Author | Naing Oo Tha
Personal Information：
2018
World Health Organization
U.S. Social Security Administration
International Non-Governmental Organization
.png)
Q：
Based on your professional experience, please reflect and elaborate on the field of health promotion across academics and practice.
A：
The background of the article is an intervention in Myanmar conducted by a retired academician when there is political instability during pandemic which worsens the situation. People have many limitations in accessibility of health care facilities, availability of vaccine and not enough facilities for isolation as well as not enough manpower and health care facilities for preventive, diagnostic, and therapeutic services. Myanmar population have experienced an erosion of social cohesion, limited access to education, and reduced income and security due to military coup in Feb 2021. Fear of infection, reduced ability to pay, and movement restrictions have contributed to significantly reduced utilization of health services. Community initiative intervention such as home-based Intervention practicing new normal lifestyles are key preventive strategies in Myanmar.Home based health Intervention was conducted from 23 July 2021 -7Sept 2021with objectives of preventing infection to all family members especially 80-year-old mother elderly and reducing anxiety and stress among family members during 3rd wave.
The intervention was planned with PABCAR health promotion model and GREEN PRECED PROCEED model.
P What is the problem and is it significant? The paper explained well about the Health Issue: Increasing cases of COVID-19cases in Yangon and delta strain in late June 2021.
How serious is the health problem? Seriousness of health problem in a vulnerable population to infection was explained as follows.
What health related behavioral and environmental factors are involved? The article stated health related factors involved as follows.
Behavioral factors- Lack of awareness for 3rd wave and delta strain infectivity from family members who are infected although they practice new normal lifestyle.
Environmental factors- Limited availability of disinfectant which is high cost, no regulation for travelling restriction, no information in time to increase preventive measures for more transmissible delta strain from Ministry of Health.
What are determinants of those behavioral and environmental factors? Covid19 3rd wave pandemic situation, family support, family dynamic, family risk communication, history of illness from infected family members, limited availability of health care services and information of global and local situation from MOH.
A Is it amenable to change? It was found tha (4)Family based intervention Strategies are applied in many western countries with evidence based and were effective.
BC Are the intervention benefits greater than cost? The paper explained Ks 300,0000 needed for disinfectants and oximeters, plants pots, food, delivery charges oxygen concentrators, cylinder, medicine stocks. Economic impact due to infection will be higher compared to prevention.
A Is their acceptance for the intervention? The intervention is acceptable for the family.
R What actions are recommended? Recommended actions and strategies are well stated by adopting risk-reducing behaviors and practice infection prevention and control, including avoiding crowds and maintaining physical distance from others; practicing proper hand hygiene; through the use of masks; and improving indoor ventilation as WHO recommended.
(1)
i) Situational Assessment was well explained with phases in model.
Phase 1: Social assessment: Family meeting and discussion about family needs and expectations, limitations, problem solving capacities, strength, resources, readiness to change and other relevant information.
Phase 2: Epidemiological Assessment: Identify health determinants and setting priorities and goals through epidemiological data collection, literature review, discussion with family members.
Phase 3: Ecological Assessment: Information gathered to analyze behavioral and environmental determinants that predispose, reinforce, and enable the behaviors and lifestyle identified. Factors such as knowledge, beliefs, attitude, social support, availability of services are identified.
Phase 4: Administrative and policy assessment and intervention alignment. Assessment of resources, development and allocation of budget, coordination and adjustment.
ii) The paper well stated the Goals of the intervention.
Fever surveillance and monitoring the parameters of 5 family members vital signs at least 2 weeks.
Preventing the COVID-19transmission with new normal lifestyle intervention by practicing new normal habits and environmental changes for at least a year.
iii) Populations of interest
It was explained that all family members including house maid willing to participate in the intervention to prevent the infection applying partnership competencies and diversity and inclusive competencies.
iv) Objectives of the intervention is to achieve lifelong new normal lifestyle among family members including house maid and to reproduce to larger community.
B) IMPLEMENTATION of intervention is well explained as follows:
Educational approach -One of the family members give talk and educate the global situation, local situation and threat of 3rd wave with delta strain, methods of preventive measures, as well as complication and severity of infection. Weekly family talk for updating and reporting. Information resources about how to maintain immunity with nutrition, double mask wearing, epidemiological situation updates from WHO etc. Using internet for online global and local situation to share the updates about 3rd wave and delta strain as there is no local news or any updated epidemiological situation information to public from MOH and local news media.
Behavioral Change approach -Training to all family members including house maid was conducted for wearing masks, washing hands frequently, proper disinfecting with 70% alcohol-based disinfectant for floors and surfaces. Separate the mealtime and avoiding close each other. Staying home for at least 2 months. Temperature, SpO2, BP, Signs and symptoms of COVID-19infection to be monitored daily every morning and recorded. Introducing new hobby such as hand craft macramé plant hangers with growing and gardening indoor and outdoor plants during stay home period for reducing stress and anxiety. Sanitizing all delivery food services and other essential goods daily. Collecting the things with masks and face shield after delivery man leaving outside the gate. Disinfecting the collected things before use, washing clothes and hands after handling immediately.
Environmental approach –
Providing Hand Sanitizers, 75% alcohol-based solutions for cleaning surfaces and floors, Oximeter, Sphygmomanometer and stethoscope, digital thermometer are used for daily checking of vital signs. Air purifier for living and bedrooms, Oxygen concentrator and cylinder were reserved incase if someone is infected. Providing supportive environment for prevention of infection by cleaning to surfaces and floors, frequent touch areas, maintaining good ventilation for all the rooms daily for 2 weeks.
C)EVALUATION of the intervention is well explained.
i) Formative Evaluation -Evaluating daily updates and discussion with family members before implementation. Reviewed Literature for implementation, interventions that were effective before.
ii) Process Evaluation-Process evaluation was done to observe with the check list for the individual behavior and environmental measures and lifestyle practices for implementation process.
iii) Impact Evaluation-Impact evaluation was done by comparing improving in knowledge about preventive measures among family members and post intervention knowledge scores by using google form.
iv) Outcome Evaluation -It was determined by analyzing the vital signs of all family members after implementation of intervention.
RESULT
The paper findings showed that all family members improved knowledge on preventive measures and practice new normal lifestyles and everybody vital signs are normal, and no one is infected during 3 months intervention period.
CONCLUSION
The article recommended that family-based intervention can prevent the COVID-19 transmission and can be applied to other community settings to reduce morbidity and mortality of COVID-19 pandemic.
In this home-based health intervention, the following competencies are well applied.
1.Program planning, implementation, and evaluation competencies
2. Partnership building competencies
3. Communication and report writing competencies
4. Technology competencies
5. Knowledge competencies
6. Special core competencies in Asia-Pacific region-Diversity and Inclusiveness.
REFERENCES
1. WHO. Covid-19 Strategic Preparedness. 2022;(February 2021).
2. Wenger PN, Halperin W, Ziga E. Public Health Surveillance for Bioterrorism. Beyond Anthrax. 2009;2019(December):253–78.
3. Maycock B, Howat P ST. A decision-making model for public health advocacy. Promotion and Education. Int J Heal Promot Educ. 2001;8:59–64.
4. Nguyen LKN, Howick S, McLafferty D, Anderson GH, Pravinkumar SJ, Van Der Meer R, et al. Evaluating intervention strategies in controlling COVID-19 spread in care homes: An agent-based model. Infect Control Hosp Epidemiol. 2020;2019:1–11.
5. Green, Lawrence & Kreuter M (2005). Green LW, Kreuter MW. Health Program Planning: An Educational and Ecological Approach. 4th Edition. 2005;
6. Robinson LA, Sullivan R, Shogren JF. Do the Benefits of COVID-19 Policies Exceed the Costs? Exploring Uncertainties in the Age–VSL Relationship. Risk Anal. 2021;41(5):761–70.
Q：
What are your suggestions or expectations for the next exchange of the seminar?
A：
Monitoring and Evaluation of the health promotion programmes and health communication and message development.