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Group name: Anca Manaf, Asmita Ghale, Comfort Kumi, Hannah Cotton, Ma-Myo Thuzar.
This essay attempts to discuss the health promotion activity on the benefit of quitting smoking. The assessment of health need, epidemiology, demography, current national or local health policies, identification of target group, approaches chosen will be discussed. Ultimately, this essay will evaluate the effectiveness of the health promotion activity.
Assessment of health need
Health need assessment (HNA) is an essential component of effective health promotion (Carroll, 2004). According to Cavanagh and Chadwick (2005), HNA is a systematic approach of recognising priority health issues, targeting the populations with the most need and taking actions in the most cost-effective and efficient way. MacDowall, Bonell and Davies (2006) stated, HNA is important for health promotion as it provide an opportunity to engage with specific populations and enable them to contribute to targeted service planning and resource allocation.
Bradshaw (1972) therefore outlines the four main categories of needs; normative need, comparative need, felt need and expressed need. Hence, normative need was the chosen need for the health promotion activity. Consequently, this need was chosen for the health promotion activity as it is based on the opinion and experience of experts according to the current research and findings (Wills, 2011). They will provide advice, evidence based information, provide individual with range of services, techniques and support them throughout the process of quitting (Will, 2011).
Epidemiology and demography, data and trends
The number of smokers over the age of 16 in the UK is reducing, from a high of 45% in 1974 to 21% of men and 20% of women in 2010 (Rutter, 2013). Smoking is most common in those aged under 35; 32% in people aged between 20 and 24, and 27% in those aged 25 to 40 (Lader, 2007). It is least common among people aged 60 and over (Public Health England, 2012). Prevalence of smoking among people in the routine and manual socio-economic group (33%) continues to be higher than amongst those in the managerial and professional group (14%) (Public health England, 2013). In England, 2010-2011, 459,900 of NHS hospital admissions were attributable to smoking among adults aged 35 and over (ASH, 2013). Among pregnant women, smoking prevalence is highest for those under aged 35 (Penn and Owen 2002; Sproston and Primatesta, 2004).
Smoking is the leading cause of preventable deaths and disease in the UK (Cancer Research UK, 2012). About half of all life-long smokers will die prematurely, losing on average 10years of life. Findings has shown that smoking related deaths are from; lung cancer, respiratory disease and circulatory disease (Huffman, 2003). This attributed to; 36% (22,500) of all respiratory deaths, 28% (37,400) of all cancer death and 14% (18,100) of all circulatory disease (Public health England, 2012). In 2011, there were a total of 442,759 deaths of adults aged 35 and over in England of which 79,100 (18%) were estimated to be attributable to smoking (ASH, 2013).
Target group and why health promotion is required
The target group for our health promotion activity is focused on smokers. This is because recent statistics has shown that smokers have a significantly increased risk of avoidable mortality and morbidity compared to non-smokers (Heidrich et al, 2007). Thus, Petrosillo and Cicalini (2011) identified that, the major causes of this excess mortality and morbidity among smokers are diseases that are related to smoking such as; cancer and respiratory and circulatory disease. Therefore, health promotion will be required as it is aimed at raising awareness of the health dangers of smoking and tobacco use, and encouraging smokers to try and quit, doing so in the most effective way (DOH, 2013) by providing motivational advice and support.
Is smoking a public health issue
Smoking is one of the biggest threats to public health, costing more than 120,000 lives per year in the UK (Peto et al, 2004).
Behaviour factors affecting health issue
Research identified ranges of behavioural factors that influence uptake and pattern of smoking (Nichter, 2003). Some of these behavioural factors include; addiction and attitude to smoking.
Being addicted are commonly mentioned reasons for keeping people smoking (Siqueira et al, 2001). People tend to find it difficult to quit smoking because they are addicted to the effects of nicotine addiction. Research reports that smokers who consider themselves to be addicted to nicotine had not expected to become so when they had started smoking (Balch et al, 2004). Furthermore, smokers who have attempted to quit smoking experience withdrawal symptoms including; cravings, difficulty dealing with stressful situations, increased appetite, frustration, irritability and anxiety (Siqueira et al., 2001)
Having more positive attitudes towards smoking has been repeatedly related to an increased risk of smoking (Buller et al, 2003). Smokers have more positive attitudes towards the mental effects, appearance features and are less concerned about negative physical and social consequences.
A recent policy that was relevant to the health promotion activity was developed by DOH in 2013, called reducing smoking. Its stresses that high prices put people off smoking, most especially young people and people on lower incomes. Therefore, the government aims to continue to set tax rates high enough to discourage people from smoking, provide updated guidelines to make it easier for local trading standards and HM Revenue & Customs officers to work in collaboration to enforce the law against fake and smuggled tobacco. The policy also highlighted that the government will continue to run ‘smokefree’ campaigns to encourage people to change their behaviour.
In 2005, the WHO issued a global policy by developing a framework convention on tobacco control, which provides international cooperation to support tobacco control. The initiative of the policy is to protect the present and future generations from the devastating health consequences of tobacco consumption, by providing a framework for tobacco control measures to be implemented worldwide. The tobacco control measures includes; price and tax policies, bans on tobacco advertising, protection from exposure to second-hand smoke, education and public awareness measures, regulation of tobacco product contents and disclosures treatment for tobacco dependence, and measures to combat illicit trade.
Health promotion has been applied to wide range of approaches to improve health of people, communities and populations. Naidoo & Wills (2009) acknowledged that there are five different approaches to health promotion, which are; medical, behavioural change, educational, empowerment and social change. However, the approach chosen, to this health promotion activity was the educational approach. This approach was chosen to provide knowledge and information to the target group on the benefit of quitting smoking, the support available and develop the necessary skills in order to enable them make well-informed and rationale choices about their lifestyles and behaviour (Gottwald & Brown, 2012), through provision of leaflet, visual displays and one-one education. Health belief model (1974) proposed that, people need to have some kind of cue such as; one-one-education, distributing of leaflet, mass media campaign, to take action to change behaviour or make a health-related decision. This information provided will help them explore their values and attitudes and a willingness to change behaviour and lifestyles.
An advantage of educational approach is that, it enables individuals to develop their knowledge and change their attitude (Gottwald & Brown, 2012). However, Naidoo & Wills (2009) expressed that; educational approach can be time consuming and individual may not make healthy choices.
Aims and objectives
The aim for the health promotion activity is to promote smoking cessation by increasing awareness of the benefits of quitting smoking. The SMART objectives were; by the end of this session, the participants will understand three benefits of quitting smoking, be able to name two diseases caused by smoking and be aware of where to get help.
Evaluation is an essential element of systematic programme planning (Timmereck, 2003). It is important to assess whether an activity has met its objectives and find out if method used were appropriate and efficient, as it will give a sense of achievement and help work out ways to improve for future (Raingruber, 2014). Therefore, Naidoo & wills (2009) identified that, there are three stages of evaluation; process, impact and outcome.
Process evaluation involves assessing the activities in the program and quality of the program (Naidoo & Wills, 2009). The group used posters, leaflets, NHS free quitting kits, cigarette timeline, AR lung website and one-one communication to address different learning styles, providing information to the target audience that came to the stand. Findings on learning styles Kolb (1984) has shown that people learn differently, so using a range of styles allow for the use of range of learning experiences to help learners develop a wider repertoire than their usually preferred style ( Bunton & Macdonald, 2002).
The posters were colourful, and clear at first glance, appealing and had catchy slogans to attract the attention of the target group. Koelen, Anne & Ban (2004) suggested that, posters should be eye-catching, appealing and stimulate the viewer to think about the content of the message in order to achieve the desired objectives. Leaflets were distributed to the target audience during the one-one communication and education. According to Koelen, Anne and Ban (2004) leaflet may have a meaningful function following interpersonal communication. This leaflet comprises of information of the health benefits of quitting smoking, advice on how to stop smoking, stop smoking service and getting professional support. Therefore, this will enable them to re-read the information given at own pace and at the moment they have a need for this information.
The NHS free quitting kit was employed by the group of health promoters to the target audience to help them think about reasons for quitting and recognising the triggers that can make them crave cigarettes, improving their chances of quitting successfully. The NHS free quitting helped the target audience work out how much money they will be saving by quitting. The cigarette timeline contained information of the health benefit of quitting smoking and the healing process, that is, what happens in the body when a person stops smoking. The AR lung website was used as a shock tactic to demonstrate to the participants the damage smoking does to their lungs. In addition, the group communicated effectively with the participant, ensuring that the language used was clear, understandable and Jargon free to convey messages (Lehman & Dufrene, 2008).
Impact evaluation involves measuring the immediate effects of the program (Naidoo & Wills, 2009). In measuring the effect of the activity, questionnaires were handed out to the participants to collect immediate feedback and assessed their level of knowledge at the end of the activity (Powell, 2009). It consisted of few questions that assessed the participant’s on their knowledge and understanding of the benefit of quitting smoking. The data collected showed that, 93.3% of the participants were able to name three benefit of quitting smoking. 80% of the participant answered the questions correctly in regards to diseases caused by smoking. 40% of the participant knew the three available services of helping people to quit smoking.
100% thought the activity was very useful; however, this may not be accurate as participants may find it difficult to give negative feedbacks due to the presence of the group. 60% of the participant did not suggest any further improvement for the activity; nevertheless, 40% requested for free freebies. The second and third questions were misinterpreted by the participant which may have been the reason why 80% incorrectly answered the question. Therefore, in future when writing the questionnaire, the health promoters will ensure the questionnaires are re-framed in a much easier format, to aid easy understanding.
The table was not big enough to contain all our leaflet, therefore In future, a bigger table will be deemed necessary for any future health promotion activity. Also, the group will have more interactive game and free freebies to attract more participants to the campaign.
Outcome evaluation involves measuring the long-term effect of the program (Naidoo & wills, 2008). The outcome will be unrealistic to measure as it will be difficult to gather participants together again due to the small scale of the activity, lack of resources necessary for undertaking the survey and time to assess participants in the future. Boltz (2012) suggested, outcome evaluation is more complex, difficult, costly and time consuming to implement. Therefore, HP activity on the benefit of quitting smoking can be carried out in the hospital and community, as supported by Youndan (2005), nurses are in frequent contact with smokers in the community and hospital, therefore, the role of nurse as a health promoter is important. WHO (2014) suggested that, smoking is one of the biggest threats to public health; hence, nurses are in a major position to help people quit by offering encouragement, providing information and refer them to smoking cessation services. In addition to Christensen (2006), nurses have a wealth of skills and knowledge and must be able to use this knowledge to empower people to make lifestyle changes and choices. These skills include; excellent communication and negotiation skills, caring and empathetic, non-judgemental and counselling skills (priest, 2013).
Health promotion is carried out in order to enable individual increase their control and improve their state of health. Undertaking this health promotion activity has broadened student’s understanding on the important of health promotion in nursing.
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