Maternal Obesity Community Health Program - Essay Example

? Maternal Obesity Community Health Program: Outcomes Evaluation Number) Maternal Obesity Community Health Program: Outcomes Evaluation Introduction Over the past years, maternal obesity has become a major epidemiologic concern throughout the nation. Statistics and surveys reflect alarming values that women are becoming heavier than before, with Kim et al. (2007) actually stating that one out of every five women are obese at the beginning of their pregnancy. The Centers for Disease Control and Prevention (CDC, 2010) also supported this claim by stating that according to surveys, around one out of five pregnant women are obese, especially at the beginning of their pregnancy. Maternal obesity is a significant concern for the society since it poses a lot of health threats not only for the mother, but also for the conceived child. Indeed, Galtier-Dereure, Boegner, & Bringer (2000) found that children born to obese mothers were 35% more likely to be admitted to the neonatal intensive care unit due to complications of care. The obese mother is also at an increased risk for hypertension and diabetes. In addition to these, the CDC (2010) also noted severe health consequences to the mother (i.e. preeclampsia, caesarean delivery, etc.) and the newborn (i.e. macrosomia, neural tube defects, etc.). Given these dangers of maternal obesity, there is then a need to increase the awareness of mothers regarding the hazards posed by it, and what can be done as means of prevention and treatment. By utilizing the Health Belief Model (HBM), obese mothers can be motivated to change their diets and lifestyle to decrease the harmful effects of obesity. By using this model, the healthcare provider will provide health education and information dissemination to obese mothers, and they will then monitor the impact of these interventions. The rest of this paper will then explore the means of evaluating the success of such interventions. Essential Elements of Evaluation Process/Model One component of the intended intervention for maternal obesity involves assessment: the identification of the mothers in need of treatment obesity. With this intervention, a significant element of the evaluation process is assessment itself, as well as the establishment of an actual need for the interventions within the community. This element (assessment) is justified by the fact that without assessment, the nurse would never know who needs help, and the patients themselves may never become aware of the need to watch their weight before, during and after pregnancy (Kozier, et al. 2008). In addition, assessment would allow the nurse to develop programs that can cater to the individual needs of the different members of the community. More importantly, assessment of the need for treatment will provide for opportunities for establishing patient goals and reasonable expectations (Foster, Wadden, Vogt, & Brewer, 1997). Another major component of the intervention for maternal obesity involves information dissemination of nutritional information, of the health risks of maternal obesity, and of the benefits gained from maintaining a healthy weight and diet. Therefore, in relation, an essential element of the evaluation process involves the degree by which the given information is understood and impacts the intended population of obese mothers. This element is essential for the whole intervention because in knowing the degree of impact of the disseminated information through evaluation, the nurse is assured of the mother’s compliance. Indeed, according to the HBM, if the mother understands the risks of the unhealthy behavior or condition, then change in health behavior can be better facilitated (National Cancer Institute, 2005). Additionally, another part of the intended interventions is the submission of a proposal to authorities and organizations for appropriate funding and possible policy changes. Thus, in relation to this, another element of evaluation is collaboration. Indeed, evaluation cannot be solely performed by the nurse, and any results of the evaluation should be shared to appropriate agencies for proper action as well as for surveillance purposes, provided that the identities of the patients are kept confidential. This collaboration is most significant in the sense that other healthcare providers can provide a second opinion, guaranteeing a greater accuracy in the evaluation process. Also, collaboration will allow for the acquisition of greater and better resources to help the patients in their behavior modification. Further, another significant component of the intended intervention is the weekly guided weight maintenance sessions, and other related steps or materials to help the obese mother. In relation to this, a significant element of the evaluation process includes the measurability and tangibility of its goals, wherein both the healthcare provider and the patients know what they should do, how to do it, and when to do it. This element of measurability and tangibility (or concreteness) is required by the fact that goals should be clear and properly-set, in order for it to be able to fully guide the intended interventions (Hansen, 2005). In fact, one of the most basic requirements for effective evaluation is the placement of SMART of Specific, Measurable, Appropriate, Reasonable, and Time-bound objectives (Diem & Moyer, 2005). In response to this, the desired or expected outcomes of the interventions will be presented below. Desired or Expected Outcomes Given the intended interventions, an ideal outcome is for women to enter into pregnancy at a healthy weight, and for them to maintain a healthy weight throughout pregnancy by adhering to the guidelines set by the Institute of Medicine (as cited by Abrams, et al., 2009). More specifically, the following involve the desired or expected outcomes for mothers: 1. Before pregnancy, mother must have a healthy Body Mass Index (BMI) of 18 to 24, as part of preconception weight management. 2. During pregnancy, mother must maintain or achieve ideal weight, or optimal gestational weight gain (GWG) as set by the Institute of Medicine: a. For obese mothers, weight gain is limited to 11 to 20 pounds b. For overweight mothers, only 15-25 pounds is recommended for weight gain c. For mothers with normal weight, weight gain should include 25 to 35 pounds d. For underweight mothers, weight gain should be as high as 28 to 40 pounds 3. During and after pregnancy, mother must establish exercise schedule involving 2.5 hours of exercise at a moderate level, including two days of muscle strengthening each week, and a diet appropriate for her and her baby’s needs. 4. Within one year postpartum, mother must gradually lose excess pregnancy-related weight through proper diet and exercise. These outcomes were developed based on various sources and the ideas of this writer. Still, the rationale for the expected outcomes will be presented in the next section of the paper. Rationale for Outcomes and How These Meet Desired Standards and Goals The first desired outcome was chosen for purposes of evaluation because it is true that prevention is better than cure. By guaranteeing that the mother is in her normal weight at the start of the pregnancy, possibilities for obesity are reduced, especially if the mother is made aware at the beginning of pregnancy regarding the significant effects of obesity. Also, by guaranteeing that the mother is already healthy at the beginning of the pregnancy, the care provider can guarantee that the desired goal of improving the health and well-being of women and children. In relation, the second desired outcome was developed to assist the mother in determining the ideal weight that she can gain during pregnancy. If the mother is already obese or overweight, then there is a need to control the amount of weight that she gains, and this can be achieved through proper health education regarding diet and exercise. Indeed, Klohe-Leman et al. (2006) found that adequate weight loss and proper weight maintenance among pregnant obese women was directly associated with a gain in nutritional or dietary knowledge. Thus, by helping the mother achieve optimal weight, this desired outcome will help the health care provider in achieving the goal of improved health for the mother and child. Moreover, the third and fourth outcomes were developed because of the recognized role of proper diet and physical activity in the reduction and maintenance of weight. Through the regulation of food intake, the mother can control the amount of energy she supplies the body, thereby forcing the body to collect energy from alternative sources by burning excess fats. In addition, through exercise, the body’s demand for energy increases, compelling the body to utilize its store of fats and similar substances (Eckel, 2003). In addition, O’Toole et al. (2003) also found that mothers who received early (early postpartum period) and ongoing educational support on diet as well as supervision on exercise were able to successfully lose weight. More importantly, all the developed expected outcomes were based on the literatures cited within the text, as well as the recommendations provided by the CDC (2010), the Institute of Medicine (as cited by Abrams, et al., 2009), the National Center for education in Maternal and Child Health, and a lot others. Possible Negative Outcome Unfortunately, if the intended interventions have a desired or expected outcome, they also have possible negative outcomes. Indeed, part of evaluation can include the anticipation of the said outcome and preparing to either prevent or mitigate its effects. For example, one possible negative outcome from the intended interventions is due to the difficulties and complications related to pregnancy, expectant mothers may resist the said program and instead gain excessive weight, despite being informed of the dangers of maternal obesity. This possibility is given the fact that childbearing is truly a difficult and demanding stage for every woman, especially since the woman now has to carry and feed “two” people. With this increase in her load, the mother’s instinct is to feed herself and the child, most often leading to excessive eating and, inevitably, obesity. However, it should be understood that the intended program does not promote that the mother should not eat or that she should starve herself. Rather, the intended program advises proper timing of food, as well as the intake of an amount of food that is only enough for her and the baby (i.e. small, frequent feedings). Still, the health care provider can actually address this possible negative outcome by guaranteeing the cooperation of the mother. One method the nurse can employ is contract-setting, wherein both the nurse and the patient will decide upon realistic and achievable goals, which will be placed in writing and will be signed by the patient and the nurse (Humphrey, 2000). By using this method, the patient sets a goal that she is sure she can achieve and she develops a form of motivation to continue with her treatment or therapy. Also, the nurse can set up regular appointments, online interactions, as well as follow-up calls to guarantee that the patient is doing her part in preventing maternal obesity. Sustenance of Interventions Sustenance of the intended interventions can be achieved in two ways: through proper monitoring or continuous evaluation and through the polishing of interventions based on evaluation results. Monitoring and continuous evaluation can be achieved through the RE-AIM model, which covers the evaluation of both long-term and short-term outcomes of the intended program or intervention. According to Abildso, Zizzi, and Reger-Nash (2010), the RE-AIM model is a tool utilized for the evaluation of programs involving health promotion by looking into five important components. These components or dimensions form the name of the model, RE-AIM: “reach, effectiveness, adoption, implementation, and maintenance” (p.1). In here, five aspects of a program will be assessed, where in reach, the degree by which the program was able to influence the affected population, as reflected by the percent of the target population that enrolls in the program and the level by which the enrolled group represents the total population of the potential participants will be evaluated. Also, the program will also be evaluated based on its effectiveness, which will be depicted by the measured improvements in the behavior of the participants while enrolled and the program. The interventions will also be evaluated according to adoption, which involves the number of centers or clinics willing to implement the program. Moreover, the interventions will also be evaluated according to implementation and maintenance, with the first one referring to the compliance of the centers and patients to the interventions, and the second one referring to the continuation of the program in the centers over a long period of time. This last component will be among the primary means for sustaining the intended interventions or program (Abildso, Zizzi, & Reger-Nash, 2010). Finally, sustenance of the program can also be made possible through the utilization of the actual outcomes of the program by determining what has worked well and what has not, as well as what has not worked. Indeed, changes can be incorporated by adjusting schedules, additional resources and support, and others. Conclusion Indeed, maternal obesity is on the rise, and so are its threats to the health of the mother and the child. However, the nurse can perform various interventions to help the mother control her weight, although these interventions need to be subjected to proper evaluation. More importantly, these interventions should be monitored, maintained, and continuously improved. References Abildso, C. G., Zizzi, S. J., & Reger-Nash, B. (2010). Evaluating an Insurance-Sponsored Weight Management Program With the RE-AIM Model, West Virginia, 2004-2008. Preventing Chronic Disease, 7 (3). Abrams, B., Bodnar, L., Bouchard, C., Butte, N., Catalano, P., Gillman, M. & Siega-Riz, A. (2009). Weight gain during pregnancy: Reexamining the guidelines (Consensus Report). Retrieved from Institute of Medicine of the National Academies Web site: http://iom.edu/report/2009/weight-gain-during-pregnancy/ Centers for Disease Control and Prevention (CDC). (2010). 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Structured diet and physical activity prevention postpartum weight retention. Journal of Women’s Health, 12(10), 991-998. Read More