Analyzing the Effectiveness of the NHS Smoke-Free Campaign

Introduction

The health promotion programs or campaigns mainly aims to empower and involve people as well as communities to determine healthy behaviours to be adopted and accordingly make alteration to lower the risk of disease or illness. The critical analysis of health promotion campaign helps to analyse the ideas in regard what is already known regarding the campaign for identifying the progress of the campaign as well as determine the weakness to be resolved by making further changes to ensure its appropriate success (Fertman and Allensworth, 2016). In this assignment, the NHS Smoke-Free Campaign is to be critically analysed by examining the campaign overview and context of the campaign. In the process, the theories and policies followed to develop the campaign is also to be discussed. Further, the evaluation of the campaign is to be done to determine its strength and weakness along with recommendations are to be provided to resolve the identified weakness.

Campaign Overview

The campaign to be focussed for critical analysis is the NHS Smoke-Free Campaign. The key aim of the campaign was to assist all individuals to quit smoking by highlighting them about the damage smoking is executing to their lungs, heart and brain (campaignresources.phe.gov.uk, 2016). As mentioned by McClure et al. (2018), creating awareness regarding the adverse impact of substance abuse activities on the health among the individuals makes them alert and progressive in accepting to change. This is because they understand the damage being caused to their health and the consequences to be faced as a result, in turn, making them develop the intention of change out of fear and concern regarding their health. Thus, this indicates that the aim of the NHS Smoke-Free Campaign to highlight adverse effect of smoking to be reported to smokers to make them change behaviour was appropriate step as they would show intention to change and accept the information out of concern regarding their health.

The key messages which involve the NHS Smoke-Free Campaign are all medical staffs working in the frontline are required to discuss the impact of smoking on their health, each smoker who is using NHS services are to be offered on-site stop smoking services or be referred to local services and each staff ensures there is no smoking on premises of the NHS trusts (campaignresources.phe.gov.uk, 2016). As criticised by Gardner et al. (2018), failure to maintain proper supportive services locally and nationally to control risky health behaviour leads to hindered success in creating change in health behaviour among individuals. This is because proper support is not able to reach at all levels to the target audience to assist them in creating change of their existing inappropriate health behaviour. Thus, the messages are relevant to the purpose of the campaign as ensuring no smoking in NHS trust premises ensures proper professionalism and delivery of good message against smoking is maintained in organising the campaign. Moreover, helping the individuals with all nature of services who are trying to quit smoking through the campaign ensures effective support is delivered to the target audience to engage and empower them in changing behaviour regarding smoking.

The campaign was initiated by the Public Health England (PHE) with the target audiences as all the individuals from different age groups in England who are involved in smoking. The campaign was initiated in December 2016 and was reported to extend until 2020 (nhs.uk, 2016). The NHS Smoke-Free Campaign is mainly funded by working in partnership with the NHS with the PHE. The print media along with broadcasting media are used for successful execution of the campaign. The campaign is evaluated and monitored by accessing feedback from the public and examining the way of delivering services that are updated according to the vision set by the Five Year Forward View Plan of the NHS (publichealthmatters.blog.gov.uk, 2016).

Campaign Context

In the UK, it was reported that 1 in 5 adults in Britain that is 19% of the population aged 16 and above are smokers as per collected data in 2013. This figure is considered to be slightly lower compared to the rate of smokier in 2012 (digital.nhs.uk, 2015). In 2013-14, there are nearly 1.8 million prescriptions dispensed to help people stop smoking and it led the NHS to bear a cost of £48.8 million (digital.nhs.uk, 2015). This indicates that increased number of people is involved in smoking with England due to which high expenses have to be made by NHS to prescribe them individually. Moreover, 454,700 hospital admissions regarding smoking health issues are made out of which 4% of the individuals belonged from the age group of 35 years and above (digital.nhs.uk, 2015). This indicates that increased number of adults in England is facing vulnerable condition regarding their health as a result of smoking. In this condition, the development of NHS Smoke-Free campaign is relevant as it focussed to create awareness and deliver wide amount of services at local level to all adults in England to collaboratively help them to quit smoking. Moreover, the campaign focussed to highlight the health risk regarding smoking apart from arranging support services which make individuals avoid following healthcare routine and show behaviour change develop concern and positive attitude towards making the change. Thus, the campaign is relevant to the research as it was regarded as a positive approach to deliver health support and increased awareness to quit smoking by wide number of individuals in the country who are active smokers.

The tools and intervention used in the campaign include posters, leaflets, television advertisement and other types of mass media. As commented by Huang et al. (2018), information for health promotion are delivered through television as they allow the messages to reach to wide number of individuals of different age groups in the society. This is because messages delivered through television are repeated as well as has a visual content which helps to attract more people to remember the information as they can actually connect through proper understanding visual images with the original content. As argued by Jung et al. (2017), many aged adults are found to avoid the use of social media and depend on availing information through television. This is because they are assured of the relevancy and truth of the news on the television instead of social media where the authenticity of the news is often unable to be judged. Thus, the television as media tool is effective to deliver messages regarding smoking cessation by the NHS Smoke-Free campaign as it led them to deliver the information to all age groups in authentic manner without facing geographic constraints. It is evident as television advisement are formed where people are showing concern regarding their family members smoking instead of their other problems in life informing individuals that smoking is required to be avoided (campaignresources.phe.gov.uk, 2016).

The use of posters and leaflets for health promotion campaign is effective as it helps to provide the information regarding health issues and way to overcome them in written manner (Barik et al. 2019). Thus, use of poster and leaflets to deliver information regarding smoking cessation in the campaign was an effective approach as it helps the campaign to deliver written information which can be kept in hand by the individual involved in smoking to refer it to develop gradual change in behaviour and thinking of quitting smoking. The use of posters and leaflets is evidently seen in the campaign as in many areas within England it is seen that under the campaign the risk of smoking on health are informed through them to the public. The NHS Smoke-Free Campaign mainly stems from the Healthy Lives, Healthy People: A Tobacco Control Plan developed by the UK government as well as it relates with Public Smoking Ban regulation and smoking laws developed by the government. In Healthy Lives, Healthy People: A Tobacco Control Plan published in 2011, it was reported that government has the plan to deliver local support services to lower prevalence of smoking in the country by 2015 (gov.uk, 2011). Thus, it is evident that the plan was followed as the key aim of the campaign was to raise awareness regarding negative impact of smoking on health among all age groups and deliver them effective local support to lower prevalence of smoking in England which is similar to plan.

The Public Smoking Ban regulation developed in 2007 informed that smokers are not allowed to smoke tobacco in confined public places but allowed to smoke in open (centreforpublicimpact.org, 2007). In the NHS Smoke-Free Campaign, it was ensured that no smoking occurs in the NHS trust area during the campaign showing they follow the Pubic Smoking ban policy to develop messages in the campaign. The Tobacco Control Plan developed for 2017-2022 has mentioned the objective that they are trying to lower smoking prevalence among pregnant women and working to lower inequality in smoking prevalence (assets.publishing.service.gov.uk, 2017). The NHS Smoke-Free Campaign has not informed any intended actions to be performed for lowering smoking inequality present in the society or special care to resolve smoking prevalence among the pregnant women in England. Thus, the issues to be raised due to the gap of focus in the present campaign with the Tobacco Control Plan is that effective delivery of services through the campaign cannot be established to resolve health inequality present regarding smoking in England. Moreover, the campaign would be unable to deliver specific intervention and awareness regarding lower smoking prevalence among pregnant women.

The Stoptober is one the Public Health England smoking cessation campaign developed for 28 days that occurs annually from 2012 under which resources that encourages smoker to cease smoking are made available to be downloaded from online site (nhs.uk, 2012). The NHS Smoke-Free Campaign is related to the Stoptober campaign as both are developed by the PHE under which they are trying to deliver similar resources for smoking cessation as far as possible through all means to the population to lower prevalence of smoking in England showing to have similar aims. The Smoking Cessation campaign is set in the UK by the Action on Smoking and Health Charity where they are trying to provide resources and education regarding the way to quit smoking by the public (ash.org.uk, 2020). The NHS Smoke-Free campaign is related to this health promotion campaign as both are trying to provide resources to help people cope with smoking habits.

The Health Belief Model (HBM) is the social psychological health behaviour change framework where different theoretical constructs are explained based on which uptake of health services and change in behaviour are shown by individuals. According to the model, through perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action and self-efficacy change in behaviour regarding health can be created (Mohammadi et al. 2017). The NHS Smoke-Free Campaign has been developed by following the theoretical constructs in the model to make public in England show cessation of smoking. According to perceived susceptibility, ability of individuals to assess the subjective risk regarding the health problem makes them attain intention to create change in health behaviour for reducing the risk (Ghaderi et al. 2016). This is because risk susceptibility regarding the heath problem makes the individuals develop concern regarding their well-being. In the NHS Smoke-Free Campaign, it was seen that the PHE informed people about adverse effects of smoking on health following perceived susceptibility construct from HBM to influence them to quit smoking. The perceived severity in HBM informs people to show behaviour change are required to have understanding of the consequences and severity of the health problem on them (Panahi et al. 2017). This because it then only lead them to show seriousness in making behaviour change and thus the NHS campaign followed the principles which led the target audience of the campaign to understand the consequences to be faced as a result of their current behaviour.

The perceived benefits inform knowledge and ability of assessment of the people regarding the benefits to be experienced with behaviour change (Lotfi et al. 2017). This aspect of the HBM is followed for developing the NHS campaign as they offered information to the smoker during service delivery about the advantage of health aspects to be faced on maintaining the change in behaviour to quit smoking. However, the perceived barrier and self-efficacy aspect from the HBM was not followed in developing the campaign. This is evident as the campaign did not focus on the barriers to be faced by people to create the behaviour change of cessation of smoking and way to resolve them. In addition, the campaign did not support individuals to determine ways self-efficacy among people are to be developed for making them quit smoking. However, cues to actions as mentioned in HBM was followed in making the NHS campaign as they used different media where they showed adverse actions to be faced on prolonged smoking by the people and their family. The emotional cue in making behaviour change is effective as leads the individual to psychologically get influences in executing the physical change (Khan and Qureshi, 2018).

Evaluation of Campaign

The NHS Smoke-Free Campaign can be determined to be effective as since its implementation from 2016 considerable number of smokers are found to have decreased in England. This is evident as in 2018 it was reported that 14.4% of the adults above 16 years smoke in England which was previously 14.9% in 2017 and 15.8% adults in 2016. This decreasing statistics has revealed that at present in England compared to 2011 nearly 2 million less people involved in smoking are present (digital.nhs.uk, 2019; theguardian.com, 2017). The theoretical underpinning of the campaign was developed by considering the Health Belief Model (HBM) and it has ensured success of the campaign in making people show change in behaviour for smoking cessation. According to perceived susceptibility regarding smoking, the HBM mentions people are required to have knowledge regarding cardiovascular risk, respiratory issues and other to be faced to show intention of change (Krosnick et al. 2017). In England, after the establishment of the NHS Smoke-Free Campaign, many people are found to have ability to understand to what extent their heart, body and respiratory organs are to be affected by smoking that has made them develop intention to avoid and quit smoking.

The perceived severity of smoking includes consequences of the actions which are heart attack, stroke, cancer and others (Ahluwalia et al. 2018). This information is found to be delivered to the people through the NHS campaign making them develop consequence of their action, in turn, intending them to cease smoking creating fall in smoking prevalence in the country. The perceived benefits of smoking cessation include healthy heart, avoid chances of lung cancer and others (Jiang and Beaudoin, 2016). These benefits are informed through the NHS campaign which has presently developed greater awareness to make smoking cessation, in turn, ensuring the campaign was effective to make change in smoking prevalence in the country. The strength of the campaign is that it has helped to reduce total number of smokers in the UK by creating effective awareness regarding the health issues related to smoking. The other strength is that trained professionals are involved in the NHS campaign due to which authenticated delivery of information in proper manner regarding smoking cessation was able to be delivered to lower smoking prevalence in the UK. This is evident as NHS professionals from national and local trust are involved to ensure required services and information reaches to the people to help them quit smoking.

The weakness of the model is that it focussed on the smokers to lower smoking prevalence whereas avoided to create awareness among people who have not smoked yet to ensure they never try to get involved in the behaviour. Moreover, the weakness of the model is that it took a general approach to cease smoking and did not informed the way specific smoking cessation services are to be provided according to age groups to current smokers for making them quit successfully. This is required as different factors are seen to affect smoking prevalence among age groups which may not be resolved through generalised action (O'Loughlin et al. 2017; Al Shahrani, 2019). The other weakness is that it did not provide information regarding the way smoking prevalence in certain vulnerable groups such as pregnant women and young people who are prone to increase smoking are to be controlled. The campaign also lacked focuses on informing principles to be followed for health inequality created regarding smoking in the UK.

Another weakness it used print media and avoided the use of social media to execute the campaign which is one of the common media used most frequently among young and adults above 65 years in the UK for accessing information. It is evident as by 2017 it is mentioned that nearly 39 million users from the UK are identified who are mainly youth and adults using social media (statista.com, 2019). In order to make the campaign more effective, the inclusion of social media as the additional tool to inform their services and support is to be executed likely done in Stoptober campaign. The policy of the Tobacco Control Plan is to be followed to improve the campaign to use specialised support for smoking cessation as per age groups and their needs rather than generalised care. Moreover, to improve the effectiveness of the campaign the target population is to be extended to include smokers and non-smokers so that holistic awareness regarding smoking cessation can be created in the country.

Conclusion

The above discussion informs that NHS Smoke-Free Campaign is developed by PHE in December 2016 with target population as smokers of all age groups to help them quit smoking. In the context of rising smokers in England, the campaign was relevant to be created. The campaign was developed by following theoretical constructs of Health Belief Model and following principles of Stoptober campaign, Public Smoking Ban regulation, Healthy Lives, Healthy People: A Tobacco Control Plan and others. The campaign was successful to reduce smoker’s number in the UK but had weakness such as generalised delivery of support, lack of concern for vulnerable groups, lack of information to lower health inequality regarding smoking and others in the UK.

Recommendations for Health Promotion Campaign

Manage vulnerable groups: The Health Promotion campaign is required to focus on developing principles regarding the way smoking prevalence can be lower among vulnerable group like pregnant women, children and others which are focussed in the policy of Tobacco Control Plan 2017-2022. This is because smoking leads to create adverse effect on unborn babies among pregnant women and instigates addictive behaviour for substance in later life for children that are hard to be resolved.

Social Media use: The Health Promotion campaign is to involve using social media as intervention in delivering information for smoking cessation as it ensures greater reach to younger adults in the UK to stop them from smoking.

Recommendations for Health Policy

Health Inequality: The Health Policy for smoking cessation is suggested to develop smoking cessation guidelines in such a way so that health inequalities regarding smoking prevalence as identified in the Tobacco Control Plan are resolved.

Increased ban: The health policy for Smoking Ban among the public is to be strengthened further by including to avoid smoking in open public places too which is currently not covered in the policy.

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