Health Promotion & Role Development in Adv. Nursing Practice

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Health Promotion Proposal, Part 1

Writing Assignment Week 4

Sluvia Algarin

Florida National University

Health Promotion & Role Development in Adv. Nursing Practice-DBX-DL01

Dr Nora Hernandez-Pupo

May 24, 2024

Breast Cancer

Breast cancer is still one of the most trumpeted health concerns facing women the world over. It is the most prevailing cancer in women, accounting for about 30% of all female cancer incidence. The magnitude that this illness carries with it is worrying; the American Cancer Society projects that it is estimated that about one in every eight United States women will develop invasive breast cancer over the years of her lifetime. Breast cancer, despite advances in medical technology and better treatments, continues to claim so many lives. Risk factors go along with genetic predisposition, lifestyle, environmental exposures, and vulnerability of some populations due to restrictions in access to healthcare, socioeconomic challenges, and educational disparities (Zafar et al., 2022). Such a health disparity creates a need for targeted health promotion for better early diagnosis rates, improved information about the disease, and a supportive environment for patient care.

Effective health promotion includes early diagnosis improved outcomes of treatments, and thus eventually reducing deaths arising from breast cancer. Such an urgent health problem is to be tackled through the all-inclusive approach that includes education, ss to screening programs and support systems, and the emotional and physical burdens disease entails. In low- and middle-income nations, the health promotion program should raise breast cancer awareness and aid early diagnosis. Community-based education campaigns, training for community health workers to provide support and navigation services, and affordable and accessible screening facilities will improve breast cancer screening knowledge. The program will aim to raise breast cancer screenings by 20% and early-stage breast cancer diagnoses by 15% in the first year. Local health records and program participation data will track these outcomes.

Vulnerable Population

Women at Risk for Breast Cancer

The susceptible groups who are highly affected by breast cancer are women from low economic status, ethnic minorities, and those who reside in rural settings. These groups tend to be associated with considerable barriers to the use of healthcare services due to inadequate insurance, poor availability of medical facilities, and cultural or language differences (Chazarri et al., 2023). Besides this, women with low education have less knowledge regarding what risks are associated with the disease of cancer and the significance of receiving regular screening services for breast cancer. Due to poor awareness and access to preventive care, the incidence of late-stage diagnoses on the rise is related to poorer outcomes and higher mortality rates. The most vital risk factor for breast cancer is the socioeconomic status in such populations. Women from economically disadvantaged families are unlikely to have insurance coverage, which consequently reduces their access to routine medical services such as mammograms and clinical breast exams. Ko et al. (2020) add that the uninsured women are diagnosed with breast cancer disease during the late stage of the disease, which is hard to cure. Furthermore, the Centers for Disease Control and Prevention continue reporting that late-stage diagnoses are more common in rural areas because women within the population usually have low income, and there are no health care services centers.

Many vulnerable breast cancer groups are ethnic and racial minorities. African American women are more likely than whites to get triple-negative breast cancer, which is more aggressive but less curable. These differences are caused by genetics, tumor biology, and detection and treatment delays. Research shows that African American women are unable to acquire prompt follow-up care after an abnormal mammography and proper treatment for their stage of cancer, which may worsen their outcome. Additionally, Hispanic and Latina women have distinct problems. They are less likely to participate in breast cancer screening programs because of cultural beliefs, linguistic barriers, and fear of diagnosis. A recent Journal of Cancer Education study found that Hispanic women often rely on family and community support for health information, which may delay medical treatment (Polek et al., 2020). Socioeconomic factors, such as lack of insurance and low income, limit their access to necessary medical services. The other significant etiological factor is the genetic factor, especially if the patient is female with a family history of breast cancer. The mutations of the BRCA1 and BRCF2 genes predispose a person to have a very high chance of developing breast cancer. However, genetic testing can be pretty helpful in the identification of high-risk individuals; accessibility in terms of affordability and availability is typically low for at-risk women in vulnerable populations. The report in the Journal of Clinical Oncology also demonstrated that minority women were less likely to be referred for genetic counseling testing.

Review of Literature on Evidence-Based Interventions for Breast Cancer

According to an evidence-based study, early detection, rapid diagnosis, and complete treatment improve breast cancer survival rates, especially in low—and middle-income countries. Wilkinson and Gathani (2021) note that community-based education and awareness programs reduce cancer stigma and promote early symptom detection. These therapies can considerably downstage breast cancer upon diagnosis, improving treatment results and reducing death. The WHO's Global Breast Cancer Initiative (GBCI) standardizes care through health promotion, timely detection, and complete treatment, which are crucial in resource-constrained areas.

Despite their benefits, these approaches need to be revised. Regional healthcare infrastructure variability is a drawback. Community health workers and education initiatives are crucial, but many LMICs need more basic diagnostic and treatment facilities. Wilkinson and Gathani note that insufficient diagnostic services can lead to over- or under-treatment. In addition, financial constraints and the high expense of comprehensive cancer care worsen breast cancer outcomes. Universal health coverage (UHC) is offered to decrease financial problems; however, implementing it is challenging. Digital innovations and artificial intelligence may reduce workforce shortages and improve diagnosis accuracy, but their efficacy and deployment in low-resource settings must be proven and studied. Therefore, while the evidence-based interventions recommended are intense, their effectiveness depends on addressing these systemic deficiencies and providing equal healthcare access.

A contrasting study by Smolarz et al. (2022) presents a detailed review emphasizing that effective interventions are multidisciplinary. Some of the key strategies include hormone therapy, chemotherapy, and emerging treatments like immunotherapy, essential for triple-negative breast cancer, which is quite challenging due to its aggressive nature, and no targeted therapies are available at this time. The strengths of the review concern detail in the source about several treatment modalities that, in the process, pinpoint their specific applications depending on the molecular subtype of breast cancer. The paper stresses individualized treatment plans, so how new treatments could affect outcomes is very apparent. However, significant weaknesses are the limited focus on preventative measures and the socioeconomic barriers inherent in advanced treatments, especially in the developing world.

Health Promotion Model: Pender's Health Promotion Model

Breast cancer early detection and prevention among low—and middle-income countries can be effectively implemented with the help of Pender's Health Promotion Model. Nola Pender developed her HPM based on individual behaviors and their determinants; hence, it applies broadly to those activities where health promotion is expected to encourage early screening for breast cancer and timely consultation with the doctor. In this model, the perception of the personal factors, perceived benefits, and barriers to action toward identified challenges in breast cancer care is critical.

Critical constructs in the model are individual characteristics and experiences, behavior-specific cognitions and affect, and behavioral outcomes. Individual characteristics such as age, educational level, and even cultural beliefs, and experience can guide health behaviors in breast cancer prevention. For example, awareness campaigns could be specifically targeted to particular demographic groups that are experiencing barriers towards screening, such as misconceptions of cancer or fear of diagnosis. The theory of HPM proposed that systematic and practical health promotion intervention design can be realized by paying particular attention to such perceived benefits as the potential for enhancement in survival rates due to early detection and reducing perceived barriers related to cost and accessibility in diagnostic services (Turner & Reed, 2023).

References

Chazarri, L. P. -, Ponce-Blandón, J. A., Immordino, P., Giordano, A., & Morales, F. (2023). Barriers to Breast Cancer-Screening Adherence in Vulnerable Populations. Cancers, 15(3), 604. https://doi.org/10.3390/cancers15030604

Ko, N. Y., Hong, S., Winn, R. A., & Calip, G. S. (2020). Association of Insurance Status and Racial Disparities With the Detection of Early-Stage Breast Cancer. JAMA Oncology. https://doi.org/10.1001/jamaoncol.2019.5672

Polek, C., Hardie, T., & Deatrick, J. A. (2020). Breast Cancer Survivorship Experiences of Urban Hispanic Women. Journal of Cancer Education, 35(5), 923–929. https://doi.org/10.1007/s13187-019-01543-0

Smolarz, B., Nowak, A. Z., & Romanowicz, H. (2022). Breast Cancer—Epidemiology, Classification, Pathogenesis and Treatment (Review of Literature). Cancers, 14(10), 2569. https://doi.org/10.3390/cancers14102569

Turner, A. R., & Reed, S. M. (2023). Theory Analysis: The Health Promotion Model and Motivation in Physical Activity. Research and Theory for Nursing Practice, 37(2), RTNP–2022-0085.R1. https://doi.org/10.1891/RTNP-2022-0085

Wilkinson, L., & Gathani, T. (2021). Understanding breast cancer as a global health concern. The British Journal of Radiology, 95(1130). https://doi.org/10.1259/bjr.20211033

Zafar, T., Naik, A. Q., Kumar, M., & Shrivastava, V. K. (2022). Epidemiology and Risk Factors of Breast Cancer. Breast Cancer: From Bench to Personalized Medicine, 3–29. https://doi.org/10.1007/978-981-19-0197-3_1

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Breast Cancer Screening Initiative

Sluvia Algarin

Florida National University

Health Promotion & Role Development in Adv. Nursing Practice-DBX-DL01

Dr Nora Hernandez-Pupo

June 15, 2024

Breast cancer is of great concern to society and is ranked as the most prevalent type of cancer among female patients. In light of recent developments in medical technology, this early signal still holds a critical role in enhancing survival and quality of life rates. Canada's health-promoting interventions are valuable institutions in raising the awareness of the target groups as well as ensuring regular checkups and early detection of possible risky conditions. This essay is an argumentative piece that outlines an evidence-based health promotion intervention for women 40 years of age and above living in urban settings. An overview of the details of that program and its overall goals, the plan to measure the effectiveness of this program, and the possible challenges that the implementation of this program could face will be given to support the argument of the solidity and effectiveness of this program.

Proposed Health Promotion Program

Through this evidence-based intervention, the proposed health promotion program will increase breast cancer awareness and screening rates for women between the ages of 40-65 who reside in urban communities. It will be achieved through the use of community health worker-led education and navigation services. CHWs can bridge the gap between healthcare providers and community members by helping break down healthcare barriers and creating better health outcomes through culturally sensitive education and personalized support (Ahmed et al., 2022). The proposed health promotion program requires a broad array of resources to implement it. This, about personnel, would entail a recruitment and training exercise for the CHWs together with the program coordinator, who would be responsible for the day-to-day program activities. Data analysts will also be needed to evaluate the program and manage it. There will be a need for educational materials such as pamphlets, brochures, and multimedia instruments that take into account the sensitive language and literacy skills of the target population to ensure that the target group sustains the information. Technology will constitute an essential backbone concerning the creation of a mobile application that will be used in appointment scheduling, reminders, data collection, and communication. Community centers, local clinics, and mobile screening units will be required for housing outreach and screening events. The program will require grants, partnerships with regional health organizations, and government support to be sustained.

Furthermore, the participants in the program will involve different categories of people to make the program completely functional. Community Health Workers will be first-line client contact personnel who will be involved in outreach, education, and patient navigation, which would involve engaging the community in a culturally appropriate manner (Allen et al., 2021). To ensure program integrity, CHWs will be supervised by Nurses with advanced practice certifications, like Nurse Practitioners or Clinical Nurse Specialists. In order to accomplish effective referral and follow-up processes, healthcare providers in a specific region shall work together. Since community leaders will be involved in the dissemination of information, the community will eventually show interest in the campaign. Also, technology partners will be of great importance in creating and sustaining the mobile application so that it serves the intended purpose of the program's users and program administrators.

Advanced practiced nurses like Nurse Practitioners or Clinical Nurse Specialists are well positioned to lead this breast cancer health promotion program (Van Hecke et al., 2023). Overall, their clinical leadership experience and specialized knowledge in patient education make them suitable to lead the program. They can be used to monitor the training of the Community Health Workers (CHWs) in order to guarantee that the information that is being disseminated is correct and relevant to the culture of the community. In addition, the abilities and experience of managing and assessing programs are critical for the implementation and monitoring of the effectiveness of the intervention to achieve its set goals and make modifications where necessary depending on feedback and analysis of data.

Additionally, the program timeline has been developed to create a systematic and all-inclusive implementation. The first three months will consist of planning the program, settling on specific dates of implementation, recruitment, and training of the CHWs, and the development of educational materials and a mobile application. Months four to six will commence outreach and education sessions. There will be an initial pilot testing of the mobile application and necessary adjustments in light of early feedback. Next, full-scale implementation over the following six months will include continued community education and navigation services, as well as ongoing data collection and monitoring processes to determine the progress. Finally, for months thirteen through twenty-four, the program continues outreach and support activities, conducts comprehensive data analysis and reports, and implements changes in the program as needed to enhance its effectiveness and sustainability further.

Intended Outcomes

The main expected objective of this program is to raise the proportion of women 40-65 years who are screened for breast cancer from the currently acceptable level in urban settings by at least 25% within two years. This result of writing SMART goals also corresponds to the specified goal writing approach of being specific, measurable, achievable, relevant, and time-bound. Namely, the desired objective here is to enhance breast cancer screening by 25 percentage points, which is an imperative aimed at tackling an important public health problem within the framework of an integrated two-year project (Zielonke et al., 2020). The SMART goal statement is: With the help of an education and navigation program involving CHWs, reach 25% increased utilization of breast cancer screening among women from 40-65 years within the next two years within urban areas.

Evaluation Plan

As a means of determining the impact of the program, it will be necessary to come up with a comprehensive plan of how the changes will be checked to determine the level of achievement of the intended goals. Process evaluation will involve the documentation of independent CHW activities on the average number of education sessions/week, the average number of education materials distributed/week, and the average number of people reached/week. Social interaction activity related to the mobile application will be measured in terms of total number of users, frequency of appointments made, and number of reminders sent. Feedback on satisfaction and perceived usefulness will be gathered through surveys and focus groups with participants.

Outcome evaluation will assess the rise in breast cancer screening by quantifying the number of screenings through available local clinic data and patient-reported screenings (Eibich & Goldzahl, 2020). A self-administered questionnaire will be completed before and after the intervention to evaluate changes in the participants’ knowledge regarding breast cancer diagnosis and the necessity of mammography. Follow-up compliance will be assessed by collecting data on the number of follow-up appointments and regarding the recommended screenings.

Moreover, quantitative and qualitative methods of data analysis shall be used in order to arrive at a conclusive result. It will be possible to calculate the extent of the program's effectiveness through statistical analysis of quantitative data that includes screening rates, application usage statistics, and survey results (Rahman, 2020). The quantitative self-reflective feedback collection will be analyzed thematically in order to determine the frequency of touchpoints discovered by participants. These include Submitting progress reports to stakeholders quarterly in formats that include a letter to stakeholders outlining achievements, barriers to implementation, and preliminary results, and a Final report, which includes a summary of overall program efficiency, evaluation, and recommendations for future programs at the end of two years. Evaluation will be used to inform continuous improvement strategies that will draw on the data collected to refine the program in ways that are effective and sustainable.

Barriers and Challenges

There are a few of the potential barriers that will influence the execution of this program. It may not be easy to effectively persuade or discuss an issue with culturally or linguistically diverse populations because variability is noticed in the perception of breast cancer and healthcare as a result of cultural and linguistic differences (Vrdoljak et al., 2021). It may be a big concern because restricted access to local screening centers and lack of suitable means of transport may negatively affect turnout levels, thereby constituting a major access factor. Certain limitations arising from the technological design of the application may be present, such as the users needing higher digital literacy, more smartphones, or internet access. Secondly, there may be realization challenges in sustaining funding in the program besides grants from initial funding by organizations.

Some of the ways that can help in overcoming these barriers include employing CHWs and staff in bearing in mind cultural sensitivity to facilitate an understanding of culture and language that can facilitate communication, resulting in trust in getting the desired change by those they are employed to serve (Palmer-Wackerly et al., 2019). In marching efforts of cervical cancer screening programs, stakeholders such as community-based organizations, community leaders, and healthcare providers should be engaged. Developing workarounds to those thoughts, such as print-based educational materials or automated call messages to remind about upcoming appointments, will address those who cannot practice digital literacy. The recoupment process should be set down to establish a long-term funding mechanism that would enable the program to obtain other grants, partnerships, and local fundraising efforts for it to be financially sustainable in the long run. It is with such barriers that the program should endeavor to implement strategies that remove them in order to maximize the results so that more women benefit from the programmer’s awareness campaign on breast cancer and screening.

In conclusion, launching a community outreach breast cancer health promotion program based on a CHW-led community education and support model offers a way where to increase the current unacceptably low mammography usage among women in the urban targeted age bracket of 40-65 years. This program, which involves engaging advanced practice nurses and community health workers, is geared towards addressing perceived knowledge deficit, lack of access, and poor compliance with recommended screening. It relates to the overall evaluation plan and strategies that were made in anticipation of possible challenges, which show that the program ought to work.

Additionally, breast cancer remains a major public health concern, yet with the introduction of specific timed activities and various unity approaches, detection and survival rates can be greatly improved. This proposal will, therefore, utilize evidence and a strategic plan to increase the rate of Breast cancer screening to improve the general health of women in urban areas. This intervention program has the possibility of being a reference in the replication of the same model in other settings to demonstrate effectiveness in the pursuit of health promotion and disease prevention.

References

Ahmed, S., Chase, L. E., Wagnild, J., Akhter, N., Sturridge, S., Clarke, A., Chowdhary, P., Mukami, D., Kasim, A., & Hampshire, K. (2022). Community health workers and health equity in low- and middle-income countries: systematic review and recommendations for policy and practice. International Journal for Equity in Health, 21(1). https://doi.org/10.1186/s12939-021-01615-y

Allen, C. G., Bridgeman-Bunyoli, A. M., Dominguez, T. C., Kham, F., Miller, E., Miller, K., Miller, S., Nisley, L. J., Sanchez, A., Tirado, L. C., Thomas, D., Thomas, M. K., Volkmann, K., & Wiggins, N. (2021). Providing Culturally Appropriate Health Education and Information. Promoting the Health of the Community, 87–123. https://doi.org/10.1007/978-3-030-56375-2_6

Eibich, P., & Goldzahl, L. (2020). Health information provision, health knowledge, and health behaviors: Evidence from breast cancer screening. Social Science & Medicine, 113505. https://doi.org/10.1016/j.socscimed.2020.113505

Palmer-Wackerly, A. L., Chaidez, V., Wayment, C., Baker, J., Adams, A., & Wheeler, L. A. (2019). Listening to the Voices of Community Health Workers: A Multilevel, Culture-Centered Approach to Overcoming Structural Barriers in U.S. Latinx Communities. Qualitative Health Research, 30(3), 423–436. https://doi.org/10.1177/1049732319855963

Rahman, S. (2020). The Advantages and Disadvantages of Using Qualitative and Quantitative Approaches and Methods in Language “Testing and Assessment” Research: a Literature Review. Journal of Education and Learning, 6(1), 102–112. https://doi.org/10.5539/jel.v6n1p102

Van Hecke, A., Vlerick, I., Akhayad, S., Daem, M., Decoene, E., & Kinnaer, L.-M. (2023). Dynamics and processes influencing role integration of advanced practice nurses and nurse navigators in oncology teams. European Journal of Oncology Nursing, p. 62, 102257. https://doi.org/10.1016/j.ejon.2022.102257

Vrdoljak, E., Gligorov, J., Wierinck, L., Conte, P., De Grève, J., Meunier, F., Palmieri, C., Travado, L., Walker, A., Wiseman, T., Wuerstlein, R., Alba, E., Biurrún, C., D’Antona, R., Sola-Morales, O., Ubaysi, C., Ventura, R., & Cardoso, F. (2021). Addressing disparities and challenges in underserved patient populations with metastatic breast cancer in Europe. The Breast, 55, 79–90. https://doi.org/10.1016/j.breast.2020.12.005

Zielonke, N., Gini, A., Jansen, E. E. L., Anttila, A., Segnan, N., Ponti, A., Veerus, P., de Koning, H. J., van Ravesteyn, N. T., Heijnsdijk, E. A. M., Veerus, P., Anttila, A., Heinävaara, S., Sarkeala, T., Cañada, M., Pitter, J., Széles, G., Voko, Z., Minozzi, S., & Segnan, N. (2020). Evidence for reducing cancer-specific mortality due to screening for breast cancer in Europe: A systematic review. European Journal of Cancer, 127, 191–206. https://doi.org/10.1016/j.ejca.2019.12.010

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