Partnership working

Communicating Health as Part of a Whole System Healthy Universities Approach

Overview

Key messages

By running ad-hoc health promotion campaigns and events in isolation rather than as part of a comprehensive ‘joined-up’ approach, universities are less likely to achieve sustainable lifestyle changes within their populations.

Communicating health through campaigns, events and activities can contribute to Healthy University goals in a number of ways, but is most effective when combined with a whole system approach.

This approach involves securing high-level commitment and leadership, engaging a wide range of stakeholders, and combining high visibility health-related projects with system-level organisation and development change.

This Guidance Package offers…

…an approach to health promotion and health education activities which is integrated under the umbrella of a whole university approach.
…a planning framework for designing and developing campaigns along with illustrative examples.
…advice on how to identify key partners and potential for collaboration in delivering health promotion campaigns, events and activities.

Action points

Find out about current health campaigns, events and activities within your institution: which department leads them? How they are organised? Explore potential links with your own work.

Consider undertaking a health needs assessment and asset mapping exercise with key internal and external stakeholders in order to identify priorities.
Make contact with your students’ union and explore opportunities for collaboration and partnership working.

Think about ways you can involve students as volunteers to help organise and deliver campaigns in a way which will enhance their employability skills and also enable you to include the approach in the curriculum i.e. as a student assignment or placement.

In the current HE climate, when planning and implementing campaigns  it is becoming increasingly important to be creative in the design of your activities to ensure you align them to and emphasise the inclusion of,  the institutions key objectives, such as employability or student experience.

Quick win

Find out about local, national or international health awareness events that may be coming up as these often offer free campaign materials and resources such as posters, leaflets and teaching materials.

Key Concepts and Terms

Public health, health promotion and health education

Public health is commonly defined as ‘the science and art of preventing disease, prolonging life and promoting health through the organised efforts of society’ (Acheson, 1988), whilst health promotion has been defined as ‘the process of enabling people to increase control over, and to improve, their health’(WHO, 1986). In this respect, health promotion must be differentiated from traditional health education, which tends to involve simply giving people information, such as a leaflet on healthy eating. However, it is also important to note that health education can be interpreted more broadly to include health literacy, skills development and consciousness-raising about the wider determinants of health (Green and Tones, 2010).

A whole system Healthy Universities approach?

A Healthy University aspires to create a learning environment and organisational culture that enhances the health, wellbeing and sustainability of its community and enables people to achieve their full potential. A Healthy University applies the settings approach to improving health and wellbeing – which has taken shape since the Ottawa Charter for Health Promotion asserted that ‘health is created and lived by people within the settings of their everyday life; where they learn, work, play and love.’ (WHO, 1986, p.3). The settings approach is characterised by three interconnected dimensions: an ecological model of health, a systems perspective and a whole system focus (Dooris, 2005).

A whole system approach involves working within and across three key areas of activity – relating to the environment of the setting, the core business of the setting, and connections to the wider community. Applying this thinking to higher education, it is evident that the Healthy Universities approach aims to:

  • create healthy and sustainable learning, working and living environments
  • integrate health and sustainable development as multi-disciplinary cross-cutting themes in curricula, research and knowledge exchange
  • contribute to the health, wellbeing and sustainability of local, regional, national and global communities.

The approach involves securing high-level commitment and leadership, engaging a wide range of stakeholders, and combining high visibility health-related projects with system-level organisation development and change. It also involves mapping and connecting between the different groupings of the university population (e.g. students, staff, visitors), the multiple domains of university life (e.g. curriculum, research, campus/facilities, transport, services, culture/ethos), and the range of topics or issues related to health and wellbeing (e.g. alcohol, food, physical activity, sexual health). Further information is provided in the Guidance Package on Leading and Developing the Whole System Healthy Universities Approach.

Health promotion campaigns, events and activities

In the context of this guidance package, health promotion campaigns, events and activities refer to processes which aim to improve the health of a population via the communication of health. Different communication methods may be used, including interpersonal and mass media, and the focus population may be staff, students or the whole population (within the context of the wider community). Most campaigns and events are explicitly or implicitly aimed at raising awareness, shifting attitudes or changing behaviours – although others may consciously adopt an empowerment or social change model, educating people about the broader political and economic contexts and seeking to raise levels of critical consciousness.

A common picture within universities is for ad-hoc health promotion or health education campaigns and events to run in relative isolation, rather than as part of a comprehensive ‘joined-up’ approach. This is unlikely to result in sustainable lifestyle changes within the population – and this guidance package is therefore designed to encourage and enable universities to consider how they could integrate such activities under the umbrella of a whole university approach.

The National Social Marketing Centre (NSMC) offers this useful explanation of how health campaigns can go beyond messaging and communications to achieve behaviour change in a university context:

Information has its place in encouraging healthy lifestyles, but information alone is rarely sufficient to prompt behaviour change. Many of the behaviours that universities may seek to address – such as smoking, excessive consumption of alcohol or unhealthy food, inactivity or risky sexual practices – are deeply ingrained. For example, ‘binge drinking’ has become a key part of many young people’s social activity, and risky sexual behaviour often arises when they are intoxicated. In both of these cases, simply being aware of the risks will not – and does not – prompt change to less risky behaviour. Furthermore, many people resent simply being ‘told what to do’, or may even bury their heads in the sand when presented with frightening truths about the dangers their behaviour places them in. Therefore, universities that rely on ‘messaging’ – through posters, media and leaflets, for example – are unlikely to make an impact. They may even compound the problem, by losing credibility with their audiences or driving them away.

Campaigns are far more likely to be effective if they look at the ‘problem’ through the eyes of those whose behaviour they seek to change. Understanding the reasons why people behave the way they do is the first step towards creating a campaign that actually makes an impact on their behaviour. This understanding will enable universities to create campaigns that resonate with the target audience. They are more likely to be expressed in terms the audience understands; provide compelling reasons why members of the audience should change; and have a long-term impact. It also enables universities to focus on those most at risk and in need of support, and to make improvements to services and organisational practices that facilitate sustained change.

The NSMC has worked with the local NHS on two projects to promote and encourage health lifestyles among young people, using a six-stage process to developing behaviour change programmes. Up for It aimed to halt the year-on-year rise in overweight and obesity levels among 16 to 24 year-olds attending further and higher education (FE and HE) institutions in Kirklees. Sub21 aimed to reduce underage street drinking and antisocial behaviour in North Tyneside.

Further reading: www.thensmc.com

There has been increasing interest during the past few years in nudge theory (Thaler and Sunstein, 2009) and how this can be applied to public health in relation to choices that people make (and more often than not, do not realise they are making). Nudge theory is frequently characterised as being ‘where economics meets behavioural psychology’ and, philosophically, is often coined ‘libertarian paternalism’ – in that it rejects the nannying role of government whilst acknowledging the need to encourage people to make ‘better’ choices (e.g. in relation in health, environmental sustainability or financial security). Central to nudge theory is the realisation that people do not always make rational or consistent choices and that by making relatively small changes to the contexts or environments within which people make decisions and respond to cues, it is possible to ‘nudge’ people and bring about significant changes in behaviour at relatively low cost. In relation to public health, policymakers and health-related professionals are viewed as ‘choice architects’.

Responses to the current Government’s endorsement of nudge theory have been mixed, with the Faculty of Public Health expressing concern about the shift of emphasis towards individual responsibility and suggesting that legislation and regulation are important tools for nudging people into making healthier choices (Maryon-Davis and Jolley, 2010) and a BMJ editorial concluding that ‘In terms of public health science, the notion of nudging adds nothing to existing approaches.  Nudge contains some eye catching ideas, but little progress will be made if public health policy is made largely on the basis of ideology and ill defined notions that fail to deal with the range of barriers to healthy living’ (Bonell et al, 2011).

Wider Context and Evidence Base

In England, the Department of Health  has tended to take the lead on national campaigns to promote health and wellbeing, for example Change 4 Life, although other agencies such as issue-based charities have also played a key role. At a local level, public health departments within primary care trusts (PCTs) often take the lead on developing and funding campaigns, in conjunction with other organisations, such as local authorities and voluntary and community sector agencies. However it should be noted that with the reconfiguration of public health services which take effect from April 2013, the new Public Health England as an ‘executive agency of the Department of Health’ (DH, 2011) will take the lead on national campaigns to promote health and well-being and change health behaviour, and the local public health function will move to local authority control (HM Government, 2010).

Department of Health, (2011)  Public Health England’s Operating Model, Crown copyright, UK

In recent years there has been a rise in the use of social marketing as an approach to designing and delivering national campaigns, with the establishment of the National Social Marketing Centre (NSMC), which has a remit to maximise the effectiveness of behaviour change programmes.

The evidence suggests the following critical success factors in changing health behaviour:

  • Consistent messages over time from a credible source
  • A focus on positives rather than negatives – although there are some exceptions where using ‘scare tactics’ has been shown to be effective (e.g. drink driving campaigns)
  • Use of a variety of interventions
  • Robust evaluation including short term and long-term health outcomes
  • Agreed targets between stakeholders.

The NSMC would emphasise the need to gain an understanding of the intended audience for a campaign and to be clear about which segments of the population are to be targeted rather than adopting a ‘one-size-fits-all’ approach.

As explored more widely in the Guidance Package on Leading and Developing the Whole System Healthy Universities approach, Healthy Universities is based on an appreciation that by investing in health and wellbeing, universities can enhance student and staff retention, performance and progression; improve staff productivity; and contribute positively to future shaping and corporate social responsibility.

It is clear that communicating health through high profile campaigns, events and activities can contribute to Healthy University goals – through:

  • effective targeting of information
  • enhanced health awareness
  • increased consciousness of the wider economic, political, social and environmental determinants of health
  • integration of health into the routine life of the institution.

However, it is also clear that this communication will be more effective if it forms part of a comprehensive whole system approach concerned to build health-enhancing policy, create supportive living, learning and working environments, develop life-skills and strengthen community-level action – through advocacy, mediation and enablement.

University Context

In communicating health messages within higher education, it is useful to reflect on the particular features that shape the specific context – remembering that a university is:

  • a centre of learning and development, with roles in education, research, capacity and capability building, and knowledge exchange
  • a focus for creativity and innovation, developing knowledge and understanding within and across disciplines and applying them to the benefit of society
  • a setting within which many students undergo life transition – exploring and experimenting, developing independence and life skills, and facing particular health challenges
  • a workplace and business, concerned with performance and productivity within a competitive marketplace
  • a context that ‘future shapes’ students and staff as they clarify values, grow intellectually and develops capabilities that can enhance current and future citizenship within families, communities, workplaces and society as a whole
  • a resource for and influential partner and corporate citizen within local, regional, national and global communities.

Source: Dooris and Doherty, 2010

Within a university context, health promotion campaigns can take a variety of forms, including:

  • one-off half day or full day events on a particular subject, such as healthy eating, alcohol or mental health – including taster sessions, information stalls and interactive activities
  • sustained campaigns focusing on a particular subject or an array of different subjects over a longer time frame.

Both of the above may be augmented by workshops, courses and a comprehensive communications strategy – utilising media such as websites, social networking, texting, emails, virtual learning environments, posters and newspaper and magazine features.

There is a clear challenge involved in introducing and integrating ‘health’ within a university, which does not have this as its central aim. In planning and implementing campaigns, events and activities designed to communicate health, it is, therefore, useful to forge links to core business objectives and to ensure that campaigns and events form part of a comprehensive approach to health improvement. Within the context of higher education, this highlights the value of taking a whole university approach, which is likely to involve:

  • careful planning and organisation ensuring that the work is meeting a need and fits with institutional, departmental and service-specific objectives
  • exploring how the work can be integrated with mainstream initiatives (e.g. student volunteers, staff advocates, student union programmes)
  • exploring how the planning, implementation and evaluation of campaigns, events and communication media could be built into the curriculum – through student projects and assignments across a range of disciplines (e.g. health, marketing, media).  This could also be done through hosting student placements to help deliver services or plan and deliver a particular project/event/campaign.
  • building on pilot work to develop a longer-term annual cycle, enhancing sustainability.

By working across the institution and with external agencies and involving students and staff in the planning and running of campaigns and events, the communication of health is much more likely to be effectively embedded into the curriculum, policies, processes and everyday life of the University, thus benefiting students, staff and local community.

Planning and Implementation

Although developed to illustrate the operational planning, implementation and management of a Healthy University initiative as a whole, Figure 1 provides a useful framework for considering the stages and key considerations involved in designing campaigns and events to communicate health messages. A number of health promotion texts also offer simple planning models (e.g. Naidoo and Wills, 2009; Scriven, 2010).

Figure 1: Healthy Universities – Operational Planning, Implementation and Management

fig5-process-cycle1

Source: Adapted from Doherty and Dooris (2006)

When planning and delivering health campaigns and communicating health within a university there are a number of factors that must be considered:

What are the needs and priorities?
Working within the university context means working within the imposed time-scales set by the academic year, particularly when students are the main target audience. Given these constraints, it is important to prioritise which campaigns to run, in order to ensure the most effective use of effort and appropriately target resources.

Assessing needs and assets can provide a useful starting point and serve as a tool to identifying key priorities.  One such assessment, focused on the needs of students, was carried out by Leeds PCT in partnership with the University of Leeds, Leeds Metropolitan University and Leeds Trinity University College.

Whilst resource constraints may make it difficult to conduct such a large-scale and in-depth assessment, it may be possible to use other mechanisms for finding out relevant information:

  • Staff-related information may be accessible via routine staff surveys or specialist audits conducted by Human Resources in preparation for signing up to a Healthy Workplace programme or award schemes.
  • By working with course and module leaders, it may be possible to harness undergraduate and postgraduate research, whereby students conduct needs assessment or asset mapping for their dissertation or thesis.

For more information on health needs assessment and asset mapping, see:

Who will lead the work and who should be involved?
As with most types of work, it is essential to have a named person or group in a co-ordination role. This may be the Healthy University Co-ordinator, the chair of a thematic working group, a marketing/communications expert, or someone from the students’ union or a particular service or department. However, whilst this co-ordination is important, there is a danger that if the work is led by one particular department or service, campaigns may have a limited reach. For example if Student Services take the lead, a campaign will most likely be aimed only at students, and likewise, Human Resources led campaigns are likely to have a staff focus. Whereas it may at times be appropriate to segment the population in this way, it is also important to appreciate that there are significant overlaps in the demography of students and staff. It is therefore valuable to consider how different departments and services – and external agencies – could work in partnership as part of a whole system approach, thereby achieving a more wide-ranging impact. At the same time as agreeing who will lead the work and identifying partners, it will be important to confirm how the work will be resourced in monetary terms.

When should the campaign, event and/or activity take place?
Working within the higher education context presents some constraints in terms of timing of events, particularly if the primary target market is the student population. It can be useful to prepare an annual calendar, possibly linked to national and international awareness days (e.g. World Mental Health Day, World AIDS Day, Green Transport Week). Depending on the focus of the work, it may be most appropriate to integrate it within the induction period for new students – recognising that messages can have a strong impact at times of transition. It is also important to consider the duration of the work, which will be influenced by the overall aims and objectives – for example, it takes less time to raise awareness and provide knowledge than to change attitudes and behaviour!

The box below presents a framework that may be useful in planning and implementing a specific campaign


The Campaign Analytic Framework 

Context

  • Map and understand the context for the communication strategy

Leadership and Collaboration

  • Agree who will lead/co-ordinate
  • Identify appropriate internal and external partners/collaborators

Media components

  • Chose media components from those available (e.g. social networking, text, email, booklets, newsletter, posters, flyers)

Structure of campaign

  • Agree and clearly state aim and objectives
  • Carry out needs assessment and/or market research to identify priorities and audiences
  • Design strategy – considering audience segmentation and different approaches and timescales
  • Design evaluation strategy

Production

  • Ensure that media/materials are relevant and user-friendly through target audience pre-testing
  • Involve key individuals to ‘front’ where appropriate
  • Plan for follow-up

Ongoing operation

  • Ensure regular updating
  • Ensure continuity of messages

Formative evaluation

  • Put in place mechanisms to secure feedback from initial work
  • Collate concerns and learning to inform future planning and delivery

Redevelopment

  • Respond to any gaps or concerns not dealt with by the planned communication strategy
  • Add new elements as appropriate

Outcome evaluation

  • Agree appropriate methods to measure success
  • Conduct impact/outcome evaluation

Source: Adapted from Backer et al (1992)

Communicating health within the context of a whole university approach

The Guidance Package on Developing an Holistic and Joined-Up Approach to Mental Wellbeing and Case Study on Rethinking Student Mental Wellbeing both illustrate how the communication of health messages concerned with mental health (with a particular focus on tackling stigma) take place within the context of a coherent whole university approach. Similarly, the short case study in the box on the right illustrates how one university developed and implemented a multi-strand approach to increasing HIV and AIDS awareness within the framework of its Healthy University initiative.


Increasing HIV and AIDS Health Awareness in a University

In the early years of UCLan’s Healthy University initiative, it was agreed that sexual health should be a priority and a working group was established – with a key aim of increasing health awareness in relation to HIV and AIDS. In communicating key health messages, a number of media were used, including:

  • features in the Students’ Union newspaper
  • information stands, with specially designed flyers and ‘safer sex in progress’ do not disturb cards
  • photographic installations designed by students as assessed work for a module
  • a hard-hitting play about HIV and AIDS, presented by Performing Arts students as part of their course peer education and outreach, with student volunteers being trained to work in club venues.

This focus on high profile communication formed part of a wider approach, supported by a diversity and equality policy, referral guidance for staff, the increased provision of condoms, and a university/community partnership AIDS quilting project.

Consultation and Partnerships

Why are consultation and stakeholder participation important?

As highlighted in the previous section, when planning and delivering campaigns, events and activities, it is important to identify priorities. As part of a broader needs assessment and asset mapping exercise, consultation is a key means of ensuring that resources are being targeted effectively.

Partnership working is a key element of a successful whole university approach – ensuring that individuals, departments, services and external agencies are all effectively engaged in the process. In relation to the effective communication of health, adopting a partnership approach offers the opportunity to harness both communication- and health-related expertise and resources in pursuit of both shared and individual objectives, and also makes it possible to ensure that the most appropriate people are delivering the messages. By working with external partners, it is also possible to ensure that the university is participating in and contributing to the delivery of local public health programmes – and ensure a more joined-up approach. There are evident challenges involved in joint working due to competing demands and differing priorities and it is therefore important to plan together in order to ensure buy-in and ownership.

Who are your key partners and how do you identify them?

It is important to identify who your key partners are, both within and outside of the university. In order to do this, a useful exercise is to carry out mapping exercises of your institution and of your local area to identify, ‘who does what’ related to health and wellbeing. Internally, there are many services already engaged in work that, whilst not called ‘health’, is congruent with the goals and ethos of the Healthy University. It will also be crucial to collaborate with your students’ union, which will often have a campaigns officer and already be running health-related campaigns and activities. Externally, it will be important to engage with and participate in relevant partnerships and to consider the roles and activities of statutory, private and voluntary and community sector organisations.

Evaluation and Impact

Evaluation should form an integral part of the planning and implementing process, helping to build evidence of effectiveness and develop understanding of what works and why. During planning, key questions for consideration include:

  • What are the aims and objectives of your campaign, event or activity?
  • Linked to this, what are the critical success factors? It is important to remember that partners may have different, sometimes competing, objectives and to decide together ‘what success will look like’ for everyone – taking account of this in evaluation planning.
  • Does your plan for your campaign or event have targets, outcomes or KPIs? If so, how do these fit with departmental and university objectives (this can be helpful for obtaining future support and funding when you are making a case for your institution to embed  the Healthy Universities approach)?
  • What type of routine information needs to be collected (e.g. number and demographic breakdown of participants; number of website hits; number of leaflets distributed)?
  • What other data needs to be collected in order to measure success (e.g. participant satisfaction with the event/communication; attitudes and knowledge before and after the campaign/event)?

The evaluation you carry out should be closely linked to your overall aims and objectives. For example, if your aim was to run an awareness campaign,  information on the number of participants and feedback in terms of their views (whether they believe that they have increased awareness) may provide you with enough detail to evaluate whether the campaign was successful – although obtaining baseline data on awareness would make the evaluation more robust. However, if your aim was  to change attitudes or behaviours, the evaluation will need to be more complex and is likely to take the form of research. If your aim was to achieve long-term, sustained impact, it will be important to have set short, medium and longer term goals – thus enabling success to be demonstrated throughout the process and providing evidence for the continuation of the work.

As explored in the Evaluation Section of the main website, an effective evaluation should focus on outcome (both shorter-term impacts and longer term outcomes) and process, and, ideally, efficiency. This will enable you not only to know whether something has worked, but understand why and how, and assess whether the approach taken and methods used were the most cost-effective and/or whether the benefits justified the costs.

As highlighted above, it may be possible to identify students to carry this out as part of their course work or for their dissertation. It is also worth considering whether partners can help support the evaluation process either by providing resources and/or expertise or data (e.g. public health departments and public health observatories can provide health-related statistical information about local populations).

References

Acheson, D. (1988) Committee of Inquiry into the Future Development of the Public Health Function. London: HMSO.

Backer et al, (1992) Designing Health Communication Campaigns. London: Sage Publications.

Bonell, C. et al (2011) One nudge forward, two steps back. British Medical Journal 342:d401

Department of Health, (2011)  Public Health England’s Operating Model, Crown copyright, UK

Doherty, S. and Dooris, M. (2006) The healthy settings approach: the growing interest within colleges and universities.Education and Health 24(3): 42-43.

Dooris, M. (2005). Healthy settings: challenges to generating evidence of effectiveness. Health Promotion International, 21: 55-65.

Dooris, M. and Doherty, S. (2010) Healthy Universities: current activity and future directions – findings and reflections from a national-level qualitative research study. Global Health Promotion 17:06-16.

Green, J. and Tones, K. (2010) Health Promotion: Planning and Strategies (2nd Ed). London: Sage.

HM Government (2010) Healthy Lives, Healthy People: Our Strategy for Public Health in England. Norwich: The Stationery Office.

Maryon-Davis, A. And Jolley, R. (2010) Healthy Nudges: When the Public Wants Change But the Politicians Don‟t Know It.London: Faculty of Public Health

Naidoo, J. And Wills, J. (2009) Foundations for Health Promotion(3rd Ed). London: Bailière Tindall.

Scriven, A. (2010) Promoting Health: A Practical Guide. London: Bailière Tindall.

Thaler, R. and Sunstein, C. (2008) Nudge: Improving Decisions About Health, Wealth, and Happiness. New Haven, CT: Yale University Press.

World Health Organization (WHO) (1986) Ottawa Charter for Health Promotion. Geneva, Switzerland: WHO.