The Health Promotion emblem(World Health Organisation 1986).
The logo incorporates five key action areas in Health Promotion (building healthy public policy, creating supportive environments for health, strengthening community action for health, developing personal skills, and re-orienting health services) and three basic HP strategies (to enable, mediate, and advocate) as described in the Ottawa Charter for Health Promotion(World Health Organisation 1986).
Cervical cancer is an important cause of morbidity and mortality worldwide. There is a strong causal relation between human papillomavirus (HPV) infection and cervical cancer 'in virtually all cervical cancer cases worldwide'(Bosch, Lorincz et al. 2002) .Cervical cancer is a significant cause of mortality and morbidity Nigerian women, due in part to inadequate screening, the rising prevalence of HIV
Criteria for effective screening
For a screening for a disease to be effective:
- the disease must be an important health problem;
- the natural course of the disease should be well understood;
- the disease should have a long detectable preclinical phase;
- must have effective treatment and early treatment should improve outcome;
- the test should be highly specific and sensitive; and
- adequate resources to perform the test should be available and it should be cost effective(Naidoo and Wills 2005).
- LINK THESE TO PAP SMEAR AND CERV CA + CITE EPIDEMIOLOGICAL EVIDENCE FOR CERVI SCREENING
SLOT IN A FIGURE/TABLE SHOWING THE NATURAL HX OF CERVICAL CA
REVIEW OF HEALTH PROMOTION APPROACHES TO CERVICAL CANCER SCREENING= CHECK LITERATURE
Potential approaches to tackling cervical cancer
Medical or preventive approach: primary prevention via HPV vaccination and secondary prevention via cervical screening (pap smears).This is closely aligned with the principle highlighted in the Alma Ata declaration which focuses on prevention rather than cure(World Health Organisation 1978).
Behavioural approach: encouraging clients to adopt healthy sexual behaviour by group or one-to-one counselling on condom use as well as mass campaigns on condom use.
Educational approach: increase awareness of the cause of cervical cancer via sex education (through peer education programmes and family life skills curriculum. Knowledge about the risk of cervical cancer may change sexual attitudes and ultimately behaviour. SE factors may limit voluntary change in behaviour. Provision of leaflets, booklets, group and one-to-one counselling.
Social change approach: free education for teen females and free vocational training programmes...improving access to education
Empowerment approach: enhance life skills through family life skills curriculum in schools and peer-education training programme which help in teaching female teenagers assertiveness and negotiation, and self esteem building regarding sexual issues. CITE Adapted from Naidoo
NEEDS ASSESSMENT-The Case for Breast Cancer Screening in Nigeria
The PRECEDE-PROCEED model is a useful structure 'for assessing health needs and for designing, implementing, and evaluating health promotion programmes to meet those needs'.
There is increasing evidence that cervical cancer is on the rise in Nigeria. Available data from Ibadan Cancer Registry indicate that cervical cancer accounted for . Within the cancers of the female, breast cancer maintained the trend rising from 11.2% to 25.7% during 1960-1980 and 1980-1985 periods respectively. A recent study by doctors at the University College Hospital, Ibadan as reported by The Punch of November 7, 2002 gave credence to the emerging trend revealing that 116 out of 100,000 Nigerian women have breast cancer. Based on this finding, 34,800 new cases would be expected in 2003 an increase from 27,840 or 25% in 1999. There are also findings indicating that the peak age incidence is 36 to 45 with a smaller secondary peak at 56 to 65. The mean age of 48 years at presentation is in marked contrast to reports of Caucasian patients in whom the peak age incidence is almost two decades later. Cervical cancer is affecting us younger and it carries in its wake grave socioeconomic consequences= Rephrase and cite BRECAN
This is important in order to help establish priorities, assist planning and justify resources and in planning evaluation(CITENAIDOO pg 35-36).It brings to light the magnitude of the problem and establishes a baseline data against which the health promotion intervention can be evaluated(NAIDOO) epidemiological evidence data from the Ibadan cancer registry. .Morbidity and mortality statistics from University College Hospital (UCH) Ibadan Cancer Registry was used to identify and quantify the incidence of cervical cancers occurring in the community
Selection of intervention population
Theoretical basis for cervical cancer screening
This intervention combines the medical (preventive) and... approaches to health promotion. The theoretical framework is the health belief model of health-related decision making. The Health Belief Model (HBM) has been widely used in the prediction of cervical cancer screening uptake(Gillam 1991; Austin, Ahmad et al. 2002; Johnson, Mues et al. 2008).This model is based on perceived risk, susceptibility to an illness and factors that influence health decisions. This theoretical model (It) suggests that whether people change their health behaviour, accept an intervention, or not would depend on if they believe its benefits outweigh its risks. It suggests that women are influenced by how vulnerable they think they are to cervical cancer (perceived susceptibility) and how serious they consider it to be a serious condition (perceived severity).The Health Belief Model of Cervical Cancer Prevention (Adapted from (Naidoo and Wills 2009)-Health Belief Model pg.
Politics can be looked at from a power perspective and defined as 'the production ,distribution and use of scarce resources'CITE HEYWOOD 2000 IN NAIDOO(Heywood 2000).
Politics plays an important role in the success of health promotion interventions.
Austin, L. T., F. Ahmad, et al. (2002). "Breast and cervical cancer screening in Hispanic women: a literature review using the health belief model." Womens Health Issues 12(3): 122-8.
Bosch, F., A. Lorincz, et al. (2002). "The causal relation between human papillomavirus and cervical cancer." British Medical Journal 55(4): 244.
Gillam, S. J. (1991). "Understanding the uptake of cervical cancer screening: the contribution of the health belief model." The British Journal Of General Practice 41(353): 510-513.
Heywood (2000). Key concepts in politics. Hampshire, Palgrave.
Johnson, C. E., K. E. Mues, et al. (2008). "Cervical cancer screening among immigrants and ethnic minorities: a systematic review using the Health Belief Model." J Low Genit Tract Dis 12(3): 232-41.
Naidoo, J. and J. Wills (2005). "Public health and health promotion: Developing practice ".
Naidoo, J. and J. Wills (2009). Foundation for health promotion. Edinburgh, Elsevier Limited.
World Health Organisation. (1978). "Declaration of Alma-Ata." Retrieved 26 Jan, 2010, from http://www.who.int/hpr/NPH/docs/declaration_almaata.pdf.
World Health Organisation. (1986). "The Ottawa Charter for Health Promotion " Retrieved 26 Jan, 2010, from http://www.who.int/healthpromotion/conferences/previous/ottawa/en/.
World Health Organisation. (1986). "The Ottawa Charter for Health Promotion:Health Promotion Emblem." Retrieved 26 Jan, 2010, from http://www.who.int/healthpromotion/conferences/previous/ottawa/en/index4.html.