Health Promotion Activities  Prevention  Health Education  Health Protection Prevention Health Education Health Protection

Prevention Primary Prevention Combating risk factors before they have even happened! Secondary Prevention Action taken to identify and treat an illness or injury early on in order to stop or reverse it! Tertiary Prevention Actions that contain or slow down the damage or serious injury or disease and hopefully rehabilitate NB. Secondary and Tertiary prevention can also involve improving quality of life by reducing pain or increasing mobility

Ideas about health promotion?  Give me some examples of ways we can promote good health??  Are these examples of primary, secondary or tertiary prevention??  What do you think are the most effective methods of promoting health??  What may be some barriers to primary prevention in particular?

Barriers to Primary Prevention  Limited knowledge about……  What behaviours are threatening to our health?  How we develop health threatening behaviours?  Social learning (Reinforcement)  Behaviour learnt in the home (Eg. Smoking)  Limited immediate incentive  Unrealistic optimism  (It won’t happen to me!)  Low self-efficacy

Cowpe Media campaigns as a form of health promotion

Aim:  To investigate the effectiveness of a media campaign to reduce chip pan fires.

Methodology:  A quasi experiment where a media campaign was shown in 10 UK television areas between 1976 and  An analysis of the number of chip pan fires reported to the fire brigade between 1976 and  Two quantitative consumer surveys to see if the people had an awareness of chip- pan fire hazards.

Procedure:  There were two television campaigns, one called overfilling and the other, inattendance.  Each were 60 seconds long and showed the initial cause of the fire and how to put it out.  Three of the 10 areas were shown the campaign a year later.  The number of chip pan fires was analysed for each area.

Findings:  The net overall decline in each area over the 12 month period was between 7 and 25%.  The largest decline was during the campaign. IN one area there was a decline of 33% during the campaign, 17% 6 months afterwards and 15% over the next 15 weeks.  ‘Overlap’ areas, which received two television stations showed the least impact.  Questionnaires showed an increase in the awareness of chip pan fire advertising and the mention of a chip pan fire being a danger increased.

Conclusions:  The advertising proved effective as shown by the decline in chip pan fires.  The behaviour change is seen more during the campaign and decreases over time.  The individual is less likely to be influenced by the comparison if overexposed to it- living in overlap areas.

Issues  Ecological validity  A real advert on TV  Social desirability bias  Self-report measures- not wanting to be seen as being ‘dangerous’ or lax  Not all fires are reported  If the person puts the fire out themselves

Dannenberg Bicycle helmet laws and educational campaigns

Aim:  To review the passing of a law requiring children to wear cycle helmets.

Methodology:  A natural experiment when laws were passed in Howard County, Maryland, USA, requiring children under 16 years of age riding bicycles to wear a helmet.  Independent design as children automatically fell into one of 3 counties.

Participants:  Children from 47 schools in Howard County and 2 control groups;  Montgomery county where a bicycle helmet law was already passed.  Baltimore county  Age ranges were; 9-10 years, years and 14-15years.  7322 children were sent questionnaires.

Procedure:  A questionnaire was sent out, containing a 4-point likert.  Topics covered by the questionnaire;  Bicycle use  Peer pressure  Awareness of the law  Helmet ownership

Findings:  Response rates were between 41 and 53% across the age ranges in all 3 counties.  Bicycle helmet use increased from 11.4% to 37.5% in Howard County after the passing of the law.  This is compared to 8.4 to 12.6% in Montgomery which used educational campaigns.  Both groups were higher than Baltimore.  87% of children in Howard County were aware of the law and 38% wore a helmet on their last bike ride.

Conclusions:  Although many children did not routinely wear a helmet, Howard County did show a significant increase in the reporting's of helmet wearing.  The area using educational campaigns was not significantly different to the area using no campaign.  Passing legislation is more effective than using educational campaigns alone and educational campaigns are not necessarily effective at all.

Issues:  Had a control group  Shows the difference that the legislation campaign makes  Not due to chance  Generalisability  Large sample – 7322 children  From USA only  Ecological validity  Legislation was passed in natural environment  Social-desirability bias  Self-report  Do not want to be seen as breaking the law

Debates:  Usefulness  Shows how educational campaigns are not significantly different to no campaign  Free will vs Determinism  Situational vs Individual

Janis and Feshbeck The effects of fear arousal

 Key facts about dental health  Worldwide, 60–90% of school children and nearly 100% of adults have dental cavities.  Dental cavities can be prevented by maintaining a constant low level of fluoride in the oral cavity.  Severe periodontal (gum) disease, which may result in tooth loss, is found in 15–20% of middle-aged (35-44 years) adults.  Globally, about 30% of people aged 65–74 have no natural teeth.  Oral disease in children and adults is higher among poor and disadvantaged population groups.  Risk factors for oral diseases include an unhealthy diet, tobacco use, harmful alcohol use and poor oral hygiene, and social determinants.

Hammond (2003) completed a longitudinal study over 2 and half years. Hammond showed that pictorial warnings on cigarette packets in Canada had a greater impact on reducing smoking than written warnings on packets in the UK. Janis and Feshbachs (953) research into the effect of fear arousal on dental hygiene shows how important it is to get the ‘fear factor’ just right:  Too much fear just makes people switch off  Too little fear the impact is lost

Aims:  To investigate the consequences on behaviour and emotions of fear appeals in health promotions.

Methodology:  A lab experiment showing fear arousal material.  Data collected through questionnaires on emotional reactions and changes in dental practice.  Independent measures including the same speaker and same content on the causes and preventions of tooth decay.

Participants:  A 9 th grade freshman class at a US high school.  Aged years with a mean age of 15.  Divided into 4 groups including a control group.  Group one: Lecture had a strong fear appeal, had painful consequences and used direct statements- “This could happen to you”.  Group two: Moderate fear appeal with little information about the consequences and statements were more factual than audience focussed.  Group three: Minimal fear arousal with mostly neutral information on tooth growth and function rather than the consequences of poor hygiene.  Group four: Control group had a similar lecture on the eye.

Procedure:  Questionnaire given one week before the lecture on dental health.  A 15 minute illustrated lecture delivered in a standard manner by the same lecturer.  Questionnaire handed out immediately after the lecture asking about emotional response to it.  A follow up one week later about the long-term effects.

Findings:  All lectures conveyed the required information and there was no difference in the amount of knowledge on dental health in the 3 groups.  Strong fear appeal was seen in a positive light and a high level of dislike was reported.  Moderate and minimal arousal has increased brushing by 44 and 50% whilst strong fear arousal only increased by 28%.

Conclusions:  Fear appeals can be effective in changing behaviours, but the level of fear must be right for each audience.  Minimal fear was the most effective with the highest conformity rate to recommended practice.

Issues:  Generalisability  Only from one school  Social desirability bias  Self report  Relied on participants being truthful about behaviour change  Control group  Changes were due to health promotion and not chance  Independent measures design  Participant variables

Debates:  Usefulness  Showed how a minimal fear appeal is the best option  Fear arousal should be tailored to the audience  Ethnocentrism  All from one school

Health Promotion Task 1: You will be given one of the three methods of health promotion. Your task, in pairs, is to: - Choose an issue - Design a media campaign/suggest legislation/method of fear arousal for that issue - Ext: evaluate your design

Comparison of issues & debates Issue/debateMediaLegislationFear Ecological validity Reliability Usefulness Free will/determinism Reduc/holism Nature/nurture Quan/Qual Methods Task 2

Task 3:  As) Discuss the ecological validity of research into methods of health promotion. (15)  Bs) Assess the effectiveness of methods of health promotion. (15)  In pairs, plan how you would answer this question – this will also help you with your homework.  You will then share your ideas with another group  You may be tested on this at a later date

Homework  To what extent is there free will in relation to health belief. (15)  Due one week today