Health Education Journal

Objective To explore the factors that influence young men's access to health services with a view to identifying the potential for health promotion interventions in this area.

Design A qualitative study using a semi-structured interview schedule with small groups of young men.

Setting Interviews were carried out in the field within school and youth settings.

Method A series of three focus group interviews were used as a means of gathering qualitative data.

Results It was found that participants consistently equated health to physical fitness, and help-seeking behaviour was dictated by social norms. These demanded that a problem should be both physical and sufficiently severe to justify needing help. General Practitioners (GPs) were not a popular choice for confiding because of discomfort associated with communication issues, unfamiliarity and feelings of vulnerability. In some cases this was expressed using homophobic comments. Participants were more likely to confide in female key workers with whom they had an established relationship.

Conclusion The complex factors influencing help-seeking and access to services require that health promotion interventions embrace a social model of health. Clients attitudes and beliefs about health and health services need to be considered within a cultural context taking into account the sociological and environmental conditions in which they live. When providing health service to young men, issues such as com munication, and vulnerability should be considered and it should not be assumed that young men would prefer to see male health professionals.

Drug prevention in prisons is an under-developed area. This small-scale exploratory study investigates the drug information needs of young male prisoners. Five focus groups and sixteen face-to-face interviews were carried out with male inmates across four different Young Offender Institutions in England and wales. The findings suggest that in this context drug information should be targeted at prisoners known or suspected to have drug problems rather than at the general prison population. Information should focus on harm reduction and provide contact details for helping services. Further research is urgently needed to build the evidence base in this area.

Background Sex workers were targeted for HIV prevention work from the mid-1980s and budgets were allocated for services and projects with a specific component of HIV prevention. We look at changing trends in service provision in the UK during the 1990s.

Methods Two surveys of services for sex workers were conducted: one in 1995 and the other in 1999. We documented different approaches to health promotion through questionnaire and telephone interview at these two points in time, as well as associated funding and support.

Results Eighty-one services were identified in 1995 and 124 in 1999. There was an increase in services for young people and those based in genitourinary medicine clinics. Most services conducted outreach and shared a common approach to health promotion, based on harm minimisation. Funding did not change significantly and the major source of support continued to be local health authorities.

Conclusion Despite the fact that sex workers are no longer a general priority for HIV prevention work, services have proved to be surprisingly resilient. Projects have developed a holistic approach, linking community intervention to specific health promotion, a model that may prove useful for new government initiatives in relation to health inequalities and social exclusion.

In response to a perceived need, the Scottish Council on Alcohol commissioned the production and piloting of an educational resource specifically for women. The aims of this resource are to educate women about their own use of alcohol, promote healthier lifestyles in relation to drinking and enable individuals to seek help at an earlier stage with problematic use. The contents of the pack were generated by an 'expert panel', and address alcohol related issues relevant to women across the life course. This paper describes the development of the resource, and its formative evaluation, using data from seven focus groups.

The new health promotion arrangements were introduced in October 1996. This study, commissioned by the Department of Health, aimed to assess the extent of health promotion activity under the new arrangements, and to explore views about their implementation. The study was conducted in two parts. The first stage consisted of a telephone survey with a nominated person from each health authority in England. The second phase, reported here, consisted of semi-structured face-to- face interviews in six health authority case study sites. Sixty-nine interviews were conducted with a range of key health promotion informants. The most common focus of health promotion activity related to coronary heart disease and stroke with less emphasis on other Health of the Nation target areas. Monitoring of health promotion was generally low-key and informal which led to concerns about effectiveness and accountability. There was little evidence of evaluation of health promotion activities by practices, although most routinely carried out audit. The regulatory role of HPCs appeared to be lessening, and they were being overshadowed by HimPs and PCGs. These findings raise issues which will have important implications for the future development of health promotion services.

This article reflects on ten years of a community health project - the Hartcliffe Health and Environment Action Group - on a housing estate in south Bristol, an area of high health need. We look at trends in health indicators over the ten years; data problems mean that only tentative conclusions can be drawn, but these are useful for understanding the social and health context of the work. We identify key factors which contribute to the success of the Group, and problems and tensions we experience. We discuss what has been achieved and the effect on the local community, concluding that we can assess effect in terms of activities and short term outputs but not in terms of quantifiable health outcomes. Our conclusions are that community health development projects such as this one can make a contribution to the wider agenda of reducing health inequalities and social exclusion, provided that key principles of community development are adhered to, and that there is basic core funding and stability.

The paper will analyse the initial community mapping, the observations of the processes of the engagement phase of the partnership and the health promotion settings of the 'Breathing Space' project. 'Breathing Space' is aiming to promote a non-smoking environment and to produce a significant cultural shift in the local community norms towards non- toleration and non-practice of smoking, in a low income area in Edinburgh. The beliefs of the local workers, revealed their significant ambivalence in considering their potential involvement in smoking action in the community The planning process has recognised that there are 'community representatives' who effectively act as gatekeepers to the wider community. It will be suggested that there is a need for a fundamental revision of our practice of community development and partnership approaches and this can be achieved by holistic planning. Such planning could be supported by a more organic and dynamic approach to health promotion settings, with consideration given to the context of the setting and the interconnections and processes between health promotion settings.