Communicating Health: Strategies for Health Promotion
Publication Year: 2013
Communication skills are essential to effective health promotion and public health practice. This textbook bridges the gap between health communication theory and health promotion and public health practice. It provides students and practitioners with the knowledge and skills they need to design, plan, implement and evaluate programmes and campaigns.
- Front Matter
- Back Matter
- Subject Index
- Introduction to the Second Edition
- Chapter 1: Theories and Models
- Chapter 2: Social and Psychological Factors
- Chapter 3: Reaching Unreachable Groups and Crossing Cultural Barriers
- Chapter 4: Mass Media
- Chapter 5: Information Technology
- Chapter 6: Using settings
- Chapter 7: Evidence-based practice
- Chapter 8: Using Evaluation
- Chapter 9: Bridging Theory and Practice – Ten Different Health Promotion Campaigns
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Editorial supervision, Introduction, Chapter 1, Chapter 4, Chapter 5, Chapter 9 © Nova Corcoran 2013 Chapter 2 © Nova Corcoran and Sue Corcoran 2013 Chapter 3 © Calvin Moorley, Barbara Goodfellow and Nova Corcoran 2013 Chapter 6 © Nova Corcoran, Anthony Bone and Claire Everett 2013 Chapter 7 © Nova Corcoran and John Garlick 2013 Chapter 8 © Sue Corcoran 2013
First edition published 2007. Reprinted in 2008 and twice in 2010. This edition first published 2013
Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the Copyright, Designs and Patents Act, 1988, this publication may be reproduced, stored or transmitted in any form, or by any means, only with the prior permission in writing of the publishers, or in the case of reprographic reproduction, in accordance with the terms of licences issued by the Copyright Licensing Agency. Enquiries concerning reproduction outside those terms should be sent to the publishers.
Library of Congress Control Number: 2012942960
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ISBN 978-1-4462-5233-8 (pbk)
Editor: Alice Oven
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List of Figures[Page ix]
- 1.1A multi-way model of communication 6
- 1.2A new model of communication 7
- 1.3Channels of communication examples 10
- 1.4Theory of planned behaviour 14
- 1.5A simplistic view of the theory of planned behaviour hypothesis 15
- 1.6The health belief model 16
- 1.7The transtheoretical model 19
- 1.8The process of behaviour change (PoBC) model 22
- 1.9Examples of theoretical models that can be used in practice by group, setting and intervention 24
- 2.1Social and psychological factors and the wider environment 31
- 2.2‘Clear on cancer’ 38
- 2.3An example of the knowledge–attitude–behaviour framework 41
- 2.4‘Think again get the whole picture’, poster with chess master Paul Leavy 45
- 3.1The double standard of language and disability 60
- 3.2Ways to overcome visual, speech or hearing difficulties 64
- 3.3The National Service Framework for Older People 65
- 4.1The four categories of mass media 71
- 4.2Tales of the Road campaign poster 75
- 4.3Designer success, based on Noar's (2006) principles for effective design of mass media campaigns 80
- 4.4Brief guidelines for re-writing, or designing written material 82
- 5.1The txt Samaritans 4 Emotional Support campaign 101
- 5.2The advantages and disadvantages of IT use in health promotion 103
- 5.3Seven-step checklist for IT-based resources 109
- 6.1Settings-based models for health promotion 115
- 6.2The seven key elements beneficial to establishing programmes 119
- 6.3The multi-level interventions in a personal care setting 129
- 7.1Three categories of evidence-based practice 136
- 7.27.2 Four classifications of evidence used in health promotion 138
- 7.3Levels of research evidence 139
- 7.4Questions to ask in determining applicability and transferability 146[Page x]
- 7.5Four ways that best practice can be achieved 148
- 7.6A selection of edited evidence from NICE (2008) maternal and child nutrition 150
- 7.7The steps for inclusion of evidence-based practice 151
- 8.1Twenty reasons for evaluating health promotion programmes 155
- 8.2Five-stage model of evaluation 157
- 8.3Example needs assessment 159
- 8.4Types and descriptors of impact 160
- 8.5Economic cost analysis types 162
- 8.6Examples of evaluation methods matched to objectives 167
- 8.7Suggestions for the evaluation of effective health communication 168
- 8.8Key questions for media analysis 170
About the Editor[Page xi]
Nova Corcoran works as a Senior Lecturer in Public Health at the University of Glamorgan where she is the award leader for the MSc Public Health. She is the author and editor of two textbooks ‘Communicating health: Strategies for health promotion’ and ‘Working on health communication’. She previously held the post of Senior Lecturer in Health Promotion and Public Health at the University of East London for 10 years. Prior to that she worked in a variety of health promotion roles including the role of Addiction Prevention Practitioner at St Georges Hospital Medical School, and as a Health Promotion Officer and Stop Smoking Development Coordinator for Cornwall and the Isles of Scilly Health Authority. She has a strong background in health promotion work, in particular the planning, design and delivery of health campaigns and programmes. Her research interests are centred on communication strategies and methods including mass media, social marketing, behaviour change and international health issues.
List of Contributors[Page xii]
Anthony Bone works as a Principal Lecturer in Health Studies at the University of East London. He has a background in higher education, and an interest in health and social policy.
Sue Corcoran is an Assistant Director of Nursing at the Royal Cornwall Hospitals Trust. She has worked in a variety of settings in nursing and midwifery in primary and acute care, higher education and senior NHS management. She has retired since the first edition of this textbook.
Claire Everett is a nutrition and health promotion consultant. She currently works as a Commissioning Manager for the Food for Life Partnership and has a teaching and research interest in food-related areas.
John Garlick is a Principal Lecturer in Health Service Management at the University of East London. He has worked extensively on health care policy development and on service delivery in central government and at local level in North East London. He has retired since the first edition of this textbook.
Barbara Goodfellow works as a Senior Lecturer in Medical Sociology at the University of East London. She has a nursing background and her particular interests are inequalities in health, especially those relating to culture, gender and old age. She has retired since the first edition of this textbook.
Calvin Moorley is a Senior Lecturer in Health Promotion and Health Studies at the University of East London. His main interests are in how culture influences health and the meaning of illness. He comes from a nursing background, with a critical and primary care specialism.
Editor's Acknowledgements[Page xiii]
Thank you to all my students and colleagues past and present from the University of East London and the University of Glamorgan for making my job worthwhile. This edition is dedicated to Ben, Ostyn and Huxley.
Nova Corcoran[Page xiv]
Activity Discussions[Page 179]
This section contains discussions from the activities throughout the textbook. They are designed not as definitive answers, but as suggested examples to the activities.Chapter 11.1 How are Health Promotion Messages Communicated?
1.2 Why not use Theory?
- Traditional sources of communication such as television, radio, magazines, newspapers, Internet, telephone, one-to-one alongside more non-traditional sources such as sign language, symbols, text messages or eye contact.
- Interpersonal information (one-to-one or group work) or different types of media including mass media (newspapers, magazines, television), print media (leaflets, booklets, posters), electronic media (Internet) and audio visual (radio, video).
1.3 The Theory of Planned Behaviour in Action
- Time, resources, finance, lack of expertise or difficulty of application to practice.
1.4 The Perceived Behavioural Control (PBC) Model in Action
- Yes, Daniel will probably take the steroids. Look again at Figure 1.5, and follow the format. He has a positive attitude (wants to look good) and a supportive subjective norm (a member of staff with ‘muscles’ already using steroids). Perceived behavioural control is more difficult; we are not sure if he is ready, willing and can access steroids, but will assume that he can. With regard to strong behavioural intention, all pointers indicate that he will try steroids to look good, resulting in the action of taking the steroids.
1.5 How are Health Promotion Messages Communicated?
- At the ‘preknowledge’ stage you would provide information or resources to move people to the ‘knowledge’ stage. At the ‘knowledge’ stage people would need to [Page 180]gain some knowledge about recycling and the facilities available. At the ‘approval’ stage people would agree that recycling bins are a good idea, and that recycling rubbish is a positive step. At the ‘intention’ stage, people would need to intend to recycle, for example, next time they have a collection of glass or paper. At the ‘practice’ stage people would be actively recycling their glass or paper. Finally, at the ‘advocacy’ stage they would be encouraging others to do the same.
Chapter 22.1 Differences in Health Behaviours
- A number of variables could be targeted. You could target social norms or perceived behavioural control from the theory of planned behaviour. You could also target perceived susceptibility or severity from the health belief model.
- What sort of messages would you target at the constructs of this model to promote safer sexual relationships? This depends on the model you chose. One example might be a message that focuses on ‘your friends and family would like you to use a condom when you hook up to protect yourself’ (social norms), or ‘don't be scared to use a condom – you have the power to insist’ (perceived behavioural control).
2.2 Messages for Education Levels
- Different emphasis on preventive behaviours, including screening, and may have different health-related behaviours with regard to issues such as sexual health, safety or physical activity. There may also be differences in lifestyles that impact on health, for example levels of physical activity or dietary differences.
- Different concerns; for example, females may have concerns around menopause or osteoporosis, in addition there may be family or religious restrictions in terms of exercise and diet. Males may have less concern for their health, or be focused on illness only when it becomes serious. Males and females are at different risks for different diseases in later life, for example men have a higher risk of CHD. In addition certain cancers are more prevalent in men (i.e. prostate cancer) and women (breast or cervical cancer).
2.3 Who is the Message Designed for?
- The Diabetes UK website has less text and more interactive features including images and pictures. The NHS website has more text and is less obvious to navigate. Both sites are very comprehensive but finding the exact information [Page 181]may prove difficult to those less computer literate. Interactive tools such as those that calculate diabetes risk encourage engagement with the site.
- Difficulties may arise for those whose levels of English are low as there is much written material on both sites. There may be a personal preference for websites depending on colour, format, ease of navigation and ease of finding information that is being searched for.
2.4 Psychological Variables and MMR
- Age: Mid- to older age adults (note the picture) who are at risk of bowel cancer.
- There is no definite answer here, but as the doctor is male it is possible the rationale was to focus more on males who are at risk.
- Socioeconomic: all inclusive as little writing means it is accessible to all. Those who are most likely to access a doctor for screening however are the middle and upper socioeconomic groups.
- Education: little writing, few complex instructions and accessible to all groups.
- Ethnicity: The doctor shown is Asian, which would suggest this particular poster is aimed at Asian groups, or those living in areas with a reasonable prevalence of Asian doctors such as large cities.
- There are differences in target group, i.e. age, the focus of the message and the type of images use (cartoon compared to photo). There are similarities in terms of the simplicity of the message and the education/socioeconomic class being less important to the overall message.
Your answer will vary depending on whether you have read any of the research around the vaccine, if you have read any of the stories in the media, what your friends and family think including parents and siblings. Your answer may also be based on knowing someone who has had the vaccine safely and your familiarities with autism and what it is. These variables will form your attitudes to the MMR and will impact on a decision to vaccinate a child.2.5 Attitudes and Complexity
2.6 Beliefs and Tobacco
- A positive attitude to bowel cancer screening as a person has known someone else who has had the screening, read a leaflet or watched a documentary on bowel cancer.
- A negative attitude to bowel cancer screening as a person may think it is invasive, that they are not at risk, that it is something that happens to other people.
- [Page 182]A positive attitude to HIV tests as a person has known other people who have been tested, they have been tested in the past and think that it is a good idea in terms of letting a partner know they are HIV free.
- A negative attitude to HIV testing as a person may consider it a personal issue, be worried about being tested positive, be concerned about insurance or employment, think that HIV is a ‘curse’ or that they will be stigmatised.
2.7 Designing Messages to Target Attitudes
- A wide range of reasons which could include; ‘it makes me look cool, sexy, good looking, older, thinner, wiser, sophisticated or grown up’. ‘It keeps my weight down’, ‘it's good for me’, ‘it helps my lungs’, ‘my doctor said it is good for me’, ‘it helps me relax’.
- You could target any of these beliefs. For example with teenagers messages for those who believe it makes them look older could focus on wrinkles or poor skin. Messages for those who believe it makes them look ‘cool’ could focus on smelly clothes or bad breath.
Chapter 33.1 Cultural Identity
- This answer will depend on your target group. An example might be 16-year-old black African girls who are leaving school with few qualifications (lower education levels).
- Messages that could be developed to target this group might centre around chlamydia being invisible and serious. In terms of personal relevance it could look at promoting condom use not just for contraceptive effect but for chlamydia prevention as well. Messages would perhaps focus on African girls in workplaces such as shops or beauty salons as places of work after leaving school or could be disseminated in this way.
3.2 Barriers to Health
- This is subjective and may centre on your own religious beliefs, behaviours or traditions, among other factors.
- Examples include: different beliefs than others, different attitudes, judgemental or discriminatory practices or inability to communicate in a different language.
- Embrace diversity and difference, consider non-traditional ways of communicating or ensure adequate translation services are available.
3.3 Challenging the Present
- Location of services, language barriers, cultural differences, late presentation of signs/symptoms, accessibility of services, difficulties in translating materials, fear of the unknown and lack of experience accessing Western health services.
- Examples include: provide additional information resources (e.g. leaflets or booklets), encourage talk between staff/patients and patient/patient, or allow time for questions in consultations and ensure the target group is aware of these issues. Images need to be culturally relevant and as a basic requirement information provision should be in a range of formats and languages.
3.4 Disability Campaigns
- Aside from the last example (outcomes of care), all of these involve contact between the user of a service and the provider of a service – either a mental health-related service or other authority (e.g. police).
- Projects could include: advocacy workers in these settings to encourage good communication, campaigns to reduce stigma of mental illness, promoting understanding of different cultural beliefs around mental illness and mental health in the wider community, providing support for those identified as at risk, either emotional or resource based.
3.5 ‘Stop Smoking’ Materials for those over 70
- Messages focus around rights and inclusion in health services. Methods include multi-media strategies not dissimilar to other campaigns.
- The main aims focus around reducing hate crime through advocacy and awareness, and enabling access to screening services through increasing knowledge and awareness.
- This depends on your personal opinion, but advocacy and awareness raising are helpful as a starting point but may not always translate into action especially when others are involved in the health care process who may know about these campaigns, e.g. health care workers.
- Further advocacy, for example a focus on other areas such as health care workers might be helpful as a two-part strategy. Other forms of multiple media might be helpful, such as information technology.
3.6 ‘Healthy Heart’ Programme Design
- A large font would be preferable on written material, and use of audio materials should be considered. Use of an appropriate planning, implementation and [Page 184]evaluation framework should be used alongside the appropriate theoretical model.
- No. Materials in this setting should use a combination of media.
3.7 National Service Framework Demonstrated OutcomesExample: Flu immunisation
- Encourage health professionals to make a referral to the class, telephone individuals, provide refreshments, offer one-to-one sessions alongside the group classes.
- Making friends, appearance related or getting out of the house.
- Website, telephone or mobile technology-based support.
3.8 Older People and Sexual Health
- A well-planned advertising campaign, letters from GP practices to all those at risk, provision of drop-in clinics (no appointments) to increase uptake.
- Message design would focus on ‘keeping well’ in the winter, or keeping fit in the winter, the fact that it is easy to protect oneself, and free.
Chapter 44.1 Different Media Sources
- This could be an extension of other sexual health campaigns, or be included in older people focused websites such as Age UK. See Chapter 9 for the example of the middle age spread campaign. Health care professionals will need to consider that sexual health for older people is still a real issue and that STIs may still be prevalent in an older age group.
- Freedom of communication and travel may promote sexual relationships, and changes to family structure, i.e. divorce and re-marriages in later life, may also promote STIs. The promotion of condoms for prevention of pregnancy in young people may mean that older people are missed out of sexual health focused campaigns in terms of STIs and condom use.
4.2 Mass Media and Tobacco
- 1 and 2 You could use a range of different media sources. Here are two examples. Leaflets or posters could use images and slogans to focus on promoting the taste of healthier food such as the sweetness of soft fruit. You could use television [Page 185]slots to promote how quickly and easily you could cook or prepare vegetables, e.g. a mini cooking programme.
4.3 Suitability of Methods for Mass Media
- The advantages of using media include widespread publicity, agenda setting, reaches the whole population, counteracts the pro-smoking lobby, opportunistic, the message that tobacco is a major public health issue. There is limited evidence that mass media are effective using these examples, and are not suitable for all groups; it could give mixed messages, and will not appeal to and reach all groups.
- One-to-one, skills-based group work, early-school-based education (primary), social marketing strategies may be effective and lobbying the pro-tobacco groups for change (see www.ash.org.uk for more information on lobbying).
4.4 A Sensible Drinking Campaign Message
- Remember that the media cannot teach skills or change strong attitudes. There is a possibility that (a) and (b) could be achieved through mass media.
- (a) Raising awareness could be achieved via mass media publicity materials. (b) As with (a), mass media could use publicity to advertise a new telephone service. (c) Mass media could provide awareness of a service, but cannot directly increase rates of those screened. (d) Mass media cannot provide skills. (e) Mass media cannot change strong attitudes, but may influence these. Alternative methods include skills-based work and interactive resources that allow active learning.
4.5 Audience Segmentation
- Sensible drinking words or phrases might include: responsibility, stopping at too much, saying ‘no’. Words for those in the 18–25 age group can include: young adults, youth or students. Motivations to ‘drink sensibly’ can include: unwanted pregnancy, accidents, appearance, not being sick, embarrassment, morning after.
- An example could be: ‘students’, ‘knowing your limit’, ‘unwanted pregnancy’.
- A slogan based on the premise of sticking to a limit, and not experiencing unwanted pregnancy, or emergency contraception, could be ‘Remember the night before and forget the morning after’.
4.6 The Four Ps
- Groups can include secondary school children, those in a workplace, churchgoers, youth groups or young parents.
- An example setting is a workplace. The group can be split into male/female, older and younger age ranges, those who manage their diabetes themselves, [Page 186]those who rely on others to manage their diabetes, those who partly manage their diabetes, and those who do not manage their diabetes. These could further be split into those who could manage or could best manage their diabetes through, diet, physical activity, weight control, insulin and so on.
4.7 Media Advocacy
- Product: breastfeeding (the practice of this). Price: this can be actual costs positive and negative (i.e. breast milk is free) or perceived costs, embarrassment, perception that it is healthy, reliance on family members so formula feeding its seen as easier, and so on. Place: Location of breastfeeding with very small babies is generally the hospital followed by the home. After this it could then be in any community location, e.g. cafes, library, playgroups. Promotion: want to look at increasing breastfeeding rates so this will be the methods used to promote it – one-to-one support, breastfeeding cafes, breastfeeding-friendly initiatives, etc. Positioning: a message in the location where breastfeeding might take place, e.g. stickers on cafe doors or windows that appeal to the proposed target group.
4.8 Fear Appeals
- Tobacco companies, fast-food manufacturers, non-fair-trade companies or large manufacturers who have lax working or employment laws.
- An example is tobacco: you can draw attention to the risks of smoking, use case studies to highlight the ‘people's’ angle, find statistical evidence, use local groups and coalitions or protest and lobby local MPs or local organisations.
Chapter 55.1 How could IT be used to …?
- Risks include: loss of memory, inability to function normally, physical or sexual assault and black-outs.
- Messages can include: keep your drink with you at all times, only accept drinks from people you know, or do not accept drinks you are unsure about or that taste unusual.
5.2 Interactive Websites
- Mobile phones, Internet quizzes, email or touchscreens.
- Email, Internet, chat rooms, interactive software (e.g. CD-ROMs) or computer games.
5.3 SMS Messaging Services
- A variety of government, organisational and commercial websites.
- Websites can contain interactive resources such as alcohol unit calculators, smoking calculators, BMI calculators, diaries, chat rooms, games, activities and quizzes as well as links to blogs, and social media such as Twitter and Facebook.
5.4 Designing a Website
- Sexual health messages; some test results; simple information such as appointment reminders; short motivating messages (mental health or physical activity).
- Complex information; behaviour change information; anything regarded as unwanted information.
5.5 Tailoring Messages
- Health and hygiene, employment and benefit advice, sources of advice, maintaining positive mental health or information around risky behaviours.
- As target groups are mixed and it is difficult to identify one single type of user, information should be simple, straightforward and jargon-free, easy to read and navigate, and available in different languages.
- Accessibility, stigma from the general public, comprehension of information, low literacy levels, poor computer skills.
5.6 Health Belief Model Barriers on a Website
- Precontemplation: general information-giving, with advice number if help needed in the future. Contemplation: appealing to current motivations, for example, losing weight before a holiday or big event. Readiness: how to achieve goals, for example, which trainers to buy, which gym class to choose or which nights of the week for walking. Action: advice on keeping going with exercise, tips for low motivation and positive reinforcement of messages. Maintenance: positive reinforcement.
5.7 The Seven-Step Checklist for a Website Design
- These include cost, habit, taste, price, access, culture, not knowing how to cook, time or children not liking healthy foods.
- Messages could centre on ‘easy’ cooking, low prices, sauces and dressings to add variety and taste, and child-friendly meals.
An example of website design for this group includes:
Chapter 66.1 Types of Settings for Different Target GroupsExample Target Group: Primary School Children, 5–11 Years
- Interactive media sources such as those in question 5, fact pages, story pages in a magazine format and other ways of presenting information that will appeal to the group.
- Someone who embodies positive body image and who is of female average size. A health professional may be helpful to answer readers’ emails.
- Ones that embody feeling good about oneself.
- Colourful, informative and encouraging ‘sharing’ of information.
- Quizzes, a chat room or a ‘reader's email corner’.
- Enable anonymous emails.
- Anywhere where this age group might be found, including university, workplaces, women's groups or other organisations.
6.2 Fitting Activities to Settings-Based Models
- Schools, after-school clubs, activity clubs, local community.
- Mixed or competing messages, parental control, different aims of teachers or the school's governing bodies.
6.3 Locations of Settings
6.4 Overcoming Disadvantages of Settings
- Examples include: Educational: schools, higher education, universities or pre-schools. Health care: primary care, hospitals, dentists, NHS walk-in centres, pharmacists. Social: supermarkets, pubs or workplaces, cinemas, shopping centres.
- [Page 189]Those settings most widely used include: schools, hospitals, neighbourhoods, workplaces. These are likely to have a bigger reach than some of the smaller settings like barbers or beauty salons.
6.5 Designing Messages for a Religious Organisation
- Manpower could involve community or voluntary groups; resources could make use of the wider community and its facilities. Reaching excluded groups will entail choosing different settings, and to include environmental and social aspects, a holistic notion of health will need to be embodied in the whole programme.
6.6 Designing a Healthy University Campaign
- 1 and 2 Any religious group could be chosen. Resources can include leaflets or posters with spiritual messages, biblical quotes on materials to encourage healthy behaviours, a prize quiz about aspects of health, competitions, a new website, SMS text messages or other interactive resources.
You could focus on an issue like healthy food and organise events in the canteen or student union which could include fruit and vegetable taster sessions, information stalls and interactive activities such as cooking demonstrations. These could also be done in halls of residence. Use appropriate-age messages with a catchy theme, show ‘student-style’ foods, for example pasta or pulses, promote ways to eat more healthily on small budgets. Campaigns could roll through the academic calendar and be integrated into different subjects, for example catering could look at healthy eating menu options, art and design could consider promotion of foods, geography or sociology could look at food choices, transportation of foods and global food issues, and so on.6.7 Using Barbers or Beauty SalonsExample: Barbers
6.8 Settings and Convenience Stores
- Sexual health, CHD risk, diabetes, prostate cancer, testicular cancer and other areas of high risk.
- Poor evidence base, so the target group will need to be in close consultation with the project. Access might be difficult and the setting will need to provide a range of opening hours. Limited resources or staff will mean that involving the wider community is essential.
Chapter 77.1 Evidence-Based Practice Rationale
- Tasting stands, promotional fruit or vegetable of the day, traffic light systems of fruit and vegetables, cooking ideas or demonstrations, promotional offers, e.g. 3 for 2.
- Free take home menus or cooking equipment, collection of vouchers or money off schemes for future purchases, involvement of the main purchaser of food and those who influence the buyer, such as their children.
7.2 What Evidence do you use?
- Evidence embodies the ideals of good practice, it ensures inclusivity and that no-one is excluded or discriminated against. It enables structured working, ensures cooperation, you can help predict any unplanned effects or additional resources and minimise risk of failures.
7.3 Planning with Evidence
- Community-based work might use 2, 3 and 4. Clinical practice is most likely to use 1 and 2. Students in subjects such as research methods will probably examine the upper of these levels, health policy or local planning might use the lower levels.
7.4 NICE Evidence Base
- You could undertake a small pilot study using the council solution (community police officers). You could set up a project that expands on existing projects, for example include ‘youths’ in this. You could also approach the ‘youths’ and see what they might want.
- You should examine other projects in similar neighbourhoods that aim to reduce crime, for example New Deal for Community (NDC) projects or Healthy Cities projects.
7.5 Grey Literature
- Their website contains a variety of policy documentation, best practice, evidence-based briefings and other guidelines for good practice. This includes public health [Page 191]guidance on behaviour change, sexual health, accidents, alcohol, tobacco and diabetes.
7.6 Including Developing Countries
- You could use health impact assessments (HIAs), needs assessments, community profiles, annual reports, minutes of meetings, informal and formal local project reports.
- You may have been involved in compiling any of these, alongside your more formal work.
7.7 Applicability and Transferability
- Problems can include: difficulties in representing those with little power; may not be able to reach all of those who should be represented; resource and financial implications; and poor or corrupt management.
- Suggestions include: start small; try to maintain a base of local projects that can be accessed at national and international level; encourage project leaders to report findings and record these; hold conferences ‘on site’ rather than in high-class locations; and delegate time and space to listening to others.
7.8 Evidence and Maternal and Child Health
- Applicability criteria indicate:
- There are few potential barriers.
- The group have expressed an interest so there may be only minor problems in acceptance.
- Contents can be tailored to the new sample; ethnicity shows some similarities.
- There are limited resources so involvement of the women's groups is essential.
- There may be some non-engagement problems.
- The organisation running the project is similar (health-promotion focused); barriers might include money or language.
- There is a professional physical activity coordinator available, although with a slightly different previous focus.
Transferability criteria indicate:
- There will be a need to investigate prevalence; general statistics indicate approximately one in three women are at risk.
- Some similarities, the women are close in age; there may be some psychological factors that are different, for example, perceived susceptibility and severity.
- [Page 192]Capacity is less in the target setting, and some activities may have to be tailored or adapted – perhaps a shortened programme or different delivery structures.
- To ensure more success you could involve women's groups in the planning and provision of the programme; consider a pilot study first, and materials may need to be translated.
Chapter 88.1 Who is Interested in Evaluation and why?
- You might focus on pregnant women, or women post-pregnancy with very small children. Guidance recommends a range of areas such as a focus on breastfeeding, vitamin supplements, liaison with key projects such as Sure Start and appropriate eating (not dieting) during pregnancy. From these data you could select a group like low income pregnant women and then consider how you could implement guidance, e.g. provision of free vitamin supplements, promotion of iron in diet on a low income.
8.2 Formative Evaluation
- The funding organisation, e.g. the local authority, local GPs who have referred, patients, local housing association, community leaders, mental health teams, voluntary groups, programme participants.
- Fiscal, particularly cost-effectiveness. Quality, assessment of need. Evidence, understanding limitations of the campaign. Policy, to inform future planning.
8.3 Impact Evaluation
- Interviews, with children, teachers, questionnaires, using a needs assessment matrix, school art projects, competitions, photographing favourite foods, keeping food diaries, testing print-based and online media, parent and sibling focus groups.
- Compare outcomes with current evidence through a systematic literature search and analysis. Investigate environmental determinants and behavioural factors.
8.4 Well Man Clinics
- That drug users accessed the service. The numbers using the service increased. A reduction in needle sharing was reported. More drug users sought help through counselling.
- [Page 193]Was this impact sustained over a period of time? Did the drug users express their satisfaction with the service? Was it provided at the right time in the right venue? Were the staff able to offer health advice and did this make a difference? For example, has there been a reduction in hepatitis C and HIV rates? Did the programme lead to better health outcomes?
8.5 Participatory Involvement
- Outcome evaluation would cover a wide range of findings in this example. The sample group could be compared with the whole male population or within the low socioeconomic group, for instance:
- Morbidity and mortality of the sample group could be measured in disease such as diabetes, coronary heart disease or cancer.
- The number of men seeking health screening six months later.
- Mean blood pressure and weight could be compared with other groups.
- The numbers stopping smoking over a period of one year or more.
- The take-up of exercise in the target group over a designated period.
- The increase in media articles on men's health issues in Scotland.
- The reduction in STIs.
8.6 Ways to Evaluate Health Communication
- You would probably want evidence of transparency in the decision-making. You would want to trust that the public health advice is accurate and you would want access to relevant information. You may require skills and knowledge to help you cope with the future. You want good access to services. You may not want direct involvement but you will need reassurance that you are represented. The impacts and outcomes of any interventions will need to be shared widely and over a long period of time.
- Interactive website where concerns can be posted. Attending focus groups, receiving regular public health bulletins. Education and training resources for capacity building to enable people to identify and develop their own needs.
Accuracy: Were there factual information and key messages about the benefits of participation in sport?
Availability: Was the information available in libraries, GP surgeries, leisure centres, workplaces, websites, local media?[Page 194]
Balance: Were messages about the benefits of sport participation supported by health advice about checking with GP and the availability of appropriate protective equipment or clothing?
Consistency: Did the messages stay the same, were they unambiguous?
Cultural competence: Was consideration given to target groups, for example were they people who already exercised or not? Was gender and ethnicity taken into account?
Evidence base: Were there claims for psychological and physical gains based on reliable studies? Had there been an assessment of need?
Reach: Were there hard-to-reach groups accessed? Were there incentives such as free equipment, competitions, etc.?
Reliability: Was there evidence of a robust planning process and consideration of effectiveness strategies?
Repetition: Were the key messages user-friendly, easily remembered and reinforced across the media?
Timeliness: Was the intervention delivered in a timely fashion?
Understanding: Did the group understand the key messages? Did they understand the information given to them?8.7 Bullying among Young Teenagers
The findings would be shared with teachers, parents, board of governors and the pupils.
- The teachers may receive written reports, a presentation and possibly a training package or manual.
- Parents of all school children may receive letters, emails or a presentation.
- Parents of the study group may have personal communication or small workshops as well as written information.
- The board of governors would receive a formal evidence-based report and a presentation of findings.
- The pupils may receive information online or through social media; they may have workshops and have a programme integrated into the curriculum.
- Barriers to dissemination would include:
- The teachers or board of governors may not accept the findings and not want to act on them.
- Parents may not understand the information, there may be language difficulties; the information may not be pitched at the appropriate level for all parents.
- [Page 195]The parents of the children who have been bullied or are bullies may be concerned about confidentiality and not want to participate in any activity.
- The pupils may not be clear what the findings show, they may not understand what bullying constitutes and how it affects people.
- The pupils may not view the findings as important.
Refers to the way the media select events that the public sees and with this selection set the terms of reference for current interest and debate.
An abbreviation for ‘applications’ of Games and services that are often connected to the internet available on mobile phones and tablets.
A group that is vulnerable or susceptible to ‘risk’ of different types of ill health or disease.
An evaluation that a person makes about an attitude ‘object’. The attitude ‘object’ could be themselves, other people, issues (i.e. in the media) or objects (i.e. alcohol).
The information that a person has about an object or action forms their beliefs.
This proposes that communities or groups know what they want and are involved in all stages of planning and implementing interventions (see Top-down approach).
A short health promotion session (i.e. 15 minutes) that is designed to prompt behaviour change or challenge attitudes to health-related behaviour.
A large bill-board style message placed on the outside of a bus.
A planned, designed and coordinated effort to promote a particular cause.
An Internet-based portal where anyone can ‘chat’ to each other via a mechanism similar to email.
An alliance for combined action between populations, parties or groups generally united for a single cause.
The characteristics of the population (i.e. social class, age or education) that can be measured via population groups.
The placement of a person below that of another person who does not share the same characteristics (i.e. ethnic group or sex).
A generic term for all IT applications linked to health and incorporating applications linked to computers, health and medicine that are used to deliver or promote health.
A term usually used to describe a way of working that enables people to develop knowledge or skills to increase control and power over life circumstances.
In health, equity is concerned with the differences in health status that are unfair or unequal and the readdressing of these.
The process by which worth or value of something is decided involving measurement, observation and comparison with the programme/policy aim.
The use of research evidence to guide practice.
The use of technology (i.e. mobile phones or internet) for game playing purposes. In health promotion these can be games with educational messages or interactions that challenge current practices or enforce current behaviours.
A combination of individual and social actions designed to gain political commitment, support or acceptance.
Health belief model (HBM)
A model of behavioural change that focuses on an individual weighing up the risks and benefits of behaviour.
Health Development Agency (HDA)
A UK-based specialist health authority that aimed to improve the health of people in England. It has now closed, and has been partly replaced by NICE (see NICE).
Providing information through constructed opportunities that improve knowledge or skills and increase healthy behaviours.
The process of enabling people to increase control over their health.
Embodying holistic notions of health (see Holistic).
A term that includes the wider definition of health including physical, mental, social and spiritual health.
Inequalities (in health)
Differences in health status between populations or sections of the population.
Information technology, generally includes all interactive media (i.e. CD-ROMs, the Internet, touch-screen kiosks or computers).
Any type of printed or electronic communication medium that is sent to the population at large.
A simplified version of a theoretical construct.
The amount of disease there is in a population (i.e. the number of people living with a disease).
The number of people who have died in the population (i.e. the number of people who have died from certain diseases).
[Page 198]National Service Framework(s)
The UK government's long-term strategies for improving different areas of care (i.e. mental health).
The National Institute for Health and Clinical Excellence, the UK's independent health-related organization responsible for providing national guidance on the promotion, prevention and treatment in health.
Ottawa Charter for Health Promotion
A World Health Organization policy statement that sets out a clear commitment to health promotion.
An education method where a person or group with credibility (i.e. older children) work with others (i.e. younger children) to promote health or prevent ill health.
Perceived behavioural control
Theoretical model that postulates behaviour can change through a series of steps.
The avoidance of hazards or risks through the creation of conditions to help avoidance or promote early detection of the hazard or risk.
The vocal intonation or rhythmatic aspects of language including pitch or stress placed on words.
Process of behaviour change
A step-based model based on the stages a person goes through when making a change in their behaviour.
A societal effort to prevent disease and prolonging life.
An education method where a person ‘acts’ a response to a situation (i.e. saying ‘no’ to cigarettes). The audience will then ‘model’ this same response in a real-life situation.
The procedure for the identification of a certain disease (i.e. breast cancer) to enable early detection and treatment of the disease.
An individual's judgement of their ability to achieve a certain goal (i.e. stopping smoking).
Any of a number of locations where people work, play and learn where health can be promoted.
a group of Internet-based applications that allows individuals to create, collaborate, and share content with one another.
‘Short messaging service’, the facility and sending of short messages via a mobile phone, more commonly called ‘text messaging’.
The act of predicting how another person will act or behave in a certain situation based on preconceived notions of how people act (see Discrimination).
In IT terms this is a wireless, mobile personal computer with a touchscreen.
[Page 199]Tailoring information
Adapted information for a specific group of people to fit their needs and preferences.
A set of ideas or arguments that help to understand behaviour in a more simplified way.
Theory of planned behaviour (TPB)
A theoretical model based on the stages a person goes through when changing a behaviour, including perceived behavioural control.
Theory of reasoned action (TRA)
A theoretical model based on the stages a person goes through when changing behaviour; this model is a recent revision of the theory of planned behaviour model.
An approach which is dictated by those with power that does not directly include the target group or receivers of the intervention (see Bottom-up approach).
Transtheoretical model or ‘stages of change’ model
A stage-step model based on the stages people go through when making a change in their behaviour.
The United Nations Children's Fund, which has 37 committees worldwide working with, and for, the world's children.
Acquired by the social world, they can influence attitudes and behaviour.
A short impressionistic scene usually with a focus on one version or behaviour at that moment in time.
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