Factors Playing Negative Role in the Deteriorating Conditions of Reproductive Health - Essay Example

?Teaching Plan Review Introduction Reproductive health is an important aspect of the modern health care concept and plays a vital role in providing services to those who are in their reproductive years and are undergoing the process of reproduction (Tulchinsky & Varavikova, 2009). This area demands special attention since it not only ensures the safety of the females of a society, but also provides a means of transferring health benefits to the coming generations. Obstetric complications contribute significantly to the morbidity and mortality of women of child-bearing age throughout the world (Middleberg, 2003); however, the figures are extremely disturbing in the under-developed parts of the world (International Development Research Centre, 1995). A number of factors appear to play their role towards the deteriorating conditions of health in these under-developed regions. Lack of health care facilities, lack of awareness, poor financial conditions and political instability are some of the major factors that affect the provision of health care in a negative way. Discussion One of the most important factors that significantly affect the lives of the women of child-bearing age is lack of awareness about the process of reproduction, its possible complications and the way they can be prevented (Tinker & Koblinsky, 1993). The notion that such knowledge demands a basic understanding of the biological principles may stand true to some extent; however, the idea that symptoms can be readily picked up by women themselves provides escape in this scenario. I planned, arranged and conducted a teaching session for a group of Somali women who were in their last trimester of pregnancy (minimum 34 weeks gestation). The topic of discussion was 'Signs and Symptoms of Labor'. This activity was based on the fact that if women of child-bearing age are educated about their reproductive health and information about the alarming signs of fatal conditions is provided to them ahead of time, there are fair chances of their health conditions getting improved in due course of time. The activity was however not limited to teaching about fatal conditions; instead the purpose was to deliver knowledge about the normal proceedings of a reproductive process, thereby enabling the participants to pick up signs and symptoms that demanded attention of expert medical personnel. Learning theories for adult learners Various theories exist that guide us about the learning process of adult individuals (Manning & Bowden, 2006). The fact that many fundamental differences exist between pedagogy and andragogy makes it necessary that the education of adults is carried out with a completely different mind-set to achieve its purpose. During this activity, I aimed to develop an opportunity of learning where adult learners get involved in the process of reflective learning. Since adult learning is more of a 'collaborative' affair (Nesbit & Welton, 2013) I made efforts to establish rapport with the participants right from the start of the session. Keeping in mind the notion of transformative learning, the design of the activity was molded to provide the maximum level of transformation possible; my aim was to achieve this transformation to manifest a change in the behavior of the adult learners. It has also been theorized that learning is enhanced when it is carried out in the context in which it is expected to be utilized. To enhance this contextualized learning, I opted for an environment (antenatal clinic) that could provide the appropriate context of learning. By keeping these facts and Malcolm's six principles (see Appendix) of adult learning in mind, I was able to develop a program and environment that could deliver the required knowledge within the time frame provided. Since the approach was reflective, I was in a better position to judge the level of learning from the responses that I received during the teaching session. I employed Gagne's (see Appendix) nine steps of instruction to make the process of instruction complete and up to the mark. Since the participants were passing through the same phase of life, this session was very enriching as it allowed sharing of personal experiences between the learners. Public health theories Tannahill (see Appendix) has suggested that any activity related to health promotion includes the aspects of prevention, positive health education and health protection. A wide range of preventable diseases can be eliminated from the society if proper education is provided about the nature of diseases (Hernandez, 2011). Similar is the case with obstetric burden of disease. Public health authorities should promote the concept the education of masses to limit the burden of disease (Davies & Macdowall, 2006). Understanding the nature of problem and being able to distinguish the normal from the abnormal makes it possible for ordinary people to seek medical help earlier during the course of a disease and in doing so reduce health related costs at the national level (Ehlers, 2002). Moreover, there are various laws which demand reporting of certain diseases when they are diagnosed at hospitals. Laws of this kind are implemented to make sure that the spread of lethal diseases is prevented before turning into epidemics. Here again, the need of education about the nature of medical conditions is stressed. The 'community organization model' demands that public health workers play their role by making possible the identification of health problems and implementing strategies to overcome these problems to the maximum limit possible. The problem that I identified was 'unawareness of the women about the upcoming labor' and the strategy that I adopted involved 'educating' them to be prepared for the same. The process of adopting newly learned healthy behaviors is a slow process and involves a number of steps. According to the transtheoretical theory, during the process of learning an individual passes through pre-contemplation, contemplation, preparation, action and lastly maintenance. Moreover, for an individual to progress to the next level, a number of interventions by the mentors are required (US Department of Health and Human Services, 2002). The teaching session that I conducted was meant to provide the pregnant women an opportunity to pass through the stages of pre-contemplation, contemplation and preparation. They were encouraged to 'act' before the onset of labor and 'maintain' what was being taught after their pregnancy was over. Signs and Symptoms of labor A talk about the signs and symptoms of labor was central to the discussion session under consideration. The reason for this is the fact that knowledge in this area appears to be directly related to the outcomes expected from this activity. An overview of the 'normal' symptoms of labor was provided to allow the learners distinguish between the expected and the unexpected happenings that were due in the weeks following this teaching session. The areas covered by this teaching session including concepts like; Coping with the initiation of labor – importance of snacks and fluids Coming away of mucus plug from the cervix – a 'show' Breaking of waters – absence of amniotic fluid and the risk of infection Types of contractions and their significance Strong, regular and persistent contractions Backaches An urge to go to toilet to urinate Importance of bleeding and its risk Smell and color of discharge Stages of labor – cervix dilatation, delivery of baby and expulsion of placenta Induction of labor and the various methods employed for the purpose These signs and symptoms were focused upon to ensure that 'warning' symptoms are readily picked up by the would-be mothers and appropriate measures taken as earlier as possible. This discussion also included some aspects of post-natal care since women are prone to certain complications during this period. Evaluation Evaluation Since accountability is an essential part of any activity, the need to evaluate the process is justified (Alkin & Christie, 2004). Various forms of evaluation may be used for the purpose of assessing the success of a teaching session. These may include options like interviews, questionnaires, surveys, focus groups, diaries, rating scales, performance indicators and cost-benefit ratios etc. Depending upon the nature of the participants and other factors that affect the outcome, the choice of an evaluation method is made. According to the concept of 'realistic evaluation', the outcome of an activity is the sum of mechanism and context of the activity (Pawson & Tilley, 2006). It is therefore important to get an insight into the effectiveness of mechanism adopted for the activity and the context in which the activity was carried out. Methods like questionnaires, surveys, diaries and rating scales are ideal for participants who are literate and well versant with the language of instruction being used. Application of these methods was however not a possibility in this setting. My plan was to observe ladies during and at the end of the session for feedback and response. Later on, I used this information to carry out a discussion with a student colleague of mine who was assisting me during the whole process. Later on, I discussed the outcome of my activity with my mentor along with my personal reflection of the process from the start to the end. As far as the successful outcome of this activity is concerned, there are certain areas about which I am confident that success was definite. First and foremost is the fact that I managed to gather a group of ladies who were approaching the end of pregnancy. There is a common tendency of women to ignore such gatherings for a variety of social reasons. However, I was successful in bringing some of the most vulnerable women to the session I planned where they participated and shared their own experiences. There are some aspects of the session where I noted some deficiencies. Firstly, some of the participants were not convinced enough to participate in the session; so they did not attend the session at all. Some of the participants were not willing to become active part of the discussion and so kept themselves partially reserved from the activity. Lastly, the participants were not very well informed about the nature of session that was about to take place, when they came. In fact some were surprised to know that this subject actually needs learning. My plan for future session of this kind would include the following improvements; - Informing the participants about what to expect in the session - Providing information about the possible benefits of the session to convince them - Preparing the participants (mentally) to accept that this is a subject that demands learning and that the outcomes of pregnancies may be improved by making informed choices - Engaging the passive learners by letting them express their views about the topic and appreciating them to encourage participation - A follow-up session (within 4 -6 weeks) to evaluate the effectiveness of the activity being carried out I am hopeful that these measures will increase the effectiveness of the teaching sessions of this type. Conclusion From the discussion above, it is apparent that the provision of health care services and education to the far flung areas of the under developed countries is an extremely challenging job that requires considerable planning and implementation skills to achieve success. Although every attempt was made to make this teaching session as productive as possible for the intended audience, I still felt the need to understand more about the cultural and religious customs of the population that was taking part in the activity. An important hindrance was the lack of basic education upon which further knowledge about anything is based. Additionally, a number of other factors appeared to be playing a central role as far as the learning behavior of the participants was concerned. Since the participants were not very literate, they were not aware of the class discipline. So, additional effort was needed to make them familiar with the present setting. A prominent and reliable marker of the success of a teaching session is the level of change that is observed in the behavior of the class that has undergone the learning process. In this case, if the expecting women manage to seek help in a timely manner upon manifestation of clinical symptoms of labor; this change will be the start of a revolution that will continue to improve the health of expecting women during the coming times. I firmly believe that behaviors which are beneficial to oneself and others are easily replicated in the society and once the cycle of change has started, people are intelligent enough to keep it rolling on their own. There is a hope that once people are educated properly, they will be able to make an informed choice based on evidence based recommendations that are accepted worldwide. References Alkin, M. C., & Christie, C. A. (2004). An evaluation theory tree. Evaluation roots: Tracing theorists’ views and influences, 12-65. Davies, M., & Macdowall, W. (2006). Health promotion theory. Maidenhead: Open University Press. Downie, R. S., Tannahill, C., & Tannahill, A. (1999). Health promotion: Models and values. Oxford [u.a.: Oxford University Press. Ehlers, V. J. (2002). Teaching aspects of health care. Lansdowne: Juta. Gagne, R. M., Briggs, L. J., & Wager, W. W. (1992). Principles of instructional design. Fort Worth: Harcourt Brace Jovanovich College Publishers. Hernandez, B. L. M. (2011). Foundation concepts of global community health promotion and education. Sudbury, MA: Jones & Bartlett Learning. International Development Research Centre (Canada). (1995). Female Client and the Health-Care Provider. IDRC. Knowles, M. S. (1990). The Adult learner: A neglected species. Houston [etc.: Gulf. Manning, V., & Bowden, Jan. (2006). Health Promotion in Midwifery 2nd Edition: Principles and practice. Hodder Education. Middleberg, M. I. (2003). Promoting reproductive security in developing countries. New York [u.a.: Kluwer Acad./Plenum Publ. Nesbit, T., & Welton, M. R. (2013). Adult education and learning in a precarious age: The Hamburg declaration revisited. Pawson, R., & Tilley, N. (2006). Realist evaluation. Development Policy Review Network Thematic Meeting, Report on Evaluation. Amsterdam, Netherlands. Tinker, A. G., & Koblinsky, M. A. (1993). Making motherhood safe. Washington, DC. Tulchinsky, T. H., & Varavikova, E. (2009). The new public health. Amsterdam: Elsevier / Academic Press. US Department of Health and Human Services. (2002) Physical Activity Evaluation Handbook. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention. Appendix Malcolm Knowles' six principles of adult learning (Knowles, 1990): -          The learner's need to know -          Self-concept of the learner -          Prior experience of the learner -          Readiness to learn -          Orientation to learn -          Motivation to learn Robert Gagne's nine steps of instruction (Gagne et al, 1992): -          Gain attention -          Provide a learning objective -          Stimulate recall of prior knowledge -          Present the material -          Provide guidance for learning -          Elicit performance -          Provide feedback -          Assess performance -          Enhance retention and transfer Downie, Fife & Tannahill's overlapping spheres (Downie et al, 1999): Read More