It may seem a long stretch from Helen's success in running a local pub to a text book on public health, but she does have a crucial common agenda with those working in infant immunization, smoking cessation, and obesity prevention; she too is dealing in voluntary behavior change. She wants - needs - people to visit her pub, buy her beer, tell their friends and family what a good pub it is, visit her pub again, organize their wedding receptions with her... And she knows they have a choice; she cannot compel them to do these things, so she has to seduce them. This means she has to understand their needs absolutely and cater to them at every opportunity. She has to avoid the trap of taking refuge in the technicalities of her work, focusing purely on the science of good beer or minutiae of stock management. These things matter, but only in so far as they help her meet her customers' needs.
As with the King's Head, so with smoking cessation. Case Study A shows how a service in the North East of England succeeded in building links with pregnant smokers from very low-income communities and persuading them through their doors. The first step was qualitative research to dig down and understand the perspective of the women and how they felt about their smoking and the possibility of quitting. This revealed a remarkable degree of ambivalence in both arenas. They knew smoking to be harmful for them and their baby, but they also valued the indulgence, affirmation, and "me-time" it provided - rewards
A. Steptoe (ed.), Handbook of Behavioral Medicine, DOI 10.1007/97S-0-3S7-094SS-5_20, © Springer Science+Business Media, LLC 2010
that were only enhanced by their constrained lives. Corresponding research with health professionals revealed that they fully understood this ambivalence among the low-income smokers and it made them reluctant to broach the idea of quitting and reticent in their approach when they did. The resulting initiative built on these insights and comparison with neighboring providers demonstrated their striking success -attendance at the local cessation service shot up.
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