The educational approach
The purpose of this approach is to provide knowledge and information, and to develop the necessary skills so that people can make an informed choice about their health behaviour. The educational approach should be distinguished from a behaviour change approach in that it does not set out to persuade or motivate change in a particular direction. However, education is intended to have an outcome. This will be the service user’s voluntary choice and it may not be the one the health promoter would prefer.
The educational approach is based on a set of assumptions about the relationship between knowledge and behaviour: that by increasing knowledge, there will be a change in attitudes which may lead to changed behaviour.
An educational approach to health promotion will provide information to help clients to make an informed choice about their health behaviour. This may be through the provision of leaflets and booklets, visual displays or one-to-one advice. It may also provide opportunities for people to share and explore their own attitudes to their own health. This may be through group discussion or one-to-one counselling. Educational programmes may also develop client’s decision-making skills through role plays or activities designed to explore options. Clients may take on roles or practise responses in ‘real-life’ situations. For example, clients taking part in an alcohol programme may role-play situations where they are offered a drink. Educational interventions require the practitioner to understand the principles of learning and the factors which help or hinder learning.
Increases in knowledge are relatively easy to measure. Health education through mass-media campaigns, one-to-one education and classroom-based work have all shown success in increasing information about health issues, or the awareness of risk factors for a disease. Information alone is, however, insufficient to change behaviour and, even the desire and ability to change behaviour is no guarantee that the individual will do so.
I have chosen to use this approach in my health promotion. Most people respond well to this approach as it lets them know what they need and therefore encourages and assists them in making these lifestyle changes without the need to force them, since they will go about them out of their own will.
Empowerment
The World Health Organisation defined health promotion as enabling people to gain control over their lives (WHO 1986). This approach helps people to identify their own concerns and gain the skills and confidence to act upon them. It is unique in being based on a ‘bottom-up’ strategy and calls for different skills from the health promoter. Instead of the expert role adopted by the other approaches, the health promoter becomes a facilitator whose role is to act as a catalyst, getting things going, and then to withdraw from the situation.
Self-empowerment is used in some cases to describe those approaches to promoting health which are based on counselling and which use non-directive, client-centred approaches aimed at increasing people’s control over their own lives. For people to be empowered they need to:
- recognise and understand their powerlessness
- feel strongly enough about their situation to want to change it
- feel capable of changing the situation by having information, support and life skills.
Evaluation of such activity is problematic, partly because the process of empowerment and networking is typically long term. This makes it difficult to be certain that any changes detected are due to the intervention and not some other factor. In addition, positive results of such approach may appear to be vague and hard to specify, especially when compared to outcomes used by other approaches, such as targets or changes in behaviour which are capable of being quantified. Evaluation includes the extent to which specific aims have been met (outcome evaluation) and the degree to which the group has gelled, or been empowered as a result of the intervention (process evaluation).
This is not the approach which I will be using in my health promotion as this approach involves targeting service users individually, whereas I will be working with a group of young children. The service-user-centred approach is not suitable to the target group in which my health promotion is directed towards as it involves empowering the service user and depends on the type of decision or action taken up by the service user. Young children will be unable to fully understand what actions/decisions to come to and would require more assistance in doing so. Therefore they will not be able to make decisions for themselves. Also many young children may not have the interest in such health based issues and so will not be that eager to obtain further information regarding health topics.
Social change
This approach acknowledges the importance of the social-economic environment in determining health. Its focus is at the policy or environmental level, and the aim is to bring about changes in the physical, social and economic environment which will have the effect of promoting health. This means the focus is on changing society, not on changing the behaviour of the individuals. This may be summed up in the phrase ‘to make the healthy choice the easier choice’. A healthy choice is available, but to make it a realistic option for most people it requires changes in its cost, availability or accessibility.
The social change is targeted towards groups and populations, and involves a top-down method of working. For such a policy to be successfully implemented, however, it has to be supported by a public who have been made aware of its importance.
For most health promotion workers, the scope for this type of activity will be more limited than for the traditional medical or behavioural change approaches.
The reason that I will not be using this approach is because the societal change approach has the objective to change the society, by putting health on the political agenda at all levels through campaigns and laws passed by the government in order to prevent people from taking such actions which can damage their health. and to the importance of shaping the environment rather than shaping the individual lives of the people who live in it. Using such an approach to promote increased physical activity would be much more effective and significant but I will not be capable of changing the behaviour of people at such a large scale.
