The Economically Disadvantaged Communities - Essay Example

Program Outline for Promoting Health in Economically Disadvantaged Communities NURS 434 Community Health Promotion Assignment 4 August 22, 2006 FarahYukeni Athabasca University (AU number 2622078) Abstract The objective is the development of a project outline for a health promotion program in an economically disadvantaged community. Such programs have their utility in creating a more equitable health among the communities of a nation, and also contribute towards making the communities more economically productive. Community ZZ in Alberta is the selected economically disadvantaged community selected. Using the theoretical frameworks of Ewles and Simnet’s 7 Stages and Green and Kreuter’s Precede-Proceed a theoretical basis for the program is laid. The program outline calls for identification of the current health status of the community, so that the objectives of the program could be set. There are four phases identified in the program outline. Nutritional aspects are identified as the means to improve the health of the community as a whole. The roles of the community health personnel in the program are discussed. The stress is on the role of the community nurse, as the community nurse is required to play several roles, each of which is vital to the successful outcome of the program. In this manner the various aspects that go into the development of a program for improving the health of communities, as a part of efficient public health are discussed in the formulation of the program outline. 1. Objective: The objective is to develop a program outline for promoting health in an economically disadvantaged community. In the process goals and objectives to encourage better health in the economically disadvantaged community would be identified. In addition two frameworks or models that influence community change towards the identified goals and objectives would be evaluated. Finally the role of the community health service worker in facilitating the program goals and objectives of health promotion in the economically disadvantaged community would be evaluated. 2. Relevance: Promotion of health in disadvantaged communities is becoming more relevant, as disadvantaged communities around the world are on the increase, and found to have very poor health parameters in comparison to their more prosperous counterparts (Heath & Haines, 2000). Therefore, for two reasons it becomes important that efforts be directed at disadvantaged communities to increase health awareness, and better health parameters. The first reason is that societal equality norms demand that these communities not be left out in the advantages that developments of science and technology have given humankind in the understanding of the nature of diseases and conditions, and the means to combat them. The second reason is that poor health parameters in these disadvantaged communities reduce their ability to contribute to the prosperity of any nation. Recognizing this, the World Health Organization (WHO) has played a significant role in articulating and promoting new public health. Since the 1970s the WHO has provided a substantial international forum for promoting the broad concept of ‘Health For All’, which has provided the momentum, and popularity in reaching health to all communities (O’Connor-Fleming & Parker, 2001). 3. Introduction: Community ZZ in Alberta has been identified as an economically disadvantaged community, because the community consists of low wage earners. This economic backwardness could lead to unsatisfactory health conditions in the community, despite their desire for better health. This community has been selected as the target for developing a program. Nutrition plays a significant role in the health condition of an economically disadvantaged community. The persistence of nutritional deficiencies leads to many chronic conditions and diseases in such communities. Interventions targeted at reducing nutritional deficiencies, lower the incidence, as well as the intensity of these conditions and diseases in these communities (Wahlqvist, 2004). Keeping this in view the program outline proposes targeting improved nutrition as the means to improve the health condition in this economically disadvantaged community. 4. Theoretical Framework for the Program Outline: The Precede-Proceed framework provides the means for identifying factors that influence people’s decisions and actions. Utilizing this information helps to develop the appropriate programs for behavior-changing interventions. According to this framework, three specific types of factors - predisposing, enabling, and reinforcing factors, influence health. Predisposing factors are those that can motivate or block a persons motivation to change. These would be their knowledge about matters of life and the beliefs, values and attitudes that they were raised with. Enabling factors are those that can sustain or deter a persons efforts to create the desired behaviour change, and include skills, resources, and barriers. Reinforcing factors are those that can promote or dampen extension of the desired behaviour that was created (Gold et al., 1997). 4.1. Comparing Ewles and Simnet’s 7 Stages & Green and Kreuter’s Precede-Proceed as Theoretical Frameworks for the Program Outline: According to O’Connor-Fleming & Parker (2001), both frameworks provide the basic identification of a particular need. In this case, both models would identify Community ZZ’s need for better nutritional practice, and the improvement of their nutritional food intake would lead to uplift of their current status. Both frameworks also denote the importance of setting goals and aims for the program. This would provide the basis of the program and identify the starting point of the program. Both models stress the importance of the identification of the method suitable for a particular need. However, Ewles and Simnet’s model does not provide detailed methods of needs assessment to identify consumer needs, nor does it make provide clarity for the various components of a ‘need’. The authors also note that Ewles and Simnet’s model does not confirm whether epidemiological evidence is important in the needs identification process, while Green and Kreuter stress on the identification of epidemiological evidence. The Ewles and Simnet 7 Stages identifies three educational objectives comprising of the Cognitive, which would include knowledge and know-how, the Affective, which includes the beliefs and values that dominate the individual, and the Behavioural, which includes the skills by which the community members learn or acquire during the process. The Ewles and Simnet 7 Stage model goes on to state that it is seldom that the cognitive domain of the model is used. It is the affective and the behavioural combination of objectives that are employed. An example of such use would be, a person trying to quit taking drugs. The affective and behavioural combination could cause him to turn away from people, who would/could influence him into resuming the habit, and such an individual would require professional help for resolution of the particular problem. The main strength of the Kreuters’ Precede-Proceed model is that it recognizes the various points for improvement of health, and its promotion. An example of this is in a community, which has more of its members sick with lung diseases, the model allows in depth analysis of the community, and its environment, leading to identification of the possible causes through the careful study of the community, and the interviews of the members of the community, all of which form a part of the detailed analysis of the community. Lung diseases or its proliferation in communities could be caused by lack of trees in the surrounding, congestion due to crowded living conditions, and the presence of pollutants due to heavy volume of traffic resulting on high emission of poisonous gases and the like. No factor is taken for granted, and the model examines all possible means that have lead to the particular health issue. Thus the model requires that all impacting factors be taken into consideration, while formulating a health program targeted at a specific health issue. Applying both frameworks for the promotion of health in Community ZZ leads to almost similar results in the formulation of the program. The Kreuters’ Precede-Proceed model offers better clarity for the implementation of program. The two theoretical frameworks call for identifying and assessing the objective and goals for the program. Once this has been done then the appropriate time frame for either the perceived solution, as a whole, or the initial segment of the perceived solution is decided on. Then the strategies to be utilized for the successful outcome of the program are decided. In the case of Community ZZ’s, which is a predominantly poor community, strategies employed could include creating awareness that nutrition doesn’t necessarily imply excessive expenditure. Influential members of the community could be persuaded to follow inexpensive nutritionally healthy diets, to act as examples for other community members to follow (O’Connor-Fleming & Parker, 2001). 5. Program Outline: The timeline set for the program is twelve to eighteen months. Within this time frame the objective of the program is to minimize the health issues of the economically disadvantaged community. Over this period the community health office, and the community health service workers would be involved in the meeting this objective of the program. The objectives for the program activity are steeped in the suggestions of Bunton, et al (1995). The authors have suggested that the aim of public policy initiatives should be to promote health, and it should be more geared to add life to year, by enabling as many people as possible to remain healthy, and active throughout their lives; to multiply health life by reducing the occurrence of illness and accidents; and to add years to life by increasing the average life expectancy of the individual. In order to do achieve these objectives an examination of how the members of the community live must be studied. Do they spend most of their time in work, and do they experience stress-free environment at home? Is there a certain kind of physical activity that encourages members of the community to use it as a form of exercise? Are they using healthy diets? The answers to these questions provide clues to the levels of healthy lifestyles within the community (Bunton, et al., 1995). Environmental factors, as well as behavioural factors have an impact on the health issues and the quality of life issues. Identifying the factors that have a significant impact on the health levels of the community, and prioritising them in order of importance, assists in the sequence with which they need to be addressed (Green & Kreuter 1991). In low-income communities, it would be is difficult to find even half of the prerequisites of a healthy lifestyle. Since these people are poor, they are beleaguered with problems pertaining to finances. Their focus is on the acquiring food with minimal considerations for its nutrition value. The stress levels in the community are bound to be high, and there will be no consideration for any form of exercise, especially if it involves expenditure. Nutrition is possible from food items that are economical, and thus it would be possible to create dietary awareness that would enable the community members to have a nutritious diet without enhancing expenses on food. By increasing nutrition levels in the community many of the health issues related to diseases and conditions would be reduced. (Wahlqvist, 2004). Community ZZ could well be a predominantly rural community, as it is located in Alberta. It now becomes important to assess the environmental facilities that are available to the community, to aid in the nutritional objectives of the program. This could be in the form of arable land, or any other resource that becomes a tool for improving their current level of nutrition. If most people in the community are farmers, they could be encouraged into planting extra vegetables in the community garden, or creating one for the community. It is also important to make a note of the fiscal matters that would be involved in the community health program. The government could provide sufficient assistance, or insufficient support to the program. The community must be made aware of which parts of the program priority should be given, so as not to waste the opportunity, the time, and especially the resources which could be limited. 5.1. First Phase of the Program: The first phase of the program would involve collection of all pertinent information on the current status of the community. This would require immersion into the community, and as part of the community, the concerned community nurse would study the habits, lifestyles, and cultural beliefs, values, and idiosyncrasies, and the impact of these factors on the health behavior of the community. Health assessment of the community would also form part of the information collection endeavor. These health assessments would come from visits of homes and schools in the community. Interviews of as many different members of the community with emphasis on the prominent leaders and members of the community would also form part of the health assessment data collection effort. The third important activity in the first phase would be trying to make as many members of the community aware of the program. Such activity at the initial stage of the program is expected to provide a better outcome for the program, as it could encourage active participation from most of the community. 5.2. Second Phase of the program: The second phase of the program would consist of collating the field reports for assessment of current status, identification of the existing health problem, and the creation of a preliminary plan of action to resolve the existing health problem. The second stage would also involve intensive information dissemination to aid awareness of the program. 5.3. Third Phase of the Program: The culmination of the second stage sets the tone for the third stage. In the third stage coordination and cooperation of the local government, along with the community leaders and the public health office becomes essential, as the program is initiated in this phase. Budgeting is an important and integral part of this phase, as without funds the program would just not take off. Based on the required plan of action budgets are created for each of the functional aspects, and expenditures that would be incurred with the activity. Budgetary sanctions, allowances, and constraints are introduced into the program. The required qualified manpower is recruited and trained, for the implementation of the program. 5.4. Fourth Phase of the Program: The fourth phase of the program involves the evaluation of the efficiency of the program. The status of origin and destination to be reached are known, and hence the evaluation parameters of the success at the end of the program are not difficult to set. However this is a long journey, and milestones for achievements need to be set at regular intervals for evaluating the progress of the program, and introducing course corrections, in case of any hindrances to the successful progress of the program are encountered. 6. Community Health Personnel Involved in the Program: There are several levels of community health personnel involved in the program. A Community Health Officer works outside of the traditional hospital setting. They focus primarily on developing basic health care systems, so that it can be accessible to populations who currently have little or no access to basic preventive care. They may also work at either the local or federal level to integrate health care systems. They also attempt to create equality in the health care provided to advantaged and disadvantaged populations. In this program, the Community Health Officer would be involved in planning, implementing, coordinating, controlling, and monitoring the program. A community health service worker is knowledgeable and skilled in health promotion/disease prevention, case management, program management, strategic planning, policy development, and is comfortable in working with culturally diverse populations. In the program the community health service workers would be involved in implementing the several phases planned for the program. The community nurses make up the other personnel involved, and play the most significant role in it. Traditionally it has been taken nurses functions are confined to individuals or families. The ever expanding acquiring of skills and capabilities by the nursing profession has made them an integral part of collaborative and strategic health-promoting initiatives that target improving the health conditions of people (Milo, 2002). 7. Role of the Community Nurse: Effecting change, especially in entrenched practices is challenging, and calls for leadership, for successful outcomes to the planned change. The community nurses take up the mantle of leading the health promotional program, and also several other roles for the successful outcome of the program (Weiss & Spiegel, 2005). The first role of the community nurse in creating a health program in Community ZZ is that of a sociologist. In this role the community nurse would attempt to study the living conditions and lifestyles of the members of the community. The community nurse would also identify the current problems that are inherent and created in the community, and those likely to arise in the future. Interviews and surveys, as well as on location look-see operations would be the tools employed by the community nurse in this role. The experiences of children in their homes due to the lack of necessities are reflected linearly in the performance of these children at school (Taras, 1997). Schools in the area would become handy in assessing the performance and behaviour of children, as a result of lack of financial resources at home. Another role of the community nurse in this situation is that of a public relations officer. The community would not be familiar in dealing with people outside their circle. For this role the communication skills of the community nurse becomes important, so that he/she would be able to get her points across to stress relevant issues. The community nurse would also make contact with the community leaders, and institutions that would have an impact on the proposed health program. He/she would aim to gain the trust of the members of the community from the highest level to the lowest level. Alienating members of the Community ZZ would not help in the implementation of the program. The community nurse will need to use the influence of media in communities. There are a lot of things that happen in communities that are directly or indirectly influenced by media. Access to media means that their choices and preferences would be linked to what is dominant in the media. (Macdonald, 1998). Culture, beliefs and values also have impact, and could be influenced by media, directly or indirectly. The community nurse is also the liaison officer of the program. The community members would impress upon the community nurse their problems or grievances, and then he/she would inform those in public offices of the current situation. All information regarding the program to and from the community would go through the appropriate channels, which means from the community leaders to the community nurse, to the public health office, to the city council, and then back again through the same channels. The community nurse would become the advocate for the community. This is because the community nurse is the only member of the program team that has first hand information and experience of the current situation in the community. Thus the community nurse advocates for additional funds or budgets for the health program. In this role he/she utilises the data that has been collected from the community to impress upon the public health office the current health problems of the community that needs the attention of the local government. The community nurse plays the role of the statistician/data analyser also. The community nurse becomes a statistician in terms of analysing the results of all the surveys that are conducted prior to the start of the project. The program proposal is mainly based upon the report that the community nurse submits after he/she collects, collates, and analyses. The community nurse is also the finance officer for the program. This is because the community nurse is the only one that links the community to the public health office where the funds are disbursed. Accounting of the funds disbursed towards the program is important for it reassures the city government that the funds are being utilised towards the program, and more importantly ensures that the scant financial resources are put to good use. Thus the community nurse plays an important and multidimensional role in the program, which is vital for the success of the program. Literary References Bunton, R., Burrows, R., & Nettleton, S. (1995). The Sociology of Health Promotion. Critical Analyses of consumption, Lifestyle, and Risk. Routledge. New York. Gold, W. R., Manning, T., & Street, R. (1997). Health Promotion and Interactive Technology: Theoretical Applications and Future Directions. Lawrence Erlbaum Associates. New Jersey. Green, L.W., & Kreuter, M.W. (1991). Health Promotion Planning: An Education and Environmental Approach, 2nd ed., Mayfield, Mountain View, CA. Heath, I., & Haines, A. (2000). Open Invitation From the International Poverty and Health Network to All Health Professionals. Retrieved October 14, 2006, from Medscape General Medicine, Medscape Today Web site: http://www.medscape.com/viewarticle/408040 Macdonald, T. (1998). Rethinking health promotion: A global approach. Routledge. London. Milo, N. (2002). A new Leadership Role for Nursing in a Globalized World. Retrieved October 14, 2006, from Medscape Today Web site: http://www.medscape.com/viewarticle/421474 O’Connor-Fleming, M. L., & Parker, E. (2001). Health promotion: Principles and practices in the Australian Context. Allen & Unwin, New South Wales. Taras, H.L. (1997). Tap Paediatricians in Your Community as Health Resource. Retrieved August 20, 2006 from School Administrator Web site: http://www.questia.com/PM.qst?a=o&d=5001627768 Wahlqvist, M. L. (2004). Nutrition and prevention of chronic diseases: a unifying eco-nutritional strategy. Nutrition, metabolism, and cardiovascular diseases, 14(1), 1-5. Weiss, D.M., & Spiegel, K. (2005). Advanced Practice Nursing Education: Opening Doors to Community Collaboration. Retrieved October 14, 2006, from Medscape Today Web site: http://www.medscape.com/viewarticle/503779 Read More