Health Education Journal

Previous attempts to influence individuals' behaviour in order to lessen cardiovas cular risk have met with limited success. We report on the way in which the Stages of Change model was used by trained practice nurses in a randomised controlled trial. Patients with one or more modifiable risk factors (regular smoking, high choles terol, or the combination of high body mass index and low physical activity) were recruited during routine care at 20 group general practices in inner city to rural areas over 18 months. Baseline measurements on 883 people show that the control and intervention groups were reasonably matched, with one, two and three risk factors found among approximately 43, 48 and 9 per cent, respectively. Some differences between groups in readiness to modify behaviour as assessed by stage of change were observed. This trial will evaluate systematically the impact of brief behav ioural counselling in general practice.

There is increasing interest in health promotion interventions which seek to change behaviour through local cultural diffusion by trained opinion-formers. This study adapted this approach to schools settings. Popular pupils in years 8 and 9 (aged 12 to 14) were recruited for intensive training by specialist staff on how to intervene effectively in everyday situations to promote smoking cessation and prevention of smoking uptake among their peers. Data on smoking behaviour, plus saliva samples for cotinine testing, were collected pre-intervention, immediately post-intervention, and three months post-intervention in two intervention and two control schools. Most differences in behaviour between intervention and control schools were not statistically significant. However, baseline ex-smokers (11 per cent of the sample and a larger group than baseline regular smokers) were significantly more likely still to be abstinent in the intervention, as opposed to the control, schools. Given the relative paucity of evidence of effective anti-smoking programmes in schools, these results are sufficiently encouraging to justify a full-scale randomised controlled trial evaluation.

This paper explores the impact of the non-formal primary education programme of the Bangladesh Rural Advancement Committee (BRAC) on raising health knowl edge of rural Bangladeshi children. Three groups of children — graduates of the BRAC programme, formal school learners and children who never went to school —were assessed with an instrument containing six health knowledge items. A sample of 720 children, equally distributed by study groups and sex, was randomly selected. Data were collected from five areas where a socio-demographic surveillance system was in operation. This study reveals that the Programme graduates were more likely to have higher levels of health knowledge than the children of the other two groups. The impact of the Programme may be due to its extra emphasis on enhancing the positive influence of education in the lives of the rural population.

A questionnaire survey, with first-aid scenarios on scalds, lacerations, choking and bleach ingestion, was carried out with parents of children aged 3-12 months regis tered at 36 general practices in Nottingham. The objective was to assess parents' knowledge and confidence with regard to first aid for their infants and to examine factors associated with uptake of first-aid training sessions in a community setting. More than 75 per cent of parents knew the correct first aid for scalds, lacerations and choking. Less than half knew the correct action for bleach ingestion. Parents from ethnic-minority groups (p<0.001 ) and those without access to a car (p<0.001 ) had lower knowledge scores. Less than 25 per cent were very confident in dealing with any of the first-aid scenarios. Parents were least confident in dealing with bleach ingestion. Parents from an ethnic-minority group were more confident (p=0.003), and young mothers less confident (p=0.002) in dealing with first aid. Those speci fying incorrect actions were significantly less confident in their action for bums (p<0.001 ), choking (p=0.027), and lacerations (p<0.001 ). Only 13 per cent of parents who were offered first-aid training, attended. Parents attending such training were more confident (p<0.001) and less likely to live in rented accommodation (p=0.003). Improving confidence in undertaking first aid is important and should be addressed in first-aid training and in other settings where first-aid advice is given. Group first- aid training sessions may not reach those parents most in need of training. Other methods of delivery of first-aid information need to be evaluated.

The 'Easy Breathing' project aimed to increase smoke-free provision in public houses across the former Avon, and raise awareness of smoke-free areas. Core activ ities from May 1995 to November 1996 included surveys, support for publicans, a membership scheme and extensive publicity. Consumer attitudes were very positive, but there were significantly fewer smoke-free areas in deprived neigh bourhoods. Subsequent work improved existing provision, and to some extent increased smoke-free facilities, especially in more affluent areas, and where food was served. Together with new voluntary guidelines, combining publicity with targeted support may prove the most effective strategy to increase smoke-free provi sion and change social norms.

Workplace health promotion has been encouraged in Europe by the World Health Organization particularly since 1987. Except in Scandinavia, little has been done to date to establish workplace health promotion activity in ways that are unfragmented. This study, conducted in the UK, involves a group of workplace health promotion specialists who have attempted to identify some of the issues for health promotion in organisations. They discuss their work with company managers within their local ities and make suggestions for future developments of their role to make a more effective impact.

The present study introduces some of the key methodological issues in conducting and using effectiveness reviews, taking reviews of accident and injury prevention in older people as an example. A comparative analysis of six effectiveness reviews was undertaken. These reviews all related to the impact of exercise on falls in older people but offered apparently conflicting conclusions. The reviews were compared in terms of their scope, search strategies, methodological quality criteria, methods for data extraction and synthesising findings and review conclusions. The reviews were found to differ in terms of: whether they addressed a narrow or broad scope; the number of studies they included; and the quality criteria used to assess the included studies such that the same studies were treated differently in different reviews. Although the implications for research and practice from the reviews were found to conflict across different reviews, the authors of the reviews exercised caution when drawing final conclusions which served to minimise these conflicts. These results are discussed in terms of the implications for effectiveness reviews and their methodology within health promotion.

A systematic literature search was undertaken and an annotated bibliography compiled on the effectiveness of alliances for health promotion. Nineteen databases were systematically searched according to a pre-specified search strategy using parts 1 and 2 of the Cochrane Search Strategy for controlled studies which generated 185 discrete references. Of the 110 published empirical studies that were identified, 19 involved macro-alliances and 91 micro-alliances. Studies involved lifestyle behav iours (n=47), reproductive health and parenting (n=20) or focused on disease ( n=34). The methods used for the literature search and their considerations are presented in this paper along with a preliminary description of the studies retrieved. The method ological issues are discussed along with their implications and suggestions for further research and health policy.