A 'component circuit approach' to needs assessment and strategy selection in health promotion

An approach to formative research in health promotion is describedwhereby significant ‘components’ in the field areidentified and involved as part of a circuit, to test and generateideas. The underlying model is similar to corporate planningprocedures whereby relevant ‘stakeholders’ are identified,and their need and interactions taken into account in generatingthe organization strategic plans for achieving its corporategoals. The process involves aspects of quantitative and qualitativeresearch, the mix of which can vary according to the requirementsof the situation. The use of the process for developing nutritionstrategies for the ‘Health for All Committee’ inone State of Australia is described.     

Community pharmacists and health promotion: a study of consultations between pharmacists and clients

Community pharmacists have been identified as being well-placedto perform a health promotion role. On average, in the UK, tenclients per pharmacy per day will seek the advice of a phannaciston minor symptoms. Performance of a health promotion role requiresan awareness of rele problems underlying symptoms (such as lifestyle,diet and smoking) and a readiness to raise these. It also requirescommunication and counselling skills where the pharmacist isprepared to listen to, and respond constructively to, client'squestions and wishes. A random sample of 64 (1 in 20) of all community pharmaciesin the London postal districts were selected Four three-hourstudy visits were made to each phar macy during which all consultationstaking place between the pharmacist and clients were tape-recordedusing radio-microphone apparatus. 711 consultations, concerninga wide range of problems, were collected and transcribed Aninvestigation of health promotion input, communication stylesand interpersonal issues and the symptom versus product focusof the consultation, was conducted Analysiss performed usingthe Statistical Package for the Social Sciences (SPSS). Pharmacists were virtually always readily available to adviseclients who presented with symptoms in the pharmacy. They paidcareful attention to clients' requests for help. However, theirstyles of questioning behaviour and the fact that their adviceis focused around the supply of products rather than a discussionof symptoms may result in many lost opportunities for healthpromotion. The style and content of consultations could be areflection of pharmacists' knowledge of health promotion issues,their perceptions of their role or the expectations of clients.     

Prevention and promotion in decentralized rural health systems: a comparative study from northeast Brazil

Policies to reform health care provision often combine the organizational restructuring of decentralization with ideological restructuring through a new model of health care that gives greater weight to prevention and promotion. Decentralization provides a discretionary space to the local health system to define and develop its own activities. The central policy aim to shift the model of health care therefore must rely on incentives rather than directives and is likely to result in variation at local levels in the extent and mode of its implementation. The local processes affecting variation in local implementation of policies for prevention and promotion have not been studied in a developing country. This study does so by comparing two rural health systems with different levels of prevention and promotion activities in one of the poorest regions of Brazil, Ceará State in the northeast. The health system with greater activities of prevention and promotion also has a more advanced stage of decentralization, but this is in combination with many other, interacting influences that differentiate the two health systems' ability to adopt and implement new approaches. While beyond the scope of this paper to detail options for regional and national managers to encourage the adoption of a greater focus on prevention and promotion, it is clear that strategies needs to target not only the vision and actions of local health system staff, but critically also the expectations of the local population and the attitudes of local government.     

Mental health promotion and illness prevention in Western Australia: a study of service capacity

While considerable evidence exists regarding the effectiveness of specific kinds of interventions for mental illness prevention and to a lesser extent mental health promotion, mental health promotion and illness prevention (MHPIP) remain underdeveloped in Western Australia. The aim of this study was to explore the current state of MHPIP in Western Australia and to highlight some of the structural and systemic issues that need to be addressed if MHPIP services are to be progressed further in this state. For this purpose, the study examined the capacity for delivery of MHPIP services. Opportunities and barriers to the further development of MHPIP were also identified. Thirty-four key stakeholders representing a cross-section of local services, central government agencies and universities were interviewed using a semi-structured interview schedule. The interviews were conducted over a 6-week period. The interview schedule included questions on the workforce, agency liaison and project implementation, and priority areas and issues with respect to research and policy setting in MHPIP. In developing the focus of MHPIP services, critical factors that constitute capacity building were identified. These included readiness to participate in MHPIP, service infrastructure development, workforce development, resource allocation, networks and evaluation of programmes.     

HIV/AIDS control in Africa: the importance of epidemiological and health promotion approaches

HIV infection and AIDS are disproportionately afflicting ThirdWorld countries, especially the countries of Africa, where substantialadult communities and villages are literally being annihilated.Because there is no known cure for HIV/AIDS, and because ofthe high costs of current antiviral therapy (e.g. AZT), it isa cost-effective use of health resources for the economicallypoor countries of Africa to use health promotion/ educationto intervene and control the incidence of HIV infection andAIDS. Crucial to any effective health promotion effort is athorough knowledge about the epidemiological specifics and distributionof HIV/AIDS in Africa, the known at-risk segments of the population,and the known at-risk conditions (e.g. male–female relationships,stress) and behaviours (e.g. peer and other pressures to engagein unprotected sex) for HIV infection. For health promotionto be successful it has to be unrelentingly applied to all at-riskgroups in African societies, region-specific and culturallysensitive, and it has to acquire active cooperation from allmembers of the community of African nations.     

The SWIM study: Ethnic minority women's ideas and preferences for a tailored intervention to promote national cancer screening programmes—A qualitative interview study

BackgroundEthnic minority women from non‐Western countries are less likely than the native women to participate in screening programmes for cervical cancer, breast cancer and colorectal cancer. This social inequality can result in loss of possibility for prevention, delayed diagnosis and treatment and, ultimately, lower chance of survival. Developing a tailored intervention might be the solution to reduce social inequalities in cancer screening, and a key feature in intervention research is to consult the target group.ObjectiveTo explore ethnic minority women''s own ideas and preferences for a cancer screening intervention and identify their attitudes to different strategies.MethodsAn interview study with five focus group interviews, two group interviews with an interpreter and three individual interviews. Thirty‐seven women from 10 non‐Western countries contributed to the study. The interviews were audio‐recorded and transcribed verbatim followed by a thematic analysis.ResultsAccording to the women, a tailored intervention should focus on knowledge in the form of face‐to‐face teaching. The women further suggested information material in their own language with a simple, positive and concrete communication strategy. They would like to be involved in an awareness strategy and share the knowledge with their network.ConclusionEthnic minority women were interested in a tailored intervention, and they were keen to contribute with ideas and preferences. The findings emphasized the potential of a tailored intervention with specific suggestions to the content when attempting to reduce inequality in cancer screening participation.Patient or Public ContributionMinority women were involved in the interview study.     

'Opportunity structures': urban landscape,social capital and health promotion in Australia

This paper presents data from 40 in-depth interviews that were conducted as part of a study of social capital and health in relation to people's perceptions of the influence of 'place' on their participation levels and health. These data were used to examine features of the western suburbs of Adelaide that were perceived as health damaging and health promoting. The paper demonstrates that our Australian suburban respondents expressed a considerable concern about these features and the impact they have on their perception of community and their ability to participate in it. Safety, connectedness to the area, the reputation of an area and the extent and nature of community facilities are all seen as important to a healthy community. The research found that in the more deprived socioeconomic areas within the study area, there was a significant degree of dissatisfaction with features of the urban environment, such as availability of amenities, provision of public transport, and proximity of industry to private dwellings. The paper concludes by considering certain features of urban environments that might make them more supportive of health through encouraging contact between people. We conclude that these environments could be improved using the following measures: a subsidy scheme to support the viability of local shops and cafés (thereby providing meeting places and employment); parks with facilitators (who could play a role in increasing safety in the park but also encouraging community development); attractive places to walk; and a general environmental improvement program.     

Health promotion in the market-place: patient satisfaction as the basis of a marketing strategy

This article looks at prevention in the context of recent policyinitiatives in the UK which have created new roles and new opportunitiesfor general practitioners (GPs) and primary care. One such opportunityis the potential to actively market preventive services in orderto retain and attract patients in a competitive market. We firstdescribe this context and then provide an example of how a patientsatisfaction survey can be an effective market-research toolThe results from a district-wide survey are evaluated in termsof socio-demographic differences which stratify the patientmarket into segments which are aware of, users of and are satisfiedwith preventive services and those who are not. This articleillustrates how GPs can use data of this kind when developinginvestment and marketing strategies.     

Health promotion in the market-place: patient satisfaction as the basis of a marketing strategy

This article looks at prevention in the context of recent policyinitiatives in the UK which have created new roles and new opportunitiesfor general practitioners (GPs) and primary care. One such opportunityis the potential to actively market preventive services in orderto retain and attract patients in a competitive market. We firstdescribe this context and then provide an example of how a patientsatisfaction survey can be an effective market-research toolThe results from a district-wide survey are evaluated in termsof socio-demographic differences which stratify the patientmarket into segments which are aware of, users of and are satisfiedwith preventive services and those who are not. This articleillustrates how GPs can use data of this kind when developinginvestment and marketing strategies.     

Breast cancer health promotion model for older Puerto Rican women: results of a pilot programme

This article focuses on the development of a health promotion model programme for elderly Puerto Rican women intended to minimize barriers for early detection of breast cancer and to increase women's compliance with recommended guidelines. The programme was designed based on the findings of a national sample to assess knowledge, beliefs and practices of breast cancer early detection in Puerto Rican elderly women and their perceptions of barriers associated with non-compliance. It involves the combination of educational and environmental support for actions and conditions conducive to health behaviour and consists of the following components: (i) a culture- and cohort-sensitive health education programme for elderly women on breast cancer screening and assertive strategies for client-physician relationship; (ii) training for primary-care providers on current guidelines and barriers affecting compliance among older women in Puerto Rico; and (iii) coordination of necessary support services to facilitate access to clinical breast exams and mammograms. Programme implementation considers appropriate theories for health promotion and education in the older population. Evaluation measured progress in the plan implementation by assessing immediate products and long-term impact of the programme. Results of the pilot programme revealed a slight increase in knowledge and a significant decrease (p < 0.05) in beliefs after the health education sessions. Interventions in breast cancer early detection practices showed significant changes (p < 0.05) for mammogram and clinical breast examination. Different strategies must be combined to increase older women's compliance with breast cancer screening. Health system and access barriers to preventive care must be addressed.     

Rural community pharmacy: a feasible site for a health promotion and screening service for cardiovascular risk factors

ABSTRACT: A pharmacist-delivered health promotion and screening service for cardiovascular risk factors in rural community pharmacy was implemented in the Upper Hunter Valley, New South Wales (NSW). We describe the development of the service and profile 204 participants at their initial screening. A standardised clinical protocol guided the pharmacist through delivery of the service. The mean age of participants was 44 years ( SD ± 13 ). Over half (54%) had a Body Mass Index (BMI) > 25, 54% had cholesterol > 5.0 mmol L^-1 and 18% a systolicBP > 140 mmHg and/or diastolicBP > 90 mmHg. Most (80%) received lifestyle information (dietary, exercise or smoking cessation). One third required referral to a general practitioner. Provision of the service through community pharmacy increased the community's access to screening, 28% reported that they had never had their cholesterol measured. Since this new service was able to identify, educate and refer people at risk of cardiovascular disease in a rural community, we recommend a broader adoption through rural pharmacies.     

System-wide adoption of health promotion practices by schools: evaluation of a telephone and mail-based dissemination strategy in Australia

Schools can potentially benefit from system-wide approaches to the dissemination of health promotion practices. This intervention study undertaken in the Hunter Region of NSW, Australia, used a pre-post design to assess whether a phone and mail intervention dissemination strategy was associated with an increase in the proportion of 218 primary schools undertaking eight health promotion practices. Health promotion practices addressed the prevention of harm associated with five agreed health issues-smoking, nutrition, playground safety, asthma and infectious diseases. The study also assessed acceptability of the dissemination strategy to schools, cost and whether intervention schools' characteristics were associated with uptake of health promotion practices. Compared to baseline a significant improvement in prevalence was observed at both 1 and 2 year follow-up for seven of the eight health promotion practices addressed. The greatest improvement occurred in the first year of the project. There was a greater uptake of the practice of providing information regarding passive smoking in urban schools. The dissemination strategy was found to have a cost per adopted practice of 121 Australian dollars and to be acceptable to the large majority (>90%) of schools. The results suggest that the dissemination strategy may represent a relatively low cost method of enhancing health promotion practices in schools and of monitoring such practices. Further research addressing the methodological issues of this study is needed to confirm these findings.