Analysis of a Health Promotion Intervention

This essay will provide an analysis of a Health Promotion Intervention primarily utilizing an Educational Approach in tackling the health issue of Cannabis misuse. Health needs assessment will be done for cannabis misuse providing significant explanations of epidemiological, demographic data and trends, analysis will be made of the HP activity in raising the awareness of abusing the prohibited substance, elaborating research activities in relation to the HP approach used, an evaluation of the health promotion activity will be discussed, emphasis regarding health promotion is an important part of the role of the nurse and particularly in relation to the health issue will be elaborated in this paper.

Health Needs Assessment

The Health Issue

Cannabis Misuse is considered a Global health Issue as such psychoactive substance particularly abusing the use of the said drug do poses a significant threat to health, social and economic fabric of families, communities and nations in general. WHO proposed that Illegal drug use inflicts its mortality problem earliest in an individual’s life. Cannabis is a generic term used to denote the several psychoactive (change how the brain works) preparations of the plant Cannabis sativa made from parts of the cannabis plant it’s a naturally occurring drug (WHO, 2006). The extent of worldwide psychoactive substance use is estimated at 185 million drug users (WHO, 2010). Cannabis misuse leads to numerous health crises as WHO reported that it is a mild sedative which often can cause a chilled out feeling or actual sleepiness and the said substance is a mild hallucinogen wherein an individual may experience a state of seeing objects and reality in very a distorted way. In addition to this, WHO proposed that there is also wealth of evidence linking cannabis with mental health problems including psychosis and Schizophrenia.

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The Epidemiological, demographic data and trends

Global epidemiology

Cannabis is by far the most widely nurtured, trafficked and abused illicit drug. Half of all drug seizures worldwide are cannabis seizures (WHO, 2006). The geographical spread of those seizures is also global, covering practically every country of the world. About 147 million people, 2.5% of the world population, consume cannabis (annual prevalence). In 21 countries that were surveyed in the western part of the WHO European Region, cannabis has been reported as the most used illicit drug by the general public (WHO, 2009). WHO proposed that in the present decade, cannabis abuse has grown more rapidly than cocaine and opiate abuse, and cannabis has become more closely linked to youth culture and the age of initiation is usually lower than for other drugs.

UK epidemiology and demography

Cannabis misuse of youths in the UK is increasing in number as reports on the results of the 2008 Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS) suggested facts.  SALSUS is the most recent of a series of school surveys used to monitor and measure specifically the abuse of drugs among young people in Scotland. By far the most common drug taken was cannabis and twenty per cent of 16 year olds reported they had used drugs in the last year and 13% of 16 year olds reported that they had used drugs in the last month (SALSUS, 2008). The survey was completed by over 10,000 students aged 16 years old across Scotland. In the other hand Drug misuse among young adults in England and Wales Cannabis remains the drug most likely to be used by young people; 18.7% of respondents aged 16-24 had used cannabis in the last year of 2008/09 (NHS Information Centre, 2009). The most recent British Crime Survey (BCS) report 8.2% aged between the ages of 16-59 in England, and Wales reported using cannabis in 2006/07. 2.4% admitted use in a month preceding the survey.

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Philippine epidemiology and demography

Drug addiction in the Philippines is a mounting problem although it is one that the Philippine government is trying to seize and take hold of. Drug addiction in the country has increased at alarming rates the Anti-Narcotics Group of the Philippine National Police disclosed that around 1.8 million of the 80 million Filipinos were regular drug users. In nationwide surveys and statistics reveals that most of the drug users in the Philippines are young people (Philippine Drug Enforcement Agency, 2009). Illicit drugs that are present include marijuana (the common term for cannabis), LSD, opiates, and barbiturates while there are no hard fast statistics available, it is estimated that as many as 60,000 young people in the Philippines are dealing with drug addiction as surveyed by the Philippine National Police recently. PNP disclosed that about 70 percent of marijuana supply in the world might be coming from the Cordillera region in northern Luzon, it claimed that marijuana fields have been found among the 300,000 hectares of Cordillera farmlands in the past (PNP, 2010).

The Target group

WHO reported that Cannabis misuse has become more closely linked to youth culture and the age of initiation is usually lower than for other drugs. Some teens may feel the need to use cannabis or marijuana to help these youths escape from problems at home, at school, or with friends (National Institute of Drug Abuse, 2010). SALSUS reported that by far the most common drug taken was cannabis by young people in Scotland starting from the age of 16.  In line with the accumulated statistics the health promoters rule out that the target group in need of health promotion starts from the ages of 12-15 in the UK, perhaps this health promotion is needed in the Philippines but considering the fact that there is no hard statistics or strong evidence of specific Cannabis misuse within the chosen age group, it would be realistic to hold the health promotion activity in the UK. This has been the chosen target group because as what

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statistics shows that the starting age of cannabis misuse are those in the age group 16 to 19 years, and such current use is generally higher.for the purpose of prevention the earlier the youths will be educated the lesser incidence of misuse will occur. The health promoters presumed that this age group health needs is great and has high probability to stay unmet if health education isn’t provided earlier on.

The Policies and Strategies

UK Health Policies and Strategies

On the 26th of January, 2010 cannabis was reclassified by the Department of Health up from a Class C drug to a Class B which means that there are more strict penalties for such possession. An independent expert group that advises Government, the Advisory Council on the Misuse of Drugs (ACMD) not long reviewed the most up-to-date information of the effects and specific disadvantages of cannabis use and made a number of recommendations. ACMD reported that for ages between 10 and 17 and caught with even a small amount of cannabis the police will take action. The cannabis possessed is confiscated and the police are likely to: reprimand if it is the first time being caught possessing such drug, parents of the young offender will be informed. Give the offender a final warning and be referred to a Youth Offending Team if it is the second time the individual is being caught. The user will be arrested if it’s the third time that could lead to a conviction and a criminal record.

Philippines Policy

In line with the global health policy for adolescents and youth, the Philippine Department of Health established the Adolescent and Youth Health and Development Program (AYHDP). The DOH, with the involvement of other line agencies, partners from the medical discipline, Non

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Government Organizations (NGOs) and donor agencies have developed a policy on adolescent and youth health as well as corresponding guidelines and service protocol to ensure young peoples’ health needs are given attention and awareness the AYHDP shall mainly focus on addressing the following health concerns regardless of their sex, race and socioeconomic background: Mental Health Substance use and abuse (DOH, 2006). DOH proposed that early education and information sharing for adolescents and service information providers: the parents, teachers, communities, health staff, media and NGOs on adolescent health concerns and intensified responsive counseling services geared towards adolescent health shall be done. This aims to increase knowledge and understanding of a particular health issue, and with the explicit intention of motivating the young people to adopt healthy behavior and to prevent health hazards such as substance use / abuse, violent behavior. The Philippine Government however further declared the policy of the State the Comprehensive Dangerous Drug Act of 2002 to provide effective mechanisms or measures to re-integrate into society individuals who have been victims to drug abuse or dangerous drug dependence through sustainable programs of treatment and rehabilitation.

Global Strategies

WHO seeks through its publications to support national health strategies and address the most pressing public health concerns of populations worldwide. The Department of Substance Abuse was merged with the Department of Mental Health to form the Department of Mental Health and Substance Abuse, reflecting the many common approaches of management of mental health and substance use disorders (WHO, 2010). WHO advocated that the Management of Substance Abuse Team is concerned with the management of problems related to the use of all psychoactive substances. It emphasizes the development, evaluation of cost-effective interventions for substance use disorders as well as the generation, and dissemination of

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scientific information on substance use and dependence, their health and social consequences (WHO, 2010). It assists countries in promoting and capacity building for the prevention and management of substance abuse disorders in all vulnerable groups.

Cannabis misuse is a huge public health issue as the Philippine Drug Enforcement Agency stated that in the Philippine context three major activities related to illegal drugs are considered as major threats include cultivation, manufacturing and trafficking. Although there is and increasing trend in the price of Marijuana (cannabis) it is still much cheaper compared to other illicit drugs such as shabu and cocaine due to its availability in the market (PDEA, 2009). Cannabis appears to be price-inelastic in the short term, but fairly elastic over the longer term, presumably with such affordability drives individual to dwell an addiction of such prohibited drug. WHO advocated that the most rapid growth in cannabis abuse since the 1960s has been in developed countries in North America, Western Europe and Australia, half of all drug seizures worldwide are cannabis seizures. The geographical spread of those seizures is also global, covering practically every country of the world, an analysis of cannabis markets shows that low prices coincide with high levels of abuse, and vice versa (WHO, 2009). WHO proposed that though the number of cannabis consumers is greater than opiate and cocaine consumers, the lower prices of cannabis mean that, in economic terms, the cannabis market is much smaller than the opiate or cocaine market. Taking into consideration the reports of WHO it can be ruled out that due to the cheap cost of cannabis as hugely marketed worldwide everyone can afford to use it, there is greater possibility of access for such prohibited drug.

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A need is something people want or something that is lacking in comparison to others (Naidoo & Wills, 2002). The health promoters have identified a NORMATIVE type of need in initiating this health promotion activity. Bradshaw (1972) advocates that normative need is what the expert defines as need in any given situation. This is especially true of normative needs

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assessment where professionals are involved in assessing an individual’s needs. It is statistically significant that Drug abuse in general is a huge global problem that long has been lurking in the society, in order to prevent the increase of users and raise awareness to the younger generation the Health promoters considers the need of a health promotion activity for the youth. Bradshaw’s classification propose that some categories are consistent with the traditional approach to service delivery which is a top-down model, controlled by professionals and allows little participation of the assessed groups in defining real needs or deciding the solutions. In Normative need it is in no sense absolute and is likely to vary as standards of living change, as knowledge develops and as political values evolve, often a desirable standard is laid down and compared with the standard that actually exist (Popay et. Al. 2004: 46). The justification of the Health promoters for using this normative needs approach is the assumption that “professionals may be better equipped that recipients to assess the needs in a particular situation and the local people do not always realize that they might benefit from certain healthcare services” (Robinson et al 2002: 42).

Analysis of the HP activity

The Health promoters chose Educational Approach as health a promotion strategy for the chosen target group. Educational Approach equips the individuals with knowledge to make well informed decisions uses information giving and attitude exploration (Ewles and Simnett, 2003). Health Education is indeed a process of passing down accumulated information from one generation to the next that which exists in every human society, both past and present. Naidoo stated that change of behavior of a learner have become linked with very different policies and approaches to health promotion. The behavior which focuses on individual lifestyles has informed much of health education because it suggests that information, advice can change behaviors such as drug abuse, smoking or sexual activity (Naidoo et. al, 2002).

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Education has been and continues to be used for many aims and intent, chief among them being the creation of an educated citizenry, the empowerment of that citizenry, and improvement of the individual, and the nation as a whole (Ewles and Simnett, 2003).

The main philosophical and practical thrust of the Health of the Nation is much more consistent with a traditional model of health Education (WHO, 2006). The health promoters chose Educational Approach which is appropriate for the health subject which is the Awareness of Cannabis Misuse and the target group with the age bracket of 12-15. The youth learner presents a unique dynamic to the learning environment (Gilbert et. al., 2008).Tones advocated that Health education is any intentional activity that is designed to achieve health or illness related learning, some relatively permanent change in an individual’s capability or disposition. It is common knowledge that individuals process information in different ways. Youths are visual learners which mean that learning is best by seeing (Gilbert et. al., 2008). This type of learners uses cues from the body language and facial expressions of others to fully understand the subject matter. These learners under such specific age group learn best from visual displays such as handouts, illustrations (Gamlin et. al. 2007). Effective health education may thus produce changes in understanding; it may influence values and bring about shift in attitude and lifestyle (Tones et. al, 2003).

In utilizing an Educational approach for health promotion there are strengths that can be considered, one is that it “empowers the individual through education as the person can use that knowledge and listeners can make informed choices and decisions regarding their own personal health for the better (Gilbert et. Al.,2008). This allows the individual to become self-sufficient. Another advantage is that with this approach in Health Education enables people the ability and resources to improve and control their overall health (Gilbert et. al., 2008), allowing an individual to have the freedom to make own choices as well as taking back control regarding their own

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health and well being. Being able to adjust and adapt to various social and physical environments in day-to-day activities is a trait of a healthy individual (Ewles and Simnett, 2003). In the other hand the weakness of this approach is that generation at the age of 12-15 are being labelled as having short attention spans (Ewles and Simnett, 2003). In This digest health promoters should investigate ways in which the learning characteristics of the young adults classified as Generation X reflect the need for the new teaching and learning strategies. This is promoted by effective teachers, such as learning in context, cooperative learning, and real-world application of knowledge (Gilbert et. al., 2008). Health educators should be very dynamic and seek for means to effectively convey the message to the youth listeners (Ewles and Simnett, 2003). Therefore health promotion becomes an issue for each individual and policy makers among others because issues such as safety and environmental factors will have an influence on the well-being of every healthcare consumer (WHO, 2006). It is crucially important that health promoters should be aware of ethical issues, health demoting factors and grabs opportunity to consider such in relation to the HP work, particularly engaging in Health education with the very aim of changing individual lifestyles (Gilbert et. al., 2008).

Controversy regarding the war on drugs worldwide today is raging. Drug abuse in general has become a growing concern for parents, educators, and policy makers. There is no question that education can play a major role in decreasing the drug problem. The health promoters were able to find Qualitative research evidence which discusses the importance of early Health education in raising awareness of cannabis misuse. The title of this research is Swiss adolescents’ and adults’ perceptions of cannabis use. This research journal utilized Swiss focus group discussions with four categories of stakeholders which includes 13 younger (12-15 year old) adolescents, 19 older (16-19 year old) adolescents, 8 parents of teenagers and 13 professionals working with young people. The Results of the research study are as follows: All

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four groups settled in the idea that even though a political decision regarding decriminalization was pending (it has since then been rejected), cannabis use and sale was in reality tolerated in several parts of the country. Also, there was a agreement, both among the majority of teenagers and adults, the access to cannabis by young adolescents should be prohibited and actively enforced, even though many adolescents recognized that this was not presently the case. Along the same line, younger and older adolescents asked for preventive interventions which should begin earlier, around 12-15 years of age. (Menghrajani, Klaue, Dubois-Arber and Michaud, 2004).

The Health promoters come up with the Aims for this HP strategy which is to raise awareness about the misuse of Cannabis and its negative effects to young adults ages 16-24 in the UK. Co the Objectives for this HP intervention is that at the end of the teaching session, the participants will be able to: explain what is cannabis, enumerate at least 2 adverse effects of cannabis misuse, Identify the penalties imposed by authorities regarding misuse aging 16-24. The health promoters come up with a short term goal that this Health teaching will raise awareness to 5-10 secondary schools in the UK within the time frame of six months and decreasing the school statistics of the number youths using the prohibited drugs.

This Health Education will be done by utilizing the methods of lecture discussion, Comic books, leaflets and media all of this will be used y the Health promoters as tools to convey the message to the specific target group. Progress towards better health for all also demands the global dissemination and exchange of information by utilizing leaflets and media (WHO, 2006). The affects of media will vary with a child’s age and stage of development (Gamlin et. al. 2007). A comic book is an effective tool for health promotion communication strategies that would promote and support dialogue of intended beneficiaries in all health matters (DOH Philippines, 2006). Address emerging issues as well as controversial and sensitive issues in a manner that

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respects the Rights of the individual and/or community including cultural beliefs and values (Tones et. al., 2005).

Evaluation

The possible method for evaluating the health promotion activity is through provision of questionnaires that will be handed each to the target health group, surveys can be accumulated from the questionnaires. The ultimate pursuit is to develop evaluation programmes that give accurate and reliable information (Gamlin et. al., 2007). There are several methods of obtaining views of the public at large from informal discussions, large scale surveys using questionnaires (Ewles and Simnett, 2003). Ewles proposed that Identifying priority groups and thinking clearly about them will influence the choice of methods used to involve the group. Considering the group with the age of 12-15 the health promoters find it relevant to utilize questionnaire in evaluating the HP activity.

The appropriate type of evaluation for this Health promotion strategy which is the Educational Approach through health teaching the Health promoters will provide questionnaires to further assess the knowledge and significant information imparted to the participants. Questionnaires gauge the knowledge gained by the listeners through health education this are well accepted and operationally practical, and are faster and are non expensive than standard diagnoses (Gilbert, 2008). Surveys and questionnaires allow the health educator to collect information for a large sample of the population (Tones et. al., 2005). Thus using this questionnaires will allow the health promoters to understand directly the group’s perception of drug abuse, from which this would gather active participation of parents and youths primarily, this represent a first step towards involving the community in control activities (Tones et. al., 2005). It is expected that the group who attended the Health Education will be able to participate the evaluation process.

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The objectives of the health promoters are as follows: explain what Cannabis is, List at least 2 adverse effects of cannabis misuse, and identify the penalties imposed by authorities regarding misuse aging 16-24. By using the Questionnaire it enables to gauge the information gathered by the target group and this will assess if the participants were able to understand the health teaching. Changes in knowledge or attitude can be assessed by written tests or questionnaires that require clients to answer questions about what they know (Ewles and Simnett, 2003). The results can be compared with those of tests taken before the health promotion activity. Development of questionnaires will give the health promoters the idea of how cannabis misuse is perceived by individuals and communities.

The method used to convey the message to the listeners is through Lecture discussion. The Lecture is a special form of communication in which voice, gesture, movement, facial expression, and eye contact can either complement or detract from the content (Farmer & Lawrenson, 2004). Farmer suggested that whatever the topic is, the delivery and way of speaking immeasurably persuade the listeners’ attentiveness and influence learning. To capture and hold the target group’s interest and increase retention the lecture discussion must be addressed in simple words to particularly with the target group of listeners aging from 12 to 15. Students’ learn and understand a concept better if guided toward it. Many are prevented from understanding the material and cannot further develop ideas about the material being taught if not thoroughly explained at the level of one’s understanding (Gilbert, 2008). The whole purpose of health teaching is to develop an individual’s understanding of a concept (Gamlin, et. al., 2007). For that reason, learner- centered instruction is an effective way in a lecture discussion.

The equipments in addressing the health teaching are the media, leaflets and comic books. The MEDIA has been a widespread creation throughout the decades. Barbour proposed that as time passed the media advanced from magazines to the television to the internet, media

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in the society is everywhere. The media is the means of communication that reaches or influence people thus developing technology allows people to do almost everything (Barbour, 2008). Nowadays, people are living in a world ‘inundated by media sounds and images. LEAFLETS are one of the equipment used for the health promotion activity, many end product s are designed to achieve an intuitive response from the readers. The evident purpose of both leaflets is to try and give accurate information about drug use and try to prevent it (Wills, 2007). Undermine all the generic resolutions so that the leaflets are in some way deliver the idea of the advantages and negative health effects of drug abuse (Barbour, 2008). As the reader registers them subliminally leaflets are very effective an example of leaflets used by the Philippine Drug Enforcement Agency 2009 is the ‘Drugs the Facts’ leaflets which has a target reader of around 12-18. The institutional belief held behind the writers about the readers is that the writers do not exploit drug use, and this topic is new to the reader of this leaflet (PDEA, 2009). PDEA proposed that the said leaflet is created to forewarn readers of the peril one could be in when the individual take drugs. Therefore the agency has produced the leaflet that it advises and raises the awareness of the youths to stay away from drugs and never come into contact with these prohibited substance. COMIC BOOKS are considered as effective equipment by the health promoters in gathering the attention of the listeners. In the same line of thought, one of the great things about comic books is that it can teach a reader a lot of things whether it is about deep things or facts that one does not know it broadens a person’s horizon (Katz et. al., 2002).

Health education and health promotion are both visualized upon the notion that various behaviours which may affect health status are susceptible to planned change (Katz et. al.,2002). While it is apparent that a great deal of behavioural change occurs, little information is available about self-initiated changes in health-related behaviour. The health education professional is not

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longer facing the old paradigm. The paradigm has change do to a learners’ education is an evolving and expanding field (Gamlin, 2007). For this reason, those in the health education position will have an enhanced understanding of the role and responsibility of an educator. However, knowing the responsibility and role of a health educator is an advantage in understanding how the role human behaviour plays in the health education profession (Wills, 2007).

The short term goal of this HP activity is that through this Health teaching it will raise awareness of 5-10 secondary schools in the UK within the time frame of six months and expectedly decreasing the school statistics of the number of youths using the prohibited drugs. The HP activity goal could be evaluated by launching a survey and coming up statistics assessing if the number of young drug abusers have increased or decreased six months after the health teaching. Teaching the youths should be approached in a different way (Popay et. al.,2004). The assumption that teachers of adults should use a different style of teaching is based on the widely espoused theory which suggests that “youths’ expect learner- centred settings where they can set their own goals and organize their own learning around their present life needs” (Gamlin, et. al., 2007 ). suggested that in the field of adolescent education is essentially the same process as education generally and therefore does not require a separate teaching approach: that is, all good teaching, whether for adults or adolescents, should be responsive in nature. The implication of the used strategy in health education is the significance for perception of the process of behavioural change.

Health promotion and role of nurse

Cannabis misuse of the younger generation is an alarming issue which needs an effective health promotion activity together with the knowledge of the health care professionals

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particularly the nurses. The effectiveness of the health promotion depends on the communication skills, creativity, teaching skills, and critical thinking skills of the Health promoters (Farmer & Lawrenson, 2005). Nurses have important roles in disseminating the information regarding the negative effects of cannabis misuse, considering the fact that these health professionals are responsible in the rehabilitation of drug users “A public health nurse is a nurse who works to advocate and protect the health of an entire population” (Katz et. al., 2006). The requirements for the nurse and the health promoters in tackling this health issue include the ability to exercise independent judgment, planning and able to dispense safe and effective public nursing care (Katz et. al., 2006). Farmer proposed that nursed should able to act effectively with individuals and families to assist them in the satisfactory solution of health problem (drug abuse), by recognizing and respecting of different cultural, ethnic and difference on health care practices. The nurse is also required to know prevention of drug abuse such as, several techniques on teaching, counseling, interviewing and resources available (Farmer & Lawrenson, 2005).

Conclusion

This essay provided an analysis of a Health Promotion Intervention primarily the health promoters utilized an Educational Approach in tackling the health issue of Cannabis misuse. Health needs assessment was done for cannabis misuse significant explanations of epidemiological, demographic data and trends were provided, analysis were made of the HP activity in raising the awareness of abusing the prohibited substance, research activities were elaborated in relation to the HP approach used, an evaluation of the health promotion activity was discussed, emphasis was made regarding health promotion an important part of the role of the nurse and particularly in relation to the health issue was elaborated in this paper. This essay enabled the health promoters to plan accordingly the health promotion activity, assessing the

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best strategy to convey the relevance of the information to the young listeners and gauge the success of the health teaching with the use of proper evaluation process.

SOURCES:

Boreham, R. and Blenkinsop, S. (2004). Drug use, smoking and drinking among young people in England. NatCen: England.

Bradshaw, J. (1972): The Taxonomy of Social need. In G McLachlan (ed.), Problems and Progress of Medical Care , Oxford: Oxford University Press

Department of Health. (2003). Statistic on young people and drug misuse: England, 2003. Retrieved September 08, 2010 from http://www.dh.gov.uk/prod_consum_dh/groups/dh