Identification of target group
The target group identified for this intervention are obese or overweight individuals living in UK. The health promotion intervention has been planned for these groups because of the increase in risk of chronic diseases in people with obesity. Obesity is associated with risk of many chronic diseases like type 2 diabetes, hypertension and cardiovascular disease. Obese individuals are less likely to lead a high quality of life and prevalence of obesity can increase the medical cost and burden of obesity too (Kolotkin and Andersen 2017). They are more likely to experience functional impairment and the likelihood of being disabled at old is also high for obese older adults compared to those with normal body weight (Kruger, Ham and Prohaska 2009). Hence, there is a need to develop appropriate health promotion intervention for the group to modify their behaviour and support them to lead a healthy lifestyle.
The main purpose of the task is to develop a health promotion intervention that targets eating habits and lifestyle of people with obesity. It can be said that the main aim of implementing the intervention is to promote behavioural modification in target group and increase awareness regarding the importance of healthy eating and active lifestyle. Focusing on behavioural change is important because of association between behaviour risk and obesity. Consumption of excess amount of high energy foods, sedentary lifestyle and energy diet are some of the main cause of obesity (Ku?bicka and Racho? 2013.). The trend starts from childhood and continues in the adulthood stage too. Although regulatory actions such as food policy reforms, changes in labelling and packaging of food and reduction in salt and sugars in food items has been implemented, however desired results cannot be obtained unless attitude of people towards energy rich foods and lifestyle preference is changed. The current food environment is such that it easily exploit’s peoples social, economic and psychological vulnerabilities. This makes it easier for people to eat unhealthy foods and poor nutritional quality persists among the high risk population group (Roberto et al. 2015). Hence, to break the vicious cycle, better effort from the community is necessary.
Prevalence of obesity in children and adults is one major public health concern that has increased the risk of adverse metabolic and cardiovascular health consequence for obese individuals. In the past three decades, the prevalence of obesity has increased significantly. This is understood from the fact that the number of overweight children increased from 32 million in 1990 to 41 million in 2016. According to WHO estimation, the number of obese children is estimated to cross 70 million figure by 2025 (World Health Organization 2017). In addition, the obesity statistics regarding adults suggest that more than 1.9 billion adults were overweight and among them, 650 million people were obese in 2016. The prevalence is also understood from the fact that 39% of adults were overweight and 13% were obese in 2016 (World Health Organization 2017). Unless interventions are implemented at the right time, risk of premature onset of disease cannot be controlled. Hence, health promotion intervention related to health eating and physical active lifestyle is necessary to help obese people reduce weight and lead a high quality of life.
Another rational for interviewing healthy promotion intervention related to lifestyle changes for obese individual is the risk of chronic disease in obese individuals. Body fat distribution and excess body weight is linked to several chronic disease. It is regarded as the cause of cardiovascular disease because of its mediated effect on cardiovascular risk factors such as hypertension, glucose intolerance and inflammatory pathways. All these can further increase morbidity and mortality in a population (Kearns et al. 2014). Hence, due to the scale of the problem, taking population level health promotion approach to reduce the burden of overweight and obesity in UK is essential.
The main aim of the health promotion intervention is to reduce the prevalence of obesity in adults and reduce risk of chronic disease in overweight or obese adults in UK.
The key objectives of the health promotion intervention are:
As the health promotion plan is focusing on behavioural changes in obese adults, the Pender’s model of health promotion is considered most appropriate for it. This is because instead of focusing on preventing the disease, the model focuses on identifying the positive dynamic state of an individual. It focuses on three areas for behavioural change which are individual characteristics and experiences, behaviour specific cognition and effect and behavioural outcomes (Khodaveisi et al. 2016). Hence, by the use of this model, the behaviour specific knowledge of target group can be identified through interaction with the environment and progressively tracking those environments to promote behavioural change. It identified nursing action as important to promote behavioural change and achieve desired behavioural outcome (Alligood, 2017). This model can provide a basis to identify self-efficacy of an individual and perceived barrier to specific health behaviour. The above mentioned model will help to plan the right intervention for a group specific to their psychosocial needs. It can be used as an approach to develop activities for the health promotion intervention. The likelihood of achieving desired behaviour is high through the use of Pender’s model because it is based social cognitive theory, which emphasizes consideration of perceived benefits, barriers and self-efficacy to promote engagement in health promoting behaviour (Khodaveis et al. 2017).
The plan is to deliver the health promotion intervention and achieve desired results within six months. The stepwise activities for behavioural change and the timescale for each activity are as follows:
June 2018:
July 2018:
August 2018:
September 2018:
October 2018:
November 2018:
December 2018:
To successfully implement the above mentioned interventions for health promotion in target group, the role of the leader will be essential in clarifying roles and allocating task to each individual. According to the principles of team-based health care, it is essential that each team members are aware about each other roles and work towards shared goal (Babiker et al. 2014). To implement the intervention, the role of following members will be important:
Social workers: They will play a role in distributing fliers and making people aware about the health promotion program. They will also convince people to take part in the program
Nurses: They will collaborate with dieticians to take a structured diet plan chart for obese individuals. They will have the crucial role to provide individualized nutrition counselling or counselling in a small group.
Physical educator: The physical educator will play a role in providing instruction regarding physical activity and hours of aerobic exercise needed. They will also provide instruction to participants regarding ways to use the pedometer
Physician consultant: Evaluation of outcome will be done by physician consultant and they will collaborate with nurses and health promotion leader to evaluate the outcome of the program.
Apart from other members, the role of the leader will be crucial in communicating with all team members involved regarding the purpose of the health promotion intervention and the main goals of the programs. Good communication between all parties is essential to resolve issues in implementation process, promote efficiency of the team and promotes role clarity (West et al. 2014). A leader with effective communication styles can influence group activities and successful encourage the team to cope with changes and challenges. For the health promotion intervention, communication with leaders is crucial to understand individual roles in health promotion, understand resources related issue and resolved other concerns related to the implementation process. The use of transformative leadership style will make the vision for the program exciting for all and it will create unity and collective purpose (Al-Sawai 2013).
To manage funding issues in arranging resources, it is planned to contact relevant health care agencies regarding arranging funds for health promotions. The implementation of the health promotion intervention is dependent on the availability of resources like appropriate area, training manuals, nutritional brochures, exercise equipments and devices and other medical devices to assess health issues in participants (Naidoo, J. and Wills 2016). Despite availability of all resources, one resource issue that may arise is that client’s may not be able to comply with adequate fruit and vegetable consumption requirement because of socio-economic barrier. Hence, to ensure that the nutritional plan is affordable and accessible for all population, it was decided to provide food vouchers to all participants where food items are available at subsidize rate.
To successful implement the proposed intervention, the implementation strategy is to contact local community agency regarding the implementation of the program and distribute fliers accordingly to make people aware of the program. To fliers will give good overview about the purpose and goal of the program and key activities to be done (Brownson et al. 2015). Furthermore, informed consent requirement will be fulfilled to ensure that no issues arise after inclusion of participants in the program. The intervention will be implemented in a residential care facility in the target locality and participants will need to attend at least 2 sessions to move towards behavioural change. The first session will focus on assessment of health status and the next session will focus on education regarding nutritional needs and physical activity. Open communication will be an agenda to build trust and ensure mutual objectives (Gittell et al. 2015). Another most important strategy is to implement those interventions which have good evidence for effectiveness.
The first hurdle that needs to be crossed before implementing the health promotion intervention is to get the required funds for the process. This will depend on appropriate marketing of the health promotion intervention and attracting interested parties to contribute for the fulfilment of goals. To get the desired funds, providing the right message through marketing and advertising will also be crucial. This is also necessary to encourage participation of desired group in the program. Hence, the focus will be to consult marketing and advertising consultant regarding creating an attractive and convincing message to attract all important stakeholders in the program.
To evaluate the success of the intervention, the evaluation strategy is to conduct both subjective and objective assessment regarding the benefits of the program. Objective evaluation will be done by collecting data related to BMI, physical activity by pedometer and weight. In addition, subjective evaluation will be done by inquiring participants regarding the experience during the intervention and the benefits of the program. Certain questionnaires will also be used to assess changes in attitude and behaviour towards diet and physical activity. Hence, the above mentioned evaluation strategy can give good overview about the effectiveness of nutrition and physical activity intervention and any possible barriers during the implementation process. Based on the outcome, more such health promotion intervention can be planned for other localities too.
While planning the health promotion intervention with multi-disciplinary group, I found that expertise and experience of individual members played a vital role in developing an effective health promotion plan. We had members coming from different field such as management, epidemiology, nursing and health management. Their knowledge and expertise had great influence on me. We could decide the target population and the type of intervention based on experience of other team members. It helped in framing good epidemiological basis for the intervention and identifies the most effective intervention to address health issues in a target population. Based on the contribution and commitment of each team members, it can be said that effective team work helped to achieve more than what could be achieved individually. I could develop an effective evidence based health promotion intervention by capitalizing on variety of knowledge, skills and abilities available (Mayo and Woolley 2016).
I was mainly involved in leading the team and engaging in decision making regarding the best approach needed to plan the intervention. My own influence on the group was that I focused a lot more on motivating the team to deliver a quality work. My focus was to keep the team engaged and ensure the best outcome for the target group. The initial process of building the team and aligning their action to common goal was difficult. There were several instances of disagreements. However, I focused on using other’s opinion constructively so that we do not end up wasting time and achieve the desired efficiency needed for the work too. We had a collective intelligent team and I use my management skills and judgement to efficiently manage skills. My communication skills helped to divide the work as per individual’s expertise and influence team work (Valentine, Nembhard and Edmondson 2015). There was one situation of conflict too when a member’s suggestion regarding use of specific tool for exercise intervention was not taken. He seemed to be agitated. However, I tried to prevent negative feelings from affecting the performance of the team by openly communicating regarding the challenges in using the tool for people coming from different background. In this way, the conflict in the team was resolved. In addition, the value of honesty, creativity and curiosity helped me to professionally develop in practice. Overall, I can say that the experience of developing health promotion intervention helped me to develop my team work skills and effectively take decisions in complex situations. The experience of managing team coming from diverse background and collaborating with multi-professional team can support me to effectively achieve clinical goals in future practice.
This section provides an overview of the planning stage and the elements that has been considered to implement the proposed health promotion intervention for obese individuals. The process of implementing the intervention has been guided by the application of social cognitive theory and the Pender’s model of health promotion. The planning related to the implementation process has been undertaken as per the social cognitive theory and the assumptions made by the Pender’s model of health promotion. A comparison between the process undertaken and the social cognitive theory can shed light on how theoretical perspective guided the implementation process.
The Pender’s model of health promotion was chosen for implementing the intervention because it is based on social cognitive theory (McCutcheon, Schaar and Parker 2016). The social cognitive theory has been used for health promotion because it focuses on analyzing the individual experiences and the effect of environmental factors on health behaviour. It seeks to provide support to individual by using reinforcements to achieve the change. The key component of behavioural change as per the social cognitive theory are self-efficacy, behavioural capability, expectations, self-control, observation learning and incentives (Young et al. 2014). The theory is considered most appropriate for application because the health promotion intervention targeted improving risk behaviours such as eating habits and poor physical activity in obese people. These elements have been incorporated in the process undertaken for developing the intervention too. For example, the screening process regarding assessment of behavioural risk was incorporated in the program guided by the social cognitive theory. This was important to understand influence of individual and environmental factors on unhealthy eating behaviour and poor lifestyle in target group. There is evidence that multi-dimensional factors such as genetics, psychological, socioeconomic and health related behaviour like diet and physical activity are the main cause of obesity (Yoon and Kwon 2014). Hence, to evaluate the effect of these factors on risk of obesity, the social cognitive theory was used as a theoretical basis to develop the intervention. This helped to plan an intervention which could reduce address both beliefs of people as well as surrounding environment which acts as a barrier in changing health behaviour.
The rational for application of social cognitive theory in the health promotion intervention is understood from the above explanation. Another reason for applying the particularly theory was that the efficacy of the theory has been proved as various health promotion program has used the theory to promote behavioural change. It been particularly used for implementing a physical activity intervention as Suh et al. (2015) examined the efficacy of behavioural intervention based on the theory to increase physical activity in people with multiple sclerosis. The study gave evidence regarding the effectiveness of the theory based behavioural intervention in increasing physical activity. Guided by these evidence, examination of risk behaviour was planned as one of the goal of the program and nurse led screening process was planned. As the theory had self-efficacy as one of the component of behavioural change, the strategy that was taken to improve self-efficacy of target group was to track progress or barriers in using the intervention by regular visits to home of participants. To improve self-efficacy of client, education materials like brochures and health websites were also proposed so that target group get the right practical steps to lose weight (Coughlin et al. 2017).
In compliance with the social cognitive theory assumption, the Pender’s health model of health promotion was chosen as a framework to develop the process for implementing the intervention. The value of Pender’s health model in health promotion is that it can increase likelihood of success of the program by looking at individual characteristics and experience and behaviour specific cognitions. The application of this model in the planning process helped in the development of a plan that is sensitive to the needs of diverse population group. This approach has the advantage of reducing any conflict or barrier to application of evidence in real practice (Eldredge et al. 2016). By the utilization of this model, interventions related to dietary change and physical exercise was developed in such a way that execution was easier for people coming from different socioeconomic group. The selected model is also an evidence based model which has been applied to assess physical activity behaviours and its predictive factors on school students. In the study, the structure of the Pender’s model was related with physical activity levels (Naserpoor et al. 2017). Similar considerations were taken to develop interventions for obese individual in this health promotion program too. For example, simple physical activity schedule like daily walking was included in the intervention so that participants do not get discouraged from the burden or effort of the intervention. The duration of aerobic exercise was also reduced to 10 minute to ensure that individual first develop the self-efficacy to behavioural change and sustain positive health behaviours.
Apart from the planning stage and use of appropriate theories to guide the health promotion process, the decision making regarding the best intervention to promote behavioural change was the most crucial part of the planning stage. The intervention of nurse-led feedback and nutritional counselling was incorporated as part of multi-faceted intervention program because it enables taking tailored approach to behavioural changes based on identification of facilitators and barriers to the change process. Training process could have directly focused on providing education to participants instead of assessing their health status and environment risk to obesity. However, this would not have given optimal result particularly in relation to bringing behavioural change in plan. It would have no effect on attitude of people and poor compliance rate would have been achieved too. Hence, nutritional counselling was a more personalized intervention that guaranteed more effective behavioural change. Celis-Morales, Lara and Mathers (2015) also proved that implementation of personalized nutritional guidance is essential to sustain dietary change and lifestyle modification for long-term period.
Improving diet and lifestyle behaviour has immense potential for reducing burden on disease across life span. However, to realize these effects, implementation of more effective and personalized intervention is necessary. Personalized interventions are effective approach to sustain positive behavioural change for a long period (Celis-Morales, Lara and Mathers 2015). Based on these benefits, personalized plan was prepare to advice patients regarding change in type of foods consumed and dietary intake. While developing the intervention, we also considered about suitable platform and device to collect data and link it with intelligent system to provide feedback. However, intelligent system like devices were used only to collect data related to step counts. Instead of relying on digital technology to provide feedback of dietary habits, home visits by nurse was taken as a strategy to ensure that participants who are not comfortable in using the device can also get constructive feedback. Self-assessment via daily diet diary was also included to assess client’s motivation to continue with the change process. Overall the intervention of nutritional counselling has been developed after brainstorming regarding the best approach to make the advice cost-effective as well as acceptable. If the health promotion intervention is successful, use of devices that can be used by lay people will also be considered.
In addition to nutritional counselling, the rational for using the step counts and aerobic exercise was that it offered the approach to provide simple as well effective option for people to reduce weight and lead a healthy lifestyle. The effect of using pedometer to set walking goals is that it can improve functional status of people with obesity (Takahashi et al. 2016). By the assessment of step counts by the use of pedometer, participants can make their personal goal of increasing walking and gait speed. The process of developing the health promotion program also has links with Public Health and professional practice as it the program focuses on improving the health of a population group. All important stakeholders such as community agencies, social workers, health care professionals and management staffs has also been involved to ensure that innovative and novel approach to behavioural change has been developed for the target population.
Background
The current study focuses upon evidence based practices for occupational health management. In the current study, the health needs assessment for security airport staff in London has been taken into consideration. The airport security staffs have been seen to suffer from long work hours and no rest. Some of these have resulted in myriad health complications within the airport security staff. One of the most pre-dominant problems that the airport staffs have been suffering from is back pain.
In the current study, a number of intervention methods have been designed for relieving the symptoms of back pain in the security staff. A number of physical therapies have been suggested over here such as- surgery, message, acupuncture, scientific based research. Though research and intervention, it has been found that acupuncture is one of the most effective methods for relieving the back pain compared to the other prescribed methods. However, a number of steps need to be undertaken for the implementation of the proposed intervention. Some of these have been discussed in more detail throughout the study.
The current study aims to design and implement effective intervention strategies for the control of back pain and other overworked complications in the airport security staff. A number of studies have been conducted to identify the health hazards of the airport security staff. It has been seen from different study that static hour during work shifts; frequent handling of baggage; violence from hostile passengers is some of the factors which have been seen to affect the mental and physical health of the airport security staff considerably. It has been seen that insufficient training along with unequal distribution of workforce has resulted in development of conditions such as back pain in the airport security staff. In the current study, effective intervention strategies have been designed for providing effective intervention for the purpose of reducing back pain in the airport security staff. This has been further divided into a number of objectives such as –
Low back pain is one of the most commonly presented health issues in western countries. In Britain alone, the occurrence of lower back pain attributable to ergonomics accounts to almost 49%. It results in the maximum number of sick leaves or unscheduled absence from work. As mentioned by Cherkin et al. (2016), such high number of sick leaves in the airport security staff resulted in loss of productive work days. The loss of working days is associated with huge amount of costs. The employees on sick leave with low back pain may consequently benefit from effective intervention strategies implemented at workplace. As mentioned by O’Sullivan et al. (2018), one of the most effective methods for treatment of back pain is by providing the employees with long recovery breaks. It has been seen that most of the times the pain have been seen to subside in the patient with proper rests. However as argued by Rossettini et al. (2018), the huge absence rates of the employees have been seen to affect the overall work productivity. Additionally, a number of psychosocial factors have also been seen to play an effective role in the development of workplace fatigue within the employees. For instance, the long static hours where the airport security staff have to constantly stand attending the visitors and commuters and sometimes also help them with the baggage they could develop stiff back (Bussières et al. 2018). Additionally, the airport security staffs often have to deal with wide variety of commuters from different geographical locations. Therefore, the communication gaps often results in the airport security staff get into heated arguments with the visitors or the commuters. Some of these could also result in the development of psychological distress within the employees. Therefore, all these factors contributed towards the development of health issues within the employees. In this respect, a number of intervention strategies have been developed over here such as message therapies, surgery and acupuncture. As commented by Rossettini et al. (2018), the acupuncture have been seen to yield positive results in the control of the lower back in the airport security staff. Recent studies and research has highlighted that acupuncture have been beneficial in controlling a number of pain conditions such as back and neck pain, osteoarthritis, chronic headache and shoulder pain. From the various researches conducted in this regard, it has been highlighted that acupuncture provides the best results as a conventional therapy. It serves as an adjunctive tool in the treatment of chronic lower back pain.
In this regard, comparison was drawn in randomised control designs where one group of patients were provided normal physical exercises as intervention methods to back pain, whereas the other group of patients were provided with acupuncture along with physical exercises. It was seen that the combinatorial methods produced better results compared to exercise alone. However, as argued by Yuan et al. (2015), message along with self care can significantly contribute to reducing the chances of development of muscoskeletal injury or lower back pain in the airport security staffs. Based on the numerous positive results obtained from the use of acupuncture in controlling the muscoskeletal injury within the airport security staff it could be said that it could definitely serve as an effective adjunctive.
A number of barriers may be faced in the implementation of the evidence based practices. In this respect, mixed responses have been received regarding the benefits of acupuncture in controlling back pain within the patient. Some of the barriers which could be faced over here in the implementation of the evidence based practices are lack of awareness or knowledge in the management, lack of effective infrastructure for supporting the implementation of the health based methods, disputes within the management and the employees , which could delay the decision making process. Therefore, some of these barriers could delay the implementation of the change management process. These could be addressed from a managerial perspective which has been further supported with the help of a number of management theories. Some of these theories are the administrative management theory and the bureaucratic theory of management.
The administrative management theory focuses upon a number of important objectives such as – division of work, subordination of individual interests to general interest, remuneration etc. Therefore, some of the attributes which are focused around providing equal opportunities to the employees are the division of labour which will help in reducing the amount of static work hours of the airport security staff. The management should take decisions in the general interest of the employees where the employees should be given sufficient breaks or holidays after a tiresome season of work, as these have been seen to prevent the burnout within the employees. As mentioned by Toomey et al. (2015), overworked staff have been linked to high rates of employee turnover. Additionally, the remuneration could be in the form of healthcare packages which could help in reducing the financial gaps for availing treatments.
The bureaucratic model of management on the other hand focuses upon some of the important alternatives such as selection of employees based upon technical expertise, promoting formal and interpersonal relations. As mentioned by Bratton and Gold (2017), in the lack of effective communication with the management the employees may often feel neglected. Additionally, the communication gaps may prevent the employees from the approaching the management with their personal issues. The majority of the communication gaps could also lead to process gaps. Hence, based upon the discussion a number of proposals could be suggested for the effective implementation of the intervention strategy. For example, implementing effective communication approaches which could help in redressing the process gaps along with providing the employees with healthcare plans (Nilsen 2015). Additionally, workshops could be organised for educating the employees on the benefits of acupuncture along with physical exercises. This is because for chronic pain the physical exercises with acupuncture methods could be useful. However, for successful implementation of the intervention the human resources team of the airport management authority need to collaborate with the alternate healthcare channels.
In order to provide effective training and education to the employees regarding the benefits of acupuncture as occupational therapy, professional workshops could be organized. There could be a number of positive and negative implications of the professional workshops. As mentioned by Toomey et al. (2015), educating the employees on the different methods of occupational therapy can promote self care. This in turn could promote the overall health of the employees and reduce the number of sick leaves enhancing the organizational productivity. Additionally, a caring management could generate a feeling of positivity in the employees.
However, there are a number of negative implications of such professional workshops such as it could lead to waste of time and resources. As commented by Leung (2015), the amount of time wasted in providing training to the employees on acupuncture based occupational therapy could be utilized in other important purposes. Additionally, the professional workshops are associated with huge expenditures.
A number of strategies could be undertaken for review of the overall health conditions of the employee. In this respect, the airport management authority could organise professional workshops for training the employees on the different methods and modes of acupuncture. In this respect, organizing a quarterly health check up of the employees could help in reviewing their recovery rates. This could be done in collaboration with the professional care channels that were responsible for providing education and training to the employees on various methods of occupation therapy. The health records collected through the reviews over here could be used by the workplace authorities for bringing about changes within workplace practices which could be provided the employees with better ergonomics. It has been found that the most of the times the employees suffer from poor health conditions owing to poor workplace conditions (Poon and Carus 2016). In this respect, providing the airport security staffs with better resting conditions amidst the tiring working schedules can in preventing the chanced of development of back pain.
Conclusion
The current study focuses upon occupational health management. In the present case, the airport security employees have been taken into consideration who had been subjected to chronic back pain due to poor ergonomics and long stressful work hours. The current study over here focuses upon the development of evidence based practices for coping up with the physical stresses which results in poor health conditions of the employees. One of the current evidence based practices suggested over here is provision of acupuncture for reducing the complaints of stiff back or back pain in the employees. It had been seen through various research based studies that physical exercises alone have been ineffective in relieving the pain symptoms. However, the physical exercises when combined with adjunctive such as acupuncture have been seen to produce better results. Therefore, the airport management authorities have been aiming to provide the employees with professional workshops in order to educate the employees on the various methods of occupational therapies. These have been further discussed with respect to managerial aspects where a number of theories have been used such as administrative management theory and bureaucratic management theory. The theories aim towards the importance of division of labour, cultivating effective inter-professional communication which could help the management understand the grievances of the employees and take measures accordingly.
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