Creating Social and Physical Environments For Good Health
Order ID 53563633773 Type Essay Writer Level Masters Style APA Sources/References 4 Perfect Number of Pages to Order 5-10 Pages Description/Paper Instructions
Creating Social and Physical Environments For Good Health
Creating Health-Promoting Social and Physical Environments
Health Literacy
Health literacy also is an essential component of public health goals that aim to create social and physical environments for good health for all.
The recognition of this topic as a serious health issue subsequently resulted in the specific naming of topics, goals, and objectives in Healthy People 2020, entitled Health Communication and Health Information Technology (IT).
The objectives in this topic area describe many ways in which health communication and health IT can have a positive impact on health, health care, and health equity.
Examples especially pertinent to health education actions taken by nurses include delivering accurate, accessible, and actionable health information that is targeted or tailored to increasing health literacy skills, providing personalized self-management tools and resources, and following sound principles in the design of programs and interventions that result in healthier behaviors. See http://www.healthypeople.gov/2020/topicsobjectives2020/ for more information.
A 2-year-old is diagnosed with an inner ear infection and is prescribed an antibiotic. Her mother understands that her daughter should take the prescribed medication twice a day.
After carefully studying the label on the bottle and deciding that it does not tell how to take the medicine, she fills the teaspoon and pours the antibiotic into her daughter’s ear (Parker et al., 2003).
The nurse in a community setting who sees a sick child at the pediatric clinic might ask the following questions:
Do the parents know the names of the medicines for their baby, how they work, and how and when to give them?
In what way might teach-back methods (described later in this chapter) help the parents have a good understanding of how to administer the antibiotic?
Will the parents know what to do if their baby gets a fever?
Is the information in their preferred language?
Do the parents know how to read a thermometer? Did I show them? Were they able to “show me back”?
Do the mom and dad know who to call and under what conditions if their baby’s condition worsens? Does the family understand what constitutes worsen?
Will the parents know what action to take in case of a very high fever at 1:00 AM? Will they have the critical literacy skills to manage similar situations?
The H. Lee Moffitt Cancer Center and Research Institute, or Moffitt, formed a partnership with Suncoast Community Health Centers, Inc., or Suncoast, in rural Hillsborough County, Florida.
The partnership initially brought breast cancer education and screening services to Hispanic migrant and seasonal farmworkers and low-income rural women via Moffitt’s Lifetime Cancer Screening Mobile Unit.
Initiated by a cancer center physician who visited Suncoast, a federally funded, community-based center located about 30 miles south of Tampa, he was struck by the center’s services and impressed with the clinic’s dedication to reaching medically underserved populations.
Suncoast consisted of multiple comprehensive federally qualified health care clinics in Plant City, Ruskin, Brandon, and Dover, Florida, and offered a wide range of primary health care services, yet it did not have mammography facilities.
Moffitt was expanding its community outreach initiatives through mobile outreach services. Moffitt was a freestanding, private, nonprofit institution located at the University of South Florida campus in Tampa.
An NCI-designated comprehensive cancer center in Florida, Moffitt is widely known for state-of-the-art treatment, novel research, ambulatory services, and advanced screening modalities.
After a series of meetings between Suncoast and Moffitt’s Lifetime Cancer Screening Center, the groups formed a partnership based on a mutual shared goal—to improve the breast health of high-risk and medically underserved women.
Both parties determined that the goal was to develop and offer the community culturally appropriate education, accessible mammography service, and follow-up care.
Description of Health Issue and Intended Audience
Despite progress in the fight against cancer, many communities continue to bear a disproportionate share of the cancer burden. Cancer disparities very likely arise from the complex interplay of factors—that is, low socioeconomic status, low levels of education and literacy, social injustice, and poverty—that impede awareness about screening and follow-up care.
Together, these factors affect access to care and cancer survival and yield an uneven distribution of cancer morbidity and mortality, which substantially affects marginalized populations (American Cancer Society, 2017; Braun et al., 2015; Chu et al., 2008; Meade et al., 2009) suggest that in the development of cancer outreach and screening programs, it is absolutely critical to layer on additional levels of understanding of and sensitivity to the social, cultural, and political conditions of home countries, language and literacy needs, obstacles to basic health care access, cultural significance of gender and age roles, culturally mediated etiologic perceptions of disease, illness experiences, religiosity, and the sociopolitical nature of immigration situations.
Such factors affect the design and meaning of health communication and health education. Our assessment revealed that many women did not appear for breast screenings because of a “fear of cancer” and uncertainty of how to navigate the health care system.
Typically, many women did not seek preventive health care, but rather sought care for episodic acute illnesses. The lack of mammography screening and education for rural Hillsborough County’s medically underserved women represented a health service gap. In particular, individuals may face a number of potential factors that get in the way of receiving acceptable mammography services.
These factors may reflect limited access points to health care; low awareness of the importance of the screening; and language, literacy, and linguistic concerns.
Educational and communication interventions and tools that address (1) unique value systems, (2) relevant and specific cultural and linguistic factors, and (3) access issues—as well as that capitalize on the strengths of the women—were warranted.
Our experiences reminded us that women want and need information about breast health but that they also experience everyday struggles. As such, peer outreach/navigation can help deconstruct those concerns and better engage community members in their health.
What was required in Hillsborough County was the delivery of a culturally relevant health service in a geographically convenient area. Women aged 40 years and older were eligible for this service.
The initial intended audience was primarily Hispanic migrant and seasonal farmworkers but also grew to include women from other diverse ethnic backgrounds (i.e., Haitian, rural white).
Goal: To prevent premature death and disability from breast cancer through early detection, screening, and culturally and linguistically relevant education.
Objectives: To increase education, mammograms, clinical breast examinations, and follow-up programs among medically underserved women in rural Hillsborough County.
Selecting Channels and Methods
Nurses selected a combination of channels to communicate health information about breast cancer, screenings, and early detection methods (e.g., community-based clinics, missions, social service agencies, health events, and fairs). Nurses conducted individual interactions at the mobile or stationary site at the screening center.
Nurses collected a variety of health materials and media about breast cancer from national, state, and local sources and determined that many of the printed materials were not culturally or educationally suited for the individuals the nurses were serving; for example, the materials were geared toward high reading levels, and few Spanish-language or Haitian Creole materials were available.
Developing Materials
Grants from Avon, National Alliance of Breast Cancer Organizations, Susan G. Komen for the Cure Florida Suncoast Affiliate, and NCI supported the development of English, Spanish, and Creole materials to educate women about breast health.
Additionally, although translators were sporadically present, it became apparent that bilingual/bicultural staff was necessary. Ongoing dialogue with community members and clinics helped refine the screening process, the education component, and follow-up services to ensure effectiveness, efficiency, appropriateness, and timely follow-up.
Implementation
The mass media publicizes the services and disseminates human-interest stories, especially during October—Breast Cancer Awareness Month. The outreach workers posted flyers at a variety of sites (e.g., beauty shops, laundromats, missions, churches, grocery stores, churches, unemployment offices, and community centers).
Twice per month, the mobile unit traveled to rural areas. There, staff greeted women and answered questions about the mammography procedure and follow-up.
Assessing Efficiency
Process Evaluation
A number of newspapers/flyers, television, and radio advertisements publicized the free or low-cost mammography service and highlighted the importance of breast health.
Also, several human-interest stories emerged, which communicated the screening services to a wider audience. Since the onset of the program, increases in the number of staff involved in the program, the number of volunteers, and the number of funded projects that support the program enhanced its breadth and depth and sparked the development of new initiatives.
Most notably, the TBCCN, an NCI-funded community network program center, a partnership of 28 community organizations, has increased the number of committed key stakeholders who have identified other areas of community need and outreach such as a need for cervical cancer navigation and increased colorectal cancer screening uptake (Davis et al., 2016; Gwede et al., 2013; Wells et al., 2015).
As a result of an additional community partner needs assessment, (Gwede et al., 2010; Simmons et al., 2015) additional cancer education workshops, health events, and cancer services have been broadened and evaluated.
For example, funding for a Patient Research Navigation Program further augmented outreach efforts. Designed to eliminate barriers to cancer diagnosis and treatment, this project generated new knowledge for the advancement of an evidence-based, culturally and literacy appropriate, lay navigation program for community members who had a breast/colorectal cancer abnormality by evaluating timeliness to resolution of abnormality and enhancing timeliness to diagnosis and delivery of cancer care (Lee et al., 2017; Meade et al., 2015; Roetzheim et al., 2012; Wells et al., 2011).
Outcome Evaluation
During the mammography screening program’s initial years, fewer than 200 women received mammography screening per year. The number of women screened approached more than 1000 per year in subsequent years.
Currently, mammography services are provided at stationary screening sites at the cancer center (women use vouchers), and funding opportunities and institutional support sustain the program. The number of community partners has grown considerably, a reflection of enhanced community capacity and awareness. Regular health events are scheduled; refinement of screening services and follow-up are ongoing.
Feedback
Reports describing process and outcome evaluation and analysis provide a point of reference for continual improvements. Such reports apply knowledge and outline methods to enhance and improve the service’s efficiency and effectiveness.
The mammography program has incorporated a network of outreach and educational components to reach rural migrant and seasonal farmworkers and other low-income women in south and east Hillsborough County.
Although the program provided desired links to screening services and has formed successful community partnerships, it is important to develop and refine community empowerment strategies through outreach and education to sustain and widely disseminate the program.
Building on this successful model of education and outreach (Meade 2014; Meade et al., 2009), the administrators of the program applied lessons learned for outreach to other high-risk populations, (e.g., Haitian and African American men and women) in the development of colorectal cancer screening initiatives (Gwede et al., 2013).
A key lesson learned here is that community outreach, based on trust, respect, and mutual commitment, can fuel community-identified research priorities and lead to the testing and evaluating of evidence-based interventions for community benefit.
Provide justification for continuing or ending the program.
Summarize the health education program or message in an evaluation report.
The reader is encouraged to think about how health education messages or programs can be planned using this model. The exercise in Fig. 8.1 can be helpful to organize your ideas.
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