Aim :To empower first time mothers who choose to breastfeed, to initiate and sustain breastfeeding exclusively for at least 3 months. This aim is appropriate to the identified health need of empowering the first time mothers by offering them active breastfeeding support, because, by helping the mothers to acquire skills the practitioners are using their own power(power-over) to help the first time mothers gain power (power-from- within).( Laverack 2009) Health promotion is enabling people to gain control over their lives. ( World Health Organisation 1986, in and Naidoo and Wills 2009).
This aim is appropriate for the first time mothers who choose to breastfeed because it has been established that first time mothers know the benefits of breast milk and indeed they would want to breast feed their babies but what they lack is the skills and confidence to initiate and sustain it. (Hong et al, 2003; Henderson and Redshaw,2010;Graffyand Taylor2005).
Objectives:
1) To set up a breastfeeding practical skills class for mothers who choose to breast feed in Wolverhampton borough to run for 6 months. 2)To increase public places where breast feeding is encouraged/supported in Wolverhampton by 50% 3)To facilitate a more positive attitude towards public breast feeding in Wolverhampton by the end of the year The first objective, the setting up of breastfeeding ,practical skills class is an educational, (behavioural or skill) objective because, according to the Jarkata conference statement, World Health Organisation(1997), in Laverack 2009, access to education and information is essential to achieving effective participation and the empowerment of people and community. The first time mothers identified practical help and active support as a need in order to successfully initiate and sustain beast feeding(Henderson and Redshaw, 2010).
Therefore this objective has an enabling effect towards empowering the first time mothers who choose to beast feed. The second objective looks at influencing local policies to increase public places where breast feeding is encouraged and supported. This is essential for successful breast feeding as this enables mothers to breast feed their babies even when they are not at home and thus remove the need for bottle feeding when mothers are going out. Policy is a major driver of health promotion(Naidoo and Wills 2005). One of the principle of health promotion as defined by WHO(1985) is directed towards action on the determinants of health , requiring cooperation between sectors and government. The third objective is about facilitating more positive attitude towards public breastfeeding. T
his is an environmental objective and this important as it has been identified that women decision to breast feed is influenced at a societal level(Henderson and Redshaw, 2010). Addressing societal perception to public breastfeeding will give the first time mothers the confidence to initiate and sustain breastfeeding. there lack of breast feeding culture in the UK(Griffiths et al.2007) This can be seen as the socieo economic, cultural and environmental determinant of health(Dahlgren and Whitehead,1991 in Naidoo and Wills,2009)
2) Models are simplified ways of describing reality which makes practice more effective(Ewles and Simnett, 2004). Several models are recommended for use in health promotion. Health belief model developed by social psychologists (Glanz,Rimer and Viswanath,2008). It suggests that the likelihood of an individual taking action for a given problem is based on their perceived susceptibility , the seriousness of the consequences the benefits and the barriers. It is useful for designing and evaluating interventions. Perceived barriers has been found to be the most influential variable for predicting and explaining health-related behaviors (Janz and Becker, 1984). It is limited in that it is a cognitive model and does not consider the emotional side of behaviour(Glanz, Rimer and Viswanath2008). The model does not take into consideration the influence of social norms and peer influences on people’s decisions regarding their health behaviours
Tones’ health action model emphasises the importance of self esteem on behaviour. People with high self esteem are motivated towards healthier living while those with low self esteem have limited control over their behaviour(Elwes and Simnett, 2004). Health promoters who work with this model seek to boost people’s self esteem and life skills before they can be ready to change(Green and Tones,2008).The model suggest that health related choices are influenced by psychological, social and environmental. Health action model is concerned with increasing the control people have over their lives which according to Laverack (2009), its empowerment.
Unlike the Health belief model, the Health action model considers more important how people feel about themselves(Ewels and Simnett, 2004). Another useful model that explains the different stages in behaviour change was developed by Prochaska and DiClamente,(1984). Transtheoratical model is rooted in research and draws understanding from psychological theories.(Ewles and Simnett2004) The premise of this theory is that change is a process and not an event, and that people often relapse or fall back into their old patterns of behaviour before successfully reaching the maintenance stage where the new behaviour becomes the norm. The theory also acknowledges that people must ultimately change themselves, it must be their own idea to succeed. The model identifies five stages that a person can go through during the process of behaviour change. It takes a holistic approach taking into consideration factors like personal choices social and environmental forces that can set limits on change.
Bandura(1997), in Munro et al.(2007),suggests that human functioning is too multifaceted to fit into separate, discrete stages and argues that stage thinking could constrain the scope of change-promoting interventions. The model specifies how interventions can be targeted for different populations with different needs and in different circumstances (Davies and Macdowall, 2009). Theory of reasoned action is based on the premise that humans are rational(Family health international, 2002). The cognitive structures, which are the behavioural and the normative beliefs influence the attitudes and the subjective norms respectively. The attitudes and the norms, in turn shape the person’s intention to perform a behaviour according to……. , a person’s intention remains the best indicator that the desired behaviour will occur. Beatties(1991) model of health education presents four paradigms of health promotion( Naidoo and Wills 2009).
Persuasion which is expert led and is directed towards individuals,Activities include advice and information. Legislative action is also expert led but interventions are directed to the protection of the community. Activities include policy work, lobbying. The third paradigm is the personal counselling which is client led and the focus is on personal development the health promoter acts as the facilitator. In community development the health promoter acts as an advocate who empowers community to find solutions to their common problems. Betties model identifies a frame work to decide on strategy and it also considers the social and political influences. Caplan and Holland (1990), in Naidoo and Wills, has four paradigms just like the Beatties model.
The traditional perspective is about giving of advice and information and can be likened to Beatties(1991) persuasion paradigm(Naidoo and Wills 2009). The humanist approach involves educating target population for the development of healthy lifestyle. This perspective is comparable to the personal counselling of Beatties (1991) model. The radical humanist seeks to empower through deprofessionalisation and establishment of self help networks. The radical structural perspective sees structural inequalities as the main determinant of health. The radical structuralist will seek to challenge the inequity and transform( Pattron2012). In Tannahill( Downie etal.,1990) the are three overlapping spheres of health education, prevention and health protection It has seven domains that are united by the principle of health education.( Davies and MacDowall,2009).
Health protection uses medical strategies for intervention while prevention utilises legislation to influence health,and health education influences health by knowledge and attitudes. Tones in Tones and Tilford argues that health promotion is a product of healthy public policy(Green and Tones ,2009). There are five health promotion approaches. according to Ewles and Simnett(2004), Medical approach’s aim is freedom from medically defined disease and it uses medical intervention and risk education methods. It is criticised for seeking compliance and ignores social and environmental factors (Naidoo and Wills2009). Lifestyle or behavioural change approach, according to Ewels and Simnett(2004), is aimed at the changing individuals behaviours that put their health at risk. The methods used are prompting cueing and learning. This approach has been criticised for victim blaming and ignores such factors as social, economy and environment, which influence individuals’ behaviour(International Foundation for Interdisciplinary Health Promotion, 2012).
The educational approach is directed at providing information and developing skills, enabling well informed decision to be made and acted upon(Ewels and Simnett, 2004). Information is given through small groups mass media, group discussions and role play (IFIHP,2012). Empowerment’s aim is to work with clients to help them identify their health needs, gain knowledge and skills to act upon them and make their own decision (Laverack, 2009). The health promoter acts as a facilitator and the clients are valued as equals (Ewels and Simnett, 2004). The method used are counselling community development and advocacy (IFIHP,2012).This approach is criticised for assuming that rational decision is a health decision. Societal change approach is aimed at changing the physical, social and economic environment to make it conducive to good health(Ewels and Simnett,2004). Methods used are lobbying advocacy policies and fiscal measures(IFIHP,2012).It requires major structural changes which may be open to opposition.
The strategy will utilise several methods. First to be considered is the setting up of a breast feeding practical skills class. This can be seen as the personal counselling approach of the Beattie’s (1993) model of health promotion. Developing personal skills is one of the five health promotion actions defined in the Ottawa Charter for health promotion (WHO,1986). This can be seen as bottom- up approach as the first time mothers identified their needs and the health promoter acts as a facilitator. Berker and Rosenstock’s (1987) health belief model predicts that individuals will take action to promote health if they believe that a course of action is available which will reduce their susceptibility, or minimise the consequences (Davies and Macdowall2009).
Therefore the health promoter, by facilitating the practical skills class for the first time mothers and reinforcing the benefits of breast feeding, will raise the mothers breast feeding self efficacy. Latching on will be explained and demonstrated using dolls and knitted or artificial breasts, benefits of breastfeeding will be discussed and anticipatory guidance on the management of breast feeding complications. The educational approach will help to address the identified needs. Personal counselling is more than just giving information, which is associated with health persuasion approach, but it is building skill to promote informed choice.
Health promotion has been defined by WHO (1986) as the process of enabling people to increase their control over the determinants of health. Self –efficacy is the belief in one ‘ability to achieve a behaviour. Observational learning and participatory learning will lead to the development of skills necessary to sustain breastfeeding, thus building self confidence and self efficacy(Davies and Macdowall,2009).This self efficacy can be seen as power within(Laverack2009). Beattie’s personal counselling can be compared to Caplan and Holland’s(1990)humanist approach which involves educating target population for the development of healthy lifestyles.