Health Promotion Strategies for Social Marketing

This assignment will identify the needs and benefits of health promotion and the various models available including social marketing. It will look at social determinants of health and how this affects an individual’s overall health. The assignment accompanies a health promotion poster aimed at tackling stress in and out of work via the use of mindfulness. The poster would be targeted in the workplace and give options for behaviour change based around the use of mindfulness.  Mindfulness has been proven to be an effective therapy in the treatment of stress. (Watt, 2012).

Health promotion refers to any activity that promotes positive health (Naidoo & Wills, 2015).  As defined by The world health organisation (WHO), (1986) health promotion is “The process of enabling people to increase control over, and to improve their health. It moves beyond a focus on individual behaviour towards a wide range of social and environmental interventions”. The WHO held a conference in Ottawa in 1986 and from this the Ottawa charter was developed which aimed to provide better health for all. The WHO had previously highlighted the importance of health promotion and how all individuals should have a more productive level of health (WHO, 1986).  A number of actions were initiated to work towards a goal of “health for all” through better health promotion by the year 2000 and beyond (WHO, 1986). From the Ottawa charter came many reports on health in the United Kingdom such as the Black Report (Department of Health and Human Services, 1980) and the Acheson report (Public health in England, 1988). The Acheson report was an independent paper that gave specific targets to reduce ill health and target mental health issues (Public health in England, 1988). It encouraged health professionals to learn more about health promotion to encourage individuals to change their behaviours to reduce ill health and supported individuals to be more involved in their own health needs (Public health in England, 1988). In 2011 the government initiated “No health without mental health” paper due to the prevalence of mental illness and its impact on physical health costs (Department of health, 2011).  In 2015 stress accounted for 37% of all work related ill health cases and 45% of all working days lost due to ill health (Health and safety executive, 2016).  Through analysis of these papers it became clear that the promotion of mental health provision for health professionals would validate the report’s findings.  The poster will target health workers and promote self-awareness regarding their own mental health needs to change behaviour and acknowledge their stress levels by practicing mindfulness. 

Health promotion should focus on support methods, education and counselling (Snelling, 2014).  Health practitioners play an important role in the promoting of health, preventing and reducing the impact of illness, and also assisting people to maintain their role at work and their social environments (Wills, 2014). The poster encompasses health promotion as it educates the individuals on the benefits of mindfulness to help reduce stress and encourages them to make positive health changes to aid well-being.

Tannahill’s model was developed when health promotion was in its infancy and helped to simplify the process of the debates on health promotion at that time (Naidoo & Wills, 2015), (see appendix A). It consists of three overlapping spheres including health education, health protection and prevention (Naidoo & Wills, 2015). The advantage of this model is that it concentrates on practice, however, it does not take into account the well-being of an individual which is the main subject point of the poster.  Salutogenesis is not included which concentrates on influences that support human health, rather than on influences that cause disease (Von der Heyden, 2006). Tannahill’s model is limited, as health promotion covers more than just the three spheres of activity and lacks definition because of its simplicity.  However, because of its simplicity it may be easier to apprehend than other complex health models introduced after this time. 

Beattie’s model identifies four strategies for health promotion, legislative action, health persuasion, community development and personal counselling (Naidoo et al., 2015), (see appendix B).  The axes signify the method of intervention that can be a bottom up approach (negotiate) or a top down approach (authoritative) and a focus of intervention that may be a group or individual (Wills, 2007). The community development and personal counselling approach enhances knowledge and empowers individuals with new skills.  The community development approach focuses on a group of individuals like the poster is aimed at. Health professionals typically operate in a top down approach by utilizing health persuasion and legislative action methods with the object of protecting communities and individuals (Wills, 2007). However, this approach could disempower people by victim blaming and may lead to restricted change (Hubley & Copeman, 2008).  Many different approaches across all the quadrants are needed for effective health promotion.  Beattie’s model allows health practitioners to analyse health promotion strategies and their role as service providers.  It helps to shape current practice and build new strategies such as mindfulness for stress as promoted in the poster.  The author considers Beattie’s model more appropriate to the poster in changing health behaviour as it covers the well-being of individuals. It is more relevant to stress and mental health problems as it is seen to empower individuals to take control over their health within a practitioner/client relationship.

As defined by Kasl and Cobb, (1966), health behaviour is “any activity undertaken by a person who believes himself to be healthy for the purpose of preventing disease or detecting disease in an asymptomatic stage.”  The purpose of a health behaviour model is to try and understand why individuals or groups do, or do not engage in health related behaviours (Snelling, 2014). Individuals partake in things that can be unhealthy and damage their health. This behaviour may not seem unhealthy to them as the benefits outweigh the risks.  Choosing healthy behaviour does not automatically lead to practicing it and an actual change in behaviour can be very difficult to sustain (Van Den Broucke, 2014). 

The author has analysed the Becker’s health belief model to produce an evidence based poster to combat stress in the work place. The poster is aimed at an average workforce susceptible to stress and the related ill health conditions that this may manifest.  The groups current behaviour would perhaps be regular sickness, lack of motivation and unhappiness at work.  Barriers may be that individual’s do not perceive themselves as stressed or do not feel that mindfulness would be a resolution to how they feel. However, a more holistic approach to mental health problems has become more prominent through the “no health without mental health” paper and encourages individuals to acknowledge their feelings without embarrassment or stigma (Barker, 2009).  The poster helps to increase motivation to change behaviour through peer support which has been proven to be effective (Sarrami-Foroushani, Travaglia, Debono & Braithwaite, 2014).  However, this method may also make an individual feel exposed in their emotions, fearing rejection and not willing to participate (Dennis, 2003). 

Becker’s health belief model is a health specific cognition model that interprets behaviour as a decision making process and assumes behaviour as planning ahead, based on outcome expectations, where many factors contribute to behavioural change (Wills, 2007), (see appendix C).  The model is useful in predicting individuals who would or would not use preventive methods and help to recommend interventions that may improve the predisposition of resistant individuals to participate in preventive behaviour (such as mindfulness therapy for stress).  However, for individuals to adopt suggested health behaviours, the threat of illness and benefits of action must outweigh the barriers to action (Naidoo et al., 2015).  The poster aims to give enough information so that if individuals did not feel change was possible, they would have further knowledge for potential change in the future with a point of contact and online information.

As defined by (Naidoo et al., 2015) there are five approaches to health promotion (see appendix D).  The poster is at a behaviour change as it is actively promoting mindfulness therapy to reduce stress and encouraging individuals to change their behaviour and promote well-being. Engaging in mindfulness could help to empower and educate individuals in the benefits of the therapy to reduce stress and alleviate the physical and psychological symptoms (Watt, 2012).  By utilizing this method, it provides the health professional the opportunity to educate and council the individual to encourage them to take the next step.  As mindfulness is an alternative therapy, individuals may not be willing to try it due to fear it may not be useful or not believing an alternative therapy would be beneficial in reducing stress.  However, practicing mindfulness is proven to reduce stress and does not have the negative side effects associated with medications (Joint Formulary Committee, 2016). As a group aimed poster, individuals may gain more success from peer encouragement which has been proven to be effective (Sarrami-Foroushani, et al., 2014). This could be valuable in preventing the barrier of individuals struggling to progress from one stage to another without a reversal due to lack of motivation and support.

Economic and social circumstances may be a barrier to individuals carrying out new health behaviours, even if they would like to (Norheim & Asada, 2010).  Dahlgren and Whitehead (1991) discuss the layers of influence on health and it’s ecological and social model (see appendix E).  They make a link to the relationship between the individual, disease and environment.  This model enables us to have a better understanding of why some people find it easier to maintain their health.  The compromise on health comes from the complexity of various barriers as outlined in the model (Dahlgren et al, 1991).  By understanding this model it helps to identify what influences health and the barriers to societal and individual health. The mindfulness poster is aimed at all socioeconomic groups and individuals at work.  It is essential that this was kept in mind when producing the poster so that it has a wide audience and does not make anyone feel isolated or alienated.  The negative determinants of stress to an individual may be lack of appropriate services to signpost for information, lack of support, stigma and lower socioeconomic status with poor working conditions.  The mindfulness course would give individuals the opportunity to practice mindfulness at the workplace and maintain new skills in managing their stress levels, which would help to combat some of these barriers.  This in theory would reduce risk factors such as negative effects within the family, further mental health issues and loss of pay through sickness as stress would be reduced.  Although people may feel apprehensive before taking part in mindfulness, it is hoped that the individual would adapt to feel better able to cope with their stress levels and have a more positive outlook on their well-being.

Social marketing is an effective way of a message reaching a large number of people quickly.  In health it is used to influence health behaviour by using an organised planning process to help people change their behaviour (Lefebvre, 2013).  However, research has highlighted that the effects of these health changes are often small (Hornik, 2002).   Social marketing should help deliver a positive benefit for society and focus on understanding the individual/group it is aimed at by using a variety of health communication strategies. These could be interpersonal, mediated and other methods of communication with marketing methods such as promotion, message placement, community outreach and dissemination (Lefebvre, 2013).  The poster could be perceived as using a shock tactic by highlighting the negative health issues associated with stress such as high blood pressure, heart disease and stroke (Elkin, 2013).  By using this along with education on mindfulness it could shock someone into thinking about their health and taking a step to changing it.  However, this approach does not always have a positive outcome as people might deliberately ignore the issue and pretend it is not happening to them (Cho & Salmon, 2006).

The poster will use social marketing to specifically target individuals in the workplace who are feeling stressed. It will aim to be likeable, to encourage individuals to be receptive to the idea of change using a variety of colours and a fun format to be easily understandable. Users of the poster will be able to identify how they feel easily based on the thermometer format and will signpost individuals to a health practitioner and website for more information.  The poster will be bold, simple to understand and immediately eye catching so not to over complicate the message.

There are many models of health promotion which can be effective for individuals and groups. Understanding the target audience and the health that requires change can benefit individuals enormously. Utilising the knowledge that the author has from the reading undertaken will ensure that the poster is effective and a good stepping stone to allow individuals from all backgrounds to begin to understand stress and make changes to their well-being.

References.

• Health and safety executive. (2016). Work related stress, anxiety and depression statistics in Great Britain 2016. Retrieved from http://www.hse.gov.uk/statistics/causdis/stress/
• Hirst, J. (2012). GP project (Citizens Advice). Retrieved from http://www.nedcab.org.uk/gpproject.shtml
• Hornik, R. C. (2002). Public health communication: Evidence for behaviour change. Mahwah, N.J: Lawrence Erlbaum Associates.
• Hubley, J., & Copeman, J. (2008). Practical health promotion. Cambridge: Polity.
• Joint Formulary Committee. (2016). British national formulary 72. London: BMJ Publishing and the Royal Pharmaceutical Society.
• Kasl, S., Cobb, S. (1966). Health behaviour, illness behaviour and sick-role behaviour. Arch Environ Health, 12:246-266, February 1966 and I1 12:534-541, April 1966.
• Lefebvre, R. C. (2013). Social marketing and social change: Strategies and tools for health, well-being, and the environment (1st ed. ed.). San Francisco, Calif: Jossey-Bass.
• Naidoo, J., & Wills, J. (2015). Foundations for health promotion (3rd ed. ed.). Oxford: Saunders.
• Norheim, O., & Asada, Y. (2010). The ideal of equal health revisited: definitions and measures of inequity in health should be better integrated with theories of distributive justice. Neonatal Intensive Care, 23(4), 53-58.
• Public health in England: Report of the Committee of Inquiry into the future development of the public health function (Cm289) (1988). London: The Stationery Office.
• Queens University Belfast. (2009). Health promotion. Retrieved from http://www.qub.ac.uk/elearning/public/HealthyEating/HealthPromotion/
• Sarrami-Foroushani, P., Travaglia, J., Debono, D., & Braithwaite, J. (2014). Key concepts in consumer and community engagement: a scoping meta-review. BMC Health Services Research, 14(1), 250. doi:10.1186/1472-6963-14-250
• Sharifirad et al., (2007). The Effect of a Health Belief Model Based Education Program for Foot Care in Diabetic Patients Type II in Kermanshah. Retrieved from http://endometabol.com/2061.fulltext
• Snelling, A. (2014). Introduction to health promotion. San Francisco, California: Jossey-Bass.
• Thermometer (clip art). (no date).  Retrieved from https://clipartfest.com/download/e1882dce4681bcc3b31d80e32830f2033a6aae90.html
• Unhealthy reflections. (2013). The Beattie model applied: obesity. Retrieved from https://unhealthyreflections.wordpress.com/2013/01/07/the-beattie-model-applied-obesity/
• Van Den Broucke, S. (2014). Needs, norms and nudges: the place of behaviour change in health promotion. Health Promotion International, 29(4), 597-600. doi:heapro/dau099

• Von der Heyden, R. (2006). Salutogenesis — a concept for health research. Ergotherapie & Rehabilitation, 45(4), 6-10.
• Watt, T. (2012). Mindfulness: A practical guide. London: Icon Books.
• Wills, J. (2007). Promoting health. Oxford; Malden, Mass: Blackwell Pub.
• Wills, J. (2014). Fundamentals of health promotion for nurses (Second edition. ed.). Chichester, England: Wiley Blackwell.
• World Health Organisation. (1986). Ottawa Charter for Health Promotion. Geneva: WHO.

Appendix A.  Tannahill (1985) model of health promotion.

(Queens University Belfast, 2009)

Appendix B Beattie (1991) model of health promotion.

(Unhealthy reflections, 2013)

Appendix C. Becker (1974) Health Belief Model.

(Sharifirad et al., 2007)

Appendix D. Five approaches to health promotion.

Medical – This identifies individuals at risk of disease.

Behaviour change – this encourages individuals to choose a healthier lifestyle and take responsibility for their own health.

Educational – this increases knowledge about how to lead a healthier lifestyle.

Empowerment – to work with communities or individuals to meet their health needs.

Social change – this addresses inequalities in health based on gender, race, class and geography.

(Naidoo & Wills, 2015)

Appendix E. Dahlgren and Whitehead (1991) Social determinants of health.

(Hirst, 2012)

Health promotion poster for stress.