Applications of Public Health Education and Health Promotion Interventions

By Rashid M Ansari

Although there have been many significant advances in health care over the years, there are still issues demanding the attention of health-care professionals, governments, and individuals. Among them are chronic diseases and problems, such as type 2 diabetes, smoking, lack of physical activity, and dietary issues.

In Applications of Public Health Education and Health Promotion Interventions, author Rashid Ansari highlights the practical applications of public health education and health promotion in various settings in addressing those health issues in particular and other health problems in general. He also provides health education concepts and processes that provide a combination of approaches to lifestyle change in order to assist individuals, families, and communities in making informed decisions on matters that affect the restoration, achievement, and maintenance of their health.

A combination of health education and health promotion interventions at the primary level of prevention can be used to facilitate behavioural and environmental changes conducive to health enhancement. Ansari also shows how health inequality among populations can be reduced.

Applications of Public Health Education and Health Promotion Interventions provides practical information on how public health theories and hypotheses can be used to combat some of the most prevalent health-care issues of the day.

• Language: English
• Publisher: Partridge Publishing Singapore
• Release date: Jun 27, 2012
• ISBN: 9781466926837

Rashid M Ansari

Rashid Ansari received his PhD from Curtin University in Australia; a master’s degree in public health, with a specialization in health promotion, from the University of Queensland; and a master’s degree in clinical epidemiology from the University of Newcastle. He has published many articles on the self-management of type 2 diabetes.

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© Copyright 2012 Rashid M Ansari, PhD.

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Created in Singapore.

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    978-1-4669-2682-0 (sc)

                978-1-4669-2683-7 (e)

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This book is dedicated with love … . .

To my parents and to my wife, Dr. Saiqaa Ansari

Preface

This book aimed at applying a wide range of public health education and health promotion interventions addressing the chronic diseases such as Type 2 diabetes and HIV/AIDS, injury prevention and control, smoking cessation, physical activity and dietary interventions at individual and community levels and assesses the effectiveness of these interventions.

The overall approach is on the principles used in conducting a health promotion intervention project, beginning with assessing the needs of communities and individuals, including target population. This book has also included the concepts of health promotion targeting population by using the information from the community specific needs and planned the intervention reflecting the need of the community, implemented and evaluated it with case studies from communities in developed and developing countries.

Chapter 1 provides an overall introduction of health education and health promotion, Chapter 2 of the book highlights the health inequality experienced by Indigenous Australians in relation to chronic disease such as diabetes mellitus and identifies the important social determinants of health inequalities. This chapter identifies the risk factors of diabetes in Indigenous Australians and provides the differences in the prevalence of risk factors between the selected and comparison groups. Finally, the chapter 2 highlights the advantages and disadvantages of health education and promotion as an approach to addressing the health inequality among Indigenous Australian population.

Chapter 3 provides insight into the health education and promotion intervention using qualitative health approach conducting one-on-one interviews with a small sample of informants – patients of diabetes (n=6) with type 2 diabetes and explored patients perceptions and experiences of undertaking physical activity and eating behaviour as part of their diabetes care. This qualitative study analyzes the health issue related to diabetes in community and identifies the barriers to diabetes care in community and healthcare clinics and recommends socio-ecological approach to self-management of type 2 diabetes.

Chapter 4 presents physical activity education and intervention among the middle-aged population of Pakistan with type 2 diabetes. The physical activity has been associated with a reduced risk of type 2 diabetes. The aim of this study was to examine health education intervention and its effect on the physical activities such as occupational, household and daily lifestyle activities and obesity on the prevalence of type 2 diabetes in middle-aged population.

Chapter 5 provides health promotion incentives for lowering hemoglobin (HbA1c) in patients with poorly controlled type 2 diabetes. The main objective of chapter 5 is to present double-blinded Randomized Controlled Trial (RCT) which is an effectiveness trial that addresses the community clinical practice specific to the population in sub-continent and its measured outcomes are most significant to diabetes care providers. The Fenugreek supplement as an intervention showed good results for lowering HbA1c in type 2 diabetes in addition to usual medical care and it is recommended that fenugreek supplementation is safe and may be considered in patients with HbA1c > 7% as a potential means to lower the high levels of HbA1c.

Chapter 6 highlights the socio-ecological health promotion strategy aimed at behaviour change, minimizing the transmission of HIV through unsafe sexual practices and reducing the stigma associated with HIV/AIDS. The health promotion strategy also addresses the inequality in the community such as poverty, lack of education and gender imbalance and promotes developing appropriate health care resources for HIV/AIDS patients. These health promotion concepts are based on relationships between support and immunity, health status and health behaviours, mortality and quality of life which have been reported to address the determinants of the problems related to HIV/AIDS.

Chapter 7 provides health promotion intervention to control the tobacco epidemic in Eastern-European country (Romania). This chapter outlines the health education and promotion strategy to reduce the smoking prevalence in that country. The most cost-effective health promotion strategies were related to population wide public policies to prevent smoking such as bans on direct and indirect tobacco advertising, promotion and sponsorship, tobacco tax and price measures on cigarettes, smoke free environments in all the public and workplaces, packaging and labeling, education, communication, training and public awareness on the harm of tobacco consumption.

Chapter 8 provides the causal model-based health promotion intervention to maternal smoking women in pregnancy. The main objective of this health promotion intervention is to provide health professional causal modelling approach to make a more comprehensive assessment of major determinants of smoking behaviour during and after pregnancy and consequently the outcomes of pregnant women smoking which are adversely affecting both the offspring and pregnant women. The causal model based on theory and evidence was modified and applied to maternal smoking cessation intervention to control the adverse effects of smoking on offspring obesity and neurodevelopment.

Chapter 9 highlights the cost-effective road safety intervention aimed at demonstrating that motorcycle helmets have proven to be an effective intervention in motorcycle crash related injury reduction, making motorcycle helmet laws a strategy with proven effectiveness. It provides evidence that with proper planning and careful analysis, low-income countries can import proven and promising interventions and strategies from high income countries. This research has also identified the limitations in describing the epidemiology of road traffic injuries in low income countries as compared to high income countries.

Chapter 10 provides evidence-based intervention and safety promotion to prevent child injuries and highlights the problems related to child injuries and violence in developing countries and discusses in details the four leading causes of child injuries in developing countries such as road traffic injuries and injuries related to drowning, burns and falls and the risk factors associated with these injuries. This chapter also draws on the ecological model to provide understanding of the multi-level, multi-faceted nature of child violence and explores the existing framework of international instruments and mechanisms applicable to violence against children.

Chapter 11 is related to health promotion intervention using zinc supplementation in the treatment of diarrhea in young children. In this research work, the impact of zinc supplementation in the treatment of diarrhea in children less than five years of age has been evaluated. This research addresses two important research questions in relation to zinc supplementation as an adjunct in the treatment of infectious disease such as diarrhea and the effectiveness of zinc supplementation method for decreasing diarrhea morbidity and mortality among the children < 5 years old.

We believe that this book will provide comprehensive information on health education and promotion interventions to a wide range of population groups and communities on various public health problems. The several chapters in this book address the self-management and treatments of type 2 diabetes offering us hope in prevention and successful alleviation of the co-morbidities associated with obesity and type 2 diabetes.

Acknowledgements

It was always my dream to write a book in the areas of Public Health and Epidemiology to help the individuals and community with a hope to prevent chronic diseases in the population and transfer the knowledge to individuals on self-management of type 2 diabetes. However, my dream would have never been realized without the help of the following people:

I extend my appreciation to Professor Fran Boyle of University of Queensland for her valuable advice and suggestions on the procedure of case studies to carry out research work. I sincerely hope that discussions during interview and intervention strategies suggested in case studies would help long way to middle-aged population in developing countries in understanding the self-management of diabetes using the concepts of socio-ecological approach to self-management of diabetes and quality of life. My sincere thanks to Dr. Akif Ullah Khan, medical director of Ibn-Al-Nafees Medical Center, Peshawar—Pakistan and to my wife, Dr. Saiqaa Ansari for providing extensive help and support to acquire the specific data of middle-aged population of Pakistan from the source www.pmrc.org.pk. I also extend my appreciation to Pakistan Medical Research Council for providing linkage to major national health studies, digital and electronic databases for educational and research purposes.

I am also thankful to Dr. Ben Ewald of University of Newcastle, Australia for providing extensive help and guidance to complete the research work on Fenugreek trial and particularly providing feedback on the research questions and hypothesis formulation. My sincerest thanks to Prof. Julie Byles of University of Newcastle, Prof. Anne Kavanagh of University of Melbourne and Prof. Annette Dobson of University of Queensland who inspired me to carry out my research work on Women’s Health with specific interest on maternal smoking cessation and intervention to help women to quit smoking and consequently helping their offspring from various diseases later in the life. Many thanks to Dr. Leila Karimi of La Trobe University showing great interest in causal modelling applications. Finally, I am thankful to Shelly Edmunds of Trafford publishing, Singapore for her help in completing the write-up of this book and to INTECH open access and Hindwai publishing for their permission to republish my articles in this book.

Table of Contents

CHAPTER 1 - Introduction

Health Education and Health Promotion

Objectives and Contributions

Intervention addressing the Health Promotion framework

Current issues in Public Health and Health Promotion

References

CHAPTER 2 - Diabetes Mellitus in Indigenous Australians:

health education and promotion approach to address the health inequality

Introduction

Description of Indigenous Australians with health inequality

Inequity in burden of illness of Indigenous Australians

Risk factors for diabetes mellitus

Explanation of inequalities

Advantages and disadvantages of health education

References

CHAPTER 3 - Socio-ecological approach to self-management:

the case of type 2 diabetes in a middle-aged population

Introduction

Case Study – type 2 diabetes

Summary of the case study

Ecological approach to self-management

Health services in the community

Interventions to improve health services in the community

Access to resources in community settings

Recommendations to improve access to resources

Community perspectives of diabetes

Psychological impacts of diabetes

Barriers to diabetes self-management and quality of life

Conclusions

References

Appendix I

CHAPTER 4 - Physical activity education and intervention: middle-aged population of Pakistan with type 2 diabetes

Abstract

Introduction

Material and Methods

Results and Discussions

Strength and Weakness

Conclusions

References

CHAPTER 5 - Effectiveness of Fenugreek Intervention:

Health Promotion incentives for lowering hemoglobin (HbA1c) in patients with self-management of type2 diabetes: A Randomized Controlled Trial.

Abstract

Background and Research Question

Aims and Significance

Brief Literature Review

Critical Appraisal of two studies in Table 1

Future Research—Justification

Hypothesis and Justification

Justification of Hypotheses

Study Design and Sampling Method

Study Population and Randomization

Measurement

Method of Analysis

Ethical Consideration for fenugreek RCT

Conclusion

References

CHAPTER 6 - Socio-ecological approach to self-management of HIV/AIDS: case study of a patient in Pakistan with HIV virus

Introduction

Case Study of a patient with HIV/AIDS

Summary of the case study

Ecological approach to self-management

Health services in the community

Interventions to improve health services in the community

Structural intervention for effective HIV prevention

Mitigating the impact of HIV/AIDS on societies and culture

Recommendations to improve access to resources

Environmental and community perspectives of HIV/AIDS

Psychological impacts of HIV/AIDS

Barriers to HIV/AIDS self-management and quality of life

Conclusions

References

Appendix I

CHAPTER 7 - Health Promotion Intervention to control the tobacco epidemic in Eastern-European country: Evaluation and implementation guidelines

Introduction

Innovative and Effective Tobacco Control Strategies

Other tobacco control strategies excluded for this study

Evaluation of Tobacco Control Strategies

Conclusion

References

CHAPTER 8 - The causal model-based health promotion intervention to maternal smoking women in pregnancy

Abstract

Introduction

Material and Methods

Techniques to support behaviour change

Results and Discussions

Theory-based behavioural determinants

Intervention points

Techniques to support behaviour change

Limitations of intervention approach

Conclusions

References

CHAPTER 9 - Road traffic injury in low income countries:

implementation of a cost-effective road safety intervention

1. Introduction

2. Evidence-based intervention for Road Traffic Injuries

3. Development of the plan to implement intervention

3.1 Karachi – the city of Pakistan

3.2 The objectives of the plan and setting of targets

3.3 The collection of data on road traffic crashes

3.4 The Stakeholders

3.5 Performance Indicators

3.8 Ensuring sustainability of intervention programme

4. Conclusion

5. References

CHAPTER 10 - Evidence-based intervention and safety promotion to prevent child injuries and violence in developing countries

Introduction

Child injuries in developing countries

Child violence in developing countries

Conclusions

References

CHAPTER 11 - Evidence-based Health Promotion Intervention:

Effect of zinc supplementation in the treatment of diarrhea in young children

Introduction

Detailed review of evidence

Critical Analysis—using Bradford-Hill Criteria

Nutritional epidemiology methods

Strengths and weaknesses of the methods

Contribution of the research

Conclusion

References

CHAPTER 1

Introduction

1.1 Health Education and Health Promotion

Health education is a structured discipline that provides learning opportunities about health through interactions between educators and learners using a variety of learning experiences. The learning process influences people to think about changing conditions or modifying their behaviour for better health and well being. In addition, health education includes the experiences and skills that affect the way people think about their health and act accordingly as it motivates them to use that information in their real life.

In Australia, health education was recognized as having potentially important roles in reducing the impact of chronic diseases and increased health care costs in the Australian health care system. Also, the health education in wider communities was included as a part of the community health programme activities and the community health staff delivered health education to prevent diseases in communities and health care units. However, in the developing countries such as Pakistan, this concept of health education is lacking and there is a need to promote these ideas from the developed nations in those settings.

The term health promotion has been used widely in public discourse following an increasing focus on health promotion and the adaptation of Ottawa Charter of Health Promotion. Health Promotion has aimed at helping people change to healthier life styles through various efforts to enhance awareness and create environments that support positive health practices that may result in reducing health risks in a population. The main tasks of health promotion include needs assessment, problem identification, development of an appropriate plan including goals and objectives, creation of interventions, implementations of interventions, and evaluation of outcomes of results.

Labonte (1992) provided a framework to consider three different approaches to health promotion. These are the medical approach, which tries to return sick people to a disease-free state; the behavioural approach, which promotes healthy lifestyles; and the socio-ecological approach, which is concerned with the totality of health experiences and the factors that help to maintain health, including