CMPH 606: Health Promotion And Disease Prevention- Domestic violence- Colorectal Cancer Assessment Annswer

Health Promotion And Disease Prevention Assignment

Assignment Task

Assess the need and analyze the health issue

a)Describe why the health issue is a public health priority

b) Describe the range of determinants of the health issue

c) Describe the major stakeholders relevant to the health issue

d) Describe the ethical framework for this topic.

Plan the project goal, objectives and strategies

a) Develop a goal that describes the change you want to make to the health issue

b) State how you will evaluate the achievement of the goal

c) State how you will evaluate the cost benefit or cost effectiveness of the project

d) Develop objectives to describe the changes you want to make to the determinants of thehealth issue

e) State how you will evaluate the achievement of the objectives

f) Select at least two strategies to implement. For each strategy, state whether it is anindividual, group, community, setting or population based strategy.

g) Which health promotion model can be used for this topic and why?

Design the project implementation activities

a) For each strategy, state the specific set of implementation activities that will beundertaken

b) For each set of implementation activities, name the theory or model to be used to guidethe change strategy

c) Describe the who, what, where and when for each activity

d) State how you will evaluate the implementation process for each set of activities

e) Describe possible challenges with the implementation and recommendations how toovercome them

ASSESSINNG THE NEED & ANALYZING THE HEALTH ISSUE

A)Domestic Violence is a matter of public health priority

Domestic violence is potential threat to human civilization and progress which is looming large on entire global population. Many women, men, children and families across the world are being victims of domestic violence across countries, borders, and language and socio economic strata.

Domestic violence is no more a private home affair, due to the broad socio economic and health consequences faced by the children, communities, cultural groups and societies across the world at large( Abbott et al, 2011). Victims of domestic violence are often found to be patients of cardiovascular diseases, strokes, hypertension, chronic diseases like irritable bowel syndrome, infertility, memory loss etc. Among the domestic violence victims nearly 42% of crimes are committed by their intimate partner, and often victims are sexually abused resulting sexually transmitted disease like HIV (HIA Report, 2016; WHO). Physical assault also causes severe head injury, depression, suicidal tendencies, alcohol and drug abuse and other associated risk behaviors. In recent report of 2014, Saudi Arabia has reported more than 2000 of incidence reporting of domestic violence which by so far the highest , and according to officials many reports go unreported (HIA Report 2016; WHO). Over 1500 cases of domestic violence have been reported to Dubai Foundation of Woman & Children, in Dubai. In UAE around 25% of married women have reported various incidents of domestic violence (HIA Report, 2016; WHO).

The issue of domestic violence can be best described as comparative need. Domestic violence comes in place from the very concept of unequal treatment even being a part of same family, community, society and humanity. It is also a critical incidence need, as damages caused by domestic violence generally have disastrous consequences (Abbott et al, 2011).

B) Range of determinants of domestic violence.

The factors working together to constitute good health and overall wellbeing of an individual and the community as a whole are known to be health determinants. Our society, relationships, family and friend circle, our education and income status, genetic configuration affect our health in an impactful way (Bartholomew & Gottileb, 2015). The major health determinants are: the socio-economic state, the physical environment, and the individual’s behavior and characteristics.

In case of domestic violence the health determinants can be income level, education level, alcohol and other substance related abuse, experience of family violence, involvement with antisocial groups, exhibiting attitudes of gender inequality, unhappy conjugal lives.

C)Major stakeholders relevant to domestic violence

Domestic violence is a worldwide problem affecting a huge population across the world. A report of WHO, on domestic violence, reveals globally around 35% of women is victims of domestic violence (Hawe, Degeling & Hall, 2015). A report reveals around three million men in USA also faced domestic violence. Though domestic violence are primarily considered as a women related crime, but in reality many men across the world become victims of domestic violence (HIA report, 2016, WHO). It is affecting people across the world regardless socio-economic-cultural differences, geographical boundaries, race, age, ethnicity etc.

The major stakeholders of domestic violence are victims (Men, women, children and others), health professionals, society, community, law enforcement, judiciary, government and policy makers, and nations.

D) Ethical framework of domestic violence.

Domestic violence does not only come with a sever cost in loss of economy but it costs mankind’s moral and ethical value system to a great extent. A person suffering from domestic violence often goes into severe depression, chronic health problems, injuries and deaths (Seedhouse, 2009). That results in loss of manpower, loss of wages, and loss of health to the individual and to the society. Children, who have suffered or witnessed domestic violence, have often showed similar behavior, involved in antisocial activities and other problems (Bacht, 2013). Domestic violence is not only a threat to the present of mankind but to the future of human civilization as well making it an ethical and moral responsibility for the world to eliminate domestic violence scar from face of the earth.

2.PLANNING THE PROJECT GOAL, OBJECTIVES AND STRATEGIES

A)Goal development

Domestic violence is a combination of socio-cultural-legal-political-educational-economic factors working together. To address the issue the important goal is to spread education and awareness related to the domestic violence causes and effects, and enhances communication within community to promote a healthy atmosphere to promote positive attitude and behavior, and social equality of all stakeholders in the community (Mittermark et al, 2013)Minimizing the risk factors of domestic violence a healthy atmosphere can be created where awareness, education and communication can simultaneously improve community & individual morale.

B) Evaluation of goal

To evaluate the achievement of goal it has to be remembered it is a long term goal, and has to be measured both qualitatively and quantitatively.

Quantitative measures

• Incidents reporting of domestic violence can be counted, i.e. before and after the awareness program
• Documenting response time to a crime after it is reported
• Documenting the behavioral changes in the victims, before and after the awareness program
• Document morbidity, comorbidity and other health status of the particular community and compare with previous data

Qualitative measures

• Identifying risk groups and behavior
• Identifying community leaders
• Demonstrating accountability levels
• Identifying level of participation in community awareness
• Decision making whether to allocate resources, and manpower to the program

C) Evaluation of Cost benefit or cost effectiveness of the goal

A ROI or Return on Investment model can be applicable in measuring the cost benefit or cost effectiveness of the project (Downie , Tannahill & Tannahill, 2012)). A particular identified population should be mapped and targeted, and prior documenting of total health expenditure and associated cost due to domestic violence-is important before the project begins (Diclemente, Crosby & Kegler, 2011). A project should be planned accordingly and cost allocation should be made. The prior investment due to domestic violence to the cost allocated for awareness build up and thus reduce domestic violence can be measured and cost benefits can be calculated.

D) Objectives of the program

To ensure a positive and long lasting change in domestic violence an atmosphere of coherence and camaraderie has to be created between the stakeholders. The following objective can be identified to ensure a positive and endurable change.

The objectives for this program can be categorized in two types, i.e. process and impact objectives. Process objectives are related to quantification or calculation of resources one wants to acquire for a particular project. Impact objectives are those which in short term focuses on your behavior, attitude and knowledge and how the program will modify, change or improve behavioral patterns, and therefore reflects the degree to which you want the change to be implemented.

Process Objectives

• No of health professionals required to participate in health promotion campaign
• No of community leaders to engage community people

Impact Objectives

• Promote gender equality
• Address discrimination against vulnerable & minority sections, victims, children, women or even men
• Increase positive behavioral changes
• Fostering cultural norms and value
• Spread awareness and education

E) Evaluation of objectives

Achievement of objectives identified to change the determinants of domestic violence can be measured qualitatively, and quantitatively, as the objectives are both tangibles and intangibles. The impact objectives should be acting as guideline of how the process objectives are going to take place (Green & Kreuter, 2011). Proper Documenting should be there that builds enough evidences of actions taken after incidents reporting of domestic violence. A technical and tactical guideline must be developed for combating issues like domestic violence. Comparison of data related to domestic violence incidents before and after the campaigns should be made to evaluate the achievements of objectives. Information sharing, awareness campaigns and measuring their effectiveness will enhance communication within the community (Lucas & Llyod, 2014). Communities and health workers must collaborate with health organizations to increase participative communication and promote value & cultural norms. No of health professional, no of community participants and leaders will have to be decided prior starting working on the project.

F) Implementation Strategies

Implementation of strategies to combat domestic violence is manifold and requires participation of multiple stakeholders.

Firstly domestic violence should be identified as a public health issue and that needs to be addressed by the law enforcement and policymakers. Policy should be formulated to address victims and their families, taking proper actions after incidence reporting, taking actions against discriminations (Green & Kreuter, 2011).

Secondly, prevention strategy needs to be strengthened. Microfinance activities combining with trainings of gender equality will help in preventing domestic violence. It will help in improving relationship building skills in individual (Bartholomew & Gottileb, 2015).

Finally enhance communication among communities to address alcohol and substance abuse related problems and promote positive attitude and behavioral changes.

G) Which health promotion model can be used for this topic and why.

Pender’s health promotion Model describes not only absence of diseases but also focuses on positive & dynamic state. It focuses not only addressing the particular health issue in question but also concentrates on overall wellbeing of the individual, and the environment with which he interacts. This model is multidimensional in nature and takes community and physical environment into count, which makes it appropriate for applying it in issues like domestic health (Abbott et al, 2011).Domestic violence or abuse is a behavior related issues induced by physical and social factors, and also can be cured and prevented by implementing positive and influential changes in behavior, social participation, building community awareness and promote cultural norms, gender equality (Dines & Cribb, 2012). These are mostly social issues and directed towards bringing a positive change in individual and outlook of society

3.DESIGN THE PROJECT IMPLEMENTATION ACTIVITIES

A) For each strategy state the specific set of implementation activities that will be undertaken

Two strategies mainly need to be focused on as discussed.

1. Identification of domestic violence as a serious public health issue and assessment of problems on a large scale- that is addressing the issue with policies, laws, technical guidelines
2. Prevention strategy –engaging community and individuals in positive attitude and behavioral modification

For the first strategy the activities need to be undertaken are majorly concerned with identification of victims, encouraging incidence reporting, reducing response time after incidence reporting, formulating policies in accord with gender equality and anti-discrimination. Gathering comparable pre and post campaigns data will help in evaluating the result of the campaigns (Green & Kreuter, 2011). Technical and useful guidance for health professionals such as doctors, paramedics, counsellors, need to be evolved.

For the second strategy implementation awareness through promotional campaigns are of obvious measures. It is important to identify risk behavior and risk individuals to focus on their behavioral modification. As long term goals, educational reform in terms of gender equality and anti-discrimination should be promoted in schools and colleges. Community participation must be engaging and encouraging for the campaign to be fruitful. Community participation should also focus on overall development and wellbeing of community, and it should boost education and income level.

B) Health promotion model or theories to channelize implementation

Social Learning or social cognitive theorycan be implemented for the first set of identified activities. The key concepts of social learning are -it induces self-efficacy, determination for reciprocal behavior; enhances behavioral capability; increases power of observational learning and improves behavioral outcome (Fogel & Lauver, 2010). This theory can be aptly applied to identify risk behavior and individual and act for behavioral improvement accordingly. Along with social learning theory Ecological Approach theoryneeds to be applied. Ecological approach theory focuses on multiple levels of environmental interaction- intra and interpersonal, institutional, community and public policy (Fogel & Lauver, 2010).

For the second set of identified activities Theory of Community or Organizational modeland social support model can be combined together and applied. Social support model theory is instrumental in driving changes related to information, and reinforcement. It also focuses on social and emotional support system and awareness development. On the other hand, Model of Community or Organization helps improving physical environment by engaging in active community participation, locality development, social actions, and planning (Fogel & Lauver, 2010).

C) Describe the who, what, where & when for each activity

First set of activities-

Identification of victims- The victims of the domestic violence should be identified and location of incidence, such as house, workplace must be noted and documented. It is also important to note the time of incidents, and in case of repeated occurrence multiple records with details need to be identified.

Reduce time after incidence reporting- The law enforcement response time is crucial in these incidents. Necessary and timely actions should be taken by law enforcement, health workers, hospitals, health centers, police station, and local council.

Policy Formulation-Broad population wise goal should be set by government and policy makers.

Technical Guidelines-strategic technical tactics should be formulated and followed by all counsellors while dealing with the victims or the assaulters.

Second set of activities

Increase awareness through promotional campaigns- The health workers and professionals need to identify a target population and geographical boundary to work on health awareness campaigns. Promotional campaigns related to information sharing, education and knowledge dissemination should be taken proactively.

Identification of risk behavior and individuals - Person committing the crime, probable behavior that leads to such incidents need to be identified. Behavioral patterns of assaulter need to be monitored, along with time and place where and when he exhibits such kind of behavior (Downe, Tannahill & Tannahill, 2012).

Educational Reforms- Educational institutes should inforce positive attitude, anti-discrimination education & promote gender equality. Classroom and outside classroom activities and learning during adolescent state are important for long term benefit and eliciting desired outcome (Dines & Cribb, 2012).

Community Participation- Community workers, Health workers should be engaging people in community activity, boost education and income level, creating positive atmosphere and promoting value base cultural norms ( Abbott, 2011). Community meet, Cultural meet, Festivals, Awareness meet, Health campaign etc., preferably during evening, and on weekends, as proactive measures and societal reform must be encouraged.

D) Process implementation

Both first and second set of activities have to be measured for desired outcomes and achievement of goals. Collection of data is of utmost important to evaluate and analyze the impact of strategic changes. A comparison between previous and post data will be helpful in evaluating the impact of awareness campaigns. Cost allocation of resources need to be measured and documented and compared with previous cost associate with treatment, and punishment of victims and assaulters. Health promotion campaigns can be measured with O’Byrne’s health promotion formula

This describes successful implementation of health reform policies and education on health can magnify the effect of health promotion strategies (Bracht, 2013). By analyzing the above mentioned points a qualitative and quantitative analysis and evaluation can be drawn.

E) Possible challenges & recommendation

While addressing domestic violence people face many challenges and hindrances. The difficulty in assessing the pattern, types and numbers of domestic violence incidents due to non-reporting, not proper documentation, misunderstanding, and miss-reporting makes the task difficult and complex. The policy makers though try hard to formulate policies, but it is not easy to bring an umbrella policy which covers all types of incident (Lucas & Llyod, 2014). Cost of these projects are usually on higher side and most often government and other health organizations lack funding for the same. As no short term visible evaluation of achievements is possible, the process takes long time and yields slow results.

Recommendation

Domestic violence is a deep rooted problem and often it is stereotyped with women abuse. Though women are the primary victims of domestic violence men, children and society are at large risk too with the consequences of domestic violence (Seedhouse, 2009). A large no of males all over the world are victims of domestic violence, not to mention the children and adolescent groups. The challenge is to overcome the social fabric which endorses discrimination and inequality (Mittelmark et al, 2013). Therefore prevention and social awareness is of utmost important. A grass root level change in education is undeniable here, where children, are adolescents are not only protected from being victims of domestic violence but are learnt to reinforce positive behavioral changes (Bartholomew & Gottileb, 2015). Policy needs to formulated to promote equality, and anti-discrimination behaviors should be practiced in both individual and community level. Healthcare should be equitable and accessible to all sections and community participation should be encouraged to maximum level. A quantum leap in the laws, policies social, educational economic and cultural reform is the need of the hour.

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