Introduction
The management of health disorders has become a serious concern in various clinical settings. Irrespective of age the problem is at the high end. To say, there is an increased predisposition to obesity and mental decline at younger ages. Lack of awareness in association with poor intervention strategies at various levels is further aggravating the problem. As children constitute better components of tomorrow’s society, the area of Child health should be given prior importance. There is a need for appropriate health promotion activities which could be possible through the interference of health care professionals.
Over the past few decades, increasing attention was paid to the role of nurses with the objective of integrating health promotional and health education activities with their routine professional schedule (Whitehead, 2000, 604-9). This could be because community-based nurses were believed to be in a good position to facilitate health-related activities and incorporate them into practice. This could enable to improve understanding in an evidence-based manner, implementation, uniformity and assistance for initiative programs among the nursing professionals (Whitehead, 2000, 604-9).
Health promotion constitutes awareness generation in a community that is at risk of a health problem and implementing methodologies to circumvent such situations so as to facilitate the people to access the assistance (Mc Murray, 2003).
Therefore, the present description is concerned with highlighting the promotional, educational, or structural activities keeping in view of child health. For this purpose, there is a need to collect data on children aged between 5 and 12 and predict the scenario in order to promote better hygiene and improve educational outcomes and make children and their parents feel comfortable in society.
To better accomplish this task, I went to a regional health care center, Nashville, authorized by a local government. This center has good medical staffing facilities and is financially supported by the Medical council of the state government. Starting in the year 1998, it has a history of receiving a good number of patients at the outpatient Department. The main objective of this health center is to cater to the needs of patients by implementing various intervention programs in order to alleviate the health complaints of residents located in and around the city. This center mainly provides educational awareness among parents who hardly understand the health aspects of their children. It also receives individuals with different ethnic origins and is well known for providing suggestions/advice.
Generally, parents visit this center to get their children registered for cases like obesity, infections, and mental retardation. I used to find children with these conditions and I was keen on investigating the health promotion strategies that used to get initiated with a structural questionnaire. The participants have briefly described the study and its significance and were willing to participate. This was accompanied by written consent provided by the participants. The questionnaires were having health-related topics specific to child health.
No external pressure was applied in any form while seeking the information from the participants. The collected questionnaires were checked for the reliability of the information gathered. The topics in sequence are Obesity, mental decline and infections.
Obesity
This is considered a metabolic disorder with increased prevalence rates. This disorder is receiving wide research interest. This disorder is an ever-growing health issue as it is associated with chronic health problems in children and adults indicating that obesity acquired during childhood would continue till adulthood stage (Mason et al.2008, 337-44).
This disorder could also withstand the strategies that might involve recommendations to reduce calorie-induced weight through increased physical activity (Mason et al.2008, 337-44). Much emphasis was given by the health care professionals to understand the psychological attitude of the family as most patients are reported to be strongly dependent on the habits, determination, and comfort of their family (Archenti and Pasqualinotto, 2008, 151-5). This could indicate that childhood obesity is more prevalent in families that have a history that might serve as a risk contributing factor for several diseases (Archenti and Pasqualinotto, 2008, 151-5).
It was reported that childhood obesity might increase the risk of the onset of premature cardiovascular factors like hypertension and this has correlated with childhood overweight (Salvadori et al.2008, 821-7). Hence, both may be interconnected and increase the risk of elevated blood pressure. Therefore, it may indicate that the alterations in cardiovascular function and blood pressure in early childhood could help in assessing the progress of childhood obesity (Salvadori et al.2008, 821-7).
According to Wills (2004, 230-5), obesity could also predispose individuals to orthopedic complications such as slipped capital femoral epiphysis, Blount disease, and acute fractures. Hence, the management of this disorder could be also made easier by orthopedicians who are familiar with the relevant complications, in addition to general physicians. In certain situations, surgical interventions are also recommended for obese children which may increase the risk of preoperative morbidities than normal-weight children.
Therefore, it may indicate that childhood obesity may influence anesthesia and surgical outcome (Nafiu et al.2007, 426-30). This could suggest careful evaluation of obese children while they undergo surgical treatment (Nafiu et al.2007, 426-30). This could help nursing professionals to handle the situation in health promotion camps.
Next, another important potential link given consideration was that between childhood obesity and pediatric liver disease (Mathur, Das & Arora, 2007, 401-7). In this case, non-alcoholic steatohepatitis (NASH) was regarded as the main component of non-alcoholic fatty liver disease (NAFLD). NASH was reported to be mainly connected to complications like obesity, diabetes, insulin resistance (IR), and hypertriglyceridemia. Children with NASH may experience progressive liver damage, including cirrhosis (Mathur, Das & Arora, 2007, 401-7).
The risk factors and the associated complications of childhood obesity would require attention and efficient management with special emphasis. Family involvement was considered as the potential interfering factor in the management of childhood obesity (Golan, 2006, 66-76).
This could be because in a study it was revealed that targeting parents as the facilitators have resulted in a significant reduction in children’s overweight percentage, and improvement in the obesogenic environment and the overall behavior, when compared to a setting where parents attended sessions with the obese child or only children attended session (Golan, 2006,66-76). The evaluation of childhood obesity was reported to involve a physical examination and selected laboratory evaluation in addition to structured information about personal and family history (Singhal, Schwenk & Kumar, 2007, 401-7).
Lifestyle interventions and behavioral modification were also proved to be influential in decreasing caloric intake and increasing caloric expenditure; hence they are central to the management of childhood obesity (Singhal, Schwenk & Kumar, 2007). To better overcome the rising incidence of childhood obesity, criteria were set by an authorized health care organization, for example, clinical practice guidelines (CPGs) that help physicians and nurses to take valuable decisions during care delivery (Delgado-Noguera, 2008). The guidelines largely depend on research documentation with recommendations for the prevention strategies.
So, improvements in the methodology and the quality of CPGs on childhood obesity may help clinicians and other decision-makers to control the incidence of this disorder (Delgado-Noguera, 2008). As such, it is reasonable to assume that this strategy could work well especially in health promotional activities in community-based settings. The next important aspect in the health promotion report is the problem of mental decline in association with ADHD (Attention deficit hyperactivity disorder) and stress in children.
Attention Deficit Hyperactivity Disorder
ADHD is considered a severe neuropsychiatric disorder. The American Academy of Pediatrics has set the guidelines and mentioned that children aged between six and twelve are vulnerable to this disease if they develop diagnostic symptoms like inattention, hyperactivity, impulsivity, academic underachievement, or behavior problems. (American Academy of Pediatrics, 2000, 158-70).
But, there are some issues related to the identification of children with ADHD. Sayal et al. (2006, 744-50) described in a report that parents should initiate support in recognizing the problem and seeking the help of the educational professionals. Data obtained in an earlier study revealed that the prevalence of ADHD in U.S children almost correlates with that in non-US children and that ADHD is not purely an American disorder (Faraone et al., 2003, 104-113).
Children with ADHD have poor academic and educational performance as reported in a study (Loe and Feldman, 2007, 82-90). Hence, school studies are very crucial in predicting the susceptibility of children to ADHD.
Very often ADHD manifests in association with other symptoms that help in easy diagnosis. Holmberg and Hjern (2006,664-70) reported that ADHD is better associated with recurrent abdominal pain (RAP), sleeping problems, and tiredness and emphasized assessing their role to evaluate ADHD.
Stress
Further, stress is the other interfering factor that influences educational outcomes in children by affecting their mental health. Children are frequently prone to be exposed to daily stressors in their routine schedule and managing the stressors was reported to be significantly related to their psychological adjustment (Pincus and Friedman ,2004, 223-40). Acquiring coping skills at a younger age helps children to overcome the effects of negative life stress on the development of psychological maladjustment. Interventions at the school level have been devised in order to guide children to aim at specific “problem-focused” skills that are anticipated to improve coping with special emphasis on their cognitive restructuring or emotional regulation (Pincus and Friedman, 2004, 223-40). This strategy may have implications for health promotion activities. This could be because poor academic performance and a gradual shortage in school attendance were identified as early signs of emerging mental health problems during childhood (DeSocio and Hootman, 2004,189-96). To better overcome this task, nursing interventions at school levels are receiving increased attention so as to provide a process for identification and resolution of students’ health needs (DeSocio and Hootman, 2004,189-96). Hence, school nursing was considered to play a vital role with regard to the need for mental health promotion, illness prevention, and early intervention related to children’s mental health (DeSocio and Hootman, 2004, 189-96).
Barriers to Health Promotion
Unawareness: Obese children were not properly brought to the notice of health care professionals as their parents are not highly educated but are reported to have a good family history of childhood obesity. This might prevent them to exchange information, the need for early identification. This is because it was reported that families with a history of childhood obesity are at increased risk for predisposing children to several diseases (Archenti and Pasqualinotto, 2008, 151-5).
Lack of qualified professionals and negligence by school nurses: Further, there were no qualified specialists to evaluate the associated complications of childhood obesity. There is a great chance of acquiring the onset of premature cardiovascular factors like hypertension in childhood overweight patients (Salvadori et al.2008, 821-7). Assessing the periodic cardiovascular changes in obese children might help to manage the severity of childhood obesity. Similarly, obese children were also in need of orthopedic consultants who could better study the associated complaints like slipped capital femoral epiphysis, Blount disease, and acute fractures (Wills, 2004, 230-5). Parents with obese children were frequently anxious about the surgical intervention that may like to be recommended (Nafiu et al.2007, 426-30).
However, creating awareness may help them to cope with the situation. So here lack of appropriate information from nurses who could better counsel parents was identified as another barrier. Most school nurses are familiar with childhood obesity but many would not provide information in recommending weight-loss treatment to promote healthy lifestyle choices for their students (Nauta, Byrne & Wesley, 2009). However, this situation could be better circumvented by providing structured information about all consequences of childhood obesity (Singhal, Schwenk & Kumar, 2007, 401-7). Therefore, the barriers identified were unawareness added to the poor educational status of parents that is preventing timely consultation with the health care professionals, and absence of medical specialists, and lack of appropriate help from nurses that is preventing the information dissemination to the participants who are in great need of protecting their obese children.
Identification problems: Secondly, children with a decline in mental functions were not identified immediately by the parents and this could serve as a barrier by preventing the children from being considered for pediatric intervention (2006, 744-50).
There is also a great need for recognition by the teachers in schools as children with ADHD have poor academic and educational performance (Loe and Feldman, 2007, 82-90). The parents and teachers may need to monitor the mental status of children to assess their psychosocial behavior.
Lack of Stress management
Stress is another problem that is preventing children to be considered for health promotion. The reason here is again the lack of interventions at school levels. This could gradually reduce the number of children to be considered for psychological counseling. This is due to the fact that children exposed to stressors are prone to alterations in psychological adjustments (Pincus and Friedman, 2004, 223-40). There were complaints from the parents that there were no nursing interventions at school levels to identify and solve this problem of stress (DeSocio and Hootman, 2004,189-96). This is because school nursing was implicated to prove support for mental health promotion and illness prevention with regard to children’s mental health (DeSocio and Hootman, 2004, 189-96).
Socio-economic conditions
Finally, children complained that they were being excluded from participating in health camps at schools. This may be considered a socio-economic barrier. From a study, it was revealed that most children face social exclusion at school, from social activities or within social networks (Davies et al., 2008).
In this context, there was a total of nine barriers reported to put children at social exclusion. They include the inability to attend school camps and participate in school activities, frightening and being left out, time and transport restrictions, financial restrictions and safety and traffic concerns (Davies et al., 2008).
The resources and actions planned and the evaluative criteria developed for this Health Promotion
The process started with investigating the educational and health status of parents and their children for obesity keeping in view of the literature. The participants are children and their parents. I made use of the documented sources in order to educate the parents about the consequences of childhood obesity.
With the available resources in hand, I drafted a mini literature point-wise to make it handy for the poster, a video presentation. The health care center was already had published pamphlets which I used for my evaluative criteria. All the parents were distributed with pamphlets that contained almost the similar content of my posters. The information in the posters was segregated to enable easy understanding. Poster, one has content on the introduction to childhood obesity. Here, I explained in detail the health problems associated with obesity and their continuity till the adolescent stage and further highlighted the need for reducing calories through exercise, as mentioned in a study (Mason et al.2008, 337-44). The participants expressed satisfaction here while interacting through queries and replies.
The second poster was about the association between obesity and the onset of premature cardiovascular factors like hypertension (Salvadori et al.2008, 821-7). I emphasized here that the connection between two disorders helps the parents to better understand the progressing complications of their obese children. I also explained to them about the likelihood of blood pressure elevation and its management through frequent check-ups at the regional health care centers. Poster three demonstrated that orthopedic complaints like fractures would result in obese individuals (Wills, 2004, 230-5); and the risk of surgical interventions as they are likely to promote morbidities (Nafiu et al.2007, 426-30).
Poster five explained another connection between obesity and pediatric liver disease with special emphasis on non-alcoholic steatohepatitis (NASH) as it may enhance the problem of progressive liver damage, and cirrhosis (Mathur, Das & Arora, 2007, 401-7).
Poster number six was about the role of parents in mediating the prevention strategies of childhood obesity because of the earlier success achieved in reducing the children’s overweight percentage (Golan, 2006, 66-76).
A Video coverage of 15 minutes, consisting of pictures of obese children and the associated complications of was also shown to the participants.
The second set of posters contained information on the child mental health. I explained poster one about the symptomology of ADHD that included poor concentration hyperactivity, educational failures and behavioral maladjustment in the society (American Academy of Pediatrics, 2000, 158-70). Parents showed great interest here as they reported to frequently observe the mentioned symptoms in their children. This has really given me immense satisfaction. Poster two was about the associated symptoms of ADHD which included recurrent abdominal pain (RAP), sleeping problems and tiredness (Holmberg and Hjern, 2006, 664-70).
The fourth poster highlighted about the role of stressors that could predispose children to develop a negative attitude (Pincus and Friedman, 2004, 223-40). I further explained to the parents to better train their children to handle various challenging skills that might enable them to improve their mental and emotional skills (Pincus and Friedman, 2004, 223-40).
Poster number six showed the information that needs to be obtained from the nurses employed especially at schools; because this would prevent undesirable consequences of abnormal mental status and tends to promote hygienic mental health at an early stage (DeSocio and Hootman, 2004, 189-96). Video coverage of 15 minutes, consisting of pictures that depict the behavior of children with poor cognitive skills was also shown.
All the participants were asked to provide comments on my presentation. Accordingly, I received good feedback.
Process of implementing the activity
I arranged a big hall at the health center after a permission grant from the concerned authorities. The chairs were arranged as per the expected number of participants and a hired television set with a video player was arranged at the stage. Two boards were arranged on the sides to paste the two sets of posters. I received the participants with a warm welcome. They were told to sit on their respective chairs with pamphlets on the desk. After a brief interaction, I introduced the topic. They were told to carry away the pamphlets with content similar to the posters and video coverage.
On completion of this explanation session, I highlighted the significance of conducting the session was to promote health by creating awareness, the feasibility involved in accessing the help desk managed by the nurse care professionals. Finally, I asked them to give their opinion by asking “Are you satisfied with the given information?”. All the participants said “Yes”.
Reflection
As there were no communication or language problems, I was greatly convinced with the way the participants responded. Although I am new to this profession, I was able to manage perfectly the situation due to the availability of pertinent research literature.
Conclusion
There is an urgent need for health promotion activities in community-based settings. The problem of childhood obesity and poor mental status is deteriorating the nation’s future developers. Health care professionals should create great awareness among parents. Nurse staffing at the school level might ameliorate the physical and mental health of children. As such, frequent intervention programs need to be implemented for shaping the society with special emphasis on child health.
References
Community health and wellness: a socio-ecological approach (third edition).2003 Australian and New Zealand Journal of Public Health. The role of community-based nurses in health promotion (2000). Whitehead D. Br J Community Nurs, 12,604-9.
Mason, HN, Crabtree, V, Caudill, P, Topp, R.(2008). Childhood obesity: a transtheoretical case management approach. J Pediatr Nurs, 23, 337-44.
Archenti, A and Pasqualinotto, L.(2008). Childhood obesity: the epidemic of the third millennium.”Acta Biomed, 79,151-5.
Salvadori, M., Sontrop, J.M., Garg, A.X., Truong, J., Suri, R.S., Mahmud, F..H, Macnab, J.J., Clark, W.F.(2008).Elevated blood pressure in relation to overweight and obesity among children in a rural Canadian community. Pediatrics, 122, e821-7.
Wills, M. Orthopedic complications of childhood obesity (2004). Pediatr Phys Ther, 16, 230-5.
Nafiu, O.O., Reynolds, P.I., Bamgbade, O.A., Tremper, K.K., Welch, K., Kasa-Vubu, J.Z. (2007).Childhood body mass index and perioperative complications.Paediatr Anaesth, 17,426-30.
Golan, M. Parents as agents of change in childhood obesity–from research to practice. (2006).Int J Pediatr Obes, 1, 66-76.
Mathur, P., Das, M.K., Arora, N.K. (2007). Non-alcoholic fatty liver disease and childhood obesity. Indian J Pediatr, 7,401-7.
Delgado-Noguera, M., Tort, S., Bonfill, X., Gich, I., Alonso-Coello, P. Quality assessment of clinical practice guidelines for the prevention and treatment of childhood overweight and obesity. Eur J Pediatr [Epub ahead of print].
Clinical practice guideline: diagnosis and evaluation of the child with attention-Deficit/hyperactivity disorder.(2000). American Academy of Pediatrics Pediatrics 105: 1158-70.
Sayal, K. , Goodman, R., Ford, T.(2006) Barriers to the identification of children with attention deficit/hyperactivity disorder. J Child Psychol Psychiatry, 47,744-50.
Faraone, S.V., Sergeant, J., Gillberg, C., Biederman, J. (2003). The worldwide prevalence of ADHD: is it an American condition? World Psychiatry, 2,104-113.
Loe, I.M., & Feldman, H.M. (2007). Academic and educational outcomes of children with ADHD. Ambul Pediatr 7(1 Suppl):82-90
Holmberg, K., & Hjern, A. (2006) Health complaints in children with attention-deficit/hyperactivity disorder. Act Paediatr 95,664-70.
Pincus, D.B.,& Friedman, A.G.(2004). Improving children’s coping with everyday stress: transporting treatment interventions to the school setting. Clin Child Fam Psychol Rev,7,223-40.
Nauta, C., Byrne, C., Wesley, Y.(2009). School nurses and childhood obesity: an investigation of knowledge and practice among school nurses as they relate to childhood obesity. Issues Compr Pediatr Nurs, 32,16-30.
Davies, B., Davis, E., Cook, K., Waters, E. Getting the complete picture: combining parental and child data to identify the barriers to social inclusion for children living in low socio-economic areas.Child Care Health Dev, 34, 214-22