Health Promotion has been defined by the World Health Organisation 2005 Bangkok Charter for Health Promotion as, “the process of enabling people to increase control over their health and is determent, and thereby improving their health.”
The early years setting I work at is geographically set in a community first area had has high levels of poverty and unemployment. I decided to promote tooth brushing with the children whilst working in partnership with the Designed to Smile Campaign. Through the use of story time and songs they were given the information to educate them on oral health and the correct way to brush their teeth.
In 1948 the World Health Organisation defined health as being, “a state of complete physical, mental and social well being and not merely the absence of disease or infirmity” It is vital as an Early Years worker to have an understanding of health and related issues to effectively promote the holistic development of the children at the setting. At the nursery we understand that health can have both a negative and positive effect on a child’s development and know that we have a responsibility to the children to educate them in an age appropriate manner and to teach them health living skills.
IN 1998 Sir Donald Acheson published a report on health inequalities, this report highlighted the difference between the social classes and the state of their health It suggested that the poorer you were the worse your health was and vice versa.
The in equalities in children’s health are unacceptably large, and overwhelmingly affects out counties, societies, communities, families and children with the fewest resources to cope with it. Even in more affluent countries, the pooper members of society carry a disproportionate share of the disease burden
(The European Health Report 2005)
Inequalities in child dental health are well documented. The 2003 Children’s Dental Health Survey found that children attending primary schools in socially-deprived areas of the UK were reported to have experienced more tooth decay than children in schools in non-deprived areas. (Office of National Statistics, 2003 Children’s Dental Health Survey) In Wales, over 50 per cent of five year-olds have experienced tooth decay.
Designed to smile suggests that there is a widening gap between the oral health of children for the least well off and the most well off families in Wales. Under the Eradicating Child Poverty in Wales Measuring Success strategy, the dental targets set are that by 2020, the dental health of five and twelve year-olds in the most deprived fifth of the population will improve.
Rates of tooth decay are far too high in Wales given that it is almost a preventable disease, We hope to extend the provision of preventative care and treatment to children in Wales so that we can reduce the number of children with poor dental health to the UK average level and then to even lower levels, .
(Morgan 2009)Designed to Smile is being developed through the National Child Oral Health Improvement Programme as a national programme to improve the dental health of children in Wales. This is the first “super pilot” tooth brushing scheme in parts of Wales, building on the experience of the established Fissure Sealant programme.
Due to the successful implementation of this programme to date, Edwina Hart, Minister for Health and Social Services announced in October 2009 that the programme would be enhanced and expanded to cover the whole of Wales.
As a Health Promoting nursery we provide an environment where the physical and mental wellbeing, health and safety of staff and pupils are supported, in partnership with family, community and multi-external agencies. Policies, practices and structures are in place that will underpin and facilitate a sustainable health promotion programme. The whole nursery is involved in the process and it features work in three key areas: • the ethosand environment of the nursery;
• the quality of teaching and learning in health-related areas of the curriculum; • links with the family, community and other agencies for health.
This Health Promotion will be incorporated within the Foundation Phase curriculum covering all the required areas of learning. The Framework for Children’s Learning advises that all children should be given the opportunity to, “Become independent in their personal hygiene needs and to be more aware of personal safety…… Value and contribute to their own well-being and to the well-being of others…. Develop an understanding that exercise and hygiene and the right types of food and drink are important for healthy bodies.”
Personal and Social Development, Well-Being and Cultural Diversity (2008:6,7)
There are a number of different approaches for a health promotion but it is important to remember that as a practitioner you have a responsibility to educate the children in an age appropriate manner. All the approaches reflect different ways of working, the two approaches I used were an educational approach and a behavioural approach and even though they are different it is possible to move in and out of them depending on the situation.
An Educational approach aims to provide knowledge and information and to provide the necessary skills so that people can make informed choices about their health behavior. The educational approach is a set of assumptions that about the relationship between knowledge and behavior and by increasing knowledge there may be a change in attitudes which could lead to a changed behavior.
By using this approach I hoped that the children would learn the importance of dental hygiene and incorporate this into their daily routine. Children can also influence their parents and if they have learnt the need for tooth brushing at school they can then go home and say they want to brush their teeth before bedtime. Health education through classroom based work has shown success in improving health issues however information alone is insufficient in changing behavior and even the desire and ability to change is no guarantee of success.
The behavior change approach aims to encourage individuals to adopt healthy behaviours which are now seen as the key to improved health. However unless a person is willing to take action it is unlikely to be effective. This is a popular approach as it views health as a property of the individual so it is therefore reasonable to assume that someone can make real improvements in their health by changing their lifestyle. As the Design to Smile programme is nationwide the Trans-theoretical Model is an appropriate model for the recruitment of an entire population.
(Prochaska & DiClemente, 1983; Prochaska, DiClemente, & Norcross, 1992; Prochaska & Velicer, 1997) It is an integrative model of behavior change. Key constructs from other theories are integrated. However behaviour can be a response to the conditions in which people live and the causes of these conditions which can make any change extremely complex, unemployment, poverty, alcohol and drugs may be part of their everyday life and be outside of their control.
The aim is to change individual attitudes and behaviours so that they adopt healthier lifestyle; examples include not smoking for brushing their teeth. Those using this approach will be convinced that a healthy lifestyle is in the best interest of their client and feel a sense of response to encourage as many people as possible to adopt a healthy lifestyle.
I am currently a volunteer at a Welsh Medium Nursery, the geographical location means that it is in a community first area with high levels of poverty, the setting has recently joined the Designed to Smile programme so I decided to concentrate on oral hygiene for this health Promotion with the aim getting the children to brush their teeth regularly and understand what food are healthy for our teeth and what foods can harm our teeth.
I also aimed at providing parents with a better understanding of oral hygiene by producing an information leaflet for them. (appendix A) As it is a nursery, the children are aged between 2 and 4 years, I chose only five children at a time, grouped them according to age and stage of development to ensure that they would fully understand the teaching.
I had already identified the need for the health promotion and had gathered the resources I would use including, story books, flash cards, a puppet, tooth brushes and tooth paste. During any health promotion ethical issues have to be considered there are four widely accepted ethical principles (Beauchamp & Childress 1995 cited in Foundations for Health Promotion) Respect the rights of individuals and their right to determined their lives The commitment to do actions that are of benefit
The obligation not to harm patients or clients (if in doubt precaution should prevail) The obligation to act fairly when dealing with competing claims for resources or rights.
Naidoo& Wills (2009:89)
These principles provide the framework for constant moral decision making. Seedhouse (1998) has developed these principles into a grid that can be used as a toll by practitioners to ensure basic principles and values are met. All areas of ethical consideration were adhered to; parents were given consent forms to give their permission for the children to take part in the programme and as it is a national programme to improve oral hygiene I was acting in a manner that was beneficial to their health.
I began by asking the children about their teeth and asked them to take a look at one another , I then showed them flash cards of healthy teeth and non healthy teeth and whilst using age appropriate language we discussed foods that were healthy and non healthy to our teeth. I then got the puppet out and introduced it to the children and they had a little bit of fun with it whist asking questions about the demist and tooth brushing, because the children were so eager to learn they asked me if they could see the toothpaste, so I took that opportunity to tell them about the ‘magic ingredient’ (fluoride) and how it helps our teeth.
I then went on to read a story called “ Pepper Pig goes to the Dentist” , I chose this book because he is a well known television character for children of this age and again this sparked a lot of discussion about who had been to the dentist and what had happened whilst they were there. At this point I had to consider health and safety implications as it was time to actually brush their teeth.
All the staff at the setting has received training from the Design to Smile co-coordinator on health and hygiene. The children then went to the toilet to wash their hands before sitting at the table to brush their teeth. The tooth brushing are all named and were given out to the children, by placing the brushes in the air it reduces the chances of cross contamination between children’s brushes.
The toothpaste is placed on a paper towel and scooped onto their brushes and then they begin for 2 minutes, whilst this is going on I have the puppet and I am brushing its teeth encouraging them to cover all surfaces , top, sides, back and front of teeth through the use of songs. The brushes were then collected and away to be washed. I thanked the children for helping me with the promotion and it was at that point that I finished.
Evaluation is an important aspect of all planned activities, as Hawe et al 1994:298 states “Sometimes to avoid ‘failure’, health promoters may avoid evaluation” On reflection, I felt that the promotion went really well, I allowed it to go in the direction that the children naturally wanted it to, there were things that I missed out and there was an occasion when some children were not so interested and I really should have encouraged them more to join in. I was also very conscious of my time management as I had not practiced before hand and felt as though I rushed through sections of it.
I intend to check with parents/carers to see if the children are more cooperative when brushing their teeth at home and also ask parents in approximately 6-12 months if after a visit to the dentist there has been any improvement in their oral health. I fully intend to run the promotion every 3 months and will improve my professional ability by using the Reflective Cycle (Gibbs 1998) and making improvements. T
he way children live their lives is by example and they cannot always be expected to know what is right and wrong so it is a our job to provide the time to support their understanding of what things affect their health Learning would be exceedingly laborious, not to mention hazardous, if people had to rely solely on the effects of their own actions to inform them what to do. Fortunately, most human behavior is learned observationally through modeling: from observing others one forms an idea of how new behaviors are performed, and on later occasions this coded information serves as a guide for action.
Albert Bandura, (1977:28).