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Factors Associated with Public Awareness of the Crown Health Program in the Al‑Jouf Region

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Factors Associated with Public Awareness of the Crown Health Program in the Al‑Jouf Region [Downloaded free from http://www.jfcmonline.com on Monday, March 02, 2015, IP: 41.128.165.40] || Click here to download free Android application for this journal O riginal Article Factors associated with public awareness of the Crown Health Program in the Al‑Jouf Region Ziad A. Memish, Mohammad Y. Saeedi, Ahmed J. Al Madani, Bernard Junod, Abdelgadier Jamo, Omer Abid, Faisal M. Alanazi, Fayez G. Alrewally1, Ahmed M. A. Mandil2 Public Health Directorate, Ministry of Health, Kingdom of Saudi Arabia, 1Primary Health Care, Aljouf Region, Kingdom of Saudi Arabia. 2Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. Address for correspondence: Dr. Omer Abid, Ministry of Health, P.O. Box 335157, Riyadh 11341, Kingdom of Saudi Arabia. E‑mail: omerabid70@ gmail.com Objectives: A community‑based intervention, the Crown Health Project (CHP), was developed by the Ministry of Health. It was implemented on a small‑scale in Al‑Jouf Region in Northern Kingdom of Saudi Arabia to assess its feasibility and effectiveness so that it can be scaled up. This study primarily aimed at investigating factors associated with the awareness of CHP in order to improve subsequent campaigns for the program in Al‑Jouf and other regions. A secondary aim was to assess possible changes of public awareness during intensification of the awareness campaign between October 2011 and May 2012. Methods: A pre‑ and post‑questionnaire cross‑sectional approach was undertaken, and the intervention was an awareness campaign. Variables collected included demographic characteristics (e.g., age, gender, education, occupation, urban/rural residence) and CHP awareness (its existence, sources of knowledge about CHP, its goals and objectives, its target diseases, location of activities, participation in such activities). Logistic regression was used to analyze the awareness of the program according to participant characteristics, with a time of the survey as a variable. Results: Awareness of the program was found to be 11 times higher among postsurvey respondents than presurvey respondents. ABSTRACT Respondents of the second survey were better at correctly identifying “health education” as the main goal of the CHP (odds ratio [OR], 4.1; 95% confidence interval [CI], 3.1–5.5), “noncommunicable diseases” as the main diseases targeted (OR, 4.8; 95% CI, 3.6–6.4) and “attention to health” as the purpose (OR, 6.0; 95% CI, 4.0–8.9). Conclusion: The different activities of the CHP were successful in dramatically increasing awareness of the CHP program in Al‑Jouf. Key words: Community‑based health education, noncommunicable diseases, Saudi Arabia INTRODUCTION key risk factors can be addressed in a well‑integrated manner.[13] Major noncommunicable diseases (NCDs), especially cardiovascular diseases, diabetes, cancers, and chronic The prevalence of NCD modifiable risk factors is quite respiratory disease, have high global morbidity and high in many Middle Eastern countries.[14] Moreover, mortality burdens,[1‑3] and therefore, have an enormous deaths in the region attributed to such NCDs are projected impact on healthcare systems.[4] However, interventions to increase by 25% over the next 10 years. The Kingdom to reduce common risk factors (including the use of of Saudi Arabia (KSA) is currently undergoing rapid tobacco, physical inactivity, poor nutrition, and obesity) demographic and public health changes, with increased are cost‑effective.[5‑12] Thus, programs to reduce the risk life expectancy at birth and substantial reductions in of NCDs can achieve major health gains, especially if morbidity and mortality from communicable diseases. However, these changes also mean that the incidence Access this article online of NCDs is increasing and has now reached epidemic [15] Quick Response Code: proportions. Website: www.jfcmonline.com Recent studies reported dramatic increases in NCD modifiable risk factors, including tobacco consumption, DOI: unhealthy diets, and physical inactivity as societal change [16‑22] 10.4103/2230‑8229.149586 progresses. The best evidence comes from the World Health Organization (WHO) STEP‑wise approach to Journal of Family and Community Medicine | January 2015 | Vol 22 | Issue 1 | 31-38 31 [Downloaded free from http://www.jfcmonline.com on Monday, March 02, 2015, IP: 41.128.165.40] || Click here to download free Android application for this journal Memish, et al.: Awareness of crown health program surveillance of chronic NDCs risk factors (STEPS) METHODS survey, conducted by the Saudi Ministry of Health (MoH) in 2005.[23] This survey reported that 13% of adult The CHP was conducted in the cities of Sakakah (urban Saudis were current smokers, 19% suffered from area), Dumat al‑Jandal (rural), and Tabarjal (rural) of hypercholesterolemia, 34% were physically inactive Al‑Jouf, Northern Region of KSA. This region was and 36% were obese. More recent data of the Saudi selected, because most health services are delivered Health Information Survey reported that the prevalence through MoH facilities that include three tertiary hospitals of diabetes is 15% and 12% for men and women, and 35 primary healthcare centers (PHCC). The CHP respectively, and hypertension is 18% and 13% for men was delivered through PHCCs, and it was assumed it and women, respectively. In fact, KSA was reported to be had reached most, if not all, people in the region. The among the top 10 countries with the highest prevalence project was officially launched in mid‑2008, during which of diabetes in the world.[24] 6 out of 34 of the PHCC started periodic screening examinations as discussed below. However, there was very Noncommunicable diseases are most effectively prevented little active publicity about the project other than posters. through a combination of community‑based and A decision was made to launch an awareness campaign individually focused interventions for risk reduction.[25,26] from November 2011 to March, 2012, so that the health Many studies have proved that community‑based programs behaviors of the community will eventually improve and reduce the incidence of NCDs.[27‑32] make use of the health promotion efforts in the primary health care clinics. Activities included the following: A community‑based intervention‑the Crown Health • Public health education and prevention programs Project (CHP)‑was developed and implemented by the provided by health promotion units, to both clients MoH on a small‑scale in Al‑Jouf Region in Northern attending the unit, and the general public (intensively KSA, to assess its feasibility and effectiveness so that during the period November 2011–March 2012). This it can be scaled up if necessary. The objectives of the included: Establishing six permanent health awareness CHP were to: Estimate the prevalence of common exhibitions (in PHCCs with health promotion clinics), NCDs and their risk factors; raise awareness of the risk rotating/displaying five mobile exhibitions (in markets, factors of NCDs and preventive measures in the public; parks, and places where people gather), holding 15 improve early detection and management of NCDs; workshops dealing with raising awareness of the build the capacity of health care workers in preventive CHP, its objectives and activities (in public and private services for NCDs; and improve diagnostic, curative, and sectors), health education to decrease NCD risk rehabilitative services for patients. The first findings of factors, visiting 60 schools in Al‑Jouf, and distributing the implementation of the program have been published 500,000 CHP brochures. elsewhere.[33] For the target population to make optimum use of this community‑based project, they need to be Five different brochures of about 100,000 each were aware of and appreciate its importance, its usefulness distributed (introducing CHP program, nutrition, and how it may be applied. physical activity, healthy behaviors for children, and obesity). A substantial (but not quantified) proportion Other studies on campaigns for different diseases of the brochures was handed directly to patients visiting (e.g. obesity, cervical cancer, salt reduction, glaucoma) the 6 primary health care clinics that had regular health have shown that the mass media can impact effectively promotion screening (4 in Sakakah, 1 in Dumat Al‑Jandal on awareness and health knowledge, attitudes, and and 1 in Tabarjal), and to participants of the 15 workshops, motivations.[34] Analyzing the results of a campaign and to children and their parents when 60 schools were by the characteristics of the population might benefit visited. The remaining brochures which constituted the future programs.[35] The results of small‑scale program majority were left at the 6 clinics for future visitors. evaluations provide lessons for use in organizing • Periodic examinations performed by the screening units wider‑scale programs.[36] included: Physical examinations (e.g. arterial blood pressure measurement, anthropometric measurements This study aimed at assessing possible changes in public as weight, height, waist circumference) and laboratory awareness of the heightened CHP awareness campaign investigations (e.g., lipid profile [total serum cholesterol, conducted among Al‑Jouf residents over time, between low‑density lipoprotein, high‑density lipoprotein, October, 2011 (immediately after the preintervention triglycerides], random and fasting blood sugar) questionnaire) and May 2012. It was also to determine • Training courses for healthcare workers
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