2.b Promotion programmes

• Health promotion programmes


  The goal is to enhance good health and prevent illness
• Health promotion


  (WHO 1986) The process of enabling people to increase control over, and to improve their health
• Health promotion programmes


  • One-on-one contact is an effective way to change behaviour in individuals or small groups
  • But this approach is not possible when one wants to change habits of whole populations
• Modern health promotion activities

  • Public health campaigns that aim to change beliefs, attitudes and motivations
  • Changing the wider determinants of health - e.g. changing the physical environment
  • Public or private health services that can help people change their behavior - e.g. family doctors, pharmacies, smoking cessation clinics
  • Political activities - e.g. legislation raising tax or implementing bans on smoking; reducing tax on healthy food and raising tax on sugar and fat
• Health campaign


  • Attempts to promote public health by making new health interventions available
  • Frequently uses education along with an opportunity to participate further, such as when a vaccination campaign seeks both to educate the public about a vaccine and provide the vaccine to people who want it
• Purposes of health campaigns

  • To increase public awareness of the effects of life-style on health
  • To enable persons to assess which life-style changes would be most conducive to their health
  • To stimulate information-seeking behavior
  • To foster the development of local health promotion activities and referral networks
• Social Cognitive Theory (SCT)


  • Behaviour can be changed through observational learning
  • Learner must develop a sense of self-efficacy - a feeling that they can do the behaviour
• WHO recommendations for evaluating health promotion strategies

  • Evaluations should draw on a variety of disciplines and employ a broad range of information gathering procedures - data, researcher and method triangulation should be used
  • Those who have a direct interest in a health promotion initiative should have the opportunity to participate in all stages of its planning and evaluation
  • Health promotion initiatives should be evaluated in terms of their processes as well as their outcomes
  • The use of randomized controlled trials to evaluate health promotion is, in most cases, not an appropriate strategy for evaluating public campaigns
• Health campaigns are often criticized for being ineffective. As it is not easy to get people to behave in healthy ways because of the many factors that influence health habits, which include such variables as social class, gender, education and culture
• Health campaigns are useful, but they cannot stand alone. They must be seen as an integral part of the entire health promotion project
• Difficulties in evaluating effectiveness of health campaigns

  • It is not possible to isolate variables when studying a large population being exposed to public media
  • Much of the data obtained is self-reported, leading to potential demand characteristics influencing the final outcome
  • Sampling is often problematic, so the results may not reflect the diversity of the population
  • Even if a public health campaign is judged to be effective, often the findings are not transferable to other populations
  • Who is doing the research is very important. Often those that design the program play an integral role in its evaluation, potentially leading to a lack of objectivity and researcher bias
  • Strong evaluation requires triangulation. This is time-consuming and expensive
  • There are individual differences in approaching health; what motivates one to follow certain principles when it comes to health depends on individual circumstances
• Evaluations should draw on a variety of disciplines and employ a broad range of information gathering procedures - in other words, data, researcher and method triangulation should be used
• Those who have a direct interest in a health promotion initiative should have the opportunity to participate in all stages of its planning and evaluation
• Health promotion initiatives should be evaluated in terms of their processes as well as their outcomes
• The use of randomized controlled trials to evaluate health promotion is, in most cases, not an appropriate strategy for evaluating public campaigns
• Study for Health Promotion

  • Godin and Kok
  • Lowe et al
• Low et Al Aim


  Measure children's consumption of fruits and vegetables with altering peer motivation and reward based learning
• Lowe et Al Procedure

  • 2 inner-city british schools (402 kids)
  • Ages 4 to 11
  • 16 Days watched videos and were rewarded to eat healthy food
  • Food dudes campaign
  • Fruit and vegetable consumption was measured
• Lowe et Al results

  • Significant increase in fruit and vegetable consumption in school
  • Four months later still 12 times as much
  • Control group had no change
• Godin and Kok Aim

  systematic review of efficacy of TPB in explaining and predicting health-related behaviours
• Godin and Kok Procedure


  56 research studies reviewed
• Godin and Kok results

  • correlation between intention and attitude = 0.46
  • TPB could explain 1/3 of observations in health related behaviour