Public health (PH) is an issue continually on the UK Government agenda and one in which it is anticipated that all health professionals will participate in (Nuttall, 2008). PH focuses on the health and well-being of a society and is the most effective means of protecting and improving it. It addresses the root causes of illness and disease, including the interacting social environmental, biological, and psychological dimensions, as well as the provision of effective health services.
PH relies on evidence, judgement and skills and promotes the participation of the populations who are themselves the subject of policy and action (United Kingdom Public Health Association (UKPHA), 2008). Health promotion is a process of enabling people to increase control over their own health to improve their health status. It is any planned action that promotes health and prevents disease. Health promotion involves developing self-esteem and social skills so that people are empowered to take action on their own health or that of their environment.
It can happen on a one to one basis with the nurse/patient relationship, a group session or the use of a mass media campaign (World Health Organisation (WHO), 2004). The PH event which was addressed, involved talking to mothers about oral mouth care for their baby/child. The event took place at a mother and baby drop in clinic, held at the Sure Start centre. This was a relevant topic to the area, according to the WHO oral healthy programme (2007), 60-90% of school children worldwide have dental cavities. The percentage number of children aged 3-5 registered with a dentist in 2008 was 47.
5% compared to N. Ireland which was 61. 2% (Northern Ireland Statistics Research Agency (NISRA), 2008). Also a recent survey carried out by the Oak Healthy Living Centre (2008) showed that 80% of the people surveyed eat fewer portions of fruit and vegetables, than while just less than one in ten had the recommended five portions a day. It was a popular topic to talk about as most mothers can relate to it. Being a health visitor, involves them providing a universal service for the individual and the community. Health visitors have an important role to play in public health.
The role of a health visitor is about the promotion of health and the prevention of illness in all age groups (NHS, 2008). Health visitors are particularly involved with families who have children under five years old, they also work with the elderly population, because most health visitors are attached to GP practices they also work with all patients registered within the practice. Health visitors look at the broader picture to identify the health needs within their community and this allows them to affect local policy (www. healthvisitors.
com). Health visitors are involved with many other members of the multi-disciplinary team, GP’s, midwives, school nurses, dentist, dental hygienist, practice nurses and speech and language therapists. According to Ackland (2009), health visitors should hold an understanding of the roles of others, this knowledge and understanding leads to better communication, which maximizes patient’s care. Many voluntary and statutory agencies are also involved in the promotion of public health, examples of these are, Sure Start and Woman’s Aid.
Sure Start is a statutory agency that works closely with the health visitors, it brings together childcare, early education, health and family support services from families with children under five years old (Department for Children, Schools and Families (DCSF), 2008). Woman’s aid is a voluntary agency that works with women who have been involved in domestic violence. Health visitors would work closely with woman’s aid if there is child involved, or if a child is in danger of the domestic violence.
Providing care in any form involves dealing with people in a way that takes account of their individuality. Every person has different aspects that form their identities, according to how they see themselves (and how others see themselves) in terms of gender, ethnicity, sexuality, age and so on. This means that seeing an individual in terms of only one aspect of their identity can be unproductive (Weaver, 2009). All mothers present at the health promotion event were of the same culture, but if there had been mothers there of different culture, their needs would have been taken into account.
An example of this would be having an interpreter present at the event and the information leaflets being in their own language. Sure Start does provide interpreters for the Polish and Hungarian mothers within the community, but due to low funding in the community, this service is not always available. When researching this topic, there is a website available, called Polish Information Plus (2009), this service translates all the National Health Service leaflets into Polish, many of these leaflets include, child immunizations, cervical screening and other health related issues.
The health visitor states that a lot of her clients are polish mothers, and this service is very beneficial for them. According to Weaver (2009), providing easy access to information, and keeping this information in a simple format, this includes accommodating the information needs of those for whom English is not a first language. A health needs assessment (HNA) is a systematic method for reviewing the health issues facing a population, leading to agreed to priorities and resource allocation that will reduce inequalities and improve health (Hooper and Longworth, 2002).
There are five steps of a heath needs assessment these are: (1) Getting started (2) Indentifying health priorities (3) Assessing a health priority for action (4) Planning for change (5) Moving on/review (Cavanagh and Chadwick, 2004). Ewles and Simnett (2003) set out a basic planning and evaluation process which consists of a seven stage flow chart, this can be used to plan and assess aspects of health promotion. This process will be used to reflect on the planning of the health promotion event that was carried out.
The seven steps are as follows: (1) Identify needs and priorities (2) Set aims and objectives (3) Decide the best way of achieving the aims (4) Identify resources (5) Plan evaluation methods (6) Set action plan (7) Action, implement your plan, including evaluation (Ewles and Simnett, 2003). Naidoo and Wills (2009) identify five approaches to health promotion; medical approach; behaviour approach; educational approach; client approach and societal change approach. Ewles and Simnett (2003 ) argue that all health promotion programmes can fall into any one of these five approaches.
For the purposed health promotion activity to be carried out, the educational model will be applied; however it will also bring in the behavioural approach. The educational approach is described as giving individuals information to discover the health benefits or detriments for themselves (Naidoo and Wills, 2009). The behavioural approach is described as a way of encouraging changes in an individual’s attitudes and beliefs to take up a healthier lifestyle (Naidoo and Wills, 2009).
According to the Northern Ireland Statistics Research Agency, 2008 (NISRA) statistics’ show that the area, (which I was involved), was in a very deprived state, statistics show that 62. 3% of households were in poverty, compared to N. Ireland which was 30. 2%. The area also has a lot of unemployment, in particular the female population (NISRA, 2008). This would reflect the fact that they wouldn’t be able to afford the healthy food for their children. A recent study did show that 80% of people in the area failed to eat one of their five portions of fruit and vegetables a day (Oak Healthy Living Centre, 2008).
This topic needed to be addressed to mothers about the importance of a healthy diet for their children. The aims and objectives for the event can be viewed on the teaching plan (Appendix 1). The aims of the event were to raise mothers’ awareness of the causes of tooth decay and dental erosion and how to prevent it, the importance of brushing your child’s teeth properly, raising awareness of the amount of sugar there are in some of the popular foods that parents may give their child as ‘treats’ and the importance of registering their child with a dentist when they are born.
The objectives of the event are to gather the relevant information about oral mouth care in babies/children. To increase the level of knowledge about the most common causes of tooth decay and dental erosion, offer mothers’ an information session on caring for their baby’s/child’s teeth, with the opportunity to ask questions, offer mothers to practice brushing teeth on the model provided by the dental department, give out toothbrushes and mini samples of toothpaste and evaluate the event. The best way of achieving the aims for this health promotion event was targeting mothers at a drop in baby clinic based in the Sure Start Centre.
Setting up a display table which included samples of sweets and sugary cartons of drinks and popular foods that mothers give their children (Appendix 4). Asking the mothers how many sugar cubes were in each food sample. This was very successful; the mothers were very shocked at how much sugar was in each sample, one mother commented that she would often give her child one of the sample drinks on a daily regular basis. Information leaflets and posters were available for the mothers to take home, and also baby toothbrushes and mini samples of toothpaste were all offered.
A therapeutic relationship was developed with the mothers through effective communication skills. The therapeutic relationship is the foundation for a good nurse/patient relationship (Alexander et al, 2005). According to Hargie and Dickson (2004) effective communication skills can lead to better self esteem and greater enjoyment. Resources to carry out this health promotion event: the promoter and their time, permission of the health visitor to use the venue, the information to be provided by the promoter, the mothers’ attendance and consent of the event.
The Nursing and Midwifery Council (NMC, 2008), makes it clear that nurses’ must gain consent before performing any procedure. The dental department to provide the toothpaste, toothbrushes and model of teeth. The British Dental Association website to provide information for the event. The NISRA website to provide statistics on the area, this is beneficial to raise mothers awareness on the topic. To plan and evaluate the event it would be beneficial to take note of the mother’s interest in the topic and how many of them took leaflets and asked questions at the end of the event.
The promoter will take note of how many mothers attended the event; also ask the mothers questions to evaluate if their knowledge had increased since taking part in the session. Ask the health visitor to evaluate the event and provide feedback. Ask mothers to provide feedback and did they find it interesting and beneficial. The health visitor will book the room and make arrangements to book two weeks before the scheduled day. Mothers coming to the drop in clinic will be told one week prior to the given time, date and venue.
The dental department will be contacted to get permission to use a model of the teeth, so the mothers can practice brushing on them. A display and information desk will be set up with leaflets and samples of sugary foods. The promoter will ask the mothers’ how many sugar cubes do they think is in each food sample (Appendix 4). The mothers’ will also get a chance to practice brushing the “5-step technique” (Appendix 3) on the model of the teeth. Mothers will have a chance to ask questions at the end of the session. The health promotion event proved to be a success (Appendix 1). Only one of the mothers’ did not turn up.
Every mother received a leaflet, poster, and toothbrushes and a mini sample of toothpaste. The event ran 30 minutes over, this was down to the interest the mothers’ had towards the amount of sugar in the samples (Appendix 4). Changes to make in the next event would be to have picked a larger room, some distractions were apparent; the parents were busy looking after their children, so full concentration was hard at times. Also the dental hygienist would have been beneficial had she been present. However everyone found it very helpful and provided positive feedback to the promoter and also the health visitor.
To conclude in this essay, the planning process for any health promotion event is of paramount. The Ewles and Simnett model (2003) was found to be very simple to follow and easy to understand. Without this health promotion model the event may not have been this successful. In the prevention of tooth decay and dental erosion decreased intake of sugar and well-balanced nutrition prevent tooth decay and premature tooth loss. It was apparent that the mothers’ were not aware of how much sugar there was in some of the food samples, so it was important that this issue was raised through the demonstration of health promotion education (Appendix 1).