National Framework for Universal Child and Family Health Services

3.8.2 Health Promotion

Page last updated: 20 May 2013

The following definition of health promotion is from the World Health Organization’s Ottawa Charter for Health Promotion [71]:

The process of enabling people to increase control over and improve their health.It involves the population as a whole in the context of their everyday lives, rather than focusing on people at risk for specific diseases, and is directed toward action on the determinants or causes of health.

Universal child and family health services have the opportunity to conduct a range of evidence-based health promotion strategies that aim to encourage families to create attitudes, behaviours and environments to promote optimal health for children.

There are many ways in which health promotion is delivered in a universal child and family health service and these may include:

  • the provision of information to parents through written or audio-visual resources;
  • a discussion between the worker and the family, or demonstration of a health- promoting behaviour;
  • role modelling through specifically set up groups and through experiences of other parents; and
  • community awareness activities.
There are four core service elements related to health promotion:
1. prevention of disease, injury and illness;
2. health education, anticipatory guidance and parenting skill development;
3. support that builds confidence and is reassuring for mothers, fathers and carers; and
4. community capacity building.

Prevention of disease, injury and illness

Prevention of disease is a core component of child and family health service provision. The combination of monitoring of child and family health whilst conducting preventative health activities provides opportunities for early intervention and detection and the prevention of ill-health. Disease-prevention activities include: immunisation, promotion of breastfeeding and nutrition, information about SIDS and co-sleeping, oral health surveillance, and safety and injury prevention, for example, road safety.

Examples of effective health promotion activities for child and family health
  • Promoting breastfeeding
  • Promoting child and family nutrition
  • SIDS prevention and education [72]
  • Injury prevention [73]
  • Promoting physical activity
  • Smoking cessation programs such as ‘quit’ activities and ‘brief interventions’
  • Promoting early literacy [63, 73]

Health education, anticipatory guidance and parenting skill development

Health education, anticipatory guidance and parenting skill development are interrelated components of health promotion. These components may occur during individual contact with parents and carers, or in a group setting [74, 75]. The benefits of a group delivery include peer support and cost-effective use of resources.

The World Health Organization (1998) defines health education as ‘consciously constructed opportunities for learning, involving some form of communication designed to improve health literacy, including improving knowledge, and developing life skills which are conductive to individual and community health’.

Health education is not only concerned with the communication of information, but also with fostering the motivation, skills and confidence (self-efficacy) necessary to take action to improve health.

For example, health education by child and family health services includes providing structured breastfeeding support. Systematic reviews in the Cochrane Library have identified the importance of support to the success of breastfeeding [76] with both peer and professional support shown to be effective in increasing breastfeeding rates during the first two months following birth. Child and family health nurses are regularly involved in interventions providing structured breastfeeding support to mothers [77].

Universal child and family health services provide structured anticipatory guidance about a child’s development and behaviour. Anticipatory guidance gives parents practical information about ‘what to expect’ in the child’s behaviour, growth and development in the immediate and longer term. It provides parents with the knowledge they need to provide positive experiences and environments for their child and reduces the anxiety for new parents. For example, universal child and family health services are well positioned to actively influence parents and carers to undertake activities that promote literacy development [67].

Furthermore, through play, children practise and master the necessary skills needed for later childhood and adult life [78]. Parents and carers play an important role in the facilitation of play as they respond to and promote the interactions of their child. Child and family health services can promote play as the ‘work’ of infants and young children and necessary for the development of language, symbolic thinking, problem solving, social skills, and motor skills.

Anticipatory guidance may also be provided for the mother’s health and wellbeing. Common anticipatory guidance topics based on the review of state and territory frameworks are provided in Table 6.
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Health education and anticipatory guidance topics
  • physical needs of the infant/young child information and skills development – feeding, bathing, clothing, skin care
  • normal infant and child sleep expectations and settling management
  • nutrition – breastfeeding, introducing a healthy diet, weaning
  • oral health education [79]
  • emotional needs of the infant – mother/child interaction, attachment, early brain development
  • normal behaviour and behaviour management – tantrums, self-comforting behaviour, separation anxiety, toilet training
  • activities to support development – speech and language, early introduction to books, movement and activity [73, 80]
  • developmentally appropriate play activities
  • child safety
  • preparing for preschool and school
Parent recall of health promotion and anticipatory guidance decreases with increasing numbers of topics set for each discussion. One study found that when more than nine topics were discussed at any one session, parent recall decreased significantly [81]. Services may determine health promotion education strategies beyond the core health promotion topics above to reflect the needs of the community, or their practice wisdom. However, some targeting of messages at each contact is likely to improve the effectiveness of the activities. It is important that clinicians develop the skill of recognising ‘teachable moments’ [82], or times when parents are keyed into an issue and express interest and are therefore receptive to input.

Support for mothers, fathers and carers
Parents value appropriate support to assist in building confidence across key transition points such as transition to parenthood [83] and transition to school [84].

Maternal health
The health of the mother (or primary carer) is integral to the health and wellbeing of the child and family. Many women report feeling unprepared for the transition to motherhood [85-87], lack confidence in their parenting skills and there is a high occurrence of parental stress, postnatal distress and depression in the short and long term after birth [27, 88, 89]. Physical recovery from birth may take 9-12 months and women report health problems including bowel problems, urinary incontinence, perineal pain, backache and exhaustion [90-92]. Some women also experience difficulties with breastfeeding in the early postnatal period, such as pain and nipple damage, inadequate milk supply and mastitis.

These health problems affect the quality of a woman’s life and may impact on her relationships [92]. The universal child and family health service is ideally situated to identify any physical health issues and offer appropriate advice and referral for women.

Perinatal mental health problems are known to impact significantly on the woman [24, 93], her infant and family [88]. The relationship between an infant and their primary caregiver is significantly affected by maternal depression and can negatively influence the child’s long-term mental and physical health [94]. Periodic contact with child and family health services provides an important opportunity to ask a mother, father and/or other primary carers about their own social and emotional wellbeing and to identify risk for and/or detect possible depression or related disorders. Services can then offer support and appropriate early intervention or referral [4]. The (draft) Clinical Practice Guidelines [95] recommend the Edinburgh Postnatal Depression Scale (EPDS) be used by health professionals as an initial step in screening all omen for possible depression in the ante and postnatal period.

Engaging fathers
Child and family health services can further promote the wellbeing of children by harnessing the full potential of fathers to contribute to the wellbeing of children and families.

‘Father-inclusive’ practice occurs when the needs and perspectives of fathers are incorporated into the planning, development and delivery of services. For services aiming to support families, bringing fathers into everyday activities is a crucial part of inclusive practice.

One example of a national parenting initiative for fathers is the Strong Fathers, Strong Families program for Aboriginal and Torres Strait Islander men. This program is providing antenatal programs specifically for males to support them in preparing for fatherhood; community and group activities and strategies that promote positive, healthy, active fatherhood and grandfatherhood, and the involvement of males in the early development of their children and grandchildren; health promotion information that promotes new fatherhood and grandfatherhood as a motivating factor for self care; and referral and support to attend local parenting, health and related services (e.g. reproductive health, family wellbeing, counselling, peer support groups) as needed.

Table 7: Principles of Father-Inclusive Practice [96]
Principle 1. Father Awareness: Services develop an understanding of the role and impact of fathers including separated fathers, father figures and stepfathers
Principle 2. Respect for Fathers: Services engage with fathers as partners with respect for their experience, gifts and capacities as fathers.
Principle 3. Equity and Access: All fathers have equal and fair access to the support provided by high quality family services regardless of income, employment status, special educational needs or ethnic / language background.
Principle 4. Father Strengths: A strengths-based approach recognises fathers’ aspirations for their children’s wellbeing and the experience, knowledge and skills that they contribute to this wellbeing.
Principle 5. Practitioners’ Strengths: The existing skills, knowledge and special qualities of the staff for working with fathers are acknowledged.
Principle 6. Advocacy and Empowerment: Services aim to empower fathers to develop their capacity rather than focus on interventions that try to prevent them from doing harm.
Principle 7. Partnership with fathers: Services aim to work in partnership with fathers and their families to build on their knowledge, skills and abilities and to help fathers enhance their positive roles with their children and as part of families.
Principle 8. Recruitment and Training: Appropriate training, credentialling and professional support for staff is a foundation for quality father-inclusive service provision.
Principle 9. Research and Evaluation: Research and evaluation of services should specifically measure father engagement and outcomes relating to this engagement.

Facilitating peer support
Child and family health services provide support for mothers, fathers and carers across key transition points in the early childhood period. For example, CFHNs may facilitate both ‘preparations for parenthood’ and ‘new parents’ groups to address their needs during this transition period. Research suggests increased levels of social support and parenting confidence and high levels of satisfaction amongst parents who attend new parents’ groups facilitated by CFHNs [97-99]. Facilitated peer support groups appear to be successful in
de-emphasising the power and expertise of the professional [99]. These groups often become self-sustaining social networks providing important support for parents [98].

Community capacity building
Community capacity building is an essential health promotion activity crucial to the achievement of the objectives of the Framework. Capacity building has been broadly defined as encompassing:
  • empowerment of individuals and groups within defined ‘communities’;
  • development of skills, knowledge, and confidence;
  • increased social connections and relationships;
  • responsive service delivery and policy based in community-identified needsand solutions;
  • audible community voices;
  • community involvement;
  • responsive and accountable decision makers;
  • resource mobilisation for communities in need; and
  • community acceptance of programs because they have been involved in development [100].
Capacity building for health promotion can occur with individuals, groups, organisations and communities and includes three core aspects: adequate infrastructure and resources in order to build capacity in individuals and communities, the establishment and maintenance of partnerships and networks are key to ensuring developed programs are sustainable and finally, organisations and communities must develop a ‘problem solving’ approach to health improvement strategies [100]. Universal child and family health services play a key role in community capacity building via activities such as community workshops, health promotion and education activities, collaboration between government and non-government organisations and community agencies such as the Australian Breastfeeding Association and early education and care services.
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