Promoting Positive Health Behaviors. Student. Walden University. NURS6050, Section 4, Policy and Advocacy for Improving Population Health

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1 Running Head: PROMOTING POSTIVE HEALTH BEHAVIORS 1 Promoting Positive Health Behaviors Student Walden University NURS6050, Section 4, Policy and Advocacy for Improving Population Health Today s date

2 PROMOTING POSITIVE HEALTH BEHAVIORS 2 Promoting Positive Health Behaviors Awareness, screening, early detection, and intervention are essential in cancer prevention and management. Early screening programs are used to identify at risk populations and educate them regarding the importance of early detection and screening of cancer. The purposes of this paper are to examine the Every Woman Matters (EWM) program (Backer, Geske, McIlvain, Dodendorf, & Minier, 2005), why it was ineffective, review two successful early intervention programs, and identify successful strategies that can be used in future programs. Examining successful programs can provide a model for developing future early screening and detection programs for breast and cervical cancer. Every Woman Matters EWM program was developed to raise awareness of the risks of breast and cervical cancer, identify early prevention strategies, and increase access to screening services in low income women (Backer et al., 2005). Women who qualified had access clinical breast exams, mammograms, and Papanicolaou smear tests (Backer et al., 2005). EWM program increased breast and cervical cancer screening for low income women in Nebraska (Backer et al., 2005). EWM program utilized the "GAPS model" (Backer et al., 2005, p. 402), which included goal setting, assessment, planning, and starting preventative care in the primary care setting (Dietrich, Woodruff, & Carney, 1994). This model was used to enhance primary care health care delivery and increase preventative care and screenings (Backer et al., 2005).Seven primary care practice settings implemented the EWM program, each in a different stage of practice development and leadership. Multiple practices lacked an identified leader to guide the practice through the necessary changes to make the EWM program effective. Multiple practices lacked

3 PROMOTING POSITIVE HEALTH BEHAVIORS 3 practice framework, clear goals and consistent follow through, which negatively impacted the effectiveness of the EWM program. Staff buy in and cohesion prevented successful implementation, intervention, and follow through, thus decreasing the likelihood of an effective program. I have identified ineffective components of the EWM program, now I will focus on two successful cancer prevention programs and the strategies used in their success. I will review two programs: the Mobile Unit of Barretos County Cancer Screening Project and Cultivando La Salud. Mobile Unit of the Barretos County Cancer Screening Project Breast and cervical cancer negatively impact health worldwide. Early screening and detection are critical in decreasing mortality rates attributed to breast and cervical cancer (Mauad, Nicolau, Moreira, Haikel, Longatto-Filho, &Baracat, 2009). Mobile Unit of the Barretos County Cancer Screening Project was implemented to promote breast and cervical cancer screenings in the Barretos County region of Brazil (Mauad et al., 2009). The project team consisted of a chief nurse, healthcare personnel, and various healthcare resources. Access to cancer screenings had been an ongoing problem for residents in Barretos County. This project used mobile units to provide mammograms and gynecologic exams. The project increased public awareness and education with pamphlets, flyers, advertising, and radio broadcasts (Mauad et al., 2009). Questionnaires and interviews assessed women's understanding of cancer, cancer screenings, and socioeconomic status (Mauad et al., 2009). The mobile unit travelled throughout Barretos County increasing awareness of cancer and providing necessary screenings.

4 PROMOTING POSITIVE HEALTH BEHAVIORS 4 Mobile Unit of the Barretos County Cancer Screening Project was successful in screening women for breast and cervical cancer. In the beginning, there was an identified population, access problem, intervention strategy, and coordination among the healthcare community (Mauad et al., 2009). Prior to program implementation, organizers identified barriers to screening and incorporated ways to decrease these barriers. Coordination of care and follow up allowed women to receive ongoing care and medical intervention based on their screening results. Mammogramsincreased by greater than 10% and Papanicolaou smear tests increased by greater than 15% in Barretos County, as the result of a well-organized, coordinated medical team, and mobile unit(mauad et al., 2009). Now, I will review the second successful program and the components that made it successful. Cultivando La Salud Cultivando La Salud was a breast and cervical cancer screening promotion program specifically targeting low income Hispanic women (Fernandez, Gonzales, Tortolero-Luna, Williams, Saavedra-Embesi, Chan, &Vernon, 2009). This program used lay health people as educators for breast and cervical cancer screening education along the United States and Mexico border (Fernandez et al., 2009). According to Fernandez et al. (2009), Hispanic women 50 years and older have more barriers that reduce the likelihood of breast and cervical cancer screenings. The program design included lay health worker education, participant surveys, consistent intervention based on survey results, and follow up education (Fernandez et al., 2009). Lay health workers received consistent education and training then provided breast and cervical cancer screening education for the target population. Cultivando La Salud found that utilizing lay health care workers to provide one on one education and in home visits decreased barriers to

5 PROMOTING POSITIVE HEALTH BEHAVIORS 5 screening. Breast and cervical cancer screening reached almost half of those who received education, which was an increase compared to prior screening among low income Hispanic women (Fernandez et al., 2009). The success of Cultivando La Salud is attributed to one on one education, in home visits, consistent education, and dedication of lay healthcare workers (Fernandez et al., 2009). I have examined two successful programs, now I will discuss how these successful strategies could be used to remodel the EWM program and make it successful. Improvements for the Every Woman Matters Project Changing the outcome of EWM must include changes on multiple levels and within its strategies. Being a leader, I would restructure the EWM program to include specific education of expectations for the project team. I would incorporate one on one education, brochures, and in home education for participants who could not travel to the primary care office. The team leader or champion in each practice would review the responsibilities of each team member and encourage staff feedback. Each participating practice would designate a team leader or champion to oversee and guide the team throughout the entire project and evaluation. Prior to the implementation phase, I would identify team goals, practice specific goals, and identify areas of improvement for each practice. I would identify healthcare resources for ongoing support such as home health agencies and health departments, intervention based on specific patient and practice needs, and follow up strategies for each practice to improve continuity and continuation of care. At the final stages of the project, evaluation would occur, examining strengths and weaknesses of the project and ways to improve for future projects.

6 PROMOTING POSITIVE HEALTH BEHAVIORS 6 Conclusion As evidenced in Mobile Unit of Barretos County Cancer Screening Project and Cultivando La Salud, identifying a target population, strategic planning, and identifying barriers to health promotion are essential. Successful programs must have an assessment, clear implementation plan, population specific interventions, and an evaluation phase. Project teams should have an identified leader, dedicated implementation and support teams, and follow up resources. With changes, the EWM program could be effective and increase breast and cervical cancer screenings among women thus decreasing mortality due to these cancers.

7 PROMOTING POSITIVE HEALTH BEHAVIORS 7 References Appropriate references provided by the student