Promoting mental health in Northern Ireland: addressing division, inequality and stigma

This article provides an overview of the literature on the impact of ‘the Troubles’ on mental health in Nor thern Ireland. It identifies three main phases of professional and policy response from concerns about the effects of the violence in the early 1970s, through many years of collective denial and neglect, until acknowledgment, following the Good Friday Agreement in 1998 (Nor thern Ireland Office, 1998), of high levels of trauma and unmet need. The issues of inequality and stigma are also considered and it is argued that peace is necessary but insufficient for promoting mental health. The development of mental health services in Nor thern Ireland and the relatively recent focus on promoting mental health are also outlined and examined. It is suggested that attempts to address the needs arising as a result of ‘the Troubles’ and more general mental health promotion strategies have, to some extent, developed in parallel and that it may be impor tant to integrate these effor ts. The relative under-development of mental health services, the comprehensive Bamford Review of Mental Health and Learning Disability (2005; 2006) and the positive approach of the Public Health Agency mean that, even in the current economic climate, there are great oppor tunities for progress. Routine screening, in primary care and mental health services for trauma, including Troubles-related trauma, is recommended to identify and address these issues on an individual level. It is also argued, however, that more substantial political change is needed to effectively address societal division, inequality and stigma to the benefit of all.

Effect of preventive primary care outreach on health related quality of life among older adults at risk of functional decline: Randomised controlled trial

Objective: To evaluate the impact of a provider initiated primary care outreach intervention compared with usual care among older adults at risk of functional decline. Design: Randomised controlled trial. Setting: Patients enrolled with 35 family physicians in five primary care networks in Hamilton, Ontario, Canada. Participants Patients: were eligible if they were 75 years of age or older and were not receiving home care services. Of 3166 potentially eligible patients, 2662 (84%) completed the validated postal questionnaire used to determine risk of functional decline. Of 1724 patients who met the risk criteria, 769 (45%) agreed to participate and 719 were randomised. Intervention: The 12 month intervention, provided by experienced home care nurses in 2004-6, consisted of a comprehensive initial assessment using the resident assessment instrument for home care; collaborative care planning with patients, their families, and family physicians; health promotion; and referral to community health and social support services. Main outcome measures: Quality adjusted life years (QALYs), use and costs of health and social services, functional status, self rated health, and mortality. Results: The mean difference in QALYs between intervention and control patients during the study period was not statistically significant (0.017, 95% confidence interval -0.022 to 0.056; P=0.388). The mean difference in overall cost of prescription drugs and services between the intervention and control groups was not statistically significant, (-$C165 (£107; €118; $162), 95% confidence interval -$C16 545 to $C16 214; P=0.984). Changes over 12 months in functional status and self rated health were not significantly different between the intervention and control groups. Ten patients died in each group. Conclusions: The results of this study do not support adoption of this preventive primary care intervention for this target population of high risk older adults. Trial registration: Clinical trials NCT00134836.

Wellness as virtue:Morality and the pursuit of health

The interest and participation in health promotion and wellness activities has expanded greatly in the past two decades. The "wellness revolution", especially in terms of diet and exercise, has been affected by both scientific findings and cultural changes. The paper examines how a particular aspect of culture, the moral meanings of health-promoting activities, contribute to the pursuit of wellness. Based on interviews with 54 self-identified wellness participants at a major university, we examine how health can be a moral discourse and the body a site for moral action. The paper suggests that wellness seekers engage in a profoundly moral discourse around health promotion, constructing a moral world of goods, bads and shoulds. Although there are some gender differences in particular wellness goals, engaging in wellness activities, independent of results, becomes seen as a good in itself. Thus, even apart from any health outcomes, the pursuit of virtue and a moral lifeis fundamentally an aspect of the pursuit of wellness. © 1994 Kluwer Academic Publishers.

Canada's Compassionate Care Benefit:Is it an adequate public health response to addressing the issue of caregiver burden in end-of-life care?

Background: An increasingly significant public health issue in Canada, and elsewhere throughout the developed world, pertains to the provision of adequate palliative/end-of-life (P/EOL) care. Informal caregivers who take on the responsibility of providing P/EOL care often experience negative physical, mental, emotional, social and economic consequences. In this article, we specifically examine how Canada's Compassionate Care Benefit (CCB) - a contributory benefits social program aimed at informal P/EOL caregivers - operates as a public health response in sustaining informal caregivers providing P/EOL care, and whether or not it adequately addresses known aspects of caregiver burden that are addressed within the population health promotion (PHP) model. Methods. As part of a national evaluation of Canada's Compassionate Care Benefit, 57 telephone interviews were conducted with Canadian informal P/EOL caregivers in 5 different provinces, pertaining to the strengths and weaknesses of the CCB and the general caregiving experience. Interview data was coded with Nvivo software and emerging themes were identified by the research team, with such findings published elsewhere. The purpose of the present analysis was identified after comparing the findings to the literature specific to caregiver burden and public health, after which data was analyzed using the PHP model as a guiding framework. Results: Informal caregivers spoke to several of the determinants of health outlined in the PHP model that are implicated in their burden experience: gender, income and social status, working conditions, health and social services, social support network, and personal health practises and coping strategies. They recognized the need for improving the CCB to better address these determinants. Conclusions: This study, from the perspective of family caregivers, demonstrates that the CCB is not living up to its full potential in sustaining informal P/EOL caregivers. Effort is required to transform the CCB so that it may fulfill the potential it holds for serving as one public health response to caregiver burden that forms part of a healthy public policy that addresses the determinants of this burden. © 2011 Williams et al; licensee BioMed Central Ltd.

Knowledge translation in men’s health research: development and delivery of content for use online

Background: Men can be hard to reach with face-to-face health-related information, while increasingly, research shows that they are seeking health information from online sources. Recognizing this trend, there is merit in developing innovative online knowledge translation (KT) strategies capable of translating research on men’s health into engaging health promotion materials. While the concept of KT has become a new mantra for researchers wishing to bridge the gap between research evidence and improved health outcomes, little is written about the process, necessary skills, and best practices by which researchers can develop online knowledge translation.
Objective: Our aim was to illustrate some of the processes and challenges involved in, and potential value of, developing research knowledge online to promote men’s health.

Methods: We present experiences of KT across two case studies of men’s health. First, we describe a study that uses interactive Web apps to translate knowledge relating to Canadian men’s depression. Through a range of mechanisms, study findings were repackaged with the explicit aim of raising awareness and reducing the stigma associated with men’s depression and/or help-seeking. Second, we describe an educational resource for teenage men about unintended pregnancy, developed for delivery in the formal Relationship and Sexuality Education school curricula of Ireland, Northern Ireland (United Kingdom), and South Australia. The intervention is based around a Web-based interactive film drama entitled “If I Were Jack”.

Results: For each case study, we describe the KT process and strategies that aided development of credible and well-received online content focused on men’s health promotion. In both case studies, the original research generated the inspiration for the interactive online content and the core development strategy was working with a multidisciplinary team to develop this material through arts-based approaches. In both cases also, there is an acknowledgment of the need for gender and culturally sensitive information. Both aimed to engage men by disrupting stereotypes about men, while simultaneously addressing men through authentic voices and faces. Finally, in both case studies we draw attention to the need to think beyond placement of content online to delivery to target audiences from the outset.

Conclusions: The case studies highlight some of the new skills required by academics in the emerging paradigm of translational research and contribute to the nascent literature on KT. Our approach to online KT was to go beyond dissemination and diffusion to actively repackage research knowledge through arts-based approaches (videos and film scripts) as health promotion tools, with optimal appeal, to target male audiences. Our findings highlight the importance of developing a multidisciplinary team to inform the design of content, the importance of adaptation to context, both in terms of the national implementation context and consideration of gender-specific needs, and an integrated implementation and evaluation framework in all KT work.

Breast is Best? Reasons Why Mothers Decide to Breastfeed or Bottlefeed their Babies and Factors Influencing the Duration of Breastfeeding.

Breastfeeding is known to confer benefits, both in the short term and long term, to the child and also to the mother. Various health-promotion initiatives have aimed to increase breastfeeding rates and duration in the United Kingdom over the past decade. In order to assist in these endeavours, it is essential to understand the reasons why women decide whether to breastfeed and the factors that influence the duration of breastfeeding. This study reports breastfeeding initiation and duration rates of mothers participating in the Growth, Learning and Development study undertaken by the Child Health & Welfare Recognised Research Group. Although this study cannot provide prevalence data for all mothers in Greater Belfast, it can provide useful information on trends within particular groups of the population. In addition, it examines maternally reported reasons for choosing to breastfeed and for breastfeeding cessation. The likelihood of mothers initiating breastfeeding is influenced by factors such as increased age, higher educational attainment and higher socio-economic grouping. The most common reason cited for breastfeeding is that it is “best for baby”. Returning to work is the most important factor in influencing whether mothers continued to breastfeed. Women report different reasons for cessation depending on the age of their child when they stopped breastfeeding. This information should inform health-promotion initiatives and interventions.

Gendered Spaces and Intimate Citizenship: The Case of Breastfeeding

This article situates breastfeeding politics in the context of intimate citizenship, where women’s capability to care in a range of social spaces is at stake. Drawing on the work of Lefebvre and Fenster, the article considers the extent to which recent breastfeeding promotion work by the Health Promotion Agency in Northern Ireland has sought to reconceive of social spaces in ways that have the potential to improve intimate citizenship for breastfeeding women.

The Social Politics of Breastfeeding: Norms, Situations and Policy Implications

This paper aims to explore the assumptions concerning the dynamics of human action underpinning breastfeeding promotion campaigns in the UK. Drawing on qualitative interviews with mothers, the ways in which three problematic assumptions shape both the promotion and experience of contemporary breastfeeding promotion campaigns are explored, in the light of Joas’s theorisation of action’s creativity and pragmatism. Public health efforts to establish breastfeeding as a rational standard against which good mothering can be judged, in ways which rely on a de-contextualised understanding of human action as instrumentally rational, where bodies are imagined as pliable instruments of human intentions, are explored as they play out in the experiences of women embarking on motherhood. The paper concludes that a target-driven health-promotion policy, relying on a mechanistic account of social and emotional life, is contributing to the burden of early motherhood in ways that are not conducive to infant and maternal health and attachment.

Social support, network heterogeneity, and smoking behavior in women: The 10-town study

Purpose. Examine the associations among social support, network heterogeneity, and smoking behavior in a large sample of Finnish female municipal employees.

Telephone survey evaluation of the educational impact of a distance learning course

The educational impact of a distance learning (DL) course entitled ''Health Screening for Health Promotion, was investigated using a telephone questionnaire survey. An introduction to the DL course was distributed to all community pharmacists in England (16,400); the main body of the course, on which pharmacists were examined, was distributed free of charge to all pharmacists who requested it (1,485). Pharmacists participating in the survey (868) were organized by random selection into groups and stratified according to age, sex and postcode. A matched control group was randomly drawn from those pharmacists who had not participated in the course. The DL course improved pharmacists' knowledge about health screening/health promotion issues (e.g., mean score of 66 percent achieved by a group who had completed the course; 51 percent achieved by the control group; P<0.001). Factors influencing score achieved included sex and year of registration. Males performed better than females (P<0.008) while performance decreased with number of years on the register (P<0.001).

Present orientation, future orientation and alcohol use in Northern Irish adolescents

Earlier initiation into more problematic drinking behaviour has been found to be associated with more problematic drinking later in life. Research has suggested that a lower future time perspective (and higher present time perspective) is associated with health-compromising behaviours such as problematic alcohol use in college student, University undergraduate and general population samples. This study used a cross-sectional design to examine whether consideration of future consequences (CFC), assessed by the Consideration of Future Consequences Scale, was significantly related to drinking behaviour in a large sample (n=707) of Northern Irish adolescents. Alcohol use was self-reported by means of a composite measure of drinking behaviour. Demographic data were also gathered. After controlling for year in school (proxy for age), sex and for clustering at school level, lower future orientation and higher present orientation were found to be significantly associated with more problematic self-reported drinking behaviour. These results extend recent findings of a significant relationship between a foreshortened future time perspective and more problematic self-reported drinking behaviour in a UK sample of University undergraduates, to a large UK sample of adolescents. Given the relationship between early-onset drinking and more problematic use in later life, health promotion interventions might explore using the CFC construct in targeting adolescent drinkers.