Health Needs Assessment

By XXXXXXXXXXXX

Course: Public Health and Health Promotion MSc

Module: Principles & Practices of Public Health NHS4207

Student ID: XXXXXXXX

Word Count: 4000 words

PART 1

Introduction

Health Needs Assessment (HNA) entails a process of systematically reviewing a specified population’s health issues and prioritizing identified needs through consensus. The process further leads to mobilization and allocation of resources towards health improvement and reduction of inequalities (Hooper & Longworth, 2002). HNA constitutes an integral component of public health which focusses on disease prevention, promotion of quality lives, and health promotion by leveraging on the society’s organized efforts (Acheson, 1988).

The process aims at integrating health actions in public policies and creating a supportive environment that nurtures health. Moreover, HNA stimulates community health action, empowers individuals to manage their health, and harnesses a holistic perspective amongst health practitioners and planners. Notable is the fact that the concept of health varies across individuals as well as communities and is largely influenced by individual perceptions, access to information, values, and beliefs (Scriven, 2010). Consequently, the ability to engage communities through the HNA process is influenced by their concept of health.

The World Health Organization (WHO) recognizes inequalities as significant factors that undermine the health of different communities, countries, and settings across the globe (Crombie, Irvine, Elliott, Wallace, & Organization, 2005). These inequalities can be best understood by conducting a HNA in order to generate actionable information to reduce their impact on health and wellbeing. However, there is need for standardized tools that can be used to objective collect and assess the health issues affecting diverse populations.

The United Kingdom (UK) Government recognizes HNA as a process for generating evidence on populations to reduce health inequalities while strengthening multi-sector partnerships that potentiate the effects of health interventions (Cavanagh & Chadwick, 2005). The subsequent sections of this essay will entail a HNA amongst nurses in understaffed settings using the five-steps approach by Hooper & Longworth, (2002) to identify their health priorities. The health priorities will then be assessed to determine an actionable intervention for health improvement coupled with a press release on the outcome of this process.

The World Health Organization defines health as a state whereby an individual enjoys complete wellbeing in all aspects pertaining their physical, mental and social domains as opposed to the mere absence of disease or infirmity (World Health Organization, 1948 ). Multiple viewpoints have been advanced in recent decades challenging the “completeness” of health (Godlee, 2011; Huber et al., 2011; Naidoo & Wills, 2000). Instead, other experts view health and wellness as a continuum that has no boundaries thus alluding to the impossibility of “complete health” or “complete illness”.

Godlee, (2011) also argued that the WHO definition of health is not workable in the present times because it out rightly ignores the capacity of individuals to cope with various ailments such as non-communicable diseases. These counter-perspectives are partly informed by advancements in modern medicine that have made it possible for individuals with a certain diseases to have a high quality of life with comparable life expectancies to healthy individuals.

There are two main models of health namely the medical model and social model of health (Nutbeam, Harris, & Wise, 2010). The medical model of health is also referred to as the biomedical or biological model and is reductionist in its approach. The model views the body and mind as separate entities while focusing on illness or absence of illness. On the other hand,

the social model is societal oriented and considers social, cultural, psychological, economic, and political factors as relevant to the health of an individual. In addition, the model recognizes that external factors such as gender, poverty, inequality, and deprivation influence the health of individuals. The social model is widely in public health as well as social and behavioral sciences.

There are five steps in conducting a health needs assessment with the first step entailing an assessment of the targeted population, the aims and objectives, the key stakeholders, the resources needed, and processes for measuring outcomes (Hooper & Longworth, 2002). The target population in this HNA comprises of nurses working in Nairobi County, the capital city of Kenya. Kenyan nurses bear heavy workloads due to an acute shortage of nurses as evidenced by the ratio of 11 nurses per 10,000 population (Ministry of Health Kenya, 2016). They work in multiple settings in the public and private sectors where they account for 67.1% and 54.3% of the health workforce respectively.

The nature of work undertaken by nurses across requires them to work for longer hours thus exposing them to stresses associated with taking care of ill persons. The uniqueness of this population is further confirmed by the frontline role played by nurses in the Kenyan healthcare system, hence, bear the brunt of frustrated citizens in the event of systemic failures beyond the scope of nurses. Nurses have a high tendency to make unhealthy eating choices especially during their shift hours (Power, 2018). These include carrying through entire shifts without having a balanced meal or consuming heavy meal at the end of their shifts.

• some instances, nurses prefer to “grab a snack” in between their busy schedules in order “to boost their energy levels” (Ahmad et al., 2015; Almajwal, 2015). The long-term outcome of these decisions entails an exacerbation of NCDs including diabetes, hypertension, cancer, and mental disorders amongst nurses (McTiernan & McDonald, 2015; Powers et al.,
• . Nurses diagnosed with these diseases experience a reduced quality of life, reduced productivity, and tend to exit the workforce early due to disability or death (Lopes, Guerra-Arias, Buchan, Pozo-Martin, & Nove, 2017). There is need to empower nurses to have more control over and improve their overall health by adopting healthy eating habits in tandem with World Health Organization health promotion agenda.

This HNA aims at generating evidence will be utilized to address the inequalities associated with unhealthy eating habits amongst nurses. The objectives of the HNA include promoting the well-being of the nurses, improving self-efficacy, harnessing nurses’ productivity and health-related quality of life. The HNA project team will include a Public Health Nurse Practitioner from Kenya currently based in the United Kingdom working in collaboration with a technical representative from the National Nurses Association of Kenya (NNAK).

The HNA process will involve different stakeholders through a multi-sector collaboration approach (Hooper & Longworth, 2002). The nurses through their professional associations and unions will constitute the main stakeholders and collaboratively explore their health needs in respect with nutrition choices to prioritize them for health improvement. The second group of stakeholders will include employers of nurses namely the Ministry of Health and private sector organizations because of their decision-making role on matters human resources. In addition, representatives from communities accessing healthcare services in public and private institutions. Finally, the public health department will also be engaged as a stakeholder to provide technical assistance through the HNA process. The resources required for the HNA process will include time by the project team to attend annual conferences organized by various disciplines in nursing during the year 2019.

The second phase of the HNA process as detailed by Hooper and Longworth, (2002) will entail identification of the health priorities. It is important to develop a health profile of the target population prior to the identification of the health priorities (McKenzie, Neiger, & Thackeray, 2005). The health profile of the nurses was developed by reviewing data from published studies and healthcare data from the Kenyan Health Management Information System. The prevalent health conditions amongst nurses include diabetes, hypertension, obesity, cancer, and mental disorders. Various determinants have been linked to the high prevalence of NCDs amongst nurses including the working environment, work-related stress, poor nutrition, low incomes amongst nurses, and lack of knowledge on healthy nutrition (Perry et al., 2018).

According to Reed, (2014), work-related stress amongst nurses contributes to poor nutritional choices thereby predisposing them to NCDs. The American Diabetes Association discourages skipping meals as well as consumption of heavy unbalanced meals because of the impact on stress levels. Additional health information will be gathered through interviews and focused group discussions organized during nursing gatherings. The barriers anticipated during the HNA include potential nursing intra-cadre conflicts characteristic of the Kenyan nursing landscape. This may make the HNA more challenging but can be overcome through consensus building amongst the leaders of the respective cadres as well as timely communication, transparency, and openness throughout the process.

Nurses in resource constrained settings such have various health needs including the need for nutritional health education as recent evidence suggests their lack of knowledge and awareness on healthy nutrition (Bauer, Halfens, & Lohrmann, 2015). Secondly, the busy and long shifts undertaken by nurses make them less mindful of their own nutritional needs, hence,

the need for healthy eating reminders (Power, 2018). In addition, nurses are in need of a supportive work environment that nurtures positive nutritional behaviors.

The heavy workload born by nurses contributes to poor dietary choices as they jostle with competing priorities namely meeting their performance tasks in order to earn a living (Power, 2018). Nurses in Kenya manage primary healthcare services whose key functions include promoting healthy nutrition in communities. However, the complex nature of the circumstances surrounding their work makes it impossible for them to benefit from the very services they provide and this makes their occupation an inequality that undermines their health. Additional health needs amongst nurses include ongoing psychological support that reduces the impact of work-related stress on their health.

Part II: Priority Health Action

Assessment of a health priority for action constitutes the third step of HNA by Hooper and Longworth, (2002). The identified health priority for assessment is the need for healthy eating reminders based on impact, acceptability, changeability, availability of resources, and feasibility (Cavanagh & Chadwick, 2005). Consequently, the applicable health action to address the identified need will entail peer driven healthy eating reminders. This will involve nursing peers enquiring from each other if they have eaten any of the daily recommended food varieties. This should generally happen during conversations at work, staff meetings, and phone calls.

The UK’s National Health Service (NHS) provides guidelines on the specific foodstuff and the recommended quantities that individuals should consume daily to meet their nutritional needs (National Health Service, 2018). The evidence adduced in previous sections confirms the fact that nurses tend to skip mills or make unhealthy choices when they have an opportunity to

consume a meal. As such, eating times are very critical considering the busy nature of nursing shifts that makes it impossible to remember when to have a meal. Peer driven healthy eating reminders will have significant impact on the nurses’ health functioning in the long-term by reducing their risk of NCDs.

Nutritional reminders can take a wide range of forms including mobile eating alerts, phone games, or reminders by peers (Cole-Lewis & Kershaw, 2010; Fjeldsoe, Marshall, & Miller, 2009; Pollak et al., 2010). The reminders have been shown to reduce caloric intake amongst dieters and people at risk of NCDs (Papies & Veling, 2013). Fry and Neff, (2009) conducted a systematic review of evidence on the efficacy of periodic reminders in promoting behavior change whereby increased frequency of the intervention was shown to reinforce healthy behaviors.

Cheung et al., (2012) also confirmed the effectiveness of reminders in promoting behavior change within clinical settings. In addition to adoption of good eating habits, the peer-driven healthy eating reminders will improve cohesion, team spirit, and collegiality amongst nurses as they will mind more about each other. This has a beneficial effect on psychological well-being by improving one’s sense of belonging and reducing the impact of stress that nurtures poor nutritional habits. As demonstrated by Maslow, (1943), a fulfilled sense of belonging promotes self-actualization and improves health.

The second criterion for assessing the identified health priority focusses on changeability and this highlights effective actions across the different levels of disease prevention. Available evidence shows that healthy eating reminders are effective in addressing unhealthy diet choices (Papies & Veling, 2013; Soureti et al., 2011; Stawarz, Cox, & Blandford, 2015). It is equally important to consider whether the identified priority is acceptable across the different

stakeholders. Acceptability of health priority is useful and confirms that the target population recognizes its health needs. Furthermore, acceptability of the health priority creates a sense of ownership of the HNA process across stakeholders and facilitates resource mobilization for health improvement actions.

There are no healthy eating reminders within the settings that Kenyan nurses execute their functions. However, guidelines exist in primary healthcare settings managed by nurses on healthy nutrition but these have been less efficacious in addressing the underlying issues promoting unhealthy eating habits (Ministry of Health, 2016). Implementation of the intended action will take place across all settings that nurses work through the pre-established nurses’ professional network. The nurses’ association in Kenya has a presence across all healthcare institutions and focuses on nurses’ welfare, hence the most suitable vehicle for reaching out to disadvantaged nurses.

The resources required for the priority health action will include the time of the project team to engage with the nursing professional leadership and nurses working across different settings in Nairobi, Kenya. The nurses will be engaged during their quarterly professional welfare meetings held at their work place. As such, no additional time demands will be placed on the nurses in order to participate in the HNA. Moreover, the engagement will take place within their work settings thus allowing most of them to participate in the HNA, take charge of, and improve their own health. The direct engagement of nurses will also enhance sustainability of the health education interventions (World Health Organization, 2009).

The actions to be taken by nurses following the engagements will include checking with colleagues if they had consumed any of the daily recommended food servings or just reminding them to do so. Additional resources include writing materials that will be used to design eating

reminders at the nurses work stations and designated eating places. The writing materials will also be used to build food diaries over specified period thus promoting shared learning through peer review of eating habits. Based on this assessment, the peer driven healthy eating reminders intervention is feasible in respect to the resources required.

The bulk of the intervention leverages on the existing resources and structures without introducing disruptive actions. Most interventions targeting nurses in resource constraint settings hardly see the light of day because of the additional resources and mediating changes that upset work environments (Scriven, 2010). Peer driven healthy eating reminders will no doubt be a perfect fit nutrition intervention targeting the improvement of healthy eating habits amongst nurses in resource constrained settings.

According to the Hooper & Longworth, (2002) model of HNA, the fourth step involves planning for health. There is need to involve the nurses in planning for their health priorities because it makes them own the process and appreciate the impact of determinants on their health. Public involvement enhances understanding, builds capacity, and empowers communities to address issues affecting their health. According to Laverack, (2004), empowerment may occur at the level of an community, family, individual, organization, and organization. The author further emphasized that political, economic, environmental, and social factors influence empowerment. The World Health Organization recognizes empowerment as a critical element that sustains health education beyond planned interventions (World Health Organization, 2009).

The aim of the peer driven healthy eating reminders is to improve the nutritional habits of nurses. The specific objectives of the intervention include increasing the frequency of consuming meals amongst nurses during shift hours. Secondly, the intervention will improve the nutritional

value of foodstuffs consumed by nurses through balanced nutrition. Finally, the intervention will reduce the risk of nurses to NCDs linked to the impact of imbalanced nutrition linked stresses.

The actions to achieve these objectives will include verbal engagements in the course of normal work conversations to find out if a colleague has had any of the recommended daily food servings or is planning to do so later. The specific food servings will be in accordance with the recommended by the NHS including proteins, carbohydrates, vitamins, fats &fatty acids. The reminders should also include fruits, vegetables, juices, smoothies, as well as ready-made meals based on recommended daily portions.

The second action will involve nurses keeping diaries of the foodstuffs they consume during shifts. These diaries will then be exchanged and appraised amongst peers who can recommend a better way of combining the foodstuffs consumed to their colleagues. The intervention will focus on using the foodstuffs already available to the nurses in developing a balanced nutrition as opposed to introducing new food commodities. This will in the long-run improve the knowledge of the nurses on nutrition and how to plan their meals using the scarce resources at their disposal. The final action will entail putting up healthy eating alerts strategically at the nurses’ stations and designated areas for meals. All these actions will progressively change the nurses’ concept and perception of their own health as they begin to appreciate the impact of healthy nutrition to their professional welfare and role in society.

Specifying responsibilities for various stakeholders ensures the timely implementation of the priority health action, reduces wastage of resources and strengthens cooperation amongst community members for future interventions. Furthermore, clear responsibilities ensure that stakeholders respect each other and minimizes potential conflict that may threaten implementation of health improvement interventions (Naidoo & Wills, 2000). In the current

HNA on the nutritional needs of nurses, the project team will equip the nurses with knowledge and skills on healthy nutrition habits and planning for optimum nutritional intake during long and busy shifts.

The capacity building exercise will be undertaken by the project team during quarterly professional welfare meetings organized by the National Nurses Association of Kenya. As such, the professional nursing leadership will be instrumental in organizing these meetings and whipping their members to attend. The outcome of the capacity building process will be empowering the nurses to take control of their own health in accordance with the principles of health promotion. The nurses will also receive guidance on proper messaging when engaging with colleagues to ensure the right information on healthy nutrition is passed across. The nurses will take charge of the verbal peer to peer reminders as they engage with each other in the course of their duties.

The management will be required to provide a conducive working environment that promotes healthy nutritional habits by reviewing work schedules, and designating suitable eating places for nurses. This may raise some ethical issues as employers attribute the long work shifts to the shortage of nurses hence the dilemma in balancing the health needs of both nurses and patients. But evidence confirms that restructuring the working environment including scheduling of staff is effective in promotes behavior change amongst nurses by improving their nutritional habits (Nicholls, Perry, Duffield, Gallagher, & Pierce, 2017).

The project team will focus on providing technical support to the nursing teams across Nairobi County. Finally, the project team will reach out to various stakeholders including the public, and private sector employers in a discourse aimed at reviewing work policies that promote healthy eating habits amongst nurses. The coordination of this intervention at the health

facility will be delegated to the branch leaders of the nurses’ association who regularly meet with their members and receive reports on professional welfare matters affecting nurses.

The planning process also entails a determination of the specifics aspects of the intervention to be evaluated, the collection of evaluation data, and a feedback mechanism to the target population regarding their progress. The aspects of this intervention that will be evaluated include the number of nurses receiving healthy eating reminders from colleagues, the uptake of healthy eating habits by nurses, knowledge gaps on healthy nutrition, and overall effect on health and wellbeing. This aspects will be evaluated using a structured questionnaire administered quarterly during the intervention implementation period. The project team will analyze the data and provide feedback to the nurses through reports disseminated in subsequent meetings.

The final stage of the HNA involves a post-intervention evaluation to determine whether the objectives were realized, the challenges encountered, and the lessons learnt. The evaluation should also focus on the aspects of the intervention that require further action beyond the implementation timeline. The project team will also consider the effectiveness of the intervention implemented in addressing unhealthy eating habits amongst nurses by analyzing data collected during the implementation phase. The main achievements of the intervention should be clearly enumerated particularly in respect to addressing the health inequalities identified amongst nurses. A potential policy implications of this HNA includes a review of policies governing provision of nursing care in order to make them favorable for healthy eating habits.

Conclusion

This HNA identified peer driven healthy nutrition reminders as the most impactful, changeable, acceptable, and feasible health priority action considering the resource constrained

nature of the Kenyan setting. The process provides an avenue for engaging with the nurses and their leaders in identifying and prioritizing their health needs for health improvement action. Finally, the process has ensured that nurses are empowered as much as possible to manage all aspects relating to their nutrition in a manner that improves their health.

Press release

Nurses in Kenya represent the largest professional group working within the health sector as confirmed by workforce reports from the Ministry of Health. They account for 68% of the professionals working in public health facilities and 54% of the private health sector workforce. Furthermore, they manage the country’s primary health services which include all health centers, dispensaries, and community health services representing 60% of the healthcare services.

This profiles nurses as a critical component of the health workforce without whom the entire healthcare system collapses. Despite being the largest group of healthcare workers, nurses are overwhelmed by the huge workload because their number is not sufficient to meet the population needs. They also bear the brunt of frustrated citizens demanding for answers in the face of inefficiencies despite these being system challenges beyond their scope.

The demanding nature of the role played by nurses in the healthcare system exposes them to higher levels of stress thus increasing their chances of developing diabetes, high blood pressure, cancer, and mental disorders. It is not unusual for nurses to long hours, skip meals, or consume unbalanced meals and this progressively worsens their health. According to the American Diabetes Association, people working in demanding jobs like nursing should avoid

skipping meals or consuming heavy unbalanced meals because it further increases their chances of developing diabetes.

This possibly explains the increasing number of nurses diagnosed with diabetes, high-blood pressure, and cancer. Nurses diagnosed with these conditions are less productive, have a reduced quality of life, and tend to leave the workforce early before their retirement thus worsening the shortage of nurses in Kenya. The premature exit of nurses from the workforce negatively affects the entire society including employers, citizens, and patients in need of nursing care.

• is ironical to imagine that nurses are solely responsible for providing healthcare services to 60% of the Kenyans and the remaining 40% in collaboration with other healthcare professionals yet the circumstances of their work exposes them to the diseases they prevent. An assessment of the health issues affecting the nurses found no interventions targeting to improve the health of this crucial workforce. This is despite the existence of innovative strategies such as healthy-eating reminders that have the potential to significantly improve nutrition habits and overall health of the nurses. Instead, the working conditions provided by employers deny nurses their right to health as enshrined under the bill of rights in the Kenyan constitution. The system makes it impossible for nurses to benefit from the same essential healthcare services they provide to the citizens making them a disadvantaged group in society.
• conclusion, there is need for collective action from employer groups, communities, and policy makers in consultation with nurses to promote healthy nutrition habits amongst the nurses. Nurses need favorable working conditions that afford them the opportunity to have balanced meals during their working hours. Finally, employers should properly designate eating places for nurses and provide management support to improve their health.

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