Qualitative study of pilot payment aimed at increasing general practitioners' antismoking advice to smokers

OBJECTIVES: To elicit general practitioners' and practice nurses' accounts of changes in their clinical practice or practice organisation made to claim a pilot health promotion payment. To describe attitudes towards the piloted and previous health promotion payments. DESIGN: Qualitative, semistructured interview study. SETTING: 13 general practices in Leicester. PARTICIPANTS: 18 general practitioners and 13 practice nurses. RESULTS: Health professionals did not report substantially changing their clinical practice to claim the new payments and made only minimal changes in practice organisation. The new health promotion payment did not overcome general practitioners' resistance towards raising the issue of smoking when they felt that doing so could cause confrontation with patients. General practitioners who made the largest number of claims altered the way in which they recorded patients' smoking status rather than raising the topic of smoking more frequently with patients. Participants had strong negative views on die new payment, feeling it would also be viewed negatively by patients. They were, however, more positive about health promotion payments that rewarded "extra" effort-for example, setting up practice based smoking cessation clinics. CONCLUSIONS: General practitioners and practice nurses were negative about a new health promotion payment, despite agreeing to pilot it. Health promotion payments do not automatically generate effective health promotion activity, and policymakers should consider careful piloting and evaluation of future changes in health promotion payments

Performance indicators and health promition targets

This paper discusses the usefulness of performance indicators in health promotion. Health promotion and target-setting in health have both risen to the fore in the light of the Health of the Nation White Paper. This coupled with increasing pressure on all sectors of health care to demonstrate their “value-for-money” have meant that health promotion activities are being scrutinised as never before. Performance indicators have been one suggested means of ensuring movement towards Health of the Nation targets and value-for-money in health promotion. The paper outlines the uses to which performance indicators have been put elsewhere in the NHS and argues that they are unlikely to be directly transferrable to health promotion. Criteria for successful performance indicators in health promotion are outlined. However, it is doubtful whether these criteria will be fulfilled to any useful extent at present. The theory of health promotion is characterised by many different views of what is an appropriate outcome measure of any health promotion intervention and therefore what will be an appropriate performance indicator. Consensus in theory is needed before any consensus on what is most suitable to measure is reached. In addition, any outcomes from health promotion, by its very nature, are likely to become apparent only over long periods of time, if at all. This reduces the likelihood of attribution and the feasibility of assigning responsibility for meeting targets. Nonetheless, there is some scope for performance indicators in health promotion and their use as an internal management tool and as mechanisms for reaching external micro and macro level health-related targets is discussed. A collection of suggested macro performance indicators from the Health Education Authority are evaluated according to the criteria developed earlier. It is argued that at present these do not qualify as performance indicators, although they are certainly useful as monitoring tools. The paper concludes with priorities for further research in this area. Despite the emphasis on target-setting brought about by the Health of the Nation, knowledge and expertise in performance indicators for health promotion is lacking. This is a matter of urgent concern. There are many complex conceptual and practical problems which will influence the future role and choice of performance indicators in health promotion. These range from the fundamental, differing views about the definition of health education and health promotion, to the practical, a lack of knowledge at the community level about how to start looking for indicators, and the technical, a lack of clear responsibility for meeting macro-level targets.performance indicators, targets

What works for promoting health at school: Improving programs against the substance abuse

The school is one of the most important contexts for carrying out health promotion programs related to the abuse of substances. Over the years, methods and intervention models have changed a great deal, both in relation to the evolution of health goals and to the role played by experts, students, parents, and teachers. We would like to offer a different perspective on health promotion at school by discussing the weaknesses and strengths of the most used methods, in order to identify the appropriate methodology, based on recent evidence research findings. We used Scopus as database for reviewing existing literature. The evolution in the methodology of health promotion programs can be synthesized through a sequence of three phases, from the 1960s to the present day

Waiting Room Health Promotion for Older Adults in Rural Primary Care

Background: Advances in health care technology have lead to adults living longer than in previous decades. Longer life expectancy in combination with the aging of the Baby Boomer generation is predicted to result in rapid and exponential growth among the older adult population. Adults in the U.S. over the age of 65 have on average five or more chronic illnesses, many of which are often poorly managed. Older adults who experience chronic diseases often report decreased quality of life, limitations in functional ability, loss of independence, and periods of decline and increasing disability. Health promotion efforts can help in delaying the onset of disability and preventing rapid decline associated with many chronic conditions. Purpose: The purpose of this project was to assess the effectiveness of the implementation of a brief waiting room health promotion activity that informs older adults about the benefits of walking, such as reducing the risk of chronic disease, improving mood, and maintaining weight, physical and cognitive function. This project took place at a federally qualified health center in Plainfield, Vermont. Methods: The target population for this educational intervention included patients, as well as family members and visitors to the primary care practice who were age 55 and older. All age-eligible participants were encouraged to participate regardless of health status or the presence of comorbid health conditions. The activity comprised of participants viewing a brief audiovisual educational activity explaining the health benefits of walking, supplemented with paper materials to support the health messages; the intervention was then followed by completion of a brief paper survey evaluation. Results: During the two-month period the health promotion activity was available, 56 individuals participated and completed the survey. Of the 56 participants, 87% indicated they either “strongly agreed” or “agreed” that watching the video increased knowledge about health-related benefits of walking. In total, approximately 73% of participants who participated in this health promotion activity agreed that they paid attention to educational materials in the waiting room setting. Approximately 57% of participants shared a health related goal that they created as a result of the health promotion activity. Conclusion: This project has suggested that implementation of waiting room health promotion activities, specifically for older adults, is a simple and cost-effective way to promote good health practices and provide patients with in-depth health care information that may not be addressed during the health care visit. Activities in the waiting room can help to supplement information provided during the clinical encounter, leaving patients more satisfied with their visits, and promoting positive behavior change

Discovery and Testimony of Unretained Experts: Creating a Clear and Equitable Standard to Govern Compliance With Subpoenas

Hearing impairment is known to be one of the most frequent sensory impairments. This condition is known to be a hidden disorder which is under recognised and under treated all around the world. The World Health Organisation (WHO) estimates suggest that there are over 275 million people with hearing impairment and 80% of them living in low and middle income countries. Moreover, the estimates suggest that incidence and prevalence of hearing loss and also the number of people with hearing loss accessing services varies considerably across countries. This rises the need for health promotion (or public awareness campaigns) directed to increase awareness and education of hearing loss and hearing healthcare. This paper provides brief discussion on ‘Stories and storytelling’, ‘Cross-culture and cross-cultural communication’ and ‘Health promotion and cultural sensitivity’. The central focus of this paper is to highlight the applications of storytelling in different cultural context in health promotion, particularly to hearing loss public awareness campaigns