This essay will be based around a health promotion activity that was carried out by 6 students, the main focus is health promotion and raising awareness of cholesterol link to CHD. Centre for disease control and prevention (2013), defines cholesterol as a waxy, fat-like substance in the body that is necessary for normal function. In addition, health needs assessment will be identify, continuing with target groups involved with support from relevant epidemiology, demography and national and international policies. It will also outlined aims and objectives, approaches or strategy needs used to identify. Finally evaluation tool to consider the effectiveness of the health promotion activity.
When promoting health, health can have different meaning to different individuals. WHO (1946), defines health as a state of complete physical, mental and social well-being, not merely the absence of disease or infirmity. Naidoo and Wills (1998), highlights in order to promote health, it is necessary to prevent disease, improve health and enhanced well-being. Hubley and Coperman (2008), supports this by identifying, health promotion as a process in enabling individuals to increase control over and improve their health, in order to reach a complete physical, mental and social well-being.
However, in promoting health, health need assessment is the first step in promoting health activity. According to Cavanaugh and Chadwich (2005), health needs assessment is defined as a systematic process of identifying priority health issues, targeting risk groups in the population with the most needs and taking action in the most cost effective and efficient way. Macdowell, Bowell and Davies (2006), went on to highlights health need assessment is important because it is a recommended tool in providing evidence about a population in which to plan services and address health inequalities. It can also help in strengthening community involvement in decision making by collaborative team work.
In carrying out the health need assessment, a target group has to be identify. According to Hubley & Coperman (2010), a target group is a section of the community at which the health promotion activities are directed. They went on to suggests, when considering a target group, it is necessary to have some consideration in mind. For instance, ethnic, cultural or age because they all have distinctive needs and their needs changed during life. The target group used for this assignment, age 25-34 was identified from statistics with the aim of trying to prevent the disease before it starts.
In tackling health promotion, Scriven (yr), highlights that in preventing ill health for individuals within the population, first try to prevent the problem, prevent the problem by detecting and dealing with the problem and finally preventing the consequences or complications of the problem. Hubley & Coperman (2010), highlights a situation assessment not only involves analysing the situation, but also asking why did the situation arose, what factors contributed to the situation and what contribution can health promotion make to improve the situation.
Epidemiology of coronary heart disease
Epidemiology is a study of the population while it provides generalisation. For instance, how much exercise an average person needs. There might be individuals who needs might be different to others because of lifestyle (Heavey, yr).
This can pose difficulty for health promotion. Therefore, taking finding from epidemiology and turn them into clear advice such as eating five portion fruits and vegetables per day and reducing saturated fat. However even with limitations, epidemiology is a key discipline in health promotion. It is necessary to understand the problem before action is taken to prevent or promote health (Hubley & Copeman, 2010).
According to Wright (2010), coronary heart disease is the most common cause of death and premature death in the uk. It has been identify that 1 in 5 men and 1 in 7 women die from CHD and the death rate each year is 94,000. LDL cholesterol widely accepted to be one of the main risk factors for CHD. Of all the key contributors to CHD, high blood pressure, low fruits and vegetables intake physical inactivity high blood cholesterol has been the greatest impact and yet use more than half the people in the western countries have cholesterol level higher than desirable.
Mortality rate is 46 percent higher in men and 51 percent higher in women. According to British Heart Foundation (2012), there is around 2.3 million individuals living with CHD. This is due to increase of hypertension, obesity, diabetes mellitus and hyperlipidaemia, along with socioeconomic deprivation and lifestyle (cite). In the UK immigrants from India, Pakistan, Bangladesh and Sri Lanka, have a 50 percent greater risk of premature CHD. However, African-Caribbean population have a lower risk than national average risk of CHD (Naidoo & Wills, 1998).
According to the Journal of Cardiovascular Nursing (2014), it was highlighted that results from the National Health and Nutritional examination survey, approximately 3.4 million American adults above 20yrs, have severe hypertryceriaemia above 500. These individuals have a higher risk for developing CHD. As a consequence, CHD, is the leading cause of death for adults in the USA. Furthermore, Roth et al (2010), went on to support this by stating, CHD, cause over 18 million death in the world in 2005. (Wright, 2010).
According to the department of health (2010), policy paper healthy lives, healthy people our strategy for public health England, set out implications of health inequalities. Social, environmental, behavioural and biological factors are important influences on health. It highlights in tackling health inequalities, a much broader context needs to be consider. For instance, providing a route for poverty. Naidoo & Wills (1998), supports this by highlighting that there are considerable evidence to show low income, inequality, diet, poor housing, lack of health care are factors that contribute to health persistent inequalities and deprivation.
There is also a social gradient of health the lower a person’s social position the worse their health. Individuals in disadvantaged areas are more likely to have shorter lives expectancy and a greater burden on health is experience. The policy went on to highlights the gap of up to 27 yrs between the richest and the poorest neighbourhood, and wide variations within areas (Lloyd et al,2007). For example in London Kensignton and Chelsea, a man has a life expectancy of 88 yrs whereas in Tottenham Green, one of the poorest the age is 77 yrs. Obesity, smoking and alcohol misuse are associated with low income and deprivation (Waugh & Brooker, 2007).
However the gap has been narrowed due to health promotion. People are now more healthier and living longer than before and their level of well-being are as good as those in European countries. Also because of public health innovations such as enhanced nutrition, smoking cessation clinics, cholesterol screening, physical activity to include exercise, has helped to reduce cost and mortality and morbidity rates (Llyod et al, 2007).
Also, empowering people and health promotion approaches, it has shown an improvement on individuals and communities behaviour or lifestyle changes. According to Tones (1995), for many health promoters, empowerment at an individual level is a central tenant of health promotion. However, empowerment is a difficult concept to measure (Scriven & Orme, 2001).
However, Bradshaw (1972), classified four needs normative, felt, expressed and comparative. For this assignment the group identify normative need. According to normative need refers to what expert opinion based on research. For instance, a decision by the GP that a patient needs medication, after cholesterol screening.
It is important when providing health promotion to have an understanding of the approaches. There are five approaches and the group has chosen the behavioural and educational approach. According to Katz et al (2002), behavioural approach encourages individuals to make positive health related changes. For instance, in the workplace it is encourage to use the stairs instead of the lifts. This is beneficial and can help to reduce weight which can have an effect on coronary heart disease. Other targeted lifestyle behaviour that can have impact on coronary heart disease is smoking, alcohol use, diet and nutrition. The aim of this approach is to prevent disease such as heart disease by reduction of associated risk factors such as eating more fruits and vegetables and cutting down on saturated fat.
The intention of the educational approach is to provide people with knowledge and information that will enable them to develop the necessary skills to make informed choices about their behaviours. Therefore, communication skills are the key to this approach.
Educational approach can be in the form of mass media, and one-one. According to Tones and Tilford (1994), there are many examples of success in enhancing knowledge and information through health education carried out in healthcare settings. One advantage of this approach, it can easily be measured. For instance, survey. With limitation, evaluation of this approach may be difficult. People may have increased their knowledge and understanding of their health behaviour but may not make the necessary change (Naidoo & Wills, 2009).
Therefore, when health promotion is carried out, aims and objectives need to be followed. They should be specific, measureable, achievable, realistic and time. The group identified several aims and objectives. The aim of the group at the end of the health promotion, was to raise awareness and educate of the danger of cholesterol link to CHD.
According to( ) aims are defined as general statement of what the programme is trying to achieve such as reduce inequality as in health promotion. Whereas, the objectives or a target is a statement of proposed change over a fixed period of time. An objective should be measurable. This will allow others to know what is been planned making a decision about its implementation and evaluates.
The objectives were as follows:
- Three risk factors which can increase coronary heart disease
- Describe what coronary heart disease is.
- Three complications that can occur because of high cholesterol.
- Where someone can go to get their cholesterol check.
Evaluation is a systematic way of learning from experiences and the lesson learnt use it to improve current activities and promote better planning (Scott & Western, 1998). Evaluation is also done to measure its effectiveness, whether or not stated objectives has been achieve, and efficiency which is the amount of effort in terms of time, human resources and cost was worth the effort and process evaluation monitoring the progress during the programme which involves to find out if what was done has been achieved (Pender et al, 2006). During evaluation programme different types of evaluation maybe undertaken at different stages including process, impact and outcome.
First the process evaluation is undertaken if the aims are to determine the degree to which the programme or its individual components is reaching the target group or the materials and components of the programme are of good quality. Process evaluation is important to undertake in conjunction with impact or outcome evaluation, as it helps to explain better both positive, and negative intervention effect ( Scott & Western, 1998).
It was highlighted that the health promotion activity objectives has been achieved. For instance, the literature such as questionnaire demonstrated to some extend that the message that was put across which is knowledge and understanding in relation to cholesterol with link to coronary heart disease. It has also shown to be cost effective because the group spend less than the fifteen pounds that was allotted for spending on resources and material used. Some resources were either borrowed or given as gifts.
To continue with the impact evaluation, this is referred to as the immediate effect Macdowell et al (2006). The participants’ knowledge and understanding of the subject was successful in most areas as highlighted by the figures after the questionnaires were done. For instance, 100% of people found that the health promotion was useful, 80% were able to list 3 factors which can increase cholesterol level, 100% tick the correct statement to describe coronary heart disease, 95% of people knew where to go to get their cholesterol level check either a GP, clinic, or hospital. The other two questions were at a lower percentage of 50% and 75%. This could have been due to some people may not of understood the question, did not read the question properly or the health promoter was not clear enough or did not explain or was lacking knowledge on the subject.
The final theory the outcome, focus on the results or changes brought about by the programme intended or unintended. The choice of outcome to measure is determined by the programme goal (Scott & Western, 1998). For example, if the goal is to achieve reducing cholesterol level of understanding the link to coronary heart disease, it will need to be measured before and after. For outcome to be measured it would be difficult for the group because the audience would be difficult to contact at a later date and the setting which was a university was not the best place in educating individuals and to get a follow up. The community clinic or GP would be more appropriate.
There were positives that came out of the forum as highlighted by the questionnaires and feedback from other members of groups and tutors. However, it was highlighted some posters were to small, target group were not identified and also one tutor highlighted the target group use from evidence and statistics were not suitable. However, the target group used which was 25-34 was discussed in lectures with our tutor and was told to target individuals from the statistics by preventing the disease before it starts.
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