|ORIGINAL RESEARCH ARTICLE
|Year : 2018 | Volume
| Issue : 3 | Page : 163-167
A time-efficient model of spreading health awareness which also provides good experiential learning to medical students
Dharav Sunil Shah1, Vidit Panchal2, Savithri Devi2, Shrinidhi Datar2, Sonika Kumari2, Anvita Ugalmugle2, Darshani Chincholkar2, Bhumika Pal2, Akshay Yadav2, Gauri Patki2
1 Department of Psychiatry, Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra, India
2 Undergraduate Medical Students, Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra, India
|Date of Web Publication||23-May-2019|
Dharav Sunil Shah
602, Sai Krishna Kunj, D. N. Nagar, Andheri West, Mumbai - 400 053, Maharashtra
Source of Support: None, Conflict of Interest: None
Background: Although alcohol and tobacco are leading causes of mortality and morbidity, their use continues to be common. We hypothesized that awareness about this issue can be spread in a time-efficient way if health talks are conducted within hospital premises itself. Furthermore, this could potentially provide good experiential learning to medical students. Methods: In this longitudinal study, we implemented such an awareness activity and evaluated the outcome. Students who showed interest to volunteer were helped to develop an in-depth understanding of the issue, through detailed presentation and discussions. They conducted health talks near the wards, with patients and their relatives, after routine college hours. An iterative process was used to improve the health talk, based on self-reflection and formative feedback. A pre- and post-self-assessment of students regarding their knowledge and skills on this issue was obtained. A structured, anonymous questionnaire was administered to the audience before and after three of the educational talks. Results: In 29 days, our team of 24 students gave 21 health talks reaching out to 1090 rural people. Pre–post analysis of audience showed improvement in their awareness level and many developed the motivation to quit their addictions. Self-rating of students across all knowledge domains increased by at least 2 points (scale of 1–7) and across all skill domains, it increased by 3 points (P < 0.0001). Conclusion: This model of conducting health talks in hospital premises can enable us to spread health awareness effectively, in a time-efficient and cost-effective way. Furthermore, this model can prove to be a novel and effective academic tool for grooming medical students.
Keywords: Alcoholism, health promotion, health talks, medical students, practice-based learning, process documentation, tobacco
|How to cite this article:|
Shah DS, Panchal V, Devi S, Datar S, Kumari S, Ugalmugle A, Chincholkar D, Pal B, Yadav A, Patki G. A time-efficient model of spreading health awareness which also provides good experiential learning to medical students. Educ Health 2018;31:163-7
|How to cite this URL:|
Shah DS, Panchal V, Devi S, Datar S, Kumari S, Ugalmugle A, Chincholkar D, Pal B, Yadav A, Patki G. A time-efficient model of spreading health awareness which also provides good experiential learning to medical students. Educ Health [serial online] 2018 [cited 2021 Sep 23];31:163-7. Available from: https://www.educationforhealth.net/text.asp?2018/31/3/163/258926
| Background|| |
According to the “Global burden of disease study 2016,” in the age group of 15–49 years, alcohol is the leading cause of death and disability globally; followed at second place by tobacco. Because of addictions and other lifestyle factors, noncommunicable diseases (NCDs) have become a rapidly growing challenge facing the medical community, accounting for >50% of deaths worldwide.,, Health systems need to make a paradigm shift toward primary prevention and train students adequately in promoting healthy lifestyles.,
Health talks given by people in the position of authority play an important role in helping people make a confident choice. The model of medical students delivering health messages in schools has been found to be effective., However, only school students can be reached through this model and it requires a significant time commitment. Medical students giving health talks in clinics has also been reported to be effective; while at the same time being a good learning experience for students.,
Attempts to provide in-depth awareness through web-based apps and E-mail-based exercises have shown good results., However, populations which do not use the Internet (poor, elderly, etc.) cannot be reached by these methods. Poor communities have less access to de-addiction services, making them more vulnerable to the devastating impact of addictions. In villages around the study college, we observed that in around 25% of households, men do not contribute to the family in any meaningful way due to alcohol addiction. There is, therefore, a need to evolve models which can take awareness effectively to underprivileged populations as well.
Awareness can be spread in a very time-efficient way if health talks are conducted frequently in the hospital premises itself, for patients visiting the hospital and people accompanying them. We, therefore, decided to test the feasibility of this model as well as its utility as an educational tool for medical students.
| Methods|| |
A longitudinal study was done wherein we evaluated the outcome of an awareness activity. Mixed methods were used to explore the output and outcome of the study. An appeal was made to students to volunteer for an awareness drive regarding alcohol and tobacco. It was planned after the examinations and health talks were to be given in evenings, after routine college hours. A faculty member went to their hostel and discussed in small groups the need to work on the emerging epidemics of substance use and NCDs. Those who liked the idea shared it through “WhatsApp groups” and 21 students turned up for the introductory lecture.
A faculty with good experience of spreading awareness on addictions gave two presentations and students did self-preparation, to develop an in-depth understanding of the issue. The plan of action was chalked out collectively with the students to increase their sense of ownership of the project. The faculty gave an actual health talk to patients and their relatives in one ward, with students observing.
Broad guidelines were decided about the points to be covered. However, students were given the liberty to be creative. A target of reaching out to 1000 people in 1 month was decided. The presentation which was given by the faculty to train the students can be seen on YouTube; titled “Poisons we love.”
Learning while doing
Different teams would go to different spots to deliver their talks. Afterward de-briefing sessions were held; with self-reflection, peer feedback and formative faculty feedback to improve the quality of the talks.
Initially, we had thought of focusing on youngsters and men. However after the talks, many women came forward and shared with students that they were also suffering a lot due to alcohol addiction in their husband/son. They eagerly asked for guidance on overcoming the problem. Hence, we included women as well in the talks. The timing of evening ward rounds was noted for each ward and the talks were timed accordingly.
We requested ward staff to encourage their patients to attend our health talks. We created a Facebook page and kept sharing photos of what we were doing. This helped in getting a lot of support from students and faculty members. Students invited their friends to come and see the activity for themselves. Many of them joined the team, and we could reach out to more people.
To evaluate the outcome of the health talks, we administered a structured questionnaire before and after three of our talks. Participating in the questionnaire was optional and informed written consent was obtained from participants. Many in the audience were short of time and/or were illiterate. Hence, they could not participate in the evaluation component of the talk and in each talk, only around 10 people participated. In total, 31 people participated in the written evaluation (pre and post). However, many more came forward enthusiastically to give their verbal feedback to the students informally.
To evaluate its utility as a teaching method, after this 1 month program, students filled a retrospective post-then-pre self-assessment. This method is regarded to be a better way to evaluate improvement when participants have limited awareness at baseline, of what exactly is a desirable knowledge/skill level. In such cases, their ratings at baseline may not be practically valid and can lead to underestimation of programme effects. Hence, participants are asked to first rate their knowledge and confidence at skills after the programme; and then comparatively rate their pre-program knowledge/skills. For statistical analysis, Fisher's test was used for qualitative data and Paired t-test for quantitative data.
| Results|| |
In 29 days, our team of 24 students gave 21 health talks and reached out to 1090 people.
Outcomes of the health talks
We could get written pre- and post-evaluation of 31 participants from three different talks. The number of people who believed that alcohol has a deleterious effect on one's masculinity (by decreasing stamina, work performance, financial power, attractiveness, etc., and by increasing the probability of impotence and infertility) increased from 12 to 20 (39%to 65%). (P = 0.0004) Awareness about the various modes through which alcohol causes deaths increased, especially about cancers, suicides, and strokes (P = 0.02, 0.01, and 0.01, respectively). They were just expected to tick the diseases/events which they thought were common causes. So even slight awareness about these causes before the talk should have been reflected in the responses [Figure 1].
|Figure 1: Awareness among audience about common causes of deaths attributable to alcohol, before and after the talks (percentage) (27 people attempted this question)|
Click here to view
Similarly, awareness about the causes of tobacco-attributable deaths increased, especially for heart attacks (30% to 56%) and strokes (11% to 44%) (P = 0.09 and 0.01, respectively). It is interesting to note that not even a single respondent continued with his/her wish to take alcohol or tobacco after attending the talk.
The verbal feedbacks we received were more revealing. Many conveyed that they found the talk informative and enlightening. Many women expressed that they felt very happy to learn that solutions did exist to this problem. Five months after the activity, a youngster spontaneously came back to give this feedback to one of the student volunteers: “Alcohol had destroyed my life. Despite the poor condition of my family, I never took my responsibilities sincerely and even stole money… I had come to the hospital to visit my brother when I heard your talk… For the first time, I was being told about this in a very soft way. So I didn't feel guilty or angry… My family members also heard the talk and after that their behavior towards me became more understanding… Since then i have never touched alcohol again… I recently started a small business. I work all day there and come home with satisfaction…”
Outcomes with student volunteers
On a scale of 1–7, self-rating of students across all knowledge domains increased by at least 2 points, and across all skill domains, it increased by at least 3 points [Table 1].
|Table 1: Retrospective post-then-pre self-assessment of student volunteers (n=18) (rated on scale of 1–7)|
Click here to view
Some verbal feedbacks from students included:
- “Participating in the activity answered most of my doubts regarding this issue. It built my confidence as well as competence. I would continue to work for this cause”
- “I have actually awaited something like this in college since 3rd semester… and when it actually happened, I knew I had to contribute even if it is the final semester. I can't thank the Psychiatry department enough for giving us this novel and noble start.”
Regarding feedback on what helped them to deliver the health talks effectively, two things reported to be most helpful by students were “initial detailed presentation and discussion on this issue' and 'critical reflection after each talk.” Being mindful to keep the demeanor polite helped. In particular, substance users within the audience felt comforted by the clarification, “We understand that people addicted to alcohol/tobacco are not bad; it is these addictive substances which are bad.” Students felt that charts were of great use to show pictures and numerical data.
Feasibility of this model
Students reported that they found it convenient to find time for the activity in the evening, as it did not clash with the routine college schedule. From gathering people to returning to their hostel, it took them just around 1 h, as it was within the campus. The only difficulty which they initially faced was that people remained distracted when they conducted the talks inside the wards. Uninterested people moved around and kept chatting. Nurses working in the ward also distracted the audience. Once students started giving talks at selected locations just outside the wards, this problem also didn't arise. The fact that students continued with the program even after the 1 month campaign was over, indicates that the students found it hassle free.
| Discussion|| |
Conducting awareness talks in hospital premises itself has many advantages. It needs minimal planning and is convenient. As it does not have any new infrastructural or traveling requirements, it can be done with minimal or no funding. As one does not need to go anywhere, minimal time is required. Since people from different places come to a hospital, we can widely disseminate medical knowledge using this model. Pamphlets summarizing the key messages can be distributed after the talks to enable the audience to revise and pass on the message in their communities effectively. This model could possibly be used to spread awareness on any topic.
This model provides a rich opportunity to students for experiencing practice-based learning. Many students reported that their confidence at public speaking and counseling increased dramatically. Many other educators have also found that participating in activities or discussion which have real-life significance, makes students engage better with the subject matter and facilitates active learning., After 2 weeks, students started planning, coordinating, and executing all by themselves; which enhanced their management skills.
The need to give training to medical students in imparting health education and advocacy has been often discussed. The experience of planning and delivering health talks during learning years can inspire students and make them feel confident to undertake health education initiatives. After this activity, students undertook new awareness initiatives on their own. For instance, they discussed this issue with the new 1st year students and posters made during the group discussions were displayed in the hostel. Their aim was to make the newcomers adequately aware about this issue before they could get influenced by seniors who took addictive substances. Three students went back during vacations and gave awareness talks in their previous schools.
Many students expressed that they always felt strongly about this issue and wanted to do something but did not know how. When the department coordinated the activity and gave them a platform, they were more than happy to contribute and did not have to be coerced.
The activity was done on voluntary basis by students who expressed interest in it. It may or may not run so smoothly if implemented as a compulsory activity. The evaluation of the outcomes of the health talks was not very rigorous. The evaluation was done only during 3 talks and as explained above, only a small part of the audience could be administered the questionnaires. Extrapolating the findings might not be possible. The change in knowledge and skills of students was self-rated. Although faculty had not tested their performance through any objective instrument, their talks and counseling were supervised and found to be satisfactory.
| Conclusion|| |
There is a huge unmet need for spreading awareness about alcohol and tobacco use, especially among poor communities. This model of conducting health talks in hospital premises itself can utilize the collective energy of the skilled workforce in a medical institution. It can effectively deliver valuable medical knowledge, regarding any issue of public health importance, to a large number of people in a time-efficient and cost-effective way. The experience of providing these health talks turned out to be immensely enriching and satisfying for students.
The remaining 17 members of our team who have been equally enthusiastic in implementing the activity are: Dolly Vaidya, Soujanya Gadhe, Himangi Kori, Anurathi Rajput, Shruthi Loudiya, Anushri Aglawe, Girisha Rao, Devashree Holi, Tejaswini Mundare, Soumya Anand, Sarang Bombatkar, Sahitya Rao, Shiva Manwatkar, Anagha Potharkar, Kriti Jain, Prathmesh Pathrikar & Ushma Vora. We thank Dr. Abhishek Raut (Associate Professor, Community Medicine) for his active support to the awareness drive and for guiding us with the statistics. We would like to thank Dr. Aditya Khetan for reviewing the draft and suggesting improvisations.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Griswold MG, Fullman N, Hawley C, Arian N, Zimsen SR, Tymeson HD, et.al
. (GBD 2016 Alcohol Collaborators). Alcohol use and burden for 195 countries and territories, 1990-2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet 2018;392:1015-35.
Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et al.
Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): Case-control study. Lancet 2004;364:937-52.
GBD 2016 Causes of Death Collaborators. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: A systematic analysis for the global burden of disease study 2016. Lancet 2017;390:1151-210.
World Health Organisation. Non-Communicable Diseases and their Risk Factors. World Health Organisation. Available from: http://www.who.int/ncds/en/
. [Last accessed on 2017 Mar 14].
Strong K, Mathers C, Leeder S, Beaglehole R. Preventing chronic diseases: How many lives can we save? Lancet 2005;366:1578-82.
Arena R, Lavie CJ, Hivert MF, Williams MA, Briggs PD, Guazzi M, et al.
Who will deliver comprehensive healthy lifestyle interventions to combat non-communicable disease? Introducing the healthy lifestyle practitioner discipline. Expert Rev Cardiovasc Ther 2016;14:15-22.
Kable A, James C, Snodgrass S, Plotnikoff R, Guest M, Ashby S, et al.
Nurse provision of healthy lifestyle advice to people who are overweight or obese. Nurs Health Sci 2015;17:451-9.
McAndrew S, Jackman C, Sisto PP. Medical student-developed obesity education program uses modified team-based learning to motivate adolescents. Med Teach 2012;34:414-6.
Olm-Shipman C, Reed V, Christian JG. Teaching children about health, part II: The effect of an academic-community partnership on medical students' communication skills. Educ Health (Abingdon) 2003;16:339-47.
Gorrindo P, Peltz A, Ladner TR, Reddy I, Miller BM, Miller RF, et al.
Medical students as health educators at a student-run free clinic: Improving the clinical outcomes of diabetic patients. Acad Med 2014;89:625-31.
Tan NC, Mitesh S, Koh YL, Ang SB, Chan HH, How CH, et al.
Evaluation of a training programme to induct medical students in delivering public health talks. Singapore Med J 2017;58:35-40.
Safran Naimark J, Madar Z, Shahar DR. The impact of a web-based app (eBalance) in promoting healthy lifestyles: Randomized controlled trial. J Med Internet Res 2015;17:e56.
Torniainen-Holm M, Pankakoski M, Lehto T, Saarelma O, Mustonen P, Joutsenniemi K, et al.
The effectiveness of email-based exercises in promoting psychological wellbeing and healthy lifestyle: A two-year follow-up study. BMC Psychol 2016;4:21.
Rockwell SK, Kohn H. Post-then-pre evaluation. J Ext 1989;27,2:FEA5.
Pratt CC, McGuigan WM, Katzev AR. Measuring program outcomes: Using retrospective pretest methodology. Am J Eval 2000;21:341-9.
Dongre AR, Kalaiselvan G, Mahalakshmy T. The benefits to medical undergraduates of exposure to community-based survey research. Educ Health (Abingdon) 2011;24:591.
Brieger WR. Developing service-based teaching in health education for medical students. Health Educ Monogr 1978;6:345-58.