Health promotion in schools and worksites — practice questions

(a) Effective settings:

• Captive audience — reach large numbers regularly without recruitment costs.
• Social context — health behaviour is socially influenced (Bandura); settings allow norm change, not just individual education.
• Settings approach (Ottawa Charter): Modify environment (factory gym, school smoke-free policy) alongside education.
• Developmental timing: School targets adolescence — when health habits (smoking, exercise) form and persist into adulthood.
• Workplace: Addresses occupational stress (Karasek) and sedentary behaviour; EAP provides access to support employees might not seek independently.

(b) Evaluation of peer education:

• Strengths:
  • Bandura's social learning theory — peers are credible models; adolescents more likely to imitate similar-age behaviour than teacher lectures.
  • Subjective norms (TPB) — peer leaders shift perceived social norms around smoking.
  • Reduced reactance — pupils less likely to reject message from peers vs authority figure (unlike Milgram authority dynamic).
  • Cost-effective — uses existing school resources.
• Limitations:
  • Peer leader selection bias — non-smoking high achievers may not relate to at-risk pupils.
  • Boomerang effect — discussing smoking may normalise it for some pupils (iatrogenic effect).
  • Short-term effects — Coombes et al. found peer education improved knowledge but behaviour change was limited without family and community support.
  • Ethical concerns — peer leaders may face pressure; confidentiality issues if pupils disclose risky behaviour.
  • Does not address external barriers — pupils whose parents smoke or who face peer pressure outside school.

Judgement: Peer education is effective for attitude change but must be part of whole-school policy (smoking rules, parent engagement) and community approach for lasting behaviour change.

(a) Calculate annual cost saving:

1. Reduction in absenteeism per employee: $7.5 \text{ days} - 5.5 \text{ days} = 2 \text{ days}$
2. Total days saved across all employees: $800 \text{ employees} \times 2 \text{ days/employee} = 1600 \text{ days}$
3. Total annual cost saving: $1600 \text{ days} \times £180/\text{day} = £288,000$

The total annual cost saving is £288,000.

(b) Calculate Return on Investment (ROI):

1. Calculate Net Profit (Savings - Cost): $£288,000 \text{ (Savings)} - £120,000 \text{ (Cost)} = £168,000$
2. Calculate ROI using the formula: $ROI = \frac{\text{Net Profit}}{\text{Cost of Investment}} \times 100\%$ $ROI = \frac{£168,000}{£120,000} \times 100\% = 1.4 \times 100\% = 140\%$

The ROI for the programme is 140%. (This means for every £1 invested, the company received £1.40 back in net savings).

(c) Methodological Issue: One key issue is self-selection bias. The calculation assumes the programme caused the drop in absenteeism across all 800 employees. However, it's likely that only a portion of employees participated. These participants may have been healthier, more motivated, and less likely to be absent even without the programme. The reduction in absenteeism might be due to the characteristics of the participants rather than the effectiveness of the programme itself, thus inflating the calculated ROI. Another valid issue would be confounding variables, such as a milder flu season or changes in management style that also could have reduced absenteeism.