Critical Reflection on Health Promotion

Introduction

Society is constantly faced with various health problems. Many are unaware of practices which work to the detriment of individual health fitness. In the recent past, governments as well as community based organizations have realized that prevention is cheaper than cure. It is on this basis that an increased number of organizations are engaging health promotion activities rather than waiting to treat the outcome of unhealthy practices. The role of health promotion is not only creating awareness to people on what they need to do to live a healthy lifestyle, but also to initiate and facilitate activities which promote healthy practices. While a number of health promotion initiatives exist, this paper limits itself to a promotional activity aimed at prevention of dental caries.

The critical reflection is about NHS Islington’s fluoride varnish application programme in Islington. It involves inspection of the children’s teeth and consequently applying fluoride varnish to the teeth. In my role as a volunteer in dental screening and fluoride/varnish application in school settings, I engaged in various roles, which greatly enhanced my knowledge of health promotion practices. I basically assisted in paper work and children‘s documentation as they received dental screening within the schools I operated from. This role included assisting in preparation and maintenance of clinical environment i.e. equipment, preparation and mixing of materials used in dental management, maintaining accurate and up to date patient records, and supporting patients as well as colleagues in instances where there are medical emergencies. Additionally, I provided patients with leaflets which provide them with information on use and effect of fluoride varnish. Changing patient’s perception towards the varnish was an important part of the project. The leaflets informed the patient that they need to eat normally prior to application of the varnish and that the process was quick and simple. Additionally, they were made aware that the varnish leaves a yellow tint on the tint of the teeth which wears off with time.

My area of interest being health promotion activities was apparent in my work process. The program was mainly in response to a crisis program to reduce widespread dental problems across the region. Initially I spent the first few days the group to assess the techniques they employed and how they motivated the children to participate in the program. Having explored the approaches and techniques they used, I actively engaged myself in the program for as much as possible. Generally, my involvement made feel more part of the program unlike when I was an observer. Campaign work continued alongside dental protection activities and after some time, it became apparent that I was part of the activity as tactical consultant and a practical assistant. Involvement into the program was generally essential to in order to lay foundation for a positive relationship with the groups involved. However, it was often important to remain the periphery and assess the ongoing events in the health promotion initiative. Ultimately though, my direct involvement enabled me to assess each and every prevailing situation/occurrence.

In my information search, I found I established a strong link between the area of community development and health promotion. Most texts I found acknowledged this link and explored the interrelation between the two. The essential element of this relational approach is that thorough health promotion, community development is also undertaken. Further, this approach allowed a closer look between the health promoter and the demands of the target society. Performance of the program was important to this study. Notably, there are persons who come into such program with noble aims but find themselves unable to meet the demands of the society. Such failure results into insecurity and ultimately inability.

I was also able to communicate with the person in charged of the health promotion initiative and he gave me useful ideas on how to build a competency based assessment of a health promotion initiative. He informed me that the entity had made rigorous efforts to enhance its health promotion strategies and adapt new approaches to the initiative.

Rationale for health promotion

Dental caries remains a major problem in the United Kingdom. Despite the non-fatality of teeth disorders and oral cavity, they result into constant discomfort and pain to the affected. The main causes of oral problems are poor health choices, social opportunities and lack of adequate prevention measures. This explains the commitment of the NHS in promotion of good practices which facilitate maintenance of dental healthcare.

The dental health service provide within schools aimed to achieve the following (Riordan, 1993: 177):

• Educate children, their parents and the community to achieve and maintain good oral health.
• Control existing dental disease in children.
• Prevent further dental disease.
• Promote a positive attitude towards seeking regular dental care.

The program emphasizes on identifying and treating each individual child’s case independently. Each child’s preventive plan takes care of individual factors and history information. Health promotion and preventive care programs for individuals aim to create favorable attitudes and behaviors for continuation of care and to encourage greater responsibility for personal dental health.

Preventive care consists of:

• Methods of oral hygiene
• Advice on diet
• Fluoride therapy
• Fissure sealants

Literature search

Background information

Many of dental care interventions focus on improving dental health. Most of the interventions are focused on fluoride availability to the teeth. The measures often require support at both local and national levels depending on the extent of implementation. The measures incorporated in Islington were mainly a result of the declining oral health within the area. Enhanced access to dental health care and preventive measures are the prime focus of the program. A recently released epidemiological study showed that amongst five year olds, the overall reduction in decayed teeth, teeth extraction and filling was significant as a result of implementation of a similar program. The research further stresses the likelihood of replication of the same results in other area within the nation. It is on this basis that similar exercises are initiated In Islington to further improve oral health within the area. Fluoride applications are therefore successful in prevention of the teeth against dental caries. Fluoride varnish is one such application.

Marketing of Fluoride varnishes dates back to the 60,s where it was used as an adjunct to conventional topical agents, such as fluoride toothpastes, for the prevention and control of caries (decay).despite widespread recommended use in across Europe, Australia and America, its usage remains relatively low just as it is acceptance in general dental care practices (Riordan, 1993: 179). In 2007, the Department of Health rolled out a plan for delivery of better oral healthcare to its population through the NHS. The plan recommends selective application of fluoride varnish twice yearly for all children and young adults aged three years upwards and for adults giving concern with regards to caries. For youngsters with special concern, a recommended application of up to four times a year is given.

It is one of the best application options of topical fluoride to the teeth and various researches have confirmed its ability to prevent dental caries. Its safe usage is proven and its application too is simple and requires little amount of training. Reliable evidence indicates that bi-yearly application results in a mean decay decline of 33%, in primary teeth and 46% in case of permanent teeth (Marinho et al, 2002). The reports support the fact that administration of varnish fluoride twice year to children between age 3 and 6 and 3 to 4 times a year for high risk patients alters the outcome to the positive side with reduced case of tooth decay recorded in both instances.

Application of fluoride varnish

Application of Fluoride varnish is rather simply and no specialized training is necessary. However, due to its high fluoride content, its prescription is restricted to dentists, though dental therapists may apply it under dentist’s prescription. Lately, dental nurses have also been allowed to administer it though under special circumstances (Helfenstein & Steiner, 2007: 4). Additionally, regulation shave been proposed to allow group prescription rather than individual prescription for each child. Unlike, water fluoridation though, no evidence is attributed to the safety of using fluoride varnish despite its consistent use over the year with no reported adverse health effects. It is however, contraindicated for children with history background of allergic episodes which call for admission into hospital e.g. asthma (Beltran-Aguilar, Goldstein, & Lockwood, 2006). Achieving benefits of fluoride varnish requires a regular need to attend to the children. This may be difficult to achieve in groups with high decay levels and increases the chances of raised rather than reduced dental inequalities. School provision of fluoride varnish requires parents/guardians consent and some medical history this is often difficult to achieve when large populations are involved and is time consuming in addition to costly. However, the effective is ultimately limited to those children who receive regular attention and provide relevant medical history as required.

In this program, all children whose parents had consented through earlier sent forms have fluoride varnish applied to their teeth. Application is performed by a member of the dental team during visit to the respective school. A clear record is kept to ensure that future administration done on basis of the past application. All children receiving fluoride varnish are dealt with according to their need. Other than this, they are also given lessons on dental health care best practices.

Costs

Fluoride varnish costs between £30 to £40 per 10ml tube and this quantity can be applied to between 20 to 30 people depending on the respective needs of the patients. The overall cost though covers application, travelling and administration costs (Helfenstein & Steiner, 2007: 5). Additionally, its cost effectiveness is dependent on the number of children attended to or regularly attends care. However, little reliable data are available with regards to costs and cost effectiveness of programs already conducted within the United States. Researchers propose that its cost effectiveness be evaluated on basis of interventions; cost-effectiveness is related to how effectively it can be targeted at high risk individuals, its implementation, and running costs as well as ability to sustain it over the required period. So far only water fluoridation and salt fluoridation has been widely used as a population measure. Fluoride varnish is often used for specific target risk group.

Reflective Commentary

Strohmenger & Brambilla (2001) assessment was rather different and complicated. Given my health promotion experience, it is my belief that specialized experience and relevant knowledge are a prerequisite to providing quality services. However, fresh and reflective approaches are fundamental and critical to successful outcomes. As a relatively non-experienced health promoter, it is my acknowledgement that inexperience and non-complacency can easily lead to a needs led approach in program assessment. Throughout the program, I have accessed websites compiled by health promoting bodies, research entities, news, and current developments in order to gather information. I have also interacted with key stakeholders in health promotion within a school setting including head teacher, class teachers, classroom assistants, residential supervisors and shift working staff. Additionally, I met with previous specialists who attended to the schools as well as advocacy workers. This proved me with an opportunity to not only gain knowledge and experience from them but also get their opinion on health promotion initiatives. I was also able to engage in constructive evaluation of the program in depth based on its school initiatives.

Of the most important issues on the agenda of the mankind, is the state of people’s health, the issue of health promotion is important as ever. With help of efficient reflective practice, the modern medicine and health care system will be likely to change the situation. Therefore, the issues concerning the reflective practice are to be studied thoroughly to realize what effect the practice will produce. One of the prior goals would be to define the very notion of health practice. Without knowing well what the phenomenon presupposes, one ill not be able to analyze its components.

Another idea that can be quite useful when creating specific health practice approach is creativity. Applying to certain norms of the health care does signify that it is the professional who is tackling the problem; yet the person creating the scheme of the health practice schedule must also make good use of his/her imagination. Otherwise, there will be no effect in the practice.

Another thing that one must think of is adjusting the healing practice process to the peculiarities of the patient. Knowing the weak and the strong points of the patient’s health, a doctor can be absolutely sure about the course of procedures that he/she prescribes to the given person. Once missing an important fact about the patient’s organism, a doctor can make a serious mistake that will drag the most deplorable consequences.

Evaluation involves measurement practice effectiveness and whether or not the desired outcomes are achievable (Strohmenger & Brambilla, 2001). It provides an opportunity for consideration of what has worked well and what has not worked. Additionally, it allows identification of what needs to be changed or could have been done differently to yield better results. Looking at the enthusiasm and commitment with which the staff and children undertook the exercise, it was obvious to me that the program would yield positive outcomes.

The experience provided me with an important opportunity to gain first hand experience with community based health promotion. The school environment offered an ideal place for such. Prior to the exercise it was important to define the basis for the initiative in context of the gains it was expected to avail to the community. Prior understanding of the phenomenon helps in setting of objectives and hence the line of activity. A number of important aspects to be considered in evaluation included process of search for health needs, specific attention to is the relative autonomy of the health practice, change of health condition; and the schedule established for the health practice. Additionally, room should be created for appropriate adjustment of health promotion activities in line with the changing needs of the target group. Another key and vital feature of such an exercise is being able to make a patient realize that his cooperation is necessary if the target problem is to be solved effectively. Therefore, making the patient aware of his problem is one of the core issues of the reflective practice. Without this element, one cannot achieve success in the reflective practice with a certain patient. Thus, specific plan must be worked out to create the pattern of a worthy reflective practice.

Working with groups helped me realize social skills and approaches are necessary in order to build a cohesive team. Needless to mention that, a cohesive team is critical to eventual success of any initiative. Success group initiatives require good communication and negotiation skills, ability to think strategically, caring and supportive. Additionally, the need to be non-judgmental can not be over stressed. The need of the group should be considered as a whole and likewise each member must respect the other. Commitment and close attention to each attention to every individual to encourage him/her participate in the activities is also critical.

Health promotion is an opportunity for one to touch on the lives of many others who are exposed to health risks. Watching people live unhealthy lifestyle is often painful and one can only wish that he/she had the ability to change this. Health promotion initiatives offer such an opportunity. For instance talking to people about effects of smoking could save a number of lives who are continuously exposed to the dangers of cigarette smoking. The health of an individual is one of the basic needs that should be observed, and I feel it is my responsible to change the world. It has been my pleasure to volunteer in many cases just to ensure that advocate for healthy living, but that has not been satisfactory, I need to see

Another important part of working with people in health care profession includes cooperating with co-workers who may treat me as a professional or as a parvenu, may try to help me or ignore my decisions and prevent me from performing my professional duties. Ability to cooperate with co-workers to treat the individuals effectively is one of the factors that contribute positively to the successful work with individuals. In this respect, cooperation concerns all parties concerned including individuals to be treated and those who treat them. My social skills are appropriate in terms of adequate response to the needs of patients and ability to explain the most complicated issues that may concern the insurance and complications related to health and rehabilitation period the change.

Lessons learnt

Health practices are meant to improve and secure future health of the target group. It also comes in form of intervention to groups already affected by a specific health condition. Health promotion is of everlasting importance. Efficient reflective practice s capable of altering the medical landscape to be more helpful than it is today. Reflection offers opportunity for identification of the strengths and weaknesses of any given program. Therefore, the issues involving reflective studies require through attention if effectiveness is to be realized. While many lessons emerge during the project, a key and important lesson is the need to search for health needs prior to implementation of any program. It is only through such identification that effective healing and attention process can be undertaken. Autonomy of the health practice must also be taken into consideration. Indeed, once starting the healing process, one must be ready for the change of health condition; therefore, the schedule established for the health practice period must be flexible enough.

Creativity is also a necessity in getting the target group to accept a give health practice. Personal imagination, and thought must complement the professional part of an individual if the effect of a give health practice is t be felt. Strict adherence to guidelines even when need demands otherwise may render a program redundant and ineffective to the target group. Another important lesson is the need to adjust the promotional practices to the peculiarities of the patient. Weak and strong points of a patient are useful in identifying the best course of action in attending to that individual case (Sheiham & Watt, 2000: 401). Patient history is critical to avoiding mistakes in diagnosis and hence prescription. Making target groups understand the importance of a given health initiative require time, skills and commitment. Most people would rather attribute their problem to some other thing than accept that it’s a result of their habits. Making the targeted group aware of their misdoings is a core issue of health promotion initiatives. Tools are also critical to successful implementation of a health promotion initiative. Applying various approaches, combining traditional means with innovative methods of health practice, one must create a reflective practice paradigm to follow and the tools to achieve the goal. Generally, health promotion brings together all the aforementioned elements to create an approach to solution of complex health problems.

The importance of quality assurance can not be ignored. Quality assurance refers to the act of putting in place in all necessary measures to ensure the end service successfully achieves its intended purpose (Sheiham & Watt, 2000: 403). Basically, healthcare providers have set of measures in place to ensure quality standards are observed. Unlike the general healthcare scenario, the presentation and behavior of staff directly represents the quality of service amongst social workers. Quality is basically a measure of service. All players strive to ensure that they not only meet the minimum quality service thresholds but even surpass the same.

The health promoting entity has an ethical obligation to ensure that quality services/products are availed to patients and clients respectively (Sheiham & Watt, 2000: 404). However, approach to quality assurance as well as assessable quality dimensions largely differ. While in the health sector quality is defined with regard of care standards and procedures including the technical standard of providers and patients expectation, social setting of health promotion is dependent on how well the society views the outcome and how aware they are about the benefits of the program. It is important to note that these definitions give a shallow but broad illustration of the variations in quality perception within healthcare and community setting. What is however evident is the fact that both sectors view quality assurance as a standard ethical procedure which must be attained at all costs. In general, quality assurance may therefore be said as involving all arrangements and activities which safeguard, maintain and facilitate quality healthcare provisions. It involves measurement of quality, identifying deficiencies, undertaking improvements and evaluating whether such improvements are successful (Pinkham, 1988: 78). A number of dimension emerge which literally define the perception of healthcare promotion implementation. These are discussed hereafter

Healthcare promotion quality

Healthcare promotion is multifaceted and comprehensive. Various experts have identified dimensions which distinguish quality in healthcare promotion to that of other areas. Experts have successfully recognized several quality dimensions important healthcare promotion quality assurance. These include: availability of social amenities, service continuity, and efficiency of provided services, interpersonal communication, and relations between staff, health-care accessibility, technical know-how and staff competence (South Australian Dental Service, 1996). These useful dimensions provide useful dimensions upon which health teams define and analyze problems within organization and measure the extent to which standards are being attained. Each of the mentioned dimensions is discussed in light of oral healthcare program implemented by NHS at Islington.

Technical Competence

This dimension refers to the skills, capability and actual performance of healthcare providers, administrators and support staff. The management has a responsibility to ensures that technically competent staffs are available to attend to patient needs and advice them appropriately. For instance, a village health worker must have necessary skills and knowledge in order to be able to efficiently provide health services. Technical aspects cover the abilities of availed staff to execute practicable guidelines and standard reference terms in a dependable, accurate, reliable, and consistent manner (Pinkham, 1988: 79). Healthcare promotion setting. For instance, an inefficient records keeper would create long queues and long wait durations before patients are attended to. The same is true for an inefficient doctor. Technical services further refer to availability of technical facilities which facilitate healthcare promotion.

Access to Services

Healthcare provision quality assurance must also take consideration of accessibility in terms of geographical location, transportation access, and any other physical barriers which may hinder accessibility. Other restrictive features include economic considerations, social factors, organizational arrangements, and linguistic obstacles. Economic consideration refers to accessibility while cultural considerations take note of the cultures of the people served by a health facility. Organizational factors on the other hand deal with how services are conveniently planned including clinic hours, systems of appointments, wait durations, and service delivery mechanism.

Effectiveness

This dimension cannot be ignored within medical practice. Overall quality is largely dependent on service delivery norm effectiveness and clinical guidelines. Basically it address the question, “Does treatment procedure if correctly applied result into desirable outcome?” and is the treatment approach the most technologically appropriate. Effectiveness issues form the pillars upon which managers/administrators reforms and adapt them to locally applicable conditions. It involves comparison of potential benefits to detriments.

Interpersonal Relations

Interpersonal relation’s dimension defines the interaction between health providers’ patients, administrators as well as other stakeholders. Good relations are based on trust and credibility which arise from demonstration of respect, information confidentiality, and responsiveness to client needs, and empathy. Effective listening and communication should be encouraged as a way of bridging rapport barriers. Patients who are treated inhumanely during their visits are likely to desist from visiting the facility or even seek advice from health practitioners.

Continuity

Continuity dimensions refer to the receipt of a complete range of health services by target group without unnecessary interruption or cessations. There is need for service provision in a continuous manner and the target should have routine access to preventive care.

Safety

Safety is an important quality dimension in all sectors of service and product manufacture. Administrators have a responsibility of engaging in safety practices which minimize injury risks harmful side effects and other dangers associated with service delivery (Short, 1987). The target group must be protected from mistaken infections, and other forms of problems which may arise from logistics. Lack of safety measures could expose the target group to various risks which would have otherwise have been prevented.

Amenities

This dimension refers to those features which health service facilities need to offer though not directly related to clinical practice and effectiveness (Short, 1987). Such facilities often dictate client’s willingness to visit the facility next time. They are also important as they directly affect client’s expectations are perception of service facility. Additionally, they help build client confidence and willingness to wait for the service being provided. Generally, amenities refer to the physical appearance of health facilities, personnel and materials available. Additionally, cleanliness, comfort and privacy also play a role in defining amenities.

Reflective discussion

The aforementioned dimensions provide a broad concept framework which defines various aspects of health care promotion outcome. The dimensions touch on all stakeholders as clients, providers, and healthcare administrators define quality form their independent perspectives. While client’s associate quality with their perceived needs, courteous delivery and timely provision, healthcare providers perceive quality as implying their possession of relevant skills, resources and conditions necessary to improve a patient’s health status while administrators focus on supervision, financial and management logistics. However, all these are interlinked and basically premised on proper administration.

Knowledge is a primer in healthcare promotion. Foundations for sharing and management of knowledge should be placed in order to ensure that quality is not only attained but it is consistent to the changing needs of the target group. Knowledge on existing techniques offers a systematic approach to acquisition, analysis, storage, and information dissemination in relation to service provision, provision techniques, and components utilized. Other than product knowledge, other information sources include prior knowledge, studies in dental care, transfer of technology, validation studies on service effectiveness, experiences, and changes in activity management. Critical evaluation offers pro-active approach to identification, scientific evaluation and control of poetical sources of risk in health promotion. It allows enhanced continuous improvement of processes and service quality.

Conclusion

In conclusion it important to reiterate that Health care is an important part of the national security because health care professionals enable the population to live healthy lives by examining their organisms carefully, prescribing appropriate medication measures, and treating them in accordance with the legal regulation in this sector of human activity. It is my belief that teaching the population on effective health management initiatives is key to achievement of a healthy population. Trust and cooperation are likewise essential. They are the key elements to communication and hence social interaction between the health provider and the target client. A health provider has an obligation of informing the clients on all possible alternatives and recommend the bets approach

The overall impact of the program, is it stressing the importance of Fluoride in dental care, fluoride is found in found in water supplies, either naturally or artificially introduced. High levels of fluoride in water often results into teethe brown mottling. Areas water lack fluoride requires that it be supplemented. Fluoride is also found in toothpaste though limitations are always set as to the amount of fluoride that tooth paste can have. Often toothpaste manufactures make low fluoride tooth pastes for children due to their tendency to swallow them. Breast milk also contains fluoride though at relatively reduce amounts. Many infant foods in the market however incorporate fluorides into their mixtures. Other sources of fluoride include the following;

• Naturally occurring in foods and drinks.
• Added to community water supply (fluoridation).
• Fluoride toothpastes, gels and mouth rinses.
• Fluoride gel painted on the teeth by a dental professional.
• Drops and tablets.

Although no immediate outcome measures can be derived from the health promotion exercise, the general response of the target group and the general perceptions of the program by the target group reflect its acceptability as a possible means of alleviating dental elated problems.

References

Beltran-Aguilar, E. D., Goldstein, J. W. & Lockwood, S. A. (2006). Fluoride varnishes: a review of their clinical use, cariostatic mechanism, efficacy and safety. J Am Dent Assoc, 131, pp. 589−596.

Helfenstein, U. & Steiner, M. (2007). Fluoride varnishes (Duraphat): a meta-analysis. Community Dent Oral Epidemiol, 22, pp. 1−5.

Marinho, V. et al. (2002). Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev, 3, pp 79-82.

Pinkham, J.R. (1988). Pediatric Dentistry: Infancy through Adolescence. W. B. Sanders Company, Philadelphia,USA.

Riordan, P. J. (1993). Fluoride Supplements in Caries Prevention: A Literature Review and Proposal for New Dosage Schedule. Journal of Public Health Dentistry. Vol. 53(3), pp. 174–189.

Sheiham, A. & Watt, R. G. (2000). The common risk factor approach: a rational basis for promoting oral health. Community Dent Oral Epidemiology, 28(6), pp. 399-406.

Short, M.J. (1987). Essential Anatomies: Oral and Head/ Neck Delmar Publishers Inc. New York, USA.

South Australian Dental Service (1996). Child & Youth Health and South Australian Dental Service Nursing Decay. Information Booklet.

Strohmenger, L. & Brambilla, E. (2001). The use of fluoride varnishes in the prevention of dental caries: a short review. Oral Dis, 7, pp. 71−80.