Health Promotion Sociology

This assignment will discuss how the psychological and sociological concepts and theories can inform health promotion and how they are applied in nursing practice.
Taylor and field, (2007 page 3) suggest that sociology is the ‘study of companionship or social relations’, while Walker et al, (2007) states that psychology is the study of human behaviour, thought process and emotion. As a health care provider, when we relate psychology in an up to date manner it provides us, to our understanding of ourselves and our networks with other people. When making an allowance for health promotion it would be valuable to contemplate sociology alongside psychology, as it states in Walker et al people we care for come from a variety of social backgrounds
which influence their well-being. Health can be viewed in different angles, biological – as the absence of disease, behavioural – the product of making healthy lifestyle choices and socio-environmental – a product of social, economic and environmental factors that offer encouragement and obstacles to the health of individuals and communities (Wills J.
, 2007). As the World Health Organisation cited in Simnett, L. et al 2003, states that, ‘Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.’ The WHO's 1986 Ottawa Charter for Health Promotion (cited in Naidoo, J et al, 2009), broadened that health is not just a state, but also a supply for normal life, not the objective of living. Health is a optimistic concept highlighting social and personal properties, as well as physical abilities. Therefore these statements of health can be viewed differently in the different views of health and therefore health promotion as a holistic view is preventing disease, education, communication of health messages, giving information and facilitating self-help, and tackling issues to make healthier choices easier (Wills J. , 2007). It is the role of the
nurse and other healthcare professionals in the multi-disciplinary team to promote health and help people on an individual level to improve their health. (Walker 2007).
There are many models and theories that support the practice of health promotion within nursing practice. The use of these models should enable people to increase their control over things that determine and thereby improve their health. (Wills J. , 2007) The focus on this discussion will be the public health model; Beattie’s model ( 1991), this will be applied to early interventions and the prevention of alcohol misuse among adolescents.
Alcohol is the most commonly used and move actively available, psychoactive substance among adolescents aged 12-16years. UK figures among 15 and 16 year olds are among the highest in Europe and the percentage of 11-15year olds who drink at least once a week has risen from 17 to 20 per cent. By the age of 16 nearly all adolescents (94%) have tried an alcoholic drink (Wright 1999 cited in Rassool G.H., 2007), 47% of these adolescents have drank alcohol at least forty times. From the age of twelve those who have tried an alcoholic drink outnumber those who have not (Haydock, 1998). The average age for the first taste of alcohol for a boy in 8 years 6 months and 9 years 2 months for a girl (Black 1994 cited in Haydock 1998). In the framework of the government health policy our healthy nation (Department of Health, 2002, cited in Rassool G.H. et al,DATE), young people are an important target group in prevention, therefore healthy attitudes early enough may reduce the risk of alcohol misuse.
The Beattie’s model has offered structural analysis in the range of approaches since 1991. Beattie 1991 suggests there are four principles to health promotion. The model is divided into two dimensions top and bottom, with each dimension having two paradigms. Each of these four paradigms provides a description of the different approaches to health promotion. The two paradigms at the top of the model describe the top-down approach. This approach is seen to be authoritarian approach, which includes health percussion and legislation action. The top-down approach aims to inform the nurse about risks and unhealthy behaviour and possibly impose change to a national level. (Simnett, 2003) (Sykes, S. in Wills J, 2007)
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 S. 2007 in Wills, J. 2007)
The first of the authoritarian approaches is health precision and these activities involve and 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. 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 perceive but judgemental manor (Sykes, S. 2007 in Wills, J. 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, G.H. et al, 2003)
It has been suggested that health promotion strategies tend to rely heavily on this technique to the exclusion of other methods. Johnson and Baun 2001 cited in Sykes, S. 2007 in Wills, J 2007). 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 there effectiveness. (Whitehead 2005 cited in Sykes, S. 2007 in Wills, J. 2007). 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 individuals. (Sykes, S. 2007 in Wills, J. 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. 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, S. 2007 in Wills, J. 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, S. 2007 in Wills, J. 2007). A major challenge may be if the prioities 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 (Warrinton and Rassool 1998). 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, 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. Social learning theory describes how peer groups influence drinking choices (Wright 1999 cited in Rassool, 2003).
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 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.
Health promotion has been outlined according to the public health model of Beattie’s model 1991, 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 cited in Sykes 2007 in Wills 2007). 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. The combination would make health promotion to alcohol more effective and reduce inequalities.