At a local level the NHS is involved in local strategic partnerships (LSPs), has oversight of the community plan (see below) and in areas of deprivation is responsible for developing a local strategy for neighbourhood renewal (see http://www.neighbourhood.gov.uk for links to local websites for LSPs and http://www.idea.gov.uk for information on local area agreements and LSPs).

Local authorities have powers to promote or improve local economic, social and environmental wellbeing. They are required to prepare community strategies (or plans) and to coordinate these activities (see Darlow et al 2008) and associated partnerships across a wide range of agencies (see, for example, LutonForum 2005).

The Neighbourhood Renewal Strategy and Fund was launched in 2001 (Social Exclusion Unit 2001) and set out a joined-up approach to tackling the social and economic determinants of health in the most deprived local authority areas.

The Healthy Living Centres (HLCs) Initiative was launched in 1999, funded from the National Lottery to develop a network of HLCs across the UK. This funding is usually used for programmes of activity rather than a physical building. For examples of the work of HLCs see Rankin et al (2006) and for an evaluation of the whole scheme see Hills et al (2005). HLCs are not mentioned in recent policy, but the intention at the outset was that HLCs would become sustainable and there is evidence that this is happening (see, for example, Chesterfield Borough Council 2009).

The first wave of health action zones (HAZs) was set up in 1997 with special government funding to improve health outcomes and reduce health inequalities (Health Development Agency 2004). HAZs have pioneered new ways of tackling health inequalities through partnership working between the NHS, local authorities, community groups, the voluntary and private sectors; linking health, regeneration, education, housing and anti-poverty initiatives. A central aim for HAZs was integrating the services and approaches they develop into mainstream activity, and some made considerable progress and had an impact on local health improvement (Barnes et al 2005, Bauld and MacKenzie 2007). Where HAZs still exist they have been incorporated into mainstream agencies, for example, Northern Neighbourhoods Health Action Zone (http://www.nnhaz.co.uk).

The NDC programme involved funding to poorest neighbourhoods in the country for 10 years to support plans that bring together local people, community and voluntary organisations, public agencies and local business in an attempt to make lasting improvements to health, employment, education and the physical environment. It was the intention that these improvements would be delivered in a way that could be sustained beyond government funding and into the long term. The government has issued various guidance notes which relate to succession, but Healey (2009) argues that it is too early to make an assessment of the contribution that guidance and shared good practice from the NDC programme is making to the development of local sustainability plans in NDC areas. For an example of how NDCs function see Newcastle New Deal for Communities (http://www.newcastlendc.co.uk).

This is a government scheme which aims to support parents and children under 4 years in areas of high health need (see Gidley 2007 for a more detailed discussion of the Sure Start programme and http://www.dcsf.gov.uk for publications relating to recent Sure Start funding and other initiatives).

Exercise 7.1 aims to help you find out about national and local health strategies relevant to your work.

There can be a gap between evidence and practice. It is not always easy for practitioners to keep up-to-date with new research findings, or to apply research findings in their own particular situation. Attention needs to be given to how research findings can best influence and also emerge from practice, and the processes of disseminating and implementing health promotion research.

There are many published research studies that help to show which health promotion interventions work best. These are easily accessible on the Internet at such sites as Cochrane (http://www.cochrane.org); the International Union of Health Promotion and Health Education (IUHPE) data source (http://www.hp-source.net) and the main evidence-based Internet site for health promotion in England, the National Institute for Health and Clinical Evidence (NICE) (http://www.nice.org.uk).

Health promotion is complex and it is sometimes difficult to provide evidence of effectiveness for single interventions. Often it is not one intervention that produces results, but a combination of activities, of which you may be involved in just one, as Fig. 7.1 demonstrates. Another example is preventing childhood obesity, where the evidence is that a multifaceted approach is the most effective. A combination of interventions range from targeting antenatal education, to working with parents and ensuring they have access to buying affordable healthy foods, to increasing children’s physical activity levels, through the targets set by the Schools Sports Strategy (OFSTED 2006) and ensuring healthy food consumption while children are at school using the new standards, which cover all food sold or served in schools (Department for Children, Schools and Families 2005).

Research shows that for many health promotion issues a more comprehensive, integrated approach that focuses both on attitudes and behaviours and changes to such things as the environment and legislative and fiscal policies is the most effective (see, for example, National Audit Office et al 2006).

Evidence may also not exist. The particular piece of work you plan to undertake may not have been done before, and indeed the particular set of circumstances in which you are working may be unique. So the best that can be done is to be aware of what the published research in related areas of work tells you, and to reflect on how what was learned might apply to your circumstances. Where evidence is not available, it is vital to ensure that you evaluate your work in order to add to the evidence base by drawing the evidence from your practice and disseminating the results.

It also helps to think carefully about what constitutes evidence (for a useful discussion on these issues see Kelly et al 2004). Evidence can be drawn informally, with the views of local people and your own experience also constituting evidence. Your job as a health promoter is to use your judgement to decide whether the evidence available applies to your clients and circumstances and, if so, how. GPs, for example, may quote a number of factors which they believe provide evidence that health promotion is effective, including changes in the health or health behaviour of their patients over time.

However, formal sources of evidence are generally regarded as the most reliable, so you should plan carefully and evaluate or audit what you do. In this way you will be building up your own body of knowledge about what is effective.

Audit is discussed later in this chapter.

Finally, it is also important to bear in mind that your decision about whether to do a particular piece of health promotion work should also be based on ethical considerations. You could decide that it is your responsibility to intervene, even though you have little or no information about what might work. Health promotion is driven by both values and evidence, which are often intertwined. So there are two key questions: Do we think this ought to be done? and Will it work?

See Chapter 3 for more about values and ethics in health promotion.

You may sometimes wish to find out about research on a particular topic, perhaps because you are proposing to introduce new health promotion work and want to know what has been shown to work best. For example, imagine you are a nurse working in cancer care and you are considering introducing a counselling service for women who are undergoing mastectomy (surgery to remove a breast, usually because of breast cancer). You want to know if research shows what the health promotion needs of these women are and how best to meet them. Where do you start?

First you need to establish a research question. It pays to take time to discuss this with colleagues and you could also discuss it with someone who has recently had a mastectomy. What did she find helpful, and what was unhelpful?

Once you are clear about what you want to find out, list no more than six key words that feature in your question. The cancer care nurse might include the words mastectomy, needs and counselling in her list. Then write words that mean the same thing, or are similar in meaning, by each key word. For example, you might put breast removal as an alternative to mastectomy, and advice as an alternative to counselling. These key words and their synonyms/alternatives will be helpful when you go to the library or search on the Internet (for excellent guides to doing your literature search and finding information online, see Aveyard (2007) and Dochartaigh (2007)). In addition, many journal articles include a list of key words after the title, which will help you to know whether the article is likely to be of interest to you. When you have found a few references, you can start by reading the most recent one. This will provide you with more references. Once you are under way, the next problem is to avoid being swamped by information. Here again, your key words should be useful in stopping you from being side-tracked and in keeping your research question in mind.

It is important to keep records of what you read. There is computer software designed to help you store and retrieve references (see for a comparison of the different software http://en.wikipedia.org). For a book, you need to record:

For articles in journals you need to record: