Mobile Health Clinics: Meeting Health Needs of the Urban Underserved

Opini:

In general, the services delivered by the mobile health team are immunization, promotion of community health, including diarrhea management, antenatal care, child nutrition, family planning services, information education and communication services (disease awareness, sexually-transmitted diseases), referral and basic laboratory tests, primary medical care, mental health, and addiction counseling.

Studies have reported on the benefits of mobile health clinics. Immunization coverage increased to 80% in Gwalior, Madhya Pradesh, infant mortality declined, and the marriage age rose from 15.9 to 16.5 years. In Bhopal, family planning increased by 14%, use of oral contraceptive pills increased by 63%, and condom use increased by 20%. 

Client satisfaction with mobile health clinics in an urban resettlement colony of the National Capital Territory of Delhi. Curative services were provided 5 days a week wherein treatment of minor ailments was provided, and specialized clinics provided antenatal and immunization services twice a week. They reported that two-thirds to three-fourths of the clients were satisfied with the mobile health care services. 

Mobile health clinics in urban areas play a vital role in providing health care services, particularly to the marginalized sections of society, for whom they are often the only source of health care. 

Berdasarkan artikel tersebut mobile clinic memberikan dampak yang positif bagu kesehatan di India. Program ini dapat membangkitkan kepedulian masyarakat dan meningkatkan taraf kesehatan masyarakat terutama masyarakat dengan ekonomi rendah dan jauh dari jangkauan pelayan kesehatan. 

Dari hasil yang diperoleh, program ini memiliki outcome yang baik sehingga dapat dinilai efektif. 

Referensi:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3760319/#!po=1.35135

Making the Healthy Choice the Easy Choice on Campus: A Qualitative Study

Abstract:

Objectives: This study identified barriers students face that limit their ability to engage in health behaviors on campus and to determine changes needed to make students’ default decisions healthy. Methods: Focus groups (N = 53) were conducted at a large diverse university. Results: Interpersonal and intrapersonal barriers including lack of time were the most prevalent themes associated with activity challenges. Environmental factors such as food cost were the significant barriers to eating-well. Conclusions: College and university administrators are in the position to create campus environments where the healthy choice is the easy choice. By doing so, they lay the foundation necessary for sound individual behaviors that lead to the physical, mental and academic health of their students.

Key words: college students; diet; activity; campus environment; health policy

Health Behavior & Policy Review. 2015;2(2):110--121

DOI: http://dx.doi.org/10.14485/HBPR.2.2.3

My Opinion:

The article that prepared by Mongiello et al from the New York Institute of Technology, School of Health Professions, provide us the reasons and barriers of major group of college students on why they cannot maintain their physical activities and majorly focus on why they cannot perform healthy diet routine.

We do know that a lot of younger adults now have difference priorities when entering colleges or universities. And, it is college and university role to actually try to combat and find the roots why their students are the main contributors of obesity among citizen in that particular city. Statistic show that younger adults are much likely lose their fitness when they entered campus to further their tertiary studies. With major focus on diet, I am going to point out few major points from the article that I found not to neglect.

According to the qualitative studies of this article, students found that food cost is the significant barriers for participating in healthy diet program. Most of the campus canteen charge their students with expensive price when it is involving healthy food such as fruits and certain vegetables. Instead, junk food is charge cheaper and much tastier. Knowledge of recognizing which of the food are healthy and non are also pointed out lacking which I find it is true since promotion of healthy diet are lesser especially to the faculties that not related to health science. Not only the food is expensive, lacking of selection of healthy food is also a major turn down for students to go for healthy diet. After all, students are younger adults that got bored easily if the choice is lacking, and they cannot afford to buy expensive food. Elimination of junk food and soda is one of suggested way to combat unhealthy food choice within a campus. Even though you cannot implement it in a big scale, starting it in a campus could lead to chain. It won’t be easy to provide subsidies of the healthy food to the campus canteen, but, it is much easier to inhibit the promotion of unhealthy diet among students.

Reference:

Mongiello, L., Freudenberg, N. and Spark, A. (2015). Making the Healthy Choice the Easy Choice on Campus: A Qualitative Study. Health Behavior and Policy Review, 2(2), pp.110-121

A Workplace Intervention to Promote Stair Climbing: Greater Effects in the Overweight

Abstract:
EVES, FRANK F., OLIVER J. WEBB, AND NANETTE MUTRIE. A workplace intervention to promote stair climbing: greater effects in the overweight. Obesity. 2006; 14:2210 –2216.
Objective: Stair climbing is a lifestyle physical activity that uses more calories per minute than jogging. This study tested an intervention designed to promote stair climbing in a workplace. Because previous studies provide only equivocal evidence of the effects of increased stair climbing in worksites, a formal comparison of the effects of the intervention on stair ascent and descent was made.
Research Methods and Procedures: In a five-story public sector building, a 2-week baseline was followed by 6 weeks of an intervention involving a 231⁄2- 161⁄2-inch poster in the lobby, the same poster and six messages affixed to the stair risers between floors, and an 113⁄4- 81⁄4-inch point of choice prompt at the elevators. Stair and elevator choices (n 26,806) were videotaped throughout and subsequently coded for direction of travel, traveler’s sex, and traveler’s load. Weight status was coded using silhouettes beside the computer monitor.
Results: A significant effect of the intervention on stair climbing was greater in those coded as overweight ( 5.4%; odds ratio 1.33) than in individuals of normal weight ( 2.5%; odds ratio 1.12). Although stair descent was more common than ascent, the intervention had similar effects for both directions of travel.
Discussion: Stair climbing at work has few barriers and seems to be a type of physical activity that is acceptable to overweight individuals. The relatively weak effect of workplace interventions compared with results for public access staircases may reflect uncontrolled effects such as the immediate availability of the elevator for the traveler.

My Opinion:

This study was conducted to determine the effectiveness of intervention in promoting stair climbing in workplace. The intervention was composed of three components. An A2 poster (231⁄2 161⁄2 inches) in the lobby displayed a manikin climbing stairs with the extended text of the main message “Doctors have found that 7 minutes of stair climbing a day halves your risk of a heart attack over a 10 year period. There are 1440 minutes in a day. Can you spare 7 minutes to live longer?” An arrow at the elevator button pointed to the stairs with the message “Stairs this way.” Above this arrow was an A4 poster (113⁄4 81⁄4 inches) displaying the same manikin as the main poster and the prompt message “7 minutes of stair climbing a day protects your heart.” The same A4 poster was positioned inside the elevator. Within the stairwell, each flight of stairs between floors contained six different messages positioned on the stair risers, three for each one-half flight. The informational messages, in order from the top, were “Regular stair climbing aids weight loss,” “Regular stair climbing burns more calories per minute than jogging,” “Regular stair climbing is free exercise,” “Regular stair climbing lowers cholesterol,” “Regular stair climbing keeps you fit,” and “Regular stair climbing provides daily exercise.” Finally, the main A2 poster was positioned at the top of each flight  to reinforce the main message. 

The result from this study is not too effective. This is because there are many other factors that can influence the choices between to use elevator or stairs. Elevator availability, distance, company and demographic variation can affects the worker choices. For example,we tend to use stairs for a short journey to the next floor. If there is escalator of course escalator will be the  main choice because it is always available. However, this intervention shows great influence in overweight group. There are many reasons that correlated such as the overweight attempt to self-manage the risk for coronary heart disease as a reflection from the posters. Another reason is, two of the six stair riser banners specifically referred to weight control. It is possible that the overweight were specifically attempting to control their weight.

Displaying posters to promote stairs climbing in workplace might be effective for overweight workers but not too effective for normal weight workers. Overall, it can be said successful with the increasing number of workers using stairs instead of elevator.

References:

1.  http://onlinelibrary.wiley.com/doi/10.1038/oby.2006.259/pdf

A Tale of Two Countries: Promoting Responsible Sexual Behaviour to Improve Reproductive Health

Advocacy in Bangladesh

Bangladesh, with a population of 124 million, is the world’s most densely populated country. Its youth population is substantial: about 51 percent of the population is less than 19 years of age. The Bangladesh advocacy initiative in sexual and reproductive health is linked to two parallel initiatives reproductive health services and population and development strategies.

The country faces a number of constraints in the area of reproductive health and gender,such as high maternal mortality rate estimated at 470 per 100,000 live births, and a high prevalence of reproductive tract infections among women. Although family planning is a Bangladesh success story, the dominance of female methods and over dependence on a temporary methods has resulted in a limited choice of family planning method, high discontinuation rates, and limited male participation. Reproductive health services and information reach neither adolescent girls (even when they are pregnant) nor men. Violence against women is on the rise and preference for sons over daughters is widespread.

The advocacy programme was developed to address these issues by promoting reproductive rights, reproductive health, empowerment of women, male participation in reproductive health and improving the reproductive health of adolescents, particularly girls. The primary aim of the advocacy efforts was to facilitate positive behaviour changes by creating a supportive environment for improvements in the reproductive health of women and men. The two main objectives of the advocacy programme were complementary: first, to enhance the support of influential leader, especially religious, political and local leaders, and second, to improve attitudes and behaviours of vulnerable and hard-to-reach groups related to reproductive rights, reproductive health and gender.

Safe sex in Kyrgyzstan

Mountainous Kyrgyzstan has a population of 4.5 million with four-fifths of the population living on 15 percent of arable land. It has a very young population; an estimated 44 percent of the population is less than 18 years of age. In late 1996 a safe sex educational campaign was launched in the capital city of Bishkek. The campaign addressed two major issues: the high abortion rate, estimated to be 610 per 1,000 live births, and the increasing of STDs, especially syphilis. The target audience included sexually active women, men, and adolescents.

The Bishkek safe sex educational campaign was successful due to the synergy of a number of departments in the Ministry of Health working together to achieve a common objective. The campaign also took advantage of the high literacy rate in the country to distribute vast amounts of printed educational materials throughout the campaign. In addition, publicity from radio and TV was intensified. A telephone helpline was found to be the most cost-effective way to provide confidential and timely information to large numbers of people. While campaign activities in Bishkek continues, the second phase of the campaign utilised the momentum created by the first phase and expanded the programme to include the rest of the country. Programme planners used the experiences from the first phase of the project to guide the design and implementation of the second phase. 

Opini

Artikel ini membahas promosi kesehatan seksual dan reproduksi yang dilakukan oleh negara Bangladesh dan Kyrgyzstan. Kedua negara tersebut memiliki populasi Muslim predominan dan populasi orang muda yang sangat besar. Hal yang saya tangkap adalah program advokasi yang dilakukan oleh Bangladesh lebih bersifat jangka panjang, sedangkan program kampanye safe sex di Kyrgyzstan bersifat jangka pendek. Tetapi kedua program berjalan dengan baik, karena kerjasama yang terjalin antar pihak terkait. Untuk program advokasi di Bangladesh, terjalin kerjasama antara pelaksana program dan orang-orang yang dianggap berpengaruh terhadap masyarakat, seperti  pemuka agama, pemimpin politik, dan pemimpin lokal. Sedangkan program kampanye safe sex di Kyrgyzstan merupakan hasil kerja sama sinergis dari beberapa departemen di Kementerian Kesehatan Kyrgyzstan.

Dalam perencanaan dan pelaksanaan program, perlu dipertimbangkan kerjasama antar pihak terkait untuk menunjang keberhasilan program. Terkait promosi kesehatan seksual dan reproduksi, diperlukan kerjasama dari pihak multidisiplin, semisal tenaga ahli di bidang kesehatan, pendidikan, agama, dan hubungan masyarakat, serta pembuat kebijakan.

Referensi

Ratne, M. A tale of two countries: Promoting responsible sexual behaviour to improve reproductive health. Promotion & Education6.2 (Jun 1999): 26-8, 41, 52. Available at http://search.proquest.com/openview/5946b363e6363ec022a889aae09cb008/1?pq-origsite=gscholar [Accessed on August 31^st 2016]

Efficacy of an E-mail Intervention for the Promotion of Physical Activity and Nutrition Behavior in the Workplace Context

Abstract:

Purpose. The purpose of this study was to evaluate a 12-week workplace e-mail intervention
designed to promote physical activity and nutrition behavior.
Design. A pre- and post-test design was conducted to compare the effects of e-mail messages
between intervention and control groups.
Setting. Five large workplaces in Alberta, Canada.
Subjects. Employees with access to a personal e-mail address (N 5 2121) were randomly
assigned to an intervention (n 5 1566) or a control group (n 5 555).
Intervention. Physical activity and nutrition messages were based on social-cognitive
theories. The intervention group received one physical activity and one parallel nutrition
message per week for 12 weeks. The control group received no weekly messages.
Measures. Each participant completed self-report measures of physical activity and nutrition
related to knowledge, attitudes, and behaviors 1 week before (time 1) and 1 week
after (time 2) the intervention.
Results. The intervention group was more efficacious at time 2 on measures of selfefficacy,
pros, cons, intentions, and behavior related to physical activity. This group also
reported more favorable changes in practicing healthy eating, balancing food intake with
activity level, cooking meals with techniques to reduce fat, and avoiding eating high-fat
foods. Effect sizes for all significant differences were small.
Conclusion. E-mail is a promising mode of delivery for promoting physical activity and
nutrition in the workplace. Further theoretically driven studies are needed.(Am J Health
Promot 2005;19[6]:422–429.)

My Opinion:

This study was to access the efficacy of e-mail intervention to promote physical activity in workplace. E-mail–based questionnaires were administered 1 week before (time 1) and 1 week after (time 2) intervention. The intervention group received a weekly combined physical activity and nutrition message to their e-mail address between September and November 2002 (i.e., a total of 12 physical activity and 12 nutrition paired messages). from the results obtained the participants in the intervention group were more confident in overcoming physical activity barriers and reported increased perceived benefits (pros) and decreased perceived barriers (cons) related to physical activity participation at time 2. Furthermore, this group had higher intentions to participate in physical activity in the next 3 months in comparison with the control group at time 2.

E-mail intervention has advantages in which it can reach a large number of people and can provide immediate feedback to the participants. Furthermore, it is cost-effective. However, there are also some disadvantages in using this intervention to promote physical activity in workplace,for example limited quality in presentation which is not attractive to the receiver. Besides that, it would be a problem for people with limited computer literacy especially in older population. So, this kind of intervention may not suitable to be implement in older group population. Although workers can access it easily during working hours, due to busy working hours the workers may not really receptive to the information compared to when they receive it during leisure time.

In conclusion, e-mail intervention is a promising method in promoting physical activity in workplace. Although there are some disadvantages,it can becomes better with increasing message frequency and extended time of intervention.

References:

1. http://ajhpcontents.org/doi/abs/10.4278/0890-1171-19.6.422?journalCode=hepr

Effects of Serving High-Sugar Cereals on Children's Breakfast-Eating Behavior

Abstract

Objectives: To test (1) whether children will consume low-sugar ready-to-eat (RTE) cereals and (2) the effects of serving high- versus low-sugar cereals on the consumption of cereal, refined sugar, fresh fruit, and milk.

Participants and Methods: Using an experimental design, we randomly assigned children (n = 91) who were attending summer day camp to receive a breakfast that included either the choice of 1 of 3 high-sugar cereals (high-sugar condition) or low-sugar cereals (low-sugar condition), as well as low-fat milk, orange juice, bananas, strawberries, and sugar packets. Participants served themselves and completed a background questionnaire after eating. Researchers measured the amount and calories consumed of each food.

Results: In both conditions, children reported “liking” or “loving” the cereal they chose. Children in the low-sugar cereal condition consumed, on average, slightly more than 1 serving of cereal (35 g), whereas children in the high-sugar condition consumed significantly more (61 g) and almost twice the amount of refined sugar in total (24.4 vs 12.5 g). Milk and total calories consumed did not differ significantly between conditions, but children in the low-sugar condition were more likely to put fruit on their cereal (54% vs 8%) and consumed a greater portion of total calories from fresh fruit (20% vs 13%).

Conclusions: Compared with serving low-sugar cereals, high-sugar cereals increase children's total sugar consumption and reduce the overall nutritional quality of their breakfast. Children will consume low-sugar cereals when offered, and they provide a superior breakfast option.

Opini

Pada artikel ini, kita memperoleh pelajaran bahwa pemilihan bahan makanan menjadi salah satu aspek penting dalam penerapan program sarapan di sekolah. Artikel ini menunjukkan bahwa anak-anak memiliki kesukaan terhada sereal yang digunakan sebagai menu makanan dalam sarapan. Tidak cukup sampai disini, pemilihan sereal dengan kadar gula rendah memiliki manfaat meningkatkan minat anak dalam menambah konsumsi buah sebagai menu sarapan pagi mereka dibandingkan dengan sereal dengan kadar gula tinggi.

Dalam penerapan program sarapan di sekolah, ada baiknya dilakukan dengan koordinasi bersama dengan ahli gizi atau dietitian untuk pemilihan menu dan pengemasannya. Hal ini disamping untuk meningkatkan partisipasi program juga akan meningkatkan kualitas gizi dari makanan yang dikonsumsi oleh anak.

References

http://pediatrics.aappublications.org/content/pediatrics/early/2010/12/13/peds.2010-0864.full.pdf

Michigan Team Nutrition Boost Breakfast Initiative Increases Breakfast Participation

Abstract

Objective

To encourage schools to increase the number of students participating in school breakfast.

Description

In 2013, a Michigan “First Fuel” Breakfast Challenge was issued to have at least 60% of National School Lunch Program participants also participate in the School Breakfast Program. In the 2008-2009 school year, only 42.5% school lunch participants participated in school breakfast. Michigan Team Nutrition sought to increase participation by implementing the following activities, convened statewide strategic partners; developed a http://boostbreakfast.com/ website, toolkit, and online training; conducted statewide “Boost Breakfast” trainings targeting over 800 food service professionals and school administrators; engaged students through a statewide Junior Chef Breakfast Competition; completed a portfolio of 20 success stories in video and print; and promoted successes through social networking websites.

Evaluation

In 2015, the number of school breakfasts increased to 48.5 students for every 100 students in school lunch. A total of 1,076 schools were successful in increasing their breakfast participation to 60%. Of these, 406 schools not only met the challenge goal, but doubled their breakfast participation numbers or met 100% participation as well. Overall, this translated to an additional 3 million school breakfasts being served.

Conclusions and Implications

Increasing statewide breakfast participation numbers is challenging. A multi-pronged, collaborative, school by school effort is required to increase participation. Other states should consider modifying Michigan Team Nutrition boost breakfast intervention materials found at http://boostbreakfast.com/ in order to promote breakfast participation.

Opini

Melalui jurnal ini, kita dapat mengambil suatu ide menarik bahwa pemanfaatan internet dan media sebagai sarana publikasi cukup memberikan impact positif dalam memberikan inspirasi dan semangat bersama dalam penerapan program di sekolah, khususnya dalam kampanye sarapan pagi. Program Michigan “First Fuel” Breakfast Challenge yang diinisiasi oleh Michigan Team Nutrition dengan promosi sarapan di sekolah dengan membuat http://boostbreakfast.com/ website, toolkit, and online training menciptakan suatu atmosfer baru yang kemudian menjadikan sekolah terpacu untuk menjalankan program sarapan di sekolah. Adanya semangat kompetisi memberikan semangat baru di sekolah-sekolah setempat, di samping juga memberikan informasi berupa sharing programs yang dilaksanakan di masing-masing sekolah.

Di Indonesia, program seperti ini sangat mungkin untuk dilakukan. Tingginya penggunaan media sosial di internet menjadi salah satu potensi yang cukup baik untuk pengembangan sharing online yang disinergikan dengan kompetisi program. Pengemasan program yang baik menjadi kunci utama dalam pelaksanaan program.

References

http://www.sciencedirect.com/science/article/pii/S1499404616304134