Action Research on Health Providers and Consumers' Collaborative Initiatives for Provision of Community-Based Health Promotion Services in a Sub-Urban Community of South-East Nigeria

Introduction: Globally, for over three decades, many member nations of the World Health Organization, including Nigeria had adopted primary health care as the focus of their health policy with emphasis on community-based health promotion and disease prevention. However, many studies have confirmed that emphasis of healthcare in many parts of the world has been on curative, short-term, institution-based and individually focused prevention interventions. Several health promotion research literature also show that community health nurses have not yet demonstrated a clear practical role in implementing community-based health promotion activities in collaboration with other healthcare providers and consumers. These deviations in health practices have resulted in low health indices of citizens in several countries of the world as indicated in the 2014 Legatum Institute reports. To bring about a transformative community health nursing practice, this action research was proposed to empower members of the community to collaborate with healthcare providers for the provision of community-based health promotion services. The objectives were to: carry out a participatory fact-finding assessment of community-based health promotion needs and service provision structures; collaboratively plan and implement actions for the provision of community-based health promotion services and evaluate outcomes of the actions with in-built measures for sustainability of the services.

Methods: Mobilization of members of the research team and the participatory fact-finding assessment took place in the third week of November 2014. For the research team members, inclusion criteria were community health nurses, community health extension workers, policy makers, community leaders, church representatives, environmental health officers and social services providers. Following ethical approval from the Municipal Council and informed consent from the participants, data were collected using twenty-seven interviews and two focus group discussions (FGDs). Each of the FGDs involved nine participants with the pre-determined criteria, recruited through purposive and snowball sampling techniques. Altogether, two FGDs and four research team meetings were carried out, and twenty-seven members of the community who were not members of the FGDs were interviewed.

Results

Data were analyzed thematically following verbatim transcription of the interviews and the FGDs. The following themes emerged: Poor public drainage system in the community, improper waste disposal; inadequate supply of potable water; need for health promotion information; youth involvement in alcoholism and cannabis smoking; poor formal educational status of the children and youth; poor infrastructure (including lack of power supply that has lasted several months; lack of Health Centre) and lack of knowledge of existing health policies for the benefit of the community.

These findings were critically reflected upon by the action research group and interventions were jointly prioritized, planned and implemented with the hope to bring about solutions.

The actions included: 1) Creating supportive environment for health promotion. This covered three perspectives: a) Establishment of health committees in the community and the two churches within the community to strengthen leaderships for health promotion; b) Advocacy meeting with the Chairman of the Municipal Council for improved health infrastructure, advocacy for the provision of a Health Centre and primary school and resource allocation and utilization for health promotion; c) For Inter-professional collaboration and multi-sectoral approach to service delivery, advocacy meetings were held with the General Manager of the electricity organization  and the Manager of the Water Board for restoration of power supply to affected parts of the community and provision of potable water supply respectively.  Similarly, the Sanitation Board was contacted to provide commercial waste receptacles at strategic locations in close proximity within the community to encourage safe and sanitary waste disposal. The services of a town-planner was engaged  by the community to advice and assist house owners on appropriate ways of channeling rain water from their homes for proper drainage to avoid the menace of flooding and collection of stagnant water along the roads with the consequences of producing unhealthy environment.

 2) Strengthening community action through community mobilization and education.

3) Capacity building through education of the action research group members and members of the health committees on health promotion and health education strategies as well as strategies for health surveillance. This action was aimed at developing their skills for health education of their people on identified areas of health promotion needs. Youth volunteers in the community were identified and trained as peer educators for prevention of alcoholism and smoking.

4) Promotion of public policies. This included new regulations agreed upon by the community leaders to control unhealthy waste disposal.

Evaluation

The first participatory evaluation of the actions was undertaken by the members of the action research group in the third week of January, 2015.  The findings included the following: political will to build a Health centre and Primary school for the community and to achieve this goal, the community was requested to provide an empty land for the projects. Also, the health committee members and the co-researchers took a decision to disseminate health information monthly at the market place, the community hall and in each of the two churches within the community. This action had commenced in December 2014 and is ongoing with one health education programme monthly in each of the designated places. The health education topic is usually based on areas identified by members of the community and research team as the area of need. Furthermore, through this community-based health promotion action research effort, it was possible for the health committee to utilize the efforts of the youths in the community and the sanitation board to evacuate refuse and improve their drainage system. Additionally, every last Saturday of the month was fixed for compulsory sanitation within the community and this has been found to be very effective in promoting the sanitary condition of the community. In addition to that, the community also decided on sanctions for wrong channeling of rain water from individual homes to cause flood along the roads and indiscriminate refuse disposal, but successfully promoted compulsory ownership of toilet facility in every home within the community. Very importantly, members of the community have continuously expressed their delight at the opportunity of having healthcare personnel available to facilitate their education on health promotion and empower them for actions, which according to them “have been very useful”

Conclusion The community is an important resource which if mobilized through the process of action research, would be empowered for health promotion activities. The process fostered inter-professional collaboration among healthcare and social services providers and similarly empowered healthcare consumers to take control over their health and its determinants, which invariably is expected to improve their health. The implication of the findings of this action research is that community-based health promotion practices should be recommended globally to enhance transformative community health nursing practice for the sustenance of health benefits to the society.