Evidence-Based Health Promotion Intervention - Smoking Prevention Program - Literature review Example

SMOKING PREVENTION PROGRAMME INTRODUCTION Initiated as an act of pleasure or ritual, smoking, has in its clutch millions of lives today. Addiction to smoking, among teenagers has made the situation grim. In a survey by Withers et al. (2000) in UK, it was noted that among 2289 children aged 14-16 years, 44·8% admitted to having smoked at some time, 14·1% were regular smokers and 7·3% of the total cohort smoked daily. Considering the above situation, curbing this habit is essential to improve the health and education of the teenagers. Health promotion and education plays a vital role in addressing such social problems. According to Health Promotion Agency for Northern Ireland (2007), Health promotion is a process directed towards enabling people to take action. Thus, health promotion is not something that is done on or to people; it is done by, with and for people either as individuals or as groups. The purpose of this activity is to strengthen the skills and capabilities of individuals to take action and the capacity of groups or communities to act collectively to exert control over the determinants of health and achieve positive change. There are several interventional strategies for addressing adolescent health promotion, school based health education, parent training and family intervention, community mobilisation, social marketing, peer intervention, community based health education etc. (Department of Human Services 2000). According to de Vries et al. (2006), “Smoking prevention programmes using the social influence approach can be effective. Sustaining the effectiveness of smoking prevention studies is therefore the most important challenge for current smoking prevention research.” NEED FOR A SMOKING INTERVENTION PROGRAMME Various smoking prevention programs instituted earlier had their own advantages and disadvantages. School based health programs have shown good outcomes. Youth recreation programmes instituted in United Kingdom were also successful. van Teijlingen developed, “The Grampian Smoke busters club”, in 1998 involving 11-14 year old children in Grampian. After four years of instituting the club, membership of smoke busters did not seem to reduce the smoking prevalence (van Teijlingen 1996). Peer-led teaching methods though promising were found to be inconclusive. In a study by Michell (1997), it was noted that, “Most 13 years olds and many 11 year olds have a clear and detailed grasp of their own social map, recognize the pecking order which is established amongst their peers and are aware of the different levels of risk-taking behaviour, including smoking, adopted by different peer groups in their school year.” Peer reputations, coping and self-concept have been the reasons behind smoking habit for many teenage girls. When a friend smokes a cigarette, it induces curiosity and encourages the teenager to start the habit. The same concept of “peer-impact” can be counter played to develop a smoking prevention programme. Peer-led programmes must be initiated and developed to combat the fierce war against smoking habit in teenagers. According to Lindsey (1997 cited in Mellanby 2000), “...friends seek advice from friends and are also influenced by the expectations, attitudes and behaviours of the groups to which they belong”. Underlying this is a concept that peer influence may be stronger than that of adults such as teachers or ‘experts’ (Mellanby 2000). THE INTERVENTION PROGRAMME: AIMS OF THE PROGRAMME: Develop an intervention process, which will reduce the prevalence of smoking among teenagers. To determine the effectiveness of ‘peer helper’ led intervention programme. Evaluate the process of intervention and determine its effectiveness. METHODOLOGY The following intervention plan involves identification of teenagers (11-19 yrs) from a selected locality. A questionnaire on smoking habit, behaviour and factors promoting the development of smoking habit will be collected at baseline. Those members with smoking habits or those who were ex-smokers will also identify a teenager or a friend who is a non-smoker, is influential and cooperative. The questionnaire will gather information regarding awareness about smoking related health issues. The teenage smokers will be divided into two groups. Group1: Low Risk Group: Those who had smoked once or twice and were ex-smokers and Group2: High Risk Group: Those who were regular smokers. The friends or peer-group identified by the risk groups will be selected. The training programme will be biphasic. Phase 1: Education and awareness programme for the risk groups and the peer-group, regarding the ill effects of smoking and health related problems. Phase 2: A short duration education programme for the peer-group regarding the management of the risk group. The peer-group will undergo rigorous training on motivating their friends to quit smoking. A sixteen week intervention program will be undertaken after appropriate training of the peer-group. At the end of the program, a questionnaire will be provided to collect the follow-up information to all the risk group members. The details regarding their smoking habit and their attitude towards smoking will be analysed. The peer-group will fill in a questionnaire stating the benefits and the problems faced during the intervention period. Evaluation will be conducted at each level of the intervention programme. RELEVANCE OF THE THEROTICAL MODEL Health professionals need to produce evidence that health promotion is actually effective (Whitehead 2002). The above theoretical intervention becomes authentic and applicable after appropriate evaluation process. The Department of Human Services (1998 cited in Department of Human Services 2000) identifies the following defining factors for evidence based health promotion strategies: They must be underpinned by the principles of best practice. They must incorporated satisfactory theoretical development. They must be effective and efficient for both the target group and the group implementing the intervention They must be cost-effective. They must be both outcome and output focussed. According to Naidoo and Wills (2000 cited in Whitehead 2002 ), health promotion is an ‘uncertain business’ and there are no guarantees that the outcome of programmes will deliver what is anticipated of them they add that evaluation is vital to ensure the on-going survival and viability of health promotion The peer-group led intervention programme will undergo process evaluation and outcome evaluation. All the processes from baseline to follow-up will be evaluated to determine the validity of the data. The outcome evaluation will provide an insight on the effectiveness of the intervention. Another important thing to remember about the advantage of evaluating programmes of activity is that it allows practitioners to design and implement the new ones. They can learn from the strength and weakness of the previous programmes. (Whitehead 2002) The theoretical intervention suggested will be a pilot project based on which the intervention period will be extended or reduced. After the initial follow-up, the programme can be extended and the effect of intervention analysed further. CRITICAL ASSESSMENT OF THE INTERVENTION The peer-group led intervention programme has been evaluated by various practitioners and was found to be effective. This mode of intervention has been implemented in various social problems such as alcohol education, sexual health, oral health and even in case of testicular caner. When compared to adult led, peer led programmes have been successful. Peer education appears to be an increasingly popular strategy in Australia for promoting harm reduction relevant to youth drug and tobacco use (Department of Human Services 2000). Michell (1997) implies that “It is apparent that different groups of pupils smoke for different reasons which are related to pecking order and group membership”. Peer smoking has always been an important factor determining the prevalence of smoking among teenagers. APPROPRIATENESS OF THE INTERVENTION In a review, Mallanby (2000) stated that “The identified studies indicated that peer leaders were at least as, or more, effective than adults. Although this suggests that peer-led programmes can be effective, methodological difficulties and analytical problems indicate that this is not an easy area to investigate, and research so far has not provided a definitive answer.” This review by Mallanby (2000) had taken into consideration the ‘peer educators’ rather than the ‘peer helpers’. In his own words, “The term ‘peer educators’ generally refers to students delivering an educational programme, who are of similar or slightly older age than the students receiving the programme”. Hence, it is anticipated that a programme led by a peer, who considers himself or herself more educated than the other counterpart, will experience problems. Lindsey (1997 cited in Mallanby 2000) identifies this correctly as “health educators must carefully assess how to use peer educators to enhance their heath promotion and disease prevention methods”. The proposed model of smoking prevention programme is based on ‘peer helpers’ as the central dogma. Informal education approach extended by these peers will be accepted readily by the risk group members. There are few drawbacks to this model. The peer helper may not be able to work efficiently due to illness, exams or other co-curricular activities. These issues can be settled by allotting more than one peer helper per risk group member to facilitate better intervention. The questionnaire provided by the peer group will be an excellent tool to evaluate this intervention programme. The problems highlighted can be addressed in the future projects. The follow-up data obtained from the risk group will be helpful in determining the effectiveness of the intervention. This peer helper led smoking prevention programme is an appropriate method, which is both practical and cost-effective. Works Cited Department of human services., 2000. Evidence-based health promotion: Resource for planning. No 2 Adolescent health, Public health division, Melbourne. Department of human services., 1998. An evidence-based planning framework for nutrition, physical activity and healthy weight, Public health division, Melbourne. de Vries, H, Dijk, F, Wetzels, J et al., 2006. The European Smoking prevention Framework Approach (ESFA): effects after 24 and 30 months.Health Education Research, 21 (1), pp.116-132. Health Promotion Agency for Northern Ireland. Available from: http://www.healthpromotionagency.org.uk/ Lindsey, B.J., 1997. Peer education: a view point and critique. Journal of the American college of health, 45,pp.187-189. Mellanby, A.R, Rees, J.B,Tripp, J.H., 2000. Peer-led and adult-led school health education: a critical review of available comparative research. Health Education Research, 15 (5), pp. 533-545. Michell, L., 1997. Loud, sad or bad: young people's perceptions of peer groups and smoking. Health Education Research, 12 (1), pp. 1-14. Naidoo, J, and Wills, J., 2000. Health Promotion Foundation for Practice. 2nd Edn: Bailliere Tindall Edinburgh. van, Teijlingen ER, Friend, JA, Twine, F.,1996. Evaluation of Grampian Smokebusters: a smoking prevention initiative aimed at young teenagers. J Public Health Med,18 (1),pp.13-8. Whitehead, D.,2002. Evaluating health promotion: A model for nursing practice. Journal of advanced Nursing, 41(5), pp. 490-498. Withers, N.J., Low, J.L., Holgate, S.T, Clough, J.B., 2000. Smoking habits in a cohort of U.K. adolescents. Respiratory Medicine, 94, (4), 391-396. Read More