Professor Notes about Program Planning And Evaluation In Public Health

Question: Discuss about the Program Planning and Evaluation in Public Health. Answer: Introduction Sexual health is the state of social, mental and physical well-being with regards to sexuality. It requires a respectful and positive approach to sexual relationships and sexuality including the possibility of having safe and pleasurable sexual experiences, violence, discrimination and free of coercion (World Health Organization 2016). There are several factors that can affect the sexual health and it includes sexually transmitted diseases, concerns about infertility, fear of unplanned pregnancy, medicines affecting sexual performance or desire and chronic diseases like heart diseases and cancer (Sti.health.gov.au 2016). Deakin University is an Australian university in Victoria with campuses and learning centers throughout Victoria. About 8,400 students in the University are international students that make up about 16.3% of the total student population (Deakin.edu.au 2016). The university provides relationships and sexual health support to its international students to avoid unplann ed pregnancies and sexually transmitted infections in the form of different counseling services. The commonly identified sexually transmitted infection among the international students in Deakin University (DU) is Chlamydia. Therefore, to improve the sexual health of the international students and meeting their sexual needs, a voluntary project has been adopted by the international students of the University. The project has been named Healthy Deakin (HD) and the funding requested for the project is $200,000 over a period of three years. The general strategies proposed for the project for meeting the sexual health needs of the international students has been listed below. Programs for driving strategic coordination and the commitment for sustaining better reproductive and sexual health outcomes for the international students. Promoting the recognition of the right to reproductive and sexual health for implying that the students are able to enjoy a mutually safer and satisfying relationship. Undertaking a comprehensive approach for early intervention, reproductive and sexual health prevention and disease prevention. Focusing on reducing the inequalities in the reproductive and sexual health outcomes for improving access to the relevant services and information for the risk of the vulnerable groups of the international students. Recognition of the needs and acknowledgment of the diversity of all the international students regardless of their sexual orientation, ethnicity, financial means and geographic location. Development of accountable and evidence-based programs and policies which are underpinned by extensive research, monitoring, ongoing evaluation and systematic data collection. Problem Statement DU has been ranked the 9th largest university in Australia with its total student count of 42,000. Out of this, approximately one-fifth of the population is international students who belong from over 100 countries. 28% of the international students are of the age 25 or older and can be identified as mature (Deakin.edu.au 2016). The common problems of the international students in DU are sexually transmitted infections (mostly Chlamydia), high rates of termination and unplanned pregnancies. It is a high priority problem that has been identified not only by the university but also by the researchers. Little resources and research data are available that explains the causes and provides recommendations for the prevention of the problems (Baum et al. 2014). Therefore, there is an urgent need for support programs and enhanced promotion of sexual health for meeting the sexual health needs of the international students studying in DU. The project HD has been designed and developed for fill ing the knowledge gap for the development of the preventive interventions and support services to the international students of DU. The project will understand and analyze the sexual health needs of the international students and provide them with the appropriate recommendations for promoting their sexual health. Background Study According to a study conducted by Inoue et al. (2016), the Japanese female students choose the withdrawal methods and condom as the practices of sexual health and contraception. Since this is the standard practice in Japan, they tend to follow the similar trend in Australia while they are the students. Any carelessness and lack of knowledge result in acquiring sexually transmitted infections, especially with the withdrawal method. Mitchell et al. (2014) carried out a study to find that surveys are done to test the knowledge of the students on HIV and other infections that are transmitted sexually like human papillomavirus and hepatitis. A knowledge gap has been identified from the study which suggested the need for appropriate intervention to prevent sexually transmitted infections and unwanted pregnancy among the students of Australia. Clark et al. (2016) opined that the students had delayed the sexual activity but with inconsistent use of contraceptives and condoms. This inconsiste ncy has led to the rise of the unwanted pregnancy and infections among the students that needs appropriate intervention. Lechner et al. (2013) opined that the university students should be provided with referrals and resources for their sexual health needs by the universities as it can result in improved sexual health outcomes of the students. Local Needs Assessment Data The international student group in DU is comprised mostly of the Chinese students of about 46% with a relatively lesser ratio of students from other countries like India, Sri Lanka, Malaysia and Hong Kong (Deakin.edu.au 2016). Therefore, it was evident from the reports obtained from the Deakin Medical Centers and Overseas Health Cover for the international students, the Chinese students suffered the most from unwanted pregnancies and sexually transmitted infections. Being away from their country of origin gives them a sense of freedom that results in careless sex life for these students and invites the health hazards of communicable sexual diseases and termination of pregnancy (Lillyman and Bennett 2014). According to a survey carried out with the 20 international students, it was found that the Japanese students followed the withdrawal method while the Indian students abstained from sexual intercourse for 9 consecutive days after the occurrence of menstruation. These are the traditi onal methods of prevention of pregnancy that these students follow and as these methods are vulnerable to the breach of protection, unwanted pregnancy occurs and the students get affected by sexually transmitted infections (Hall 2016). Project Summary The HD project aims to provide guide and support for all the sexual health promotion, provision and prevention and ensure that equitable provision of higher quality of clinically effective care for all the international students in DU. The project goal is to deepen the sexually transmitted infection knowledge, reduce the sexual risks, improve the correct use of condoms and setting long-term goals for utilizing the skills and knowledge learned during the project from the education, support, information and counseling services. To provide sufficient knowledge to the international students regarding the consequences of risk-associated sexual behavior among the international students. To evaluate and develop novel methods of health promotion for measuring the outcomes of the project implementation utilizing the media like social networking websites and cellular phones. To carry out several awareness campaigns by the project volunteers in association with the university medical centers and local health bodies. To make the university campus free of sexually transmitted infection and unwanted pregnancy among the international students by making use of the available resources. To achieve the goal of the project within the project duration of three years and meet the sexual health needs of the international students in DU. Project Description Several strategies will be adopted for implementing the project. The strategies have been explained below. Educational intervention: Comprehensive sexual education helps to emphasize the benefits of abstinence apart from teaching about the methods of disease prevention and contraception. This has been found to be effective in reducing the rates of sexually transmitted infection and unwanted pregnancy (Arnett 2014). Therefore, policies have to be developed to incorporate compulsory sexual education for all the students in the university to attain their sexual health needs. Apart from this, culturally compatible educational sessions can be carried out with the international students to make them aware that traditional methods of contraception are risk prone and can invite health hazards (Hald and Mulya 2013). Sessions will be conducted every fortnight by the international peers with periodic evaluation of the knowledge gained. Development of awareness: The beliefs, attitudes, values, knowledge levels and patterns of communication regarding contraception, relationships, sexuality and sexual health varies significantly across the ethnic groups and cultures. Free distribution of STD (Sexually Transmitted Diseases) prevention and birth control devices like condoms, diaphragm, cervical cap, oral contraceptives and intrauterine devices can significantly bring down the prevalence rate of sexually transmitted infections and can help to avoid unwanted pregnancy. Often, fear of judgment and lack of money prevents the students from buying the contraceptive devices (Oppong and Oti-Boadi 2013). Free distribution can make them confident in condom carrying, acquisition and use that will result in reducing the diseases. A proportional share of the budget has to be allotted for the distribution of the sexual health commodities and it has to be done every weekend throughout the project when the students tend to relax. Student support networks: Student support networks can be beneficial for the students in the information they perceive and consequently the decision they make considering their sexual health. Friends and classmates can be helpful in influencing the behavior and attitudes of the students by providing them with the ongoing prevention and health messages (Coleman et al. 2013). Interaction of the international students with each other and with the peers during the educational sessions will have their unique cross-cultural contributions for shaping the knowledge base, self-efficacy and attitudes of the students regarding their sexual health needs (Wang et al. 2015). Improved access to testing: University students are at high prone to develop the sexually transmitted infections which are often left undiagnosed and untreated. Since testing of the disease is a new experience for the students, they can prove to be intimidating due to the perceived stigma and risk (Fonner et al. 2014). The project will arrange for facilitating testing opportunities in the university where the international students will have to participate in a compulsory sexual health check up every month. Routine screening process and offering the testing as a part of the regular health checkups will decrease the stigma and increase the awareness of the act of testing among the international students (Protogerou et al. 2013). Beatties model can be effective for examining the assumptions for delivering health promotion. Beatties model makes use of the criteria of the focus of intervention (individual collective) and mode of intervention (authoritative-negotiated) (Drcath.net 2016). In the project HD, the radical humanist approach was used for forming self help groups to help the international students with their sexual health needs. The humanist approach was used for conducting awareness campaigns and providing peer education to the students in the form of debates, role plays and dramas. Health persuasion approach was used for modifying their behavior and life skills and personal counseling was used for focusing on the personal development. Figure 1: Beatties Model of Health Promotion Source: Eldredge et al. (2016) Target Population The campuses of DU are located in the Warrnambool, Geelong and Burwood in Melbourne and the learning centers of DU are located in Werribee, Craigieburn and Dandenong in Australia. Considering both the campus and learning center, approximately 8,400 international students are the target population of the project (Deakin.edu.au 2016). The students have to be divided in the both these places to facilitate their learning process from the peer education and the students who are on cloud learning have to be communicated through cellular phones or social networks. The on-campus students will be segregated according to their freshness in the campus, like the beginners will be provided the training first followed by the intermediates and the experts. However, contraceptive devices distribution has to be carried out for all the international students who are either on on-campus or off-campus learning modes. For the cloud learners, the sessions and evaluations can be done online by conducting w ebinars. Project Partners The project HD will be partnered primarily with the DU medical center at its Burwood and Geelong campus for promoting the health outcomes of the international students. The university students will be provided with the free health checkups and counseling through the DU medical centers and will be treated for free in case of any infection or pregnancy detected. Termination of pregnancy will also be provided by the medical center. The project will be partnered with Island Sexual Health Society as they have a chain of comprehensive and pro-choice sexual health clinics in Victoria. This will be of help for the off-campus and cloud students to avail the checkup, counseling and treatment near to their residence without attending the university. The project was also partnered with DU Student Association (DUSA) and for collaborating with the arrangement of activities and events, even for the cloud students, to promote the project and bringing the students together. Similar Activities Previously, an attempt was undertaken by the University authority to educate the students regarding safe sex habits. For this, the university partnered with the Department of Education and Training, State Government of Victoria for providing free sex education to the international students to bring down the rate of sexually transmitted infections and unwanted pregnancies. However, the students complained that the education provided was of school level and was not of the university level students. In addition, the cultural competence factor was not considered while giving out the sessions and many of the international students were not comfortable with it. Therefore, the education was of no good use for the students and a gap was identified between the education and the outcome. Project HD was designed to overcome this barrier and recruited professional peers and physicians who are not only competent but also multicultural to provide appropriate cultural education to the international students for meeting their sexual health needs. The project also aims at providing free educational material for future references and contraceptive devices to convert the goal of the project into a reality within the specified duration of the project. Success Measurement The success of the process will be measured by collecting data from the number of education sessions conducted by the peers and the types of policies developed for making sexual education compulsory. The number of STD prevention and birth control devices freely distributed can also give an estimation of the success of the process. The cost incurred to promote the project through various means on and off the campus and the satisfaction rate of the target population at the intermediate stages are the parameters of process measure. Data will be collected half yearly for process measure. Impact Measure The impact of the project can be measured by conducting surveys at the beginning, intermediate and finished stages of the project to retrieve comparative values regarding the behaviors, attitudes and knowledge of the international students regarding their sexual health. Data from the DU medical center and Overseas Health Cover will determine whether there has been any improvement in the rate of STDs and unwanted pregnancies. Data will be collected annually for impact measure. Project Sustainability The project HD is a sexual health project with a vision to meet the sexual health needs of the international students in the university. Therefore, even after the funds get exhausted, the peer educational sessions will continue for free according to the developed policies for the next five years. Thereafter, it will be given for free for the initial two years to the new comers of the University. The same procedure will be followed for the cloud students through webinars. Free distribution of the STD prevention and birth control devices will continue from the DU medical center for the next one year after the completion of the project as part of the university grant and thereafter, it will be distributed for free only to the newcomers for the first one year according to the grant. Direct Costs Category 1st Year 2nd Year 3rd Year Total Peers Charges 30,000 30,000 30,000 90,000 Clinical Charges 10,000 10,000 10,000 30,000 STD prevention and birth control devices 4,000 3,000 3,000 10,000 Total 130,000 Indirect Costs Category 1st Year 2nd Year 3rd Year Total Publicity Charges 10,000 10,000 10,000 30,000 Cloud Maintenance 4,000 3,000 3,000 10,000 Miscellaneous Charges 10,000 10,000 10,000 30,000 Total 70,000 Reflection From the planning model implemented in this project, I have learned that the educational intervention by the peers had the greatest strength. I firmly believe that comprehensive sexual education will help the international students to know more about their sexual health needs and will eventually help them to lead a healthier life. This is what I would like to implement on my professional life in future. Appropriate education will help me understand the best practices about care delivery and will help to develop as a professional with up-to-date knowledge. Lack of sufficient knowledge and poor education might lead to mistakes and subsequently, will cost the health of the patients (Potter et al. 2016). This writing experience gave me an extensive knowledge about the sexual health needs of the international students in an Australian university. Since the international students belonged from diverse cultures, this writing experience will help me to deliver appropriate care to the cultura lly diverse patients in future. 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