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Chapter 1

THE PROBLEM

Introduction

Health promotion is the process of enabling people to increase

control over, and to improve their health. It moves beyond a focus on

individual behaviors towards a wide range of social and environmental

interventions. It is the encouragement of health ideas and concepts to

influence individuals to adopt health behaviors. Participation is very crucial

to support health promotion action (World Health Organization, 2016).

The concept of health promotion was developed to emphasize the

community-based practices of health promotion and community

participation based on social and health policies (Baisch, 2009). A lot of

organizations saw that health promotion has been proven effective to a lot

of countries today such as the United States. According to the study of

Feinstein (2012), every year there is a decrease of acquiring the disease by

3.6% in the United States through health promotion. Health issues can be

effectively addressed by adopting a holistic approach by empowering

individuals and communities to take action for their health, fostering

leadership for public health, promoting inter-sectoral action to build

healthy public policies in all sectors, and creating sustainable health

systems (Anderson, 2012).


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Health promotion is in line with the mission of Xavier University

Ateneo de Cagayan that aims to encourage students for social

engagement in their respective communities. It is important for the

communities because it builds a social and cultural understanding of health

and illness.

Thus, health promotion programs was given to the residents of the

Sitio Patpat, Lumbia to create supportive environments, reorienting health

services at the residents respective health center, developing personal

skills such as preparing herbal plants medication, and promoting awareness

to different types of diseases that are present in the country.

In the Philippines, the Department of Health provides health

campaigns to the Filipinos such as proper nutrition to children,

immunization, prenatal care, and lifestyle modification for hypertension

and diabetes. However, according to a new research from Sun Life

Financial Asia (2014), 62% of Filipinos do not exercise regularly and 45%

admit to the habit of unhealthy eating. Also, the Philippines has the highest

rate of family history of chronic illness, that is, 19%. This is why the nursing

students of Xavier University Ateneo de Cagayan implement health

programs both promotive and preventive to help the people of Sitio

Patpat improve their health. Identification of the factors that may facilitate

or hinder the effectiveness of the health programs implemented may help

identify the impact on the health behaviors of the community members


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and the areas to be improved in relation to program implementation and

training of community leaders.

Theoretical and Conceptual Framework

The study is premised on the Health Promotion Model (HPM) by Nola

J. Pender. The Health Promotion Model proposes concepts on how people

make decisions regarding their health specifically on the aspect of

promotion of health and prevention of illnesses. Though similar in

construction with the Health Belief Model, it explains beyond the area of

disease prevention behavior, further including behaviors that enhance

health across the life span. According to Alligood and Tomey (2010),

Pender defines health-promoting behavior as an end point or action

outcome that is directed toward attaining positive health outcomes such

as optimal well-being, personal fulfillment, and productive living. Thus,

these are set of behaviors that aims to achieve an increase in functioning

and the actualization of human health potential of the whole person.

Meanwhile, Pender emphasizes that health protection or illness prevention

is driven by the aspiration to prevent any development of illness, early

detection of diseases, and the maintenance of functioning even when

illnesses arise. The Health Promotion Model constitutes three major

concepts. The first concept comprises of the individual characteristics and

experiences, this then sets the behavior-specific cognitions and affect,

which then stems into the possible behavioral outcomes, an interrelation of


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the two. As each individual has their own unique characteristics, a set of

ideals is established regarding health which directly affects the individuals

perception on the actions taken in health promotion. The behavior-specific

cognitions and affects subsequently involves the individuals perception on

the importance of health, control of health, self-efficacy, definition of

health, health status, benefits of health-promoting behaviors, and barriers

to health promoting behaviors.

With this knowledge on the interrelation and interaction of personal

factors and prior related behavior, the researchers evaluation on the

effectiveness of health promotion programs implemented by Xavier

University College of Nursing at Sitio Patpat, Barangay Lumbia, Cagayan

de Oro City grounds itself on the perspective that response to a behavioral

change for the increase of health maintenance is affected by either

unmodifiable or accustomed factors which should be considered when

assessing and evaluating impacts of a program. Furthermore, this

interaction and interrelationship of such factors and considerations either

can facilitate effectiveness and adherence to the implanted health

programs or can result to passiveness and noncompliance despite the

value of health information disseminated. The theory primarily frames the

study that the following variables are to be considered as behavioral

outcomes effect into cues to action and implying the likelihood of an

individual to engage in health-promoting behaviors.


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As Pender notes a direct link among the effects of prior related

behavior and personal, interpersonal, and situational influences to ones

individual perception about health leading to the possible outcomes of

programs regarding disease prevention and health promotion, the

variables namely age, economic status, educational attainment, family

structure, gender, and sources of information are considered in this study.

As Senol, et al. (2014) points out, as one gets older, the level of

health-promoting behaviors increases. Aside from ones vulnerability to

illnesses and degenerative conditions, this personal biologic factor is a

determinant of an individuals health consciousness. Thus, because of such,

one gains life experience and health consciousness through the aging

process and through developmental changes in life such as parenthood.

Tseng and Lin (2008) adds that because of the decline of health behavior

patterns, older adults account for consumers with high health

consciousness. This is also ones way of empowering himself for improved

sense of control.

On the other hand, economic status relates to an individuals

condition with regards to his wealth and assets as according to a persons

income and occupation. This factor falls under an individuals

characteristic and experience which influence one to engage in health-

promoting behaviors. A study proposes that insufficiency of resources, skills,

social support, connection to the community, and an increased exposure


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lead to maladaptive and ineffective health-promoting behavior, which

may be understood as a potential barrier into effectively committing to a

plan of action for health practice modification(Adler, 2007). Economic

status also determines an individuals needs. For instance, families who

belong to middle-to-high income earners may be less dependent on

material needs but are much affected by demands from decision-making

circumstances at home and at work, while those who belong to the

marginalized sectors often lack the basic human needs such as adequate

housing, food, and appropriate working conditions, negatively affecting

their health (WHO, 2007).

Educational attainment, likewise, as a direct consequence of

economic status from an individuals personal sociocultural factor has

similarly impact health. Cohen and Syme (2013) adds that, educational

attainment is a well-established social determinant of health. This

determinant improve ones health literacy and health behavior, sense of

control and empowerment, and life chances. Thus, contributing to the

perception of the ability to create better health outcomes and to improve

the potential for an effective understanding and practice of a health-

promoting behavior. It affects ones health literacy and their ability to have

access to resources which facilitates health promotion (Javadzade, et al.,

2012).
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Another sociocultural variable is family structure. Family structure indicates

the composition of people living in one household, considering their age

and their relationship to each other. A familys function, the roles that each

member contributes, structure, and the identity of its members affect their

status when times are good or when crises arise and their ability to organize

themselves when potential threats happen (Pillitteri, 2014). With its direct

relationship to socioeconomic status, family structure predisposes an

individual to living conditions, food patterns, and risk exposure which are

either conducive or detrimental to health-promoting behaviors and

primarily health (Kumar and Ram, 2013).

Meanwhile, gender, as a biological factor, influences health and health-

promoting behaviors accustomed from ones sociocultural factor.

Evidence-based demographics have also purported significant differences

between two gender groups. For instance, women are seen to have higher

life expectancy due increased engagement to health promoting

behaviors, avoidance of health-damaging behaviors, and differences of

exposure among various health-related hazards (Bird and Rieker 2008;

NCHS 2010; Preston and Wang 2006; Waldron 2009). This can also be linked

to an individuals personal psychological factors such as self-esteem, self-

motivation, personal competence, and perceived health status, which

may be disparate among gender groups. Instances such as decreased


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health literacy for men and a womans role as the primary caregiver in the

family demonstrate this variability.

Lastly, another sociocultural factor, namely source of information, can

significantly promote modification in health behaviors and encourage an

individual to carry out interventions. Sources of information recognizes the

utilization and impact of mass communication in health promotion. The

scope of health information ranges from the physician or the primary health

care provider, traditional media such as newspaper and magazine, and

online health information particularly the Internet, the most used today, yet,

the least reliable (Geana, et al., 2012). Sources of information potentiate

the effectiveness of a health program in way that they increase

compliance to medical services and health teachings (Lawson, et al.,

2011). They may either promote reinforcement to health programs or may

unsuccessfully convince passive audience into becoming active in health

promotion (Geana, et al., 2012).

The Health Promotion Model creates a firmer evidence and support

that the implementation of health promotion programs in the area and the

evaluation of their effectiveness are an interrelationship among various

factors which influence the success or the failure of the program. These

disparate forces which confluence an individuals health behaviors to

engage into action may serve as bases for the evaluation of the program.
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These biological and sociocultural factors in return affects ones perception

to how the program improved their behaviors towards a healthier lifestyle.

The following Figure 1 shows the interrelationship of the independent

and dependent variables in the study.


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Independent Variables Dependent Variables

Characteristics Extent of Effectiveness

on Health Promotion

Programs
Age
Hygienic Practices
Gender
Sanitation Practices
Economic status
Management of
Educational
Acute and Chronic
attainment
Disease
Family structure
Herbal Medicine
Sources of
Maternal and Child
information
Care

Figure 1: Schematic diagram showing the relationship between the

independent variables and the dependent variable.


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Statement of the Problem

This study will attempt to determine the extent of effectiveness of the

health programs implemented in Sitio Patpat, Lumbia. Specifically, it will

aim to answer the following:

1. What is the profile of the respondents in the study according to the

following:

1.1 Age

1.2 Gender Economic Status

1.3 Economic Status

1.4 Educational Attainment

1.5 Family Structure

1.6 Source of Information

2. What is the extent of effectiveness of the health promotion programs

implemented in terms of:

2.1 Hygienic Practices

2.2 Sanitation Practices

2.3 Management of Acute and Chronic Disease

2.4 Herbal Medicine

2.5 Maternal and Child Care

3. Is there a significant difference in the extent of effectiveness of the health

promotion programs implemented according to:

3.1 Age
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3.2 Gender Economic Status

3.3 Economic Status

3.4 Educational Attainment

3.5 Family Structure

3.6 Source of Information

Hypothesis

Problems 1 and 2 are hypothesis free. Problem 3 will be tested at 0.05

level of significance. The hypothesis will be formulated based in the

assumptions that follows:

H03: There is no significant difference on the extent of effectiveness of the

health promotion activities implemented according to:

3.1 Age

3.2 Gender Economic Status

3.3 Economic Status

3.4 Educational Attainment

3.5 Family Structure

3.6 Source of Information

Significance of the Study

The findings of this study will be beneficial to the following:

Barangay Captain and Barangay Officials. The study will provide

them with facts about the effectiveness of the programs implemented such

as herbal planting, waste management, communicable diseases, etc.


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implemented in their community. In line with this, the study will facilitate the

health care providers of the sitio with a platform on what to improve and

modify with the current programs and to properly establish structured plans

for the future programs.

Residents of Sitio Patpat. This study will help them gain knowledge

and understanding regarding on how effective the programs were

implemented in their community, which can be applied to their daily lives

and how this has made an impact to them.

Local Government Unit. The study would provide a platform of

information for the LGU regarding programs and techniques or strategies

appropriate for their community. The results of this study would also help the

LGU create new health programs and modify current programs for the

advancement of their community.

Public Health Nurses. Nurses are one of the primary sources for

information regarding different health programs offered for the community.

The study will help provide them with evidence-based findings regarding

on how effective their programs are and provide a platform on more

effective and efficient ways to promote and improve the different health

services or programs offered.

College of Nursing. The study will provide information from the

residents regarding on how useful the programs are in the community. With
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this, the study will provide the college with an idea on what future programs

would be the most effective or useful in the community.

Nursing Students. The study will help nursing students enhance and

develop their skills on formulating effective health programs and

interventions addressing the health needs in the community.

Future Researchers. This study will serve as a baseline data for future

researchers on the extent of effectiveness of health programs in Sitio

Patpat. It will also serve as a guide on improving or developing the study for

future researches.

Scope and Limitations

This study will focus on the evaluation of the effectiveness of health-

promoting programs that were implemented in Upper and Lower Patpat,

Lumbia, Cagayan de Oro City by nursing students of Xavier University

Ateneo de Cagayan. It aims to identify the impact on health behaviors of

the community members and the areas to be improved in relation to

program implementation and training of community leaders.

The study will be limited to school years, 2015-2016 and 2016-2017.

Assessments were done by the level II nursing students, school year 2015 to

2016, from June to October and by the level III nursing students, school year

2016 to 2017, from second to fourth week of September. In level II, there

were two blocks and per block, there were four groups of nursing students

each and at the end of each CHN rotation, the nursing students held a
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microteaching program. In level III, it was done per block and there were

two blocks, which means that there were two sets of topics. Assessments

and microteachings were based from the concepts of maternal and child

nursing, medical - surgical nursing and from the problems of the community

assessed by the nursing students. The specific health promotion activities

implemented in Sitio Patpat, Lumbia includes hygienic practices, sanitation

practices, management of acute and chronic diseases, herbal medicine

and maternal and child care.

The study is also limited to the 231 household of Sitio Patpat, Lumbia.

Respondents of the study will be considered as representatives from each

household. The instrument that will be used in the study is a researcher-

made questionnaire and purposive sampling will be done. The following

variables, age, economic status, educational attainment, family structure,

gender, and sources of information will be used to evaluate the extent of

effectiveness of the health programs implemented both preventive and

promotive.

Definition of Terms

To help understand the study, the following terms are defined

operationally:

Age. Operationally, it refers to the current age of the respondent at the

time of the study.

Gender. Operationally, it refers to as male and female.


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Economic Status. Operationally, it refers a combined income per month per

members of a family could earn at Sitio Patpat, Lumbia.

Educational Attainment. Operationally, in this study, it refers to the highest

educational attainment of a respondent.

Effectiveness. Operationally, it refers to the favorable outcome of the

implemented health promotion programs, as perceived by the

respondents in terms of the program implemented by the College of

Nursing.

Family Structure. Operationally, it refers to the composition of a household

categorized as extended, nuclear, step families, and single parent.

Health Promotion Programs. Operationally, it refers to the activities that

were provided by the students to the residents in Sitio Patpat, Lumbia

through microteaching.

Herbal Medicine. Operationally, it refers to the actual planting of the herbal

medicines and orientation conducted with regards to herbal medicine

preparation.

Hygienic Practices. Operationally, it refers to good grooming and proper

hygiene such as handwashing, proper mouth care and bathing.

Management of Acute and Chronic Diseases. Operationally, it refers to the

microteachings conducted by the students to the residents in terms of

prevention and management of selected acute and chronic diseases.


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Maternal and Child Care. Operationally, it refers to the health teachings

provided to the pregnant and postpartum mothers.

Sanitation Practices. Operationally, it refers to the sanitary practices on

storing food and water, waste segregation and drainage system.

Sources of Information. Operationally, it refers to the source of information

the respondents utilize for health information.