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Northern Territory Department of Health Library Services Historical Collection
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H E A L T H W O R K S
A HEALTH PROMOTION PROJECT
IN THE NORTHERN TERRITORY
AUSTRALIAN COUNCIL FOR HEALTH,
PHYSICAL EDUCATION AND RECREATION
SIXTEENTH NATIONAL BIENNIAL CONFERENCE
L A U N C E S T O N
JANUARY 12 - 17 1986
ROSS SPARK DIRECTOR OF HEALTH PROMOTION
NORTHERN TERRITORY DEPARTMENT OF HEALTH
DL HIST PO BOX 40596
613.099429 CASUARINA NT 5792
DON
1986 AUSTRALIA
Tel. (089) 20 3370
..
OOG\~ABSTRACT
The 1979 New South Wales North Coast Healthy Lifestyle Project has become a model in this country for media-based health promotion.
With this project, health promotion moved from having a mainly information-giving role, into the market place.
This paper outlines a new project in health promotion, Healthworks, being developed by the Health Promotion Unit of the Northern Territory Department of Health, which includes media and community-based interventions.
The Healthworks Project, with its many different elements has been designed to consider the factors that make the Northern Territory and Territorians themselves different from the rest of Australia, while building on the successes of similar projects in other States.
The project follows extensive qualitative and quantitative research to establish the health status and health attitudes of Territorians.
The challenge for Healthworks, besides addressing the needs of people in the major population areas of Darwin and Alice Springs, is to make the project relevant to those Territorians who live in more isolated communities as well as the 25%
of the population who are Aborigines.
The evaluation plan includes a short-term, market research evaluation to examine the effectiveness of the initial
"umbrella" campaign to establish the project, as well as evaluation of individual campaigns to be conducted by the Menzies School of Health Research in Darwin.
. . . 1 . . .
Since the "North Coast Healthy Lifestyle Program" was set up in 1979 to test the effects of media and community programs on lifestyle, a great deal has ~een learnt in this country about selecting the most effective mediums to communicate the messages of prevention in order to change health-compromising behaviours.
The North Coast Program represented a benchmark in the development of health promotion in that it focussed on the major health problems of the New South Wales North Coast area, which are common to most parts of Australia~ these being heart and circulatory disease, carcinomas, hypertension, stress and accidents, and aimed to reduce their associated risk factors.
What was particularly significant was the use of social marketing techniques as a means of effecting attitude and behaviour change. Social marketing concerns the explicit use of marketing skills to help translate present social efforts into more effectively designated and
programs that elicit desired audience response.1
communicated
The North Coast program used professional commercial media and
the
advertising resulting
techniques to prepare campaigns developed and
media refined
messages and this social marketing communication model to deliver health messages to the public. This was based on a theory of the process of persuasion in which resonance and arousal are followed by action consequences.
Resonance occurs when the style and content of a message strike a sympathetic chord with the audience. Creating arousal within an audience is the result of powerful resonance being achieved.
••• 2 •••
The model operates on the premise that persuasion is confirmed and re-inforced when an audience actively responds in some way to the media message. Consequently every message in the campaign had a built- in "act ion consequence" , an obvious opportunity to respond. "Push" . _without "guidance" results in the dissipation of the original arousal or undesirable behaviour change. A variety of action consequences were used in the campaigns, including kits to write or phone for, people available to advise and help, classes to join, public occasions to attend, products to buy, a shop to visit, commitments to make, records to keep, tests to do. Every message had an explicit action consequence, encouraging arousal to become overt behaviour.2
The North Coast Program was a three town study and the most significant results were shown in the town which was subjected to both media plus community programs.
The "Quit For Life" campaign which aimed at reducing cigarette smoking over a two-year period was considered the most successful, with a decline in the prevalence of
in the test town of up to 16% in certain age groups.3
smoking
This has proved the campaign with most portability and elements have since been extended to all of New South Wales and Victoria, In Western Australia the Smoking and Health Project of the Western Australian Department of Health has built upon these concepts and further refined the social marketing principles in relation to smoking control which has resulted in considerable declines
State.
in smoking prevalence rates in that
In spite of a level of cynicism by some at the high cost of large-scale health promotion media it is unlikely and certainly not desirable that
perceived campaigns the new era of health promotion will see a return to p_rograms which rely only on providing information.
••• 3 •••
What has emerged over recent years is a group of health promotion professionals who recognize
a variety of different strategies
the advantage of using in combination as the most effective means of changing behaviours.
The simple persuasive campaign model has now been replaced by a more socially-oriented approach in which the mass media are viewed as one of many possible sources of information in society which cannot be discussed in isolation from personal information sources which may support or contradict media messages.
A combination of locally-based, carefully targeted educational programs, concentrating in the first instance on issues defined by the population deemed to be at risk, comprising mass media and personal communication techniques, supported by extensive baseline information and supplemented by careful monitoring and process evaluation would seem to offer the best chance of real progress at the present time.4
With this approach as designed for a region
a guiding that had
principle, not been
a project was subjected to a large-scale
Territory.
health promotion project before, the Northern
The set
project, up early
titled, in 1985
Healthworks (In The through an allocation
Territory), was by the Northern Territory Government and its aim was to determine the major health problems of Territorians and to initiate programs which would reduce the risk factors associated with those problems.
Rather than establish a short-term project with short-term goals and using an imported project team as had been the case with the North Coast Program, the objective with Healthworks was to aim for short term as well as longer term behaviour change and to operate the project within the newly established structure of the Health Promotion Unit of the ~orthern Territory Department of Health.
••• 4 •••
Health Promotion Services are small in the Northern Territory compared with larger branches in other States, however it was felt that the Healthworks Project could be implemented using the team of Health Promotion Officers and support personnel in the Health Promotion Unit in Darwin and the network of Regional Health Promotion Officers in other centres, supplemented by interstate consultants with experience in similar projects.
It was also an initial strategy decision not to begin the Project with behaviour-specific campaigns, but rather to first establish Healthworks as a broad "umbrella" campaign with act ion consequences and later to link behaviour-specific campaigns to the established and major themes of Healthworks.
The first step was to learn the Northern Territory which in conducting such a project.
specific information regarding would need to be considered
The Northern Territory possesses some characteristics which make it unique in Australia. It occupies an area which is approximately one sixth that of Australia. It has a population of 140,000 with 50% of that population residing in Darwin and 15% in Alice Springs. 72% of the Northern Territory is under thirty-five years of age. 25% are Aborigines.
The Northern Territory to most Australians represents the last frontier - the outback, the Top End, the "real" Australia.
Along with this goes on image of its inhabitants as hard living, hard drinking people.
As the line from the Ted Egan song goes, "There's a lot of bloody good drinkers in the Northern Territory".
O~G\5
••• 5 •••
An early need was held myths were
to establish whether indeed reality. A
some of these commonly market research firm, R. J. Donovan and Associates, was
out both qualitative and quantitative Territorians attitudes, beliefs and to health and healthy activities.
commissioned to carry research to investigate behaviours with respect
As the first phase of the Healthworks Project was confined to Darwin due to the availability of elect.ronic media, this research was conducted with Darwin residents only.
In May, 1985 a series of focus group discussions was carried out with Darwin residents. The groups were composed to provide a broad range of points of view as ·well as some in depth discussion of particular issues.
Conclusions drawn from these discussions were that tropical hygiene, depression, and excessive alcohol consumption were recognized by Darwin residents as areas for concern. Diet and skin cancer issues were considered lesser concerns.
There was also a growing resentment expressed towards Darwin's
"l,eer-swilling" image.
Recommendations for an advertising strategy were made following this qualitative report. These included recommendations that the strategy should:
create and reinforce a positive attitude . towards being healthy, in an active sense.
create an awareness an information and relating to health.
of the referral
Department source for
of Health as all matters
••• 6 •••
It was also recommended that and that specific issues overall umbrella campaign.
the campaign not be should be addressed
too general within the
An advertising agency with John Bevins Ltd, of Sydney,
experience in social marketing, was then given the initial market research report from which to design a creative advertising plan for the Healthworks umbrella campaign.
The market research firm then began a second quantitative study, the aims of were to:
quantify various findings of the qualitative study;
provide quantitative data with behaviours on which the Department or no information; and
respect to various of Health had little
provide benchmark data against which the media campaign could be evaluated.
A questionnaire was constructed which included a first face-to-face section and a second self-completion section.
Three hundred and fifty-four questionnaires were completed.
Data was collected on a variety of issues, including perceptions of health problems in Darwin, Darwin residents perceptions of health and beliefs about their own healthiness and various behavioural data of interest to the Department of Health.
..
Oo~1S• •• 7 •••
The most frequently nominated health problem or issue by both men and women in Darwin was "excess alcohol consumption".
Heat and "tropical "-related issues were fairly frequently mentioned however it was clear ~t.hat Darwin residents varied widely in their views of what are the health problems in Darwin.
Interestingly, in response personally needed to do to to their highlighting it as 9.3% of residents answered the amount of alcohol I drink".
to the question of what they become healthy and in contrast a major health problem, only
"yes, definitely" to "reducing
Increasing physical activity was clearly the most popular behaviour nominated in order to become healthy (44.9%).
Other relatively frequent . responses fruit and vegetables, stopping smoking, weight and reducing fat in the diet.
included eating more relaxing more, losing These tend to be the most common concerns of all "health aware" Australians.
Darwin residents' image of themselves as being fitter and more active than other Australians was reflected in the question concerning engaging in vigorous physical activity at least three times a week, which showed that the level of participation is much higher than the national average, even during the wet season. Nevertheless, approximately 40% of the total sample never engage in vigorous physical activity.
••• 8 •••
The findings showed a significantly higher level of cigarette smoking amongst Darwin
population. Proportion
residents than amongst the of drinkers and drinking in Darwin is higher than in other capital cities, perhaps not as high as might be expected.
Australian frequency although
The qualitative data provided information for setting campaign priori ties. Following the initial umbrella campaign, specific campaigns would be needed to focus on the key health problems identified. Campaigns on smoking control, reducing alcohol consumption, increasing awareness of tropical heal th and orientation to life in tropical conditions, improving diet and reducing dietary fat intake and managing stress are some of those planned to take place over the next two to three years.
The advantage of a broadly based project like Healthworks is that it is more likely to gain initial acceptance by a larger number of people than beginning with a behaviour-specific campaign, particularly if a large enough section of the target population are already predisposed to the basic messages of the campaign, i.e., living an active, healthy lifestyle.
More opportunities are present also, to diversify the project through its major elements.
••• 9 .•.
The major elements of Healthworks are:
1. Media Messages
These are television, radio delivering campaign themes,
00~\S
and print advertisements tagged with invitations for an action consequence, to call, write or visit.
2. Health Promotion Centre
The Healthworks, a health promotion centre, has been established to act as a key focus for the whole campaign.
It is an reliable health information and referral centre, offering a variety of services and activities, including health assessments. It is a booking point for courses and a central promotion point for large displays.
It the
has a latest
deliberately technology
up-market design, incorporating and aesthetic appeal. There is not only free information but products for sale.
The Healthworks is also a good public relations vehicle for the Health Department as it is a concrete example of the Department's commitment to preventive health.
It has been set up in at Casuarina, with access by the public.
3. Corrununity Promotions
the major suburban extended hours to
shopping centre allow maximum
Displays and special promotions which are campaign-specific may take place at the Healthworks Centre or at other locations, for example at the Show, in the City Mall, to launch a special "week" or as a culminating activity for a campaign, such as the Quit For Life Beach Day.
. . . 10 . . .
4. Community Training Programs
Special workshops and seminars are held for small groups with local or interstate speakers or lecturers as one-off lectures or over a number of s~ssions.
These provide opportunities for more intensive training.
Examples are Quit Smoking Courses, Communication Skills Training, Relaxation and Stress Management Courses.
5. Individual Assessment
At the Healthworks, individuals may have short and full computer lifestyle assessments to provide a broad analysis of their health habits and which suggest areas for improvement. Health Promotion Officers and health advisors are on hand to provide basic information and referral.
Referrals may be made to other Health Department professionals where appropriate, for example, Community Dietitians, Physiotherapists and Psychologists.
6. Self-Help
Self-help instructional kits, videos and packages are available at the Healthworks Centre or by mail order.
A priority project for 1986 is the development of a Territory Survival Kit incorporating a variety of information on how to cope with life in a tropical environment, including tropical infections, environmental hazards, good nutrition and dealing with isolation stress.
i .
'
c,o~\S
•.. 11 .••
7. School Programs
In conjunction with the Northern Territory Department of Education, through the inter-Departmental Joint Co-ordinating Committee on ~ealth and Drug Education, materials will be available in schools to complement most campaigns, for example, smoking prevent ion programs for students to coincide with the Quit For Life Campaign.
8. Healthworks Outreach
The next most important phase of Healthworks is to take elements of the project to the other 50% of the Northern Territory who do not reside in Darwin and also to make the project relevant to specific groups
including isolated towns and Aboriginal communities.
Commercial Television is being set up to alcohol abuse as well community development Use will be made of the new Remote
Station and an Aboriginal Project address the specific problem of as other health problems, using and locally-based media techniques.
The mechanism for planning each campaign, with the exception of the initial umbrella campaign, is to establish an Advisory Committee, comprising Health Promotion staff, including the Healthworks Centre Manager, relevant other Health Department professionals, representatives from community agencies and an evaluation consultant.
Research analysis is being
and evaluation for of data collected at
co-ordinated by the Research in Darwin.
each campaign, including the Healthworks Centre, Menzies School of Health
. . . 12 . . .
The Healthworks Project was launched in Darwin on November 18, 1985, by the Minister for Health. This included the official opening of the Healthworks Centre and the subsequent commencement of the media campaign.
The Healthworks Project has been initiated following considerable experience and demonstrated success of similar projects in other States. It is not an experiment and has been designed to be ongoing, but with the capacity to change and diversify with changing needs and problems.
It presents good health as a goal which not only increases quantity of life but enhances its quality.
Healthworks reflects the energy, growth and activity which is part of life in the Northern Territory today.
It is also an investment in the future health of all Territorians.
,
1. Kotler P, to planned 35: 3-12.
R E F E R E N C E S
Zaltman G. Social marketing; an approach social change. Journal of Marketing. 1971;
2. Fr ape, G and Tyler, C. The North Coast Healthy Lifestyle Program 1979-1981 Department of Health New South Wales.
June, 1984.
3. Egger, G at al. Results of large scale media anti-smoking
4 •
campaign in Australia: North Coast "Quit For Life"
program. British Medical Journal. 1983, 287: 1125
McCron, Media
( ed),
R. and Budd, J. (1981) The Role in Health Education: An analysis Health Education By Television and K.G. Saur.
of in
the M.
Mass Meyer Radio. Munchen
