Campaign Purpose and Rationale
The purpose of this project proposal is to develop a heart disease health promotion campaign. Cardiovascular disease (CVD) accounts for 29% of all deaths according to AIHW 2015 statistics (AIHW, 2017). Additional statistics shows that 44% of deaths within cardiovascular disease are due to coronary heart disease (CHD) (AIHW, 2017), whereas 32% of hospitalisations for CVD were due to CHD in 2009-10 (Waters et al., 2013). Apparently, no explicit health promotion campaign exists in Australia to specifically address cardiovascular diseases and/or coronary heart disease: instead, current health promotion campaigns centre on the CHD and CVD risk factors, such as poor diet and lifestyle, and obesity, when CVD/CHD remains the main killer of Australians. Waters et al. (2013), predict that the prevalence of CHD is on an upsurge trend even as the ageing population grows.
The campaign targets men and women aged between 45-64 years old. The target group are Australians of lower socioeconomic status, the majority of whom have higher literacy level, as well as higher unemployment rates in the society, subsequently affecting their access to [critical] health care services (SBS, 2017). Thus, the campaign targets Australians with the following traits:
- Lower socioeconomic status
- Lower education level
- Higher unemployment level
- Lower access to healthcare services
Campaign Aims and Objectives
The aim of the health promotion campaign is to reduce the incidence of coronary heart disease in people from lower socioeconomic groups and over 45 years old in the most vulnerable areas in Sydney through both preventative measures and follow-up interventions
For the proposed health promotions campaign, there are three (3) objectives. The first objective is to educate lower socioeconomic status individuals and people over 45 years old the risk of CHD from particular lifestyle choices/behaviours and increase awareness of CHD programs. The second aim of the campaign is to increase access to clinical screening and assessment of CHD. The final objective of the program is to decrease the proportion of at-risk targets in developing CHD via access to a nutrition and exercise regime.
In light of the project aim and objectives, we want to curtail mortality and mortality associated with CHD, and close the health gap between socioeconomic groups in Australia. Aforementioned, we will target mature Australians (aged between 45-64 years old). This group was selected because, according to the Heart Foundation (2018), people aged 45+ are the most vulnerable age group. The program will be launched in the five most socioeconomically disadvantaged local areas in Sydney. These areas include Fairfield, Blacktown, Parramatta South, Bankstown and Wyong.
Campaign Implementation Strategies and Methods
To educate lower socioeconomic status individuals and people over 45 years old the risk of CHD from particular lifestyle choices/behaviours and increase awareness of CHD programs, the proposed health promotion campaign will use a setting-based approach.
For decades, setting-based health promotion has been used as a means to enhance public health. Setting-based approaches are associated with building awareness with council partnership/awareness on heart health and the free screening services offered (Watson & Platt, 2000). This approach allows for wide range implementation of health programs (Whitelaw et al., 2001). Moreover, healthcare practitioners can identify common interventions for complex health issues (Whitelaw et al., 2001). Even so, according to Whitelaw et al. (2001), this form of orientation is likely to exacerbate health inequalities, leading to imbalanced access to health care services.
To implement this approach, we will use bus stop ads and banners, which will be designed and managed by the local health district, and possibly heart foundation. We will also take advantage of local councils events, in addition to advertisements at local health centres medical centres and offices of general practitioners to raise awareness of the campaign/intervention program at the grassroot level. Moreover, mails will be delivered to people within our target locations. The campaign will also be advertised on the local newspaper. In light of Nutbeam (2000), deductions, we believe that through health literacy, the program participants will be more autonomous and self efficacious, thus, increasing their understanding of improving their health.
To increase access to clinical screening and assessment of CHD, the proposed health promotion campaign will also leverage a setting-based approach.
For the proposed project, the aim of a setting-based approach is to bring CHD health services closer to the older poor Australians with limited access to health care services. According to Poland et al. (2000), this approach ensures people with individuals with health issues are identified, and thus, prepared for long-term care. Neufeld & Kettner (2014), note that it creates a supportive environment for optimal health, and is flexible, promotes community participation and partnerships, and ensures equity. However, the according to setting approach theory, integrating all stakeholders can be a challenge because of bureaucratic matters within the healthcare system (Neufeld & Kettner, 2014).
To implement this approach, the campaign will leverage mobile screening services using a mobile health vehicle. These will be disseminated around the disadvantaged/high risk communities in the western Sydney region. The screening will involves different types of tests, including:
- Measurement of BMI and Waistline circumferences
- Blood Pressure – Cost effective, Simple way to identify High Blood Pressure
- Blood Test (pathology tests are rebated by the MBS)
This project is likely to succeed as its Neufeld & Kettner (2014), associate setting based approach with 70 percent success rate.
To decrease the proportion of at-risk targets in developing CHD via access to a nutrition and exercise regime, the project will use an individual approach.
Individual approaches to health promotion have high benefits to individuals, promoting high subjective motivation and doctor motivation (Tones et al., 2001). According to Keiser et al. (2008), individual approach in healthcare is associated with effective implementation of long-term illness programs such as HAART. Even so, Keiser et al. (2008), note that the rate of follow up could be low as the number of participants undergoing screening increases.
To implement this approach, we will conduct a one week follow-up from screening after obtaining the test results. The target group will be categorised into medium-high risk and low risk, where each group will be approached differently. For the medium-high risk group, the campaign will focus on behavioural risks associated with CHD, as well as the medical risks based on the recommendations of health practitioners. Meanwhile, the lower risk group will entail focusing on behavioural risks to encourage the participants to change their lifestyle (specifically alcohol and substance use/abuse and poor nutrition) and exercise more. In light of Raphael (2000), strategies of public health improvement, this campaign is highly likely to educate the patients and alter their risky behaviours and attitude towards healthy living.
Campaign Challenges and Solutions
Significant challenges pose in the way of successful implementation of the CHD health campaign programs (Kemm, 2014).
Funding and availability of mobile service
For one thing, it may be difficult to receive enough funding for multiple mobile carts as this will be an expensive project and its effectiveness is not yet clear at the moment. Accordingly, this may affect the availability of the mobile services to traverse across Sydney’s suburbs. In the event that we do not receive enough funding for enough carts, we can establish a roster where services alternate between suburbs each week, according to Seedhouse’s (2004) program planning. Nonetheless, we expect funding from the NSW Ministry of Health and LHDs on a fixed term contract to ensure timing and availability of service.
Location of service
The second challenge is the location of services. When the mobile services are first established using the mobile health vans, the campaign team may find it difficult to determine their optimal location for reaching older lower SES people. To determine the precise locations, the team will monitor traffic in public areas, such as hospitals and shopping centres, which are commonly and easily accessed by the campaign’s target population.
Making sure that patients follow up with services after the screening
The final challenge entails following up the patients after they have been screened. This would be a challenge especially when the patients are neither aware of treatment options nor motivated to change negative health behaviours. Nonetheless, the campaign team intends to resolve this problem via patient education by disseminating flyers on how to prevent and/or manage CVD. Moreover, partner medical centres will be encouraged to keep in contact with patients via a preferred method (mail, phone) to remind patients to follow up besides organizing CVD health talks monthly.
Another challenge is ethical issues. Considering that the campaign involves humans, we will be required to uphold the highest integrity and transparency. More so, all the stakeholders in the program will respect the medical principles of autonomy, benevolence, maleficence, and justice (Raphael, 2000). Overall, the campaign team will ensure every participant has non-discriminatory access to screening and follow up.
For the proposed health promotion campaign, the main stakeholders include: (1) Lower SES Australians aged 45+ years old in Sydney; (2) Healthcare workers (including Nurses/GPs/Hospital staff/other AH); (3) NSW Ministry of Health and Local Health Districts; and, (4) the National Heart Foundation of Australia. Each stakeholder will play a distinct role in the campaign.
Lower SES individuals, aged 45+ in Sydney
This is the group directly affected by cardiovascular diseases, according to the Heart Foundation.
Healthcare workers (Nurses/GPs/hospital staff/cardiologists)
Nurses will conduct the screenings in the mobile vehicles and administer blood tests. GPs will conduct follow-up sessions with the patient to discuss results and, when necessary, prescribe medications or refer the individual to hospital for a procedure where they will be admitted as a public patient. The GP may also refer the patient to a cardiologist for consultation, where 5 sessions will be covered by the MBS, in light of the Australian Government Department of Health (2016).
NSW Ministry of Health and Local Health Districts
The NSW Ministry of Health will fund the mobile screening service by providing block funding to the Local Health Districts of each target location (e.g. the South West Sydney Local Health District for Fairfield and Bankstown). Meanwhile, the Local Health Districts will provide medical equipment (ECG) and vehicles, recruit the nurses, and promote the mobile service to the public.
National Heart Foundation of Australia
The Heart Foundation will be approached to endorse the health promotion program to increase its credibility among the populace.
Successful implementation of the health promotion campaign requires substantial resources, most of which are quite expensive to bring on board, and thus, the need for block funding and strategic partnerships with both local and national institutions. The following resources will be needed: (1) mobile vehicles/mobile carts (x4) to provide on-site screening; (2) Medical equipment most reliable for screening and diagnosing CHD (3) Staff (drivers to transport personnel, nurses to conduct screening, GPs to follow up and/or refer patients; (4) Advertisement to spread the word about the mobile screening services and the overall health promotion campaign.
The campaign will leverage both individuals involved directly with the mobile screening programs and secondary personnel, such as community health centres, clinics, councils, carpark/shopping centre management. The nurses will direct, screen, and monitor the patients; pathologists will assess the blood samples; nutritionists and physiotherapists will lead nutrition and exercising programs; the GPs will identify high risk individuals and facilitate follow ups and referrals; drivers will transport the staff and equipment to various screening locations; and, volunteers will provide extra support during the program. Moreover, the team will be in contact with community health centres, clinics, and council members, as well as car parking/shopping centre management for a space to park the campaign vehicle. Such high foot traffic places will increase the program exposure.
Campaign Equipment/ Utility
To ensure the health promotion program runs successfully, the project team will require various utilities. First, the team will require four (4) mobile screening vehicles to transport the staff and screening equipment, act as on-site screening centres, and provide accessibility to various screening locations. The van will have an extended roof and wheel base suitable for the campaign operations. Moreover, it is easier to manouver the vans than trailers, which require the use of a truck to move the trailer around to the various locations. White vans, with the campaign ad will be used to enhance identifiability. Each van will be loaded with medical equipment, including blood pressure/blood analysis, and mobile ECG/EKG. Imperatively, cost and space effective methods for screening and diagnosing will be used.
Campaign Advertising and Cost
The campaign will depend on intensive advertising to reach the target population. We will need an advertising agency to spread the word about the mobile vans. Some of our partners will include oOH!, JCdecaux, and the NSW Health. The will erect posters in Local Health Centres/Clinics, billboards and bus stop ads, and aforementioned, making the vans identifiable. The advertisements will be placed in these high traffic areas to increase exposure of the service. Among the good places to erect the billboards include M7, M4, and Parramatta Road.
Approximately, each van and equipment will cost AUD 90,000 and AUD 10,000, respectively, adding up to AUD 400,000. Staffing will cost AUD 320,000 annually per van, adding to AUD 1.2 million. Overall, we approximate the program will cost, excluding advertising and intermediaries, AUD 1.6 million.
The project will be evaluated in light of the purpose of the campaign. The project team use process evaluation. According to Diaz et al. (2014), this method allows teams to assess whether it is achieving the campaign activities are being implemented. In addition, impact evaluation will be used. This is an effective method for assessing the program’s effectiveness in achieving its aims and objectives (Raphael, 2000).
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