Sandy Whitelaw

The ‘stages of change’ model in health promotion: Science and Ideology

The transtheoretical or ‘stages of change’ model has greatly influenced health promotion practice in the USA, Australia and the UK since the late 1980s. Application of the model has shaped service planning, provision and implementation. ‘Stages of change’ also has impacted on training agendas at local, regional and national levels. Associated areas of motivational interviewing and brief intervention have led health promotion initiatives in areas such as smoking cessation and alcohol-reduction policies. A number of critiques have recently challenged the ‘stages of change’ model and health promotion orthodoxy. This review examines these critiques, with a focus on the ‘scientific’ status of ‘stages of change’. The review also examines a data-based approach to stages of change, model adequacy, the social and ideological context of change theories in health promotion contexts, levels of explanation and prediction in the ‘stages of change’ framework. Some reasons are offered for the apparent popularity of the model amongst health promotion workers. Recommendations are made about alternative conceptual frameworks.

The emergence of a ‘dose–response’ analogy in the health improvement domain of public health: a critical review

Public Health specialists have increasingly deployed the concept of ‘dose–response’ in areas such as diet (‘five-a-day’), alcohol (‘21 weekly units’) and physical activity (‘150 minutes of weekly activity’). Using these examples and a case study that sought to establish an optimal dose of physical activity for mental health gain, this article offers a critical assessment of the nature, robustness and function of ‘dose’ in public health. Drawing on a ‘sociology of knowledge’, the article argues that dose–response can best be considered an analogy that does not necessarily translate favourably from its original expression in toxicology to some public health domains – an over-extended analogy. Rather than having technical robustness, its attractiveness and utility is seen to lie in it possessing ‘cultural capital’, here, the ability to link behavioural concerns to clinical practice, to simplify complex ideas and to act as a regulatory form of behavioural governance. The article is skeptical of further empirical pursuits in identifying optimal doses and offers an alternative course for public health framing.

Interventions at the end of life – a taxonomy for ‘overlapping consensus’

Context: Around the world there is increasing interest in end of life issues. An unprecedented number of people dying in future decades will put new strains on families, communities, services and governments. It will also have implications for representations of death and dying within society and for the overall orientation of health and social care. What interventions are emerging in the face of these challenges? Methods: We conceptualize a comprehensive taxonomy of interventions, defined as ‘organized responses to end of life issues’. Findings: We classify the range of end of life interventions into 10 substantive categories: policy, advocacy, educational, ethico-legal, service, clinical, research, cultural, intangible, self-determined. We distinguish between two empirical aspects of any end of life intervention: the ‘locus’ refers to the space or spaces in which it is situated; the ‘focus’ captures its distinct character and purpose. We also contend that end of life interventions can be seen conceptually in two ways – as ‘frames’ (organized responses that primarily construct a shared understanding of an end of life issue) or as ‘instruments’ (organized responses that assume a shared understanding and then move to act in that context). Conclusions: Our taxonomy opens up the debate about end of life interventions in new ways to provide protagonists, activists, policy makers, clinicians, researchers and educators with a comprehensive framework in which to place their endeavours and more effectively to assess their efficacy. Following the inspiration of political philosopher John Rawls, we seek to foster an ‘overlapping consensus’ on how interventions at the end of life can be construed, understood and assessed.

Promoting Health in Hospitals: The Role of Beacon.

“Best practice” is currently being used to enable modernisation within the National Health Service (NHS) in the United Kingdom. One element of this is the Beacon programme where examples of hospitals that exemplify local “best practice” are supported to develop and disseminate learning across the wider NHS. The aims of this research were to map public health‐related Beacon hospital initiatives and then to identify opportunities and barriers in this context. This was achieved by seeking the views of a range of relevant national and local stakeholders. The work suggests that whilst Beacon hospital projects have some potential in developing relatively innovative activity they are not perceived to be stepping‐stones to wider public health action. Five possible ways forward are suggested.

Achieving sustainable social enterprises for older people: evidence from a European project

Purpose – In light of the contemporary UK policy framework elevating neo-mutualism and communitarian ethics within social policy, the purpose of this paper is to report on the delivery of an EU project Older People for Older People that tested the proposition that older people in remote and rural communities can contribute to providing services for others in their age group through the creation of sustainable social enterprises – either in “co-production” with statutory public service providers or as new, stand-alone services. Design/methodology/approach – In the context of a literature based theoretical exploration of the nature of “sustainability”, the paper reports on a series of rural community “case study” social enterprises (e.g. community transport schemes, care hubs, cafes and a radio station; “drop in” and outreach services (including alternative therapies and counselling); ITC training, helping, and friendship schemes; volunteering support and history and culture projects). Findings – From this,...

Sustainable development, equity and health-time to get radical

People form an integral part of the earths ecosystem. Their health is fundamentally interlinked with the total environment. All available information indicates that it will not be possible to sust...

Mapping the “housing with care” concept with stakeholders: insights from a UK case study

Purpose The purpose of this paper is to present the findings of an early stage, exploratory case study of a proposed housing with care initiative (the Crichton Care Campus (CCC)). This sought the perspectives of a range of key stakeholders on the proposed model and how it might be best realised. The analyses of these findings show their relevance to debates on integrated housing with care, and reflect on the methodology used and its potential relevance to similar projects. Design/methodology/approach The study used a transactive planning approach, where grounded views are sought from a variety of stakeholders. A purposive sample identified informants from relevant health, social care and housing organisations and nine semi-structured interviews were conducted. These were transcribed and data analysis was undertaken on an “interactive” basis, relating care theory to empirical expressions. Findings The authors identify two contrasting orientations – inclusive “community-oriented” and professional “service-oriented”. This distinction provides the basis for a rudimentary conceptual map which can continue to be used in the planning process. Two significant variables within the conceptual map were the extent to which CCC should be intergenerational and as such, the degree to which care should come from formalised and self-care/informal sources. The potential to achieve an integrated approach was high with stakeholders across all sectors fully supporting the CCC concept and agreeing on the need for it to have a mixed tenure basis and include a range of non-care amenities. Originality/value This paper offers originality in two respects. Methodologically, it describes an attempt to undertake early stage care planning using a needs led transactive methodology. In more practical terms, it also offers an innovative environment for considering any approach to care planning that actively seeks integration – based on an acknowledgement of complexity, a variety of perspectives and possible conflicts. The authors propose that the concepts of “community-orientation” and “service-orientation” are used as a helpful basis for planning negotiations, making implicit divergences explicit and thus better delineated.

Physical activity promotion in care homes

Purpose The purpose of this paper is to report on the implementation of a physical activity (PA) scheme – Let’s Motivate (LM) – within private care homes (CHs) in Dumfries and Galloway (DG aiming to provide an insight into the different factors which might contribute to its success and further sustainability. Design/methodology/approach A qualitative study is described in which one-to-one semi-structured interviews were carried out with eight key staff involved in implementing the project within two purposively sampled CHs; in order to explore their views and experiences of implementation. Findings The paper provides an insight into the different factors which stand to both promote and impede the successful implementation of LM, within the two CHs involved. Originality/value This paper explores a new and innovative PA initiative in CHs in D&G, Scotland. Studies exploring the factors which can both promote and impede implementation are important as they can help to usefully inform the implementation and sustainability of initiatives.

Promoting integration within the public health domain of physical activity promotion: Insights from a UK case study

Purpose The purpose of this paper is to report and critically reflect on the methodological processes involved in a formal attempt to promote health and social integration in the rarely reported public health domain of physical activity promotion. Design/methodology/approach A quality improvement (QI) methodology was deployed, comprising three elements: a diagnostic tool that assessed strategic and practice positions; a half-day workshop that brought senior leaders together for to reflect this evidence; and a structured process that sought to generate proposals for future integrated action. A mixed-method evaluative approach was used, capturing insights of the integration processes via quantitative and qualitative data collection pre-event, in-event, immediate post-event and at six-month follow-up. Findings Insights suggested that despite some critical concerns, this QI process can be considered as robust, offering pointers to elements required to successfully promote integration in this domain, including the significance of leadership, the preparatory contribution of a diagnostic tool and position paper, the opportunities for active exchange and planning within a workshop situation and the initiation of a process of integrated work via tangible “pledges”. Originality/value The paper offers originality in two respects. Generally, it describes and reflects on the relationship between theoretical and empirical dimensions of a model of integration promotion. Specifically, in offering an account of integrative public health work across health service, local authority and third sector partners, it addressed an area that has received relatively limited prior attention.

Declarations on euthanasia and assisted dying

ABSTRACT Declarations on end-of-life issues are advocacy interventions that seek to influence policy, raise awareness and call others to action. Despite increasing prominence, they have attracted little attention from researchers. This study tracks the emergence, content, and purpose of declarations concerned with assisted dying and euthanasia, in the global context. The authors identified 62 assisted dying/euthanasia declarations covering 1974–2016 and analyzed them for originating organization, geographic scope, format, and stated viewpoint on assisted dying/euthanasia. The declarations emerged from diverse organizational settings and became more frequent over time. Most opposed assisted dying/euthanasia.