The Health Promotion logo incorporates five key action areas in Health Promotion (build healthy public policy, create supportive environments for health, strengthen community action for health, develop personal skills, and re-orient health services) and the three basic Health Promotion strategies (to enable, mediate, and advocate) as described by the World Health Organisation in the Ottawa Charter (World Health Organisation 1986; Nutbeam 1998).
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In Nigeria, incidence rate of cervical cancer is the estimated at 25 per 100,000 women; with an about 8000 new cases of cervical cancer diagnosed each year(Adewole, Benedet et al. 2005). CITED IN... OKONOFUA. The National Cervical Cancer Prevention Programme (NCCPP)-the first national effort towards the cervical cancer prevention in Nigeria-was formally launched by the Honourable Minister of Women Affairs and Social Development in October, 2008.
Potential approaches to tackling cervical cancer
Medical or preventive approach: primary prevention via HPV vaccination and secondary prevention via cervical screening .This closely aligns with the principle highlighted in the Alma Ata declaration which focuses on prevention rather than cure(World Health Organisation 1978).
Behavioural approach: encouraging clients to take-up screening services and also encouraging clients to adopt healthy sexual behaviour through group or one-to-one counselling as well as mass campaigns.
Educational approach: increase awareness of the cause of cervical cancer via sex education (peer education and family life skills curriculum). Knowledge about the risk factors for cervical cancer may change sexual attitudes and ultimately behaviour. Socio-economic factors may however limit voluntary change in behaviour. Provision of leaflets, booklets, group, and one-to-one advice may be used to educate on the risks of the disease.
Social change approach: free education for teen females and free vocational training programmes and improving access to education.
Empowerment approach: enhance life skills through family life skills curriculum and peer-education which help in teaching female teenagers assertiveness and negotiation, and self esteem building regarding sexual issues.
Theoretical underpinning for cervical cancer screening
This intervention combines the medical (preventive), behavioural and educational approaches to health promotion. The theoretical framework is the modified health belief model(Rosenstock, Strecher et al. 1988) of health-related decision making. The Health Belief Model (HBM) has been widely used in the prediction of cervical cancer screening uptake (Gillam 1991; Austin, Ahmad et al. 2002; Johnson, Mues et al. 2008).It is based on the individual's perceptions of the threat posed by a health problem (susceptibility, severity), the advantages of avoiding the threat, and factors influencing the health related decisions (barriers, cues to action, and self-efficacy). This value-expectancy model(Shumaker, Ockene et al. 2009) suggests that whether people change their health behaviour, accept an intervention, or not would depend on if they believe its benefits outweigh its risks (e.g. death) or costs (time and money). It suggests that women are influenced by how vulnerable they think they are to cervical cancer (perceived susceptibility) and how serious they consider it to be (perceived severity). This theory has however been criticised as being unable to predict behaviour but it can potentially serve as a framework for elucidating women's reactions to screening and help in devising methods of increasing participation, improving the quality of the service, and reducing women's anxiety towards cervical cancer diagnosis(Fylan 1998). According to the HBM, asymptomatic people may not go for cervical screening unless they accept that, though they have no symptoms, they may in fact have pre-cancerous lesions (perceived susceptibility). They must understand that cervical cancer is a leading cause of death (perceived severity). Taking a Pap smear test will reduce the risk of cervical cancer (perceived benefits) without negative side effects or excessive difficulty (perceived barriers). Posters, reminder letters and messages, or radio announcements especially in the local dialect might encourage women to go for screening (cues to action). For those who have had a friend or relative developing cancer, counselling might help build confidence in taking up the service (self-efficacy).
Individual perceptions Modifying factors Likelihood of action
Perceived benefits of cervical screening-avoidance of premature death minus Perceived barriers to cervical screening -accessing healthcare facilities (transport), inconvenient clinic times, lack of a female screener (especially for muslim women), fatalistic view of cancer, cost of testing, lack of patient-friendly services, cultural health beliefs, language barriers, fear of discrimination, spouse disapproval, absence of symptoms
Age (>20), female (gender),marital status
Low socio-economic status, poor nutrition, level of education, polygamy, multiple sexual partners
Knowledge about cervical cancer, prior contact with people with cervical cancer
Perceived susceptibility to cervical cancer
Perceived severity of cervical cancer
Perceived threat of cervical cancer
Likelihood of having a pap smear
Cues to action
Advice from physicians and lay persons (friends, neighbours, relatives, community leaders, and spiritual leaders)
Mass media campaigns-radio announcements and broadcasts (in English and local dialect), newspaper articles, billboards, television, press advertisements
Booklets, leaflets, and posters placed in public places like supermarkets; handbills
Illness or death of a friend or close relative from cervical cancer
Reminders from physicians
Health Belief Model of Cervical Cancer Prevention (Adapted from (Naidoo and Wills 2009)-Health Belief Model pg.
The theory of reason action and theory of planned behaviour may be used to predict response to cervical cancer screening based on looking up to the health promoters as 'models'.
Role of the media in cervical screening
Using the media to pass on information and advice is an important strategy or tool for health promotion. Much of public health issues-including smoking and HIV/AIDS -have been successfully improved via extensive media campaigns. Media messages help in reaching large numbers of people. The vital role of research in health promotion has been supported by research (Marcus and Crane 1998; Jenkins, McPhee et al. 1999).Mass media campaigns aim to raise awareness or provide messages about participation in the intervention.
Mobile phone text messaging is a potentially useful means of sending invitations and reminders for screening. A research finding also stated that mobile phone messages `seems to be an effective tool for increasing compliance with vaccination schedules'(Vilella, Bayas et al. 2004).A trial demonstrated that attendance at primary care centres improved via mobile phone text messaging (Leong, Chen et al. 2006)and unhealthy behaviours such as smoking(Rodgers, Corbett et al. 2005) has been shown in research to be improved by text messages. Furthermore, a systematic review also indicated that mass media interventions may play a key role in influencing the use of healthcare interventions(Grilli, Freemantle et al. 2000).
Linear causal and diffusion of innovation model have been used to explain the effects of media on an audience.REVISE AND ADD 3 LINES FROM TAG AND NAIDOO
Though media is effective at reaching large nos of people the understanding and recall by the target audience cannot be guaranteed .It must be supported by other strategies like reimforcement from experts. CITE NAIDOP189 PLUS SOURCESCHECK NAIDOO AND WILLS .There is also a problem of interpreting statistics research studies and interpretation of risk.
Social marketing=market women,university students,female health care wokers,women in churches,muslim women
Read pg 194 plus few other ar
Rationale for cervical screening
For a screening for a disease to be effective:
the disease must be an important health problem;
the natural course of the disease should be well understood;
the disease should have a long detectable preclinical phase;
must have effective treatment and early treatment should improve outcome;
the test should be highly specific and sensitive; and
adequate resources to perform the test should be available and it should be cost effective(Naidoo and Wills 2005).
LINK THESE TO PAP SMEAR AND CERV CA + CITE epide/sys reviews/rcts
The Ewles and Simnett model(Ewles and Simnett 2003) combined with a logic framework would be used in planning the programme.
Needs assessment: the case for cervical cancer screening in Ibadan
The needs assessment for this programme is carried out from the professional's perspective using the epidemiological approach (Williams and Wright 1998; Bowling and Jones 2002; Tones and Green 2004).Needs assessment is best carried out using both qualitative and quantitative information(Gilmore and Campbell 2005).It is done in order to help establish priorities ,assist planning, justify the use of resources and also in planning evaluation. It brings to light the magnitude of the problem and establishes a baseline against which the health promotion intervention can be evaluated.
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Ibadan is large community located in Nigeria. It shares a unique mix of middle class -mainly government workers and university staff -and socially disadvantaged groups. It has a substantial number of Muslims spanning the Yoruba and Hausa ethnic groups .Literacy level is low. The transport system is inexpensive but poorly organised and most women are involved in petty trading. Health services available are one teaching hospital, 3 state-owned general hospitals, and primary health centres located within each LGA.
Epidemiological data-morbidity, and mortality statistics-from the University College Hospital (UCH) Ibadan cancer registry- was used to identify and quantify the incidence of cervical cancers occurring in the community. The mean age of ?? years at presentation.
A recent study by doctors at the University College Hospital, Ibadan as reported by The Punch of November 7, 2002 gave credence to the emerging trend revealing- that out of- Nigerian women have breast cancer. Based on this finding, 34,800 new cases would be expected in 2003 an increase from 27,840 or 25% in 1999.
Selection of intervention population
Based on needs assessment, practical considerations such as level of funding, the pathogenesis of human papillomavirus infection and to a lesser degree current life-expectancy statistics? This intervention targets women between 20 and 65 years old??? Justify with evidence
The programme overall aim is to reduce the morbidity and premature mortality from cervical cancer in Ibadan?
To raise the awareness of cervical cancer and screening to 85% by the year 2014
To increase to about 70% participation( the percentage of eligible women screened by )
Intervention and resources=500 words
The intervention is a community-based intervention set in Ade-Oyo Ibadan, a community in the South-Western region of Nigeria.
Mass media campaigns to promote cervical cancer screening-planned media coverage funded by sponsoring bodies plus unpaid media coverage in newspapers-the recent death of a former first lady from ovarian cancer may increase awareness and the involvement of the current first lady in cancer initiatives has led to a dramatic increase in media coverage of cancer related issues.
Stakeholders-represenative of the press?
Primary staeholders-the women
Health professionals-general practitioners,specialist gynaecologists,health promotion and public health nurses,community health extension workers
Key stakeholders Funding bodies and ngos World Health Organisation , Mass Medical Mission (MMM) ,PATH Policy makers- agencies/FMOH/Oyo State moh,Ministry of Women Affairs
Pap smear plus acetoacettttt???
Target? by 2014
Evaluation of the cervical cancer prevention programme=300 -400 words
Ethical principles 3-4 lines
Political dimensions3-4 statements
Politics can be looked at from a power perspective and defined as 'the production ,distribution and use of scarce resources'Cite IN NAIDOO(Heywood 2000).
Politics play an important role in the success of health promotion interventions.
ATTACH LOGIC FRAMEWORK Quantitative approach:
This health promotion intervention has used the medica approach to hp which is often viewed as being mechanistic redustic view of health
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