3.5 Health promotion
- Syllabus
- 9990–2028–2029
- Topic
- 3.5
- Level
- A2
Learning objectives
3.5.1Strategies for improving health• 3.5.1 Strategies for improving health- fear arousal: use of fear to improve health, including a study, e.g. Janis and Feshbach (1953).- providing information: giving information so people know how to improve their health, including a study, e.g. Lewin et al. (1992).- Relevant issues and debates and methodology for this topic include: individual and situational explanations, cultural differences, longitudinal studies, objective and subjective data, ethics.3.5.2Health promotion in schools and worksites• 3.5.2 Health promotion in schools and worksites- schools, with a focus on healthy eating, including a study, e.g. Tapper et al. (2003).- worksites, with a focus on health and safety, including a study, e.g. Fox et al. (1987).- Relevant issues and debates and methodology for this topic include: use of children in research, experiments, longitudinal studies, quantitative and qualitative data, generalisations.3.5.3Changing health beliefs• 3.5.3 Individual factors in changing health beliefs- unrealistic optimism: reason for disregarding positive health advice, including a study, e.g. Weinstein (1980).- positive psychology: defining positive psychology. Three focuses: pleasant life, good life, meaningful life, including a study, e.g. Seligman (2004).- application of positive psychology (exemplified by the following key study).- Key study on using positive psychology in schools to improve mental health: Shoshani and Steinmetz (2014).- Relevant issues and debates and methodology for this topic include: individual and situational explanations, cultural differences, idiographic versus nomothetic, psychometrics, generalisations.
Effective health messages pair manageable threat with achievable action
| Message component | Needed inference | Failure mode |
|---|---|---|
| Susceptibility/severity | ‘This relevant harm matters to me’ | Too little threat is ignored; extreme threat can trigger denial, avoidance or helplessness |
| Response efficacy | ‘The recommended act reduces the harm’ | Fear without a useful response leaves anxiety rather than change |
| Self-efficacy/instructions | ‘I know exactly what to do and can do it’ | Information that is complex, costly or inaccessible stays as knowledge |
| Ethical delivery | Accurate, proportionate, age/culture appropriate, with support | Deception, stigma and traumatic imagery can cause harm |
| Janis & Feshbach (1953) | Evidence map |
|---|---|
| Design | About 15-year-old high-school students received equal-length dental-hygiene talks with minimal, moderate or strong fear; a control group and pre/immediate/one-week questionnaires enabled comparison |
| Result | Strong appeal produced most fear, but reported conformity was greatest after minimal fear: 36% versus 22% moderate and 8% strong |
| Interpretation | High fear may promote defensive avoidance; tolerable fear leaves recommendations usable |
| Limits | Short follow-up and self-reported hygiene do not prove durable brushing/clinical health; minors, frightening material and consent raise ethics/generalisation issues |
| Lewin et al. (1992) | Evidence map |
|---|---|
| Design/sample | 176 post-myocardial-infarction patients randomly allocated to a home self-help rehabilitation/heart manual or standard care plus placebo information/counselling |
| Intervention | Manual gave structured exercise, relaxation and risk-management information; facilitator contacted patients at 1, 3 and 6 weeks to review progress, encourage adherence and solve problems |
| Results | At one year psychological adjustment was better; intervention patients had fewer GP contacts and fewer hospital readmissions in the first six months, especially those anxious/depressed at discharge |
| Boundary | Information was bundled with follow-up/problem-solving, so the manual alone cannot receive all causal credit; one cardiac population limits transfer |
A defensible campaign states a credible consequence, immediately shows a small effective action, removes practical barriers and measures behaviour over time. Tailor intensity and delivery to age, culture, prior experience and perceived control rather than assuming one external message affects everyone equally.
The strongest emotional reaction is not the same as the strongest behaviour change. Janis/Feshbach supports low over high fear in that dental context; Lewin supports a supported self-help package, not passive information as a universal solution.
Schools and worksites change health through repeated cues and consequences
| Setting | Behavioural levers | Outcome to measure | Risk |
|---|---|---|---|
| School healthy eating | Peer/media role models, repeated tasting, availability, small rewards, teacher/parent consistency | Observed fruit/vegetable selection and consumption at school/home | Consent/assent, allergies, coercion/stigma, reward dependence and home inequality |
| Worksite safety | Clear rules, hazard redesign, feedback, group/individual reinforcement and reporting culture | Injuries, lost days, equipment damage, near misses and safe actions | Under-reporting, blame, inequitable incentives and reward removal |
| Tapper, Horne & Lowe (2003): Food Dudes | Evidence map |
|---|---|
| Programme | Hero role-model videos/letters, repeated fruit/vegetable exposure and small rewards; designed for primary ages 4–11 and delivery by school staff |
| Evidence | Longitudinal field work across nursery/classes/whole schools found large increases in school fruit/vegetable consumption, some home transfer and maintenance; a five-month experimental–control comparison reported substantially higher school/home intake in intervention children |
| Mechanism | Modelling prompts tasting; reinforcement establishes repetition; repeated exposure can make the food intrinsically liked and alter school norms |
| Limits | Programme components are bundled, schools/classes are not equivalent to individual randomisation, observation can be reactive, and UK child/cultural transfer needs testing |
| Fox, Hopkins & Anger (1987) | Evidence map |
|---|---|
| Setting/intervention | Workers at two dangerous open-pit mines earned trading stamps for injury-free individual/group performance, no equipment damage, adopted safety ideas and exceptional prevention; awards were lost after injuries/damage/non-reporting |
| Outcomes | Introduction was followed by large, multi-year reductions in lost-time injuries, days lost and accident/injury costs; savings exceeded programme cost |
| Strength | Long-term objective operational outcomes in a high-risk real workplace show practical maintenance/cost value |
| Limits | Before/after field evidence cannot isolate tokens from concurrent culture/procedure changes; incentives may suppress reporting and mining does not represent every worksite |
A strong institutional programme changes the environment as well as the person: make the healthy/safe act easy and visible, model it, reinforce early success, monitor objective outcomes and fade rewards while maintaining opportunity and norms.
Observed change after a multi-component programme does not identify one active ingredient. Rewarded performance may start behaviour, but maintenance, intrinsic value, accurate reporting, ethics and transfer determine whether promotion is genuinely successful.
Health beliefs improve when realistic risk and well-being resources develop together
| Unrealistic optimism | Mechanism/consequence |
|---|---|
| Comparative judgement | ‘My negative outcome is less likely—and positive outcome more likely—than for similar others’ without adequate evidence |
| Bias sources | Focus on one's protective factors but neglect others', little personal experience, perceived control, low estimated probability and stereotype distance |
| Health effect | Advice is discounted, screening/lifestyle change delayed, warning signs minimised; optimism may still support hope/coping when evidence-calibrated |
| Weinstein (1980) | Evidence map |
|---|---|
| Study 1 | Rutgers students judged 42 future events: own positive outcomes above average and negative outcomes below average |
| Study 2 | Students generated factors affecting eight events; another group shown those factors displayed less unrealistic optimism |
| Conclusion | Bias partly arises from egocentric focus—people know their own favourable circumstances but fail to consider that peers also have advantages |
| Limits | Hypothetical self-report and US college samples support comparative judgement, not actual health behaviour or every culture/age |
| Positive-psychology focus | Core route | Example/boundary |
|---|---|---|
| Pleasant life | Frequent positive emotion and savouring everyday enjoyment | Enjoyable activity; pleasure alone can be brief/adaptive only in context |
| Good life | Use personal strengths in absorbing, connected and satisfying activities/relationships | Skilled work, learning or relationship engagement—not merely ‘more positives than negatives’ |
| Meaningful life | Belong to and serve a purpose larger than oneself | Family/community/service; meaning can involve effort, not constant happiness |
| Shoshani & Steinmetz (2014) | Evidence map |
|---|---|
| Design/sample | Two-year repeated-measures school comparison: 537 Israeli grade 7–9 students received a one-year whole-school intervention; 501 attended a similar wait-list school. Initial wider sample 1,167; 1,038 completed data |
| Programme/measures | Teacher training plus 15 positive-psychology lessons using activities/discussion/media; BSI distress/symptoms, self-esteem, self-efficacy, life satisfaction and optimism scales |
| Results | Intervention distress, anxiety/depression and interpersonal sensitivity decreased while controls increased; self-esteem, self-efficacy and optimism strengthened |
| Limits | Applied longitudinal multi-measure evidence, but schools—not individuals—were randomised; self-report, school/history/culture and attrition restrict causality/generalisation |
Positive psychology studies strengths and well-being; it does not require constant positivity, blame distressed people or replace clinical care. Realistic optimism keeps hope while updating risk from evidence; pleasant, good and meaningful routes may overlap but are not synonyms.