BREAST AND PROSTATE CANCER SCREENING AND AWARENESS PROGRAM FOR ADULTS AGED 25-49 LIVING IN LONDON
Over the last decades, cancer has become one of the greatest health challenges facing young adults living in London. The cost of managing different types of cancer has been rising, posing a huge financial burden for the government. Individual management of cancer is costly (WHO 2007, p.5), hence increasing the need to invest in preventive measures to reduce the cost burden for families, as well as the government. Cancer is not one disease, but a group of diseases, according to Silverstein, Silverstein & Nunn Silverstein (2004, p.9). Many studies have been done on cancer in the UK over the last few years with most of them being successful in identifying some of the pre-disposing factors. However, the real cause has not been established (Jones 1998, p. 17).
Among the prevalent types of cancer in London, there are breast and prostate cancers. Several medical and psychological reasons have been offered to explain the rapid increase in breast and prostate cancer over the past decades, one of them being increased levels of stress and worry. Due to the prevailing economic and social pressures, more and more people today are subject to stress or worry, thus weakening their nervous systems and, consequently, opening the way for cancer (Jones 1998, p. 20). After reviewing several sources of literature, it has become clear that one way of reducing the rate of spread of cancer is by creating awareness and encouraging screening.
From the numerous studies conducted on the sensitive issue of cancer, it is clear that it is not gender sensitive. Men and women alike are at the same risk of suffering from this disease. However, it is evident that men and women are to be expected to suffer from different types or forms of cancer. In light of this, it is important to create awareness about different types of cancer and who is likely to suffer from what type. Common cancers among females include malignant melanoma, cervical, and breast cancer while men are likely to suffer from testicular, malignant, bowel, and prostate cancer.
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Adults, both young and old, need to be aware of breast or prostate cancer and the importance of screening. Many forms of cancer are curable if detected at an early stage (Pories, Moses & Lotz 2009, p. 79). Owing to this fact, there is a dire need to inform the public that cancer is not a disease for the old people only and that knowledge of its existence alone is not enough. It is equally important to embrace routine screening. All this can be achieved by creating a suitable health promotion program the object of which is creating awareness on breast and prostate cancer and its screening among adults aged 25-49 living in London.
The health promotion will target adults living in London who are between the ages of twenty-five and forty-five. According to Cancer Research UK (n.d.), adults in this age group contribute to approximately ten percent of new cancer cases in the UK. Among the female population, breast cancer was the most common type of cancer at 45%, with malignant melanoma and cervical cancer at 9% each. Testicular cancer at 15% was the most common type of cancer among men in this age group, closely followed by malignant melanoma and prostate cancer at 11% and 9% respectively.
Statistics also indicate that the number of cancer cases among women is almost twice that of men within the same age group. However, the difference in recorded incident rates has been attributed to an increased routine of breast cancer screening among women. This means that if men of the same age group went for regular cancer screening, the disparity would not be as big as it currently is. The need for increased prostate cancer awareness among men in order to avoid late diagnosis as well as to have a clear picture of the correct incident rates between these two groups is also brought to light by this piece of information. As such, it is necessary to have a health promotion program in place that equally focuses on both groups.
Based on the above statistics, it is apparent that breast and prostate cancer pervasiveness among adults aged 25-49 is an issue that calls for attention. It is also evident that the management and treatment of cancer is costly, almost unaffordable to persons within this age group who are already burdened with other financial responsibilities such as school loans and mortgages. For them, being diagnosed with cancer presents a big financial challenge, yet the country cannot afford to lose its productive population to cancer. It is therefore important that this target group be equipped with the right information. Monninkhof et al. (2007, p. 46) note that preventive measures are more effective than curative measures. Some types of cancer do not physically manifest themselves until they are in their final stages, making it difficult for doctors to treat or cure them. All this can be avoided if adults within this age bracket embrace regular screening and become more aware of this disease. Regular screening, for instance, helps detect cancer early before it becomes expensive to treat (Cohen, Neumann & Weinstein 2008, p. 662).
To address the discrepancies in screening identified earlier, the program will ensure that it equally targets men and women, which is an important social aspect of the promotion. Availing equal opportunities to both groups will address the growing inequities in health among different groups in the country.
The program will also seek to engage all stakeholders to ensure that it receives the support it requires in order to achieve its goals and objectives. It will see to it that their suggestions and input are incorporated in its planned activities.
Additionally, the program will ensure that patient privacy and confidentiality are maintained by working with professional bodies and institutions. No patient information will be disclosed to third parties without their approval and the program administrators will only work with qualified and professional personnel to protect the integrity of the project and earn public confidence.
Government sponsorship, corporate support, and donations will be the major sources of funding for this program. Board members who will also be expected to identify new sustainable sources of funds will handle the financial aspect of the program. Project team leaders will be expected to regularly submit their financial reports for audit to ensure that the program utilises all its resources efficiently and effectively.
Levels of Health Promotion
There are four levels of health promotion: individual, environmental, social, and organisational. These levels represent different types of interactions during health promotion.
- The individual level involves assessing the possibility of behavioural change in order to accept new health practices. This is an important aspect in health promotion planning as it determines the type of activities that may be considered as effective.
- The environment and organisational assessment is a key to deciding the type of model that the program should adopt. It also influences the structure of the program as well as informs decisions.
- The social level perhaps has the most influence on the program. Factors such as values, norms, and principles influence community participation among other factors.
Health Needs Assessment (HNA)
Health needs assessment refers to a systematic method of identifying, collecting, and reviewing health needs information from the public, leading to formulation of policies or programs that are aimed at improving health and reducing inequalities (Bartholomew et al. 2011, p. 32.). The HNA supports national priorities such as health equity audits, community strategies, and health promotion programs among others. Health promotion needs assessment provides comprehensive information about health problems in the community. For this reason, carrying out a needs assessment for the cancer awareness and screening program will help to identify the magnitude of the problem amongst the target group. Conducting a needs assessment additionally helps one gather more information about the problem along with facilitating sharing of the same information with the community in an effort to create more awareness about the health issue.
During the assessment, it is important that one factors in how different types of needs may affect the designing process. Perceived needs express people’s perceptions and this is likely to affect the program. Relative needs reflect equity concerns and need to be dealt with in order to ensure both males and females equally benefit from the program. Per se, the health program should ensure that it fulfils the expressed needs of the community over and above, focusing its efforts on addressing the cancer problem.
Health needs assessment strengthens community involvement in decision-making. It also encourages public-patient participation that is a requirement for the success of the cancer awareness and screening programs (Goetzel & Ozminkowski 2008, p. 307). Other benefits of the HNA include: professionals get to improve their skills along with gaining more experience, better communication among government agencies, and improved patient care.
One approach that can be used to evaluate the prevalence of cancer among the target group is analysis of existing data. This involves going through community-related data such as statistics and reports. Ease of access is one of the advantages of using this method since the data already exists making it almost effortless to study the changes that have occurred during a particular period.
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Another approach that can be adopted is conducting an attitude survey. A representative sample of the population will be identified and interviewed on the subject matter. Data collection can be done through face-to-face interviews, telephone interviews, or by answering questionnaires. This approach allows assessors to evaluate the people’s attitude towards cancer as well as their level of awareness.
An alternative method that can be employed is holding group or public sessions. Not only is it an inexpensive and quick method of collecting data, but it is also a way of fostering good public relations besides giving the community an opportunity to ask questions relating to the planned program.
Finally, yet importantly, one can collect information by interviewing a key informant. These people are knowledgeable on the subject and may include health practitioners, researchers, or other relevant professionals. Once all relevant data are collected, it is important to review existing organisational mandates. This is to ensure that the program is in line with the goals and objectives of the institution. It is important that one considers relevant legislations and regulations in order to identify some legal factors that are likely to affect the program. It is also important that one evaluates existing policies and regulations. Finally, one needs to make sure that the program meets set professional and ethical standards.
Aims and Objectives
The aim of the program is to create cancer awareness among adults between of the age of 25 and 49. The program will initiate several public cancer campaigns aimed at informing the group on the need to be aware of different types of cancer that are common in this age group. Creation of awareness will demystify this disease and encourage people to get facts about the disease.
The program hopes to encourage the target group to go for regular cancer screening, which is something that many people still consider a thing for women only. However, it is equally important that men go for regular prostate cancer screening as well. In the next one year, the program hopes to double the number of people who go for regular cancer screening, ensuring that early detection through screening is associated with full recovery (Gigerenzer, Mata & Frank 2009, p. 1217).
Another objective of the program is to encourage the target population to adopt healthier lifestyles. The focus of the program will be to educate them on the importance of healthy diets and exercises. Lundstrom (2012, p. 65) acknowledges that some forms of cancer occur because of high cholesterol diets and unhealthy diets. Lung and liver cancers have been associated with excessive smoking and alcohol intake respectively. If more people are encouraged to make better lifestyle choices, then it is possible to reduce the number of new cancer cases recorded each year.
The health belief model focuses on the power of perception. According to this model, for people to adopt the proposed changes, perceived threats have to outweigh their perceived barriers to action. This model suggests that, in order for the health promotion program to succeed, the target population has to first understand the severity of cancer and acknowledge the benefits of early screening.
The transtheoritical model suggests that, in order for people to adopt healthy behaviours, they need to go through the identified five stages. These stages include: pre-contemplation, contemplation, preparation, action, and maintenance. The model suggests that at each stage different strategies should be employed to help people proceed to the next stage. If adopted, the program has to have at least five action stages.
The relapse prevention model focuses on skills training, cognitive reframing, and lifestyle rebalancing. This model suggests that health programs should anticipate barriers or challenges that may lead to a relapse. It focuses on developing interventions that will encourage the target audience to continue seeking more information about the health issue. This model supports intervention plans such as free screening services in all hospitals.
The information-processing model emphasises the need to inform the public continuously about the health issue. This approach aims to popularise a particular health issue so that everyone comprehends its significance. The model focuses on drawing attention to the message, ensuring the public grasps the content, and finally providing acceptance of the content
Social learning or social cognitive model proposes that behavioural change occurs because of social interaction (Downie, Tannahill & Tannahill 1996, p. 34). This theory acknowledges the role played by environmental factors in instilling new practices. According to this model, personal traits influence one’s ability to adopt and accept new practices.
The theory of reasoned actions notes that the power to adopt new practices lies within an individual and external factors can only attempt to influence their intentions. This model focuses on how beliefs, social norms, and values influence human intentions. If a health program is to be formulated based on this model, it will be required to share similar values with the target population to positively influence their intentions.
According to the theory of planned behaviour, an individual’s perceived level of control influences his or her behaviour. The adoption of a health program therefore depends on opportunities, resources, and skills available to the population.
The social support theory believes that, for a health promotion program to be successful, it must receive social support of all stakeholders. This support ensures that the program receives informational, emotional, and appraisal support necessary to achieve its goals and objectives.
The community organisational model holds that community participation is crucial to any health program. In this model, public health workers interact with the communities to identify health issues that affect them. According to this model, health issues addressed in a promotion program reflect the community’s health issues.
The ecological approach acknowledges that health issues are shaped by various environmental subsystems (Sallis, Owen & Fisher 2008, p.465). The model notes that effective health promotional programs must influence public policies, communities, and institutions.
The organisational change theory states that, for a health program to be effective, the particular issue has to be well defined. The purpose of doing so is to create awareness. The next step involves initiation of action. At this stage, programs begin to roll out the planned activities. The third stage involves implementation of change, whereby it is hoped that the participants have adopted suggested changes. The final stage entails institutionalisation of change.
According to the diffusions and innovations theory, the rate at which people adopt new behaviours or ideas is affected by factors such as complexity of the problem and compatibility among other predictable factors. Therefore, if one is to develop a program based on these factors, then it is important to ensure that planned activities are easily adaptable.
Formative evaluation includes activities such as needs assessment, testing of program models, and audience analysis (Nutbeam & Bauman 2005, p. 45). This evaluation is conducted to ensure that the program is utilising resources, material, and procedures effectively. This exercise investigates and evaluates whether the program is meeting its goals and objectives. A quantitative evaluation may be undertaken, especially concerning financial resources.
Process evaluation examines whether the procedure and tasks identified have achieved the desired effects. This may be done by evaluating the number of people who have been reached by the program. Other activities that can be done include assessing the type and quality of services provided.
A summative evaluation involves assessing the changes in attitudes or behaviour of the target population (Tilford & Tones 2001, p. 77). This evaluation aims to measure changes that have occurred since the implementation of the program. The activities performed during this exercise include cost effectiveness analysis and impact assessment among others.