Dean Whitehead

How effective are health education programmes—resistance, reactance, rationality and risk? Recommendations for effective practice

Behavioural-change-related health education programmes represent a mainstay of health care activity. Where adopted, however, the theoretical and practical constructs and constraints are not always considered. The failure of many health education programmes to achieve their intended life-style-related behavioural-change outcomes is often directly related to the complexity of the task itself. Changing a clients health behaviour is notoriously difficult and requires concerted and systematic activities to ensure any measure of success. This article draws upon existing literature to develop a critical theoretical and practical perspective for health education practice in nursing. It aims to explore the underpinning theoretical considerations for undertaking behavioural-change health education programmes. This article also proposes specific recommendations for nurses current and future health education practice, as a means for facilitating a more structured approach to health education programme planning and evaluation.

Action research in health promotion

Objectives This article aims to define what is action research and where it fits in with health promotion practice, through drawing upon associated literature and personal action research experience. It also seeks to investigate the possible reasons why it is that health promotion researchers have not readily taken on the processes of action research strategies. Rationale The place of action research in health promotion programmes is an important yet relatively unacknowledged and understated activity. It has proven to be very popular with other professional groups, such as in the education, management and social sciences. In terms of health service activity, it is widely established in the fields of nursing and mental health and is beginning to establish itself in medicine. While there are a few health promotion examples to draw upon, they tend to be isolated, dated and often lie outside of the mainstream literature. It is suggested that this continuing state of affairs denies many health promotion researchers a valuable resource for managing effective change in practice. Conclusion The authors suggest that action research is both a valid and important research method for health promotion researchers, who are advised to further consider its merits in future studies. This article draws attention to the National Health Service (NHS) South West Regional Office-commissioned Our Healthier Nation: Improving the Competence of the Workforce in Health Promotion participatory action research project, as a means of promoting and validating action research strategy. The authors were all actively involved in this project.

The health-promoting nurse as a health policy career expert and entrepreneur

A plethora of literature suggests that many nurses struggle in their attempts to develop a political role that allows them to directly influence and implement health policy activity. Nursing curricula are an integral part of ensuring that nurses are capable of taking on a more active role in initiating and developing health policy processes, through a broadening of the health promotion curriculum that focuses on socio-political approaches to health care provision. Despite this, the available literature suggests that the majority of nursing curricula are yet to fulfil this role. Such a role could be supported by attempts to define and promote a specific career route that develops nurses as health policy experts and entrepreneurs early on in their careers. This article aims to put forward a rationale for developing such a position in nursing education.

In pursuit of pleasure: health education as a means of facilitating the “health journey” of young people

Purpose – To highlight recently emerging issues and discussions related to the “health journey” of young people, and how health education interventions may be best applied in light of these.Design/methodology/approach – A general review of the “health journey” phenomena in young people is explored.Findings – Many health education interventions involving young people target emotive issues such as illicit drug‐taking or sexual promiscuity and are often aimed at reducing the prevalence of health‐damaging behaviours primarily through the provision of health‐related information. It is well known and accepted by many, however, that “limited” health education methods are often ineffective, and may lead to more problems than they resolve. This is particularly so where the interventions seek to deny the individual the health‐related experiences that may serve as an integral part of that persons “health journey”. Recently emerging literature highlights counter‐behaviours initiated by young people, in defiance of a...

The behavioral ecological model as a framework for school-based anti-bullying health promotion interventions.

This article presents a conceptual strategy which uses the Behavioral Ecological Model (BEM) as a health promotion framework to guide school-based bullying awareness programs and subsequent anti-bullying strategies for school nursing practice. Anti-bullying frameworks and tools are scarce despite the extent of the problem of bullying. This article reviews existing literature centered on the BEM and illustrates how the model can be applied to the school-setting. This is the first time that a multilevel framework has been proposed for school-based anti-bullying in the form of a model. The BEM is a useful tool for assisting in the development of more comprehensive programs to influence anti-bullying intervention in school-based nursing practice.

Before the cradle and beyond the grave: a lifespan/settings-based framework for health promotion

AIM To develop a unique framework which combines the concepts of settings and lifespan where they are applied to health promotion. BACKGROUND The influential World Health Organisations 1986 Ottawa Charter for Health Promotion supported certain settings being nominated as unique social systems for enabling specific health promotion activity. These initially included a whole raft of proposed settings ranging from the micro to macro; these at the time mainly being hospitals, communities, schools, workplaces, cities, villages, islands and the home and family. Several other settings have since also been added to the list - which now include health-promoting universities and health-promoting prisons. Most of the mentioned settings have in more recent times being acknowledged in the nursing literature. DESIGN Discursive. METHOD A critical examination and exploration of the existing health promotion literature related to both settings and lifespan. RESULTS It is possible to combine the related, but hitherto unexplored, concepts of health promotion settings and lifespan. This has resulted in a useable framework to further assist practitioners with their health promotion work. CONCLUSION What has not yet surfaced in both the nursing and the general health promotion literature is that most settings can be linked as a whole, not just by their geographical location and proximity to each other, but also to the fact that they tend to follow a linear direction that ranges across the total lifespan. RELEVANCE TO CLINICAL PRACTICE Viewing health promotion in the way that this framework proposes further assists in locating and clarifying the often confused and contested position of health promotion in nursing.

What are New Zealand children eating at school? A content analysis of `consumed versus unconsumed' food groups in a lunch-box survey:

Eating patterns among school-aged children continue to be highly reliant on frequent consumption of food items that are perceived to have low or poor nutritional value. This has become a serious public health concern. In this New Zealand-based study, primary school childrens food consumption behaviour was investigated via two sources: a cross-sectional survey of school foods from 927 lunch-boxes, and the content analysis of unconsumed foods deposited in provided food waste disposal bins. The results indicated that most lunch-boxes contained an over-representation of the food groups high in fat, sodium and sugar, and an under-representation of fruit and vegetables. In this study, the measured high proportions of unconsumed healthy foods (mainly fruit and vegetables), in comparison to unhealthy foods, being thrown away by school-children were of concern. The results indicate that schools and parents should pursue initiatives that support healthy diets for children as best practice.

The relationship between health promotion and complementary therapies

The underlying philosophies of health promotion and complementary therapies are very closely related and, consequently, share many similarities; yet such similarities that exist between these two disciplines are rarely expressed, acknowledged or explored. It would be almost impossible to practice complementary therapies without incorporating elements of health promotion within them, whether this is done so knowingly, or not, by the practitioner. This account sets out to establish the nature of such a relationship and highlights the common advantages and dilemmas in recognizing such a relationship. It seeks to determine the validity of closer collaboration (between the two disciplines) in order to provide a collective consensus for like-minded nurses to move towards a more holistic and empowering paradigm. It concludes by suggesting that, in order to move the shared aims of health promotion and complementary therapies forward, closer ties need to be established, between the disciplines, and built upon.

A Multidisciplinary Osteoporosis Service-Based Action Research Study.

Objective To investigate an existing Trust-based osteoporosis services preventative activity, determine any issues and problems and use this data to reorganise the service, as part of a National Health Service Executive/Regional Office-commissioned and funded study. Setting A UK Hospital Trusts Osteoporosis Service. Design & Method A Participatory Action Research (PAR) methodology was adopted, using PAR group sessions and reflective journals to collect and analyse qualitative data. Results The service was investigated and found to be lacking in preventative osteoporosis-related activity. Subsequently, the research participants identified and implemented a range of preventative activities. Conclusion Osteoporosis is a preventable disease that is known to place both a huge economic and social burden on societies worldwide. Despite this, evidence suggests that preventative osteoporosis activity is afforded a low priority within health services. This was the case with the osteoporosis service at the beginning of this study, but demonstrates how a service can be reorientated to accommodate a programme of preventative activity.

Ottawa 25+--'All aboard the Dazzling Bandwagon'--developing personal skills: what remains for the future?

The remit of this paper is to identify what might be the future direction of one of the Ottawa Charters five main action areas; developing personal skills (DPS). It is contested that this was never going to be an easy task. This opinion article argues that, while a watchful eye should be kept on evolving and innovative DPS strategy and programmes that Ottawa principles generally espouse, that type of activity is not representative of the current location and practice of many health practitioners--particularly clinically located health professionals. Targeting such professionals who, otherwise, might remain unaware of or unengaged with health promotion practice is the main reform required for future DPS activity. It is predicted that, where universal progress can be made, the potential for DPS development would be significant.