hypertension

 

INTRODUCTION

Each year, our world loses 17million people due to deaths by cardiovascular diseases, out of which, 9.4million deaths can be attributed to the complications of hypertension (World Health Organisation [WHO], 2013). Similar grim scenario is prevalent in Australia, where hypertension is categorised as the greatest contributor to burden of chronic cardiovascular disease (CVD) among Australian population, accounting 42.1% of the total burden of CVD. According to National Aboriginal and Torres Strait Islander Health Survey [NATSIHS] 2004-2005, the prevalence of hypertension ranges 1.5 times higher in males and 1.7 times more common in females compared to their non-indigenous counterparts (Gray, Brown & Thomson, 2012). Therefore, this dreadfully growing epidemic of hypertension should be responded insightfully incorporating an innovative health promotion project plan and encouraging a collaborative approach among national and local government bodies, local health councils, civil societies, stakeholders and partners and active support from food and beverage industry. This essay will draw upon the innovative health promotion project plan focussing on NT remote hypertensive indigenous to explore and analyse the chosen health message, implemented strategies, prevention and management actions were adequate and appropriate to bring positive health outcomes in targeted group.

THE PROJECT

This project primarily looks at hypertension in Northern Territory aboriginal remote communities because the statistics and resources show that, there is the highest prevalence of hypertension in remote aboriginal communities particularly aged 50 and above due to their unhealthy food and lifestyle habits. My health message is that, the likelihood of suffering from hypertension can be tremendously decreased by reducing salt contains in daily food consumption and maintaining healthy lifestyle habits. Therefore, “reduce salt -reduce hypertension”, identifying low sodium natural foods, prioritizing fresh fruits and vegetable against junk and preserved foods and cessation of alcohol are key points emphasised in the health message in order to prevent occurrence of hypertension associated cardiac and renal complications. Majority of my targeted audience are illiterate and have low educational qualifications therefore, audio/visual aids and pictures will be the major measures of health message delivering process through simple language avoiding the use of medical terminologies.

TALKING TO THE COMMUNITY

It is crucial to involve community members in public health promotion project as the actual pressing needs and priorities of the community are better known by the local people. The effectiveness of health promotion project widely depends upon the meaningful active participation of the local members and their genuine implementation of outlined health promotion measures; alongside supporting their right to be included in decision-making process of their own health (Australian Institute of Family Studies, 2011; Australian Institute of Health and Welfare [AIHW], 2013b). Indigenous elders in particular are the key decision makers and role models for the families and community, hence they are the first point of consultation for project planning and implementation. Effective communication and rapport built on trust and integrity play a vital role to break down the barriers; get deeper into their actual issues and concerns; discuss their preferences for its solution for barrier-free smooth transformation of information between public health workers and community members (AIHW, 2013b).
It would then be relevant to broaden the scope of consultation and incorporate local community organisations and councils such as local health care service providers (Aboriginal Medical Service Alliance Northern Territory [AMSANT]), indigenous community leaders, local governments, stakeholders and local media such as radios and newspapers. Community consultation also helps in identifying any similar project implemented previously, its effectiveness, local people’s feedback about that project, what they liked and what they want to improve and how differently they want this project to be done. However, it is equally important to demonstrate sensitivity towards their culture; and respect their sense of connection towards their land and their people, while planning and implementing indigenous community based health promotion project.
IDENTIFYING THE ISSUE

The alarming prevalence rate of aboriginal hypertension, according to national statistical findings, drives a keen interest for the health promotion project to consider hypertension prevention and management among indigenous adults in remote northern territory of Australia. According to Australian Bureau of Statistics [ABS] (2004-2005), the national indigenous hypertension rate reached 22%, which is twice the national prevalence rate of hypertension (11%) among the overall Australian population (ABS, 2006). NT remote communities share the greatest responsibility for the higher prevalence of hypertension among indigenous in the national health figures, with 50% prevalence rate at age 50 and over (Zhao, Connors, Wright, Guthridge & Bailie, 2008).

Cardiovascular disease including, hypertension was the leading contributor, accounting 14.9% of the total burden of the disease and injury in NT of which, NT aboriginal population beared 2.5 times higher burden of the disease compared to their non-aboriginal counterparts (Zhao, Guthridge, Magnus & Vos, 2005).The burden of hypertension among Indigenous community can be attributed to interwoven high risk modifiable and non-modifiable determinants such as their dietary patterns, lifestyle habits, and socio-economical, educational, cultural and geographical backgrounds.

Statistical evidences reveal that the indigenous population are socio-economically disadvantaged compared with non-indigenous Australians, thereby their dietary choice includes lowest cost food options such as fast foods, processed and junk foods which are rich in salt, saturated fats and sugar content (Australian Government Department of Health, 2012). Furthermore, high risk level alcohol consumption, physical inactivity and prenominal access to health services for majority of NT remote indigenous inhabitants, accompanies to surge up the susceptibility of hypertension (AIHW, 2013a).

IDENTIFYING STAKEHOLDERS AND PARTENERS

Stakeholders are the individual, group or organisation with an authority, interest, involvement or investment on the project who have the ability to influence the behaviour of targeted population or can itself be affected by the activities and achievements of project (WHO, 2015; Friedman & Miles, 2006). Active participation of stakeholders and collaboration among partnerships is vital as it fulfils the knowledge, skills or any professional deficits of either parties eventually leading to successful accomplishment of desired goal. However, it is equally essential to ensure that collaborative multidisciplinary team approach including interested and committed relevant stakeholders and partners is formed with appropriate delegation of roles and responsibilities among the members. Similarly, regular discussion and participation in planning the strategy and implementation of project helps in avoiding conflicts of ideas and interest among stakeholders (Fleming & Parker, 2011).

Stakeholders and partners in this project include community elders who have the ability to spread knowledge among community members, enforce change in the behaviour of community members, evaluate for any positive and negative outcomes and provide feedbacks for improvements if needed. The indigenous community health workers play a pivotal role in identifying real concerns of the local people, their willingness towards implementing change and also establishing good rapport among the community members and project launchers (National Aboriginal Community Controlled Health Organisation, 2014). Other stakeholders and partners such as local indigenous organisations, health clinics, local government bodies and leaders, indigenous health promotion coordinators have a crucial role in the optimal success of the project.
PUTTING THE PROJECT TOGETHER

The project plan “reduce salt reduce hypertension” aims at creating healthy food awareness in indigenous adults through implementation of innovative health promotion strategies and management plan in order to achieve optimum or near outlined positive health outcomes. Hypertension is caused by number of bio-medical, environmental and lifestyle factors such as unhealthy food habits (particularly high salt intake), alcohol consumption, smoking, obesity and inactivity. Looking at the priority need of community and educational background of its people, the project primarily focuses only on addressing the food habit and alcohol consumption problem, as a lot of information together can be overwhelming and difficult to understand and retain, for the community people.
The project includes health promotion activities such as two way group discussion among community people, primarily focusing indigenous adults, local indigenous health worker, and remote community health nurses. Role play featuring the local people can be an effective way to reach the health message to targeted group. Role play used to create awareness on health impacts of risky alcohol consumption can be effective as both aspects, benefits of alcohol cessation and fatal impacts of alcohol consumption can be highlighted. Use of audio/visual aids; display posters, puppet show, flash cards, newspaper, radio and television program in collaboration with local media outlets help in reinforcement of information to the local people.

Involving community leaders and indigenous elders in short health message delivery speech ensures that information are seriously taken by the audience as elders are the trusted educators in indigenous culture. Locally grown fresh food demonstration installs can be effective to educate the people in the selection of low salt contain, high potassium foods and also aids in identifying the hypertension inducing versus preventing foods. Apparently, there are many evidences of effectiveness of cooking classes in changing the food consumption and selection pattern in indigenous community (Browne, Laurence & Thorpe, 2009). The striking problem of inaccessibility of fresh fruits and vegetables in the remote indigenous community can be minimised by encouraging community garden (Byrne & Anda, 2006). However, it is very crucial to ensure that health message is delivered in a simple language avoiding use of medical terminologies and where possible by their own people in their language/slang.

BUDGET AND TIMELINE

Budget estimation and management is one of the challenging steps in project management. However, realistic, well-crafted and accurately estimated budget facilitates smooth progression through timely implementation of the strategies, thereby preventing the project getting off the tract (“GUIDE: Developing a population”, n.d.). Active involvement of local community members and stakeholders is imperative in budget processing as it enhances the transparency and generates well-thought ideas and strategy for appropriate fund allocation (Fleming & Parker, 2011). Most of the stakeholders here are local members, thereby their participation insures actual needs, problems and constraints are prioritized during budget allocation.
It is crucial to identify budget sources in discussion with stakeholders and partners, which may include government funds, cash contributions or voluntary manpower from local organisations, indigenous health council’s budget for community health programs and even voluntary fundraising program among stakeholders, partners and community members can be established. Next, a clearly outlined timeline can be developed appropriating time for implementation, evaluation, feedback, which also aids in the accomplishment of the project within the desired timeframe.

EVALUATION OF HEALTH OUTCOMES

Evaluation is the process of judgement of effectiveness and progress with the purposes of; ensuring accountability of stakeholders, partners, community member, local health councils and government bodies; and determining whether the desired goals are met, what went well and what needs to be improved (Fleming & Parker, 2011). Engaging stakeholders, partners and local members in evaluation process is important. As stakeholders and partners invest funds for the project they are interested in the result of the project. This way, flexibility, trust and feedback and capacity sharing among stakeholders and program staff are maximised (Butterfoss, Francisco & Capwell, 2004). Moreover, it also increases the likelihood of effective implementation of evaluation result for long term basis.

Similarly, the commonly used four components evaluation approach in health care includes, context evaluation, which determines whether the environment, targeted group and their impeding factors has been directly addressed. For example, indigenous adult in remote NT communities, low socio-economic status, illiteracy and geographically remote habitat. Next is the input evaluation, where adequacy and appropriateness of program plan, public health resources, audio/visual aids, manpower, and practicality of health message are analysed to see whether it meets the goal of the project.

Thirdly, process evaluation is an ongoing assessment of programs, strategies, and activities implemented to determine whether they are likely to generate expected results on time. Lastly, outcome evaluation assesses the change in nutrition knowledge of indigenous adults, inclusion of fresh fruits and vegetable in daily consumption, salt intake amount, alcohol consumption habit and other positive health outcomes that can be attributed to project intervention. Finally, once the evaluation results are obtained it is good to disseminate and share the lesson learnt so that it can be useful to intended users for information and reference purpose (Fleming & Parker, 2011).
CONCLUSION

Hypertension accounts as one of the most common burden of cardiovascular diseases in Australia. Sorrowfully, the scenario is even worse among Australian indigenous reaching approximately two folds higher prevalence rate compared to non-indigenous population. Therefore, an innovative health promotion project plan addressing the impeding socio-economical, bio-medical, cultural geographical factors, particularly focussing on healthy nutritious diet with the key message of avoiding excess salt intake can have a significant influence in reducing the hypertension complications in indigenous adults. However, collaborative approach, including community participation, support from local health councils and government bodies and involvement of stakeholders and partners in planning, implementation and evaluation helps in targeting the actual needs and constraints of community. Taking stakeholders and partners on the board during the evaluation process develops a trustworthy relationship, promotes exchange of feedbacks and capacity and thereby increases the likelihood of learnt behaviour to be implemented for long term basis.
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