In The Ottawa Charter for Health Promotion, it is stated that health promotion is “the process of enabling people to increase control over and to improve, their health.” (WHO, 2008, p.1) Green & Kreuter (1991) define health promotion as “the combination of educational and environmental supports for actions and conditions of living conducive to health.” (p.23). Health promotion can also be described as a philosophy and a strategy. The current paper is concerned with these two approaches to health promotion that is applicable in Papanicolaou test practice.
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The Pap test (also known as the Pap smear, the abbreviation comes from the last name of the doctor who studied changes in cervical cells) is a way of checking normal and potentially cancer-causing cervix cells. In 1924, George Papanicolaou, M. D., observed that cervical cancer could be discovered by studying cells taken from a woman’s genital tract. The development of the Pap test named after him was based on this finding. During the decades that followed, the Pap test has become a routine part of gynecologic examinations and one of the most widely used procedures for detecting cancer (Hale, 1989, p.23).
The importance of the Pap test in detecting cancer should be realized by every woman that has either become sexually active or reached the age of 21, no matter which comes first. Health promotion is an effective tool that Pap test providers should resort to in their practice to achieve women’s awareness of the importance of the Pap test and to reduce the incidence of invasive cervical cancer.
If health promotion is considered as a philosophy, it is based on the belief that individuals need support in their efforts to establish control over the determinants of their health (Green & Kreuter, 2005, p.123). The philosophical strategy of health promotion implies a philosophical shift from an orientation based on illness to one of health and wellness (Green & Kreuter, 2005, p.124).
As far as the Pap test is concerned, women should realize that it will help them to detect changes in the cervix cells if any, that may cause cancer. The Pap test provider’s role is to ensure the patients of the necessity of the test and of the importance of the measures taken adequately. Further, the patient should come to realize that the Pap test is a step towards a healthy life and not a movement towards an imminent disaster. Health promotion, in this case is understood as the art and science of helping people identify areas of the changes needed while moving towards the goals of optimal health (Green & Kreuter, 2005, p.125).
As a strategy, health promotion incorporated in the Pap test practice may be viewed in two aspects, namely, individual and community strategies. On an individual level of health promotion, Pap test providers should care about developing personal growth skills, should establish learning self-care management, and emphasize positive outcomes-oriented toward well-being and empowerment. Application of community health promotion strategies means creating “supportive environments and strengthening social empowerment through community action.” (Raeburn & Rootman, 1998, p.145)
Effective health promotion implies encouraging women’s decision-making at every step on their way to recovery. This decision-making is, in its turn, dependant on the information supply that is also provided by the Pap test specialists. As Screening to Prevent Cervical cancer: Guidelines for the Management of Asymptomatic Women with Screen Detected Abnormalities. National Health and Medical Research Council of Australia (1994) by Commonwealth Department of Human Services and Health states:
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Women should be involved in the decision-making process at every level. To enable women to make an informed decision, it is essential that they be given clear and accurate information. There must be adequate time allowed to address any questions and to discuss any anxiety about the significance of the cervical smear finding and the evaluation and management options. The management pathway should be based on the result of investigations and the preferences of the woman, including whether fertility is an issue.
Each woman should be counseled regarding the significance of the cervical smear report, what the choices and assessment and treatment and rationale are for recommended actions for the next stage of evaluation and management and what she can expect to happen. The explanation should occur at each stage of assessment and treatment (p.5).
The document also stresses the importance of the written information that is presented to women during the Pap test. This is expected to reduce anxiety and increase compliance. Verbal information that Pap test providers supply women with should be reflected in the written material. Pap test providers should care for the women’s understanding of the information and the management options. Moreover, various pieces of advice concerning women’s health should be given. For example, advice about the role of smoking in the development of cervical abnormalities is of extreme importance for all women who have an abnormal cervical smear; adequate assistance should be offered to help them to give up the smoking habit (Commonwealth Department, 1994, p. 6).
The quality of the Pap tests and the treatment that the women undergo much depends on the competence and proficiency of the nurse Pap test providers. These people are required to complete accredited training courses and become ‘credentialed’. Credentialing is a process of evaluation of nurse’s expertise. This is also a demonstration of a nurse’s participation in the process of self development that is aimed at meeting the standards of practice.
The credentialing for nurse is important in terms of ensuring the quality of the cervical screening services provided by nurse and its constant improvement. Demonstrating accountability and responsibility for the practice, nurses help the patients to be optimistically geared up for the results of their Pap tests, or in case of dissatisfactory results, strive for health and wellness. Re-credentialing takes place every three years thus maintaining high standards of the Pap test practice.
We are inclined to believe that it is in Pap test providers’ hands to shift women’s attitude to the test from the useless routine medical observation to the effective tool of preventing the serious disease. The methods of health promotion we have discussed are expected to help to change the drastic situation with women’s neglecting the importance of being Pap tested for a better one, where the level of incidence of invasive cervical cancer will be reduced to a minimum.
Bren, L. (2004). Cervical Cancer Screening. FDA Consumer, 38.
Commonwealth Department of Human Services and Health. (1994). Screening to prevent cervical cancer: Guidelines for the management of asymptomatic women with screen detected abnormalities. National health and medical research council of Australia. Web.
Green L, & Kreuter M. (1991). Health promotion and planning: An educational and environmental approach, 2nd ed. Mountain View, CA: Mayfield Publisher.
Green, L.W., & Kreuter, M.W. (2005). Health program planning: An educational and ecological approach, 4th ed. NY: McGraw-Hill Higher Education.
Hale, E. (1989). The Controversial Pap Test. FDA Consumer, 23, 20+.
Raeburn, J., & Rootman, I. (1998). People-centred health promotion: John Wiley & Sons.
World Health Organization. (2008). The Ottawa Charter for Health Promotion. Web.