Summary
The article evaluates the main factors that hinder effective delivery of cervical and breast cancer screening services in Nebraska primary care. With the help of a GAPS model, the researchers develop a practice-based intervention program whose aim is to enable clinicians identify barriers to implementing the every woman matter (EWM) program. Seven clinics participate in this study, and of all of these seven clinics only two clinics manage to achieve their goals. The other five clinics only manage to achieve some of them. This notwithstanding, the article claims that GAPS model is an effective model of introducing changes in organizations (Backer et al., 2005).
In all the seven cases, the clinicians approached the issue of women’s preventive health care by adopting the following strategy. First, they identified the barriers of delivering effective cervical and breast cancer screening services to women. Second, upon identifying the barriers, the clinicians in respective hospitals developed plans for reducing those barriers by coming up with preferred goals. Third, upon developing the said plans and goals, the clinicians went ahead to implementing the EWM program among the low-income patients (Backer et al., 2005).
Possible reasons for inefficiency
In spite of developing a good program for the change, the program was ineffective because it did not achieve its desired goals. Some reasons that led to this included the following. First, there lacked proper management and good leadership in almost all clinics that participated in the study. For example, the physician in the second practice did not manage the program effectively even if he knew that his staff members did not embrace the program. In fact, he did not ensure that his staff members embraced the program before proceeding with it. Second, in almost all the seven clinics evaluated in the study, the nurses and other members of the staff did not work as teams. Instead, majority of them worked on their own without helping one another as indicated in the third practice. This notwithstanding, some clinicians did not support the program given that some of them were less enthusiastic about it; thus, they did not support it (Backer et al., 2005). Third, the lack of resources to implement some goals was also another factor that rendered the program ineffective. This is in relation to the fact that some clinics did not have resources to increase their education materials and awareness. Fourth, in some instances, clinicians did not show interest towards implementing the changes; thus, they were minimally involved in the change plans. As a result, even if some staff members especially the support staff supported the change plans, they did not implement the changes effectively. Fifth, disorganization was also another factor that rendered the program ineffective. With regard to this issue, even if some clinics strived to achieve their goals, they did not achieve all their goals because their programs were unfocused and stagnant (Backer et al., 2005).
Characteristics of preventive programs
The Jade Ribbon Campaign (JRC) program is a community outreach campaign aimed at promoting early detection, prevention and management of lung cancer and chronic hepatitis B virus (HBV) among the Asian Americans. This program is successful because it has influenced the target group to taking the necessary measures for preventing lung cancer and HBV. The program creates awareness through the media and offer free screening services to participants for the said medical conditions. Among other things, the screening process requires participants to provide their family histories of lung cancer infections. Upon screening, the researchers send medical results to participants via mails with their respective interpretations. The researchers also recommends for follow-ups based on the medical results. They also urge participants to encourage their friends and relatives to participate in the program (Chao et al., 2009). In case a participant is HBV positive, the program encourages that participant to go for lung cancer screening.
According to Sankaranarayanan, Budukh and Rajkumar (2001), efficient screening programs for cervical cancer among low income women from developing countries should have the following characteristics. First, they should have adequate financial resources for them to be sustainable. This is in relation to the fact that majority of them have been unsuccessful in the past because of inadequate financial resources. Second, they should come up with the essential infrastructure for the screening process. Third, they should training or have the necessary manpower to execute those programs. Fourth, they should have elaborate examination mechanisms for treating, investigating and screening cervical cancer. Fifth, they should have effective follow-up programs for reaching targeted women.
A skin cancer prevention program by Peattie, Peattie and Clarke evaluates the implications of early detection of skin cancer to policy makers. The program recommends that public policy makers should create holistic public approaches to sun safety of the children. According to this program, the current policies lack proper coordination among them in promoting sun safety among children. Based on this fact, public policy makers should strive towards enhancing coordination among those policies. Besides this, policy makers should promote two-pronged approaches towards sun safety of the children. On one hand, they should promote family-focused education on sun safety that would reduce sun exposure to children. On the other hand, they should develop environmental policies that would encourage sun safety behaviors in families. Finally, public policy makers should prioritize sun safety issue in their social marketing strategies and change their skin cancer prevention strategies by approaching them differently (Peattie, Peattie, & Clarke, 2001).
Strategy to follow
If I were a nurse in charge of developing a follow-up to the every woman matter (EWM) program, then I would propose the following strategies for creating a more effective prevention program. First, I would propose for an effective follow-up program that would follow the model to the letter. As it can be seen from the case study, the fieldwork nurse in charge of implementing the strategy does not follow the model to the letter. This is in relation to the fact that as opposed to empowering the nurses and other staff members to implement their plans of reducing barriers, the fieldwork nurse just waits for the nurses and their staff members to implement the plans on their own. In spite of this fact the researchers at the beginning of the study indicate that they would provide the necessary support, but they do not provide it (Backer et al., 2005). In relation to this fact, if I were a nurse in charge of developing a follow-up program, then I would ensure that the fieldwork nurse provides the necessary support to the clinicians. Second, I would organize for frequent follow-up programs that would aim at ensuring that clinicians strive to achieve all their goals. Once again, clinicians did not strive to achieve all their goals even if they achieved some of them. This indicates that apart from failing to work as teams, some clinicians did not bother to execute the preventive strategy. This could have resulted from the lengthy period of the follow-ups that was scheduled to take place after every four months (Backer et al., 2005). In order to counter this challenge, as a nurse in charge of developing the follow-up program, then I would reduce the period of the follow-ups to one month. This could perhaps assist clinicians in accomplishing their goals and executing the preventive cancer strategy.
References
Backer, E. et al. (2005). Improving female preventive health care delivery through practice change: an every woman matter study. JABFP, 18(5), 401-408.
Chao, S. et al. (2009). The jade ribbon campaign: a model program for community outreach and education to prevent liver cancer in Asian Americans. J Immigrant Minority Health, 11:281–290.
Peattie, K., Peattie, S., & Clarke, P. (2001). Skin cancer prevention: reevaluating the public policy implications. Journal of public policy & marketing, 20(2), 268-279.
Sankaranarayanan, R., Budukh, A., & Rajkumar, R. (2001). Effective screening programmes for cervical cancer in low- and middle-income developing countries. World health organization. Bulletin of the world health organization, 79(10), 954-962.