The relevance of a healthy lifestyle today is caused, on the one hand, by an increase and change in the nature of loads on the human body due to the complication of social life, an increase in the risks of a technogenic, environmental, psychological, political and military nature. There is deterioration of food, air and water quality, which provokes negative shifts in a state of health. On the other hand, a sharp decline in demographic indicators, an increase in mortality from preventable causes, morbidity and disability of the population forced to pay special attention at the highest level to both healthy lifestyle factors and risk factors for the development of various diseases.
Representatives of the philosophical and sociological direction in medicine and prevention consider a healthy lifestyle as a global social problem, an integral part of the life of society as a whole, although the very concept of a “healthy lifestyle” has not yet been unambiguously defined. According to experts, people’s health depends by 50-55% on lifestyle, 20% – on the environment, 18-20% – on genetic predisposition, and only 8-10% – on health care (Roth, 2015). Smoking, poor nutrition, hazardous alcohol consumption, physical inactivity and weight (SNAPW) occupy the main place among the preventable causes of diseases. Thus, the prevention of healthy lifestyles through appropriate advocacy, counseling and community education is of particular importance. Harris et al. (2013), in their quantitative research, made an attempt to experimentally evaluate the impact of a brief lifestyle intervention delivered by generalist community nurses in Australia.
The authors in a comprehensive manner provide justification of the research topic relevance for today public health and health care in Australia and the role of risk behavior in prevalence of such chronic diseases as heart disease and diabetes. Based on the data of Australian Health Survey for 2007-2008, they claim about rather severe situation with community members lifestyle. However, taking into account that the article was published in 2013, time range for these data seems to be not appropriate, as 5 years is rather long period in health care and social development
The design of study was a quasi-experimental trial with involvement of four generalist community nursing (CN) services in New South Wales, Australia. Randomization procedures were applied to allocate services in the group of ‘early intervention’ and a ‘late intervention.’ “Services were recruited via an expression of interest mailed to all Area Health Services (AHS) in NSW (n = 8)” – the authors explain (Harris et al., 2013, p. 2). The design for protocol of the study with the aim to enable nurses to identify clients with high risk and offer brief SNAPW intervention during routine, as the author note, was described previously. They give reference to the article published in 2010 by some of the current study authors – Laws, Chan, Williams, Davies, Jayasinghe, Fanaian, and Harris, devoted to efficacy trial of brief lifestyle intervention delivered by generalist community nurses. However, it seems expedient to mention the protocol design at least in brief, to enable reader to understand it without the necessity to read the mentioned source. Moreover, despite the fact that design is well linked to research question, rationale for choosing design is not presented.
Describing study outcomes, measurements and data collection, when speaking about measurement tools validations, the authors again refer to one of their previous publications, which seems inadmissible for the article in peer-reviewed journal. The 5As Model of participants’ readiness to change is given only in the form of a scheme, without explanation and clarification. Moreover, the authors even do not mention if the model is a standard adopted tool or their own ‘invention.’
The study outcomes, measurement tools, and timeframe for data collection are presented in summarized table. At the same time, inclusion and exclusion criteria are given in a table form, which was not necessary and could be listed just in text. Dependent and independent variables were not described and even mentioned. Moreover, the authors write that “the a priori sample size was 400 clients per group (n = 800). This was calculated based on estimates of change in mean risk scores of self-reported measures of lifestyle risk factors. This was sufficient based on a standard deviation from previous research.” Here, again, one can see a reference to previous research without at least brief mentioning of its contents, and the criteria for choosing sample size are not clear at all.
Analysis of results is given in more comprehensive, detailed, and scientifically sound manner than other sections. However, Ethics section is better to be placed after describing methods of research and recruitment. Results and discussion sections represent interesting and valuable data, contributing to EBP in part of healthy life style propaganda and preventive work with the population in communities. However, no matters of diversity impact on study results were mentioned in the article under consideration.
At the same time, taking into account specifics of health care practices among Indigenous communities and, respectively, features of prophylaxes among them, it would be expedient to include this concerns and research in the current study. For example, Aboriginal people in Australia have a high incidence of diabetes, and are at high risk of this disease. Among adult Indigenous people, more than 25% of the population suffers from it, in 6% of Aboriginal children under the age of fourteen years this disease is found in a latent form (Abreu et al. 2013). However, the authors well describe other limitations of study and analyze mismatch of the results obtained with the results of other studies in the field, with explanation of possible reasons. In overall, the study outlines challenges for long-term continuing care in Australia with regard to preventive practices in public health care.
Health is viewed as one of the key aspects of human security and occupies a prominent place in the selection of priorities for the development of society. This is reflected in national: concepts and strategies of social development. The country is gradually losing the preventive focus of health care. There is no sufficient information available to the general public about the values of a healthy lifestyle. Addiction to tobacco, alcohol, and drugs begins in school years, and unhealthy eating habits lead to an epidemic of obesity (Australian Institute of Health and Welfare, 2017). The argumentation put forward determines the relevance and significance of the research topic for science and practice and the need for scientific substantiation of economic developments in the field of the formation of a healthy lifestyle for the population as a strategic direction for ensuring the country’s socio-economic security – developments that are essential for ensuring national security.
There are many teaching methods and many opportunities to promote healthy lifestyles. It is important, first of all, to interest the patients, and then start education, and give them as much information as possible and show by examples how the fulfillment of all conditions affects the health of everyone. Medical professionals, first of all, must find out what patients need using focus groups of participants – they are selected from the audience to which their activities are directed. It is wise to use simple language, short words and sentences (Dossey et al., 2016). Moreover, each group of population requires its unique approach to preventive work and education. Neither of these factors are covered in the article of Harris et al. In particular, in some countries, there is practice to regularly (once every 3 months) carry out special events “Days of Health” with media coverage (Dossey et al., 2016). These days, patients can take clinical blood tests for free, take an electrocardiogram and get a consultation from a cardiologist, listen to a lecture on a healthy lifestyle. These promotions are also effective for retirees.
It is important to form a fashion for a healthy lifestyle. This is especially important for the younger generation. The propaganda materials did not take into account the psychology of the “market” generation with a more individualized consciousness than the older generation, its new consumer subculture, in which the main concept is prestige. All these factors should be given attention when speaking about preventive work conducted by nurses and its effectiveness. Without this in-depth work, any research concerning effectiveness of nurses involvement in prophylaxes among population will be only an ‘outline’ of the existing problem, which is clearly observed in the article under consideration.
References
Abreu, L., Walder, K., & Gibert, Y. (2013). Diabetes mellitus in the australian indigenous community. Journal of Medical Disorders, 1(4), 1-5.
Australian Institute of Health and Welfare (2017). A picture of overweight and obesity in Australia. Australian Government.
Dossey, B., Luck, S., & Schaub, B. (2016). Nurse coaching: Integrative approaches for health and wellbeing. Nurse Coaching: Integrative Approaches for Health and Wellbeing.
Harris, M. F., Chan, B., Laws, R., Williams, A., Davies, G., Jayasinghe, U., Fanaian, M., Orr, N., Milat, A. (2013). The impact of a brief lifestyle intervention delivered by generalist community nurses (CN SNAP trial). BMC Public Health, 13(1), 1-11.
Roth, I. (2015). Disease prevention and healthy lifestyles, HED 110, Monroe Community College, health and physical education. McGraw Hill Education.