Dr Dean Whitehead
Schofield et al. (2007) are to be highly commended for their research into the smoking-related health beliefs of older people with chronic obstructive pulmonary disease. While I am often at a loss to understand the nursing ‘obsession’ with smoking-related research, to the cost of more important health constructs, their research differs in several ways from much of the ‘glut’ of smoking-related nursing research. Firstly, it acknowledges the challenges and complexities of socio-cognitive orientated behavioural-change strategies and thus avoids the trap of many nursing-related smoking cessation studies. The trap lying in the suggestion that smoking-cessation (or any health-related behavioural change for that matter) is not the highly complex social process that it is, but merely an uncomplicated notion of personal choice supported by health advice (Whitehead & Russell, 2004). Their research is far more an attempt to rationalise and understand the complex ‘rationality’ of a high-risk group of clients who have already attempted, in most cases, many strategies to quit smoking. This understanding, in their own words ‘is the first stage in the complex and uncertain process of behaviour change’ (page 1733). Schofield et al. (2007), therefore, avoid the ‘here’s how to set up a successful smoking-cessation programme’ (when often smoking- cessation programmes are not successful – they just appear that way in the short term), in favour of the ‘let’s be real about this’ approach – identifying potential strategy for realistic outcomes by first exploring the nature and context of the patient’s belief structures. Any research that does this, in place of existing studies that are set up as ‘smoking-bashing’ attempts to alter the smoking behaviours of clients at any cost or method, is to be valued.
Secondly, the authors should be commended on their correct reference to and framing of their health-related approach. The second keyword in their article is health education. It is used in the correct location and context for this type of study. This is a refreshing change from the majority of nursing-related health education literature, of a similar nature to Schofield et al.’s (2007) study, which incorrectly persists in calling it health promotion. McMurray (2003) indicates that the most significant shift in the conceptualisation and emphasis for health promotion has been from teaching people how to manage their health (from a preventative/reactive individual, medical and behavioural orientation) to a socially embedded methodology that capitalises on the inherent capacity of community members to establish their own goals, strategies and priorities for health through a socio-ecological developmental approach to community health. Therefore, health-related interventions that remain within individual and behavioural- change orientations are now generally classified as health education, to distinguish them from an altered health promotion construct (Whitehead 2001, 2003, 2004, 2005). This is not to say that health education holds any a lesser place in health care, just that it is different and needs to be contextualised and approached in a certain manner to be effective (Whitehead & Russell, 2004). Health education studies need to follow due process which involves using identified contemporary socio-cognitive models, as this study does in the form of the Health Belief Model. I therefore recommend that those who are interested in socio- cognitive and behavioural-change interventions refer to Schofield et al.’s (2007) study, as a framework reference for identifying realistic and contextually correct health education strategy.
McMurray A (2003) Community Health and Wellness: A Socioecological Approach, 2nd edn. Mosby, Sydney.
Schofield I, Kerr S & Tolson D (2007) ‘An exploration of the smo- king-related health beliefs of older people with chronic obstructive pulmonary disease’. Journal of Clinical Nursing 16, 1726–1735.
Whitehead D (2001) Health education, behavioural change and so- cial psychology: nursing’s contribution to health promotion? Journal of Advanced Nursing 34, 822–832.
Whitehead D (2003) Viewing health promotion and health education as symbiotic paradigms: bridging the theory and practice gap between them. Journal of Clinical Nursing 12, 796–805.
Whitehead D (2004) Health promotion and health education: advancing the concepts. Journal of Advanced Nursing 47, 311–320.
Whitehead D (2005) Letter to the Editor. Research in Nursing & Health 28, 357–359.
Whitehead D & Russell G (2004) How effective are health education programmes: resistance, reactance, rationality and risk? recommendations for effective practice. International Journal of Nursing Studies 41, 163–172.