Ideologies of health promotion.

This thesis represents a study which began when the term health promotion first appeared in health authority policy documents but, at the same time it appeared to be a term little understood by those health care professionals deemed responsible for its implementation. Clarification of the concept of health promotion was pursued by the researcher using grounded theory methodology. Health visitors, health education officers/health promotion officers, and general practitioners participated in a series of group interviews and the data was analysed by cognitive mapping (Jones 1975), and constant comparative analysis (Glaser & Strauss 1967). Results from analysis of the qualitative data formed a theoretical framework which guided the second, quantitative stage, of the study. A postal survey of a national sample of 1000 health visitors was undertaken. The response rate was 65% comprising 557 health visitors. Analysis of data was carried out using the SPSS statistical package. The results revealed that health visiting workloads and priorities remain fairly traditional although over 60% of respondents identified client and community led health education/health promotion work as one of their priorities. Examples of health promotion undertaken by health visitors revealed a wide range of activites but with emphasis placed clearly on parent/child issues. A majority of health visitors (63%) thought health promotion activities could be measured, but over 80% of respondents recognised the complexities of doing so. Although over half of the practising health visitors rated their mode of practice as both individualistic and community approach, over 50% of respondents identified a need for additional skills in group work, teaching, research and assertiveness. A number of obstacles preventing health visitors from developing health promotion activities were identified. The position of health visiting in the context of current political ideology is examined