Answer

Health Promotion among Women to reduce Stroke and Cardiac Disease Prevalence

          Health Promotion/Disease Prevention Problem Specific to the Target Population

This promotional campaign aims to increase stroke and cardiac disease awareness and early screening among women aged between 45 and 65 years. Many women might be unaware of the fact that stroke and heart disease are significant threats to their wellbeing. According to Shen et al. (2013), heart disease happens to be the leading cause of death among women in the United States, while stroke is placed at the third position. Mochari-Greenberger et al. (2012) also assert that heart disease is the leading cause of death among women in the U.S., killing an approximate of 292,188 women in the year 2009. Even though heart disease is, in some situations, believed to be a “man’s illness,” it is estimated that an equal number of men and women die every year of heart illness across the world. However, Alshuwaiyer & Taylor (2014) point out that, despite an increase in awareness campaign in the last ten years, only fifty-four percent of women noticed that heart illness is their leading killer. Heart disease and stroke cut across all races and ethnicities. For instance, Hastings et al. (2014) inform that for the white and African American women in the U.S., heart disease is the leading killer. Among the Hispanic women, heart illness and cancer account for the same number of death every year, while, for Alaska Native or American Indian, and Pacific Islander or Asian women; heart illness comes second to cancer.  Wang et al. (2015) add that approximately 7.5% of black women, 5.9% of white women, and 5.7% of Mexican women experience a stroke.

While many women do not exhibit symptoms of heart disease, some of them experience pain in the throat/jaw/neck, angina (i.e. discomfort or dull and heavy sharp pain), or pain in the back or upper abdomen (Mochari-Greenberger et al., 2012). These experiences may be witnessed during rest or can be triggered by psychological or mental stress. They can also occur during physical exercise/activity. Women have a higher probability of describing a chest pain, which is burning, sharp, and more regularly experience pain in the back, throat, abdomen, neck, and jaw.  In some situation, the heart illness may mute and not identified until the victim experiences symptoms or signs of heart failure, heart attack, stroke, and arrhythmia.    

Considering the significant threat that stroke and heart illness poses to women, Alshuwaiyer & Taylor (2014) point out that early screening for these conditions is essential in preventing deaths that might occur from them. As such, a promotional campaign aiming at creating alertness or awareness among women concerning stroke and heart illness is significant. Such a promotion should take into consideration the aspects of good or effective leadership, incentives, resource availability, teamwork, and training among others.

Effective leadership helps in guiding the implementation of the campaign/program while incentives serve to encourage team members or employees to engage actively in the promotion. Effective leadership also provides the required support regarding ‘buy-ins’ and motivation.  Resource availability and teamwork are essential for the efficient execution of the promotion activities. Training is significant in ensuring that tea member develops appropriate skills on how to execute the campaign activities (Alshuwaiyer & Taylor, 2014). It also ensures that employees appreciate the significance of the intended change (i.e. the program aimed at creating heart disease and stroke awareness among women).   Some of the issues that should be emphasized during this promotion are the need for women to know their blood pressures, consult their healthcare providers, quit smoking, check their triglycerides and cholesterol levels, make health food selections, and limit their alcohol intake. Alshuwaiyer & Taylor (2014) argue that embracing such measures ensure that a health awareness promotion is executed in an efficient and effective manner, thereby leading to its success.

How the Chosen Issue Applies to Advance Practice within the Student’s Role Option

The heart disease and stroke issue have a robust connection to the advance practice within my role option. The relevance of this topic to advance practice lies in the fact that addressing it requires the establishment of an intervention, which is an evidence-based practice. Some of the actions that are associated with the promotional campaign, particularly early screening awareness for the heart disease and stroke are obtaining health histories and performing comprehensive physical assessments, with the inclusion of functional, psychological, and developmental assessment. Developing differential diagnoses as well as ordering and interpreting laboratory outcomes and other diagnosis studies are also included. Besides, developing and ordering therapeutic care plan for stroke and heart disease patients is among the activities associated with the intervention. Other activities are maintaining patient records, evaluating patient’s response to the care plan and modifying it as required, and arranging patients’ consultations/referrals.

According to Mochari-Greenberger et al. (2012), chronic vascular illnesses such as stroke and heart disease represent a significant and increasing quota/percentage of practitioner workloads and healthcare expenditure. Behavioral risk factors associated with these illnesses are poor nutrition, smoking, physical activity, and hazardous alcohol consumption. The recognition of the increasing burden and costs of chronic illnesses has resulted in an increasing research aimed at identifying effective mechanisms/approaches to prevention. Alshuwaiyer & Taylor (2014) assert that there in now substantial evidence concerning the effectiveness on programs aimed at preventing vascular illnesses such as stroke and heart disease within high-risk populations. For instance, Jin et al. (2013) executed a study that demonstrated the possibility of delaying or preventing the onset of stroke in high-risk patients through cycling. Jin et al. (2013) also identified the significance of promoting/encouraging healthy lifestyles, with the inclusion of addressing the use of alcohol, smoking, physical activity, and smoking among others. Considering this information, it can be noted that the topic is selected (i.e. heart disease and stroke promotion among women) applies to the advance practice within my two role options. The first role is supporting the early diagnosis/detection of chronic diseases (i.e. stroke and heart disease in this case) via a “well person’s health check”.  The second role is supporting risk modification and lifestyle via referral services that help individuals (i.e. women in this case) desiring to make changes to their style of life.  

Analysis of the Prevailing Information on the Interventions addressing the Problems within the contexts of the Communities from Sciences, Nursing, and Humanities

Several researchers have focused on various interventions that are targeted at addressing the heart disease and stroke issue. Younge et al. (2015) conducted a randomized controlled trial study on the web-based mindfulness program/intervention in heart disease. These researchers established that compared to usual care, mindfulness demonstrated a borderline substantial improved the 6MWT (i.e. exercise potential measured with the 6-minute walk test).Besides, the researchers established a substantially lower rate of heart for the mindfulness category. These researchers concluded that mindfulness training is critical for the current management of  heart disease in patients. Considering that patients having the heart disease demonstrate the high frequency of psychological and physiological problems/issues, these patients may gain from mindfulness training. As such, this study plays a significant role in highlighting the beneficial psychological and physiological effects associated with online mindfulness training among patients having the heart disease. The fact that this intervention employed the internet in reaching or assessing the target audience, it was effective in creating awareness about stroke and heart disease.

Kim et al. (2016) performed a meta-analysis and a systematic review to evaluate the impacts of CPAP (continuous positive airway pressure) on the frequency of stroke among the patients with obstructive sleep apnea (OSA). Based on the cohort studies’ meta-analysis, the researchers established that the CPAP treatment resulted in a lower incidence of cardiac and stroke occurrences with the relative occurrence risks of 0.54 (0.38-0.75) and 0.27 (0.14-0.53) respectively. However, the finding could have been regenerated in the RCT (Randomized Clinical Trial) as well as researches employing administrative data. As such, these researchers concluded that the CPAP treatment among patients having OSA might lower or reduce the risk of stroke. Moreover, such an impact was more prominent in stroke than in events associated with cardiac. The CPAP intervention resulted in lower frequencies of stroke and cardiac events, it can be noted that this intervention is effective.

Gong et al. (2015) executed a study to assess the effectiveness of the method “Keep Moving towards a Healthy Heart and a Healthy Brain (KM2H²)” in motivating regular physical exercises to prevent stroke and heart attack among patients with high blood pressure enrolled within the Hypertension Control Program that is community-based. This study involved a randomized clinical controlled trial having three main phases of longitudinal evaluations at the baseline, three and six months after the intervention. These researchers established that in relation to the quality of care, being subjected to the KM2H² was linked with substantial lowering of stroke prevalence (5.11% vs. 9.90%; p<0.05), heart attack event (3.60% vs. 7.03%, p < .05), and temperate decrease in the blood pressure in the body ((-3.72mmHg in DBP and -2.92 mmHg in DBP) during the sixth month after the intervention. Substantial improvements in regular physical exercises at six-(d = 0.45, 95% CI: 0.04, 0.85) and three- month (d = 0.53, 95% CI: 0.21, 0.85) after the intervention, respectively. Jin et al. (2013) point out that engagement in continuous physical activity acts as a suitable way of minimizing incidences of stroke and heart disease. Gong et al. (2015) concluded that the intervention KM2H² is effective in minimizing the risk of stroke and heart attack in the elderly patients receiving medications for high blood pressure. Considering this finding, it can be argued that this research offers robust data backing a structured phase-III clinical trial to determine the efficacy of the KM2H2 program for employment within the community-based environment to promote positive health-seeking behavior.

Jin et al. (2013) evaluated the impacts of the aerobic cycling patient education on cardiovascular fitness (i.e. the peak VO₂) and the heart rate recovery (HRR) in the patients with chronic stroke. The researchers also investigated the association between changes in peak VO2 and those in HRR. In this study, 128 respondents having a chronic stroke were subjected to a randomization to a 12-week (i.e. five times a week) progressive aerobic group of cycling (n=65) or a control category (n=63). Besides, a six-minute walking distance (6MWD), muscle strength, and HRR were determined before and post intervention. The findings of this study revealed that cycling training results in a substantial increase/rise in muscle strength, HRR, 6MWD, and peak VO2. In the cycling category, percentage changes within the peak VO2 were noted to have a positive relationship with those within the non-paretic and paretic HRR and muscle strength. The findings of the study’s linear regression demonstrated that percentage rises in peak VO2 were substantially correlated/associated with percentage changes within the HRR when regulating for pre-peak VO2, gender, age, improved muscle strength, and duration of stroke. Considering the findings of these researchers, it can be argued that aerobic cycling training favorably modifies the HRR in survivors of stroke. As an indicator of improved autonomic function, rapid HRR is significant for forecasting gains within cardiovascular fitness. These results also reveal that the underlying significance of autonomic variation/modulation on cardiovascular versions to the rehabilitation of stroke exercise. Therefore, by encouraging many individuals to join cycling training, awareness of stroke and heart disease can be created.

Ntsiea et al. (2015) executed a study aimed at determining the impact of workplace intervention on the return to work rate of formerly employed survivors of stroke within South Africa’s Gauteng province. The workplace intervention was designed in accordance with workplace challenges and function-ability of every survivor of stroke. The findings of these researchers revealed that following a follow-up conducted after six months, 60% (n=24) of survivors of stroke within the intervention category returned to work relative to 20% (n=8) within the control category (P<0.001). It was also established that the return to work for survivors of stroke within the intervention category was 5.2 for each unit increase in cognitive and ADLs assessment score rose by 1.7. Furthermore, the odds associated with return to work rose by 1.3. The researchers also established that those who resumed their occupations exhibited better life quality relative to those who did not (P<0.05). As such, this study has succeeded in revealing that the return to work intervention, which takes into consideration workplace visits and workability assessment, is effective in enhancing the return to work for survivors of stroke. Therefore, this strategy can be employed in creating awareness about stroke and heart disease.

Parke et al. (2015) point out that key elements associated with the self-management support program such as action planning, goal setting, and problem-solving happen to be key components of therapy rehabilitation programs/interventions. These researchers established that supported self-management resulted in short-term improvements in extended and basic activities of routine living, and the decrease in poor results/outcomes (death/dependence). Considering this information, it can be noted that therapy rehabilitation presently offers elements/components of self-management support to survivors of stroke and their care providers with enhanced outcomes. Future study should be directed toward establishing the medical, social tasks, and emotional tasks of long-term survival/survivorship.

Rasura et al. (2014) executed a study to determine the effectiveness of educational interventions in promoting stroke awareness. These researchers focused on twenty-two interventions researches. The researchers established that most of the interventions were partially effective in terms of type/nature of information retained, gender preference (women), or media preferred. Only a single intervention was noted to be ineffective. According to Mochari-Greenberger et al. (2012), media promotions can be effective, but need a continuous funding, and their potential to focus on high-risk subgroups/sub-categories, whether linguistic, aging, or socioeconomic is still unclear. The findings of these researchers revealed that the three community-based and participatory stroke campaign interventions were incomprehensively effective. Moreover, web-based promotion were noted to be effective in reaching/covering a larger audience, but only attracted a self-selected and selected population. As such, these findings reveal that stroke educational promotions have the ability to improve awareness and knowledge as well as behavioral change among a larger population.   

Considering the above literature, it can be noted that several interventions aimed at preventing or creating awareness about stroke and heart disease have been successful. Those that have not been successful have at least managed to accomplish a significant portion of their objectives. Besides, these interventions have also been effective in minimizing the effects of these illnesses on the victims.

Appropriate Health Promotion/Disease Prevention Theoretical Framework that Applies to the Problem

The ecological concept/theory can be employed in addressing the heart disease and stroke issue. This theory integrates concepts on individual behavioral change with the comprehension of the role of enhancing and restructuring the environment to better comprehend the association between a person and her or his physical and social environments as a potentially robust influence on the determinants of health and health. A palpable implication of this association is that the restricting and enhancement of a setting could beneficially impact large numbers of persons within an at-risk population (Brown et al., 2006). This framework is founded on the Health Impact Pyramid, which involves the creation of interventions to alter the setting to make default decisions of individuals healthy. In this pyramid, a significant portion of individuals would be impacted by healthier settings in which individuals have to evade actively the benefits associated with healthier setting/environment.

Such individual-environment association need to happen within communities targeted for interventions focused on reducing cardiovascular risks. The theory of “diffusion of innovation” established by Shoemaker and Rogers can aid in explaining the wide disparity in risk mannerisms across population and communities.  According to the diffusion of innovation theory, the economic, educational, and social environment enables subpopulations or some communities in communities to embrace readily recommendations linked to cardiovascular health (Brown et al., 2006). Such communities will employ the information concerning the risk they encounter and involve actively in a change of behavior in relation to health education promotion that alters their attitudes and knowledge. Brown et al. (2006) point out that these approaches have been effective in realizing their objectives in certain communities. Communities with different economic, educational, and social characteristics are often resistant to these similar interventions, leading to widening discrepancies in burdens of disease. For instance, after the release of the Surgeon General’s reports on tobacco smoking risks in the 1960s, it was noted that changes in rates of smoking cessation were not distributed in an even manner across the Society of the U.S (Brown et al., 2006). Low-education and low-income strata, and dwellers of regions producing tobacco lagged in their decline rates in tobacco use (Brown et al., 2006).

Brown et al. (2006) inform that the combination of diffusion of innovation theory and social, ecological model suggests that approaches to late- versus early-adopter populations should be very different.  Early adopter communities only need the identification of health burden associated with heart disease and stroke, with limited health education through social media and mass to alter their societal norms to result into changes in the risk behaviors. However, for a late-adopter society/community, extra efforts may be required to back changes in attitudes and knowledge by the extra provision of services of health or community-wide efforts. Environmental and policy change in which behaviors, which are considered healthy, would be default alternative or other policy-oriented incentive may be essential for behavior change aimed at a larger population within later-adopted communities. Brown et al. (2006) assert that the social-ecological concept highlights that such associations between cultural and social characteristics as well as environmental alterations may prove to be an effective mechanism to change risk on a population-wide basis, as opposed to being experienced within the privileged society strata.

Intervention to Address the Problem within the Selected Setting/Population Based on Social, Epidemiological Assessment

The intervention’s name is “Free Women from Heart Disease and Stroke”. This intervention is a community-based campaign, which will target women from all social dimensions such as low-income earners and those practicing unhealthy living habits/lifestyles, but between ages 45 years and 65 years. This approach is adopted because the heart disease and stroke issue is comprehensive and encompasses all women. Since the intervention aims at creating awareness among women on the heart disease and stroke issue, with the aim of preventing the deaths associated with this problem, excluding any segment of women from this campaign will not be prudent.  The “Free Women from Heart Disease and Stroke” campaign will focus on motivating women to attend Matta General Hospital for early screening for heart disease and stroke. Incentives such as free screening and consultation will be provided to encourage more women to attend the facility for early screening. Moreover, participants will be educated on the risks associated with heart disease and stroke.

Mochari-Greenberger et al. (2012) inform that social media platforms offer an efficient platform on which target audiences can be reached. This intervention will employ electronic tools such as social media platforms (i.e. Facebook and Twitter) in reaching out to all women. Incentives will be provided to those who will respond to this campaign. For instance, checking of blood pressure will be conducted at a free cost. Booklets/Brochures highlighting all the healthy foods and healthy lifestyle behaviors will also be offered freely to those who will come to check their blood pressures and consult providers of healthcare. The intervention will also adopt a multidisciplinary approach, whereby professionals from all disciplines such as medicine, nutrition, and psychology among others will be involved in counseling and handling those found without and with heart disease and stroke related issues.

Alshuwaiyer & Taylor (2014) point out that effective leadership offers the necessary buy-in and resources at all levels to ensure the success of a promotion intervention. As such, effective leadership and teamwork will also be embraced in this intervention. Training will be provided to the staff on how to handle and communicate to the targeted audience. Members of staff will also be educated on the significance of the campaign to themselves and the target audience. Treatment interventions will be arranged for those found with the heart disease and stroke related issues. Follow-ups will also be conducted to determine the effective of the campaign in creating awareness of heart disease and stroke in women.  

An Evaluation Plan to Measure the Efficacy of the Proposed Intervention

Martínez-Donate et al. (2015) argue that effective health promotion interventions contribute to the realization of improved health results such as more effective services of health, healthier lifestyle, decreased disability and morbidity, increased life expectancy, and healthier environments. Other outcomes are the quality of life and functional independence. As such, when evaluating the impacts of health promotion interventions the more instant/immediate within populations, persons, and their settings are considered (Martínez-Donate et al., 2015).

The evaluation plan aimed at measuring the effectiveness of the “Free Women from Heart Disease and Stroke” intervention will begin by measuring the objectives accomplished by the intervention and changes observed in women concerning the impact elements (i.e. behavioral change such as reduced smoking and alcohol, improved healthy eating habits etc.). The specific objectives of this intervention are as follows:

• To increase the number of women aged between 45 and 65 who attend Matta General Hospital with 5% in the next three months
• To ensure that 90% of the women attending the facility are aware of the risk factors associated with stroke and heart disease within the next three months

To determine the efficacy of the intervention in relation to the first objective, the number of respondents attending the hospital for heart disease and stroke screening will be taken before the onset of the campaign. The same procedure will then be repeated three months after the campaign to determine the percentage increase in the number of women attending the facility for early screening of heart disease and stroke. This step will then be followed by establishing target levels. To determine the effectiveness of the intervention in relation to the second specific objective, a focus group survey will be conducted before the execution of the intervention and then repeated three months after the intervention. Participants will be selected by means of convenient sampling to ensure ease of selection of the targeted group (i.e. women aged between 45 years and 65 years). A questionnaire will be employed in measuring the knowledge, attitude, and practices (healthy lifestyle) of women in relation to heart disease and stroke prevention to determine their level of awareness. This approach will ensure that the efficacy of the “Free Women from Heart Disease and Stroke” campaign is measured appropriately.  In case the set target (i.e. 90% is not attained within the three months, necessary adjustments will be made to the intervention such as increasing incentives to motivate more women to attend the early screening.