Health promotion approaches
When we simply offer health advice to people (‘You should stop smoking if you want to get rid of that cough and improve your general health’, or ‘No wonder you’re putting on weight – you should get out and do a bit more exercise!’), we approach it from our perspective. We think the person should do ‘this’ (stop smoking or take more exercise) to improve ‘that’ (their cough or weight).
But when we come at it from a health promotion point of view, we look at it from the person’s perspective. It’s no longer what we think the person should do – it’s about what he or she wants and, probably more importantly, what he or she is prepared to change to get what they want.
So instead of advising or telling the person what they have to do to improve their health, we begin by finding out what the person would like to see improved, how he or she thinks it could be improved, and how ready he or she is to make the change – even just a small change to get things started.
That’s not to say there isn’t a place for giving people advice to improve their health. People will see you as someone they can turn to for advice and they will actively seek it – when they’re ready. You’ll then be able to use your knowledge to suggest appropriate changes, or help the person access expert advice or information. But that’s a bit different from taking one look at a person who is clearly overweight and saying to him or her: ‘You need to lose weight’. It might seem like good sense from a health point of view, but the approach you’ve taken may have the opposite effect from the one you seek by making the person feel he or she is losing control of their own body and stubbornly refuse to play ball.
You may come across some people who are signed up to a formal health promotion ‘course’ – they may have joined a smoking cessation group run by a practice nurse, for instance, or are attending specialist counselling sessions to help them overcome anxieties or worries that are stopping them from getting on with their lives and affecting their health as a result. But more often than not, positive health promotion messages emerge during normal everyday conversations you’ll have with your patients/clients, when a problem or issue they raise offers the chance to speak about lifestyle changes that might not only solve their identified problem, but also improve their general health. Patients/clients might well speak casually about their weight, or lack of physical activity, or any part of their life that presents an opportunity to talk about lifestyle change.
This idea of making every contact with a patient/client a chance to speak about improving their health is now seen as being very important. Health Education England’s Making Every Contact Count website provides resources and information on the effects it can have. While it has been developed for England only, the lessons it teaches have far wider relevance.
In the meantime, we’re going to look at another idea that is very important in terms of supporting people to live healthier lifestyles – the Stages of Change Model.