Methods of health promotion

Healthy Living: explaining health behaviours

METHODS OF HEALTH PROMOTION

·         MEDIA CAMPAIGNS: Keating et al.

·         LEGISLATION: Wakefield et al.

·         FEAR AROUSAL: Janis and Feshbeck

METHOD: MEDIA CAMPAIGNS

The phrase “media campaigns” refers to various forms of media, which are used to communicate and interact with a range of audiences. There are many forms of media, but typically health campaigns tend to use print media, such as pamphlets, electronic media, such as television and radio, and new-age media, such as social networking. Media campaigns are a prominent method of health promotion as there is a wide range of diversity and accessibility; most households in the West own a television set, and almost everywhere has access to newspapers or the Internet. Health media campaigns can be on various health behaviours, including sexual health and drug use. Health media campaigns are broadly based on the Yale Model of Persuasion from 1953, which describes how for a campaign to be successful, it must consider the communicator of the message, the communication of the message, and the target audience. The health belief model, which roughly fits this but is more complex, is also often used heavily in media campaigns, such as in the TV adverts for Change4Life and Hands-Only CPR.

EVALUATION: MEDIA CAMPAIGNS

Mass media campaigns are a practical method of health promotion in that they can reach a large population in a relatively short amount of time. However, they require access to some resources that people don’t have, can be avoided or ignored, and may not be seen by the full target population, which reduces the effectiveness. Media campaigns are time effective, but not really cost effective, and only reach a certain demographic – so many forms will be needed. It is also important to remember that improved knowledge doesn’t necessarily mean improved behaviour, and particularly stressful campaigns may cause people to switch off from the message.

STUDY: KEATING et al.

Keating et al. conducted a study which aimed to assess the successfulness of the mass-media campaign VISION on reproductive health and HIV/AIDS prevention. A sample of 3278 participants aged between 15 and 49, from various ethnic and economic groups in Nigeria was used. Verbal informed consent was given, and then participants were asked various questions from a questionnaire on sexual health, with 3 critical fixed choice (yes/no) questions: one on talking with a partner about preventing AIDS, one on whether using a condom reduced the chances of getting AIDS, and finally one on whether they used a condom on their last sexual encounter. Chi square and regression analysis was used on the results. It was found that media campaigns were more accessible by males, with females being more exposed to the information from clinics. Exposure to VISION was high, and this appeared to be associated with positive responses to the first two questions; however appeared to have no effect on the third question. It was therefore concluded that different media campaigns reached different people, but whilst campaigns were successful in giving information, this did not seem to directly lead to behavioural changes, and thus media campaigns should also look at giving practical information on how to do certain health behaviours (such as obtaining a condom).

EVALUATION: KEATING et al.

The study used stratified sampling to improve the representativeness of the sample, which was important in Nigeria for ethnic balance. The sample was also large, but ethnocentric to Nigeria. The study was ethical in that verbal informed consent was given, however the questions were quite personal and this may have caused embarrassment or psychological harm. The questionnaire appears to have highlighted the important points about the success of media campaigns rather efficiently; however it would have been more useful if reasons why condoms had not been used had been included in the self-report – a pilot study could have shown this. The study is useful in that it shows that information is not all that is required for a behavioural change, which is something that could be generalized or investigated further for other health behaviours. The study is also useful as it shows the effectiveness of media campaigns varies by population.

METHOD: LEGISLATION

Legislation refers to law making processes, and this is a method of health promotion as laws can be implemented to change health behaviours, by promoting and enforcing positive health behaviours, whilst banning unhealthy behaviours. Certain behaviours that have been made illegal are smoking in public places and smoking if under 18 (rather than 16), whilst behaviours that have been made compulsory in a legal manner include wearing a seatbelt.

EVALUATION: LEGISLATION

Legislation raises the issue of freewill versus determinism, and the ethical nature of forcing or banning certain behaviours. To what extent is it ethical or right to ban dangerous health behaviours, or to enforce improved health behaviours? Some would argue that the legislation against smoking in public places is denying people human rights, such as freedom of movement, whilst others would suggest smoking itself is so dangerous that it should be completely banned. In addition to this, whilst legislation is far reaching and supposed to be enforced equally wherever it applies, obedience is somewhat optional. In areas such as Greece, where there is the same smoking ban as in the UK, people still tend to smoke in public places due to the fact the authorities don’t fully enforce it. Legislation is only effective if people listen to it and abide by the laws.

STUDY: WAKEFIELD et al.

Wakefield et al conducted a cross-sectional study into the effect of restrictions on smoking at home, school and in public places on teenage smoking. A random sample of 17,287 high school students was taken from over 200 schools in the USA – one school in each county of mainland USA. A self-report method of a questionnaire was used to gather demographic data and information on whether adults and siblings at home were smokers, as well as their smoking history and intentions. Participants were then classified into six categories, ranging from non-susceptible non-smokers to established smokers. Further questions asked about restrictions at home and school. Researchers also gathered information on smoking bans and the strength of enforcement. The study found that legal restrictions and enforced bans were significantly associated with not developing an early smoking habit, that home bans were more effective that legal restrictions on taking up smoking, and extensive restrictions on smoking in public places were associated with lower probability of transition between later stages of transition. However, school bans appeared to actually increase the probability of transitions to the last stage. It was concluded that school bans needed to be enforced to actually be effective and that although causality cannot be deduced, their findings are consistent in showing that parental opposition and banning smoking in the home reduces the uptake of smoking amongst teenagers.

EVALUATION: WAKEFIELD et al.

The study used a very large sample, which although was not stratified was random, and so likely to be representative of teenagers across the USA. As the findings are consistent with earlier research, it is likely that the study is reliable; however the use of self-report may reduce this as there is no sure way of checking honesty or accuracy of memory. Social desirability bias may have affected the results. As it was a cross-sectional self-report study, causality cannot be deduced which reduces the usefulness and conclusiveness of the findings; however it is not ethical to do an experiment to determine causality when health is involved. The study highlights that there are complexities within health behaviours, and that there are many factors to consider during health promotion.

METHOD: FEAR AROUSAL

Fear arousal as a method of health promotion refers to using fear and intimidation (usually through strongly emotive media campaigns) to persuade people into doing (or avoiding) certain health-related behaviours. Fear-arousing communication usually features two parts: stressing the severity of the issue using fear, and recommending an action to reduce or eliminate the health risk. The basic underlying assumption is that if the negative consequences of an action are made clear to an individual, they will be more likely to do something to prevent it. A large body of research into fear arousal suggests that high fear campaigns tend to be more successful than low fear campaigns, and this research was guided by the drive reduction model: the idea that fear or emotional tension is a drive to action, and so if a threatening situation is presented, individuals will feel motivated to take action to reduce the threat.  

EVALUATION: FEAR AROUSAL

The major issue with fear arousal is the ethical considerations it raises. Causing someone to feel fear goes against protection from harm, and actually causes psychological harm, which is against BPS ethical guidelines. Aside from this, although it is arguable that fear is a basic human emotion and as such fear arousal is applicable to everyone, people feel and respond to fear differently so fear arousal is unlikely to be effective for large populations. For example, whilst a graphic advert showing the damage smoking does to your body may cause some people to not take up smoking, smokers may ignore or avoid the messages due to it being too emotional and distressing to watch. Fear arousal appears to go against the Yale model, which outlines how too much emotion will not deliver a message successfully, so this is a worthwhile evaluative point. It is reductionist in the way that it is assumed fear arousal will automatically result in a change in behaviour – what about social factors such as the desirability or social pressure to conform to certain lifestyles, or self-efficacy issues such as thinking they cannot do it, and nobody they know would be able to.

STUDY: JANIS AND FESHBECK

Janis and Feshbeck conducted a cross-sectional study to investigate the consequences on emotions and behaviour of fear appeals in communication. A 9^th grade freshman class at a US high school was used as the sample; they had a mean age of 15 years. Janis and Feshbeck used a laboratory experiment, which investigated how the strength of fear arousing material presented in a lecture affected the emotional and behavioural changes in dental practices. An independent measures design was used, with four conditions: strong fear appeal, moderate fear appeal, minimal fear arousal, and the control group. A questionnaire was used before the lecture and afterwards. The strong fear arousal was generally received positively in terms of interest and necessity, but also had higher levels of dislike and unpleasantness. It showed a net increase in positive dental hygiene of 8%, whilst the moderate group had 22% increase, and the minimal fear group showed 36% change. The researchers concluded that fear appeals can be helpful in changing health behaviours, however it is necessary for the level of fear arousal to be appropriate for the appropriate target audience, and that (in teenagers) minimal fear is likely to be more successful.

EVALUATION: JANIS AND FESHBECK

The sample was very limited in that it was small, ethnocentric and age-biased; therefore it is unlikely that the findings could accurately be generalized much further than other American high school students. However, it is useful in that it highlights how high fear arousal does not always result in higher behavioural changes. The use of questionnaires allowed experiences to be relayed; however this raises the issue of internal validity due to the possibility of demand characteristics, dishonesty and social desirability bias.  The use of and findings from the control group however did improve the likelihood that it was the independent variable of fear arousal causing the behavioural changes. The other main issue with this study is the ethics, as children were exposed to material that they knew would be distressing and was intended to cause psychological harm, and whilst it was to try to improve dental hygiene behaviours, the ends here do not justify the means.