Public Health, Health Promotion Behaviour Change Initiatives - Essay Example

?Public Health, Health Promotion Behaviour Change Initiatives Introduction The increased rates of HIV-AIDS in most parts of the globe have brought tothe surface concerns on sexual health. Sexually transmissible diseases among the young population have manifested an increase in recent years and without the necessary precautions, these incidents will continue to increase. This paper shall critically evaluate the efficacy of a behaviour change initiative relating to sexual change, especially among young people engaging in unprotected sex with multiple partners. Concepts in relation to health promotion shall also be considered by this paper. A discussion of the theories which help explain health promotion activities will also be presented. The ethical considerations encountered in health promotion practices shall also be considered below. Finally, a reflection on the complexities of partnership working will also be presented in this paper. Body Initiatives Various initiatives for the management of sexual health among the young population have been established throughout the years. One of these strategies is the Teenage Pregnancy Strategy which was established in 1999. This strategy is managed by the Teenage Pregnancy Unit and implemented by individual coordinators within the local and regional levels (Parliamentary Office of Science and technology, 2004). This strategy, in general, has been implemented as a means of decreasing the conception rate for under-18 year olds by the year 2010. In order to meet this target, a significant reduction in pregnancy rates have to be seen – and yet reduced rates have not been apparent from the years 1998-2002, and based on these trends, the goal for the year 2010 might not be met (POST, 2004). Another initiative to manage the sexual health of young people includes the National Strategy for Sexual Health and HIV which was set forth in 2001 (POST, 2004). It has varying goals, including the 25% reduction in the number of HIV/AIDS and gonorrhoea cases by the year 2007 (POST, 2004). This goal calls for the reduction of current trends. The strategy will foresee a three-level model in the provision of sexual health services, supported by the Primary Care Trusts (POST, 2004). These trusts are based on the Commissioning Toolkit which specifies models for service delivery and other individuals who function as sexual health and HIV leads (POST, 2004). These two initiatives bring support for initiatives on the national and local levels and the main targets of these initiatives are on changing the trends in sexual behaviour among young people via education and improved awareness; improving the access to the various sexual health services; and carrying out “screening for asymptomatic infection” (POST, 2004, p. 2). Factors impacting on sexual behaviour Various factors are now impacting on the sexual behaviour of young people. These factors mostly relate to social and personal influences (Johnson, et.al., 2001). Studies indicate that social influences include family issues, poverty, early school age, as well as alcohol and drug abuse (POST, 2004). The initiatives discussed above have sought to address the personal factors impacting on sexual behaviour which largely include knowledge, parental considerations, beliefs, and skills and awareness (Johnson, et.al., 2001). These factors have been considered in terms of how they impact on sexual promiscuity among the young population and for the most part, the initiatives introduced have studied the fundamental causes of sexual promiscuity within this population. The importance of these factors which have been considered under these initiatives have sought to reassess the root of sexual behaviour. Accurate sexual knowledge among young people cannot easily be assumed because young people often have inaccurate sexual knowledge (Hughes, et.al., 2001). For example, some of them believe that having sex for the first time or washing thoroughly after sex would negate the risk for pregnancy or for acquiring any sexually transmissible diseases. As a result, these young people often engage in sexual intercourse not knowing its associated risks (Hughes, et.al., 2001). The importance of reviewing sexual knowledge is important in the overall frame of sexual behaviour because risky sexual proclivities are common among the young population who often consider their friends, the media, and TV shows as sources for sexual information (Wellings, et.al., 2001). In the end, such information is inaccurate and unreliable. The initiatives seek to shift the source of sexual knowledge of these young adults towards school and other accurate sources of knowledge. The initiatives have also rightly considered the impact of parental input in the sexual behaviour of young people. Those whose parents are more engaged in discussing sex with them are less likely to be involved in risky sexual intercourse. Unfortunately, studies indicate that about 40% of young adults claim that their parents have not shared any information about sexual behaviour with them (BMRB, 2003). Noting the lack of parental input has placed concerned government officials in the right track in their evaluation of sexual behaviour among young people. In acknowledging the gap in parental input, the initiatives have sought to consider how input from parents could be improved and how parents can be engaged in relaying the accurate input on sexual behaviour to their children. The initiatives on improving sexual behaviour among young people have also noted that beliefs and perceptions have a significant impact on sexual behaviour. Inaccurate perceptions of social norms seem to be dominant among young people with studies indicating that about 50% of young people believe that most of their friends and peers have engaged in sexual intercourse before the age of 16 (BMRB, 2003). Moreover, according to the British Medical Association, the media culture has also become sexualized and sexual relations are often not associated with risks of sexually-transmissible diseases (POST, 2004). Armed with this knowledge, initiatives have considered the impact of the society on sexual behaviour, noting how the media often becomes a legitimizing factor for promiscuity and risky sexual behaviour. These unfortunate trends popularized by the media often do not mention the risks associated with unprotected sex, and government initiatives have rightly sought to address this issue. The initiatives of the government to address the issue of sexual behaviour among young people have also considered the skills and awareness of these young adults. For the most part, young individuals lack the practical communication skills to consider condoms and to manage their sexually-related decision-making considerations. Studies indicate that about 40% of teenage boys are not even aware that they can avail of free condoms in family planning centres (BMRB, 2003). The skills and awareness of young people about sexual behaviour is filled with significant gaps and this circumstance has placed the burden on authorities to consider how their initiatives can improve the young people’s skills and awareness and reduce if not totally eliminate their sexually risky behaviour. In reviewing the two initiatives by the government, it is important to note that these programs have considered the possible causes behind risky sexual behaviour of young people. Identifying these causes assisted the government initiatives in establishing strong programs and policies. Pinpointing these causes also helped address risky sexual behaviour among young people and reduce incidents of transmission of sexually transmitted diseases, including HIV-AIDS. The actual efficacy of these programs are being continually assessed; nevertheless, these initiatives have laid down a strong foundation towards efforts to inform the concerned individuals and educate them accurately about sexual intercourse, its risks, its possible effects, and its inherent dangers. Health promotion is an important requirement in achieving favourable health outcomes. Behaviour change theories include structures which educators can utilize in order to plan educational programs, and explain the efficacy of a program (DeBarr, 2004). There is no definite theory which can explain all variables which support a person’s behaviour, and not all theories apply to all circumstances. Most of the theories which support and explain the need for health promotion target eight elements which help promote behaviour change, including the fact that: the person has established a strong desire to carry out the behaviour; that there are no environmental barriers which would prevent the behaviour; that the person has the necessary skills to carry out the behaviour; that he believes that the benefits of carrying out the behaviour actually outweighs its disadvantages; that the person sees more pressure from society to perform the behaviour than not to perform it; that the individual believes that performing the behaviour matches his self-image; that the individual’s emotional reaction to the behaviour is very much positive; and the individual believes that he has the capacity to carry out behaviour under different circumstances (Bartholomew, et.al., 2006). The first three elements are needed in order to secure behaviour change, and the other five influences a person into changing. The precaution-adoption process model can be used to explain the behaviour change in young people in relation to their sexual behaviour (Frost, et.al., 2008). While in the process of considering a protective behaviour or relinquishing a risky one, individuals go through various stages. First, they are unaware of the issue, and are also unengaged in the issue. Later they decide to act or not act on an issue. They then make a decision to act and then to maintain such act (Frost, et.al., 2008). This model can apply to the behaviour change process as the target population is first unaware and unengaged about the issue. Next, they then decide to act or not act on the issue or the behaviour change. After making the decision, they also seek to maintain such behaviour. Behaviour change in this case is therefore very much a process, one which spans various phases and progressive steps towards a clear and decisive end. The promotion of changes in sexual behaviour must be highly supported by sexual education, mostly in the academic scene. This is what is otherwise known as school-based sex and relationships education (SRE) where the initiatives discussed above have founded their interventions on (POST, 2004). SRE in schools is a very controversial topic because religious and some ethnic groups believe that sex must not be discussed in school and must be personal family topics. Nevertheless, sexual education has now formed a major part of the educational system, and this process has made it possible for students to accurately learn about sex, its consequences and its risks. The role of parental input has been recognized by most health promoters, and initiatives within local communities have been made in order to improve communication with parents in relation to the sexual behaviour of their children (POST, 2004). Promoters also support the notion that school-based sexual education must also be followed-up and supplemented with family discussions. The cooperation of schools and of families help ensure that young individuals understand sex and its consequences and risks and that in engaging in sexual acts, they would understand the responsibilities which go with it (Wellings, et.al., 2001). In reviewing the application of SRE, its contents are still very much controversial. Some promoters believe that totally abstaining from sex must be the very foundation of SRE (POST, 2004). Other promoters are also concerned that the discussions on sexual behaviour may cause the young people to be curious about sex. Their early understanding of sex may also cause them to engage in sexual activities very early in their lives (POST, 2004). However, based on studies in relation to the impact of SREs on sexual behaviour, the majority of the evidence suggests that SRE does not lead to an increase in sexual activity (Health Development Advice, n.d). Health Committees also did not see any favourable outcomes in implementing abstinence-based SRE as these SREs did not actively teach the young people ways by which they can protect themselves from pregnancies and sexually-transmissible diseases. Health promotion also seeks to establish and secure public awareness. The process of preventing and managing sexually-transmissible diseases is a topic which has been supported by the Department of Health in securing the general health of the public. With the support of the DH, local awareness initiatives have been secured, including the implementation of national campaigns ‘RUThinking’ which focuses on 11-18 year olds and ‘Sex Lottery’ which focuses on 18-30 year olds (POST, 2004). With the current knowledge of growing information technology measures, the DH has considered the media as tools for its awareness campaigns, utilizing the radio and print advertisements in order to secure help lines for young people and to improve access to sexual health information. So far, the use of these services by target service users have presented with favourable results. In 2002 alone about 1.4 million calls were fielded in the ‘Sexwise’ telephone helpline (POST, 2004). The ‘RUThinking’ website has also manifested favourable access for ethnic minorities. However, concerns on the actual impact and understanding of crucial sex information still remain, especially as far as ethnic minorities are concerned (Netto, et.al., 2010). For the most part, the initiatives have not sufficiently secured the efficient delivery of sex information to these minorities. The promotion of changes in sexual behaviour has also been largely based on the access of young people to sexual health services. Securing these changes has been affected by the capacity of the health promoters, as well as their accessibility, acceptability, and confidentiality policies. Waiting time in some of these centres have extended up to six weeks for some, and in some areas, delays of 10-12 days have been seen (POST, 2004). Such delays are not favourable for sexually active individuals who often continue to engage in risky sexual behaviour while waiting. In the interim, they may sometimes end up getting pregnant or infected by sexually-transmissible diseases. Target reductions in waiting times have since been implemented by the government, and up to 48 hours waiting time has been targeted by the program initiatives (National Health Services, 2011). An assessment of waiting times in various centres has been implemented by the Health Protection Agency and so far, these efforts have established that most centres have attempted to reduce these waiting times (POST, 2004). However, with limited resources, these centres would still find it difficult to reduce these waiting times. Accessibility has also been considered an issue in the health promotion process for sexual health services. The location and the operating hours of centres for sexual health services may sometimes conflict with school commitments, and thereby limit the opportunities for these young people to visit the centres (POST, 2004). Health promoters recognize the fact that schools play a crucial role in improving access to sexual health services. And government authorities have sought to improve the link between the schools and the local health sexual service centres. Improvements in this regard have included moves towards introducing the young people to the services already available in their centres and the various available visiting hours they can choose (Creighton, et.al., 2002). Guiding the service users towards the direction of these centres are solid steps towards the access of services in relation to contraceptive advice, treatment and interventions, and STI and AIDS testing. These centres all in all are qualified as one-stop-shops for sexually active individuals who would prefer the easy access of information they would most need (POST, 2004). The health promotion process in relation to sexual behaviour change is also affected by the acceptability of the sexual health services among the young population. In instances when the services offered to these young individuals are not friendly or accommodating to their disposition and their needs, they often end up being discouraged in engaging in these services (Lewis, et.al., 2004). Some young people perceive the behaviour of the staff to be judgmental and are often turned off by such attitudes. Based on these circumstances, the importance of sexual health services fashioned to the needs of the service users have emerged, as these types of services are set to improve acceptability of services among the target population (Lewis, et.al., 2005). In order to make the most of health promotion activities in relation to sexual behaviour, the use of youth-oriented services helps achieve better processes in partner notification, sets up follow-up consults, and monitors medication compliance. Confidentiality has also been considered as an element impacting on the promotion of sexual health and safety. Confidentiality is a major factor which impacts on young people and their health-seeking behaviour. For these young people, they often seek sexual health services because they feel assured that their confidentiality would be protected (Beddard, et.al., 2003). For health promoters and those working in sexual health service centres, confidentiality measures within these centres have been secured; however, some studies have indicated that about 45% of 13-17 year old teenagers express that confidential sexual health services are not available in their locales (POST, 2004). Many parents also believe that for their children below the age of 16, they must also be involved in their child as they seek sexual health services (POST, 2004). However, the presence of parental figures often dissuades these teenagers from seeking assistance from these centres. There is an inherent requirement of confidentiality of health services between patient and health professional. Confidentiality helps ensure a relationship of mutual trust and respect between the parties involved. The knowledge that his sexual health concerns would be kept confidential helps the young individual to open up and to express his concerns about his sexual health. In the process, an assessment of the individual’s overall knowledge, sexual behaviour, and risks can also easily be assessed by the health professional. All in all, this open relationship ushered in by confidentiality works well for both the health promoter and the service user. Ethical considerations Ethical considerations which relate to health promotion and the implementation of sexual behaviour changes often involve issues on autonomy, equity, and community (Family Planning Association, 2012). The primary ethical consideration in relation to health promotion is on autonomy. In considering on the impact of liberalism and democracy, any attempt to dictate on the behaviour of individuals is not favoured (Bayer and Moreno, 1986). Privacy is an inviolable concept for most democracies, and when a person’s actions is influenced by a powerful and dominating force, interfering with such behaviour would have to be carried out. Since the state is very much committed to the autonomy of its citizens, state actions which often interfere with the liberty of individuals are sometimes difficult to justify and support (Bayer and Moreno, 1986). Although the paternalistic principles can be used to justify state regulations, these principles may not always be welcomed by the people. Their misinformation about state regulation may sometimes close their mind to the improved understanding of improved health outcomes. Nevertheless, the overall goal of paternalism is to protect the citizen from the negative effects of his actions (Bayer, 2005). In relation to the promotion of appropriate sexual health behaviour, government regulations may indeed be viewed as contrary to the individual’s right to autonomy (Bayer, 2005). However, where the concerns for the larger population outweigh the concerns for the individual, the paternalistic principle must apply over and above individual claims to autonomy. Another ethical consideration in relation to health promotion is equity. The emergence of the social effect of personal qualities on the health rates has provided the basis for various discussions on the appropriate coverage of governmental regulations (Bayer and Moreno, 1986). Government reports establish significant evidence of this circumstance. These reports have been based on the economic assessment of the external issues linked with personal behaviour. The price of health care and insurance, as well as social security payments to the disabled or to those who are economically embattled are the economic costs which are referred back to the private activities of individuals who engage in behaviour which eventually cause diseases and health issues (Bayer and Moreno, 1986). Equity concerns seem to argue that those who choose to engage in a negative behaviour must also bear the economic burden of their behaviour. When no remedies are available to internalize the costs of such negative behaviour, equity may require the use of prohibitions on the behaviour (Bayer and Moreno, 1986). The emphasis on quantified social costs in relation to personal behaviour points out the ultimate and underlying concept that as far as public health is concerned, financial and social costs must be considered. Another ethical concern in relation to health promotion is the fact that most court decisions on the constitutionality of government efforts to regulate behaviour for health considerations have emphasized the state’s need to limit the negative impact of the behaviour. Theorists like Beauchamp were quick to point out that public health and morals may be put in danger by the unfavourable actions of individuals (Stephenson, 2003). While others quickly utilize autonomy and paternalism as main issues in government regulatory actions, Beauchamp emphasizes that a person’s freedom is not limited in order to establish benefits to himself, however to provide protection to a class of citizens (Stephenson, 2003). Individual liberties are not the only justification which seeks to support government actions. Other conceptions of politics are also available in order to improve general welfare, to support the distribution of information, to support the behaviour of citizens, and to protect their individual liberties. Reflect critically on the complexities associated with partnership working In reflecting on the complexities associated with partnership working, it is appropriate to note that ensuring partnership working is a difficult process, especially when some of the involved parties are not armed with the necessary information about the behaviour in question. In working with the young population, sorting through their sexual behaviour, it is unfortunate to note how accurate information among them is not available, and that even with the limited knowledge they have about risky sexual behaviour, they are still actively engaged in unsafe sexual activities. As such, their health is very much compromised and they are vulnerable to early and unwanted pregnancies, as well as sexually-transmissible diseases. The complexities of partnership working in health promotion activities are also founded on ethical considerations. These ethical considerations sometimes serve to limit the efficacy of regulations on negative health behaviour, especially behaviour which places the lives of the general population at risk. Complexities in partnership working can also be seen when working with uncooperative clients. In relation to young people and the promotion of appropriate sexual health practices, they may be of the insistent belief that the state does not have the right to regulate their behaviour. To some extent, they are correct in this belief, however, under the paternalistic principle, regulating sexual behaviour, especially those which place the health of the general public at risk, is an inherent part of state functions. Nevertheless, the burden of proving that such regulations are justified is on the state. And for the most part, proving such regulations to be justified is still a significant dilemma and problem for most government regulators. Conclusion Based on the above considerations, health promotion in relation to sexual behaviour is one of the most difficult activities for the state and its agencies to implement. Health promotion of appropriate sexual behaviour among the young population includes initiatives like the Teenage Pregnancy Strategy and the National Strategy for Sexual Health and HIV. These initiatives have sought to teach and educate the young people about the impact of sexual activities and the precautions they need to take in order to reduce, if not eliminate the risks involved in such activities. These initiatives have been based on theories and concepts behind health promotion and on the implementation of favourable behaviour. Significant ethical considerations have been forwarded on the use of health promotion activities. These considerations have focused on autonomy, equity, and community welfare. In general, these considerations have been known to secure a balance between regulatory and permissive powers of the government. In the end, the application of partnership working as well as the health education has resulted in overall improved health outcomes, as well as an improved understanding of sexual behaviour and related activities. Reference Bartholomew, L. K., Parcel, G. S., Kok, G., & Gottlieb, N. H. 2006. Planning Health Promotion Programs. (2nd ed.). San Francisco, CA: Jossey-Bass. Bayer, R. 2005. Ethics of Health Promotion and Disease Prevention [online]. Columbia University. Available at: http://www.asph.org/UserFiles/Module6.pdf [accessed 12 January 2012]. Beddard D, Chandiok S, James P. 2003. A 6-month pilot of a collaborative clinic between genitourinary medicine services and a young person’s sexual health clinic. J Fam Plann Repro Health Care 29, 40–2. BMRB International. 2003. Evaluation of the Teenage Pregnancy Strategy. Tracking Survey. Report of 9 waves of research. Creighton, S. Edwards, S. Welch, J. & Miller, R. 2001. STIs in teenagers attending a GUM clinic in South London. Sexually Transmitted Infections 78, 349-51 DeBarr, K.A. 2004. A review of current health education theories. Californian Journal of Health Promotion, 2, 74-87. Family Planning Association. 2009. Under-16s: consent and confidentiality in sexual health services factsheet [online]. Available at: http://www.fpa.org.uk/professionals/factsheets/consent [accessed 12 January 2012]. Frost, R. Zuckerman, M. & Zuckerman, E. 2008, Health Promotion Theories and Models for Program Planning and Implementation [online]. University of Arizona. Available at: http://azrapeprevention.org/sites/azrapeprevention.org/files/2008_01_UA.pdf [accessed 12 January 2012]. Health Development Advice. (n.d) Prevention STIs [online]. Available at: www.hda-online.org.uk/documents/prevention_stis_evidence_briefing.pdf [accessed 11 January 2012]. House of Commons Health Committee. 2002. Third report of session, volume 1. Hughes, G. Brady AR, Catchpole MA, Fenton KA, Rogers PA, Kinghorn GR, Mercey DE, & Thin RN. 2001. Characteristics of those who repeatedly acquire STIs. Sexually Transmitted Diseases, 28, 379-86 Johnson, A. Mercer CH, Erens B, Copas AJ, McManus S, Wellings K, Fenton KA, Korovessis C, Macdowall W, Nanchahal K, Purdon S, & Field J. 2001. Sexual behaviour in Britain: partnerships, practises and HIV risk behaviours. Lancet, 358, 1835-42 Lewis, D., McDonald, A., Thompson, G., & Bingham, S. 2004. The 374 clinic: an outreach sexual health clinic for young men. Sex Transm Infect, 80, 480–483. Low, N. 1997. Gonorrhoea in inner London: results of a crosssectional study. British Medical Journal, 314, 1719-23. Netto, G., Bhopal, R., Lederle, N., Khatoon, J. & Jackson, A. 2010. How can health promotion interventions be adapted for minority ethnic communities? Five principles for guiding the development of behavioural interventions. Health Promotion International, 25(2), 248-257. National Health Services. 2011. Visiting an STI clinic [online]. Available at: http://www.nhs.uk/Livewell/STIs/Pages/VisitinganSTIclinic.aspx [accessed 11 January 2012]. Parliamentary Office of Science and Technology. 2004. Teenage Sexual Health [online]. Available at: http://www.parliament.uk/documents/post/postpn217.pdf [accessed 11 January 2012]. Stephenson, J., Hopwood, J., Babiker, A., Copas, A & Vickers, M. 2003. Recent pilot studies of Chlamydia screening. Sexually Transmitted Infections, 79, 352 Wellings, K. Nanchahal K, Macdowall W, McManus S, Erens B, Mercer CH, Johnson AM, Copas AJ, Korovessis C, Fenton KA, & Field J. 2001. Sexual Behaviour in Britain: early heterosexual experience. Lancet 358, 1843-50. Read More