Health promotion in primary health care: the situation in England

Health promotion practices as perceived by primary healthcare professionals at the Ministry of National Guard Health Affairs, Saudi Arabia

INTRODUCTION

In recent years, several research studies have investigated health promotion practices in Saudi healthcare organizations, yet no published literature exists on health promotion practices of primary healthcare professionals working for the Ministry of National Guard Health Affairs (MNG-HA).

METHODS

A cross-sectional study was conducted in a convenience sample of 206 primary healthcare professionals at the MNG-HA. A self-reporting questionnaire was used to investigate the attitudes, awareness, satisfaction, and methods regarding health promotion practices of primary healthcare professionals.

RESULTS

Of the 206 primary healthcare professionals surveyed, 58.1% reported awareness of health promotion programs conducted in the hospitals and 64.6% reported that the health promotion system in the hospitals needs to be improved. Language barriers and cultural beliefs were viewed as obstacles to carrying out effective health promotion by 65% and 64.6% of primary healthcare professionals, respectively. The majority (79.9%) of the primary healthcare professionals perceived themselves as having the necessary skills to promote health and 80.6% believed that printed educational materials are the most prevalent method of health promotion/education, whereas 55.8% reported that counseling was the most preferred method of health promotion.

CONCLUSION

The awareness level of health promotion policies, strategies, and programs conducted in the hospitals was not found to be satisfactory. Therefore, widespread training programs are recommended to improve the health promotion system in the hospitals. These programs include facilitating behavioral change, introducing health promotion policies and strategies in hospitals, mandatory workshops, and systematic reminders.

Which providers can bridge the health literacy gap in lifestyle risk factor modification education: a systematic review and narrative synthesis

Background

People with low health literacy may not have the capacity to self-manage their health and prevent the development of chronic disease through lifestyle risk factor modification. The aim of this narrative synthesis is to determine the effectiveness of primary healthcare providers in developing health literacy of patients to make SNAPW (smoking, nutrition, alcohol, physical activity and weight) lifestyle changes.

Methods

Studies were identified by searching Medline, Embase, Cochrane Library, CINAHL, Joanna Briggs Institute, Psychinfo, Web of Science, Scopus, APAIS, Australian Medical Index, Community of Science and Google Scholar from 1 January 1985 to 30 April 2009. Health literacy and related concepts are poorly indexed in the databases so a list of text words were developed and tested for use. Hand searches were also conducted of four key journals. Studies published in English and included males and females aged 18 years and over with at least one SNAPW risk factor for the development of a chronic disease. The interventions had to be implemented within primary health care, with an aim to influence the health literacy of patients to make SNAPW lifestyle changes. The studies had to report an outcome measure associated with health literacy (knowledge, skills, attitudes, self efficacy, stages of change, motivation and patient activation) and SNAPW risk factor.

The definition of health literacy in terms of functional, communicative and critical health literacy provided the guiding framework for the review.

Results

52 papers were included that described interventions to address health literacy and lifestyle risk factor modification provided by different health professionals. Most of the studies (71%, 37/52) demonstrated an improvement in health literacy, in particular interventions of a moderate to high intensity.

Non medical health care providers were effective in improving health literacy. However this was confounded by intensity of intervention. Provider barriers impacted on their relationship with patients.

Conclusion

Capacity to provide interventions of sufficient intensity is an important condition for effective health literacy support for lifestyle change. This has implications for workforce development and the organisation of primary health care.

A study to investigate the extent of delivery of an intervention in asthma, in a UK national community pharmacy chain, using mystery customers

OBJECTIVE

The objective of this study was to implement a brief intervention in asthma within a UK national pharmacy chain, and through the use of mystery customers, measure the extent of delivery of the intervention over a 4-month period.

METHODS

Mystery customers gathered information on which of the asthma intervention questions were asked, and any lifestyle advice that was given. Additional information was collected on the type of store they visited and the personnel who served them.

RESULTS

Mystery customer results indicate delivery rates of the intervention between 48.1 and 84.3% across the 4-month assessment period. This intervention was delivered by both pharmacists and healthcare staff, although the extent and content of delivery varied across the 4 months.

CONCLUSION

The use of mystery customers has helped to assess the successful take up and delivery of this intervention. Based on the learning points gained throughout this study, future services can be designed for other condition areas.

PRACTICE IMPLICATIONS

Each service that is designed needs to be simple to implement and deliver, and have the flexibility for pharmacists and staff to adapt the services to meet local requirements.

What we can learn from the British maternal child health system

Infants born in Great Britain have a better chance of living until their first birthdays than do infants born in the United States. Although Great Britain spends less than half what the United States spends on healthcare, its estimated infant mortality rate was 5.5 as compared to 6.8 in the United States in 2001 (Central Intelligence Agency [CIA], 2001). What is different about healthcare in Great Britain? This article details some of the differences, suggesting that there are ways the United States can improve its infant mortality rates.

Falls in elderly people: is the risk suitably assessed?

Results of the annual screening of people over the age of 75 years were used to determine whether the risk of falling in this age group is adequately assessed. The study group comprised primary healthcare professionals employed within six counties throughout England and Wales. Three per cent of respondents indicated that they use formal risk assessment tools when undertaking screening of people over 75 years. Analysis of the answers provided by these respondents, and of their assessment tools used, indicates that none of the tools are suitable for identifying those people at risk of falling within the home environment. Ninety-seven per cent of respondents indicated that they did not use a formal risk assessment tool for this age group. Analysis of the data provided by these respondents identified that the information gathered did suitably identify those people at risk of falling within the home.

Patient education and health promotion: clinical health promotion--the conceptual link

A model linking health promotion, health education and patient education is presented. Claims to health education being distinguishable from patient education on the basis of setting and working with well, as opposed to sick, individuals are disputed. Many health education encounters create the role of proto-patient for the individual receiving care. A further distinction is made between patient education and clinical health promotion on the basis of the focus of care as seen by the professional. The linking elements in the model are those of the patient role and relationships adopted, another distinction is seen in the area of the focus of the encounter. Traditional patient education focuses on the disease process whereas clinical health promotion emphasises the place of illness in the person's life and looks to influence non-medical factors that impinge on the disease.