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PUBH643 Malnutrition Among Older Australian in Residential Care: Health Advocacy Assessment 2 Answer

Background

Having identified the context and theoretical framework for health advocacy in assessment 1, this paper requires you to prepare a strategy plan based on a clearly articulated understanding of social change that draws on social movement theory. The strategy will address advocacy as an activity involving power and contest, and contain the following key elements

  1. processes for recruiting support to campaign and incorporating voices from the grassroots
  2. identification of key goals,
  3. proposals for message framing
  4. tactics and strategies for pressuring decision makers

Assessment specifications

Weighting: 50%

Length and/or format: 2000 words, standard academic essay format

Purpose: To apply knowledge of a theory of change for health advocacy to a strategic planning process.

Assessment criteria: See separate marking rubric on LEO

Instructions

This essay requires you to prepare a Health Advocacy strategy plan for the topic identified in Essay One.

Your essay should:

  1. Include an introduction that briefly summarises the essay topic area and introduces the strategy plan.
  2. Give one or two examples of previous interventions/advocacy efforts in your topic area. For each example identify and comment on:
    1. how the problem was represented, and the goal of the intervention
    2. the level of grassroots community mobilisation and participation
    3. the capacity of the organisation in terms of finances, membership building, and leadership - read Pastor and Ortiz (2009, pp. 38-43)
  3. the theory of change that the approach adopted
  4. tactics and strategies used to achieve the goal
  5. Most of your essay should be dedicated to providing a strategy plan to effectively implement health advocacy. This plan should include the following
    1. the identified problem and advocacy goal is clearly linked to social determinants of health
    2. reference to a theory of change
    3. two or three examples of effective communication tactics to inform, mobilise, and pressure decision-makers
    4. explicit recognition that effective advocacy planning involves building citizen power to pressure power holders
  6. Include a short conclusion that concisely summarises your key points.

Answer

PUBH643: Health Advocacy

Assessment Task 2: Health advocacy strategy

Introduction

The essay topic area is malnutrition among older Australian in residential care. It is a key health concern in Australia that requires proper intervention or health advocacy strategy plan in light of United Nations Sustainable Development Goals (SDG) because of the breadth of the problem and its continued effect on Australia’s health inequality status. It had been estimated that 10–44% of elderly Australian over the age of 65 are at risk of malnutrition triggering severe clinical consequences and recovery being delayed and difficult for elderly people (Craven et al. 2017). The majority of these incidences had been traced back to residential aged care facilities making it a major health and social care concern. 

This essay focuses on analysing the previous existing interventions or advocacy efforts to the concerned area and producing an advocacy strategy plan focusing on social determinants of health, the theory of change, communication tactics. 

Previous Interventions or Advocacy Efforts

How the problem was represented, and the goal of the intervention

The problem of malnutrition among older adults in Australia had been recognised at the clinical level by any experts and researchers and had been discussed widely. At government level as well this problem had been recognised. Some clinical intervention efforts had been outlined with the key goal of recognition of malnutrition state and risk factors and managing those at the clinical level.

In most cases of these intervention programs the goal was the to recognise and categorise people under the category of malnourished and at risk of malnutrition using screening tools Mini Nutritional Assessment Short Form (MNA®-SF)* and Malnutrition Screening Tool (MST)† and referring appropriate clinical actions to address and managing the problem as per category. The intervention programs also had the focus of Identifying and addressing contributing factors and developing management strategies. Some management strategies were also social and functional interventions in nature, having goals of addressing problems in community care services and providing dietary and social support (Flanagan et al., 2012). Evidence-based practice guidelines detailed intervention programs approved by the Dietitians Association of Australia (DAA) having the key focus on nutrition screening and providing NHMRC recommendations (Hickman, & Tapsell, 2009). 

The level of grassroots community mobilisation and participation

The intervention efforts being more clinical than focusing on social causes and eliminating those, the level of grassroots community participation and mobilisation were observed very less. The key focus was on elderly patients living in residential care. However, the intervention efforts lacked focus on raising awareness against the causal factors, signs, and symptoms andexisting management strategies of interventions for associated communities of patients, caregivers, and residential facilities. The programs failed to address the UN's SDGs and organised no social agendas or awareness programs such as social campaigns or sit-ins, public marches, and public programs. These show the lowest levels of community mobilisation or participation. 

The capacity of the organisation

The capacity of organisation of such Intervention programs with respect to finances, membership building, and leadership was woefully limited. The intervention programs were limited to building management strategies and listing those on papers or websites requiring very limited financial and leadership efforts. While the intervention program detailed in Evidence-based practice guidelines focused on empowering social care service providers providing elderly support at home and residential care with knowledge of risk factors of malnutrition and using assessment tools for diagnosing malnutrition among the elderly population, efforts for developing leadership capabilities among them were limited or low. Membership building efforts in clubs were limited as well because no efforts were observed for making elderly clubs or nursing clubs fighting against malnutrition in elderly residents living in residential care. 

The theory of change that the approach adopted

No single obvious theory of change approach was observed to be adopted in the previous intervention programs. The essential component of the theory of change has been detailed as describing why and how a particular change is expected to happen in a particular context (Rosenau, 2018). While the previous interventions had detailed why change is required in the malnutrition scenario and elderly Australians and how it can be done by management strategies the intervention programs had not linked the practices to the elements of theory of change based on social justice theory by Klugman or attention generation framework for global health issues as detailed by Shiffman. 

Tactics and strategies used to achieve the goal

The goals of clinical interventions for addressing malnutrition among elderly adult Australians or social interventions used various management strategies. Community care service goals involved strategies such as centre-based daycare, domestic assistance, home-delivered meals while Dietary and social support goals under the social intervention programs involved strategies like dietitian, cooking lessons, and community meal programs. Clinical management strategies under clinical intervention involved strategies like identification of red flag conditions, i.e. serious medical conditions such as cancer or cardiac, hepatic or renal failure that may have led to serious weight loss and malnutrition, and managing chronic or reversible medical conditions. Interventions as per outcome category involved various strategic actions. For malnourished individuals the strategic actions involved commencing nutritional intervention through the administration of oral nutritional supplementation (400–600 kcal/day), diet enhancement, monitoring weight changes closely and carrying out proper assessment of nutrition and referral to a dietician. For those who are at risk of malnutrition, strategic actions were not much different from those who are malnourished. The only exception of oral nutritional supplementation with a key dose of 400kcal/ day (Flanagan et al., 2012). The evidence-based practice intervention argued in favour of strategic actions such as nutrition screening, nutrition assessment and diagnosis, setting nutrition goals, clinical and sub-clinical management of nutrition goals and nutrition monitoring and evaluation on a regular basis (Hickman, & Tapsell, 2009). 

All tactics and strategies outlined directed a path of management for diagnosing malnutrition and managing the situation. However, it failed to address concerns of community awareness enhancement, empowering people to advocate in favour of their health and demanding effective government interventions.  

strategic plan to effectively implement health advocacy

The strategy plan for implementing health advocacy concerning the health issue of malnutrition among elderly adult residents of residential care facility involves the goals of raising awareness in the society regarding issue of malnutrition in older adults (Wise, 2001). The strategy will be addressing the root causes such as poverty and hunger as well as lack of proper care through community development and engagement and social awareness programs. The strategy is to develop a social campaign that would recruit people from the grassroots community involving older adults, doctors, nurses, and caregivers at all levels raising awareness against the clinical and social risks imposed by malnutrition and demanding greater government support for eradicating the root social and clinical causes of malnutrition. The strategic plan involves communication tactics for informing, mobilising and pressuring decision-makers (health policymakers). 

The link between problem and advocacy goal to SDGs

The increased susceptibility to malnutrition among elderly people living in residential care facilities is largely due to a lack of understanding regarding the causal factors of malnutrition and risks associated with malnutrition for such people. In-depth investigations suggested that underlying clinical conditions such as cancer, renal diseases often lead to malnutrition, suggesting that malnutrition could be an indicator of a wide range of associated clinical conditions. Workers in residential care having limited knowledge fail to recognise the significance of this condition resulting in negligence in care. The advocacy goal of awareness generation regarding the causal factors and associated risks is directly linked to the problem and highly significant with respect to addressing the problem and reducing those through policy formation. The goals of raising awareness in the society regarding the issue of malnutrition in older adults, addressing the root causes such as poverty and hunger as well as lack of proper care through community development and engagement and social awareness programs are also highly significant directly reflecting on the SDGs namely no poverty, zero hunger and health & wellbeing (Assembly, 2015). 

Reference to the theory of change

The strategic plan of developing a social campaign that would recruit people from grassroots community involving older adults, doctors, nurses and caregivers at all levels raising awareness against the clinical and social risks imposed by malnutrition and demanding greater government support for eradicating the root social and clinical causes of malnutrition is based on the theory of change framework for social justice advocacy as presented by Barbara Klugman. Her theory of change framework describes a model for analysing advocacy process for influencing public values and policy (fig 1) (Klugman, 2011). 

Model for analysing advocacy process

Figure 1: Model for analysing advocacy process

Source: (Klugman, 2011)

The 5 components of this model are also applicable for health advocacy strategies surpassing beyond the context of social advocacy. With respect to the problem at hand, malnutrition impacts the public spheres and influencing the public norms and values creates pressure for doing justice on bureaucracy and administration as well as solution development. At the same time, bureaucracy and administration influence as well as influenced by politics which fosters solution or policy development (Klugman, 2011). Thus, the strategy of social campaign can inform the public norms and values which could create pressure on bureaucracy and administration followed by influencing political leaders to consider policy development or development of appropriate framework that offers a guideline for such residential care regarding how to recognise and manage elderly adults in order to avoid being susceptible to malnutrition as well as measures for reducing causal factors such poverty and hunger and ensuring good health and wellbeing. 

Communication tactics

Informing, mobilising, and pressuring decision-makers to require effective communication tactics. One example of such communication tactics is framing. Under this tactic of framing news, media coverage is used for influencing mass opinion. While framing news by journalists is often influenced by larger societal norms and values, pressures from interest groups, government bureaucracies, organisational pressures and constraints, and external pressures from interest groups and other policymakers, social campaigns and news coverage can influence these factors vice versa as well. The tactic is to frame the news in such a manner that moves public opinion to an extent where government bureaucracies, political parties, and interest groups are moved and pressured enough to develop appropriate policies and solutions to the problem. Meaning-making the problem pressing enough for government consideration (Wymer, 2015). 

The second example of communication tactics involves advocacy tactics which involve actions like mobilising the press, arranging marches and sit-ins and raising funds for policy development. If marches and sit-ins are arranged for raising awareness against malnutrition and demanding justice for elderly Australians news media can be moved enough to cover the news. This helps the first tactic whereby the framing of news influences policymakers by creating pressure. If enough people are speaking for policy development and demanding proper solutions to the problem of increased malnutrition instances among elderly adults in Australia decision-makers would be pressured enough to consider the matter of highest concern and develop policies and frameworks for addressing the underlying issues (Zoller, 2017).

Focus on building citizen power

Efficient advocacy planning requires building citizen power as citizens would pressurise power holders and decision-makers to develop proper policy and framework. Citizen power could be developed through the following actions. 

  1. The first concern is creating knowledge among citizens regarding the issues that can be done by arranging social campaigns (Wolff et al., 2017). 
  2. Next workshops can be arranged to discuss the social determinants of health (here malnutrition). 
  3. The campaign goals which directly reflects the UN’s SDGs (here no poverty, zero hunger and health & wellbeing) are to be created and communicated to the mass by mobilising the press through internal and external framing of news. 
  4. Increasing confidence among affected groups and the larger public so that they become active in various social media platforms advocating in favour of policy development. 
  5. Influencing people to demand proper measures and being vocal about the issues and problems associated with malnutrition in older adults publicly. 

These actions can empower the public and public having a greater influence on choosing political leaders would influence both government and opposition political parties working towards proper policy development.

Conclusion

 To summarise the key points, it can be noted that the issue of malnutrition among elderly adults requires a proper focus on policy development which requires proper health advocacy strategy. The strategy involves communication measures and actions for empowering the public to create pressure on decision-makers.  

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