Introduction
Registered nurses are faced with the responsibilities of not only treating and managing health conditions in patients, but also promoting health in an effort to prevent the development of diseases. Nurses can achieve this role by advocating for certain changes that improve the lives of their patients, or through educating the target population on how to manage or improve their health statuses. Health promotion aims at either behavioral changes or empowerment of the target population (Chinn, 2011). This paper will, therefore, discuss how the community nurse, using an empowerment approach, could promote health literacy. The chosen scenario for this paper is:
You are working as a registered nurse in a community centre that serves a large migrant population.Goal: You want to promote the women’s health literacy and decision-making related diet.
Health Literacy and Empowerment
Health literacy is used to describe skills imparted on a person, which helps that person to understand their current health status and use the available information to promote health or to prevent development of serious health problems (WHO, 2015). Health literacy is a skill that the nursing profession imparts on the populations that they serve, especially where there is an observed disparity in the well being of patients. For health literacy to achieve its goals and functions, it must be accompanied with evaluation and application of the learnt skills in changing the lifestyles or behaviors of the target populations. According to Rubinelli, Schulz & Nakamoto (2009), health literacy is an effective approach in changing the behaviors of people. It goes further to not only provide information to the target population, but also to improve the access of such information and enhance people’s capacity to apply it in improving their health. WHO (2015) describes health literacy as an important concept in the empowerment of individuals in improving their own health through healthy interaction with the environment and the social contexts.
Empowerment, on the other hand, is defined as the “process of enabling communities to increase control over their lives” (Dailly & Barr, 2008). Empowerment enables communities to have control over factors that have a negative effect on their health and lives. Through empowerment, the communities are sanctioned with skills, assets, and resources that enable them make informed decisions and gain access to health information that can help in improving their lives. According to WHO (2015), communities in this context is used to describe a group of people, whether local, national, or international, who share common health concerns, identity, and interests.
WHO (2015) notes that empowerment is a feature that can only be passed on, but cannot be performed on behalf of another. Therefore, to empower communities, they (the communities) must continuously acquire information and apply it accordingly in order for them to be empowered. Empowerment is more than just engaging the target populations in decision making and health promotion, but it also explicitly gives the communities power to own change and act upon achieving the desired social and political changes (Dailly & Barr, 2008). Empowerment must focus on economic, social, cultural, and political factors that contribute to the observed health issue in a community.
The two general approaches to health promotion include behavior change and empowerment. Health literacy endeavors to provide the populations with enough information for them to be able to make informed choices, while empowerment seeks to give the populations power to achieve change under their own will. When populations are provided with the relevant information, they become empowered such that they take action to improve or change certain situations affecting their lives and health.
According to WHO (2015), empowering a community implies that the already powerful persons will be sharing the power with the empowered people, hence forcing others to give up the existing power. Additionally, the concept of health promotion acts within the grounds of a power struggle, since an existing notion must be given up in order for a different one to take charge. The aspect of globalization has made empowerment and health literacy a challenging responsibility, due to the numerous interaction of varying social, cultural, and economic factors that determine the health of a community (WHO, 2015). The concept of health literacy, just like empowerment, addresses the determinants of health, for example, the environmental, social, and political factors. Built on health education and behaviorally adjusted communication, health literacy aims at not only influencing the behaviors of communities, but also at raising enough awareness about the need for a change.
This awareness is what drives the community to change or to develop strategies towards the changes that they want to achieve (WHO, 2015). Health literacy and empowerment are interrelated in regards to achieving changes in a community in that they are both approaches that recognize the impact of power on the health of communities. Power affects the availability of information to various users, hence affecting the effectiveness of its use and application in promoting health. Consequently, this affects the empowerment process, which is a vital component in the achievement of internationally agreed goals of health promotion.
Working as a registered nurse in a community centre that serves a large migrant population, health literacy and empowerment can be used to promote the women’s health literacy and decision-making related to diet. Health literacy approach could be adopted to provide the women with facts about the importance of a proper diet to their health, and that of their families. Furthermore, health literacy can be utilized to first raise awareness about illnesses that result from lack of a proper diet, for example, diabetes, cardiovascular diseases, and obesity and overweight (Tengland, 2012).
The diet of immigrant women is greatly affected by their educational level, cultural beliefs, environmental factors, and economic status. Therefore, one way of promoting health within this population would be to provide them with information on how the above mentioned factors affect their diet, and alternatively their health. This can be achieved through public forums at the primary care level of nursing practice. On the other hand, empowerment can be achieved by assisting the women to own the challenges such that they see the need for a change. Providing them with facts and information through effective communication can contribute to the achievement of the goal.
Application of Community Health Approaches and Principles to the Scenario
According to Gregson & Court (2010), community-led strategies that are intended for improving the health of selected groups of people are common approaches in improving health policies and practices. Community based strategies are developed with the intention of reducing observed disparities among the various populations. As discussed above, the two approaches for achieving community-led health improvement are health literacy and empowerment.
The target populations are considered to be the architects of the desired change, hence, they are empowered through health literacy. Resource allocation and support are some of the actions that must be accorded to the communities in order for them to take the necessary action towards improving their own health. Nurses working at the primary care level interact with these populations most, and are aware of the changes that can contribute to the promotion of health in such communities (Gregson & Court, 2010). They derive information and evidence on the problems that challenge such communities from the daily hospital records.
Migrant people are faced with a myriad of problems that put their health at risk. Immigrants settle in crowded places due to their economic statuses, and this puts a strain on the social amenities, including access to health care. Due to their faltered economic status, immigrants have difficulty maintaining a healthy diet, since they eat what they can afford (Kaushal, 2009). Additionally, the strain on social amenities such as parks and recreational areas place them at the risk of inactivity, hence the risk of developing diseases related to such conditions.
The chosen population is immigrant women, and the goal is to promote their health literacy and decision making in relation to diet as a lifestyle issue. Diet is affected by economic status, culture, and regulations that surround the issue. Women, from the global perspective, are considered as the feeders of their families, whether as the breadwinners or not. They make the choice as to what meals and in what proportions their families consume (Oza-Frank & Narayan, 2010). Therefore, targeting women as the population through which promotion of health literacy and decision making towards diet is relevant in achieving the expected changes.
The most observed health conditions among the immigrants are obesity, diabetes, and cardiovascular diseases, among others. Improvement of diet is one of the many interventions available for the immigrants towards improving their health. Immigrants have a diverse culture, especially when it comes to diet, and what is considered as healthy. Additionally, this is further affected by their ability to afford healthy diets (Tanentsapf, Heitmann & Adegboye, 2011). Therefore, health literacy approach should aim at availing information to the immigrant women, so that they understand the health problems that may be encountered due to improper diet.
Also, health literacy should further address all the other factors that affect accessibility to nutritious diet. The focus of health literacy should be in developing a partnership relationship between the nurses and the immigrant women (Oza-Frank & Narayan, 2010). After analysis of the health indicators and the appropriate intervention, in this case diet, organizing the women and empowering them should then follow. Empowerment follows after health literacy by analyzing and prioritizing requirements, while delivering support services that help in the development of skills that can help women make healthier choices towards improving their health.
Organizing forums and discussions with the immigrant women is a strategy that helps in not only imparting the required knowledge, but also in learning about the challenges that such women face in choosing a healthy diet for their families and themselves. Some immigrant women have limited education that limits them from making healthy food choices because they can’t read. Health literacy can include empowering such women with information on what to check for when buying food for their families (Tengland, 2012).
Healthy eating is also affected by cultural beliefs. It is a challenge dealing with cultural beliefs since they are deep-rooted, and define a community. Therefore, attention should be paid not to interfere with culture, but rather help women adopt healthier options when it comes to diet, for example, replacing unhealthy meals with healthier ones. Economic factors also affect the dietary choices of immigrant women. Most of them immigrate in the search for jobs, which doesn’t occur automatically. They are forced to rely on meager wages, making it difficult to feed themselves and their families healthily.
A community nurse can empower such women by advocating for the provision of opportunities that help them make money, instead of relying on employment. Formation of community groups that empower women with resources and provide them with channels of earning a living for a specified and predefined purpose has been found to be effective in empowering women.
In addition, the community nurse can advocate for the change in policies that can benefit immigrant women in making better choices regarding diet. According to Tanentsapf, Heitmann & Adegboye (2011), policies such as imposition of higher taxes on unhealthy foods and beverages while providing subsidies for the healthier options is one way that can contribute to a change towards healthier decision making in regards to diet. However, such efforts are usually challenged by the interaction of external factors such as politics, as such regulation requires political input. However, as an advocate for the targeted population, a community nurse can push for such policies by visiting with the legislator and presenting facts on how such efforts can contribute t the improvement of the health of immigrant women.
Conclusion
In conclusion, community health approaches are commonly used in achieving community based goals. This paper discussed health literacy and empowerment as approaches in assisting immigrant women achieve healthy diets. Health literacy and empowerment can help immigrant women make better decisions in regard to their diets. Literature reveals that immigrants are at a higher risk of acquiring diseases and illnesses that are related to lack of proper diet than other populations. Therefore, addressing the issue of diet among immigrant women is a step towards the achievement of health goals. Health literacy can be achieved by providing women with the necessary information. The information assists the women to make the informed choices. However, the community nurse cannot make such decisions for the target population. On the other hand, empowerment can be achieved by providing the women with developmental support and resources to support the changes that they may make towards adopting healthier diets. Such support is aimed at bringing the women to a point where they initiate change for more healthy food choices on their own, rather than being pushed into adopting such changes.
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