Blog 11

Blog 11: Intervention Implementation and Evaluation

As a policy maker for health issues, an implementation that I will address

Screening to all pregnant women for tobacco use and all receive best practice cessation counseling

This is a policy that should be implemented to all those pregnant women’s or every woman in their communities should be reinforced to go. Tobacco usage in general is already bad and screening could prevent it to these women and to orient them. Also if a woman doesn’t smoke and she has high levels of cotinine it is highly due to second hand smoking. This could be caused by one of the determinants, environmental, such as her workplace or even a member in the household which could be even prevented and leading to another implementing program which is:

Education programs for women/partners as well as health and social services providers.

As well as prenatal care services will be held, a short term outcome of the program will be that since these workers know the sighs and symptoms of preterm labors an the appropriate response they can share the guidelines and labor assessment if the screening doesn’t look good before the 22 weeks pregnancy.

The effectiveness of this implementation is considered secondary and tertiary since they are directed to each person individually as well as a solution for the aftermath. To show and prove its effectiveness is the amount of pregnant women who come to get screened. If a group number of pregnant women are recorded per community per week, it can be seen if it is effectiveness based on their appointments and if they come. Also based on their screening and their cotinine level if values of 10ng/mL or less is considered no smoking, 10 ng/mL to 100 ng/mL are associated with light smoking or moderate passive exposure, and levels above 300 ng/mL are seen in heavy smokers - more than 20 cigarettes a day. In urine, values between 11 ng/mL and 30 ng/mL may be associated with light smoking or passive exposure, and levels in active smokers typically reach 500 ng/mL or more. Based on this data you can divide the women into groups and based on their data you can know what statistics or measurements you have to take.

For this to be implemented, I will like it to be a policy in their community that for every woman pregnant, they should have a screening for cotinine levels. During the 18 to 22 weeks. The barriers that will be encountered is the social factor. Some women would not like to go to screening or they will not go just because they don’t feel like it. To overcome this issue, free screening could be offered or a minimal cost that they could afford or create medias for it, and not sell it as a smoking propaganda. The advertisement will be more for a check up and it could be free. Another barrier is transportation. Some women due to economical issues, they can’t go to a prenatal care; however, for this to be overcome, prenatal care services could be placed into those communities for screening, prenatal care services and educational programs that will follow up with the program. Another barrier that could be encountered is the infrastructure (what is mentioned above) and also the issue with the money. The money can be donated from potential action groups that could make fundraisers or even get grants for this public health issue, as well governmental support.

Once I have the barriers, the stakeholders that I will communicate the information too will be:

-       The pregnant mothers

-       Physician: Neonatologist and Obstetricians and Gynecologists

-       Prenatal Care Staff

-       National Institute for Health and Clinical Excellence

The pregnant mothers will be the first one to talk to. Once they are convinced, then we are able to talk to the other stakeholders for money, services and more. My strategy for these pregnant women is to tell them that the screening will be a way to check on their health and their baby. There could also be educated forums that these women can go to. Another way of doing it is these women have Medicaid meaning that their primary physicians for the screening view should contact them. These will make them go, and with that we can count the number of women who came and who didn’t for other extra measures to take such as to see if they had trouble to come to the prenatal care services or to educate them as to why screening is such an important thing to do. Once that is done, we can contact the National Institute for Health and Clinical Excellence for grants or any other action groups, and once money is secured, prenatal care staff as well as physicians.

The evaluation for this effectiveness for my intervention will be the total number of women in a community, and based on that the number of pregnant women who go to these screenings based on their appointment records and if they come. Based on that we can tell if it is working or not and to see the other measures to take. Identify one partner to coordinate the data collection and collate the data from the various sources for the evaluation.