange to give families a “holiday” from caring for their sick family member to providing assistance and support for the families themselves. Others may join an informal support group where they can discuss how their illness, or that of a family member, is affecting them, their fears for when they are gone or how their passing will affect their family, this can give a great deal of comfort and support as it is sharing the experiences with people who are in the same situation.
The fact that people’s habits are steadilly changing shows that health promotion is working however, there is a long way to go before everyone is “on board”. Changing the views of people still in the pre-contemplation stage is probably the most difficult hurdle to cross but on the same token the more people that change the more the others will begin to face it which might be enough itself so getting to as many as possible, whether formally or informally, can only do more good in the long run.
Bandura A. (1977). Social Learning Theory. New York: General Learning Press.
Prochaska J.O. & DiClemente C.C. (1983). Stages and processes of self change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51, 390 395.
http://www.rospa.com/about/history/tufty.aspx Tufty Club (Online)
(http://www.hopeuk.org) (Online) (Accessed 22.05.14)
http://raceforlife.cancerresearchuk.org/index.html Race For Life Cancer Research UK(Online) (Accessed 22.05.14)
http://www.macmillan.org.uk/Home.aspx We are Macmillan Cancer Support (Online) (Accesssed 24.05.14)
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