Interventions and Public Health

• Types of intervention

  • Prevention
  • Treatment
  • Maintenance
• Treatment


  Identifying or diagnosing what the underlying issue is and undergoing the standard treatment for that condition or illness
• Maintenance


  Looking after long term health conditions such as long-term medication, managing diet to manage things like diabetes or heart conditions and after care, including rehabilitation
• Prevention


  Interventions which aim to prevent health conditions
• Types of prevention interventions


  • Universal
  • Selective
  • Indicated
• Universal prevention


  Aimed at everyone. Often campaigns which aim to reduce stigma are aimed at a general public rather than a particular group which is at risk of stigmatising
• Selective prevention


  Aimed at groups who may be particularly at risk
• Indicated prevention


  Aimed at people already showing early signs or symptoms but haven't yet developed the illness, disorder, or condition
• Public health campaigns are nearly always universal interventions. However, they may be ever so slightly targeted towards certain groups who may be increased risk compared to others
• Forms of public health prevention

  • Campaigns
  • Changes in policy and law
• Public health campaign


  Raising public awareness of important health issues to encourage the public to adopt behaviours which promote good health or avoid behaviours which may be damaging to health
• Policy


  Outlines what a government intends to do and what it does not intend to do and what it wants to achieve. It develops the methods and principles for achieving its goal
• Law


  A set of standards, principles and procedures that must be followed in society. Used for implementing and maintaining justice in a society
• Types of law


  • Criminal law
  • Civil law
  • International law
• Advantages of public health campaigns

  • They reach a lot of people
  • Reaching lots of people means less likely to miss certain people
  • The more people that are aware, the more people that can encourage one another to take part having an effect
• Disadvantages of public health campaigns


  • Difficult to measure the effectiveness of the intervention
  • Media based so may not reach low-income families who don't have access to the facilities
  • People may not respond to the info or may not stick to the changes
  • A lot of money gets invested into marketing the campaign
• Public health interventions to change behaviour

  • Increasing knowledge and awareness of risks
  • Changing attitudes and motivations
  • Increasing physical or interpersonal skills
  • Changing beliefs and perceptions
  • Influencing social norms
  • Changing structural factors and influencing the wider determinants of health
  • Influencing the availability and accessibility of health services
• Characteristics of successful public health interventions

  • Using theoretical models in developing interventions
  • Intervening at multiple levels when appropriate
  • Targeted and tailored, making use of needs assessment or formative research
  • Providing basic, accurate information through clear, unambiguous messages
  • Using behavioural skills training, including self-efficacy
  • Joining up services with other community provisions
  • Working with community members as advocates of appropriate services
  • Providing alternative choices and risk reduction rather than simply telling people not to do something
  • Addressing peer norms and social pressures
• Theory of Planned Behaviour


  The core variables (attitude, subjective norms, and perceived behavioural control) shape an individual's intentions regarding whether or not to engage in a certain behaviour or not
• Theory of Normative Social Behaviour

  Behaviour can change via normative mechanisms including an individuals belief about the prevalence of a behaviour (descriptive norms) and an individuals belief about what they feel they should do based on others expectations e.g. beliefs about the importance of social approval (injunctive norms)
• Seat belts: A short history

  1. 1930s: Several US doctors equip their own cars with seat belts

  2. 1955: Society of Automotive Engineers (SAE) appoints Motor Vehicle Seat Belt Committee

  3. Late 1950s – early 1960s: Car manufacturers started to offer seatbelts as optional extras in cars

  4. 1962: 'Which?' strongly advocated belt wearing, revealing that a "first survey" of their effectiveness in Britain showed they would reduce the likelihood of death and serious injury by 60%

  5. 1965: compulsory to fit seat belts in the front of cars built in Europe BUT not compulsory to wear

  6. 1970s: first TV commercials BUT no substantial increase in seat belt wearing

  7. 1983: compulsory for drivers and passengers to wear seat belts for a three-year trial period

  8. 1986: Both Houses of Parliament voted overwhelmingly in favour of the requirement to wear seat belts becoming permanent at end of 3-year period

  9. 1987: cars having rear seatbelts becomes compulsory (but not wearing them)

  10. 1991: Wearing rear seat belts becomes compulsory

  11. 2000: Think! Was officially established as the governments road safety campaign
• Groups with low seatbelt wearing rates

  • Young men, and men in general
  • Rear-seat passengers
  • Goods vehicle and company car drivers
  • Journeys taken late at night or early in the morning
  • People driving in urban areas with relatively low speed limits
• Department of Transport data shows the percentage of people who died in road traffic accidents and were not wearing seat belts rose from 19% in 2013 to 27% in 2017
• Epidemiology


  Research into the distribution (e.g. frequency or pattern) and causes of health-related states and events (not just diseases) in different populations
• Think! Campaigns


  • Wearing rear seat belts (Julie)
  • Young people (Backwards)
  • Short journeys in low-speed limit areas
  • Men
• Psychological principles at Think! Campaigns

  • Emotive
  • Social norms
  • Targeting
• The Think! Campaigns aimed to meet 2010 objectives for reducing road deaths and injuries by 40% for adults 50% for children
• Achieved target of reduction of road deaths and serious injuries by 40% (50% for children) between 1994 and 2010
• Although increases in some beliefs of the dangerousness of not wearing a seatbelt, decreases in other areas AND more adults saying that they didn't always wear their seatbelt
• Difficulty of evaluation due to confounding variables
• Too many things changing at once!