Final Assessment for Wayne County

Running head: WAYNE COUNTY ASSESSMENT

WAYNE COUNTY ASSESSMENT 9

Project and Wayne County Assessment

The Need for the Intervention

Several health-related issues arise from the Wayne County Assessment 1999-2004. First, approximately 10 percent of the population lacks health insurance, a majority of whom are seasonal workers employed on a part-time basis. Worryingly, 22 percent of the county’s payroll employees are either uninsured or underinsured. To some extent, the large populations of uninsured persons is as a result of structural factors such as low income and restrictive insurance plans that limit access to migrants who have lived in the county for less than two years. However, low education levels also play a significant role as most uninsured residents lack knowledge about affordable health coverage plans such as Value Med. Data on educational attainment shows that only 63 percent of the population completed high school and only 14 percent were college graduates. It is likely, therefore, that most residents do not, in fact, understand the value of having health insurance.

Secondly, access to preventive healthcare services is limited. The lack of health insurance and low-income levels limit residents’ ability to seek out care. For instance, 8.3 percent of the population lives below the poverty line, including 23.9 percent of the elderly aged above 65, and who bear the greater burden of chronic illness. Further, most residents are employed on a part-time basis and depend on a daily wage, which makes it difficult to take time off work during weekdays to seek healthcare services. Such residents would be available during weekends, when most physicians are unavailable. With the low education levels, it is likely that most residents do not understand the value of preventive care services. The lack of access to healthcare results in negative health behaviors evident in the high prevalence of sexually-transmitted diseases and the high mortality from chronic illnesses. These factors indicate a need for intervention.

The Proposed Intervention

The proposed intervention is geared at increasing i) health insurance coverage and ii) access to preventive care. It is based primarily on the theory of planned behavior (TPB). However, Wayne County residents are at different stages – for instance, there are the uninsured, then the underinsured, and the insured who may still not understand the benefits of preventive care. In this regard, the theory of planned behavior will be integrated with the trans-theoretical model to identify the most plausible strategies for persons at different stages of change.

Specific Intervention Strategies

The TPB argues that intention is the driving factor behind behavioral change. The greater the intention; the higher the likelihood of behavioral change. However, intention is a function of the individual’s attitude towards the current and proposed behavior, the subjective norm (social pressure to change or not change behavior), and perceived behavioral control (the extent to which one believes they can change behavior) (Glanz, Rimer & Viswanath, 2015). An individual is more likely to change their health-seeking behavior if they harbor positive attitudes towards health insurance and preventive care, face sufficient social pressure to change, and if they believe that they can manage the change successfully. Specific strategies need to focus on realizing these outcomes.

Influencing Residents’ Attitudes

Studies have shown that establishing the right attitudes towards tobacco control among middle school students significantly reduced their smoking rate (Tapera et al., 2020). As such, there is a need to influence residents’ attitudes towards health insurance and preventive care. One way to do this is by educating Wayne County residents on the benefits that they stand to derive from health insurance coverage and how accessing preventive care could help improve their quality of life and reduce mortality from chronic illness. The youth could be educated on how seeking out healthcare services would equip them with information on responsible sexual behavior and how to protect themselves from the risk of teen pregnancies and sexually-transmitted diseases.

The study by Tapera et al. (2020) found that teens who understood the consequences of smoking on their quality of life were less likely to be engage in smoking behaviors than those who lacked such knowledge. Education could take several forms. To begin with, fact sheets and posters from the Center for Diseases Prevention and Control (CDC) could be distributed randomly and placed in strategic locations to educate residents on the risks of not having health insurance coverage, the benefits of seeking preventive care, and how health insurance could improve one’s quality of life. Further, programs on the same content could be aired on local media stations to educate the masses on the necessity of coverage and preventive care. At healthcare facilities, nurses and physicians could be empowered to educate visiting patients and their families and link them to appropriate plans. Door-to-door campaigns could also be organized to reach the elderly in their houses to educate them on the value of health insurance and preventive care, and enroll them into relevant plans without them having to leave their houses. The aim is to ensure that residents have access to all relevant information needed to take on positive attitudes towards insurance and preventive care.

Sources warn, however, that educational strategies geared at telling the people what to do may not be fully effective and may attract resistance (Hood et al., 2015). There is a need to consider the contextual factors that drive individuals’ health behavior and to involve the residents in the decision-making process to ensure that their needs are adequately addressed (Hood et al., 2015). In this regard, there is a need to conduct surveys and interviews beforehand to identify why people opt to forego health insurance and preventive care. This would help in adequately identifying residents’ health needs, their respective stage of change, and what they expect from an insurance plan. This information would then dictate the focus of the educational campaign. For part-time workers at the pre-contemplation and contemplation stages, for instance, low income may be an underlying issue, and it may be necessary to educate individuals on not just the importance of having insurance, but on the available low-cost coverage plans as well. The underinsured payroll employees may have some degree of knowledge about health insurance and have already taken some form of action towards the same (action stage). As such, education campaigns to this group could focus more on increasing knowledge about affordable health insurance plans rather than the value of having health insurance. For the elderly, the campaign could focus more on educating them on the benefits of preventive care and how health insurance could increase access to the same, hence minimizing the risk of mortality due to chronic illness and old age. The underlying idea is that improving knowledge through education would help change their attitudes and, hence, and induce their desire to change their health-seeking behavior.

The Subjective Norm

People are likely to hold more intention to change their behavior if other people in their social circles approve of the proposed behavior. Intervention strategies in this area, therefore, have to do with instilling social pressures to help residents change their attitudes towards health insurance and preventive care. Studies have shown that middle school students whose close relatives, including parents and siblings, were smokers were more likely to adopt smoking behavior (Tapera et al., 2020). At the same time, children whose parents continually talked about the negative consequences of cigarette smoking were less likely to engage in smoking tendencies (Tapera et al., 2020). Parental attitudes towards the proposed behavior are, therefore, a crucial determinant of intention and willingness to change. One strategy that has been shown to have significant benefits is social marketing campaign. A social marketing campaign works more or less like commercial marketing, but uses theory to influence behavioral change for social good. In a social marketing campaign, the government, media, industry players, and healthcare workers come together to promote healthy behaviors and make the same appear achievable and fun. A similar campaign was organized in the UK during the Change4Life campaign in 2009 (https://www.nhs.uk/change4life/activities). The campaign sought to engage parents in at-risk families to make changes to their children’s lifestyle behaviors to minimize the risk of obesity. The campaign included mass media coverage to reframe obesity as a public health issue affecting all, and provided a platform for parents to receive personalized feedback on their child’s physical activity and healthy eating (Croker, Lucas & Wardle, 2012). Online and print resources were available to provide guidance on physical activity and healthy eating (Croker et al., 2012). 87 percent of mothers who joined the campaign reported it had changed their attitudes and that that they had changed their children’s behavior as a result (Croker et al., 2012). A similar campaign could be organized to engage parents in Wayne County to change their attitudes towards preventive care, which they would, in turn, pass on to their children.

Other strategies could involve organizing parent forums and conferences at school where they are educated on the value of health insurance and preventive care for their children. Peer education sessions could also be organized with the help of local community and religious leaders to educate other community members on the value of insurance and how preventive care could help minimize the risk of negative behaviors (Hoseini et al., 2015). To create a snowballing effect, residents could receive rewards for every colleague that they manage to convince to take insurance cover.

Studies have shown that people are more likely to change their attitudes if the campaign is run by people with whom they identify (Jimmieson et al., 2008). Celebrities and other popular figures from the community could also be engaged in public campaigns to sensitize the community and help change societal attitudes. The aim is to create as much social pressure as possible to influence commonly-held norms and beliefs (Hosseini et al., 2015). It is crucial, however, that implementers understand the community’s health beliefs through asking open-ended questions that can then open the door for important conversations about their expectations, views, and experiences (Hood et al., 2015).

Perceived Behavioral Control

Perceived behavioral control has to do with whether or not people believe that they can manage the proposed change. Stronger perceptions about behavioral control are associated with stronger intentions and desire for behavioral change. Strategies are geared at empowering individuals who have already taken steps towards behavioral change to maintain the course of intervention. As such, behavioral control strategies would be used on individuals at the preparation, action and maintenance stages, who understand the value of preventive care and are either already on an insurance plan or are ready to take action in the next 30 days (Glanz et al., 2015). The aim is to encourage them to hold on or stick to the course towards behavioral change and strategies are thus more personalized to specific individuals.