[Transition of the roles and mandates of public health professionals]

There is a call for a new intervention paradigm that integrates all dimensions of physical, political and economic environments that might impact on health. The Ottawa Charter, the Global Plan for Health Promotion and the Health and Welfare Policy to mention a few, suggest that public health agents broaden their roles and their mandates. From health educators, they are now being asked to not only continue to favour the development of personal skills, to help create supporting environments, to reorient health services, to reinforce community action, as well as elaborate health public policies but to also become consensus builders towards this new paradigm. This article discusses the transition of the role and mandate of the individual health professional. In order to do so, the article traces the practice of the health professional beginning at the end of the 1970's and compares it to that of 1996 looking at the following dimensions: roots, objectives, place of activity, favoured strategies and approaches. Furthermore, it will try to identify new obstacles in health promotion. Finally, it will underline the new challenges for public health near the year 2000.

Coeur en santé St-Henri--a heart health promotion programme in a low income, low education neighbourhood in Montreal, Canada: theoretical model and early field experience

STUDY OBJECTIVE

Coeur en santé St-Henri is a five year, community based, multifactorial, heart health promotion programme in a low income, low education neighbourhood in Montreal, Canada. The objectives of this programme are to improve heart-healthy behaviours among adults of St-Henri. This paper describes the theoretical model underlying programme development as well as our early field experience implementing interventions.

DESIGN

The design of the intervention programme is based on a behaviour change model adapted from social learning theory, the reasoned action model, and the precede-proceed model. The Ottawa charter for health promotion provided the framework for the development of specific interventions. Each intervention is submitted to formative, implementation, and impact evaluations using simple and inexpensive methods.

PARTICIPANTS

The target population consists of adults living in St-Henri, a neighbourhood of 23,360 residents. Because of costs constraints, the intervention strategy targets women more specifically. The community is one of the poorest in Canada with 46% of the population living below the poverty line and 20% being very poor. The age-sex adjusted ischaemic heart disease mortality in 1985-87 was 317 per 100,000 compared with 126 per 100,000 in an affluent adjacent neighbourhood.

RESULTS

Thirty nine distinct interventions have been developed and tested in the community, eight related to tobacco, 10 to diet, seven to physical activity, and 14 which are multifactorial. The interventions include smoking cessation and healthy recipes contests, a menu labelling and healthy food discount programme in restaurants, a point of choice nutrition education campaign, healthy eating and smoking cessation workshops, a walking club, educational material, print and electronic media campaigns, heart health fairs, and community events.

CONCLUSION

An integrated heart health promotion programme is feasible in low income urban neighbourhoods but not all interventions are successful. Such a programme requires substantial energy and resources as well as long term commitment from public health departments.

Efficiency of printed materials in worksite health promotion

BACKGROUND

Printed health promotion materials are widely believed to be an efficient means of achieving basic health promotion objectives, such as increasing knowledge of risk factors. This study examined the efficiency of cardiovascular health promotion leaflets in reaching employees in a heterogeneous sample of worksites.

METHODS

Two types of distribution were used: copies of the leaflets were either made available centrally or distributed to each individual employee. Interviews were conducted with 272 employees in six worksites. Respondents were asked whether they recognized, had read, and had learned something from the leaflets.

RESULTS

Only one-quarter of respondents recognized the leaflets and only 14% stated that they had learned something. The efficiency of the leaflets was therefore much lower than expected. Z-tests for proportions showed that recognition, reading, and learning were significantly greater among those employees who had been given individual copies of the material. Among those who had been given individual copies, 45% reported recognizing the leaflet, 36% reading it, and 23% learning something from it. Among those who had only central access, the respective scores were 11%, 7% and 6%.

DISCUSSION

These results suggest that the potential cost-effectiveness of printed materials such as leaflets and brochures should be weighed against alternative forms of intervention, given specific program objectives and characteristics of the target population. They also suggest that the cost and effort required in organizing the distribution of individual copies may be recouped in greater penetration.

[Yes, I'm quitting: a scripto-visual tool on anti-smoking for functionally illiterate women. Problems and educational research]

In Montreal a team of social workers has developed a scripto-visual method for breaking tobacco dependency. It is intended for functionally illiterate women between 18 and 35 years old with less than nine years of schooling. Before testing it on the target population, the team completed a developmental experiment with the goal of evaluating and measuring the efficacity of this method. The article presents the various components of the manual and summarizes the findings. The preparation of the manual naturally took into consideration the diverse factors affecting the decision to begin smoking as well as the arguments advanced for breaking the habit. These included: stressing the personal advantages (increased self-esteem and self-confidence); taking the guilt out of this behaviour by revealing its impact and the link between social and advertising incentives to smoke; offering women a means of verbalizing their situation; dedramatizing relapses to maintain self-respect; presenting specific devices to facilitate this step. Comic strips are the principal support mechanism. These present information on the causes and consequences of tobacco dependency and illustrate its effects. They also introduce practical ways to assist the target population in breaking the habit and provides examples of activities which boost motivation and will power. In order to analyse the manual, sessions were organized with potential users. They were invited to complete a short questionnaire, to participate in mock exercises and to comment on the visuals. Beyond the message conveyed, the intention was to measure interest and assimilation.(ABSTRACT TRUNCATED AT 250 WORDS)