Health beliefs and their influence on United Kingdom nurses' health-related behaviours

BACKGROUND: Because there is a demonstrated empirical link between nurses' personal health habits and their tendency to raise health issues with clients, researchers suggest that nurses can improve their health promotion role if they adopt health-related behaviours. Few researchers, however, have identified the factors that influence nurses' health-related behaviours. AIMS: To describe nurses' beliefs about the importance of health-related behaviours, and investigate the relationship between these beliefs and their health-related behaviours. DESIGN: A cross-sectional survey from which nested-case control comparisons were made. SAMPLE: One hundred and thirteen nurses attending tertiary level education courses in London and Essex. MEASURES: Health Behaviour Survey and a scale measuring nurses' beliefs about the importance of health-related behaviours. RESULTS: Nurses' health beliefs significantly influenced the practice of 14 health-related behaviours. CONCLUSIONS: The findings from this study support the view that nurses' practice of many behaviours linked to health and longevity are influenced significantly by their beliefs about the importance of these behaviours. Changing nurses' beliefs about the importance of health-related behaviours through specific health promotion sessions are meaningful as they may improve nurses' health promotion role.     

Health Beliefs and Experiences of a Health Promotion Intervention Among Psychiatric Patients With Substance Use: An Interview Study

We aimed to explore beliefs about physical health from the perspective of patients with concurrent mental illness and substance use and to explore how a health promotion intervention influenced their personal agency for changing health-related behaviour. Our findings were that patients' beliefs were focused on their present day state of health and that patients had strategies to normalize their health and health-related behaviour. Health promotion to this group of patients should be tailored to fit their particular beliefs. Health measurements were experienced as providing tangible insight into their health and appeared to prevent patients from minimizing physical health problems.     

Health promotion practices of emergency physicians

In this article we describe health promotion practices of emergency physicians (EPs). A survey was mailed to members of the West Virginia American College of Emergency Physicians. Main outcomes included the EP's beliefs regarding health promotion, perceived roles in health promotion, and perceived effectiveness in modifying the behavior of patients. Over 90% of respondents routinely asked about cigarette smoking and half about alcohol use. A minority routinely asked about illicit drug use, diet, exercise, domestic violence, or stress. The majority stated they were the main person responsible for patient health education in their emergency department (ED). Most felt prepared to counsel patients about smoking (68%) and alcohol (59%), although very few described themselves as successful in helping patients change their behavior. Although EPs feel responsible for promoting the health of their patients, only a minority reported routinely screening and counseling patients about prevention and most were not confident in their ability to help patients change their health-related behaviors.     

Do nurses’ personal health behaviours impact on their health promotion practice? A systematic review

BackgroundThere is a growing expectation in national and international policy and from professional bodies that nurses be role models for healthy behaviours, the rationale being that there is a relationship between nurses’ personal health and the adoption of healthier behaviours by patients. This may be from patients being motivated by, and modelling, the visible healthy lifestyle of the nurse or that nurses are more willing to promote the health of their patients by offering public health or health promotion advice and referring the patient to support services.MethodsAn integrated systematic review was conducted to determine if nurses’ personal health behaviour impacted on (1) their health promotion practices, and (2) patient responses to a health promotion message. Medline, CINAHL, SCOPUS, and PsycINFO databases were searched. A narrative synthesis was conducted.Results31 studies were included in the review. No consistent associations were noted between nurses’ weight, alcohol use, or physical activity level and their health promotion practice, although smoking appeared to negatively impact on the likelihood of discussing and engaging in cessation counselling. Nurses who reported confidence and skills around health promotion practice were more likely to raise lifestyle issues with patients, irrespective of their own personal health behaviours. The two studies included in the review that examined patient responses noted that the perceived credibility of a public health message was not enhanced by being delivered by a nurse who reported adopting healthy behaviours.ConclusionsAlthough it is assumed that nurses’ personal health behaviour influences their health promotion practice, there is little evidence to support this. The assertion in health care policy that nurses should be role models for healthy behaviours assumes a causal relationship between their health behaviours and the patient response and adoption of public health messages that is not borne out by the research evidence.     

Health beliefs: a cultural division?

Uptake of preventive health programmes seems to be related to people's underlying motivations, attitudes and beliefs about health and illness. Current theories used to account for variance in behaviours by social group (such as the health belief model and locus of control model) explain only some of the variance in these motivations and attitudes, and have not been adequately tested on women from different ethnic minority groups. Health beliefs have important implications for nursing given the role of the nurse in health promotion and patient teaching. This paper identifies and compares the health beliefs of women of Asian origin and white indigenous women living in an inner-London borough, through in-depth semi-structured interviews, and considers the findings in relation to health promotion practices and the role of the nurse. The Asian women rated their health as worse than the white women; this requires further study. Comments and views gathered about the causes of various diseases indicated that it may be unrealistic to fit a person's health beliefs into a distinct model. Beliefs about disease appeared to be culturally sensitive; health education, therefore, must also be culturally sensitive.     

Tobacco use and baccalaureate nursing students: a study of their attitudes,beliefs and personal behaviours

Aim. To report findings about student nurses' attitudes, beliefs and personal behaviour in relation to tobacco issues. Rationale. Nurses have the potential to influence clients' behaviours and public policy concerning tobacco use. However, a review of the literature suggests that this is not happening. Further understanding of nursing students' attitudes, beliefs and behaviours regarding tobacco use is needed in order to develop strategies which can positively impact on their future health promotion role. Methods. A cross‐sectional survey of the total population of baccalaureate nursing students in one Canadian province was employed. Students were asked to complete a self‐administered questionnaire, which included questions related to their smoking history; stage of behavioural change, and beliefs and attitudes towards tobacco. Students also completed the Health Promotion Lifestyle Profile (HPLP) and the Fagerström Nicotine Tolerance Scale. Findings. Two hundred and seventy‐two students (61·9%) responded. Sixty (22·1%) indicated that they smoked daily or in social situations. These smokers were found to have a fairly low level of nicotine dependence and although 91·4% said they wanted to quit, few were actively engaged in the quitting process (16·9%). When comparing the beliefs and attitudes of smoking and non‐smoking students, proportionally more of the non‐smokers agreed that smokers will need close family/friends to help them quit; that the health of society should be protected by laws against smoking; and that nurses should set a non‐smoking example. Non‐smokers indicated more health promoting behaviours on items in the HPLP especially on the variables of physical activity, nutrition and stress management. Conclusions. Nurses have the potential to influence clients' behaviours and public policy concerning tobacco use. Developing future nurses with the knowledge and skill to do so needs to be an important emphasis of nursing curricula.     

Heart health-associated health beliefs and behaviours of adolescents of African and African Caribbean descent in two cities in the United Kingdom

The following paper presents the findings of an exploratory ethnography, the purpose of which was to identify and describe heart health associated beliefs and behaviours of year seven (Y7) and year 10 (Y10) secondary school young people of African and African Caribbean descent in two UK cities. Data were collected by the data collection technique of focus groups. However, eight focus groups were conducted involving 47 Y7 young people and 29 Y10 pupils, 76 pupils in total. The data were analysed utilizing ATLAS/ti qualitative data analysis software. This software is informed by grounded theory. Data from the study formed six themes. The findings informed the development of an interactive health promotion website which can be found at http://www.shef.ac.uk/web/uni/projects/mshhp. The paper argues that in order to provide meaningful programmes of health promotion to be developed by health care providers including school nurses and health visitors, it is essential that interventions are informed by an understanding of the health beliefs and behaviours of African and African Caribbean young people.     

Social support and locus of control as correlates of UK nurses' health-related behaviours

Social support and locus of control as correlates of UK nurses' health-related behaviours ¶ Background : Despite the number of studies describing nurses' health-related behaviours, few have investigated psychosocial factors that influence these behaviours. Aim : To investigate the relationship of social support and locus of control to nurses' health-related behaviours. Design: A cross-sectional survey was used. Subjects : 114 nurses' attending tertiary level education courses in London and Essex. Measures : The Health and Behaviour Survey, The Six Item Social Support Questionnaire and the Multidimensional Health Locus of Control Scale. Results: Social support did not significantly relate to any health-related behaviour except eating fruit. Subjects high on internal locus of control also significantly reported eating less red meat, eating three meals per day on a regular basis and eating fewer between meal snacks. Conclusions: Locus of control is more strongly associated with United Kingdom nurses' health-related behaviours than social support. Given the empirical links between nurses' health-related behaviours and their tendency to counsel clients about health issues, attempts to improve nurses' internal locus of control may ultimately improve their health promotion role.     

Theories of behavior change through preventive and health promotion interventions in occupational therapy

BACKGROUND: Community occupational therapy practice challenges therapists in their health educator role and incites them to implement preventive strategies with their clients. Working in the community also provides an interesting context for the implementation of strategies targeting health promotion at the community level. PURPOSE: This article describes some of the theories that are used in the public health and health promotion fields to explain health-related behaviour change. It also highlights their potential for community practice in occupational therapy. The theories presented in this paper are the health belief model, social cognitive theory, theory of reasoned action and theory of planned behavior. They are among the most widely used for health-related behaviour analysis and intervention. PRACTICE IMPLICATIONS: Since these theories emphasize a set of factors that influence health behaviours, reviewing these theories could contribute to enhance the effectiveness of educational interventions with regards to clients'adherence to their prevention and health promotion recommendations.     

The experience of collaboration: a comparison of health visiting in Scotland and Norway

This investigation compared health visiting in Scotland and Norway by focusing on collaboration in health visiting. The data are based upon in-depth interviews with a non-probability sample, with voluntary participation of nine health visitors from Scotland and 12 health visitors from Norway. The results showed that there were more similarities than differences between the Scottish and Norwegian health visitors' experience of collaboration in their work. Both groups had a complex role-set and experienced dependency on role partners. Collaborative strain was experienced through lack of recognition and system deficiencies. Tensions in collaboration evolved from the definition and question of responsibility in grey areas, jurisdictional threats and conflicts. Within these areas the degree and importance of collaboration differed. The Scottish health visitors were more dependent on client referrals to them and their referrals to other agencies, whereas the Norwegians health visitors experienced an asymmetrical relationship, as they were more dependent on the capacity of the agency to accept the referrals. Lack of recognition seemed to be a stronger experience in Norway than in Scotland. All of this had a marked influence on the performance of the health visitors. Further research should address the question of collaboration in health visiting work and to what degree it influences the quality of health visiting and consequences for clients, the community and health visiting service.     

Audit of health promotion practice within a UK hospital: results of a pilot study

Introduction and aim There is clear evidence that modifiable risk factors – smoking, alcohol misuse, poor diet, lack of exercise and obesity – are detrimental to health. UK public health policy now requires hospitals to have in‐place health promotion programmes to empower patients to swap risky for healthy behaviours. This audit aimed to determine a baseline level of health promotion practice for modifiable risk factors in a UK hospital. Method Case notes from two hundred and fifty hospitalized adult patients (excluding all terminally ill patients), discharged alive between January and June 2004, were audited for evidence of screening for risk factors (smoking, alcohol, diet, exercise and obesity) and the provision of health promotion to change these risk behaviours. Results The majority of inpatients were asked about smoking (88%) and alcohol consumption (74%), but few were screened for obesity (18%) or asked about their normal diet (5%) and physical activity (3%). Health promotion was delivered to a third of smokers and over half of inpatients reporting misuse of alcohol. Healthy diets, exercise and weight management were rarely discussed. Only three inpatients were screened for all risk factors. Conclusion This study indicates that the majority of hospital inpatients were screened for smoking and alcohol use, but improvements need to be made in the delivery of health promotion for smoking cessation and sensible drinking. It is clear that inpatients’ are not routinely screened for diet, exercise and weight status, nor delivered health promotion for the management of these risk behaviours.     

Hong Kong nurses' health-related behaviours: implications for nurses' role in health promotion

The health-related behaviours of a random sample (n=92) of Hong Kong nurses were assessed by a questionnaire written either in English or in English and Chinese. Hong Kong nurse reported negligible smoking or a alcohol use, low levels of breast self-examination, cervical screening behaviour and regular exercising, seat belt use and driving within the speed limit. The sample reported high levels of making efforts to avoid foods high in cholesterol, eating foods high in fibre and eating fruit daily. Dental hygiene was reported to be high. Just over half the sample reported sleeping 7–8 hours each night and eating breakfast daily. Most nurse reported maintaining their body weight at a healthy level and eating snacks between meals. The English language version of the questionnaire produced a slightly better response rate than the bilingual questionnaires. The results are discussed with reference to previous studies of females' health-related behaviours in Hong Kong and elsewhere. The implications for Hong Kong nurses' role in health promotion is discussed.     

The role of motivation and self‐efficacy on the practice of health promotion behaviours in the overweight and obese middle‐aged American women

The study investigated the relationship between motivation, self‐efficacy and demographic variables, and determined if they affect the performance of health promotion behaviours in overweight or obese middle‐aged American women. The sample consisted of middle‐aged American women from a small town in Michigan. Two groups of women aged 30–65, one with a body mass index (BMI) range of 25–29, and the second with a BMI of ≥ 30, completed the Health Self‐Determinism Index, the General Self‐Efficacy Scale and the Health Promoting Lifestyle Profile‐II. Self‐efficacy was found to be a significant predictor in the performance of health‐promoting behaviours in both the overweight and obese participants in this study. Motivation was not found to be a significant predictor of performance of health promotion behaviours in either participant group. Education was found to be a significant predictor of performance of health promotion behaviours in the obese participants only. Nurses need to develop effective methods of supporting self‐efficacy in both the overweight and obese middle‐aged American women. Nursing‐based research focusing on interventions to improve self‐efficacy, as well as studies identifying effective educational techniques to improve the practice of health promotion behaviours in this population is necessary. Further investigation into the effect of motivation and demographics on the performance of health promotion behaviours is also needed.     

Physical fitness in pre-registration nursing students

BackgroundNurses are ideally placed to deliver health promotion interventions, including physical fitness, however evidence suggests that nurses themselves are failing to engage in healthy lifestyles; this in turn making them less likely to promote health. It would appear that some nurses are allowing their own values, beliefs and behaviours to hinder this role. We propose these nurses are in breach of the Nursing and Midwifery (NMC) code.Currently nurses self declare their fitness to practice through the NMC, however self-monitoring has been criticized for its lack of reliability. Recruitment of student nurses in the UK does not currently assess physical fitness levels in line with other professionals such as the armed forces, police or fire service. Over half the nursing workforce is now overweight or obese, with alarming levels of inactivity.Physical activity positively correlates with motivation, wellbeing, coping and positive attitude. These attributes in turn impact on employability, retention and absence. This article explores promoting health, focussing on physical activity and discusses innovative ideas to promote physical activity within the nursing Curricula.     

Promoting physical activity in primary care settings: health visitors' and practice nurses' views and experiences

AIM: This paper reports a study investigating health visitors' and practice nurses' attitudes, beliefs and practice associated with routinely advising patients about physical activity. BACKGROUND: There is worldwide concern about increasing rates of obesity and decreasing population levels of physical activity, and it has been argued that primary healthcare professionals are ideally placed to promote physical activity within local communities. In recent years, the public health role of primary care-based nurses in the United Kingdom has been considerably expanded to include playing a key role in improving the health of their local practice populations. A systematic literature search revealed that very few studies investigating nurses' views and experiences of this type work have been published. The limited amount of research that has been conducted is generally small-scale and primarily concerned with general medical practitioners' practice and attitudes, and not those of nurses. METHODS: A questionnaire survey (n = 630) and 20 in-depth interviews were conducted with health visitors and practice nurses in four health regions in Scotland between March and April 2004. The response rate was 63% overall. RESULTS: Ninety per cent (n = 149) of health visitors and 88% (n = 186) of practice nurses said that they were very likely or likely to recommend all apparently healthy adult patients to take moderate exercise. Health visitors were more likely to discuss psychological benefits than practice nurses. However, only 9% (n = 15) of practice nurses and 11% (n = 15) of health visitors correctly described the current recommendations - an accumulation of 30 minutes of moderate physical activity five times a week. Interview data suggested that most nurses gave physical activity advice based on their beliefs about the patient's willingness to change and their impressions of the patient's presenting condition, underlying physical condition and life circumstances. No measure of underlying physical fitness was used. There was a lack of agreement between the questionnaire and interview data associated with levels of physical activity advising. CONCLUSION: There were high levels of enthusiasm for physical activity promotion amongst health visitors and practice nurses. However, nursing leaders and opinion-makers should challenge practitioners' current beliefs and assumptions about physical activity promotion in the general population.     

Using mass media within health-promoting practice: a nursing perspective

For some time health professionals have recognized the growing importance of utilizing mass media strategies as part of their health-promoting practice. The ever-evolving climate of technology and increasing reliance on mass communications has further reinforced the position of mass media initiatives. The enormous potential for mass media resources to reach certain audiences and influence their health-related behaviours has become particularly well established. Despite these facts, however, it is argued that the nursing profession has been less than pro-active in acknowledging, accommodating and adopting such practices. Consequently, the incorporation of health-related mass media initiatives into nursing's health-promotional role remains an elusive exercise. The maintenance of such a position, it is claimed, is potentially damaging for the profession as a whole. In light of this state of affairs, this paper seeks to review the literature surrounding the nature and processes of mass media strategies, their relevance to health promotion and nursing, how they are currently utilized and how they can be incorporated further into nursing practice. In conclusion, it is argued that nursing should seek to become a more active user of mass communication/media technology--especially in relation to its health-promotional practices.     

Smoking behaviour and attitudes among German nursing students

Tobacco consumption is a major public health threat. Healthcare workers can contribute to the reduction of tobacco use. The principles of intervention need to be provided already during vocational school.This research examines the smoking habits, the personal attitudes towards smoking and the professional beliefs of healthcare trainees. The aim of this study is to ascertain the necessity and the general conditions for multilevel interventions of prevention and health promotion.In 2010, a questionnaire survey was conducted in a Berlin vocational school for healthcare workers.Of 148 students (RR = 49.3%) 41.9% of the students are daily or occasional smokers. The nicotine dependency and the number of cigarettes per day are comparatively low. The majority of smoking students is willing to quit and has already undertaken several attempts. Non-smoking protection is evaluated to be very important and intervention rates in patient care range between 49% and 72%. In both questions, non-smokers and smokers differ significantly.The self-reported smoking prevalence in our population is considerably lower than in previous studies. However, the smoking rate among healthcare trainees is still higher than in the general population.The students' own smoking behaviours and its influences on the treatment of patients should be reflected during school. It is necessary to develop adequate recruitment strategies and attractive interventions for this target group.