|Type of paper:||Research paper|
|Categories:||Cancer Healthcare policy Community health|
Health intervention is an act performed with, for or on behalf of a target population or an individual. It starts with the identification of a health issue that affected the intended community. The purpose is to assess, modify, promote, maintain, or improve health conditioning or functioning. In the current project, the target group in California, and health intervention is based on breast cancer.
It is clear from the stats that the marginalized groups, such as the African Americans, among other minority groups women are at a higher risk of cancer mortality due to aspect of lack of screening, early identification, and poor treatment. As such, the cancer health intervention in this program will focus on enhancing the areas of weaknesses as a way of reducing cancer in the target population.
According to Blok et al. (2018), early identification of breast cancer enhances the chances of being treated. However, statistics show that in California, the number of women who turn up for breast cancer screening is not desirable. A study that was conducted by Kumar, Cross, De Leon, and Moonie (2018) shows that 44% of women in California were non-adherent for national guidelines for breast cancer screening. At follow up, only 25% reported receipt of breast cancer screening with their provider. The current project will hence aim at increasing the number of women who attain breast cancer screening to allow early intervention. To achieve this, Community Health Advisors (CHAs) will be required to sensitize the population a need for breast cancer screening. Besides, this health intervention plan also aims to use the intended CHAs in corroboration with the health practitioners to educate the possible women symptoms related to breast cancer and what they should do when they note any of the symptoms. Besides, the plan also entails educating the women from the target population on available preventive measures such as how they can reduce the risk of breast cancer by improving their lifestyle as well as some of the things they should avoid as they may increase their chances of developing breast cancer. Finally, the CHAs will also take responsibility for counseling women, and providing necessary information on how they should go along with the treatment of breast cancer is detected as well as advice on coping strategies.
The desired health outcome for this health intervention project is to reduce the number of women who develop breast cancer. This will be attained by advising women on how to decrease their chances of getting breast cancer through improving their lifestyle. The other outcome is ensuring that incidents of breast cancer in this population are detected early enough in such a way that treatment will be sufficient. According to Blok et al. (2019), 90% of women who are identified with breast cancer during its first stage and treatment resume immediately get healed with no further complication compared to those who recognize it during later stages. The plan will also improve the coping strategies of the patient undergoing cancer treatment and hence improving their health and enhance recovery. Overall, this project aims at reducing the breast cancer mortality rate by 50% in ranger Los Angeles.
Comprehensive Needs Assessment
Cancer has been among the most deadly illness in California and the United States as a whole. However, according to the updated status from the American Cancer Society's biennial 2019-2020, breast cancer is the second cause of women's cancer deaths after lung cancer and the most diagnosed among American women. The statistic predicts that, in 2020, 41,760 women will die out of breast cancer, and 268,600 new cases of invasive cancer will be diagnosed (DeSantis et al., 2018). In California, the overall cancer death has been declining since 1989 through 2017 by 40% due to increase awareness of symptoms, screening, and treatment. The rate of mortality decline had been steady at 1.9% per year from 1989 through 2011. As it may, this rate has reduced from 2011 to 2017, largely driven by the trend in white women.
Nevertheless, the black-white cancer mortality rate, which had widened during the last few decades, has remained constant since 2011. However, the most recent stats 2013-2017 shows that black women's death rate is 40% higher than that of white women despite fewer incident rates. The gap is even higher among the black women who are under 50 years, where their death rate is more top by 50% that of the whites (County Health Ranking, 2019).
Breast cancer is mainly caused by genes inheritance where an individual from a family identified with it has higher chances of developing it. However, other incidences lead to the risk of breast cancer. Obesity has been defined as a significant condition that increases the risk of breast cancer among women (Peuker et al., 2019). In California, a report from the county ranking report shows that 30% of adults have obesity. The statistic also shows that adults who are over 20years old who reported a lack of physical activity during their leisure are 17%, although 93% have access to adequate physical activity locations. Besides, lack of screening is also an incident that increases breast cancer mortality on women, where county health ranking shows that among those enrolled in Medicare, 36% is the one who attends mammography (County Health Ranking, 2019). This indicates that certain areas need to be addressed to reduce the breast cancer mortality rate in California.
The registries will be used to show the number of women who attend breast cancer screening as required by national guidelines. It will also provide insight into the factor underlying non-adherent to the instructions. The risk will be stratified by age, race, education, and socioeconomic factors. Regarding the available breast cancer data, race causes a disparity in health indicators where breast cancer for the minority groups is higher than that of the white. For example, African Americans are 50% more likely to develop and die of breast cancer compared to whites (Peuker et al., 2019). Other indicators such as age and obesity due to poor lifestyle and lack of physical exercise also show a substantial disparity in cancer indicators.
Health Promotion Program
Community Health Advisors program will involve partnerships with health ministries and churches in California. The design of the program will include sensitizing the women in public meetings and churches the need for breast screening. Women seminars will also be conducted for the same intention. Besides, in partnership with health ministries, reminder calls, print materials, and one-on-one counseling will be held to encourage screening for the overdue tests.
Various interventions will be considered to connect the primary care with the specialists. The main objective of this plan is to ensure that there is early screening, an improved lifestyle, and sensitizing the target population on possible symptoms for breast cancer. As such, there is a need for real testing. A public forum where specialists can conduct free breast cancer will be provided will be held in various areas, especially those with a high population of women with a record of not adhering to screening outlines. The primary care will assume the role of mobilizing women to attend the screening on the planned occasions. On the same note, primary responsibility will be connected to a specialist on matters of counseling and guidance on the expected lifestyle and how to cope with cancer treatment by providing respective specialists a podium where they can address women on such issues during the planned forums.
The project aimed at improving the wellbeing of society as a whole. As such, specific resources in the community will be utilized. Some public schools will be selected to provide a space where free screening forums will be held. Besides, churches will be used to conduct female seminars to sensitize women about the need to have breast cancer screening and how to reduce risk factors as well as breast cancer management during treatment.
Behavioral change is an essential determinant of the health outcome of a population. Incorporating behavioral change in this program will make it more effective. To attain this, a social cognitive framework will be adopted. This includes reciprocal determinism, which involves showing the target population how they will benefit from the adoption of individual behaviors such as being involved in physical activities and proper dieting. The issue of behavioral capability will also be taken into consideration. Some people will not be involved in a particular behavior due to a lack of knowledge on how to go about it. As such, the program will include educating the target groups on what to do and how it appropriately. The other intervention to enhance behavioral change will be the provision of reinforcement. The Community health advisors will be used to direct and encourage the target group to continue with the expected behavior. The expectations of a particular action will also be explained to the target group to ensure that they would prefer the adoption of the new practice compared to the old ones whenever the way the outcome (Flannery, 2017). Finally, a sense of efficacy will also be instilled in their mind to make them hold a belief that they can change their behaviors toward healthy life as far as breast cancer prevention, identification, or management is concerned.
Having breast cancer survivors to testify during sensitization and educating seminars will be used as a nudge to make the program a success. Both women who have been treated for cancer after early identification, as well as those undergoing treatment after the late identification of disease, will address women on these seminars. This will allow the target group to see the seriousness and need for early screening and preventative measures. It will make them more willing to adhere to national screening guidelines and behavioral change.
The Institute of Medicine (IOM) defines patient-centered care as the provision of care that is responsive and respectful to patients' values, needs, and preferences while making sure that their values guide all clinical decisions (BrummelSmith et al., 2016). In this project, a patient-centered intervention will be ensured by giving the patient time to indicate the most effective approach they would prefer in carrying out certain activities. For example, various ways in which they can conduct physical exercises will be analyzed, and individuals will be left to choose the one that fits them, considering their preferences, values, and needs. To ensure that the program uses shared decisions, the group will be given a chance to suggest how and where certain activities should take place, such as in case of open free screening programs in their neighborhoods.
Reporting, Evaluation, and Measurement
The implementation of fidelity will be assessed by reviewing the baseline counseling scripts and screening assessments completed by the community health advisors. Monthly screening records from the healthcare registries will be used as the metrics to measure implementation progress. The overall outcome will be measured through a behavioral change such as more women being involved in physical activity, reducing the rate of obesity among women, and the reduction rate of cancer mortality in the target group. During the process, the percentage of women adhering to screening, involved in physical activities, or effectively coping with cancer treatment will be used to determine whether the program was effective and to determine areas that may require some revision.
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