Community Analysis and Healthcare Planning - Literature review Example

Running Head: COMMUNITY ANALYSIS AND HEALTHCARE PLANNING Community Analysis And Healthcare Planning [Name Of Student] [Name Of Institution] INTRODUCTIION In recent years it has been recognised there is the need to strengthen and develop community capacity if health inequalities are to be reduced. Health education made an important contribution to community participation for health, by sharing knowledge and education about health and disease (Wilkinson, 2005). Neighbourhood Community Development work is being undertaken every day in many different settings by many different agencies. Yet Community Health Development is widely misunderstood, and its potential often underestimated – except by those engaged in it. Community Development does not offer an instant solution to social problems; it is just one of a wide range of possible ways of setting out to achieve a positive social change (Bracht, 1993). It has to operate within a largely hostile political and economic climate, in which poverty and unemployment is the backdrop to many people’s lives, however, when given time and adequate resources, it can lead to exciting and significant transformations in the quality of lives of those it touches. BACKGROUND The inequality in health experience in South Australia, Adelaide is evident. Adelaide has a resident population of approximately 260,000, with lower than average life expectancy at birth for both men and women compared to Australia (Adelaide TPCT 2008a). Many early deaths are attributed to cancer and coronary heart disease linked to harmful health behaviours in particular high levels of tobacco and alcohol consumptions, unhealthy eating and low levels of physical activity. One quarter of Adelaide five year olds were found to be over weight or obese (Adelaide TPCT 2007). In response to the challenge of tackling health inequalities and improving the health of the residents of Adelaide, The Adelaide Teaching Primary Care Trust (HTPCT) contracted the Community Health Development Workers (CHDW), to lead on a citywide Community Weight Management Programme, funded through Neighbourhood Renewal Funding (NRF). The main focus of the programme was to review how effective Community Health Development is in strengthening social capital, creating opportunities for inclusion and, reducing obesity whilst Adelaide residents were attending a ten-week weight management programme (Bracht, 1993). DISCUSSION Looking Good, Feeling Good (LGFG) is a community weight management programme, designed and developed with the community for the community, supported by Community Health Development. The ethos is based on service provision, which is delivered at a local level, and is supported by the Our Health, Our Care, Our Say White Paper (2006), which set out a whole new directive at reforming health and social care. Its vision to address better access to improved service provision, more choice and improved services at a local level stem directly from what people have said they want from health and social care in the future. When people access community services, they should do so in places and at times that fit in with the way they lead their lives. Organizational boundaries should not be a barrier (Robson, 2002). More recently, this person-centered ethos is reflected within world class commissioning competencies. The vision of world class commissioning is to achieve outstanding performance in the delivery of health and care services in the NHS (World Class Commissioning, Dept of Health 2007). Looking Good Feeling Good (LGFG) has therefore provided an opportunity to test a method, which involves and gives responsibility back to local communities to engage with health practitioners, influence decisions and inform future practice. Community groups are demonstrably effective in providing health gain (Twelvetrees 1991). These groups attract people who are motivated by social issues as well as health improvement they contribute greatly to social capital (Wilkinson 2005). They also draw membership from the key targets for health improvement, i.e. people in deprived communities, and those at greatest risk from cancer, coronary heart disease, diabetes and other illnesses linked to poor diet and lack of physical activity. AIM To critically evaluate the methods and degree of impact a community weight management programme called Looking Good, Feeling Good (LGFG) (which uses community development principles as its framework) has, in increasing continued participation in exercise, after the initial weight management programme ends (Muntaner, 1999). This study will look at the extent to which involving the community at the “developmental stage” is effective in tackling obesity, improving social inclusion and encouraging long term health gain. OBJECTIVES This study attempts to: (a) explore factors influencing weight loss whilst participating in a community weight management programme. (b) investigate the possible short-term effect and long term impact of a community weight management programme, whilst engaging with participants at the development stage. (c) investigate sustained participation in exercise and weight loss post LGFG. METHODOLOGY THE TEN-WEEK INTERVENTION The City of Adelaide has a resident population of approximately 260,000. Adelaide is the 11th most deprived authority in Australia based on the Index of Multiple Deprivation 2007. It has improved slightly from the 9th most deprived in 2004. However, the health of people in Adelaide is worse than the Australia average (Engel, 2000). Life expectancy, deaths from smoking and early deaths from heart disease, stroke and some cancers are all higher than the Australia average. Male and female life expectancies in Adelaide continue to be lower than the average in Australia and this gap shows no signs of narrowing. Premature deaths attributable to cardiovascular disease (CVD), cancer and respiratory disease, accounts for much of the gap in life expectancy between Adelaide and the national average (Adelaide TPCT 2007)). It is no surprise therefore that the people of Adelaide also experience higher prevalence rates for risk factors linked with these conditions. As part of the 2003 Health and Lifestyle Survey, over 8,000 randomly chosen adult residents of Adelaide and East Riding returned information on their height and weight. From this information a Body Mass Index (BMI) was calculated for each person. The calculation is: BMI = weight (kg) divided by height (in m) squared. Individuals with a BMI of fewer than 18.5 are classified as underweight, although this is generally not in itself a medical problem; a BMI of over 30 is classified as obese, and over 40 (where there are severe risks of consequent health problems) morbidly obese. The recent House of Commons Health Committee report on Obesity highlighted the growing risks to Public Health from obesity and particularly urged the Government to increase its preventative actions. A report by Experian International which analysed expected rates of Diabetes in Local Authorities gave Adelaide Australia’s highest obesity index rating. Despite the figures being ill founded the mass media widely reported that Adelaide was top of the fat league and Other findings are that the highest levels of obesity locally are among women in Adelaide. The more materially deprived an area, then the higher the levels of both obesity and underweight. The highest levels of obesity are in the age groups 45-64, with around a 60% rise in the obesity level in the last decade both locally and nationally. The local data presented comes from “self-reported” height and weight data, whereas the Australia data is from actual measurements. Research has shown that overweight individuals, particularly the elderly, tend to under-report their weight and hence their BMI too. Recent estimates of the degree of underreporting in Western cultures indicate that levels of obesity may be underestimated by the survey by 1 to 7 percentage points. (Nutbeam, 1997) This particularly needs to be borne in mind when comparing local and national figures (Adelaide Health Authority, 2000). The Looking Good Feeling Good project was developed after having community input on what people said they needed, how it should be developed, and who should be involved. Initially the main element for people accessing the group was to access affordable weight management services, with the emphasis being on take up of physical activity, healthy eating and sustainable lifestyle change. Individuals were given a weight management card, which they could take with them throughout the ten-week programme (Nutbeam, 1997). This allowed them to make personal goals setting around sustainable lifestyle changes and weight loss indicators: education support and advice on all aspects of healthy living: one hour of physical activity which included aerobic, dancing, salsa with tutors brought in for specialist activities (Rootman, 2001). This was then recorded weekly and evaluated by the health professional to identify achieved weight loss and other health indicators. Although the projects main element was weight loss – a multi-faceted programme that incorporated elements of healthy eating, it brought in other elements including alcohol awareness, basic cooking skills, healthy recipes, meals on a budget, menu planning (Pawson, 1997). Health and life expectancy are still linked to social circumstances (Rootman, 2001). All information relating to the programme was translated and written up in their native tongue to meet their need. Joint work with other health promotion initiative including links to local smoking cessation services, referral to local Health Trainers, who provide personalised intensive one to one support to assist people to make further lifestyle changes. CONCLUSION AND RECOMMENDATION This study shows that the majority of respondents attending the programme are women from a wide age range however, predominately coming from those who are 45 and over. Future intervention studies examining changes in physical activity are needed to examine whether the changes made at the end of the study have a short-term effect or a long lasting impact on health improvement (Pope, 1999). The result of the intervention suggests that people who attended the course have experienced some immediate health benefits (Rootman, 2001). Respondents relate that they feel happier since joining the course, and would readily attend a group much more than they would before the start of the course. One of the most significant but not too surprising findings when looking at long term health improvements is the need for the NHS to support future interventions that factors such as the longevity of community groups, and their ability to engage people in the lowest income groups and therefore contribute to health improvements (Raphel, 2000). There is a need to increase male participation in weight loss programmes. Future course planning and marketing to target male population using social marketing techniques to identify where, when, and what is delivered using appropriate materials (Raphel, 2000). Additional targeting of groups around specific age ranges, and gender would encourage further participation. The primary aim of this project was to determine the effectiveness of a community based weight management intervention specifically tailored to address the individual needs of obese, low-income, adults. The intervention developed for this study was unique in that it sought to address potential weight management barriers in several ways (Engel, 2000). First, the method of delivery involved using the skills of the Community Health Development Worker to support the process of engagement, who had previously established rapport with the participant (Bradley, 1995). Second, nurse practitioners provided an ongoing system of support, follow-up, and motivation, consistent with the treatment model of managing obesity as a chronic illness (Rissel, 1994). The current results suggest that regularly scheduled, tailored weight loss interventions can result in significantly greater weight loss. Intervention participants demonstrated a reduction of 2-5% body weight. Although the weight loss achieved by participants in this study was smaller than that obtained by more time intensive treatments, even modest weight losses can produce health benefits. Weight reductions between 5% and 10% of body weight are usually considered a criterion of success to positively impact health outcomes. In summary, the current results are encouraging and provide valuable insight for a number of reasons. First, weight loss was achieved, with a population of people often viewed as unmotivated, and minimally responsive to traditional weight loss techniques. Also, the intervention was incorporated into the Community Health Development Worker (CHDW) and Practice Nurse schedule and once structured required minimal time on the part of both the physician and the participant (Epstein et al, 1996). These results suggest that beneficial results in successful weight loss interventions outside a clinical setting can be obtained. Developmental initiatives facilitating planning, implementation and ownership of interventions by community members and organisations can be a feasible and effective way to achieve sustainable improvements in health behaviours and selected health outcomes in people attending a community settings weight intervention programme (Rissel, 1994). REFERENCES Bracht, N, (1993) Health Promotion at the Community level 2nd Edition Bradley, J. Cousins, Earl, L M, (1995) Participation and Evaluation in Education Studies in Evaluation in Organisational Learning: Engel, G, L (2000) Social Psychology and Health – Second Edition pp 8-9 Epstein, L,H, Coleman, K,J., & Myers, M, D (1996) Exercise in Treatment of Obesity in Children and Adolescents. Medicine and Science in Sports and Exercise. Vol. pp 428-43528. Health Promotion: Models and Values Oxford Medical Publications, Adelaide Obesity Strategy Group (2007) London Sage Muntaner, C. & Lynch, J,. (1999) Income inequality and mortality: importance to health of individual income, psychosocial environment, or material conditions BMJ 2000;320:1200-1204 Nutbeam, D. (1997) Leading Health Promotion into the 21st Century, Health Promotion Glossary Nutbeam, D. (1998) Evaluating health promotion-progress, problems and solutions. Health Promotion International 13(1):27-44 Pawson, R. and Tilley, N. (1997) Realistic Evaluation, Sage Publications, London. Pope, C, Mays, N (1999) Qualitative Research in Health Care: Second Edition Raphael, D (2000). The question of evidence in health promotion. Health Promotion International Volume 15(4); 355-367 Rissel, C. (1994) ‘ Empowerment: the holy grail of health promotion?’, Health Promotion International, 9 (1):39-47 Robson, C. (2002). Real World research. Second Edition. Oxford, Blackwell Publishing Rootman, I., (2001) Evaluation in health promotion –principles and perspective pp 13-1 Tones, K. & Green, J. (2004) Health Promotion Planning and Strategies. Tones, K. Measuring Success in Health Promotion: Selecting Indicators of Performance (Hygie, Vol. XI, 1992/4) Twelvetrees, A., (1991) Practical Social Work - Community Work Second Addition pp 80-93 Wilkinson , R. Marmot, M, (2003) Social determinants of Health: The Solid Facts. 2nd edition Wilkinson, R,. (2005) The Impact of Inequality – How to Make Sick Societies Healthier: pp 47-55 WORLD HEALTH ORGAISATION (1996) Ottawa Charter for Health Promotion Regional office of Europe The response from participants who attended the programme reported a positive outcome. A total of 87% (27 respondents) said they achieved their aims whilst attending the programme. Table 3 – Demographics Table Age Frequency Percent Valid Percent Cumulative Percent Valid 25-34 2 6.5 6.5 6.5 35-44 2 6.5 6.5 12.9 45-54 12 38.7 38.7 51.6 55-64 4 12.9 12.9 64.5 65-74 7 22.6 22.6 87.1 75 + 4 12.9 12.9 100.0 Total 31 100.0 100.0 Table 4 Frequency table for weight loss Why did you join (To lose weight) Frequency Percent Valid Percent Cumulative Percent Valid yes 23 74.2 100.0 100.0 Missing System 8 25.8 Total 31 100.0 Table 5 Frequency table for people attending the course: Did you lose weight whilst attending the course? Frequency Percent Valid Percent Cumulative Percent Valid yes 22 71.0 71.0 71.0 no 9 29.0 29.0 100.0 Total 31 100.0 100.0 Table 6 Frequency table for continued exercise since attending course Table 7 Frequency table for average do you continue to exercise for 30 minutes or more: How many days on average do you still continue to exercise? Frequency Percent Valid Percent Cumulative Percent Valid Less than 30 min 6 19.4 19.4 19.4 For 30 min at least once a week 10 32.3 32.3 51.6 30 min at least 2-4 times a week 12 38.7 38.7 90.3 30 min 5 times a week 1 3.2 3.2 93.5 More than 5 times a week 2 6.5 6.5 100.0 Total 31 100.0 100.0 Table 8 Frequency table for diet before LGFG: Before attending LGFG did you eat a healthy diet? Frequency Percent Valid Percent Cumulative Percent Valid yes 4 12.9 22.2 22.2 no 14 45.2 77.8 100.0 Total 18 58.1 100.0 Missing System 13 41.9 Total 31 100.0 Table 9 Frequency table for improved diet since participating on course: Has your diet improved since attending the course? Frequency Percent Valid Percent Cumulative Percent Valid yes 18 58.1 60.0 60.0 no 12 38.7 40.0 100.0 Total 30 96.8 100.0 Missing System 1 3.2 Total 31 100.0 Table 10 Frequency table for understanding of food labels before LGFG: Did you understand nutrition label before attending LGFG (Not at all)? Frequency Percent Valid Percent Cumulative Percent Valid yes 10 32.3 100.0 100.0 Missing System 21 67.7 Total 31 100.0 Table 11 Frequency table for improved understanding product labels post LGFG: Do you feel more informed when reading food labels since completing? Frequency Percent Valid Percent Cumulative Percent Valid yes 21 67.7 70.0 70.0 no 9 29.0 30.0 100.0 Total 30 96.8 100.0 Missing System 1 3.2 Total 31 100.0 Table 12 Frequency table for continue to see network of friends: Since joining have you continued to see your network of friends? Frequency Percent Valid Percent Cumulative Percent Valid yes 24 77.4 77.4 77.4 no 5 16.1 16.1 93.5 occasionally 2 6.5 6.5 100.0 Total 31 100.0 100.0 Table 13 Frequency table for did you enjoy being part of a group: Did you enjoy being part of a group? Frequency Percent Valid Percent Cumulative Percent Valid Yes 27 87.1 87.1 87.1 No 4 12.9 12.9 100.0 Total 31 100.0 100.0 Table 14 Frequency table for feelings since joining the course: Since joining the course do you feel Happier? Frequency Percent Valid Percent Cumulative Percent Valid yes 15 48.4 100.0 100.0 Missing System 16 51.6 Total 31 100.0 Table 15 Frequency table for encouraged further participation in other activities: Has taking part in LGFG encouraged further participation in other activities? Frequency Percent Valid Percent Cumulative Percent Valid yes 20 64.5 66.7 66.7 no 10 32.3 33.3 100.0 Total 30 96.8 100.0 Missing System 1 3.2 Total 31 100.0 Table 16 Frequency table for would you take part in a weight management course in the future: Would you take part in a weight management course in the future? Frequency Percent Valid Percent Cumulative Percent Valid yes 22 71.0 71.0 71.0 no 5 16.1 16.1 87.1 Maybe 2 6.5 6.5 93.5 Don't know 2 6.5 6.5 100.0 Total 31 100.0 100.0 Table 17 Frequency table for achieved aims whilst attending course: Have you achieved this aim/these aims? Frequency Percent Valid Percent Cumulative Percent Valid yes 27 87.1 87.1 87.1 no 3 9.7 9.7 96.8 A little 1 3.2 3.2 100.0 Total 31 100.0 100.0 Read More