The overall health condition that will be assessed is lung cancer in Hamilton County, New York, of adults aged 45 through 64. The behavioral factor that will be inspected is smoking cigarettes. As of January 2019, the intervention will be implemented in Hamilton County, New York for six months, followed by an evaluation that uses phases six through eight of the Precede-Proceed Model. These phases will measure the process, impact, and outcome evaluation of the intervention (Green & Kreuter, 2005). In order to implement this intervention and evaluation, key stakeholders will be needed, such as: lung cancer patients aged 45 through 64 in Hamilton County, health professionals, environmental experts, and community nurses. Table 1 is a Logic Model for the interventions, and depicts the different aspects of the program.
Intervention for Behavior
The behavioral objective is to lower cigarette smoking rates in Hamilton County, NY. The predisposing objective is to change the perceived barrier of the attitudes of health professionals. The reinforcing objective is to provide more information about smoking and its consequences to intervention participants. The enabling objective will be to increase the number of participants who have passed a smoke-free policy in their own homes. The intervention will first educate the stakeholders mentioned above. Their negative attitudes and pessimistic outlooks create a barrier to their clients who smoke. The intervention will then encourage smokers aged 45 through 64 in Hamilton County to create a smoke-free home, and explain the benefits of doing so.
The intervention will focus on increasing cues to action, which is a reinforcing factor and a construct of the Health Belief Model (Simons-Mortan, 2012). If a patient communicates that they would rather not quit smoking, the doctor must accept this answer in a way that is not judgmental, and leave an offer of help on the table (National Institute for Health and Clinical Excellence [NICE], 2006). First, the patient will be asked if they are still smoking (Phillips, 2012). Then, if the answer is “yes,” they will be asked if they are interested in quitting. Following “yes,” they will be informed about different programs that offer support. They will then be referred to a specific support program. If they accept, the process is over; if they decline, they will be offered treatment with the use of drugs. If they decline drugs, they will be given brief advice on how to quit smoking, and this will be recorded (Phillips, 2012).
Kerr, Watson, Tolson, Lough, & Brown’s (2007) research found that former smokers reported that specific external influences acted as a trigger for quitting. Because the elderly person may be more resistant to receive information, their families will be given the information as well, in order for them to further translate the information into a way that they truly understand (Phillips, 2012). In order to change a health behavior as intense as smoking cigarettes, it must be acknowledged that it is a process with many different steps; it includes recognizing the client’s attitudes, knowledge, beliefs, and perceptions (Phillips, 2012).
Participants will be encouraged to keep a smoke-free home. Not allowing smoke in the house at all is the only way to prevent secondhand smoke, which irritates airways and increases the risk for disease and cancer, from occurring (NYC Health, 2012). There are many health benefits of having a personal smoke-free house policy; children who are raised in these types of homes are less likely to become smokers, and are less likely to develop diseases such as asthma, bronchitis, and ear infections. A healthy heart and lungs are more likely in smoke-free environments, and this type of housing reduces the risk of fires and fire-related deaths. Smoke-free homes will be free of dangerous tobacco toxins. Because smoke-free housing does not ban smokers from buildings and only bans the act of smoking, it is not considered to be discriminatory (NYC Health, 2012).
Evaluation for Behavioral Intervention
The comparison group will be a group of residents who identify as “smokers” in Hamilton County, New York, aged 45 through 64, who will not receive the intervention. Both the experimental group as well as the comparison group will be individually interviewed at the beginning of the intervention as the pre-test, and at the end of the intervention as the post-test. Throughout the intervention, three separate times, surveys will be distributed to the participants regarding their satisfaction with the program, ask for suggestions, satisfaction with the healthcare professionals, and overall how the program has been helpful or not when it comes to quitting smoking.
Process evaluation. In order to conduct the process evaluation, participants will be interviewed as a pre/baseline test, and will be asked when the last time they had a healthcare visit was. Then, they will be asked if their healthcare provider seemed interested in their smoking status, and whether or not they were encouraged to quit.
Impact evaluation. In order to conduct the impact evaluation, we will assess the
behavior change by taking a post-test interview of the participants. Six months after the end of the program, the impact evaluation will be used to determine the short-term effects. If the number of participants who report to have quit smoking are higher than the comparison group, the behavioral intervention was successful. At the end of the program, we will count how many participants had achieved a smoke-free home, and how high this number is when compared to the control group.
Outcome evaluation. Two years following the conclusion of the program, long-term effects will be determined in an outcome evaluation. A post-test personal interview will be conducted to the participants. This interview will explore whether or not the intervention has improved the overall quality of life of the participants, and whether or not the participants’ symptoms of lung cancer have decreased. Data from the New York State Department of Health will be investigated in order to determine if the behavioral goal has been reached, which is to: reduce lung cancer rates among adults aged 45 through 64 in Hamilton County, NY. Data regarding smoking and lung cancer from past years in Hamilton County will be the source of comparison.
Final Summary
A needs assessment was performed in Hamilton County, New York using the Precede-Proceed Model (Green & Kreuter, 2005), in order to decrease lung cancer rates among adults aged 45 through 64. This was done through changing the views of healthcare providers on smoking cessation in older people (Phillips, A. 2012), and increasing homes that are smoke-free (NYC Health, 2012).