Discuss about the Community Nursing Practice for Health Education and Literacy.
Health education can be defined as a field of social science that lures information from the biological, psychological and the environmental sciences for promoting sound health and prevent diseases, disabilities, morbidities and mortalities by the help of activities or interventions that is driven by education. Health literacy is important as it enables a person to take their own health care decisions. Health literacy skills can be conceived as an important asset for improving the health of the people. Low levels of health literacy skills can act as a barrier to assess the health care information, medication use or the prevention to diseases. Hence low health literacy can be associated with poor health outcomes (van der Heide et al.,2013). This paper aims to discuss about the health literacy among the key population such as those taking the injecting drugs, the trans genders, those behind the bars, sex workers. This paper would also focus on the risk issues faced by the vulnerable group and would focus on how community nursing strategies would help to alleviate the condition.
People having lower levels of health literacy and not only less healthy but is also found to be less efficient in dealing with chronic diseases and they also have less knowledge regarding their health. They face difficulties in understanding the information provided in the medicine packages or the hospital reports. Low levels of health literacy is generally linked with lesser levels of health education. It has also been found that people with lower health literacy are more likely to engage in unsafe medical practices and inappropriate use of the prescriptions and over the counter medications. They are less likely to use the preventive health care services.
According to van der Heide et al., (2013), health literacy is dependent on the socioeconomic status of the people and education, which increases the and thereby increasing the risk of diseases in the most vulnerable population. Among the most common types of diseases that affects these vulnerable group of population, HIV /AIDs disproportionately affects these vulnerable group of people (people having low SES and the members of the ethnic and racial minorities), making their low health education to be one of the factor for the spread of this disease. Literacy is a condition that results from the process of reading and writing (Wawrzyniak, et al., 2013). It is a cognitive ability for understanding, interpreting and implementing the spoken and the written health information. According to studies, the functional literacy is essential for having a proper follow up health guidelines. However it has to be remembered that functional health literacy is always not linked with education as many people having higher rate of education are found to have breaching the healthcare guidelines proposed by the allied health care team (Wawrzyniak, et al., 2013).
Although, due to the advancements of the treatment the AIDS victims live for longer years but their life becomes complicated due to other chronic conditions. One of the challenges faced with health literacy is that new challenges are faced as the HIV patient ages (Cunha et al., 2017). AS a population with HIV ages, the necessity of the health literacy in that population may become salient. Hence a containing investigation and research regarding the improvement of the health literacy among the HIV affected individuals remains important (Nachega et al., 2016).
Anyone can contract HIV, but the occurrence of this disease is particularly found in the community among the IDUs due to their practices related to drug use, unsafe sex. Among the population some of the vulnerable groups that are likely to contract AIDs are gay or bisexual men who have sex with men, the injection drug users. Women within the ethnic minorities. HIV surveillance data have shown that the rate of the HIV transmission is higher within the ethnic minorities than any other group of population (Paudel & Baral, 2015). It has been found that nearly two -third of the infections are found to be occurring in the African American, Native American/ Hawaiian, Latino/Hispanic, Pacific Islander/ Asian. The young minority men has been found to have a greater risk of the infection. Some of the key issues faced regarding low health literacy among the HIV patients are non-adherence to medications or anti-retroviral therapy, non-adherence to the safety guidelines such as debarring from the using of injectable drugs, or using the same syringe, debarring from practicing safe sex (Golub & Gamarel, 2013). Many illiterate people not even have the idea of the signs and the symptoms associated with the infection or do not understand the credibility of the situation. HIV is a disease where the whole immune system becomes compromised. Hence the patients have to remain aware about the contraction of any other kinds of infections such as tuberculosis.
A key population who are susceptible to HIV are the people who are in prison. Some of the individuals under imprisonment are found to be engaged in a number of high risk activities linked with HIV transmission, such as the intravenous drug users (IDUs) and those who engage in homosexual activities (Egger, 2018). Prisoners are considered as high risk individuals due to the transmission of HIV among the prisoners and in the general population on their release. Another Key population concerned with the HIV transmission are the Trans genders. Multiple factors have put the trans genders at the risk of HIV infections, which included the presence of multiple sex partners, sex without protection and other drug paraphernalia, mental health problems, imprisonment , commercial sex work and low social esteem (Kalichman et al., 2013). Furthermore the interventions that has been made for the other risk groups may not be suitable for this group of population. Transgender people are faced with discrimination stigma and social rejection that creates barrier for them to participate in the health promotion activities (Poteat et al., 2012). Furthermore, the transgender specific data are insufficient that makes it difficult to give a fixed record of the number of transgender affected by the HIV.
Many studies have showed the association of health literacy with the antiretroviral medication. Kalichman et al., (2013), has developed an intervention for improving the medication adherence among the HIV patients. Since HIV is a disease that impacts a whole community, a community based approach should be taken. The community nurses plays a vital role in spreading awareness in a community or improving the health literacy of a community. A lot of techniques can be used by the nurses to promote health education in the community (Campbell et al., 2013). Nurses can make important contribution towards the prevention and the treatments of AIDS. Nurses should be urged to become more active in the professional societies, adapt community based approaches, patient advocates, council patients and provide individual education the risk associated patients (Abe et al., 2013).
Globally the nurses are playing a crucial role in managing the burden of care for reducing the mortality and the morbidity. Nursing as a profession are taking greater initiative for the clinical management of the HIV (Campbell et al., 2013). Nurses now collaborate with the government and the non-government organizations to take part in the HIV prevention programs, resulting in the decrease of the HIV related deaths. Some of the preventions programs include the “100 percent condom program” where the nurses and the health care workers distributed condoms free of cost and educated the people about the usefulness of the condoms and other information about AIDS (Golub & Gamarel, 2013). The program as well as the governmental policies instructed the commercial sex workers to use the condoms, have been found to decrease the new infection rates (Wilson, 2015). It has been found that the health literacy in the rural areas are much less than the urban settings. Hence the nurses often has to visit the remote places of Australia to provide health literacy to those communities. The indigenous and the Torres Strait Islander people have low health status, low literacy status and low socio-economic status and hence are more susceptible to infections like AIDS (Cunha et al., 2017). The role of the community nurses not only lies in providing information about how to prevent AIDS but also to help the communities get past the stigma of AIDS (Abe et al., 2014). Since AIDS belongs to the class of the sexually transmitted disease therefore a family having an AIDS patient might feel prejudices and stigma from community. Due to the fear of being rejected by the community or the family, many adolescents fear screening for the disease, when early detection of this deadly disease is the only way out to live longer. Hence it is the duty of the nurses to educate the young generation about the importance of the screening of the disease. This can be done normally by conducting awareness programs in the school, creating role play (Abe et al., 2014). This can be done in collaboration with the school nurses and the teachers to educate the students. Awareness among the aboriginal population can be done by creating documentary using simple languages, by using simple signs and symbols. The nurses have to adopt a culturally safe practice while providing health education, especially to the women. Midwives and female nurses can conduct workshops involving the aboriginal women and educate them about the screening procedures or the community services that are available to them if they are faced with any such difficulties. Nurses also work in a range of settings providing daily comfort for the AIDs related illness, the palliative care for the dying, maternal and child care Cunha et al., 2017).
According to Wilson, (2015), nurses not only plays a pioneering role in promoting effective public policy but also advocate the policy makers on behalf of the individuals and the community. They are entitled to foster a collaborative partner with the organizations and the community groups. An example of one such service is the provision of a medical help in a particular location that is accessible to the target population, opening hours enabling the users to access services 24X7. Nurses can also help out the patients to minimize the barriers such as financial constraints and create a non –judgmental and professional environment for the one engaging with the service (Madden & Wodak, 2014).
According to Wilson (2015), three principle models for promoting health care are- The biomedical model, the social model and the ecological model. The biomedical models of the health promotion emphasizes on the reduction of the social inequalities to access the health care and involve in the intersectoral collaboration (Campbell et al., 2012). Apart from this the nurses can be involved in the capacity building approaches such as training of the HIV volunteers via the community support agencies and organizations such as AIDS council. Social marketing has long been a medium to promote health literacy. Nurses can get engaged in social marketing by getting the target population participate in the community events such as the World’s AIDS day (ampbell et al., 2012). According to Egger, (2018) compulsory testing programs currently operate in Queensland , Northern Tasmania guided by troupe of registered nurses and physicians.
“Needle and syringe program” has been found to be effective for the prisoners who are the injection users, where the community nurses and the health care professionals provide education to the prisoners to debar from sharing the same syringes (“Our Work – Australian Federation of AIDS Organisations”, 2018).
HIV programs for the female sex workers have been found to be fruitful in spreading awareness among them. The core element of a HIV prevention program for the sex workers involves behavior change and communication, HIV testing and treatment, promotion of condoms and their distribution, a complete health care involving the mental health, reproductive health , harm reduction interventions, addiction care, group empowerment, solidarity and a supportive government (Wilson, 2015). While providing education to the injectable drug users focus should be given on the reduced use of drugs rather than the distribution of syringes to the prisoners.
Conclusion
However, the care provided to the vulnerable group of people are faced with several challenges due to their low health literacy. It has been found that obtain health education but do not respond to them firmly. Hence the key population is faced with several problems such as the insufficient hygiene habits, non- adherence to the medication regimen, modifications in the diet and the sexual activity. Based on the gaps identified there lies a cluster of recommendations such a prioritization of the HIV programs focused on the sex workers and their implementation in a robust basis. Integrated and comprehensive health care services for the ensuring an equitable care to the transgender or the LGBTQ communities, development of the financial programs for the vulnerable population. In all, nurses should be able to support for equal rights for the minorities and the transgender to get access to proper health education.
References
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Campbell, C., Nhamo, M., Scott, K., Madanhire, C., Nyamukapa, C., Skovdal, M., & Gregson, S. (2013). The role of community conversations in facilitating local HIV competence: case study from rural Zimbabwe. BMC Public Health, 13(1), 354.
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Egger, S. (2018). HIV/AIDS and Australian Prisons [Ebook]. Australian Institute of Criminology. Retrieved from https://aic.gov.au/sites/default/files/publications/proceedings/downloads/04-egger.pdf
Golub, S. A., & Gamarel, K. E. (2013). The impact of anticipated HIV stigma on delays in HIV testing behaviors: findings from a community-based sample of men who have sex with men and transgender women in New York City. AIDS patient care and STDs, 27(11), 621-627.
Kalichman, S. C., Cherry, C., Kalichman, M. O., Amaral, C., White, D., Grebler, T., … & Schinazi, R. F. (2013). Randomized clinical trial of HIV treatment adherence counseling interventions for people living with HIV and limited health literacy. Journal of acquired immune deficiency syndromes (1999), 63(1), 42.
Madden, A., & Wodak, A. (2014). Australia’s response to HIV among people who inject drugs. AIDS Education and Prevention, 26(3), 234-244.
Nachega, J. B., Morroni, C., Zuniga, J. M., Schechter, M., Rockstroh, J., Solomon, S., & Sherer, R. (2012). HIV treatment adherence, patient health literacy, and health care provider–patient communication: results from the 2010 AIDS Treatment for Life International Survey. Journal of the International Association of Physicians in AIDS care, 11(2), 128-133.
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Wilson D (2015) HIV Programs for Sex Workers: Lessons and Challenges for Developing and Delivering Programs. PLoS Med 12(6): e1001808. https://doi.org/10.1371/journal.pmed.1001808
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