Health Pro otio i Chur hes: Case Study o No -Co u i a le Diseases With Focus on Hypertension INTRODUCTION A. Background The rising number of non-communicable disease (NCDs) is a global health challenge. According to WHO, non-communicable diseases account for 38 million of the 56 million deaths each year. That is more than half of the cause. This includes cardiovascular disease, cancer, diabetes and chronic lung diseases. Of all death due to NCDs in low to middle income countries, 48% were considered premature deaths as they occurred before the age of 70. More than 80% of premature heart disease, stroke and diabetes can be prevented (WHO, 2015). In the church community, clergy are not spared from NCD. A 2013 survey among United Methodist pastors i the U“ sho ed 0% of respo de ts are o ese a d % are o er eight— much higher percentages than a demographically-matched sample of U.S. adults. Nearly 51% ha e high holesterol, also u h higher tha o para le e h arks (GBOPHB, 2013). Here i the Philippi es, of the total deaths i 00 , % are due to the fatal four NCDs, namely cardiovascular disease, cancer, diabetes, and chronic respiratory disease. It is estimated that 35 to 50 percent of NCD deaths occurred before age 60 years. (WPRO, 2015). Aside from modifiable death, NCD is cause of poverty and hindrance to economic development. A growing number of individuals, families and communities has been burdened by this problem. Common modifiable risk factors such as tobacco use, inactivity, obesity, elevated blood pressure, sugar and cholesterol underlie the major NCDs. (WPRO, 2015). B. Significance of Health Promotion Health promotion can help address non-communicable disease like the control of hypertension. Health promotion contributes to controlling hypertension through enabling people, to increase control over their health and its determinants, thereby promoting and sustaining good health. The answer lies in Health Promotion which involves changing behavior at multiple levels (Dobe, 2012). As hyperte sio is a lifestyle disease, ha gi g people s eha ior to ards a healthy lifestyle will help control hypertension. OBJECTIVES OF HEALTH PROMOTION PROGRAM The objective of a health promotion program is to develop and implement multisectoral public policies for health, integrated gender- and age-sensitive approaches that facilitate community empowerment together with action for health promotion, self-care and health protection throughout the life course in cooperation with the relevant national and international partners (WHO, 2015). Health Promotion should also be able to empower communities and individuals to live active and healthy lives through promoting, maintaining and improving healthy behavior (Utah County, 2008). For this case targeting hypertensive clergy in the Visayas region, the specific objectives are: A. To educate the clergy (especially ages 40-55) on the risk of factors of Non-Communicable Diseases especially hypertension B. To encourage the clergy to adopt healthy lifestyles to prevent hypertension IMPLEMENTATION A. Rationale for Health Promotion Strategy/Theory Hypertension is a growing problem but it is preventable. Globally, 38 million of the 56 million deaths worldwide are due to Non-Communicable diseases like hypertension. Around 48% of these deaths happened before a person reached 70 years old. It is estimated that 80% of premature heart disease, stroke and diabetes cases can be prevented (WHO, 2015). The best preventive way is to educate people and promote health. The most appropriate theory that will satisfy the objective of persuading the target individuals to adopt a healthy lifestyle to prevent hypertension is the Health Belief Model. The health belief model motivates the individual to have behavioral change because of six constructs of the HBM (US Department of Health and Human Services, 2005). The focus of the HBM is the indi idual s perception of the threats posed by a health problem, the benefits of avoiding the threat and the fa tors i flue i g the de isio to a t (US Department of Health and Human Services, 2005). Using the Health Belief Model, we consider how the target individuals – that is the clergy, perceive his/her susceptibility to have NCD especially hypertension. Knowing the social determinants makes the clergy understand that they are a high risk population susceptible to develop NCD. Their sedentary lifestyle, mentally stressful responsibilities and their traditional practice of frequent meals with church members gives clergy the understanding of the severity of their risk. Educating the clergy on the benefits of adopting a healthy lifestyle is a key step towards behavioral change. Addressing the possible barriers that will prevent the clergy to adopt change, having cues that reminds them what action they need to take and seeing positive results as sign of efficacy will help the clergy adopt a healthy lifestyle. B. Description of Health Promotion Strategies and Actions The health education of each clergy member of a particular region will be the health promotion activity effective for this NCD program. The purpose of the campaign is to persuade hypertensive church pastors to adopt a healthy lifestyle. This is best done by teaching individuals about hypertension and equip them with skills how to prevent it. Health education is a health promotion strategy that works well for influencing individual behavioral change. Health education is often done with one-on-one or group or in classes. Since the target audience are individual pastors, health education is an appropriate strategy for pastors especially the hypertensive ones. These pastors often had regular regional gatherings quarterly, thus a health education activity will be feasible and doable when they gather. The first step in planning health education is to undertake a situational analysis (ILEP, 2015). It is important to identify problems which health education interventions are needed. Among clergy, the problem might be the high number of pastors who have uncontrolled hypertension. After identifying the problem, the next step would be to decide which kind of intervention is best to achieve the objective (ILEP, 2015). In this step, it is important to identify the target group and know their characteristics including age, education and behavior. For the pastors, uncontrolled hypertension may be concentrated among high risk male pastors age 40 to 55 years old. Health education activities may then be directed towards educating them of the importance of reducing the modifiable risk factors of NCDs including weight loss, physical activity, cholesterol level and drinking/smoking habits. The next step in planning health education is to know what kind of intervention is to be given (ILEP, 2015). This includes choosing what message to emphasize and what medium to use. For the pastors who regularly read their Bibles, a reading pamphlet with Bible verses or a devotion guide integrated with health facts about hypertension will be an effective tool. This can also be used as cues for adopting a healthy lifestyle. Part of the strategy is to consider the advantages and disadvantages of the interventions to be used. Lastly, evaluating the health education interventions should also be done to evaluate the effectiveness of the strategy in reducing hypertension cases among the clergy. EVALUATION OF HEALTH PROMOTION PROGRAM Evaluating the health education is necessary to know if the health promotion is effective. A 10step for conducting an evaluation developed by Public Health Ontario can serve as guide for evaluating the health education of pastors about hypertension (Ontario Agency for Health Protection and Promotion, 2015). First step in the evaluation is to know what is to be evaluated. For this case, the health education program will be evaluated. A logic model that includes the objectives, activities, outcome and output needs to be developed. Next is to identify and gather stakeholders to develop evaluation questions that will lead to useful data for everybody. In this case, the stakeholders may include the hur h ou il, o gregatio s, the pastors fa ily, a d e e their atte di g physi ia s. Third step is to assess the resources and if the program is ready to be evaluated. After which, evaluation questions needs to be determined and selected. The questions should be able to meet the evaluation goals of the case. In this case, the questions will be outcome evaluation questions to easure the progra s su ess i eeti g its goals. The fifth step is to ide tify the ost feasible and credible methods of measurement and procedure. In this case, a plan on how to gather the data, what to measure, when to measure and from where data will come needs to be carefully considered. After identifying the evaluation methods, the sixth step is to develop an evaluation plan (Ontario Agency for Health Protection and Promotion, 2015). This will detail how the health education program will be monitored and evaluated and how to use the results. A similar matrix as below can be used for this case: Evaluation activity Stakeholder invitation Indicators Methods Data source Letters Email and Stakeholder snail mail list Stakeholder meeting Attendance of stakeholder Open forum Attendance sheet Resource Deadlines Allocation 1% of End of 2nd budget week of evaluation phase 5% of End of 1st budget month of evaluation phase The seventh step would be the actual gathering of data to be evaluated (Ontario Agency for Health Protection and Promotion, 2015). This case would need to gather the hypertension monitoring record of the pastors and the frequency of taking medicines from their health care provider and family members. Next step is to process the data and analyze the result. In this case, the data needs to be organized and summarized ready for the next step which is data interpretation. Interpretation of the data and disseminating it to the stakeholders is important to engage them with possible recommendations to improve the program. The data results can be shared with the church council, family members and the health provider through an audio visual illustrations and graph showing the difference in the BP measurements of the clergy before and after the program. The stakeholders can also offer ways how to improve the project. Last step is to use the evaluation results for actionable steps. For this case, it may include improving the health education materials and shifting from Bible verses handouts to entire Bible Study books. The important this is to be able to use the evaluation data to improve health outcomes of the target population. References Dobe, M. (2012, July). Health Promotion for prevention and control of non-communicable diseases:unfinished agenda . Retrieved May 10, 2015, from PubMed: http://www.ncbi.nlm.nih.gov/pubmed/23229208 GBOPHB. (2013, May 16). 2013 Clergy Health Survery Report. Retrieved May 8, 2015, from Global Board of Pension and Health Benefits: http://www.gbophb.org/news/release/pr20130515/ ILEP. (2015). Planning Health Education Interventions. Retrieved May 11, 2015, from ILEP: http://www.ilep.org.uk/technical-advice/ilep-technical-bulletins/technical-bulletin-13/ Ontario Agency for Health Protection and Promotion. (2015). At a glance: The 10 steps for conducting an evaluation. Retrieved May 11, 2015, from Public Health Ontario: http://www.publichealthontario.ca/en/BrowseByTopic/HealthPromotion/Pages/THCU-HasMoved.aspx/resource_db/pubs/107465116.pdf US Department of Health and Human Services. (2005). Theory at a glance. Retrieved from http://myportal.upou.edu.ph/mod/resource/view.php?id=36033 Utah County. (2008). Health Promotion Mission Statement. Retrieved May 8, 2015, from Utah County Health Department: http://www.utahcounty.gov/Dept2/Health/Health%20Promotion/mission.html WHO. (2015). Health Promotion. 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