Promoting the Evaluation of Health - Essay Example

Evaluation of Health Promotion I. A Brief Summary of the Article: “The results of a worksite health promotion programme in Kuala Lumpur, Malaysia” (Moy, Sallami, and Wong 2006, 301-309) The article under analysis is an evaluation of the long-term impact of a worksite health promotion programme on the employees’ lifestyle practices and their cholesterol levels. The said program was implemented in 2003 to a group of security guards at a public university in Kuala Lumpur aimed at reducing their risks of chronic diseases. The subjects of study are two groups: intervention group (111 participants) and comparison group (99 participants) – all composed of Malay male security guards of the same university, where the program was implemented. “The intervention group received intensive individual and group counseling on diet, physical activity and quitting smoking. The comparison group was given minimal education on the same lifestyle changes through mail and group-counseling.” (301) A pre-test–post-test non-randomized experimental study design – the most common type of quasi-experimental study design – was used; it was found most effective in studying causal relationship between the intervention and whatever change transpires in outcome measures, thus providing strongest evidence for evaluation. Different research instruments were used to gather needed data: (1) pre-test self-administered questionnaires for the participants’ socio-demographic characteristics, medical history and self-reported lifestyle behaviours, specifically their individual dietary practices, physical activity, and smoking; (2) in-depth interviews and focus group discussion for the researchers’ better understanding of the participants’ behaviours and perceptions after the programme; (3) “anthropometric measurements (weight, height, waist and hip circumference), blood pressure and biochemical measurements (fasting blood glucose and full lipid profiles) were taken at baseline and at 6-month intervals for 2 years” (all italics mine) (302), with the total cholesterol level the main outcome measure, while the rest the secondary outcome measure. Data gathered were statistically analysed, preset at 0.05 level of significance: (1) ANOVA – “to evaluate changes in outcome measures,” (2) Hyunh–Feldt correction – “to correct for the violation of the assumption of sphericity (compound symmetry)”, (3) t-test – “to compare the baseline and the final readings,” (4) x2-test – to analyse categorical data. (all italics mine) (302-303) Results of the study were as follows: 1. There was a significantly reduced level of cholesterol for the intervention group (5.83 to 5.62 mmol/l), while an increased level for the comparison group (5.44 to 5.61 mmol/l). Also, high cholesterol participants of both groups registered decreased cholesterol levels, with the intervention group registering the larger decrease. The same result applies with their HDL-cholesterol. The positive result on the intervention group was perceived as the result of the two-year worksite intervention health promotion programme implemented. While that of the comparative group was attributed to their unchanged total calorie and fat intakes. 2. There was minimal change in the lifestyle of the participants in both groups: The intervention group reported a lesser number of cigarette sticks smokers smoke and a reduction in their fat and food intake. Whereas, the comparison group reported taking-in more fruits and vegetables, and taking-in lesser sugar. 3. The BMI of both groups did not improve because they did not have time and stamina to exercise due to the nature of their work, and they misconceived obesity as a sign of prosperity while losing weight a reflection of ill-health. Furthermore, for them reducing their cholesterol level is enough because it keeps them away from heart attacks and strokes. The study concluded that, “The worksite was shown to be an effective channel for health promotion. The adoption of the new lifestyle behaviours should be supported and sustained through modification of work policies.” (301) II. Critique The study is somewhat confusing as to its focus: Was it evaluating the efficacy of the intervention per se, or was it evaluating the efficacy of the worksite as an effective channel for health promotion? It’s quite confusing because it was concluded with the worksite as an effective channel, yet the discussion centred on the efficacy of the intervention. Furthermore, the objective of the study was not categorically stated, which was very important as this would on the onset give the focus of the study. But the paper only stated in its introduction: “This paper reports the long-term impact of the programme on the employees’ lifestyle practices and their cholesterol levels,” (302) which, when analysed, centres on the intervention per se. It could be argued that since the programme was health programme designed and intended for worksites, then it follows that if the programme work positively among the employees – and it did – ergo, worksite is an effective channel for health promotion. But this assumption is not accurate, because the worksite may be an effective channel for health promotion but the intervention might be ineffective or vice-versa. Meaning, one does not necessarily confirm the other. If this was the basic premise of the study – which I can see it was – then this is the biggest flaw of the study. The treatment of the study on the two issues of concern: intervention and channel was not clearly delineated. This then made the general design of the study not perfectly fit, as shown by the gap between the findings of the study and its conclusion. The study centred on the effects of the program on the intervention group as against the comparison group, but the conclusion centred on the channel. If, the focus of the study is the worksite as an effective channel of health promotion, then it would have been more appropriate to test the similar intervention program in a worksite vis-a-vis a community. In this way, it would be tested what makes the worksite an effective channel for health promotion. This will also shed light on the most appropriate approach to implement health promotion programme in a worksite. In this case, experimental study design will be the appropriate because you have to compare two different controlled groups of respondents. On the other hand, the design of the study being analysed is more fitted in evaluating the efficacy of the health intervention as was shown by its results: Reduction in the cholesterol level and a slightly improved lifestyle in the intervention group as against the comparison group. Since what were being compared were two similar groups – Malay male security guard in the same university –quasi-experimental design is appropriate. Actually, except for the introduction and conclusion, the study had been consistent in testing and proving the efficacy of the health intervention in worksites, and the importance of healthy lifestyles in improving the health conditions of the security guards, who in earlier studies were found at higher risk of chronic diseases. Although, there was a discussion comparing the magnitude of the achieved overall cholesterol reduction level (6.5%) of the study with other earlier studies, these studies presented different results: A much higher cholesterol reduction level (7-15%) was reportedly achieved in clinical setting (Clarke et al., 1997; Delahanty et al., 2001), while a lower cholesterol reduction level (5.3%) was noted in free-living participants (Tang et al., 1998), and a broader range of 5-9% cholesterol reduction level reportedly achieved in a worksite based nutrition and cholesterol control program (Harris and Fries, 2002) (cited in, 307). In other words, this particular discussion is not enough to deviate from the initial focus (intervention) of the study and jump into a conclusion which focused more on the channel. However, despite this confusing implication, the conclusion did not actually negate the study. The simple problem was the proper emphasis. The study should have been better concluded as follows: Implementing health promotion programme in worksites improves workers’ health condition, supporting the importance of instituting health promotion programme in worksites. It should be clarified though, that, what was clearly evaluated was the positive impact of implementing a health promotion program in improving lifestyle behaviours of the participants. The literature review was incorporated in the introduction, understandably, to justify the overall framework of the study. The literatures reviewed were relevant to the study, and the references used were not only relevant but were also of quality. With this, the introduction generally established the growing concern of increased chronic diseases among adult population, composing a high proportion of the less than 40% of Malaysia’s employed population. The increased in chronic diseases was attributed to Malaysia’s sudden change of lifestyle brought about by its rapid social development. Although, the study cited two studies supporting the worksite as an important target for health promotion, three studies supporting the efficacy of a multi risk-factor intervention combined with group participation and individualised risk reduction to high risk employees, and two studies revealing security guards at high risk of chronic diseases, it failed to establish the choice of the site. Why security guards in a public university? Why not security guards in a corporate building or commercial building? Since what was evaluated was the efficacy of the intervention program, it would be necessary to justify the choice of site, especially so that the programme is being evaluated, too, against its setting. The methodology was also described in detailed, justifying its utilisation. For example, why did the study use a non-randomised experimental design, and why did the study utilised different research instruments. However, against this detailed account of the methodology, it failed to justify why there should be two comparative groups – intervention group and comparable group – in the same site, when what is being evaluated is the efficacy of the health programme. I think; evaluating the programme with the intervention group is enough because data would only have to be compared between the baseline data and the outcome measures. In short, the comparable group is unnecessary to prove the point of the program. Instead, it even created confusion as to what is being studied. The intervention programme was clearly described, but was not fully explained. For example: Why was one-to-one counselling done only at least twice yearly when what was being changed was the lifestyle behaviour of the security guards, which work schedule alone was no longer healthy? Also, why was group teaching done 3-4 times a year only, when what was being changed were a long-held misconceived health facts? Furthermore, considering the participants’ view of obesity and weight loss, which was regarded by the study to be the reason why the participant’s BMI did not change, shows that the programme failed to factor in cultural factors, which were very important considerations in effecting behaviour change. In short, it was not clear, why the programme was designed that way and what was the expected result. It appears to me that the programme was more of a trial and error, being a pilot project. This would explain why it was designed that way. For me, an intervention program to be effective, all its components should be clearly purposeful. Meaning, each component is meant to improve certain behaviour patterns. For example, a one-to-one counselling is done to understand the health behaviour of the individual participants to be able to address them in the other components of the program. Also, the group teaching is done to change the views or way of thinking of the individuals regarding healthy behaviour. If this is so, then the group teaching should at least ensure that possible misconceptions blocking the participants’ in changing their behaviour must have been addressed. This was not the case in this article being analysed. With, these problems in the programme, it would be unsurprising to know that it achieved only minimal result. III. Relevance Despite of all its flaws, the study remains relevant because it showed the need, not simply importance, for worksites to institute health promotion programme to improve healthy lifestyle among employees. Furthermore, the study also showed that a change in lifestyle affects one’s health. These findings are perfectly relevant not only in Malaysia, but in all developing countries, wherein people develop unhealthy behaviours such as too much work, too much processed food, too much liquor, smoking, etc. Aside from this, the study also shows the effect of culture in changing people’s behaviour. This study could be a good reference in designing better health promotion programmes for the worksites. Work Cited Moy, Foongming, Atiya A. B. Sallami, and Meelian Wong. 2006. The results of a worksite health promotion programme in Kuala Lumpur, Malaysia. Health Promotion International 21: 301-310. Read More