194 MOTIVATION AND BEHAVIOUR
It is based on choice and participation and aims to extend opportunities and social
justice for participants (Durie and Wyatt, 2007).
Community interventions to promote health-related behaviour patterns may target
particular health-promoting or illness-management behaviours. By contrast, compre -
hensive interventions may target a range of health-related behaviour patterns.
For example, the North Karelia Project, which began in Finland in 1972 included
education on smoking, diet and hypertension using widely distributed leaflets, radio
and television slots and education in local organizations. Voluntary sector organizations,
schools and health and social services were involved and training was provided for
personnel in various contexts. The intervention included education of school students
about the health risks of smoking and the social influences that lead young people to
begin smoking, as well as training for students in how to resist such social influences.
This comprehensive intervention was found to be effective in changing a series of
outcome measures including smoking reduction and serum cholesterol levels. For
example, 15 years later, smoking prevalence was 11 per cent lower among intervention
participants compared to controls (Vartiainen et al., 1998).
In a review of evaluations of comprehensive community interventions (including
the North Karelia Project), Hingson and Howland (2002) found that greater
effectiveness was observed when interventions (1) targeted behaviours with immediate
health consequences such as alcohol misuse or sexual risk taking; (2) targeted young
people to prevent uptake of health-risk behaviours; (3) combined environmental and
institutional policy change with theory-based behaviour change interventions; and (4)
involved communities themselves in intervention design.
We considered the important role that social support plays in moderating stress (in
Chapter 5). Social support can be crucial to behaviour change. Motivation to change
can be undermined if changes are disapproved of, or resisted, by valued others,
including family members or opinion leaders. Consequently, additional social support
can enhance the effectiveness of interventions both in initiating and maintaining
behaviour change. For example, planning how barriers to change may be overcome
or the signing of behavioural contracts are change techniques facilitated by interpersonal
interaction. Moreover, community and worksite interventions (such as the Expert
Patient intervention we considered in Chapter 8) can provide social support by
establishing buddy systems or support groups in which two or more people work
together to support initiation and/or maintenance of behaviour change. Establishing
how interpersonal processes influence a target behaviour and assessing skills in managing
relevant social interactions and available social support is important when designing
such interventions.
Societal structures and processes also regulate our behaviour patterns. We saw in
Chapter 4 how relative poverty arising from the distribution of wealth within a country
can affect health (Whitehead and Dahlgren, 1991). The management of taxation and
benefit systems have large effects on health and longevity within countries (Wilkinson,
1996) but such change requires action by legislators. So, in certain cases, effective health
promotion necessitates lobbying politicians and legislators and presenting the results
of research to decision-makers in government (e.g. Schaalma et al., 2004). Legislative
change can have far-reaching and immediate effects on health. For example, in the
UK in 2007, smoking in public places was banned and it became illegal to sell tobacco
to people below the age of 18 years. Evaluating a similar legislative change, Sargent,