Promotion

The application of health promotion theory and principles to
mental health promotion involving adults
As in other chapters there is a mixed picture with regards to the application of health
promotion theory and principles to research and practice. There are programmes
which have in a number of cases been implemented widely that represent well
conceived intentions to reduce psycho-social consequences of disadvantage and to
reduce inequalities in mental health. Use of a settings approach is central to health
promotion. There is increasing recognition of the need for workplace programmes
to address the elements of a health promoting setting approach although there are
relatively few evaluations. The health promoting hospital movement has slowly
grown but the evaluation activities do not, as yet, parallel those for health promoting
schools. The WHO Health in Prisons Project is another example of an international
programme based on the principles of a settings approach. However, in the few evaluation
studies so far published the theoretical underpinning is less clear. The barriers to
securing adoption of the health promotion principles in hospitals have been discussed
(Whitehead 2004).
There is now a good evidence base developed from programmes involving parents.
Some of the programmes subject to experimental styles of intervention have taken a
clear at-risk approach and drawn on psychological theories. Others, such as Sure Start in
the UK are strongly rooted in health promotion principles and there is good evidence
from local evaluations that the commitment to active participation of parents in
decision-making has been achieved. The reporting of the theoretical bases of programmes
differs. In some such as Soul City which drew on Bandura’s social cognitive
theory, it was clear and detailed. Likewise the study of an outreach programme for the
homeless found that the theory of planned behaviour could be used to predict homeless
adults’ behaviour and consequently be of value when planning interventions.
Studies which have evaluated the effectiveness of exercise have in main utilized a theory
base from other disciplines, such as psychology. This is not unusual in health promotion.
Appendix 1 summarizes the theory reported in studies drawn on in the chapter.
Conclusions
ADULTHOOD 167
In this chapter we have considered the factors that impact on mental health in adulthood,
the policy context of mental health promotion and the evidence of effective
mental health promoting interventions. One thing that stands out when planning
mental health promotion interventions for this age group is the potentially large number
of points of transition and life events. Adults in this age group have a large amount
of caring, financial and political responsibilities and are faced with life challenges, all of
which impact both positively and negatively on mental health and well-being. Some of
these life events have been researched extensively, such as parenting and adverse
childhood experiences, while others to date have received limited attention, for
example pre-retirement, homelessness and forced migration. It would seem that this
is also the case with regards to the evidence of effective mental health promoting