resume - Global Health Promotion

D. Levin, G. Coronel
Aspects of National Health Promotion
Programmes for Youth
The
~
~
need to address adolescent health behaviour has been documented extensively,
particularly as health habits that are established during the teenage years often
expose youth to premature health risks, and develop into habits that are difficult
to change during the adult years.
The health behaviour of Israeli adolescents has been studied
by
selecting criteria to measure standards, comparing practice
with standards, identifying reasons for differences, taking
action and reviewing3. Assessment methods were chosen
based on each programme’s characteristics’. Briefly,
highlights of some of the programmes follow.
Harel and
colleagues as part of the WHO Health Behaviour of School Children study in which
outstanding results included extensive dieting among females’. As we witness a steep rise
of melanoma in Israel, the risk behaviour involved cannot be neglected, including the
hours of sun exposure and the use of protective clothing and sunscreens. Finally, while
Israel has a low rate of HIV infection, a high level of awareness by continually reinforcing
proper use of condoms or postponing sexual activity, is necessary if this low rate is to be
maintained. These are examples of indicators which provided a basis for the
development of a national strategy for adolescent health
promotion in Israel by the Kupat Holim Health Insurance
Institution’s Department of Health Education. Kupat Holim
is a health maintenance organisation which provides
approximately 65 % of Israel’s population, three and a half
million people, with comprehensive health care, from
preventive services to major university status hospitals.
Kupat Holim has over 300 community clinics, with 16 of
them tailored specifically to health care for adolescents.
A three year strategy was developed and funded by the
Ministry of Health’s Committee for Health Promotion.
Having now completed the first year, the topics within the
strategy include:
1. Nutrition: Promoting healthy eating habits while
preventing eating disorders.
2. Sun protection: Promoting sun protective habits.
3. Preventing HIV/AIDS: Creating awareness regarding
high risk behaviour and health promoting skills for avoiding
risk.
DOS IER
4. Living with Adolescence in the Family: Understanding
the changes that occur during the different stages of
Nutrition and Sun
/
Exposure
Before developing workshops on nutrition and sun
exposure, to be conducted as a school-based programme, a
behavioural baseline was established. The baseline was one
of the elements used to develop the content and methods of
the programme. As an example, baseline data for the sun
exposure programme is illustrated in Table 1.
Similar data was gathered and analysed for the
nutrition programme showing a high interest in dieting and
very low awareness of weight control methods that
promote proper eating habits.
As a result, experiential school-based workshops were
developed on these topics and implemented in over 10
schools. The workshops were designed with the
participation of an inter-disciplinary health team, including
a physician (adolescent medicine, dermatology) health
educator, a nutritionist and a social worker.
The assessment of the programme has taken place on
both effectiveness and process levels, with satisfaction
levels measured and analysed mainly via self-administered
questionnaires. An important outcome of the assessment
was the indication that over 40 % of the teens said that they
would be interested in having access to health information
via a telephone line.
adolescence, including physical, nutritional, emotional and
psychological, while emphasising the improvement of
Table 1
communication with teenagers.
5. Involving Adolescents in Developing Health Mass
Media: promoting an interactive mass/multi-media tool
emphasising the aspects of nutrition, sun exposure,
smoking, AIDS prevention and other topics.
Assurance Elements
within the National Strategy
Quality
Applying quality assessment measures is accepted
practice in health promotion’.
A six-stage quality assurance cycle was adopted for use
in the national vouth health promotion strategy which
includes identifying/reviewing key areas, setting standards,
16
&dquo;Lite-Line&dquo;
an
In order to offer legitimate information on nutrition in
efficient and acceptable way, the concept of a &dquo;Lite-Line&dquo;
was
developed.
Registered dieticians were trained to give instruction
the phone to teens and their families, which provided
the basis for the weekly service opened subsequently With
appropriate social marketing of the line, an increasing
number of calls have been received, both from teenagers,
their parents, grandparents and even adults who are
interested in asking questions about their own health. Three
separate &dquo;Lite-Lines&dquo; have now been established throughout
the country.
The quality assessment techniques for this programme
focus more on the process and maintenance of the method
than the effect of the &dquo;Lite-Line&dquo; on eating habits, as the goal
is to provide valid, appropriate and accessible information.
While the caller remains anonymous, questions are asked in
order to create a profile, including the:
’ gender, age and residence of the caller
’ reason for the call
health insurer (for information purposes only)
’ source of information regarding the &dquo;Lite-Line&dquo;
outcome of the call: information, referral, invitation to a
group discussion.
From this assessment of the first 450 calls, we know
that 87 % of the callers are female, with an average age of
15,1 years. The most likely question asked relates to normal
growth and development, while many take interest in
weight control as well.
over
Preventing
scholastically. their average grade was 58 before the programme. It rose however. to 98
immediately following the intervention. More importantlf-. interest lev el for the
programme was measured. Participants were extremely enthusiastic about the prospect
of sharing the knowledge that they now owned. and were positive about taking an
active part in peer education. Furthermore, those who were exposed to the sessions led
by the peer educators were very positive about the method, excited about someone
from their own age group talking about the topic on their level. Bo comparison of the
method was made with that of the teachers in their schools, in that peer education is not
meant to act as a substitute for education given by school counsellors and educators. The
teens have initiated new avenues of communication to convey their message, such as
opening a hotline, writing newspaper articles, and have even participated in community
health fairs.
Living With Adolescence
When dealing with adolescent health, it is important to consider those factors
affecting adolescent health behaviour. Hence, a workshop for parents of adolescents was
developed by an interdisciplinary adolescent health team, including a gynaecologist, a
nurse, a health educator, a dietician, a social worker and a psychologist.
The six session workshop raises awareness regarding changes adolescents
experience physically, psychologically, socially and emotionally as well as on
communication skills that can be adopted, enabling parents and teenagers to experience
adolescence with minimal emotional scars.
Quality assessment of the programme is based on both effectiveness and process
evaluation. A self-administered questionnaire, that allows the parents to express their
opinions, needs and attitudes is completed at the first and last sessions. In addition, the
participants are asked to evaluate the workshop regarding its level of contribution
towards skills for understanding and coping with the period of adolescence.
Perhaps the programme’s greatest success indicators were the participants’ desire
to continue and recommend the programme to others, as well as their expression of
improvement in coping with adolescence issues throughout the workshop, including
receiving positive feedback from their adolescent children.
STDs/AIDS
Israeli adolescents rarely encounter an individual with
HIV and rarely see items regarding AIDS in the media.
Lectures are given about AIDS once a year on AIDS Day, and
often little is done in addition. Therefore, a special method
had to be chosen for bringing the message across. A peer
education method based on the PEP/LA model (Peer
Education Programme/Los Angeles) was chosen as
appropriate. It tested very successful in one centrally
located school, with 30 teenagers from the 9th-12th grades
involved in teaching other teenagers about the prevention
of HIV infection. A four day training workshop was
documented on video for the purpose of process evaluation,
and it has been edited to a 40 minute excerpt for social
marketing purposes.
The group acquired teaching skills during the four
days, and began teaching in their own class, and in others
within their school. They have since been invited to. and are
active in other schools, instructing teenagers they havee
never even met previously. Over 2200 teenagers have been
reached in one year.
The quality assessment of this segment of the
programme was measured in several ways. Firstly, the teens
participating in the programme were evaluated regarding
their knowledge, attitudes and intended behaviour
regarding
HIV
Although
this
was a
high
level group
17
Process assessments of many of the activities also
indicated that teens can be, and are often interested in being
involved as full partners in health promotion initiatives.
Involving Teenagers in
Health Promoting Mass Media
effort to convey the health messages appropriate to youth culture, the
of
a
health promotion newspaper for kids was developed. A search was made
concept
for teenage journalists who could translate health messages into relevant language and
icons, as well as initiate health topics relevant to youth. The newspaper is published 3-4
times a year, with the type of articles found in the newspaper including: health opinion
surveys conducted by the kids, editorials on controversial issues (i.e. allowing smoking,
condomats in the schools), information updates, description of health centers for
adolescents, and the opportunity to ask questions of experts.
A competition for naming the newspaper was held, and the winning name was
&dquo;Stetho-Scoop&dquo;, chosen by a group of teens and professionals. Prizes were issued to the
winners in a ceremony covered by the press. The newspaper is distributed via one of the
popular newspapers for youth in Israel, in addition to schools and community clinics.
Formative and summative evaluation is currently being conducted both through mail
surveys and focus groups.
Finally, a web site on the Internet was established to provide an opportunity for
kids to correspond with experts from our institution. Nutrition, AIDS, sun protection,
acne, smoking, and other issues appear on the web, which is also publicised in the
In
Conclusion
an
’
Applying quality assessment tools for programme
development, implementation, and evaluation has proven
useful in making appropriate investments in health
promotion for youth. Because of the relatively short period
of time of adolescence, there is a need for continually
involving new teenagers and parents in the programme.
This requires a constant effort on the part of the programme
initiators, and it is clear that the investment must be made
on an
inter-sectoral level in order
to
reach
References
1 - King A, Wold B, Tudor-Smith C, Harel Y The Health of
Youth, A Cross-National Survey. WHO Regional Office for
Europe; 1996.
2 - Evans D, Head M, Speller V Assuring Quality in Health
&dquo;Stetho-Scoop&dquo;.
The quality assessment of this activity focuses on exposure and utilisation of the
more than 3000 users since it was opened.
with
site,
Promotion. London: Health Education Authority;
Preliminary Findings
Promotion
Measures of
long-term
implementation.
1994.
3 - Ellis R, Whittingon D. Quality Assurance in Health
Care: A Handbook. Edward Arnold; 1993.
4 - Mullen P, Zapka JG. Assessing the Quality of Health
an
Patient Education Programs. HMO Practice.
1991; 3:3.
change as a result of the programme have showed these preliminary
results:
Diane Levin, MPH,
Improvement in intention to diet.
Improvement in willingness to seek professional help when dieting.
3. Improvement in self-efficacy regarding safer sex.
4. Improvement in willingness to adhere to low-risk sun exposure.
Gabriel Coronel, Coordinator of Youth Health Promotion
Department of Health Education, Kupat Holim Clalit
1.
2.
CHES, Director,
Health Insurance Institution, 101 Arlosorov St. Tel Aviv,
Israel 62098
RESUME
L’évaluation de la qualité dans la planification, la mise en place et l’évaluation
des statégies nationales de promotion de la santé des jeunes en Israel
L’utilisation syrstematique de m6thodes d’6valuation de la
qualite d’un projet est indispensable a toutes les ~tapes de
sa conception, de sa mise en place et de son evaluation,
pour obtenir des r6sultats qui a leur tour permettent de
justifier 1’investissement. Un programme national de
promotion de la sant6 a 1’intention des jeunes, portant
essentiellement sur la nutrition, la prevention des rayons
nocifs du soleil, et du Sida a ete mis au point en y integrant
des elements devaluation a la fois quantitative et qualitative
a chaque 6tape pour ameliorer les chances de succes. Une
evaluation préliminaire du comportement des jeunes a
permis d’orienter le contenu du projet pour chaque sujet
abord~ et une evaluation formative a aide a choisir les
m6thodes appropriees. Des m6thodes participatives ont ete
pr~f6r6es (education par les pairs) de memo que des
methodes qui utilisent les moyens de telecommunication
(lignes telephoniques ouvertes. communication via
un bulletin de promotion de la sant6, des
ateliers a 1’ecole et a 1’intention des parents. La r6vision du
programme par des pairs et la participation d’616ments du
groupe cible aux diff6rentes 6tapes de d6veloppement a
am~lior6 la qualité des outils produits pour les diff6rents
projets. L’6valuation du processus s’est faite par le biais
d’un documentaire visuel et d’interviews de participants
pour apprécier leur degr6 de satisfaction. L’6valuation
d’impact a indiqu6 des ameliorations dans 1’intention de
suivre un r6gime, dans les comp6tences pour changer
d’habitudes alimentaires, dans les capacit6s a trouver une
aide professionnelle. dans 1’adoption de pratiques sexuelles
prot6g6es et dans l’intention de se prot6ger des rayons
nocifs du soleil. Quant au maintien de ces tendances
positives dans la dur6e. il conv ient d’approfondir les
differentes parties des programmes sur un plan
intersectoriel.
internet, etc.),
18