The two paradigms at the bottom describe the bottom-up approach with personal counselling and community development. The aim of the bottom-up approach is to empower individual and communities to make healthier choices. (Sykes 2007 in Wills 2007).
The first of the authoritarian approaches is health persuasion and these activities involve an expert let top-down approach. The primary objective of this approach is to convince an individual to change their behaviour and therefore adapt a healthier lifestyle. This intervention on giving the individual information on their behaviour for example trying to educate a young person on the misuse of alcohol and the effects this would have to their health. The approach is bases on the approach that the expert knows best. This is a popular technique because it can be delivered as part of the consultation process in any health care environment. Adolescents that either use alcohol recreationally or dependent on alcohol are a vulnerable group and have the potential physical, social, psychological and educational difficulties. This may have major implications for health care services, therefore health care service and specialist professionals should be prepared to recognise that young people need to be informed and educated in order to avoid problem drinking in these young people (Rassool and Winnington, 2003).The approach of the health professional should include health education and prevention initiatives as well treatment interventions necessary. The health professional should offer information and advice on the risks to their health around alcohol consumption in a precise but non- judgemental manner (Sykes 2007 in Wills 2007). This advice and health information should also be supported by the provision of printed literature for example You, Your, Child and Alcohol (Public Health Agency 2009). This not only informs the child but informs the parents. The use of brief or minimal intervention for example a few minutes of advice and encouragement are effective in reducing alcohol and associated harm, especially male excessive drinkers (Bien et al 1993 and Wilk et al 1997 cited in Rassool and Winnington 2003)
It has been suggested that health promotion strategies tend to rely heavily on this technique to the exclusion of other methods (Johnson and Baum 2001). Critics argue that if used in isolation, attempts to persuade patients to change behaviours that are expert driven and medically approached are likely to be limited and their effectiveness (Whitehead 2005). This suggest that this technique is not as likely to understand if the patient is ready or focused enough to make the changes required.
The second approach in the authoritarian part of the model is legislation action. While this is also concerned with challenging behaviour it does so by the state or organisation. This approach may include changes to legislation policy changes at a national, local or organisational level. It may also aim to provide resources that aim to support national programmes of health. The aim of legislation action is to make healthier choices easier, and while this can encourage change that often does not meet the specific needs of the minority groups or individual (Sykes 2007 in Wills 2007). The law states that buying and consuming alcohol is illegal when under the age of 18 (NI Direct accessed 2011). There are also extremely strict rules for the advertising of alcohol and these have been further strengthened since 2005 when tough new laws were introduced for all broadcast media when advertising alcohol. These laws ensure that alcohol is promoted in a socially responsible way so as not to present alcohol in a manner that reflects social success, linked with sex, appealing to the under 18 age group or their culture (Advert Standards Authority 2011). It could be argued however that advertisements such as those for WKD do in fact appeal to this age group (Advert Standards Authority 2011). On occasions when the law supports this approach the interventions may reselected by sections of the population and have the effect of driving behaviour underground. This can make it more difficult for vulnerable groups and therefore increase the inequalities in health care for these vulnerable groups. (Sykes 2007 in Wills 2007)
The bottom – up approach also known as the negotiated approach is also sub-divided into two sections. The first being community development. This approach is committed to bottom-up community led and participatory actions. An intervention such as this is based on empowering the community to identify any priorities its own needs. It encourages working together to find solution to the needs put in place any needs necessary. People that support this intervention state, they are more relevant as they create a sense of ownership and as a result are more likely to be effective and sustained. The principles in which this process is based are those of social justice and equality. It requires the professional working to be led by the community to which they are working, regardless of whether it is geographical community or one defined by culture, gender interest or social identity. This is a radical approach to health promotion and as a result certain challenges may present themselves (Sykes 2007 in Wills 2007). A major challenge may be if the priorities of the community are not the same as the professional. Community development is generally a partnership were many agencies work together with the health agency including those from the statutory and voluntary sectors. Binge drinking is very common among young adults and using alcohol may result in risk taking behaviours, included are anti-social and increased sexual risk, accidents, death, suicide violence and crime all of which impact on the community. Adolescents do not view alcohol as risky because they perceive its use as a recreational activity and find the effects enjoyable (Rassool and Winnington 2003). Peer association is also accepted as a major factor as adolescents who are already experimenting with alcohol and other drugs are likely to choose friends who share similar interests (Ghodse 1995 cited in Rassool and Winnington 2003). Working with these young people within the community may have the best effect, they can be provided with enough information within the community led environment to make informed choices about alcohol and their future drinking habits. The community should engage in preventative work with adolescents in their peer group, educate them via peer led discussions and use the group to influence each other while developing a positive attitude to alcohol misuse as Wright 1999 states social learning theory describes how peer groups influence drinking choices.
The second approach in the bottom-up approach is personal counselling. Within this approach interventions are led by the patient or at least negotiated with the patient and are generally based on a one-to-one situation. Within this situation it is the role of the nurse to listen to the patient, to work to empower them to make the changes they want to. This empowerment may include building confidence and self-esteem as well as developing problem solving strategies and skills. These approaches can be used in a number of ways, including promoting positive health and well-being and the prevention of ill-health via disease management. This approach provides a client-based centred care therefore the nurse in this situation would necessary engage the individual by conducting assessment or screening in a sensitive and non-judgemental manner, and the reassurance of confidentiality would be established, but this may take time for the individual to gain trust in the health care professional. Also peer led discussions could be used in familiar surroundings of the adolescent’s i.e. school, church, or youth club. These can be very affective as they may open up more freely to their friends and could come up with their own ideas about their own health related issues with alcohol.
This approach to health promotion is criticised as it is not without its limitations also, as an individual may find it difficult or impossible to sustain the changes when they are faced with social economic or structural issues that create the barriers to change but that however are beyond the control of the individual (Bunton and Gordon 2002). Health promotion has been outlined according to the public health model of Beattie’s model 1991 (cited in Sykes 2007 in Wills 2007), and is a very valuable approach to promoting health to individuals. Even though this is a good approach, as it is built upon distinctive values, objectives and political persuasions. A nurse will need to embrace Beattie’s (1991) approach to be able to move past the out-dated role of the health educator (Latter 2001). This approach alongside other approaches, such as the stages of change model would make health education more successful, as this recognises behaviour to do with changing attitudes, to make healthier choices, as well as focusing on patient/client centred care. The combination would make health promotion to adolescents and alcohol more effective and reduce inequalities. (Sykes 2007 in Wills 2007).
References
Advert Standard Authority, (2011), Alcohol advertising, Available at http://www.asa.org.uk/ResourceCentre/~/media/Files/ASA/Background%20Briefings/Alcohol_Background_Briefing_April_2011_ecopy.ashx, London, Advertising Standards Authority. Accessed 24/10/11.
Beattie, A. (1991), Knowledge and Control in Heath Promotion: A Test Case for Social Policy and Social Theroy.In Gabe, J., Calnan, M., Bury, M., (Eds), The sociology of the Health Service. Routledge, London,
Beattie, A. (1991), Knowledge and Control in Heath Promotion: A Test Case for Social Policy and Social Theroy.In Gabe, J., Calnan, M., Bury, M., (eds), The sociology of the Health Service. Routledge, London, Cited in Sykes, S. (2007). Approaches to Health Promotion. In Wills, J. Vital Notes for Nurses, Promoting Health (pp. 46-63). Oxford: Blackwell Publishing Ltd.
Bien, T.H., Miller, W.R. & Tonigan, J.S., (1993). Brief Intervention for Alcohol Problems: A Review, Addiction, 88, 3, page 315-336, cited in Rassool G.H. and Winnington, J., (2003). Adolescents and Alcohol Misuse. Nursing Standard, 46-52.
Black J (1994) Alcohol and Young Adolescents. Lancaster University,unpublished study, cited in Haydock, A. (1998). Alcohol Education in Primary Schools. Nursing Standard, 43-46.
Bunton, R., and MacDonald, G., (2002) Health Promotion, Diversity and Development, London, Routledge.
Department of Health, (2002). Drug Use, Smoking and Drinking Among Young Teenagers. A Survey Carried Out On Behalf of the Department of Health by the National Centre for Social Research and the National Foundations for Educational Research, www.doh.gov.uk, cited in Rassoll G.H., W. J. (2003). Adolescents and Alcohol Misuse. Nursing Standard, 46-52.
Ghodse, A. (1995). Drugs and Addictive Behaviour. A Guide to Treatment. Oxford, Blackwell Science, cited in Rassoll G.H., W. J. (2003). Adolescents and Alcohol Misuse. Nursing Standard, 46-52.
Haydock, A. (1998). Alcohol Education in Primary Schools. Nursing Standard, 43-46.
Health Promotion Agency Leaflet, (2009). You, Your Child and Alcohol. Belfast: Public Health Agency.
Johnson, A. and Baum, F. (2001), Health Promoting Hospitals: A Typology of Different Organisational Approaches to Health Promotion, Health Promotion International, 16, 3, 281-7.
Latter, S. (2001), The Potential for Health Promotion in Hospital Nursing Practice. In Scriven, A. and Orme. (Eds), Health Promotion: Professional Perspectives. Basingstoke, Palgrave MacMillan.
Manson, C., (2009). Improving Service for people with Alcohol related Problems. Nursing standard, 35-40.
N.I. Direct, 2011, Alcohol, young people under 18 .and the law. Available at; http://www.nidirect.gov.uk/index/parents/your-childs-health-and-safety/young-people-and-alcohol/alcohol-young-people-under-18-and-the-law.htm, accessed 24/10/11. Northern Ireland, Direct Gov. Accessed 25/10/2011.
Naidoo, J. and Wills, J. (2009). Health Promotion, Foundation for Health Promotion.Edinburgh: Bailliere Tindall/Elsevier.
Rassool G.H.and Winnington, J. (2003). Adolescents and Alcohol Misuse. Nursing Standard, 46-52.
Simnett, L. and Eweles. (2003). Promoting Healt, A Practical Guide, 5th Edition. London: Bailliere Tindall.
Sykes, S. (2007). Approaches to Health Promotion. In Wills, J. Vital Notes for Nurses, Promoting Health (pp. 46-63). Oxford: Blackwell Publishing Ltd.
Taylor, S. and Field, D, (2007), Sociology of Heath and Health Care; Oxford, Blackwell Publishing Ltd.
Walker, J., Payne, S., Smith, J. and Jarrett, J. (2007). Psychology for Nurses and the Caring Professions, 3rd Edition. Berkshire: Open University Press.
Whitehead, D. (2005), The Culture, Context and Progress of Health Promotion in Nursing. In Scriven, A. (ed) Health Promoting Practice: the contribution of nurses and allied health professionals. Basingstoke, Palgrave Macmillan.
Wilk, A., Jensen N. M. and Havighurst, T. C., (1997). Meta-analysis of randomized control trails addressing interventions in heavy alcohol drinkers. Journal of General Internal Medicine. 12, 5, pages 274-283, cited in Rassool G.H., Winnington. J. (2003). Adolescents and Alcohol Misuse. Nursing Standard, 46-52.
Wills, J. (2007). The Role of the Nurse in Promoting Health. In Wills, J. (ed) Vital Notes for Nurses: Promoting Health (pp. 1-10). Oxford: Blackwell Publishing Ltd.
World Health Organisation (1948) Constitution cited in Ewles, L. and Simnett, I. (2003), Promoting health a Practical Guide, 5th Ed, Philadeljia, Bailliere Tindall. Page 6.
World Health Organisation (1986), The Ottawa Charter for Health Promotion: Health Promotion 1: iii-v, cited in Naidoo, J. and Wills, J. (2009). Health Promotion, Foundation for Health Promotion. Edinburgh: Bailliere Tindall/Elsevier.
Wright, L. (1999). Young People and Alcohol. What 11-24 Year Olds know, Think and Do. A Literature Review. London, Health Education Authority.