Health Promotion Research PaperHealth Promotion and Public Health
In this paper I will pay attention to the analysis of teenage pregnancy, sexually transmitted infections, issues of their behavior, and barriers to sexual health of young people as well as training of peer lecturers and adequate condoms distribution. In this extent I will critically analyze six articles regarding these various questions, including the discussion of the health behavior theory application. I will present current public health policies and practices and examine current debates regarding health promotion practices. I will critically evaluate roles and contributions of care professionals in promoting public’s health.
Sexual health is undividable part of the well-being of each single young person. If the person is not healthy, he cannot live the full life and enjoy it. The same situation is with teenage pregnancies. When the young girl becomes pregnant, it is a real threat not only for her social life and future education process, but primarily to her physical and emotional health.
2. Current public health policies and practice.
Nowadays there are very high levels of teenage pregnancies in the United Kingdom, as well as occurrences of sexually transmitted infections (STI). Being pregnant when still studying in school will definitely have a detrimental influence upon the future life opportunities of all three involved- the young mother, father and the future child. In case of the abortion there is a certain risk that the young woman will not be able to give birth to children in the future and also will have a great impact upon her mental health.
Government institution so far are very much concerned about these issues and therefore government recommend, through documents, establish more sexual health services to reduce teenage pregnancies and STIs. Richardson Todd (2006) describes an example of Ipswich, which provides services concerning sexual health of young people at the reproductive health center, sexual health clinic at local hospital, statistical studies show that these means of sexual health care are not very much successful, as not all young people can access them. The reasons are different- from lack of awareness to fear of such places, which seems to be too official.
It was decided that the most effective way to deliver useful information about pregnancy control and STI prevention is said to be linking of school-based sex education with correspondent local services (Center for Reviews and Dissemination, 1997).
Accessible sexual health services for teenagers (ASSIST) were established being the part of the multi-agency, drop-in service. ASSIST is an effective way to diminish quantity of teenage pregnancies age 13 to 18. First clinic of such a pattern had been established in 2003 in the secondary school. The reasons for establishment were rather obvious- low educational level and many unplanned teenage pregnancies. The partner agencies included the following services: school nurse, Connections worker, counselor, health visitor, youth worker, drug and alcohol workers, and community police officer if necessary (Richardson- Todd, 2006). Teenagers are able to get all needed information concerning the series of important to them questions: contraception, sexual health, pregnancy issues, as well as receive helps on emergency contraception, distribution of condoms, pregnancy testing, etc. Drop-in session appear to be more effective then a whole clinic, as they are more accessible and protect young people from being labeled. ASSIST helps to reduce health inequalities, have friendly not judging professional staff, which respects confidentiality and is open for listening and discussions. These are key constituents of success. ASSIST is open two days a week at convenient to young people time, sessions are called WANT2TLK. For such institution gaining trust is the primary task. Involvement of parents and schooling staff will increase the success of the drop-in sessions; questionnaires are involved in service development and improvement. Particular guidance is developed regarding issuing condoms to young people under 16 and also minimum list of question to ask new clients for statistics and analysis.
So, the main task of ASSIST is to advise and educate young people about sexual health, which is expected to decrease teenage pregnancy rates and STIs occurrences. But the problems of social education are so complex that such drop-in sessions cannot solve all of them.
In order to analyze the existing problems with sexual health, it is necessary to understand factors that shape the present day situation. In recent years opinions of young people towards relationships are constantly changing- multiple sexual partners and experiences, homosexual relationships are becoming the normal thing (Donaldson and Donaldson 2000). There special risk-groups defined that include gay men, young men and ethnic minorities. Young people should be specially educated about condoms use and the image of condoms should be transformed from unfashionable to an important aspect of each sexual encounter (Ritchie, 2006). Young people cannot be called sexually competent at the fullest extent. By being sexually competent is meant absence of regret after sex, autonomy of decision-making process to do this and the use of reliable of protection. Reasons for early pregnancies can be from family indifference to the young person and low social status of parents. That is why, speaking about public health policies and practice, I can’t help mentioning sexual education in schools, that lays the foundation for the future young people sexual life and their perceptions of it. It is important to remember that such lessons in schools should not have the less priority then other subjects, which are connected with probable future career. Religion and cultural beliefs can diminish the importance of sex education or even ignore it. Such studies should be given more priority in school schedule (Ritchie, 2006). Adolescents can also create barriers for perception of the information upon sex education and they suggest that this kind of lessons be more positively directed, tactful, focus more upon relationships, provide information about sexual health clinic and drop-in sessions in them to increase young people awareness that they are not alone with their problems and are able to receive help with confidentiality maintained.
As the part of the National Health Strategy, Genitourinary medicine (GUM) clinics are open, as well as community family planning clinics and services of primary care (Ritchie, 2006). Nowadays GUM clinics are very busy because of attendance rise and drop-in access to this clinic is an exit from the situation. It doesn’t allow any delays, as delays may result in infections spread, and offer proper treatment. The Chlamydia screening program, which was effective and assisted in reduction of disease transmission and exposure of the disease at the early stage can make the treatment easier (Ritchie, 2006).
The most effective practice in health education is said to be the peer- support and peer-educators instead of the adults. When young people deliver the information regarding sexual health, it appears to be more exciting and accessible (Svenson, 1998). The reason is that young people accept new knowledge, advices and skills more efficiently when they are delivered by someone of approximately of their own age. There are also some social roots in this phenomenon. There are several factors that identify that young people are more satisfied with peer support: perception of it as a credible information source, more relaxed atmosphere during sessions, good attitudes towards speakers, understanding problems of young people better than teachers. Peer-led SRE have positive results in changing attitudes of young people to their sexual lives and have positive gains in knowledge. Among advantages of peer support work are: they are able to present information in the way that adults cannot and make sessions more interesting, it has positive influence on peer-educators themselves, they are able to help young people who are socially excluded in schools and communities, increase of clients flow, have clear view regarding SRE future (Forrest and Lynch, 2002). There are also some problems occurred with peer-educators connected with their lack of commitment, some disruptions and lack of planning skills. So, among disadvantages are: peer support needs a lot of organization and management, peer- educators may be too busy with their own life, studies, examinations and families, lack of funding, needs a lot of training. But still the research results are still positive.
3. Government Initiatives and Debates Around Health Promotion Services
English Government had developed the National Strategy for Sexual Health and HIV (Ritchie, 2006), as the part of national program of health protection. The aim of this strategy foes around improving health and sexual health, reduce STIs and HIV, set achievable goals to improve sexual health practices. On the national level there were developed a series of sexual health services and three levels of health care established.
Sex and relationship education (SRE) is also the part of the Government program. It was governmental guidance to incorporate peer-led sexual health interventions (Forrest and Lynch, 2002).
There are a lot of debates now around sexual health of adolescents and their needs. The transition from childhood to adulthood covers a wide range of changes in physical, psychological, psychosocial and social developments. So, young people are immature and need special approached to reach them. Physical immaturity increases risks of acquiring STI as compared to adults, as young people organisms are not able to combat STI as the one of an adult can (Metcalf, 2004). Speaking about psychological development, I must say that young people are very much confident in themselves and “egocentric” (Erikson, 1968). They think that bad things with their sexual health are something that would have never happened to them, but studies show the opposite. They belief and assurance is not enough protection, or not a protection at all. They can neglect use of contraception, get infected and not even know about that. As to the psychosocial development, adolescence is the period when people are moving from their families towards independence and independent behaviors. In this extent they are not listening to what their parents are telling them and are more exposed to external influences. They want to feel more ‘grown up’ not understanding that having sexual relationships is not the only thing that differentiates adolescents from adults. The environment plays significant role during this period as adolescents tend to listen more to their peers, those who have sexually active peer start to have sexual relationships earlier.
4. Health promotion resources
Media plays not the least roles in shaping sexual behavior of young people. Hidden messages about different goods, which deliver that sexuality is something that should be striving to, confuses values of young people. The same situation with movies in which protection is not intended to be obviously used (Metcalfe, 2004).
Within the political framework the promotion of sexual education has more positive frame. It is necessary to mention that any promotion should primarily have optimistic and positive content or present facts only regarding pregnancies of young people and STIs, as delivering fear will not be productive and effective.
There are also some barriers to the promotion of sexual health: discrimination, stigma, language, poverty and social status, low awareness, and also embarrassment, previous bad experiences with relationships and help services, concerns about confidentiality, cultural differences, etc.(Ritchie,2006)
5. Role and contribution of health and social care professionals
The importance of health and social care professionals cannot be underestimated. In schools, schools nurses are ideal means of delivering sex and relationship education, and encourage partnership and openness with teachers (Ritchie, 2006). In clinics there are nurses whose key roles are managing, educating and supporting patients not only in clinical environment, but also across the range of non-clinical settings (for example, schools, youth services and walk-in centers). Nurses’ roles are not limited to listening and advising, they can also prescribe medicines and fit intrauterine contraceptive devices. Nurses’ key role is to develop trust relationships with patients and eliminate all possible barriers to getting adequate support and help.
In ASSIST nurse role is tightly connected with health of young people on the contrary with that of the school nurse, which role is more general and only restricted with sexual students’ health. ASSIST nurse’s role include providing advices and guidance about the relationships equally sexual ones, peer pressure issues, sage sex, STI and contraception. They are also responsible for appropriate condoms distribution, testing of the pregnancy and dispensing of emergency contraception (Richardson- Todd, 2006). They try to deliver an idea that building trust in the relationships of young people are essential for their developments and decrease risk-taking sexual behaviors.
It is essential that health and social care professionals were educated enough and felt free during the communication process with young people, as ideas that they deliver make adolescents do particular steps and make definite choices regarding their sexual life.
But still in general, school-nurses, reproductive health nurses and ASSIST nurses have the same mission and encourage young men and women to discuss what is bothering them and what they want to know with their parents or rely on confidential talks with professional in this sphere.
6. Application of health behavior theories to the development of health promotion activities
Health behavior can be analyzed and understood through implementation of Health Behavior Theory (HBT) (Noar and Zimmermann, 2005). HBT assists not only in accessing health behavior, but also lays the foundation to which improving public health of individuals and communities can be evaluated and developed. The reason of not having much progress in this sphere in 1993 Weinstein described as the lack of empirical comparisons between many existing theories. And continued with stating that there is little evidence at present moment that some theories are better then others or provide more accurate data. Therefore, scientific progress is very vague.
So let’s investigate what is the theory itself. Glanz provides the following definition: “A set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by specifying relations among variables in order to explain and predict events or situations.” Linking the theory with health behavior, different variables and levels can be measured- individual, interpersonal, organizational and community (Noar and Zimmermann, 2005). Everything starts with the theory development, as later on they serve as the tool and the pattern for evaluating various behaviors. There are five basic health behavior theories that have similar elements in their descriptions and assumptions made. The first one is called attitudinal beliefs, and it is about evaluation of positive and negative aspects of behavior as well as expected outcome from it. The next is called- beliefs about control over behavior (confidence in one’s ability to perform the behavior). Normative and norm-related beliefs and activities theory is about the belief that other people can influence behavior of the individual, be supportive as well as motivate their behavior. Risk-related beliefs and emotional responses theory is about the belief that it is risky not to get involved in the behavior and that can lead to severe consequences, including experiencing negative emotions. And finally the last theory is called intention/commitment/planning that means intending or planning of the behavior, setting objectives regarding it and making a commitment for the performance. So, it is essential that each theory be deeply analyzed and in order to move forward, they should be compared and may be some integrated one developed.
In the conclusion I would like to summarize all key founding of my research regarding sexual health and education of teenagers and importance of condoms use.
Nowadays, government is very much concerned about the situation with numerous teenage pregnancies and STI transference. And therefore government develops strategies in order to improve the situation and control it, if it possible. The task of health care and education promotion is upon school nurses and nurses at different clinics and institutions who are in charge of helping adolescents with their problems, distribute condoms and emergency contraception, speak about the relationships and test pregnancy. Some services are very successful, because they offer private and confidential service, which is very important to teenagers, as well as relaxed atmosphere and non-judgmental staff. Such institutions promote the importance of contraception, especially condoms. They view condoms not as old-fashioned mean of protection, but try to increase its popularity by means of making them a common thing of each teenage who practices sexual relationships. All nurses also inspire teenagers listen to their parents and speak with them more about things they want to know or which are bothering them. Nurses advice young people not to percept parents as judging individuals and to see that the only thing parents perceive- is healthy and happy life of their children. Being independent doesn’t mean not to listen to their friendly advices.
Peer support is one of the successful promotion strategies of sexual health care and education, as teenagers tend to percept information more effectively when it is delivered by their peers, they feel more relaxed and open and can discuss things they would not probably discuss with adults. Even though there are some disadvantaged of peer support, the outcomes of such education are very successful.
The only thing that teenagers have to realize that health is the basic thing in their lives and that without strong health they will not be able to fulfill desired planned and achieve set goals. If the young woman in school becomes pregnant then it is a threat to her future and the future of the child and the husband. Her self-realization and future career are endangered. And in case of the abortion, there is a real threat to her health and she can probably never have children again when the decision to have them will be well-thought.
Is teenagers make the decision to have sexual relationships like adults, they should take the responsibility of what they are doing and not neglect contraception and at least visit some drop-in sessions and try to obtain the more information the possible about probably outcomes of their sexual relationships.
There are a lot of health behavior theories, which can many in common. All of them help to find the best approach to sexual health problems and to analyze different teenagers’ behaviors. The development of theories and theoretical basis will allow establishing more effective means of influence, analysis and control.
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