Exemplar: Effectiveness of programs

The following sample is a response to the question: Discuss the effectiveness of one or more health promotion programs. A "discuss" should not only evaluate the program, but also the difficulties in determining the effectiveness of programs.

The sample response is an example of an exemplary response that should receive top marks. Comments about the essay are included below.

The highlighted areas of the essay demonstrate critical thinking.

Sample essay

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One of the primary goals of psychologists is to help improve the standard of living by changing behaviours and attitudes in a positive way.  Health psychologists try to do this through health promotion programs.  One of the strategies that is used by health psychologists is to increase a sense of self-efficacy through social learning. Social Cognitive Theory argues that we can learn indirectly by watching others and the rewards or punishments that they receive.  As a result of observing and identifying with others, we build a sense of self-efficacy which empowers us to take control of our own behaviour. The Food Dudes program is an example of a health promotion campaign.

The health campaign and the theory/strategy on which it is based are identified

Sanderson and Yopuk carried out a study to see if the social cognitive theory could be applied to increase safe sex behaviour. The sample was made up of university students. The students were randomly allocated to either viewing an HIV prevention video or a control group. In the video, the problem of HIV infection was discussed and then a focus group discussed the use of condoms. They discussed how important it was for them that their partners used condoms, that it was a sign of respect and that if their partner refused, they would say no.  They were asked to fill out a questionnaire both immediately after the videos and another one three-months later.  In both cases, the researchers found a higher rate of self-efficacy for condom use and intention to use condoms compared to the control group.

A study is used to demonstrate the use of SCT to promote health behaviour.  The aim, procedure, and findings are clearly described.

The Social Cognitive approach to promoting health appears to be successful here, but there are limitations to the study.  First, the sample was small.  It was also a student population, so it is not representative of the more general population. The study is reliant on self-reported data, so it is likely that the social desirability effect may play a role in the findings.  The students would not want to look bad in front of the researchers.  As the participants were volunteers, the study is also not able to control for participant variables – for example, personality dispositions which may have influenced the findings. However, the study indicates that social cognitive theory may be effective in health promotion.  What happens when this is applied to a larger population?

Lowe et al carried out a study to test the effectiveness of the Food Dudes Program in the UK.  The campaign was a series of adventure videos in which a group of superheroes – the Food Dudes – trying to save the world from the Junk Punks.  The videos promoted social learning by having heroes that children would want to imitate, who also ate fruit and vegetables in order to have their superpowers.

A second example, this time focusing on an actual program, rather than a study. A basic description of the program is provided.

The study had a sample of 750 elementary school children in two London schools. One school was a control and the other underwent the Food Dudes program. Before the health promotion program started, the researchers measured the students' level of fruit and vegetable consumption. This was done both by observing their food choices and by giving questionnaires to their parents. The researchers then measured their fruit and veg consumption during the program and then four months later.  They found that on average children dramatically increased their diet of fruit and vegetables during the intervention – from eating 4% of the fruit and veg they were given to 68%.  Four months later they were still eating 12 times as much fruit and veg as they were at the beginning of the study.  In the control group, where the same fruit and veg was offered at lunch, there was no change in consumption.

The study is described in terms of the sample, procedure and findings.

It appears that watching superheroes, whom children would want to imitate, increased the consumption of healthy foods. According to Bandura, because it was interesting, the children paid attention – which is important for learning. The message was repetitive, so the message was retained by the children. Discussion in class and prizes for eating fruit and veg increased their motivation.  And lastly, since the school was providing fruit and veg, they had the potential to change their behaviour. Children were given a sense that they could make their own choices – and this increased self-efficacy.

The study is explained in terms of social cognitive theory: attention, retention, motivation and potential.

This study had a large sample size and used a pre-test, post-test design.  Unlike the first study where behaviour was self-reported, this study relied on measuring children’s lunch choices, which was more quantitative in nature – and less open to demand characteristics. The study was also longitudinal; the study shows change over time and that the behaviour continued even after the program was finished. However, the study was done with British elementary children.  It may be difficult to generalize the findings to children in other cultures or older children – for example, middle school children, who would potentially identify less with superheroes.

The study is evaluated.  There is a good breadth of evaluation strategies.

Overall, it is difficult to evaluate the effectiveness of health campaigns because it is not possible to isolate variables.  In the classroom environment of the Lowe study, it is possible that classroom leaders may have played a more significant role than the videos themselves.  Peer pressure or role modeling in the group may have played a more significant role than the videos – even if the video may have led to a group leader changing their behaviour.  If a significant number of the children thought that the video was "stupid“ that may have had an effect on the success of the program. 

Variables that may have affected the study and made it difficult to determine the actual effectiveness of the program are discussed.

When trying to assess the success of a pro-condom video, one way to determine whether it has an effect is to look at the success of such a program would be to measure new HIV infection rates in a community.  However, it would not be possible to measure the level of attention paid to videos that were shown on television.  It would also not account for the many variables that may influence a person’s sexual behaviour. Perhaps another television show, a tragic story in the local community or a change in the availability of condoms may have more of an influence than the program itself.  Finally, the number of new infections would have to be based on hospital records; therefore, it would be the lowest estimate because not everyone gets tested for HIV. This means that there would always be a level of doubt about the success of the program.

The response explains in more detail why it is difficult to determine the level of effectiveness.

SCT appears to be a relatively successful strategy for promoting positive health behaviours, but there are some serious limitations in being able to measure its effectiveness.  

A very simple conclusion
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