The prevalence of cardiovascular disease (CVD) is one of the major public health burden as it accounts for 17.7 million deaths per year globally (World Health Organization, 2018). It also regarded as the largest health problems for Australia as CVD affects one in every six Australians. Coronary heart disease is the most common type of CVD and currently it affects around 1.2 million people in Australia (heartfoundation.org.au, 2018). To take action against the CVD epidemic, it is essential to target specific risk factors and implement appropriate health promotion programs to educate or manage the risk factors for specific community. This report aims to develop a health promotion programs for smoking prevention in men living in the Northern territory of Australia and smoking has been chosen as it is the most common risk factors that leads to coronary heart disease in people. Tobacco smoking is the greatest cause of mortality worldwide, hence implementing health promotion initiative to combat tobacco usage is a necessity in high risk population group (Golechha, 2016).
The health promotion program related to smoking cessation is being developed for men living at Northern Territory in Australia. Northern Australia consists of the city of Darwin, Alice Springs, Palmerston, Tennant Creek, Katherine and Nhulunbuy. 32% of the population of the community lives in remote areas and the mean population age is 38 years. However, the problem for people in the Northern Territory is the highest death rates from coronary heart disease in both males and females. In addition, the death rate is seen both in indigenous and non-indigenous population group. The health promotion initiative related to smoking prevention focuses on the male population group because of the wide difference in death rate statistics for ischemic heart disease in 2012. In the year 2012, Northern Territory recorded 134.6 deaths per 100, 000 in men and boys compared to 65.7% in the women and girls (Ilton, 2012). The review of the risk factors related to coronary heart disease in the region also showed highest prevalent rate for smoking and lowest for hypertension and cholesterol. Hence, planning effective smoking prevention and risk awareness program is essential for the men living in Northern territory to reduce the incidence of coronary heart disease in the region. As the population of Darwin is larger than other cities, hence the health promotion initiative targets men living in Darwin.
The health promotion program related to smoking prevention and awareness about its role in increasing risk of cardiovascular disease will be beneficial for men living at target group as they have the highest smoking rate. Risk awareness and education about risk of smoking will motivate men to quit smoking and look at other alternative options to reduce the impact of smoking on cardiovascular health. Such health promotion initiative can also reduce the death rate, increase people’s preference for healthy lifestyle and reduce the health care cost associated with hospitalization for people living in Darwin. The uniqueness of this smoking cessation initiative is that it targets both orientation and psycho-education to first make people aware about the ill-effects of smoking and then target risk reduction by means of smoking cessation lessons. It is a community based prevention program and evidence has shown that community based interventions are effective in preventing tobacco use among adolescents (Shrivastav et al., 2012).
The goal of the health promotion programs related to smoking prevention and cessation are as follows:
Health Promotion prevention management perspective (primary, secondary or tertiary)
As the health promotion is looking at eliminating the factor that increases the risk of coronary heart disease, it falls under the primary health promotion management initiative. Primary prevention is the health promotion strategy that focuses on eliminating the factors that result in manifestation of a disease. This means it focus on preventing a disease before it starts and from this perspective, risk factor reduction programs comes under primary prevention steps. Smoking is one risk factor that increases risk of damage to the arteries and increase the likelihood of cardiovascular complication in people. Mons et al. (2015) explained that incidence of cardiovascular event increase with age and risk factor management is essential to reduce the burden of heart disease. Hence, as the main aim of the health promotion program is to communicate about the risk of smoking and benefits of quitting to smokers, it falls under the primary health promotion prevention management initiative. Such initiative can be developed for one individual or the whole community and the health program for health promotion at Darwin targets the male population of the region
As health promotion initiative is a community based health promotion programs, involvement of health professionals as well community support staffs is necessary for the success of the program. Community support staffs are necessary for successful execution of the program, whereas the health professional team is necessary for delivery of the right health message in a professional manner (Bahraminejad et al., 2014). The key stakeholders of the health promotion program include the counsellors, the physicians, nurses, social workers, community organizers and psychologist. Role of physicians and nurses are essentially in preparing and developing health promotion message related to risk of smoking and promoting positive behavioural change in male group living at Darwin. Since they have the clinical knowledge and experience related to management of smokers, they are in a unique position to provide the right assistance to smokers during quit attempts. They can also provide the most credible source of information regarding risk of smoking on cardiovascular health (Stoddart & Evans, 2017). In addition, the health promotion workers and community organizers can provide idea regarding delivering the health message in the most innovative and accessible manner so that the program is accepted by the target group and has maximum impact on people too. Considering the factors that influence the acceptability of a health prevention essential is necessary to achieve the goals of the program.
While reviewing the health statistics of Northern Territory, it was found that smoking habits is a great risk for the health of the make population. Hence, the logo that has been created for the health promotion program is ‘Quit smoking before it’s too late’. This logo has been taken as it directly gives the warning to smokers and also makes them inquisitive regarding the need for urgently quitting smoking. Such message can attract attentions of target group and it will act as the first step to build connection with community support group.
There are two stages that have been planned for health promotion related to smoking prevention in Darwin. This includes:
The most vital element of heath promotion is to consider the medium by which the health promotion will be delivered. As the health promotion targets male population, sports events has been selected as a medium to deliver the health message as male are most likely to participate in such events. Hence, during breaks, such form of health promotion can be carried out. Similar approach of using sports or school event as a medium to deliver health message was also taken by Hilland et al. (2015) and it proved that such medium are engaging mechanism to pass health message to target group.
The first target is to catch the attention of the male population group by creating one poster that would make all public aware of the program. The poster will have appropriate visual graphics and message to catch the attention of public. Secondly, the male population can be made aware about the harmful consequences of tobacco smoking by showing them videos or film documentary on consequences people faced who smoked cigarette for a long term period. Using the digital media for health promotion can help the target group to get the right message in the most effective manner to have maximum impact. Evidence has proved that online documentaries is an effective tool that increases intention to quit and increasing quit attempts (Brown et al., 2015). After the sports event, all audience will be given pamphlet so that they can join further session to know about the risk of smoking and improve their quality of life. Social workers and community organizers will be the main player in implementing the above mentioned health promotion schedule,
The strategy planned for second phase related to behavioural intervention and education for smoking cessation will focus on delivering behavioural intervention to motivate people to quit smoking. This will be delivered counsellors and physician and the sessions will focus on reinforcement of motivation to quit, rationalizing smoking prevention for good cardiovascular health and making men aware about high risk situations due to smoking. This form of health education is also known as psycho-education. In addition, for the purpose of increasing smoking attempts and introducing target group to other alternative source for smoking, web-based source was planned. This was done by developing a web-based smoking cessation website where they got all the self-help material, information and resource to know about ways to quit smoking. This also paved way for providing self-guided intervention to male groups who could easily access the website in the long run and get proactive support to quit smoking. Such mode of delivery of health promotion program through internet can promote health behavioural change. Another advantage of internet based smoking cessation intervention is that they are low cost and most accessible option to aid cessation among smokers (Bottorff et al., 2016).
The success of any health promotion program is dependent on the extent to which the program was successful in achieving the goals of the program. In this context, the success of the ‘Quit smoking before it’s too late’ program will be evaluated by monitoring and recording response of participants related to smoking habits before and after the program. The main parameters that will be evaluated include number of cigarettes smoked per day and number of quit attempts before and after the program. The participants will also be interviewed regarding their ability to manage withdrawal symptoms and cope with cravings for cigarette and use safer option for smoking after the program. Getting such statistics after the end of the program can help to estimate whether the program was effective in increasing awareness about risk of smoking and increasing quit attempts in people. This will also help clinicians decide the level of intensity needed to influence quit rates and improve cost effectiveness too (Asvat et al., 2014).
Conclusion
The report gave an insight into the process of development of health promotion program for preventing smoking among male population group living in Darwin to reduce the incidence of coronary heart disease in Northern Territory. By the process of developing the health promotion activity and identifying stakeholder’s involvement in the program, it can be said that the success of a health promotion is dependent on consideration regarding the effective medium for health promotion and feasibility and acceptability of the program for target audience. By using sports event as a trigger to increase participation rate and considering use of online documentary to give the right message to audience, the program took an innovative step towards promoting maximum engagement of target group in smoking prevention and cessation program.
References:
Asvat, Y., Cao, D., Africk, J. J., Matthews, A., & King, A. (2014). Feasibility and effectiveness of a community-based smoking cessation intervention in a racially diverse, urban smoker cohort. American journal of public health, 104(S4), S620-S627.
Bahraminejad, N., Ibrahim, F., Riji, H. M., Majdzadeh, R., Hamzah, A., & Keshavarz Mohammadi, N. (2014). Partner’s engagement in community-based health promotion programs: a case study of professional partner’s experiences and perspectives in Iran. Health promotion international, 30(4), 963-975.
Bottorff, J. L., Oliffe, J. L., Sarbit, G., Sharp, P., Caperchione, C. M., Currie, L. M., … & Stolp, S. (2016). Evaluation of QuitNow men: an online, men-centered smoking cessation intervention. Journal of medical Internet research, 18(4).
Brown, J., Michie, S., Walmsley, M., & West, R. (2015). An Online Documentary Film to Motivate Quit Attempts Among Smokers in the General Population (4Weeks2Freedom): A Randomized Controlled Trial. Nicotine & Tobacco Research, 18(5), 1093-1100.
Golechha, M. (2016). Health promotion methods for smoking prevention and cessation: A comprehensive review of effectiveness and the way forward. International journal of preventive medicine, 7.
heartfoundation.org.au (2018). Heart disease in Australia. The Heart Foundation. Retrieved 15 April 2018, from https://www.heartfoundation.org.au/about-us/what-we-do/heart-disease-in-australia
Hilland, T. A., Beynon, C. M., McGee, C. E., Murphy, R. C., Parnell, D., Romeo-Velilla, M., … & Foweather, L. (2015). Training sports coaches to tackle tobacco: formative evaluation of the SmokeFree Sports campaign. International Journal of Health Promotion and Education, 53(1), 2-16.
Ilton, M. (2012). State of Cardiovascular Health in the NT. Ntcardiac.com.au. Retrieved 15 April 2018, from https://www.ntcardiac.com.au/downloads/Cardiac%20Care%20in%20the%20NT/1%20State%20of%20Cardiovascular%20Health%20in%20the%20NT%20Ilton.pdf
Mons, U., Müezzinler, A., Gellert, C., Schöttker, B., Abnet, C. C., Bobak, M., … & Kromhout, D. (2015). Impact of smoking and smoking cessation on cardiovascular events and mortality among older adults: meta-analysis of individual participant data from prospective cohort studies of the CHANCES consortium. bmj, 350, h1551.
Shrivastav, R., Nazar, G. P., Stigler, M. H., & Arora, M. (2012). Health promotion for primordial prevention of tobacco use. Global heart, 7(2), 143-150.
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