Introduction
Alcohol and substance abuse is a health problem of concern to the community. Alcohol and substance abuse not only affects the health of the users directly, but also predisposes them to other life threatening situations. The prevalence of alcohol dependence in the community and at national levels is worrisome. In response to the worrying statistics, this project was designed to raise the awareness of people on the dangers of alcohol and substance abuse, hoping for behavior, attitudes and change in practices.
Rationale for Intervention
The future of any nation is vested in their young population (Nies & McEwen, 2013). As such, the health of this population is very important. This is not to negate the importance of the health of other populations. The statistics adduced about the health of the youth paint an impeding health calamity. Statistics on alcohol and substance abuse, especially among the youth are appalling. Besides, a community needs assessment performed by New York City Health Hospitals Corporation (2013) identified diabetes, asthma, arthritis, hearth disease, obesity, behavioral health, stroke and end stage renal disease as some of some of the health needs. All these needs impact on the health of the young population.
It is necessary to carry out interventions that aid behavior change and promote a change in attitudes, perceptions and practices for this population. The choice of health education as an intervention for this health issue was informed by its ability to inform behavior change by educating on the dangers of an unhealthy habit, and raising awareness regarding the significance of the health issue. Additionally, studies have shown that behavior change through health education is more achievable when dealing with young people as opposed to getting older populations to change unhealthy habits (U.S. Department of Health and Human Services, 2007).
History of Alcohol and Substance Abuse
Alcohol and drugs have been consumed by human beings for a very long time. The consumption of wine can be traced back to ancient Egypt. Narcotics were used as early as 4000 B.C. Medicinal marijuana can be traced to 2737 B.C. in ancient China. However, active substances were extracted from drugs in the 19th century. The period following the 19th century saw an unregulated period where the narcotics were prescribed by doctors and sold freely. Morphine was used extensively during the Civil War by American soldiers. With continued use, gradual signs of addiction were noted. The first regulatory laws were not effected until 1875 in San Francisco, where dens extracting and selling opium were outlawed. The first national law was assented in 1906 under the Pure Food and Drug Act that required clear labeling of food items containing these drugs. Since then, laws regulating alcohol and substance abuse have evolved to incorporate the perceptions of the public (The Columbia Electronic Encyclopedia, 2012).
National and Community Statistics
As highlighted earlier, the statistics of alcohol and substance abuse at the national and community level are appalling. A report by the Center for Disease Control and Prevention from the National Health Interview Survey showed that more than half (52%) of Americans aged above eighteen years consumed alcohol regularly. The proportion men who consumed alcohol regularly was at 60% at the national level compared to 44% of women (Center for Disease Control and Prevention, 2014).
When considering population over twenty one years, 53% agreed to drinking. This was compared to 56% at the community level who reported to drinking alcohol (New York Department of Health, 2010). Statistics at the local level show that 11% of the adults aged over twenty one years were heavy drinkers compared to 42% who were binge drinkers. Additionally, statistics by the National Council of Alcohol and Drug Dependence (n.d.) reported over 17.6 million people at the national level who were diagnosed with alcohol dependence. These statistics highlight a health problem increasingly getting worse. They also justify the choice of alcohol and substance abuse as the topic for this project.
Development Plan
The development of the project required research in order to determine the best approach and intervention to the health problem. It was important to find a study supporting the chosen approach. Given the limited nature of resources and the significance of the problem, it was important to find an approach that has been tested and shown as successful. The development plan also involved coming up with lesson plans for the six weeks that the program was going to run. The development of lesson plans was dependent on information derived from the baseline survey at the beginning of the program.
Implementation Process
The implementation of the project was done over a period of six weeks. Prior to the commencement of the program, I performed a baseline evaluation of the participants in order to determine the knowledge of the participants regarding alcohol and substance abuse. This baseline evaluation was important as it would inform the formulation of the weekly lesson plans. The baseline survey was also important in informing any changes in the program depending on the knowledge levels of the participants. Based on the findings from the baseline survey, the following weekly lesson plan was developed:
The teaching strategies that I used were health lectures, informative films and focus group discussions. In order to facilitate these strategies, certain resources were required. Part of these resources included handouts containing information on various aspects of the lesson plans. The handouts were offered in order to increase the health literacy of the participants. The development of this material cost some money. More precisely, I used sixty dollars to photocopy the handouts that were used throughout the entire program. In order to prevent the escalation of costs, I sent some of the material via email to those participants who were conversant with this technology.
I performed a process evaluation on week three in order to determine the effectiveness of the approach used and its ability to meet the objectives of the program (Spaulding, 2008). This was important in order to make any necessary changes to the design of the program. At the end of the sixth week, I performed an outcome evaluation to determine any changes in behavior, practices and attitudes as a result of the activities of the program.
Evaluation Plan
It is important to evaluate the progress of a program in order to determine whether the established objectives are being met. For this program, I performed a baseline evaluation at the beginning of the program. I performed a baseline evaluation of the participants in order to determine the knowledge of the participants regarding alcohol and substance abuse. The information derived from the baseline survey was important in designing the lesson plans for the six-week program. I also performed a process evaluation on week three in order to determine the effectiveness of the approach used and its ability to meet the objectives of the program (Spaulding, 2008). This was important in order to make any necessary changes to the design of the program. At the end of the sixth week, I performed an outcome evaluation to determine any changes in behavior, practices and attitudes as a result of the activities of the program. Ideally, I preferred the impact evaluation. However, the span of the project was not enough to measure the impact of the program activities on the population.
Results of the Program
The results of the program were determined from the outcome evaluation at the end of the six-week program. The determination of the results was based on the achievement of the objectives established during the design of the program. Contrary to the status at the beginning of the program, the health literacy levels increased at the end of the program. In this regard, the program achieved the objective of increasing the awareness of the participants on the dangers of alcohol and substance abuse. The outcomes evaluation also showed a change in behavior, attitude and practices among the participants. It was the objective of the program to inform the change of behavior through health education on the dangers of alcohol and substance abuse. The change in attitudes, behavior and practices was informed by the increased awareness because of the activities of the program.
For instance, more participants at the end of the program compared to the beginning considered alcohol and substance abuse a health problem of concern in the problem. This is attributed to the increased knowledge of the prevalence of the problem both at the national and community level, the dangers of alcohol and substance abuse and the prevalence of alcohol dependence among the young population. Additionally, the participants were more willing to participate in other health education programs on alcohol and substance abuse at the end compare to the beginning of the program. Finally, many of the participants were willing to take part in a challenge where they committed that they would not consume alcohol, use illegal substances and prescription drugs (National Drugs Campaign, 2013). This denotes the success of the program in informing the behavior change of the participants.
Ethical issues
Throughout the implementation of the program, I faced several cultural and ethical issues. One of the ethical issues faced was the personal and societal responsibilities of the health problem. In this instance, the ethical dilemma was whether the participants, especially those who were affected by alcohol and substance abuse, should be assigned personal blame for the personal choices to engage in alcohol and substance abuse (Nies & McEwen, 2013). Given the previous research I had performed on the matter, I knew that the social environment was also a predisposing factor.
The relative ignorance of the participants on the issues of alcohol and substance abuse, especially participants of the Indian descent was another ethical issue. Given that the children were the first generation in America, most of them were not entirely exposed to the different social environment. The ethical issue was whether or not to educate the participants on the effects of the social environment, especially its influence towards alcohol and substance abuse (Masse & Williams-Jones, 2012).
Barriers Faced in the Program
One of the barriers that the program was faced with was low proficiency in English. This hampered the communication at times. This is because the composition of the participants reflected diverse cultural backgrounds. In order to overcome this barrier, I employed the use of group discussions where the issues were articulated by peers, at times in ethnic dialects (Singleton & Krause, 2009).
Another barrier faded in the program was the cultural barrier (Timmerman, 2007). Different cultures have different perceptions of the importance of alcohol and substance abuse. For instance, participants from the Caribbean region had difficulties understanding why the program listed Marijuana as one of the substances that were often abused, and had adverse health effects. Their opinions, especially when shared among the group of participants might affect the objectives of the program. In overcoming this barrier, I adduced statistics on the health effects of substance abuse. This helped bring to perspective the negative effects of this drug (Singleton & Krause, 2009).
Low health literacy levels was another barrier that faced the program (Singleton & Krause, 2009). Health education programs build on the existing knowledge regarding health issues in the community. Low health literacy levels on on a particular health issue affects a health education program, especially when such programs do not have enough time to achieve the knowledge threshold required to achieve behavior change. In overcoming this barrier, I gave handouts with general information for the participants to read before the following classes. I also moderated focus group discussions in order to enhance group learning.
The Role of the Nursing Process in the Program
The role of a community health nurse is very vital in this project. This can be seen through the application of the nursing process throughout the three levels of prevention. One of the nursing processes involves assessment. At the individual level of prevention, the roles of the nurse include assessing the priorities of the participants willing to change their unhealthy behaviors. Additionally, the community health nurse asses the perceived barriers to ceasing alcohol and substance abuse, the perceived benefits of behavior change, the support systems that the participant has, the confidence levels that the participant has regarding his ability to change and sustain behavior change. At this level of prevention, the role of a community health nurse is very important because it helps the affected population who have been educated through the program to initiate and sustain behavior change (Nies & McEwen, 2013).
Another nursing process involves diagnosis. A nursing diagnosis is very important towards designing behavior change programs. At the individual level of prevention, the community health nurse develops nursing diagnosis that can be used in informing future programs to aid in behavior change. At the family level of prevention, the community health nurse develops diagnosis that conceptualize issues at the family level that inhibit behavior change. At the community level, the community health nurse develops nursing diagnosis that conceptualizes the availability or lack thereof of behavior change programs, the community-building coalitions and the economic resources and how this contributes to inhibiting behavior change (Nies & McEwen, 2013).
Recommended additional improvements to the plan
Conclusion
The intervention chosen for the health problem under consideration was informed by findings from a study. The choice in intervention exploited the relative ease of inspiring behavior change in young population compared to older populations. The program ran for six weeks, a period in which the dangers of alcohol and substance abuse were highlighted as outlined in the lesson plan. Several ethical issues and barriers impeded the implementation of the program. However, in their resolution, I drew several lessons that will be used to improve future programs. Nonetheless, the program was a success as evidenced in the findings of the outcome evaluation.
References
Center for Disease Control. (2014). Summary health statistics for U.S. Adults: National Health Interview Survey, 2012. Retrieved from> http://www.cdc.gov/nchs/data/series/sr_10/sr10 _260.pdf
National council of Alcohol and Drug Dependence. (n.d.). Alcohol and drug information. Retrieved from> https://ncadd.org/for-the-media/alcohol-a-drug-information/257- alcohol-a-drug information?format=phocapdf
National Drugs Campaign (2013). How drug use can impact your life. Retrieved from> http://www.drugs.health.gov.au/internet/drugs/publishing.nsf/content/youth4
New York City Health Hospitals Corporation (2013). 2013 community health needs assessment and implementation strategy. Retrieved from> http://www.nyc.gov/html/hhc/downloads /pdf/community -assessment/hhc-chna-cih.pdf
New York Department of Health, (2010). Health Consequences of Alcohol Use in New York City. Retrieved from> http://www.nyc.gov/html/doh/downloads/pdf/survey/survey- 2010alcohol.pdf.
Nies, M. & McEwen, M. (2013). Community/Public health nursing: Promoting the health of populations. St. Louis. Elsevier Saunders.
Singleton, K. & Krause, E. (2009). Understanding cultural and linguistic barriers to healtsh literacy. The online journal of issues in nursing, 14 (3): Manuscript 4.
Spaulding, D. T. (2008). Program evaluation in practice: Core concepts and examples for discussion and analysis. San Francisco: Jossey-Bass.
The Columbia Electronic Encyclopedia (2012). Drug addiction and drug abuse: History. New York. Columbia University Press
Timmerman, G. (2007). Addressing barriers to health promotion in underserved women, Family & community health, 30 (1): 34-42
U.S. Department of Health and Human Services. Healthy Youth: An Investment in Our Nation’s Future, 2007. Atlanta, GA: U.S. Department of Health and Human Services, CDC, Coordinating Center for Health Promotion; 2007. Retrieved June 3, 2007 from http://www.cdc.gov/HealthyYouth/about/pdf/HealthyYouth.2007.pdf.
