Acknowledging different needs of a population contributes to effective health education programing

A requirement for becoming a Changing Carolina Peer Leader (CCPL) was successfully completing a comprehensive Certified Peer Education (CPE) training provided by the BACCHUS Initiatives of NASPA. Through this training offered in my HPEB 301: Practicum in Health Promotion course, I developed my leadership skills by applying preventive health promotion ideologies to CCPL events for students throughout the University of South Carolina (UofSC) community. One of the principles discussed during CPE training was creating change in high-risk behaviors in an individual or group, and ultimately a community, through the social-ecological approach.

During the development phase of an effective prevention program, action plans require a detailed understanding of factors that influence the behavior in question. The social-ecological approach incorporates both behavioral factors, such as personal attitudes and background knowledge, and multiple-level factors, such as national attitudes and legal policies, in a template divided into four levels. The steps can occur in numerical order, but they are all interconnected to show the effect each level has on each other.

The presence of increased smoking behaviors within populations of college students at the University of South Carolina led to university policies being established in hopes of improving health outcomes among this age group. In class, we further analyzed the university’s policy for on-campus tobacco and smokeless tobacco usage through the social-ecological model. The first level of the social-ecological model begins with the individual to address anything from biological predispositions and personal factors that would expose a person to a particular behavior. For example, we discussed the risks we expect students to be aware of from smoking behaviors, a student’s possible history of substance abuse, and student opinions on tobacco usage. Next, the second level examines the relationships an individual has with either their closest social circle or family members. Again, this could be recognizing that students who use tobacco products also know friends and family members that use them as well, so prevention programs can also reach these audiences. The third level of community addresses behaviors in settings including schools, workplaces, and neighborhoods. Finally, in the fourth level, there is a focus on societal norms around smoking that increase a student’s likelihood to use tobacco products.

While enrolled in HPEB 301, I had the opportunity to apply the social-ecological model abroad. During my spring break freshman year, I along with other members of UofSC’s Association of Pre-Physician Assistant Students volunteered with International Service Learning in Managua, Nicaragua. Our group went on the medical service trip with the goal in mind of enhancing our passion for healthcare through evaluating and diagnosing patients in the free medical clinic we set up, donating medical supplies to a community in need, and sharing our expertise coming from a nation with advanced healthcare. However, we quickly learned the importance Nicaraguan culture and the community’s landscape had in addressing global health issues.

On the first day of the trip, the members of the Piedra Menuda community welcomed us with open arms as we conducted home visits. Here, I applied the concepts of the social-ecological model as we took note of each household’s living conditions by engaging in conversations with family members on their present health concerns, understanding of health conditions, health access limitations, and social dynamics within their family. This moment is when I realized common medical interventions commonly seen in the United States, such as routine wellness visits and access to medications, were not an adequate solution for improving the wellbeing of the community. Instead, through understanding our member’s culture and living situations, we as a group of students with the guidance of local medical professionals identified how lifestyle correlates with common diseases in the area and brainstormed natural preventive and sustainable treatments and education programs for the community members that could benefit them long term.

For instance, we recognized after our five days of clinic that a large percent of the community experienced hypertension. In the United States, typical medical advice for patients with high blood pressure is modifying the patient's diet by eating less refined carbohydrates and processed foods, participating in daily exercise, or managing the condition with prescription medication. Yet, these suggestions were almost unfeasible for the community. The Piedra Menuda community was located about thirty minutes from the capital city, Managua, at the bottom of a mountain accessed by a road on a cliff so steep that I cannot even describe the magical driving skills our trip transporter had. Members rarely left the community boundaries and as a result consumed large quantities of white rice due to its long shelf life, scheduled doctors’ visits only if it was an emergency, and had to go to extensive efforts financially and physically to go to pharmacies and continue treatment regimens. The community also experienced barriers with exercising that I have never considered before such as not wanting to sweat from physical exertion due to not being able to properly shower afterwards since they needed to manage their water supply that routinely ran through piping for collection once a week.

Our group took these variables into consideration when we led a public health education celebration on our last day of clinic. The purpose of this day was to discuss with community members helpful tips to manage their health and wellbeing. Regarding hypertension, we outlined plans and gathered supplies with members to create and maintain sustainable farming efforts that would introduce fresh produce to their diets, demonstrated stationary exercise routines to incorporate movement into their daily routines, and educated on signs of when to consult medical help since we were only to provide a week’s worth of medication.

Overall, the same openminded principles apply as I continue to work towards becoming a physician assistant. Different towns, states, and regions of the United States combat health conditions prominent in their area and while these conditions can occur across the country, a successful health education program in one area may not be applicable for all populations. Through my experiences in Nicaragua and HPEB 301, I have learned that it is necessary to recognize current frameworks of a community to understand how certain conditions persist first before planning the right course of action. By doing so, I can adapt my efforts for each patient I see in a clinical setting and best serve their needs with practical resources, realistic treatment options, and relevant education that allow them to stick to treatments outside of the scheduled appointments.

Inside the Piedra Menuda Community

The photos above highlight moments from my medical service trip in Nicaragua during March of 2018. Through this trip with members of UofSC's Association of Pre-Physician Assistant Students, I got to learn about the residents of Piedra Menuda community by conducting home visits and providing direct patient care under the supervision of local physicians in the free medical clinic we set up in the community’s church.

Certified Peer Educator (CPE) Certification

The certificate above indicates my completion of the Certified Peer Educator training offered through the BACCHUS Initiatives of NASPA. In spring of 2018, the training offered during my HPEB 301 course focused on developing leadership skills and an understanding of health topics necessary for creating and implementing campus health initiatives with the Changing Carolina Peer Leaders.