The writer seeks to carry out an assessment of health needs of migrant women with HIV in London from age group 19 to 54 years. The rationale for choosing this group is that there are disadvantages faced by the chosen group such as housing, social support, spiritual needs, low self worth and self-esteem, love and belongingness, lack of information or education on HIV/AIDS. The other reason is that women are the most affected by HIV in the UK accounting for nearly 80% of those currently receiving HIV treatment and care.
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In life every community or individual has a need and in the health field it is imperative to assess, plan, implement and evaluate the needs of the assigned population group. After assessing and identifying the needs, you then check the availability of resources, depending on the limitations, then priorities and allocate resources appropriately starting with the most need, from the lowest to the highest needs Maslow (1954) Hierarchy of needs in (Naidoo and Willis (2000, p.330). Naidoo and Willis (2000, p.329) state that needs may be something people want or something that is lacking in comparison to others.
In this piece of work, the writer has found three current and peer reviewed articles that are similar if not same that focuses on health needs of migrant women with HIV living in UK . See Appendix-1.
The three articles identified are both qualitative and quantitative data (Parahoo, 2006; Polit and Beck, 2004) and are as follows:
Article 1 Anderson and Doyal (2004) Women from Africa living with HIV in London: a descriptive study.
Anderson and Doyal (2004) research article is a summary of findings
from a qualitative study of African women living with HIV in London, a participatory approach is used to assess their health needs. The women described their survival and experience in their own words.
They need housing as they frequently experienced unsatisfactory and very poor housing, thereby agreeing with Doyal and Gough (1999) in Tones and Green (2004) on the need for adequate protective housing. Naidoo and Wills (2004, p331) cites (Doyal and Gough, 1994) who argues that the ultimate goal of all people is to participate actively, fully in their society and for this to happen basic needs for physical health and autonomy should be first met. Maslow (1954)’s hierarchy of needs in (Naidoo and Willis, 2000) state that for people to move to the next level basic needs, must be met first for example shelter, food and protection.
The women lack awareness in knowing that they have HIV epidemic (Anderson and Doyal, 2004). The women described their experience of health care, found hospital depressing and were reminded of their diagnosis repeatedly on visits whilst others needed education on antiretroviral therapy (ART).
Spiritual need is very important need as vast majority expressed their religious faith as extremely important in their lives and a major source of support in coping with difficulties. Ewles and Simnet (1999) state that churches and religious organisations plays important role in developing values, attitudes and beliefs that affect health. Bradshaw (1972) cited in Macdowall, Bonell & Davies (2006) states that allowing ‘felt’ and ‘expressed’ needs to be spelt out encourages a holistic model of health.
Article 2 Onwumere, J. Holttum, I. S and Hirst, F. (2002) Determinants of quality of life in black African women with HIV living in London.
Onwumere et al (2002) study argues that better mental health related quality of life was predicted by practical coping and higher social support. Coping and Social support has been identified as the most important and greatest need that help to explain differences in quality of life following a diagnosis of HIV (Felton and Revenson 1984) in Onwumere et al (2002) and Anderson and Doyal, (2004). Onwumere et al (2002) identified a need from Maslow’s hierarchy of needs which isself esteem need, recognition and approval (Naidoo and Willis, 2000). The women with HIV stated that they experienced frequent episodes of low self worth and self-esteem because of their condition and face barriers in accessing health contributed by language barriers, social exclusion, stigmatisation and discrimination.
Women with HIVreportedsuffering rejection from their partners, friends and relatives and the community. Their safety, love and acceptance needs are not being met which might result in failure to fulfil the higher need of affiliation with society (Maslow, 1954 in (Naidoo and Willis, 2000). According to Seedhouse (1997) health in its different degrees is created by removing obstacles or barriers and providing basic means to enable the achievement of biological and chosen goals. A proportion of women used the Specialist voluntary sector organisation a much-valued resource, providing a range of social, emotional and practical support.
Article 3. Ibrahim et al (2008) Social and economic hardship among people living with HIV in London.
The findings in this study states that a considerable number of people living with HIV in London face social and economic hardships predominantly Black African and other ethnic minority participants. Ibrahim et al (2008) further argues that in London HIV is associated with poverty, mainly among migrant, ethnic minority population and most participants are unemployed and have not enough money to cover their basic needs (Maslow, 1954) in (Naidoo and Willis, 2000).
According to Ibrahim et al (2008) tackling poverty and unemployment among people with HIV in London UK and entire UK should be given priority by policy makers. The independent inquiry into health inequalities report by Sir Donald Acheson (1998) uses the socio-economic model of health by Dahlgren and Whitehead (1991) to illustrate that the determinants of health are layers of influence one over another. These are described as individual lifestyle factors, social and community networks, living and working circumstances and general socio economic, cultural and environmental conditions and are interrelated resulting into health inequalities.
Pantazis and Gordon (2000) states that in Britain inequalities are a collection of contribution such as income, employment, wealth, standard of living, education, crime and health. This population group also reported insecure residency status in the UK which may have limitations opportunities in finding work. Bunton and Macdonald (2002, p. 112) cites Maslow (1954) who state that the next level of need is to feel safe and out of danger.
In conclusion the United Nations joint Programme on HIV/AIDS (UNAIDS) and World Health Organization (WHO, 2009) statistics shows that Sub-Saharan Africa region remains the most heavily HIV affected worldwide, with over two thirds (67%) entire people living with HIV and with nearly three quarters (72%) of AIDS-associated deaths in 2008. Women probably account for almost 60% of HIV infections (UNAIDS, 2009) in this region.
In the United Kingdom in 2005 about 63,500 adults were predicted to be living with HIV amongst ages 15 to 59. In 2005 heterosexually acquired HIV infections were just under two thirds (2,571) and were in women and in both heterosexual men and women were just over two thirds were probably acquired in Africa (Office for National statistics, 2005).
Lastly the findings suggest that very few studies have been done to address the particular needs and experiences of this population group and it appears that there is no defined relevant strategy or policy in place on the government side to make medical and support services to be easily accessible. There is a need to address issues like social exclusion (SEU, 1998) in (Pantazis and Gordon, 2000) and access to information regarding HIV prevention, testing and treatment through appropriate and relevant educational programs.
The writer has identified the following needs to be discussed in Assignment 2
- coping and social support
- love and belongingness
- information on HIV prevention testing, treatment
- spiritual needs
The health promotion strategic proposal aims at addressing the needs identified in assignment one for African migrant women living with HIV in London. On this strategic proposal the writer will follow a strategic plan to implement a health promotion initiative with the use of various theoretical aspects.
The writer will apply appropriate theories and models of approaches which will lead to the recognition and prioritising the health needs of African migrant women. Ewles and Simnet (1999, p.80)’s hierarchy of needs states that it is possible to tackle various issues and come up with multiple aims and objectives, all aimed towards fulfilling one purpose, which in this case would be to raise awareness of HIV. The strategic proposal will be evaluated to assess its effectiveness.
The writer has identified the following needs in assignment one:
- Basic needs such as adequate housing
- Coping and Social support
- Need for love and belongingness
- Information on HIV prevention, testing and treatment
- Spiritual needs
The strategic plan follow Ewles and Simnett flowchart for planning and evaluation conforming to Beattie’s Model of health promotion in its approach to the promotion initiative (Ewles and Simnet 2003, pp.84-106) which includes the following:
- Identifying needs and priorities
- Set aims and objectives
- Decide the best way of achieving the aims
- Identify resources Ewles and Simnett (1999)
- Plan evaluate methods
- Set an action plan
- Action-implement the plan, including evaluation
The strategic proposal aims to increase levels of awareness on HIV and to achieve or effect changes in attitudes, beliefs and lifestyle. It also aims to increase take up of services through increased participation and working together with African migrant women living with HIV on the identified needs. For these to be achieved a number of specific, measurable, achievable, realistic, time limited (SMART) objectives will be proposed (Naidoo and Wills, 2000)
- Increase levels of knowledge to at least 85% within the first twelve months by providing relevant information to healthcare providers to understand cultural, habits and lifestyles of African minority ethnic group (Anderson and Doyal, 2004).
- To recruit and train staff from black and minority ethnic group.
- To undertake outreach and awareness raising work targeting specific minority ethnic group or use local black and minority celebrities such as sports, musicians and television stars.
- To increase levels of knowledge on HIV prevention, testing and treatment within the affected target population.
- To advertise in all local and national black and minority ethnic media.
- Lobby for a relevant government policy for the black and minority ethnic group.
The first objective is to help health service providers to understand the minority ethnic group in terms of their cultural norms and values thereby enabling them to tailor services and information that are relevant to this population group.
By recruiting and providing training to this population group, health providers will be in a better position to respond in ways which meet the patients’ charter objectives of responding to privacy, dignity and religious and cultural beliefs.
The third objective would assist to overcome lack of information, stigmatisation and stereotyping within the black African minority group by bringing relevant information right at their door step.
Lobbying for a relevant government policy to address immigration issues of this population group for example housing, stigma and discrimination.
The UK’s policy clearly illustrates the contradiction of universal access to HIV treatment for all those who need it by 2010 but at the same time charging for HIV treatment for undocumented migrants. Lobbying for instance for a government policy would encounter bureaucracy and government red tape. The policy therefore would take time before its finalised, passed and take effect. On the second note, even if passed, the policy would not be easily implemented due to the differences within the black African groups for example culture and language differences. Media advertising is likely to be costly and may fail to reach the target group because most of women with HIV within this minority ethnic population are also economically disadvantaged and may not have the financial resources to spend on newspapers, TV licences etc.
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4. MODELS AND APPROACHES
The Beattie (1991) model of approach will be utilised in this strategic proposal in order to attain its stated aims and objectives, though different approaches will be spoken about depending on the situation. According to Naidoo and Wills (2000) the Beattie’s model of approach offers a structural analysis of health promotion and suggests four paradigms which include health persuasion, legislative action, personal counselling, and community development.
Health persuasion approach means that practitioners will play the role of an expert or prescriber with the aim to persuade or encourage people to access services on treatment, prevention and testing on HIV(Naidoo and Willis, 2000).
The model will also include activities that will have some advice and information disseminated through outreach and awareness, raising work and advertising in local and international black minority ethnic media or making use of local black and minority ethnic celebrities such as sport, musicians and television personalities (Naidoo and Willis, 2000). Caplan and Holland (1990)’s model support the approach on the traditional perspective which argues that knowledge lies with the experts and emphasis is on information given to bring about behaviour change.
Personal counselling focuses on empowering individuals to have more confidence on taking more control over their health. The educational approach’s purpose is to provide knowledge and information, and to develop the necessary skills so that people can make an informed choice about their health behaviour. Bandura , (1997) self-efficacy, self confidence theory has vital implications with regard to motivation and states that people are likely to engage in activities where they perceive themselves to be competent.
Caplan and Holland’s approach in (Naidoo and Wills, 2000) agrees that the humanist perspective relates to the educational approach which enables individuals to maximise their chances of developing what they consider to be a healthy lifestyle. The educational approach’s purpose is to provide knowledge and information, and to develop the necessary skills so that people can make an informed choice about their health behaviour. The Beattie model of legislative action involves the practitioner playing the role of custodian and includes activities such as policy work or lobbying and concurs with the Ottawa Charter (WHO, 1986).
The Beattie model fourth paradigm is community development and the practitioner plays the role of an advocate with activities which includes outreach and awareness, raising work, recruitment and training of staff from minority ethnic people. Caplan and Holland’s approach refers this as the radical humanist perspective which involves encouraging individuals to form social organisational and economic networks. According to Naidoo and Wills (2000) the Beattie ‘s model is a useful model for health promoters as it identifies a clear framework for deciding a strategy and reminds them of the choice of intervention that is influenced by social and political perspectives.
Tannahill (Downie et al 1996)’s approach talks of three overlapping spheres of activity which include health education, health protection and prevention. This model argues that the three different approaches are inter-related in health promotion. However, Naidoo and Wills (2000) argues that the model does not give any insight into why a practitioner can choose one approach over another and also the different approaches reflecting different ways of looking into health promotion.
The model of Tones & Tilford (1994) emphasizes on education as the key to empowering people by raising consciousness of health issues and further argues that people are then more able to make choices and exert pressure for healthy public policies. The Beattie model as well as Caplan and Holland model of approach clearly illustrated that there is a distinction and self-empowerment and community empowerment.
However Naidoo and Wills (2000) states that Tones argues that there is a common relationship between the two. It changes the social environment achieved through healthy public policies which facilitates the development of self-empowered individuals. The models argue that this illustrates that people who have the skills to participate effectively in decision making are better able to access resources and shape policy that meet the needs.
Different models of approaches can be used as most of them compliment each other even though they have their own limitations and strengths. For instance Ewles and Simnett’s (1999) approaches seem to cover various areas whilst emphasizing on expert power. Beattie’s model empowers both the person and community and concurs with the Ottawa Charter. Tannahil’s model is the most easier to follow though it is seen as too basic and has no empowerment or socio-economic factors.
Tones’ Health Action model empowers and concurs with the Ottawa Charter. However it is seen to be too idealistic and does not focus more on environment. Furthermore, both the Black report and Sir Donald Acheson’s (1998) Independent Inquiry into inequalities in health report uses the socioeconomic model of health by Dahlgren and Whitehead (1991) which suggests that most of the models and approaches can be linked to each other.
Resources that are required to implement the above strategies are:
- Expertise and skills from relevant personnel
- Telephone, postage and photocopying, computers and printers
- Leaflets/publications, policy and guidance, press centre, multimedia centre, blogs, speeches, feature stories, newsletter, art for AIDS, fast facts about HIV, events calendar (UNAIDS, 2009)
- Facilities and services such as community centre for training and meetings
6. Plan evaluation methods
- Asking participants their views at the end of the session so as to measure participants’ perceptions and reactions.
- Design a more formal means of evaluation such as a questionnaire for participants to fill in anonymously. This can be used to measure immediate impact and if used at a later stage can also assist to compare outcomes within the specific target group to see if desired change has taken place.
- Carrying out a post-mortem after the event to note down own perceptions of what went well or wrong and what needs to be done or improved.
7. Setting an action plan
According to the above aims the action plan would involve launching a campaign to raise an awareness of HIV prevention and treatment among the black African minority ethnic group by using the Beattie model of approach.
On the persuasion activities and advertising someone popular or a celebrity from the black and ethnic minority group is required. For this to be successful or achieved an access or the use of local and national black and minority ethnic media, community centres as meeting places, leaflets and learning packs is required. Evaluation can be achieved through asking participants to fill in questionnaires to air their views at the end of the sessions.
As per Beattie model of approach identify an individual to coordinate manage and spearhead the awareness campaign. The named coordinator is to work with people with relevant expertise and skills in areas where service is required. The campaign’s effectiveness and progress would be monitored by persuasion techniques, personal counselling, community development and legislative action supported by Doyal and Gough (1999). Funding and, other resources and facilities are required and the effectiveness and progress of the campaign will be through asking participants’ views using a questionnaire (Bradshaw (feltneeds, 1972) in Naidoo and Willis, 2000 p. 331).
8. Action and Evaluation
The purpose of evaluation is to found out if the aims and objectives with the use of models and approaches have been met (Ewles and Simnet, 2003). Action and evaluation can be through the use of a log diary or log sheet to record unexpected problems and how these have been overcome as well as unexpected benefits. This information will then be fed into the evaluation process stated above.
Tones and Green (2004, p. 306) states that we evaluate to check whether or not an intervention or programme has worked whilst Naidoo and Willis (2000 p.348) looks at planning as important as it helps direct resources to where they will have most impact and ensuring that health promotion is not overlooked instead prioritised as a work activity. Naidoo and Willis (2000, p. 101) looks at evaluation as a complex process as it is not always possible or easy to link one particular outcome to a particular health promotion. Therefore the health promotion plan’s main purpose of evaluation is to help cut costs after identifying the initiative that works.
Beattie’s model is recommended for this strategic proposal for health promotion because it empowers both the person and community and also fits in with the Ottawa Charter. The model also fits in with most of other models, for instance, it has been shown to be effective by National Institute for health and Clinical Excellence (NICE, 2008) and the Department of Health.
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