Health Promotion: Giving up Smoking in Pregnancy
The object of this assignment is to critically appraise a health promotion initiative related to midwifery practice. The initiative chosen is a NHS Health Scotland leaflet entitled 'Smoking: giving up during pregnancy: a guide for pregnant women who want to stop smoking' (NHS Health Scotland 2003). It will be referred to as the 'initiative' or the 'leaflet' throughout this assignment. The World Health Organisation (WHO) identified that health promotion was a way of equipping people to have more power enabling them to make choices in regard to improving their well-being (WHO 1986). Ewles and Simnett (2003) determine from this, that the fundamental elements of health promotion are improving health and empowerment. The Scottish Office paper 'Towards a Healthier Scotland' (1999) recommended making more health promotion available for pregnant smokers. This appraisal will systematically review the literature relating it to the health promotion initiative chosen using Ewles and Simnett (2003) Five Approaches to Health Promotion model. It will furthermore evaluate the midwife's role in promoting the issue highlighted and conclude with a summary and any proposals to improve future practice. Critical Appraisal
The Scottish Office paper 'Towards a Healthier Scotland' (Scottish Office 1999) recommends reducing the numbers of women smoking during pregnancy from 29% to 20% in the next 5 years. According to the Health Education Authority (1999) the rate for smoking in pregnancy in the UK was 30% however nearly 90% classified smoking as dangerous to their unborn child. Johnston et al (2003) point out that smoking is the main preventable cause of disease and disability in the fetus and newborn. Around 13 000 individuals die from smoking in Scotland each year (NHS Health Scotland and ASH Scotland 2004a). This initiative is based on the normative needs concept as it is influenced by expert opinion and government policies (Ewles and Simnett 2003). Epidemiological evidence in its favour allows the initiative to be evaluated by reduction in the mortality and morbidity (Naidoo and Wills 2000). This is cost effective because the initial resources for implementing the smoking cessation will be significantly less than the cost of hospitalisation later in life (NHS Health Scotland and ASH Scotland 2003). The leaflet that will be critiqued (appendix 1) is aimed at pregnant women who currently smoke but who want to give up. It is split into five sections titled: pregnancy and smoking; stopping smoking; tips for stopping; stopping smoking is worth it and thinking about your smoking. The Ewles and Simnett (2003) model comprises of five approaches to health promotion; medical approach; behaviour change approach; educational approach; client-centred approach and societal change approach. The behaviour change approach is the main focus for this initiative, although it does utilise aspects of all approaches. The behaviour change approach as described by Ewles and Simnett (2003) is a way of encouraging changes in an individual's attitudes and beliefs to take up a healthier lifestyle. It is, however considered by some, to be more forceful depending on the degree of encouragement and persuasion utilised (Crafter 1997, Norton 1998). The behaviour change approach uses a number of models to guide health promoters to facilitate clients to achieve a positive outcome. The Stages of Change Model (Prochaska and DiClemente 1984 as cited by Ewles and Simnett 2003) is a five stage cyclical model that has been found to be particularly useful in work with addictive behaviours (Naidoo and Wills 2000). This cycle incorporates a pre-contemplation stage where the individual is unaware of any need for change or has no interest in changing (Ewles and Simnett 2003). At this stage the midwife would assess whether the woman is genuinely not interested in stopping smoking at present and respect this decision but inform...
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