Health Promotion: Intervention & Evaluation - Dissertation Example

Health Promotion: Intervention & Evaluation Introduction: Health is an important factor to determine the individual, collaborative and national successes. A number of factors influence health including the social, cultural, spiritual, economical well being of the person, community or nation concerned. In order to improve the living standards, it is important to improve the health patterns of the concerned entity. The concept of health promotion is given more and more importance in today’s world to lay hands on improved health and as a result a better quality of life. Health promotion can be defined as the procedure of making it possible for the people to have much control over their health and make it better (Canada, 1986). In order to implement a sound health promotion intervention, there is a need to follow a few strategic steps. The first and foremost chief step is to build healthy public policy. The implementation of this healthy public policy requires a supportive environment to progress rapidly. There is a need to encourage the community to act upon that policy and use personal skills to achieve its objectives. In the end, there is a need to evaluate the policy after specific intervals and adjust the shortcomings of the plan (Canada, 1986). Health promotion is much about developing health prospective and acquiring health benefits. Health promotion includes the issues about nutritional diet, immunity power, physical and mental potency and general health behaviors. These issues help the individual in coping up with the strain that body may encounter (Al Khayat, 1997). The increasing number of health risking diseases are emerging with increased intensity in the Eastern Mediterranean Region have proved it essential to design and implement health promotion interventions. The health promotion interventions are more inclined towards fighting against non-communicable diseases which is continuously rising in this region. Health promotion is cost effective and end up creating positive impact on the overall productivity and healthiness of the concerned region. It also benefits by decreasing the economic burden of health risking factors like diseases, epidemics, and uncertain incidents. The Eastern Mediterranean Region: The Eastern Mediterranean Region includes 22 countries and ranges from morocco to Pakistan. The population in the region is about 500 million. The region consists of a large young population of about 40 percent under the age of 15 (WHO, 1994). The dependency ratio is also as high as 79 percent. The crude birth rate is also examined to be high (i.e. 28.5) and birth rate shows a high rate too (i.e. 8.0). The annual growth rate is 2.3 percent and annual fertility rate is 4.0 percent (WHO, 2003). However, an improved trend of these records has been noticed in the past few years, there is still enough space to make more improvements and make the region better place to live. Different countries in the region show different per capita GNP and the huge variations in these figures have a large impact on the power of spending on health and hence, create a significant impact on overall health system and its effectiveness. The GNP per capita in the region varies from as high as USD 28,000 ($28000) for Qatar to as low GNP per capita as of USD 160 ($160) for Afghanistan. A report suggests that Afghanistan, Djibouti, Somalia, Sudan and Yemen are the five least developed states in the Eastern Mediterranean Region (UNSTAD, 2002). The EMR Intervention: The health promotion throughout the Region is based on different principles for instance, the base of health promotion through Islamic Lifestyles and resolutions of regional committee by Amman. The region involves community participation approach to promote health and health awareness among the vast population. The Regional Health education includes the Regional publication “The Right Path to Health” to promote the motives. The community based interventions include plans and programs that promote active participation of the regional population in the interventions. Healthy cities, healthy villages, healthy schools and basic development needs are some of the community based schemes to improve health and health related issues around the region. These initiatives involve most of the population in the fight against diseases, injuries, epidemics and other health risking factors. Hence, these programs help achieving the health promotion targets easily. This approach can be categorized as community participatory approach. The health promotion strategy of the region is based on the holistic approach of health which involves the development and welfare of physical, psychological, social and spiritual health and not merely a disease free region (Al Khayat, 1997). The approach of this region is based on the idea that healthy lifestyle and environment is a basic human right and must be available for every individual (United Nations Development Program, 2003; Alkhayat, 2004). Community-Based Intervention: The Community based interventions are very useful in reducing the health risking diseases and behaviors among the people of a particular region. The basic elements of community based projects are: Planning: This involves the analysis of the community. The identification of the extent of problem is also carried out in this step. The intervention’s main objectives are set out and resources are organized to move towards the path of achievement of those objectives. All preparatory steps are taken in order to attain a successful completion of the intervention. Implementation: This element of the intervention involves the implementation of the plan set out earlier. The plan made previously was limited to a single group. The proper implementation of a community based intervention requires the involvement of the whole community. This step hence requires choosing the individuals who will be involved in the intervention. For the successful implementation, it is necessary to organize the community, provide comprehensive plans, and use a mix of strategies to overcome the problem and a flawless program organization. Evaluation: The third element is evaluation. After successful implementation it is required to check the credibility of the intervention. It is not necessary that the estimates of the intervention’s costs and benefits perfectly match with the original values that are incurred or earned. Hence, this step involves the comparison of costs and benefits with the expected outcomes. This evaluation does not only involve the monetary comparison but also incorporates the nonmonetary benefits and costs that arose. The evaluation then helps in the revision of the plan, strategies used and resources distribution. The evaluation process also analyzes the program design, compliance with the objectives and helpfulness in achieving the health targets. Surveys, questionnaires and other techniques may be used to evaluate the perception of other community members about the intervention (Nissinen, Berrios, and Puska, 2001). Benefits of Community Based Intervention: These community based programs offer a new system in which community, itself is fighting against the health risking factors that are present in the region. This new system provides a new motivation to achieve and take part in the intervention to protect themselves and their children. This active participation of community helps the governments and health departments in improving the quality of life and health of the community members. The community based interventions encourage the members to create a change in themselves and the society. It motivates partnerships of bigger organizations to collaborate in terms of functioning and resources to provide healthier life for the people. It breaks the vicious cycle of dependency. The community functions for the people, by the people. This intervention is more beneficial because the active participation by the community people allow them to understand the health risking behaviors, elements and issues. Their active participation in the intervention makes them realize the hazards they face if they do not drop health risking activities. Moreover, awareness about the dreadful diseases, incidents and issues motivates them not only to prevent themselves but also their families. This awareness, which takes a long time and requires some great hard work to achieve, is accessible by such intervention. The results of these interventions are far reaching and the awareness developed by them is more beneficial in terms of knowledgeableness than the awareness created using other strategies. The masses of population benefit from active participation in these interventions as they develop awareness about their rights and needs, get a comprehensive idea about healthy living, practically observe health care measures and evaluate the factors to attain a healthy lifestyle. Such interventions encourage decentralized management and provide a limited power and authority to every individual in order to carry out their duties as set out in the intervention planning. These interventions also change the attitude of government authorities with the community members are both have to work in collaboration and make a positive change in the attitudes of the people. It eradicates the negative perceptions about the governments and creates a peaceful and more helpful technique to work against the unhealthy or life risking patterns that prevail in the society. Community Based Interventions in EMR: The following community based interventions are introduced by the World Health Organization for the Eastern Mediterranean Region. Basic Development Needs approach (BDN), Healthy Villages Program (HVP), Healthy Neighborhood Program (HNP), Healthy Cities Program (HCP), Women in Health and Development Isfahan Healthy Heart Program Nizwa Healthy Lifestyle Project In order to justify the credibility of these interventions, the examples of Isfahan Healthy Heart Program and Nizwa Healthy Lifestyle Project worth mentioning here. Isfahan Healthy Heart Program was proposed for the Islamic Republic of Iran, whereas, Nizwa Healthy Lifestyle Project was proposed for the Sultanate of Oman. Isfahan Healthy Heart Program: Isfahan Healthy Heart Program consists of 10 community based interventional projects. These projects are designed and promoted by Isfahan Cardiovascular Research center which works in collaboration with World Health Organization to prevent the EMR from cardiovascular disease and control the existing situation of these diseases. These interventional projects are designed in a 3 phase system and take around 4-5 years for completion. The intervention was planned in a logical manner and research studies were conducted before and after the interventions. Numerous cross-sectional surveys were carried out to analyze the situation before the intervention to evaluate the existing condition, during the intervention to check the progress and performance of intervention and after the intervention to check the success level of interventions. The results showed that daily smoking reduced and daily work out raised in male members of the intervention community, however, less improvement was observed among the female counterparts. Regular exercise habits among the young members increased and the daily smoking patterns among them reduced significantly. Health knowledge and healthy life style information improved during the intervention among general population along with the professional including, doctors, nurses and health trainees. Age, gender, qualification and residence in rural or urban areas created an impact on the behaviors of community members and results varied on the basis of these factors. The overall result of the community based intervention in Islamic Republic of Iran was satisfactory and considerable improvement was observed (Sarrafzadegan et. Al., 2006). Nizwa Healthy Lifestyle Project: The Nizwa healthy lifestyle project was designed to reduce the mortality and morbidity rates in Oman which are connected with non communicable diseases. This project includes several public awareness campaigns and healthy school promotion schemes. These programs and schemes helped promoting health awareness among school children, principals, teachers and also the lower staff. This project emphasized on the promotion of physical exercise needs for the body as a daily routine activity. The emphasis on physical activities helped reducing a number of non communicable diseases promoting factors including obesity, high cholesterol rates, hypertension etc. The project aimed to reduce the preventable risk factors of Non communicable diseases. The project focused on 3 main areas which required careful consideration to reduce the NCDs. These main areas included lack of physical activity, tobacco misuse and unhealthy diet patterns. Results revealed that the physical activity increased by 15% among men and from 27 percent to 42% in women. The rate of overweighed men reduced from 31.9 percent to 25 percent among men and 25.3 percent to 19 percent among women. The obesity trends show a decrease from 8.6 percent to 5.6 percent among men and 17 percent to 11 percent among women (Abdelrahim Belal & Halima, 2009). Challenges associated with intervention: There are several challenges that are associated with community based interventions. One of the most crucial challenges that most of community based projects face includes the insufficient amount of skilled workers. Community based practices involve a huge population in the relevant work and hence require careful planning, implementation, progress and methodologies. Without trained and fully acknowledged staff about the intervention, its motives, its shortcomings and the issues that might occur; the health promotion project may end up creating confusion in the community where that intervention is implemented. In order to take full advantage of community based intervention the staff requires to be trained and qualified. The relevant staff must be aware of their duties and authority. There is a need of leadership skills, teamwork experience and patience to work in collaboration in the main staff that is responsible for the direction and management of the teams. These interventions promote preventions and early discontinuation of harmful activities rather than waiting for the actual health issue to arise and curing it afterwards. These interventions are basically designed to take a long term benefit by increasing awareness about the health risking factors among a massive population. The low priority given to prevention in health systems makes it difficult to implement such strategies and benefit from them for a long time. In addition, another fundamental barrier in the way to success is the continuously changing social and economic environment in the community. Community based interventions generally require government approval to carry out such a project on a country level. This requirement makes the procedure difficult and time consuming. Financial planning is very crucial in this type of projects as failure to provide funds during the intervention may discontinue the whole project and the total benefits achieved may be wasted. In addition, failure to continue community based interventions would discourage all the active participants from the society and the results might get more devastating than before. People do not generally trust such interventions and do not cooperate that easily. Hence, after completing half of the efforts and persuading people to participate it would be a great loss to discontinue the intervention due to insufficiency of funds. If we look at the complications that arose while implementing Nizwa we find out that there was a lack of trained staff. With a limited availability of human resources it was difficult to carry out the tasks as the manpower is mandatory in such interventions. In addition, there was a delay in starting the projects (i.e. from 2001 to 2004) due to legal requirements and government approval. There was an unavailability of reference area for the project. The design of the projects and evaluation strategies required more concentration and experienced workers to be acquired. Tackling the Challenges: In order to tackle with these challenges, there are several steps to be followed. In order to be self sufficient in trained and well qualified staff there is a need to start training campaigns before implementing such interventions. However, this step may create a new challenge to tackle, which is the costs of training campaigns. These costs should be included in the financial funds planning for the intervention. In order to increase the awareness of prevention as a better solution to the health problems, the governments must include these prevention strategies in their health plan. Those who are planning a community based intervention must seek help from other health organizations to spread the awareness of prevention as a better strategy than medications. In addition, the people, departments and organizations concerned with these preventive interventions must propose to the governments to collaborate in these projects and must demand for funds to start campaigns through latest media and technologies available. In order to tackle with the financial obstacles a proper financial plan must be designed before proposing it elsewhere. The financial plan must include all necessary expenses and costs that are probable to be incurred throughout the health promotion intervention. These plans must also account for emergency funds and in the absence of required funds they must follow strategies to overcome this shortfall before beginning the intervention. The strategies that may be adopted to tackle such situations include collaboration with other concerned departments, local fund raising from general public and applying for government finances. Strategies to monitor Community Based interventions: The community-based interventions, as described above, involve active community participants, hence the simplest way to monitor the success of such an intervention is by questioning about the intervention from the participants. This can be called as a self report measure (Koepsell, Wagner, Cheadle AC, et al., 1992). Another approach is by obtaining and analyzing data on health measures which do not include participants’ replies. Similarly, non-verbal or objective measures can also be used to assess the effectiveness of such interventions (Mittelmark, Hunt, Heath, et al., 1993). These measures involve physiological tests, observations of clinical endpoints and other interpretation systems. A number of researchers have warned about the credibility of self report measure as they think that the responses may be biased and probably the reactivity to the assessment. On the other hand, some argue that self report measure provide the most efficient results and can be utilized efficiently by assessing a greater number of participants and evaluating the results. If the evaluation involves a few participants then it is probable that the outcomes revealed might be biased and do not provide the true picture of the outcomes that are achieved. A few researchers declare the community based practices as expensive (Syme, 1978) and in particular they criticize the individual level surveys that are required to evaluate and monitor the performance of relevant intervention. Another approach to eliminate this criticism is the evaluation of intervention through environmental or community-level indicators (. Koepsell, Diehr, Cheadle, et al., 1995). These indicators direct towards the evaluation at macro level (i.e. to examine food providers’ reports to evaluate the dietary habits of individuals rather than surveying individuals for their food choices). All these approaches are fundamental and have some pros and cons. However, proper planning and strategies may be adopted to benefit from these approaches. Bibliography: ABDELRAHIM, M BELAL, HALIMA GA. (2009). 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Regional office for the eastern Mediterranean. WHO Regional Office for the Eastern Mediterranean, Statistical database, July 2004. Read More