Health promotion and evaluation - a programmatic approach

Health promotion has evolved significantly in the past twenty years. Its emphasis has shifted from relatively simple monocausal models focused on behavioural risk factors to a greater emphasis on broader social determinants of health. Single method, single risk factor interventions have increasingly been replaced with multiformat, multiple risk factor interventions and extended campaigns, with whole-of-govemment implications. Health promotion structures have developed from ad hoc single shot activity to large dedicated agencies with continuing responsibilities and a wide ambit.

The development of health promotion research and evaluation has followed these trends. The early epidemiology studies linked behavioural risks such as smoking, diet and physical activity with systemic conditions such as cancer and cardiovascular disease. A raft of small and large scale intervention studies aimed at demonstrating that these behavioural risk factors could be modified and that modification would lead to improved health outcomes followed with mixed results.

More recent evidence suggests that behavioural risks are not the onIy social factors that influence health outcomes. There is now strong evidence that social determinants such as income, education and employment have highly significant direct effects on health outcomes, which are not mediated by behavioural risks, and that behavioural risks are also correlated with these broader determinants.

Health promotion now operates in a variety of ways at different scales and different levels of the health system (and the wider social system). The goals of health promotion, and the measures that assess whether a project, campaign, or general strategy has met its goals, differ accordingly.

Arguably, where local, state and federal governments begin to coordinate their efforts systematically across settings, intervention strategies, health action areas and population groups, health promotion becomes more
programmatic, sustainable and effective. A programmatic approach also integrates knowledge generation, the development of health promotion capacity, practice and evaluation together.

However, programmatic approaches to health promotion are comparatively new. Only recently have governments begun to develop and resource
comprehensive and sustained health promotion programs that address a range of health issues using multiple intervention strategies. The scope of a more programmatic approach and its functions and purposes is still developing.

Although evaluation has a key role to play in this respect, the development of programmatic strategies for health promotion has generally outpaced evaluation theory and practice. While we now have reasonable technologies for measurement of behavioural risks and individual attitudinal and cognitive influences on them, strategies to evaluate organisational and community interventions are still emerging.

Similarly, while new approaches to evaluate small scale community and organisational interventions have been developed, comprehensive models to monitor and evaluate health promotion programs and strategies across multiple intervention sites over extended periods have not yet emerged. Nor have we resolved the methodological problems of teasing out the relative contribution of different intervention strategies to observed change in health outcomes.

More programmatic approaches to health promotion require a more programmatic approach to health promotion evaluation. This paper represents an issues based examination of the evidence base for a more programmatic health promotion and the evaluation issues that arise

Changing risk behaviours for non-communicable disease in New Zealand working men - is workplace intervention effective?

Aims. To evaluate the effectiveness of a health promotion
programme targeting dietary behaviours and physical
activity among male hourly-paid workers and to explore
demographic and attitudinal influences on dietary patterns
at baseline.
Methods. A controlled field trial compared workers at one
intervention and one control worksite. The intervention
comprised nutrition displays in the cafeteria and monthly
30-minute workshops for six months. Key outcome
measures at six and twelve-months were self-reported
dietary and lifestyle behaviours, nutrition knowledge, body
mass index (BMI), waist circumference and blood pressure.
Results. 132 men at the intervention site and 121 men at the
control site participated in the study and a high retention rate
(94% at 6-months and 89% at 12-months) was achieved. At
baseline, 40% of the total sample (253) were obese, 30% had
elevated blood pressure, 59% indicated an excessive fat intake
and 92% did not meet the recommended vegetable and fruit
intake. The intervention reduced fat intake, increased
vegetable intake and physical activity, improved nutrition
knowledge and reduced systolic blood pressure when
compared to the control site. There was no difference in
change in mean BMI or waist circumference. Reduction in
BMI was associated with reduction in fat intake.
Discussion. Low intensity workplace intervention can
significantly improve reported health behaviours and
nutrition knowledge although the impact on more
objective measures of risk was variable. A longer duration
or more intensive intervention may be required to achieve
further reduction in risk factors.

Customer perceptions of responsible retailing in Australia

For retailers, the adoption of Corporate Social Responsibility (CSR) can act as a source of differentiation and affect reputation, customer loyalty, and competitive advantage. Despite these potential benefits, there has been limited empirical investigation of CSR within the retailing literature. This paper proposes that for retailers to implement CSR to strategic benefit, they must understand how their customers perceive the concept. This paper utilises Carroll’s (1979, 1991) four-part framework of corporate behaviours to operationalise the concept of CSR. To build on Carroll’s (1979, 1991) framework, respondents are asked to identify specific behaviours that constitute socially responsible behaviour for a retail supermarket. Results support the four corporate behaviours proposed by Carroll, but do not support the rank order of economic corporate behaviours being first and foremost. The findings suggest the inclusion of ‘supply chain management’ and ‘provision of customer value’ as additional factors for retailer CSR. From these findings, an initial model of retailer CSR is proposed for further investigation. For academics, such a model provides greater clarity in understanding CSR, allowing future development across alternative retail settings. The model provides retailers with a tool for implementing CSR for strategic benefit, by way of meeting customer CSR demands.

Testing the circumplex model of emotions in a consumer setting

There is widespread belief that more positive emotional reactions to consumption situations will lead to positive business outcomes such as increased market share through the combination of increased loyalty, repeat purchase and strengthened reputation. However, most of the psychological work on emotions has not dealt directly with consumption experiences, but rather broader everyday experiences. In this study, psychological models of emotion were tested using magazine subscribers, specifically looking at their emotional responses to the magazine and the overall subscription package. The aim was to determine whether one of the major theories on emotional structure, the circumplex model, is relevant and consistent when applied specifically to a consumption experience. The results are positive, with the model being supported, and they provide insight into the structure and relations of different emotional responses (e.g., satisfaction, delight) consumers might have to a consumption experience.

Do organizational service recovery actions impact on hotel guests future intentions and does speed of recovery matter?

This paper investigates hotel guests’ responses to organizational actions dealing with service failure. Eight service failure scenarios were used to identify guests’ intentions towards future visits. Guests’ intentions to switch hotels, revisit the property and remain loyal to the chain were found to vary based on the recovery efforts undertaken. This research found that empowering employees contribute to positive consumer intentions toward the service provider. Compensation was also found effective if offered through empowered employees. Speed of response to service failure was also identified as important action to improve consumer future intentions. Based on these findings, implications for future research are highlighted. Recommendations to the practitioners of hospitality and tourism sector were made for the management of failed service encounter.

Rethinking the significance of attitudes in preventing men's violence3 against women

The concept of attitudes has been an important component of campaigns to address men’s violence against women. Attitudes have been examined in relation to men’s perpetration of violence, women’s experience of violence and community and institutional responses. In this article we argue that there has not been sufficient interrogation of the limitations of attitudes in understanding and addressing men’s violence. We propose a social constructionist approach to attitudes and emphasise the need to locate attitudes within the context of familial, organisational, community and social norms which support violence against women. Furthermore, we argue that to prevent violence against women, we must develop interventions beyond cultural and attitudinal change to encompass changes in structural relations and social practices.

Professional attitudes towards deliberate self-harm in patients with borderline personality disorder

Objective: The aim of the present study was to assess the attitudes of mental health and emergency medicine clinicians towards patients diagnosed with borderline personality disorder. The clinician gender, primary occupation and service setting, level of university training and years of experience, frequency of clinical contact, and completion of specific training in borderline personality disorder were expected to influence the attitudes of health professionals towards working with borderline patients that engage in self-harm.

Method: A purpose-designed questionnaire and an assessment tool to quantify attitudinal levels were used to collect demographic information and assess the attitudes of 140 mental health and emergency medicine practitioners across two Australian health services and a New Zealand health service.

Results: Statistically and clinically significant differences were found between emergency medical staff and mental health clinicians in their attitudes towards working with borderline personality disorder. The strongest predictor of attitudes was whether the clinician worked in emergency medicine or mental health. This was followed by years of experience and specific training in personality disorders as significant predictors of attitudes to self-harm.

Conclusions: The implications of these findings for the professional training of clinicians in the management and treatment of borderline personality disorder patients are discussed.

Gambling and corporate social responsibility (CSR) : re-defining industry and state roles on duty of care, host responsibility and risk management

During the 1990s, states embraced legalised gambling as a means of supplementing state revenue. But gaming machines (EGMs, pokies, VLTs, Slots) have become increasingly controversial in countries such as Australia, Canada and New Zealand, which experienced unprecedented roll-out of gaming machines in casino and community settings; alongside revenue windfalls for both governments and the gambling industry. Governments have recognised that gambling results in a range of social and economic harms and, similar to tobacco and alcohol, have introduced public policies predicated on harm minimisation. Yet despite these, gaming losses have continued to climb in most jurisdictions, along with concerns about gambling-related harms. The first part of this article discusses an emerging debate in Ontario Canada, that draws parallels between host responsibility in alcohol and gambling venues. In Canada, where government owns and operates the gaming industry, this debate prompts important questions on the role of the state, duty of care and regulation ‘in the public interest’ and on CSR, host responsibility and consumer protection. This prompts the question: Do governments owe a duty of care to gamblers?

The article then discusses three domains of accumulating research evidence to inform questions raised in the Ontario debate: evidence that visible behavioural indicators can be used with high confidence to identify problem gamblers on-site in venues as they gamble; new systems using player tracking and loyalty data that can provide management with high precision identification of problem gamblers and associated risk (for protective interventions); and research on technological design features of new generation gaming products in interaction with players, that shows how EGM machines can be the site for monitoring/protecting players. We then canvass some leading international jurisdictions on gambling policy CSR and consumer protection.

In light of this new research, we ask whether the risk of legal liability poses a tipping point for more interventionist public policy responses by both the state and industry. This includes a proactive role for the state in re-regulating the gambling industry/products; instituting new forms of gaming machine product control/protection; and reinforcing corporate social responsibility (CSR) and host responsibility obligations on gambling providers – beyond self-regulatory codes. We argue the ground is shifting, there is new evidence to inform public policy and government regulation and there are new pressures on gambling providers and regulators to avail themselves of the new technology – or risk litigation

Conceptualising the effect of self-service technologies on established brands

Self-service technologies (SSTs), such as machine assisted and electronic services are prevalent. Many established brands in industries such as banking, retailing, and hospitality have adopted SSTs to complement or replace existing channels of service delivery, e.g., face-to-face service. However, the influence of SSTs on established brands has not been examined previously. In the light of this, a conceptual model is proposed that incorporates SST-related variables and their influence on brand satisfaction, brand associations, brand attitudes, and brand loyalty, along with customers' future likelihood to reuse the SST. Arguably, these outcomes affect brand equity and the long-term survival of SSTs.

The role of emotions in member renewal and non-renewal : an exploratory study

This paper examines the emotions of lapsed and continuing members of a high involvement, subscription based organisation. In-depth interviews were conducted with 400 renewing and non-renewing members of an Australian Football League Club in order to gain initial insight into the role emotions play in renewal (loyalty) behaviours. The interviews highlighted the complexity of the relationship between emotions and behaviours. There is a range of both positive and negative emotions present in responses of both renewing and non-renewing members. As expected, the negative emotions of disappointment and frustration were present amongst those who did not renew, while there were many positive emotion examples of satisfaction and joy present for those who had renewed. Surprisingly, there were also examples of annoyance, fear, and guilt amongst those that had renewed. These feelings were often linked to the particular member's history and level of family involvement in the Club over many years. In addition, there were positive feelings of hope and loyalty expressed by those respondents that had not renewed. On a positive note for the Club, many still expressed a strong emotional connection to the Club and had not ruled out joining again in the future.

Outbound cause-related marketing at the West Coast Eagles : measuring awareness and impact

This paper examines sports sponsorship from the perspective of the sports organisation as the sponsor of charity and community events - an increasingly common practice. Most of these sponsorship activities fit within the framework of cause-related marketing, but their effectiveness and value to the clubs involved are not known. We examine the activities of one AFL club which is heavily involved in a range of outbound sponsorship activities. In order to assess the impact of theses activities, we surveyed season ticket holders of this club and examined issues such as their general awareness of these activities and the both the antecedents and outcomes of this awareness. We find that general awareness (recognition) levels were high, and that the correlated with loyalty, involvement and specific brand associations. The conclusion is that outbound sponsorship of charities and the community has a number of positive outcomes for sporting clubs, and should be encouraged.

The impact of the work conditions of allied health professionals on satisfaction, commitment and psychological distress

BACKGROUND: Allied health professionals are integral to the effective delivery of hospital-based health care, yet little is known about the working conditions associated with the attitudinal and health outcomes of these employees.

PURPOSE: The purpose of this study was to investigate the extent to which the demand-control-support model, in combination with organizational justice variables, predicts the employee-level outcomes of allied health professionals.

METHODOLOGY/APPROACH: Allied health professionals from an Australian health care organization were surveyed, with 113 (52.6%) participating. The survey included measures of job demands, job control, social support, organizational justice, satisfaction, commitment and psychological distress.

FINDINGS: Multiple regression analyses reveal that the additive demand-control-support model predicts the outcome variables of job satisfaction, organizational commitment and psychological distress, whereas the organizational justice variables predicted organizational commitment and psychological distress. Further, both work and nonwork sources of support, in addition to specific justice dimensions, were closely associated with employee-level outcomes.

PRACTICAL IMPLICATIONS: When coupled with previous research involving social support and organizational justice, the findings from this study suggest that initiatives aimed at strengthening supervisor and nonwork support, while enhancing perceptions of organizational fairness, may offer useful avenues for increasing the levels of satisfaction, commitment and well-being experienced by allied health professionals.

Supervisors are central to work characteristics affecting nurse outcomes

Purpose: To examine the predictive capability of the demand-control-support (DCS) model, augmented by organizational justice variables, on attitudinal- and health-related outcomes for nurses caring for elderly patients.

Design: The study is based on a cross-sectional survey design and involved 168 nurses working with elderly patients in facilities of a medium to large Australian organization.

Method: Participants were asked to complete a questionnaire consisting of scales designed for measuring independent (e.g., demand, control, support, organizational justice) and dependent (e.g., job satisfaction, organizational commitment, wellbeing and psychological distress) variables. Multiple regression analyses were undertaken to identify significant predictors of the outcome variables.

Findings: The DCS model explains the largest amount of variance across both the attitudinal and health outcomes with 27% of job satisfaction and 49% of organizational commitment, and 33% of psychological distress and 35% of wellbeing, respectively. Additional variance was explained by the justice variables for job satisfaction (5%), organizational commitment (4%), and psychological distress (23%).

Conclusions: Using organizational justice variables to augment the DCS model was valuable in better understanding the work conditions experienced by nurses caring for elderly patients. Inclusion of curvilinear effects added clarity to the potentially artifactual nature of certain interaction variables.

Clinical Relevance: The results indicated practical implications for managers of nurses caring for elderly patients in terms of developing and maintaining levels of job control, support, and fairness, as well as monitoring levels of job demands. The results particularly show the importance of nurses' immediate supervisors.

Consideration of corporate social orientation in managing sport organisations' internal stakeholders

Increasing pressure from the public has raised the expectations on corporations to be better citizens of their communities and society as a whole (Bennet 2002; Carroll 1999; Epstein 1989; Van Marrewijk 2003; Wood 1991). As a result, corporations have engaged in corporate social responsibility efforts with most of the subsequent research focused on its impact on consumer response (e.g., attitudes, behaviours, etc.) (Bhattacharya & Sen 2001, 2004; Porter & Kramer 2002). Similarly, research interest on corporate social responsibility in the sport industry has risen, yet no research studies have explored the influence and perceptions about corporate social responsibility of important internal constituents (employees and volunteers) of sport organisations. Particular interest would be in uncovering what employees and volunteers specifically believe are important among CSR elements (ethical, discretionary, legal, economic) and what impact a sense of 'shared CSR values' with the respective sport organisation would have on employee and volunteer response. Will understanding how shared social values influence organisational commitment provide insight on recruitment, retention and/or development strategies of employees and volunteers? Further, assessing any difference in sensemaking between these two groups would be of additional value to this line of enquiry, as the perceptions of the organisation are understood as "tantamount to reality, since organisations are social constructions made up of and acting in accordance with shared perceptions," (Brickson 2007, p. 865) particularly those of employees and volunteers of sport organisations. With increasing academic and industry interest of corporate social responsibility in sport and to address the obvious gap on CSR and employees and volunteers in the literature, the present study will explore how CSR impacts internal constituents (employees and volunteers) of sport organisations. Specifically, the main purpose of the present study is to assess the level of perceived shared values as they related to CSR (measured as corporate social orientation) between employees- organisation and volunteers- organisation. Further, the influence of the level of perceived shared corporate social orientation (CSO) on organisational identification will be evaluated in the context of a proposed model, which includes the relationship of perceived shared corporate social orientation>organisational identification> attitudinal and behavioural outcomes (i.e., commitment, satisfaction, and organisational behaviour). Using a sample of employees and volunteers of a sport organisation, the respondents will be asked to complete an online survey composed of demographic items, the corporate social orientation scale, and items that measure organisational identification, value commitment, job/ volunteer satisfaction, and organisational citizenship behaviours. Discussion of how other stakeholder (e.g., sponsors, consumers, etc.) perceptions on CSR potentially impacts the model and outcomes (e.g., corporate reputation, consumer behaviour) will be addressed. Analyses and results will support discussion and conclusions made to provide evidence for practitioner and researcher implications.

Exploring the types of SMEs which could use blogs as a marketing tool : a proposed future research agenda

Blogs appear to be gaining momentum as a marketing tool which can be used by organisations for such strategies and processes as branding, managing reputation, developing customer trust and loyalty, niche marketing, gathering marketing intelligence and promoting their online presence. There has been limited academic research in this area, and most significantly concerning the types of small and medium enterprises (SMEs) for which blogs might have potential as a marketing tool. In an attempt to address the knowledge gap, this paper presents a future research agenda (in the form of research questions) which can guide the eBusiness research community in conducting much needed studies in this area. This paper is particularly novel in that it aims to demonstrate how the heterogeneity of SMEs and their specific business uses of eBusiness technology such as blogs can form the central plank of a future research agenda. This is important because the existing eBusiness literature tends to treat eBusiness collectively rather than focusing on the specific business uses of different eBusiness technologies, and to treat SMEs as a homogeneous group. The paper concludes with a discussion of how this research agenda can form the basis of studies which use a range of different research methods, and how this "big picture" agenda approach might help the eBusiness research community build theory which better explains SME adoption and use of eBusiness.