A COMPARATIVE STUDY ON HEALTH EDUCATION INTERVENTION ON MENTAL STABILITY AND OBESITY

CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND OF THE STUDY

Mental health problems have a two-way association with obesity, with conditions such as depression often leading to weight gain, which in turn can trigger depression (Public health England 2013). In such instances, food can be used as a coping strategy, diet can be unhealthy and low mood can affect adherence to weight management programs. (Gatineau M, Dent M 2011) Weight gain can be both a secondary manifestation of a mental disorder and a side effect of medication. The common factors that are characteristic of physical and mental health problems are increasingly being recognized. For example, a recent inquiry concluded that a new way of thinking is required to address the historical division between care of physical and mental health (MHF 2013). There is little doubt that prevention and prompt treatment of obesity can be potentially life-saving, and certainly can reduce the physical morbidity resulting from it. People with severe mental health problems are prone to the risks associated with obesity beyond that of the general population. However, currently, no specific guidance is available that relates specifically to obesity prevention and weight management for service users residing in secure mental health units. A priority recommendation for research is how obesity can be managed for people with conditions associated with increased risk, for example, individuals with enduring mental health difficulties.  One of the rising concerns in Western countries is the high prevalence of obesity which has mainly been attributed to a constant decrease in physical activity levels and increased energy intake [T. Lobstein, L. Baur, and R. Uauy 2004, C. L. Ogden, M. M. Lamb, M. D. Carroll, and K. M. Flegal 2010]. Although recent research suggests stabilization in prevalence rates of overweight and obese person in developed countries [M. Wabitsch, A. Moss, and K. Kromeyer-Hauschild2014], evidence shows that once obesity is established, it is problematic to reverse [H. O. Luttikhuis 2009]. Additionally, it has been shown that obesity during youth is likely to follow through to adulthood [A. S. Singh 2008]. Correspondingly, obesity has been pronounced the main health issue in developed countries [A. S. Singh 2002] with consequences for the physical as well as psychological well-being for the affected children and adults. Hence, obesity is a risk factor for subsequent chronic diseases in later life which should not be neglected [M. K. Gebremariam 2012, P. T. Katzmarzyk, T. S. Church, C. L. Craig, and C. Bouchard 2009]. Sufficient physical activity and a well-balanced diet on the other hand are essential for normal growth and development [A. P. Hills, N. A. King, and T. P. Armstrong 2007] and play an important role in the prevention of increased weight and obesity [W. B. Strong, R. M. Malina 2012]. Health educators professionals, governments, and many communities have long identified  obesity as an increasing health problem and therefore have developed different programs targeting inappropriate weight gain by reducing energy-dense foods and sedentary time (mainly television viewing) as well as increasing the daily amount of physical activity people engage in [M. M. Fernandes 2013]. Since several studies have shown positive and preventive effects of an active lifestyle later life and also that sedentary behavior is maintained as an adult health promotion has to start early in life. Therefore, schools have been identified as providing an ideal environment for the promotion of health-enhancing behaviors. According to the results of a recent review, Waters [2011] suggest that for interventions to be successful, they have to be integrated into the school curriculum and include amongst others “healthy eating, physical activity, and body image” [E. Waters 2011] as well as support for teachers and parents. Furthermore, interventions intended to last longer than one year are more likely to become integrated into curriculum, school and parents activities than shorter interventions [J. A. C. Silveira 2011] and therefore are more promising to increase knowledge and behaviors which contribute to a healthy lifestyle and enhanced quality of life in the long term. This program enhances a healthy lifestyle in the people in Baden-Wurttemberg, southwest Germany, and ¨ started in 2009 (for more detailed information see [J. Dreyhaupt 2012]). The program’s contents and materials are coined into the school curriculum focusing on health promoting behavior change towards more physical activity, less time spent with screen media, and a more balanced diet, especially targeting a minimization of soft drink intake and breakfast skipping. The teaching materials, developed in collaboration with experienced health educators, are delivered by the classroom teacher and promote healthy and active alternatives, which people are offered in order to lead a healthier lifestyle. The prepared, ready-to-use teaching units include lessons that increase awareness, teach health-related topics and offer ideas and alternatives for leisure activities. In order to know whether the implementation and intended outcomes were achieved a large-scale evaluation had to be carried out.

1.2 STATEMENT OF PROBLEM

A small body of mainly exploratory, mixed method research has identified that in order to address obesity and achieve parity of esteem between mental and physical health in secure mental health units, a number of elements need to be in place. These include access to health education interventions and the associated training and equipment required a range of dietary and physical activity strategies to reduce the obesogenic environment and changes in policy at ward level that address staff and patient behavior change. Interventions require attention to national guidance and policies, alignment with quality assessment and robust evaluation. However, there is strong evidence of the need to tackle obesity in secure settings. There is much more to be explored in terms of tackling the problem. Interventions would need to be evaluated in larger-scale studies to assess how effective and applicable different approaches might be for specific populations, including those detained in secure units.

1.3 AIMS AND OBJECTIVES OF THE STUDY

The major aim of the study is to examine a comparative study on health education intervention on mental stability and obesity.  Other specific objectives of the study include;

1. To examine health education responsibilities and intervention in respect of mental stability and obesity.
2. To examine the prevalence and impact of obesity in adults, as well as investigating interventions that might prove effective.
3. To examine the impact of health education intervention on mental stability and obesity.
4. To examine the challenges of implementing health education intervention programs
5. To examine the relationship between health education intervention, mental stability and obesity.
6. To proffer solutions to the challenges of implementing health education intervention programs

RESEARCH QUESTIONS

1. What are health education responsibilities and intervention in respect of mental stability and obesity?
2. What are the prevalence and impact of obesity in adults, as well as investigating interventions that might prove effective?
3. What is the impact of health education intervention on mental stability and obesity?

1. What are the challenges of implementing health education intervention programs?
2. What is the relationship between health education intervention, mental stability and obesity?
3. What are the solutions to the challenges of implementing health education intervention programs?

1.5 RESEARCH HYPOTHESES

Hypothesis 1

H0: There is no significant impact of health education intervention on mental stability and obesity

H1: There is a significant impact of health education intervention on mental stability and obesity

Hypothesis 2

H0: There is no significant relationship between health education intervention, mental stability and obesity.

H1: There is a significant relationship between health education intervention, mental stability and obesity.

1.6 SIGNIFICANCE OF THE STUDY

The study would be of benefit in highlighting the importance of involving mental health staff in delivering, supporting and adopting lifestyle change interventions. Involving patients in decision making maintains their autonomy and helps to empower patients to care for their own needs. The study would also be of immense benefit to students, researchers and scholars who are interested in developing further studies on the subject matter.

1. SCOPE AND LIMITATION OF THE STUDY

The study is restricted to a comparative study on health education intervention on mental stability and obesity

LIMITATION OF THE STUDY

Financial constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview)

Time constraint: The researcher will simultaneously engage in this study with other academic work. This consequently will cut down on the time devoted for the research work.

1. DEFINITION OF TERMS

Health: The WHO Constitution of 1948 defines health as a state of complete physical, social and mental well-being, and not merely the absence of disease or infirmity. In addition, the Ottawa Declaration states an “individual or group must be able to identify and realize aspirations, to satisfy needs, and to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities”

Mental health:  is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.

Health literacy :The degree to which people are able to access, understand, appraise and communicate information to engage with the demands of different health contexts in order to promote and maintain good health across the life-course.