Make every contact count: talking about public health

In the first of two articles on physio’s role in public health, CSP professional adviser Carley King looks at making every contact count.

Prevention is key regardless of which country or sector you work in

Over the last few years, you may have noticed more of a focus on the prevention of ill health rather than purely treating problems as they occur, often broadly referred to as ‘public health’. For the NHS to be sustainable there must be more of a focus on preventing ill health in the first place.

This has been highlighted recently across the four countries with an emphasis on prevention in England’s Five year forward view, Scotland’s 2020 vision, Together for health from Wales and Northern Ireland’s Transforming your care (see links at end of article). Local decision-makers are likely to start looking more and more for evidence that the services they procure are contributing to the public health agenda.

Prevention is key regardless of which country or sector you work in and which speciality or banding you are. As physiotherapy staff, we have a huge contribution to make to help people live well for longer.

Getting started

During the summer of 2014, the CSP conducted a member survey to get a baseline of your views on public health and the physiotherapy contribution to public health.

It revealed that while the vast majority of physiotherapy staff already take opportunities to promote health, this wasn’t always recognised as being ‘public health’. Health promotion is such an integral part of everyday practice in physiotherapy, but can easily be overlooked.

This article should help you identify things that you do that contribute to the public health agenda.

How do you do it?

Health promotion can be easier said than done. For example, how do you broach difficult subjects with your patients about weight? How do you recognise when somebody is open and ready to hear the brief advice you can give them about smoking, and what should you do if they aren’t?

These questions reflect very real situations for all healthcare professionals, not just physiotherapy staff... but there are plenty of resources to support you. And just think, if you, as a healthcare professional, aren’t prepared to advise somebody on living a healthy lifestyle, who will?

There is a public appetite for this, as shown by the Healthy conversations and the allied health professionals (AHPs) report (co-published by the Royal Society for Public Health) A survey showed that 86 per cent of members of the public would trust this type of advice, if given by an AHP.

Useful links to UK reports

So what is public health?

The term public health can be a little off-putting, evoking images of grand government interventions that reach an entire nation.

The definition from the Faculty of Public Health is: ‘The science and art of promoting and protecting health and wellbeing, preventing ill-health and prolonging life through the organised efforts of society.’

In reality, public health is what we do on a daily basis. For example, if you have ever discussed increasing physical activity levels, quitting smoking or referred somebody to a falls prevention class, then you are taking on public health activities.

Scope of practice

Some CSP members have asked if this type of activity is within their scope of practice. The Healthy conversations report, mentioned above, found that a fifth of AHPs felt they lacked the skills or knowledge to engage in healthy conversations.

Looking back at your case study, was one of your barriers a lack of knowledge or skills? Try to identify areas for development. Helpful resources can be found no the Public Health webpages.

Activity

This activity is designed for all physiotherapy staff. Before we start thinking about how you can embed public health into your everyday work, think about a patient you saw today, this week or on a placement.

Make a note of the following

why were they seeing you? What was the main problem that you were helping them with?
did they have any other problems that came up during your session? If so, what were they?
did this problem provide you with an opportunity for starting a healthy conversation or signposting to another service or further information?
can you identify any barriers to doing this, and how these could be overcome?

You may find it difficult to think of ways to overcome some barriers, but hopefully after reading this article you will be able to go back and add to that list.

Does it work?

Evidence suggests that using opportunistic openings to provide brief advice and the option of signposting increases participation in healthy behaviour, primarily in smoking cessation, alcohol consumption and physical activity.

For more on the evidence base, see the National Institute for Health and Clinical Excellence Public health guideline 49, Behaviour change: individual approaches.

Incorporating healthy conversations into practice

Below are a few ideas that you could incorporate healthy conversations into everyday practice, and you may wish to add to this list

create an in-service training around offering opportunistic advice
create a role within your team for somebody to be responsible for holding details of the different services you may wish to refer to (such as smoking cessation or weight management)
add a relevant standard (for example, from the NICE guidance) to your clinical audit to gain a benchmark of how your service
currently addresses public health issues
if you use a notes proforma, add a prompt for healthy conversations
add a component around healthy conversations to your patient reported experience measure.
use the tools highlighted on the Public Health webpages to help develop your healthy conversation skills.

If you have implemented a change in your workplace to help get the public health message out, and you have data to support the success, please get in touch.

Author

Carley King CSP professional adviser

05 August 2015

05 Aug 2015