Model answer part b) for health promotion

b. Assess the effectiveness of methods of health promotion (15)

When assessing the effectiveness of methods of health promotion, it is first necessary to define effectiveness, and then discuss ways in which effectiveness can be measured. A commonly accepted definition of effectiveness is the degree to which objectives are achieved and targeted problems are solved. Health promotion in terms of media campaigns and fear arousal tend to be based on the Yale model, which describes how for an attempt to be effective, the communication (message), communicator (how the message is given) and audience (keeping in mind the population that is being targeted) must all be considered. Methods of health promotion can be measured in terms of whether they are effective in real life and who they are effective for, as well as time and cost effectiveness.

Ideally, health promotion methods need to reach as wide of an audience as possible to be the most effective. Studies such as Keating et al have shown that different audiences receive more information or advice from different sources; in Nigeria, it was found that men tended to get more information from media campaigns, for example radio advertisements on sexual health, whilst women tended to get more advice and support from clinic visits. This suggests that media campaigns may not be effective in reaching a wide audience, and although this may be less true in populations with higher access to the media, such as in the UK. Fear arousal campaigns of course have the same problem as media campaigns, but also have another issue. Although fear is a basic human emotion, so it could be assumed that studies and theories based around fear arousal are nomothetic, people react to fear in different ways, so individual differences may affect the success of fear arousal campaigns. For example, some may turn off an advert on sexual health that they find shocking, or leave an area with a poster showing mouth cancer as a result of smoking, meaning they avoid the campaigns rather than the dangerous health behaviours. Potentially the most effective way of reaching a large population would be legislation, as laws apply to everyone in the country or state and can be enforced by the police, by giving punishments such as fines and imprisonment if laws are not followed. However, obedience to legislation is arguably optional – some choose to deliberately disobey the law, whilst others simply do not consider it and may even not realise they are doing something wrong. Studies such as Wakefield have demonstrated how the existence of a rule itself does very little to change or reduce (smoking) behaviour unless it is heavily enforced in schools, homes and neighbourhoods, and therefore legislation is only most effective within a population if it is strongly enforced there. Thus it can be assumed that health promotion methods probably cannot reach the entire target audience, and that this would be better achieved through a combination of methods.

The real test of effectiveness of a method of health promotion is the extent to which it improves health behaviours or the overall health of people in the real world. It is often assumed that if a message is put across and seen, heard or known of by a large population, then it is effective. However, whilst a method of health promotion that only reaches a small audience is not effective, equally, one which reaches a large audience but doesn’t actually move much of the population to change their behaviour for the better is ineffective. Studies have demonstrated that media campaigns may not really be effective in changing behaviour, for example, Keating’s study showed that whilst more people who had had access to VISION had discussed and knew about the risks of HIV/AIDS, this didn’t appear to correlate with condom use. However, this is not to say media campaigns themselves are ineffective, but goes to suggest that merely information about risks is not enough. Campaigns with practical advice, such as where to get condoms, or how to quit smoking, rather than just arousing fear or providing statistics, are more likely to be the most effective in real life. Research also tends to suggest that in real life, legislation is effective only if properly enforced (Wakefield), and that fear arousal is only successful if used minimally. It can be assumed that methods of health promotion have limited applications, due to there being conditions for them to be effective which cannot always or easily be met for large populations.

Another aspect of effectiveness is the extent to which a method of health promotion is cost and time effective; that is, that the success of the method is more substantial than the time and money it costs to implement. Legislation is cost effective in that it has minimal cost to implement new laws, however, the legislative process can take years, which means it lacks time effectiveness. It is a long term investment which is good as it only needs to happen once, for example the smoking ban only needs to be implemented once, however until the law is in place, other health promotion methods will be needed – which will actually cost. On the other hand, media campaigns often cost a lot of money especially if the communicator is a celebrity; however they usually take a shorter amount of time to produce – so they have a better time effectiveness but are more expensive. Fear arousal campaigns are problematic in this way in that as they usually fall under a media campaign or visits to schools, these lack both time and cost effectiveness – finding the right amount of fear to induce for the target population takes a fair amount of time and research, whilst visits and media campaigns need money to fund. Therefore, methods of health promotion will usually have at least one “effectiveness area” where they are insufficient – cost effectiveness is achieved by reducing time effectiveness, and vice versa.

In conclusion, it would appear that methods of health promotion are most (and only truly) effective when used in conjunction with one another, as various methods are required to appeal to wide target populations, and to be effective both in the long and short term. Legislation is more effective in the long term; however, media campaigns and fear arousal methods are likely to be more effective immediately.