Chapter 12 Health Facility Settings © John Hubley & June Copeman 2013

The ‘settings’ approach Seeks to maximise health education activities within the setting Makes healthy choices easier within the setting. Seeks to develop a health promotion ethos within the setting which addresses values, organization and structural dimensions. Develops links between that setting and health promotion activities within the wider community.

Health promotion should be an integral part of all health activities – public or private, curative or preventive, community or hospital, inpatient or outpatient

Potential Health promotion activities with members of the community that come for treatment Communication between health staff and inpatients and outpatients on treatment, use of medicines, self-care Rehabilitation and self-care of patients and families after major illnesses and surgical procedures Outreach health promotion by staff to the surrounding community Health promotion should be an integral part of all health activities - public or private, curative or preventive, community or hospital, in-patient and out-patient. Depending on the kind of facility it is and the community that it serves, their specific contribution will include a mix of following: Health promotion activities with members of the community that come for treatment Communication between health staff and inpatients and outpatients on treatment, use of medicines, self-care Rehabilitation and self-care of patients and families after major illnesses and surgical procedures Outreach health promotion by staff to the surrounding community

Communication between health care provider and patient with involvement of other family members where appropriate Can be part of consultation, by specialist educator/counsellor, separate group activity at facility, or on home visit Support materials, e.g. leaflets, posters, videos, audio-cassettes Patient education

Approaches to Patient Education Patient compliance approach or Health empowerment approach Which do you prefer and why? Much of what takes place under the name of patient education is carried out within the medical model, individualistic, persuasive or ‘patient compliance’ approach. However increasing attention is given to health empowerment approaches in which the communication approach between health provider and patient shifts from information transfer to information exchange (Lee and Garvin, 2003)

The Expert Patient An approach that sees the patient in a partnership role with the health provider in taking decisions about the management of his or her condition With improvements in overall health status and greater longevity, there are increasing numbers of people living with a long-term chronic illness, such as cancer, heart disease, stroke, arthritis, mental illness, diabetes and asthma. The expert patient approach is a core element of national policy for supporting people with chronic illness. (Department of Health, 2001). Using techniques such as self management discussed in Chapter 5, the Expert Patient approach (see box 12.6) represents a shift towards patient-centred care which assigns a key role to health promotion and health empowerment.

Pharmacist – underutilized resource for health promotion Highly accessible Can advise about over-the-counter medicines Suggest visit to the GP Explain the use of medicines and any possible side effects

Communicating with patients on Hospital Wards Provide any information they need. Give them a chance to practise any skills. Give them encouragement. Find out if they have any concerns or anxieties. Get them to think ahead and find out if there are any obstacles. Explain any medicines they need to take. Discuss practical strategies for remembering medicine procedures. Tell them where they can get help. Suggest that they join a self-help group. Ask them to invite a partner, relative or friend to participate in your advice session. Box 12.12 How to help your patient get better Provide any information they need, both verbally and through leaflets, to speed up their recovery. Give them a chance to practice any skills they will need to help their recovery and reassure them that they can do what is necessary. Give them encouragement. Boost their confidence but keep expectations realistic. Find out if they have any concerns or anxieties and try to deal with them. Get them to think ahead and find out if there are any obstacles that might prevent them putting into practice your advice. Discuss possible strategies to overcome those obstacles. Explain any medicines they need to take. Discuss practical strategies for remembering medicine procedures such as timings and dosages. Tell them where they can get help (e.g. from telephone advice lines). Suggest that they join a self-help group – give them details. Ask them to invite a partner, relative or friend to come in and also participate in your advice session.

Six barriers that prevented people’s access to health services Structural Personal Social and cultural Past experience and expectations Diagnostic confusion Lack of knowledge and awareness Box 12.13 Case study Barriers to uptake of services for coronary heart disease in Yorkshire. Tod et al. (2001) In a research study in Yorkshire, qualitative research was carried out with patients with stable angina, primary care staff and community groups, and identified six barriers that prevented or delayed people taking up health services. Structural – difficulties in transport and access to health services, inconvenience of location of surgery and opening times, appointment systems with difficulty in contacting the surgery by phone, the need to wait a few days before seeing doctor, the absence of a nurse-led clinic and perception of the general practitioner as always busy. Personal – fear of the consequences of diagnosis of illness, denial of illness and resort to self-management. Social and cultural – local social mores that over-valued self reliance, coping with pain, stoicism and tolerating extreme discomfort. Past experience and expectations – previous bad experiences of person or family members resulting in low expectations of health services. Diagnostic confusion – when people did not make the connection between symptoms and health problems e.g. breathlessness was attributed to lung problems and not the heart, pain was wrongly perceived to be arthritis. Lack of knowledge and awareness - lack of knowledge about the causes, treatments and risk of heart disease and a low perception of the risk of heart disease due to low visibility of the disease.