Publication
Indicators for health education in Scotland; summary of findings from the 1996 Health Education Population Survey (HEPS)
Introduction
The national targets for health are concerned with reducing the rates of premature mortality and morbidity, and the prevalence of health damaging behaviours. The priority topics for action are identified in the national policy statements Health Education in Scotland (SOHHD, 1991), Scotland’s Health: A Challenge to Us All (SO, 1992), and in other key documents. Behaviour and health are shaped by a wide range of factors, including the provision of services and the implementation of health protection policies at all levels. Achieving the national targets therefore requires the concerted effort of many agencies, including those concerned with health promotion. The particular contribution of the Health Education Board for Scotland (HEBS) to the health promotion effort in Scotland is expressed in its strategic aims (see BOX).
HEBS STRATEGIC AIMS
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In relation to the first three strategic aims, health education activities seeks to influence people’s health related knowledge, motivations and skills. Performance indicators are needed which reflect these strategic aims in order to monitor HEBS’s progress towards achieving these. The indicators presented in this report involve measures of knowledge, motivation, and skills in the priority topic areas, supplemented by prevalence data for relevant health related behaviours and health status measures. The Health Education Population Survey (HEPS) is the instrument by which the data are collected.
In addition to monitoring performance indicators, HEPS also contributes towards the evaluation of specific health education campaigns and other outputs, as well as to the planning and development of future health education initiatives.
HEPS is intended to complement existing surveys, most notably:
- the HEBS Communications Tracking Survey which focuses specifically upon the communications effectiveness of HEBS mass media campaigns; the survey gathers data on the perceived impact, acceptability and understanding of messages and information, together with measures of awareness
- the Scottish Health Survey commissioned by The Scottish Office Department of Health to provide monitoring data on national health trends and changes in behaviour in the population over time; the first sweep in March 1995 focuses on risk factors relevant to cardiovascular disease (CVD) and people’s experience of such disease, as well as other aspects of health related behaviour
- health and lifestyle surveys conducted periodically by health boards; the Scottish Needs Assessment Programme (SNAP) has recently developed and piloted a set of core questions to promote consistency and comparability across health board areas.
The Health Education Population Survey
The survey is commissioned by HEBS and conducted by the British MarketResearch Bureau (BMRB). It is carried out twice a year (March and September)from March 1996 using computer assisted personal interviews, with moresensitive information on topics such as mental health, sexual health and drugsobtained using self completion. Each survey wave involves interviews witharound 900 people aged 16-74 in mainland Scotland. A ‘rolling’ randomprobability sampling procedure is used which allows results to be combined fromconsecutive waves.
The topic areas covered by the survey are:
- disease prevention (coronary heart disease (CHD), stroke, cancer andHIV/AIDS)
- smoking
- diet/nutrition
- physical activity
- mental health
- accidents/safety
- dental/oral health
- sexual health
- alcohol misuse
- drug misuse.
The questions included in HEPS were developed within a frameworkincorporating the five dimensions described above (see BOX).
| HEPS: FRAMEWORK FOR INDICATORS |
| Knowledge
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| Motivations
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| Skills
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| Behaviours
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| Health status
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This report presents a summary of the main indicators devised for each topicarea and gives baseline data for 1996 using combined results from the first twowaves of the survey conducted in March and September 1996. Interviews wereachieved with a total sample of 1813. The response rate was 72% of the eligiblesample.
Disease prevention
One of HEBS’s strategic aims is to ensure that people know about major health issues and about the means to achieve good health. Among the causes of premature death in Scotland for which there are behavioural risk factors are CHD, stroke, certain types of cancer and HIV/AIDS. CHD and stroke are currently among the top priorities for the NHS in Scotland.
Six indicators are used to assess people’s knowledge in relation to these diseases. For the first two surveys, skin cancer and stroke were selected in order to ascertain awareness levels regarding preventive measures.
Knowledge indicator: The proportion of people aged 16-74 who correctly identify either CHD, stroke or cancer as the main cause of death for people in Scotland today. |
Respondents were asked what they thought was the main cause of death in Scotland. The cause mentioned most often was CHD (72%), with cancer (20%) and stroke (1%) being mentioned by much smaller proportions.
Knowledge indicator: The proportion of people aged 16-74 who regard CHD, stroke, cancer or HIV/AIDS as a possible risk to their own health. |
Similar proportions of respondents felt that they were at risk from CHD and cancer (61% and 66% respectively), and somewhat fewer (41%) thought they were at risk from stroke. Only 5% regarded themselves as at risk from HIV/AIDS
Knowledge indicator: The proportion of people aged 16-74 who think they can do something to reduce the risk of getting CHD, stroke, cancer or HIV/AIDS. |
Relatively high proportions of respondents felt that they could do something to reduce the risk of getting cancer (91%), HIV/AIDS (81%), and CHD (80%). The percentage for those who thought they could reduce the risk of having a stroke was much lower (40%).
Knowledge indicator: Knowledge levels of people aged 16-74 regarding the three main behaviours which reduce the risk of CHD:
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Respondents were asked how important they thought various actions were in reducing the risk of CHD. Each action was classified as very important, fairly important or not very important and scored on a scale from 0 to 100 with very important scoring 100 and not very important scoring 0. Respondents showed high awareness of the importance of not smoking, taking regular exercise and having a healthy diet. The mean scores are shown in Figure 1.
Figure 1: Importance of actions to reduce the risk of CHD
Action |
Mean score |
Giving up/cutting down smoking |
88 |
Taking regular exercise |
81 |
Having a healthy diet |
76 |
Controlling weight |
75 |
Reducing stress levels |
72 |
Knowledge indicator: The proportion of people aged 16-74 who correctly identify the main ways of reducing the risk of developing skin cancer. |
The main preventive action mentioned by 68% of respondents involved avoiding exposure to the sun to some extent, including not sunbathing (13%) or getting sunburnt (2%), and avoiding the midday sun (3%). Using sunscreen was mentioned by a much smaller proportion (30%).
Knowledge indicator: The proportion of people aged 16-74 who correctly identify the main ways of reducing the risk of stroke. |
As high blood pressure is the most important risk factor for stroke, respondents were asked what were the main ways of keeping blood pressure down in order to reduce the risk of stroke. Figure 2 shows the main ways mentioned, with avoiding stress being cited most often. Exercise, healthy diet and not smoking were mentioned much less frequently.
Figure 2: Main ways of keeping down blood pressure cited by respondents
Action |
% |
Avoiding stress |
60 |
Exercise |
35 |
Eating healthily |
28 |
Cutting down or stopping smoking |
20 |
Reducing salt intake |
16 |
Losing weight |
16 |
Behavioural risk factors
Health education seeks to influence the population prevalence of healthrelated behavioural risk factors, although of course there are many otherinfluences which affect trends in these behaviours. HEPS provides prevalencedata for four behavioural risk factors for the adult population in Scotland, aswell as a summary score consisting of the number of risk factors present foreach individual. These risk factors are smoking, poor diet, being sedentary andalcohol consumption above the recommended maximum limits.
For the purposes of the survey, eating fruit and vegetables daily is used asa proxy indicator of a healthy diet since good nutrition has been found to beparticularly highly correlated with a high consumption of fruit and vegetables.Being sedentary is defined as not doing any 20 minute sessions of vigorous or30 minutes of moderate physical activity during a typical week. For alcoholconsumption, the weekly equivalent of the current recommended maximum limitsare used (28 units for men and 21 for women).
Behaviour indicator: The proportions of people aged 16-74 presenting anyof the following behavioural risk factors:
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The proportions of respondents in each risk category are shown in Figure 3.
Figure 3: Percentage of respondents with behavioural risk factors
| Risk factor |
% |
| Smoking regularly |
37 |
| Not eating fruit and vegetables every day |
43 |
| Being sedentary |
36 |
| Drinking more than the recommended maximumlimits |
11 |
The extent of risk behaviours in the population expressed as the percentagesof people presenting a given number of risk factors is illustrated in Figure 4.
Figure 4: Number of risk factors present among respondents
Number of risk factors present |
% |
0 |
26 |
1 |
35 |
2 |
28 |
3 |
9 |
4 |
3 |
Stages of behaviour change
The process by which individuals go about changing often long-establishedbehaviours is a complex one and is the focus of a number of psychologicaltheories. There is accumulating evidence to support the stages of changemodel developed by Prochaska and DiClemente (1982) as a means of targeting andevaluating health promotion initiatives. The five stages proposed by this model(pre-contemplation, contemplation, preparation, action, maintenance) are usedin HEPS as the basis for questions about changing the following health damagingbehaviours: smoking, poor diet, physical inactivity and heavy drinking.
For the purposes of this report, the population of interest consists ofrespondents who perceive themselves as having an unhealthy lifestyle inrelation to the above behaviours. The stages of change therefore relate tothose who describe themselves as smokers, having an unhealthy diet, being unfitor being heavy drinkers.
Indicator: The proportion of people aged 16-74 who describe themselvesas having a health damaging behaviour, and who
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Figure 5 shows the proportions of respondents at thedifferent stages of change for each behaviour.
Figure 5: Percentage of respondents in each stage of change by behaviour
Percentage of people who |
smokers |
having an unhealthy diet |
unfit |
heavy drinkers |
who are in the following stages: |
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pre-contemplation |
21 |
44 |
41 |
49 |
contemplation |
16 |
13 |
9 |
5 |
preparation |
14 |
8 |
16 |
11 |
action |
32 |
20 |
20 |
22 |
maintenance |
16 |
14 |
13 |
13 |
Smoking
Smoking is the single most preventable cause of ill-health and premature death in Scotland and is a major risk factor for CVD. It is also considered to contribute to approximately 30% of all cancer deaths, and is directly implicated in at least 80% of lung cancer deaths. The key strategic aims for health education are set out in Towards a Non-Smoking Scotland (HEBS, 1995) and include educating people about the harmful effects of smoking, and motivating and enabling smokers to quit.
Motivation indicator: The proportion of smokers aged 16-74 who want or intend to cut down or stop smoking. |
When asked whether there were any changes they would like to make to improve their health, approximately two-thirds (65%) of smokers said they want to cut down or stop smoking, and 41% intend to do so in the next six months.
Motivation indicator: The proportion of smokers aged 16-74 who do not regard their smoking as a problem. |
Among respondents who smoked, 48% agreed with the statement that they did not regard their smoking as a problem.
Skills indicator: The proportion of smokers aged 16-74 would like to stop smoking but are not sure how to go about it. |
Forty six percent of smokers agreed that they were not sure how to go about stopping smoking.
Behaviour indicator: The proportion of people aged 16-74 who have cut down or stopped smoking during the past year. |
When asked what changes they had tried to make over the past year to improve their health, 21% of respondents said they had cut down or stopped smoking.
Indicator: The proportion of non-smokers aged 16-74 who never or seldom come into contact with people who are smoking. |
Among the non-smokers, 30% said they never or seldom come into contact with people who are smoking.
Diet / nutrition
The role of diet and nutrition in improving health has been highlighted inThe Scottish Diet (SOHHD, 1993) and Eating for Health: A Diet ActionPlan for Scotland (SODoH, 1996). Healthy eating is of particular relevanceto health education given the current emphasis on reducing the incidence of CVDand cancer, and in the promotion of dental/oral health.
| Knowledge indicator: The proportion of people aged 16-74who can identify the recommended daily level for fruit and vegetableconsumption for a healthy diet. |
Figure 6 shows the amount of fruit and vegetables respondents thought wasthe recommended daily amount. Only 13% of respondents correctly identified therecommended level for fruit and vegetable consumption as five portions per day.
Figure 6: Amount of fruit and vegetables identified as the recommended daily consumption level
Number of portions |
% |
0 |
* |
1 |
17 |
2 |
23 |
3 |
22 |
4 |
12 |
5 |
13 |
More than 5 |
6 |
Don’t know |
6 |
Note: * represents a percentage less than 0.5% but greater than 0%
Motivation indicator: The proportion of people aged 16-74 who want or intend to eat more healthily. |
When respondents were asked whether there were any changes they would like to make to improve their health, 18% said they would like to eat more healthily, while 11% intend to do so in the next six months.
Motivation indicator: The proportion of people aged 16-74 who report motivational barriers to eating more healthily. |
The main motivational barrier was lack of will power (mentioned by 32%), while 21% said they did not like or enjoy eating healthy foods.
Skills indicator: The proportion of people aged 16-74 who feel they lack the necessary skills to enable them to eat more healthily. |
Lack of skills does not emerge as a particularly strong barrier to eating more healthily. Not knowing what changes to make or how to cook more healthy foods was only mentioned by 17% and 13% of respondents respectively. However, 29% expressed an interest in knowing more about preparing healthy food on a budget, which suggests that financial considerations have some influence on choosing healthy foods. This is supported to some extent by the observation that 27% of respondents reported the expense of healthy foods to be a barrier to eating more healthily.
Behaviour indicator: The proportion of people aged 16-74 who have tried to make changes in their diet during the past year. |
Respondents were asked whether they had tried to make any changes in their diet in the past year. Overall, 83% of respondents reported having tried to make some sort of change, the main ones being shown in Figure 7.
Figure 7: Dietary changes made in past year
Change made |
% |
Eating more fruit and vegetables |
43 |
Using low fat alternatives |
43 |
Eating less fatty foods |
38 |
Eating more fibre |
38 |
Eating less sugary foods |
36 |
Among those who tried to makes changes in their diet, high proportions reported that they had maintained those changes. In this respect, the dietary change which was most successful was eating less fatty foods (93%), while the change least often maintained was eating less sugary foods (81%).
Physical activity
Physical activity helps protect against CHD and a number of other diseases,and is considered beneficial in terms of mental health. Recent new guidelineson the health benefits of moderate intensity physical activity (‘activeliving’) issued by the American College of Sports Medicine/Centre forDisease Control (Pate et al, 1995) have prompted a revision of healtheducation strategies in this topic area. These are outlined in The Promotionof Physical Activity in Scotland: A Strategic Statement (HEBS, 1997). Thisdocument recommends a two-stage approach: those who are not regularly activeare encouraged to spend at least 30 minutes doing moderate intensity physicalactivity most days of the week; those who are regularly active are encouragedto increase the frequency, duration and intensity of their exercise.
Knowledge indicator: The proportion of people aged 16-74 who canidentify the recommended minimum exercise levels
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Respondents were asked how often they thought someone needed to exercise tostay physically fit. The current minimum recommended level of exercise forphysical fitness is three sessions of 20 minutes vigorous intensity exerciseper week and 35% of respondents correctly identified this. Respondents werealso asked how much time per day somebody should spend on moderate physicalactivity in order to stay healthy. Thirty percent of respondents correctlyidentified the minimum recommended daily amount as 30 minutes. For bothquestions, relatively large proportions of people thought the recommendedlevels were higher (43% and 47% respectively).
Motivation indicator: The proportions of people aged 16-74 who wouldlike or intend to become, more physically active. |
Under a third of respondents (29% and 21% respectively) stated they want tobecome more active or intend to do so in the next six months.
Motivation indicator: The proportion of people aged 16-74 who citemotivational barriers to becoming more physically active. |
Figure 8 shows the motivational barriers to being more physically activementioned by respondents.
Figure 8: Motivational barriers to being more physically active
Barriers |
% |
Preferring to do other things |
18 |
Feeling too fat or overweight |
14 |
Not enjoying exercise |
13 |
Being too old |
5 |
Skills indicator: The proportions of people aged 16-74 reporting ways in which they have become, or intend to become, more physically active. |
Among those who had, or intended to, become more active, most (59%) mentioned doing more exercise, sports or other physical activities outside the home, while somewhat fewer cited walking more as part of their daily routine (46%). Smaller proportions mentioned doing more exercise at home (30%) and cycling more as part of their daily routine (10%).
Skills indicator: The proportion of people aged 16-74 who feel they lack the skills or confidence to become more physically active. |
Only 7% of respondents reported that a lack of skills or confidence was an important barrier to becoming more physically active. However, 23% said they would like more information about how to become more active.
Behaviour indicator: The proportions of people aged 16-74 who
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Respondents were asked a series of questions on the types of physical activity they did during an average week. Each activity was classified according to its intensity, frequency and duration and used to derive a summary activity level. This was classified as irregular if respondents did at least one 30 minute session of moderate activity or 20 minute session of vigorous activity per week, but did not reach the recommended levels of exercise described above. The proportions of respondents at each physical activity level are shown in Figure 9.
Figure 9: Proportion of respondents at each activity level
Activity level |
% |
Sedentary |
36 |
Irregular physical activity |
28 |
Recommended levels for regular moderate or vigorous physical activity |
36 |
Behaviour indicator: The proportion of people aged 16-74 who walk for 30 minutes or more on an average day. |
Sixty three percent of respondents reported spending 30 minutes or more walking during an average day.
Behaviour indicator: The proportion of people aged 16-74 who have become more physically active during the past year. |
Thirty seven percent of respondents said they had increased their exercise levels over the past year.
Behaviour indicator: The proportion of people aged 16-74 who report making ‘active choices’. |
In order to ascertain the extent to which respondents were engaged in active living as part of their day to day activities, they were asked how often in the past year they had chosen to walk or cycle a short journey instead of using mechanical transport, or chosen to use the stairs instead of taking the lift or escalator. The percentages of people saying they always or sometimes did so were 82% and 80% respectively.
Mental health
Mental health has been identified as one of the top priorities for the NHS in Scotland. A strategic statement for mental health promotion is currently being developed by HEBS, and the September 1997 HEPS will include a mental health module in order to contribute toward the development of appropriate indicators for mental health promotion. At present, the only mental health indicator in HEPS consists of the 12 item version of the General Health Questionnaire (GHQ12) which is scored on a scale from 0 to 12. This questionnaire has been widely used in general population surveys in order to assess levels of psychological morbidity (Bowling, 1991).
When using the GHQ12 as a screening instrument to detect the presence of mental illness, the generally recommended threshold score is 1 or 2 (Goldberg and Williams, 1988). For this survey, a score of more than 2 is taken as an indicator of potential mental health distress. The mean score is also useful in terms of comparing populations or assessing changes over time (Bowling, 1991).
Health status indicator:
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Twenty four percent of respondents had a GHQ12 score greater than 2, while the overall mean score was 1.75.
Accidents / safety
Accidental injury is the main cause of death for children and young people, and the accident mortality rate in Scotland is twice that in England (SO, 1992). However, the only national targets specified relate to road accidents, although accidents in the home account for more fatalities, particularly among children and the elderly. The strategic direction for HEBS activities is outlined in Accident Prevention and Safety Promotion: A Strategic Statement (HEBS, 1997) and focuses on home and community safety. The emphasis in this survey is thus primarily on home safety and accident prevention measures in the home, an area where there is as yet relatively little information and much scope for improvement.
Knowledge indicator: The proportion of people aged 16-74 who correctly identify the main cause of serious injuries in the home for
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For children under five, 56% thought the main cause of injury was burns and scalds, while 29% thought it was falls. Only 3% identified poisonings as the main cause of serious injury in the home for children under five. However, 76% of respondents correctly identified falls as the main cause of serious injury in the home for older people.
Motivation indicator: The proportion of people aged 16-74 who intend to improve safety in the home in the next six months. |
Twenty nine percent of respondents intended to take action to improve home safety. Figure 10 shows the types of measures and the proportions of respondents intending to take each one.
Figure 10: Home safety measures respondents intend to take in next six months
| Intended measures |
% |
| Carbon monoxide detectors |
11 |
| Burglar alarms |
7 |
| Window locks |
4 |
| Locked cupboards for hazardous chemicals |
3 |
| Socket covers |
3 |
| Stair gates |
3 |
| Safety kettles |
3 |
| Fire guards |
2 |
| Safety glass in windows |
1 |
| Water kept under hand-hot temperature |
1 |
The main motivation reported for taking, or intending to take, these safetymeasures was that it was a good idea (31%), while professional advice orpersonal experience were given as a reason by 16% and 15% respectively. Mediareports were mentioned by only 14%.
Skills indicator: The proportion of people aged 16-74 who want to knowmore about
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Twenty six percent of respondents wanted more information about first aid,while 19% and 13% respectively wanted to know more about teaching safety tochildren and preventing accidents in the home.
Behaviour indicator: The proportion of people aged 16-74 who have
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The large majority of respondents (81%) had a working smoke detector intheir home, while 25% had taken first aid training in the past five years. Only19% had a fire extinguisher or fire blanket in their home.
Behaviour indicator: The proportion of people aged 16-74 who reporttaking other measures to improve home safety. |
Most respondents (75%) reported taking other actions to improve home safety.The proportions taking each measure are shown in Figure 11.
Figure 11: Home safety measures currently taken by respondents
| Measures taken |
% |
| Window locks |
47 |
| Safety kettles |
27 |
| Burglar alarms |
17 |
| Safety glass in windows |
15 |
| Socket covers |
15 |
| Locked cupboards for hazardous chemicals |
13 |
| Fire guards |
12 |
| Water kept under hand-hot temperature |
10 |
| Carbon monoxide detectors |
8 |
| Stair gates |
6 |
Dental / oral health
The principal aims for health education in this priority topic area areidentified in The Oral Health Strategy for Scotland (SODoH, 1995) andare to encourage people to eat a healthy diet, use preventive measures andvisit the dentist regularly. Activity in the area of dental/oral health is ofparticular relevance given Scotland’s relatively high incidence of dentaldecay.
Knowledge indicator: The proportion of people aged 16-74 who can identifythe main ways to keep teeth in good condition. |
Respondents were asked to identify the three most important ways of keepingteeth in good condition. The main factors mentioned by respondents are shown inFigure 12.
Figure 12: Ways identified by respondents as important in keeping teeth healthy
| Factors affecting health of teeth |
% |
| Frequency of visits to the dentist |
61 |
| Brushing teeth thoroughly |
60 |
| Brushing teeth often |
55 |
| Frequency of eating sugary foods |
48 |
| Drinking fluoridated water |
13 |
| Using fluoridated toothpaste |
10 |
Motivation indicator: The proportion of people aged 16-74 who do not visitthe dentist regularly who cite motivational barriers to visiting more often. |
Regular visits are defined in terms of three or more visits in the past twoyears. Among those who visited the dentist less often, the main deterrent toregular visits was not liking going to the dentist or fear of treatment (22%).
Behaviour indicator: The proportion of people aged 16-74 who regularly visitthe dentist for a routine check-up. |
Forty two percent of respondents reported that they visited the dentistregularly for a routine check-up, while 65% said they were planning to visitthe dentist in the next six months.
Sexual health
At present, the primary aims of sexual health education are to prevent thespread of HIV and other sexually transmitted infections, and to preventunwanted pregnancy. HEBS is currently developing a strategic statement to guidefuture action in this area.
Knowledge indicator: Knowledge levels among people aged 16-74 regardingmodes of HIV transmission. |
Respondents were asked to classify a number of possible types of contactinto four risk categories: high, moderate, low and no risk. A risk score wasthen assigned with high risk scoring 100 and no risk scoring 0.Awareness of the principal modes of transmission was high, and scores for themain risk factors are shown in Figure 13.
Figure 13: Mean risk scores for HIV transmission risk factors
| Risk factor |
Mean score |
| Sharing needles |
98 |
| Sex between men without a condom |
94 |
| Sex without a condom |
91 |
| Maternal transmission before birth |
88 |
| Contact with blood |
84 |
Motivation indicator: The proportion of people aged 16-74 who claim that
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Most respondents (66%) agreed with the statement that they would not havesex with a new partner without a condom. One third agreed that buying condomswas an embarrassing experience. However, 26% and 27% of respondents said thesestatements were not applicable to them.
Skills indicator: The proportion of people aged 16-74 who would likeinformation on
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The proportions of respondents wanting more information on each topic areshown in Figure 14.
Figure 14: Percentage of respondents wanting information on sexual health topics
| Topic |
% |
| STDs |
40 |
| Having an HIV test |
25 |
| HIV/AIDS transmission |
21 |
| How to have a satisfying sex life |
19 |
| Emergency contraception |
19 |
| Abortion |
15 |
| Safer sex |
7 |
| Contraception |
7 |
Behaviour indicator : The proportion of people aged 16-74 who have changedtheir sexual behaviour because of concern about HIV/AIDS. |
Thirteen percent of respondents said they had changed their behaviour due toconcern about the risks of HIV/AIDS.
Alcohol
Alcohol misuse contributes to high blood pressure and a number of otherhealth problems, including cirrhosis of the liver and cancer of the mouth,pharynx, larynx, oesophagus and liver. Excessive or inappropriate use alsoincreases the risk of accidents and crime, and is associated with a variety ofsocial problems. However, there is also some evidence of health benefits formoderate alcohol consumption for men over 40 and post-menopausal women. Thereport Sensible Drinking (DoH, 1995) presents new daily benchmarks foralcohol consumption based on a revised approach which is designed to preventthe health and social problems related to short term episodes of heavydrinking.
For the purposes of the survey, respondents were classified as‘drinkers’ if they had consumed any alcohol during the past year.
Knowledge indicator: The proportion of people aged 16-74 who correctlyidentify the number of units of alcohol in a pint of normal strength beer. |
Respondents who had heard of measuring alcohol in units were asked how manyunits were in a pint of beer, the correct answer being two units. Theproportions giving each response are shown in Figure 15. Sixteen percent ofrespondents had not heard of measuring alcohol in units.
Figure 15: Number of units of alcohol thought to be in a pint of beer
| Number of units |
% |
| Less than one |
1 |
| One unit |
11 |
| More than one, less than two |
2 |
| Two units |
37 |
| More than two, less than three |
1 |
| Three units |
5 |
| More than three |
11 |
| Don’t know |
32 |
Knowledge indicator: The proportion of people aged 16-74 who
|
While most respondents believed that the limits had increased (51%), only 1%mentioned that the new limits were for daily consumption. Again, a relativelylarge proportion (38%) said that they did not know what the change hadbeen. Only 10% of respondents could correctly identify the weekly equivalent ofthe new maximum sensible limit for men (28 units), and 12% were able toidentify the old weekly limit of 21 units.
Motivation indicator: The proportion of drinkers aged 16-74 who want orintend to cut down on their drinking. |
The proportions of drinkers who said they want or intend to cut down were 6%and 4% respectively.
Motivation indicator: The proportion of people aged 16-74 who have, or wantto, cut down on their drinking who cite motivational barriers to cutting downon drinking. |
The main motivational barrier reported was finding it difficult to cut downor stop when friends were drinking (52%).
Skills indicator: The proportion of people aged 16-74 who want to know moreabout how to cut down on drinking. |
Only 4% expressed a desire to know more about how to cut down on drinking.
Behaviour indicator: The proportion of drinkers aged 16-74 who have cut downon their drinking. |
Sixteen percent of drinkers said they had reduced the amount of alcohol theydrank in the past year.
Drug misuse
There has been increasing emphasis given to the development of healtheducation interventions as a means of preventing drug misuse among youngpeople. The report of the Ministerial Drugs Task Force Drugs in Scotland:Meeting the Challenge (SOHHD, 1994) reaffirmed the leading role ofprevention in tackling drug misuse. Due to concerns about a rise in drug misuseamong young people, established approaches to drug education (‘just sayno’) are being challenged in favour of appropriate multi-componentprogrammes.
Skills indicator: The proportion of people aged 16-74 who feel they lackknowledge about the risks of taking drugs. |
Respondents were asked to what extent they felt that they did not knowenough about the risks of taking drugs. Forty two percent of the total samplesaid they agreed with this statement, whereas a somewhat smaller proportion of16-24 year-olds (34%) expressed agreement.
Behaviour indicator: The proportion of people aged 16-74 who have
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Thirty four percent of respondents said they had taken illegal drugs at somepoint in their lives, with 16% claiming they had done so in the past 12 months.Among 16-24 year olds, the percentages were higher at 61% and 42% respectively.The drugs most often reported used in the last year are shown in Figure 16 forall respondents and those aged 16 to 24.
Figure 16: Drugs used in last year
| All respondents |
16 to 24 year olds |
|
| Cannabis |
10% |
33% |
| Amphetamines |
4% |
15% |
| Tranquillisers |
3% |
2% |
| Ecstasy |
2% |
12% |
Conclusions
This report presents the baseline data for a set of indicators relevant tohealth education in Scotland which are concerned with knowledge, motivation,skills and behaviour. These indicators will continue to be monitored viasubsequent waves of HEPS.
Having obtained baseline data, appropriate targets can now be specified inan attempt to define what constitutes successful achievement over time. Thelimitations of this target setting exercise are recognised. First, there is apaucity of scientific methods for gauging precisely how much variation in theperformance indicators may be expected over time and how much change might beexpected as a result of particular actions. Second, it is difficult to assessthe specific contribution of health education initiatives to trends in healthrelated knowledge, motivations, skills and behaviours.
The baseline data from HEPS will contribute to the planning and developmentof future health education initiatives in Scotland by helping to identify areasof need where activities might be effectively directed and other areas wherethere is little scope for further change. For example, the baseline data showthat future actions might be focused in the following areas:
- Stroke prevention. Knowledge levels regarding stroke and preventivemeasures are much lower than for other diseases. In particular, there is lowawareness of the benefits of a reduced salt intake in controlling bloodpressure
- Motivation to improve diet and exercise levels. Compared to smokers,there are relatively high proportions of pre-contemplators among those with apoor diet and those who regard themselves as unfit. Moreover, there is lowpublic awareness of the recommended levels of daily fruit and vegetableconsumption, coupled with a relatively high prevalence of this behavioural riskfactor and a high proportion of the adult population attempting to make changesin their diet
- Smoking cessation skills. There is still quite a high proportion ofsmokers who are not sure about how to go about quitting
- Awareness of poisoning accidents among children under five. Thereare low levels of knowledge about poisonings as the main cause of seriousaccidental injury to children in the home
- Information on STDs. There is high demand for information aboutsexually transmitted diseases.
There is less scope for further change in the following areas:
- The role of lifestyle in disease prevention. The vast majority ofadults in Scotland feel they can take action to reduce their risk of gettingCHD, cancer and HIV/AIDS and realise the importance of giving up/cutting downsmoking, taking regular exercise, eating a healthy diet and controlling weight
- Fire prevention and smoke detectors. A high proportion of householdsclaim to have a working smoke detector in their home (although relatively fewhave any other forms of fire prevention such as extinguishers or fire blankets)
- HIV/AIDS education. There is a high level of awareness of theprincipal modes of HIV transmission.
It is interesting to note that the above three areas have all been the focusof intensive and long-term educational campaigns in Scotland.
References
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Goldberg, D.P. and Williams, P. (1988). A User’s Guide to theGeneral Health Questionnaire. NFER-Nelson, Windsor
Health Education Board for Scotland (1995). Towards a Non-SmokingScotland. HEBS, Edinburgh
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