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

The alcohol improvement programme: evaluation of an initiative to address alcohol-related health harm in England

Aims: The evaluation aimed to assess the impact of The Alcohol Improvement Programme (AIP). This was a UK Department of Health initiative (April 2008–March 2011) aiming to contribute to the reduction of alcohol-related harm as measured by a reduction in the rate of increase in alcohol-related hospital admissions (ARHAs). Methods: The evaluation (March 2010–September 2011) used a mix of qualitative and quantitative methods to assess the impact of the AIP on ARHAs, to describe and assess the process of implementation, and to identify elements of the programme which might serve as a ‘legacy’ for the future. Results: There was no evidence that the AIP had an impact on reducing the rise in the rate of ARHAs. The AIP was successfully delivered, increased the priority given to alcohol-related harm on local policy agendas and strengthened the infrastructure for the delivery of interventions. Conclusion: Although there was no measurable short-term impact on the rise in the rate of ARHAs, the AIP helped to set up a strategic response and a delivery infrastructure as a first, necessary step in working towards that goal. There are a number of valuable elements in the AIP which should be retained and repackaged to fit into new policy contexts

Negotiating the 'grey area between normal social drinking and being a smelly tramp':a qualitative study of people searching for help online to reduce their drinking

INTRODUCTION AND AIMS: Delivering brief interventions for hazardous and harmful drinking on the Internet may broaden the availability of services and overcome some barriers to accessing help in person. The Down Your Drink (DYD) website, an extended brief intervention, attracted a large number of people looking to reduce their drinking. The aim was to explore the experiences of this e-help seeking population.  METHOD: Semi-structured interviews were conducted with participants in the DYD trial - an online trial of the effectiveness of DYD compared with an information-only website. Interviewees were asked how they came across the DYD website. Interviews were recorded and transcribed verbatim. Data were analysed by a multidisciplinary team using detailed thematic analysis.  RESULTS: Eighteen participants were interviewed. Most interviewees perceived their drinking to be a problem, which led them to search the Internet and register for the DYD trial in order to gain access to an intervention to help them reduce their drinking. The type of help required varied from information on the harms of drinking to help with a recognized problem. The privacy of the Internet was perceived as important when searching for help with drinking, as this avoids the stigma and embarrassment associated with help seeking in person. Almost all interviewees perceived a lack of services both online and offline for people wanting to moderate their drinking.  CONCLUSION: There is a perceived gap in services for hazardous and harmful drinkers wanting to reduce their drinking which could be addressed using online interventions

Factors influencing the consumption of alcohol and tobacco - a review of demand models

There has been a considerable adebate about the need for Government action in relation to the consumption of alcohol and tobacco. The policies discussed include tax changes, advertising controls, health education and regulation of outlets. In order to develop effective policies, an understanding of the factors which influence consumption of these substances is necessary. There have been many attempts to estimate models of consumer demand for alcohol and tobacco. The purpose of this paper is to review several of these studies. Previously estimated models have varied in a number of respects. The differences between previous studies are examined in three sections. Firstly, the underlying demand theory and some aspects of specification employed in the empirical studies are explored. Secondly, the aspects of the main variables and their policy relevance are discussed. Thirdly, some results of recent studies are compared and the statistical procedures that may help to choose between competing models are considered. Thus a framework for further analysis can be devised. FInally some concluding remarks are made on nthe advantages and disadvantages if using demand models for policy formation.alcohol, tobacco

Impact of unemployment on the living standards of families

Social security for the unemployed was not designed to cope either with large-scale or long-term unemployment and recent developments in the structure of unemployment and in social security policy give rise to concern for the living standards of the unemployed, especially the long-term unemployed. This article draws on data from the Family Finances Survey to assess the living standards of the unemployed after various durations of unemployment and compare these with the living standards of families with low incomes from work. The measures of living standards used are income, expenditure and the availability of consumer durables. The implications of the findings for social security policy are discussed

Effectiveness of computer-tailored Smoking Cessation Advice in Primary Care (ESCAPE): a randomised trial.

BACKGROUND: Smoking remains a major public health problem; developing effective interventions to encourage more quit attempts, and to improve the success rate of self-quit attempts, is essential to reduce the numbers of people who smoke. Interventions for smoking cessation can be characterised in two extremes: the intensive face-to face therapy of the clinical approach, and large-scale, public health interventions and policy initiatives. Computer-based systems offer a method for generating highly tailored behavioural feedback letters, and can bridge the gap between these two extremes. Proactive mailing and recruitment can also serve as a prompt to motivate smokers to make quit attempts or to seek more intensive help. The aim of this study is to evaluate the effect of personally tailored feedback reports, sent to smokers identified from general practitioners lists on quit rates and quitting activity. The trial uses a modified version of a computer-based system developed by two of the authors to generate individually tailored feedback reports. METHOD: A random sample of cigarette smokers, aged between 18 and 65, identified from GP records at a representative selection of practices registered with the GPRF are sent a questionnaire. Smokers returning the questionnaire are randomly allocated to a control group to receive usual care and standard information, or to an intervention group to receive usual care and standard information plus tailored feedback reports. Smoking status and cognitive change will be assessed by postal questionnaire at 6-months. DISCUSSION: Computer tailored personal feedback, adapted to reading levels and motivation to quit, is a simple and inexpensive intervention which could be widely replicated and delivered cost effectively to a large proportion of the smoking population. Given its recruitment potential, a modest success rate could have a large effect on public health. The intervention also fits into the broader scope of tobacco control, by prompting more quit attempts, and increasing referrals to specialised services. The provision of this option to smokers in primary care can complement existing services, and work synergistically with other measures to produce more quitters and reduce the prevalence of smoking in the UK. TRIAL REGISTRATION: Current Controlled Trials ISRCTN05385712.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

Impact of unemployment on the living standards of families

Social security for the unemployed was not designed to cope either with large-scale or long-term unemployment and recent developments in the structure of unemployment and in social security policy give rise to concern for the living standards of the unemployed, especially the long-term unemployed. This article draws on data from the Family Finances Survey to assess the living standards of the unemployed after various durations of unemployment and compare these with the living standards of families with low incomes from work. The measures of living standards used are income, expenditure and the availability of consumer durables. The implications of the findings for social security policy are discussed

Developing personal relationships in care homes: realising the contributions of staff, residents and family members

Personal relationships are all integral part of living, working and visiting in care homes, but little research has made relationships the main focus of enquiry, and there have been few studies of the perspectives of residents, staff and family members. The study reported here sought to redress this neglect. Using a constructivist approach, the nature and types of relationships between residents, staff and family members were explored in three care homes in England using combined methods including participant observation, interviews and focus groups. The data collection and analysis Occurred iteratively Over 21 months and three types of relationships were identified: 'pragmatic relationships' that primarily focus oil the instrumental aspects of care; 'personal and responsive relationships' that engage more fully with the particular needs of individual residents; and 'reciprocal relationships' that recognise the roles of residents, staff and family members in creating a sense of community within the home. This paper explores the contributions made by staff; residents and family members in the development of these relationships. The findings enhance our understanding of the role of inter-personal relationships in care home settings and of the factors that condition them. The implications for developing improved practice in care ponies are also considered