Starbucks Growth Strategy Essay Example for Free

Starbucks Growth Strategy Essay (Nasdaq: SBUX) reported strong fourth-quarter and fiscal 2003 results yesterday after the bell, with annual revenues jumping 24% to $4. 1 billion and earnings growing 26% to $268. 3 million. Shares are dipping about 2% so far today, presumably because the companys $0. 17 in Q4 EPS met, rather than beat, expectations. Despite the markets lukewarm response, theres much to praise here, and opportunities for more growth abound. The companys comparable-store sales results were again impressive, and the future of its international expansion looks promising. Further, Starbucks plans for domestic growth are encouraging, thanks to the rollout of more drive-through stores. Starbucks (which I happily own shares of) posted an 8% comparable-store sales gain for the year, marking the 12th year in a row the companys comps have been 5% or better. Its projecting 3%-7% comps growth for fiscal 2004 the same guidance it gave for the just-completed year. Starbucks same-store sales success is primarily transaction-driven, meaning that its not relying only on higher prices to drive growth. Thats an important factor in the quality of its comps gains. We already know it entered its first quarter upbeat, with same-store sales growth of 9% for the month of October. With the rollout of its famed holiday drinks (dont come between me and a Gingerbread Latte), and the continued success of the Starbucks card, Q1s likely to be another winner. Starbucks international operations will turn profitable this year, a significant milestone for the company. It will add 350 international locations to its lineup, with 300 of them being licensed stores. Troubles in Japan havent squashed Starbucks belief that it can be a welcome part of diverse cultures the world over. The company will continue to partner locally in order to achieve this balance between a consistent Starbucks experience and a locally tailored one. In the U. S. and Canada, Starbucks will add 950 locations this year. About a third of those will be drive-through locations, which have some of the best unit economics of all of Starbucks concepts. Its surprising to me that Starbucks just now seems to be catching on to the fact that drive-throughs can be hugely successful for it. Yes, its contrary to the whole coffeehouse culture the company wants to cultivate, but from the customers point of view, the convenience factor is attractive. Starbucks finished the year with 7,225 stores, and as laid out above, plans to add 1,300 new locations globally in fiscal 2004. Thats all while maintaining its excellent comps growth and producing total revenue growth of 20% and earnings growth of at least 20%. Ambitious, to be sure, though Starbucks hasnt given us a reason to doubt it yet. At 38 times the 2004 estimate of $0. 85, its stock, predictably, isnt allowing for much doubt, either.

Cyberbullying A Social Problem Education Essay

Cyberbullying A Social Problem Education Essay An old school yard problem has taken on a new electronic face for the twenty first century. No longer is the bully confined to the halls of the high school, they are now going home with students in their cell phones and in their computer monitors. Cyberbullying has become a new trend with terribly destructive consequences. The effects of cyberbullying have been linked to negative academic, social and mental consequences for targets and perpetrators alike. Due to the fresh nature of the problem, schools and parents have had difficulty in developing programs and policies that effectively deal with these behaviors at home and at school. The following paper provides a sound discussion of this new phenomenon and offers proposals for educators and parents on how to address and prevent cyberbullying among youth. It is time we combat this social problem and take a stronger stand against cyberbullies. Definition and prevalence Cyberbullying is the willful and repeated harm inflicted through the medium of electronic communication (Hoff Mitchell, 2008). Victims of cyberbullying are targeted with threatening, degrading and/or sexually explicit messages and images in chat rooms, blogs, social networking sites, cell phones, instant messaging, etc. (Katzer, Fetchenhauer, Belschak, 2009). Recent studies have found that 95 percent of American teenagers between the ages of 12 and 18 have access to the Internet and 75 percent own cell phones (Cox Communications, 2009). Of these teens, 20 percent report experiencing some form of cyberbullying during their school careers. (Hinduja Patchin, 2007). The increased access and anonymity provided by these technologies have made it possible for perpetrators to easily harm a persons social standing, peer relationships and physical safety. Children are not the only ones affected by cyberbullying where adults are increasingly targeted by perpetrators. Cyberbullies have been k nown to create slam sites where individuals are ridiculed or rated in insulting ways, gather private financial details, and share personal information with organizations that advocate for child molestation. Cyberbullies also remotely access webcams and secretly record individuals without their knowledge or permission. These behaviors are increasingly pervasive and have consequences for every member of society if action is not taken. Costs of cyberbullying The costs of ignoring and failing to prevent cyberbullying have proved immense. Targets of cyberbullying display increased signs of anger, depression, anxiety and emotional distress (Smith, 2008). Victims may also exhibit signs of failing health and decreased academic performance. In extreme cases victims have dealt with their frustration through school shootings or by committing suicide. According to research, victims of cyberbullying are almost twice as likely to attempt suicide compared to those who have not endured such bullying (Hinduja Patchin, 2007). Children who cyberbully others have difficulty in communicating their emotions and lack appropriate methods of relieving aggression. Contrary to popular belief, cyberbullies are known to have high self-esteems and bully others in order to establish dominant social roles (Agatston, Kowalski Limber, 2007). This creates a power differential where cyberbullies feel superior to others who are unable to defend themselves. These childr en are more likely to engage in other forms of anti-social behavior such as vandalism, fighting, dropping out and using drugs (Hinduja Patchin, 2007). Nearly 25 percent of school bullies will also be convicted of a criminal offense in their adult years (Juvonen Gross, 2008). For the school, cyberbullying has been attributed to high absentee rates, poor student performance, low teacher morale and negative perceptions from the community. Schools have been targeted for failing to provide a safe learning environment and in some cases have been held responsible for the suicides of students who have been victimized (Hoff Mitchell, 2008). The most significant cost for schools are the lost opportunities of children that are affected by cyberbullying. Suggestions for schools. Schools must establish that any type of bullying is unacceptable and perpetrators will be punished. By adding cyberbullying into student codes of conduct, educators and students enter a contractual agreement where penalties can be applied. Currently it is difficult for teachers and administrators to punish cyberbullies so adding this definition to student handbooks will give educators cause for suspending or expelling offenders (Calhoun Daniels, 2008). This sends the message that this type of harassment will not be tolerated. Most policies involving cyberbullying are reactive and do not address why these behaviors occur. Schools are encouraged to employ programs that openly discuss the dangers of cyberbullying and what targets can do when they become victimized. The goal is to take a proactive step and prevent cyberbullying from ever occurring. In order for students to take a proactive stance on cyberbullying they must be educated that their online interactions have real life consequences. School officials can help by adding cyberbullying to existing curriculum in health classes and allowing law enforcement officials to speak at assemblies about the legal implications of cyberbullying. Informing students on how to deal with cyberbullies in a legal sense will likely deter students from engaging in cyberbullying (Smith, 2008). Schools can also implement further programs that discuss critical thinking and the dangers of bullying behavior. This can come in the form of assemblies with guest speakers that offer a message of hope for targets as well as bullies. Students will be provided with information on how to get help and how to prevent this type of treatment. These programs can also offer tips on how to avoid becoming a target for cyberbullying. Students are encouraged to never reveal personal information to anyone that they do not know. Cyberbullies have been known to pose as trusted friends online and trick targets into revealing potentially embarrassing information. Also, students will be informed of the potential legal implications of sending or transmitting nude pictures of minors under the age of 18 through cell phones or e-mail messages in what is known as sexting (Cox Communications, 2009). Teaching students how to protect themselves though smart usages of technology decreases the chance that they will be victimized in the future. With the enthusiasm behind social media, teachers have begun using sites like Facebook to provide an engaging educational experience for students when they are not at school (Diamanduros, 2008). This extension of the classroom will require students to friend the site giving teachers access to student accounts. The point here is not to spy, but to create an online presence for teachers which sends the message that students will be held accountable for their online behavior just as in real life. This will allow administrators to appropriately handle internet interactions that are in violation with the updated student codes of conduct. By creating an online learning environment students are encouraged to participate and share their ideas while refraining from acting irresponsibly. To prevent cyberbullying while at school, school computers must be updated with recent firewall software and search restrictions. Each computer should require that students login with their real names (not pseudonyms or handles) to ensure that violators can be easily traced. Any attempt to disable protective software or damage networks should be viewed the same as destruction of other school property and handled accordingly. Computers and technology access are a privilege at school and violations of these policies can result in these privileges being removed. Students should be informed that any electronic transmission created at school is subject to school rules including text messages, e-mails and phone calls. Ultimately, the lines of communication must be kept open between students and teachers. Students will be more willing to report cyberbullying if they know that school officials will actually do something about it (Diamanduros, 2008). Teachers need to be informed on how to handle bullying they witness in person and how to report it to the proper authorities. It is important that teachers also ask the assistance of school counselors who can get involved with a students parents and the situations they face at home. These measures will ensure that students remain willing to contact trusted adults when their efforts at defusing potentially dangerous situations are unsuccessful. Suggestions for parents. Parents must learn to recognize the warning signs that their child is a perpetrator or target of cyberbullying. Common characteristics of perpetrators include frequent computer use, especially at night, combined with loud bursts of laughter. Cyberbullies tend to be secretive and attempt to disguise what they were doing when adults enter the room (Dehue, 2008). Targets are known to become noticeably sad or angry following computer use and may abruptly stop using the computer. Additional signs of bullying victimization are the avoidance of friends, family and school (Hoff Mitchell, 2008). Parents should be aware of these signs and maintain a dialogue with children about what their lives are like and what happens to the child on a day to day basis. In the ever evolving social lives of youth it is important to allow children to continue use of electronic forms of communication. This has become an essential way for them to organize events and stay in contact. For this reason a child may be less willing to report instances of cyberbullying for fear that parents will restrict Internet of cell phone access (Hinduja Patchin, 2008). It is therefore important to not restrict use, but to set rules on appropriate online behavior and internet safety. This will make children more willing to report cyberbullying to trusted adults and authority figures. To further ensure that children are not engaging in cyberbullying parents need to make use of search filters and website blockers that restrict offensive material. An additional step would be to place the computer in a common area of the house. Upon learning of of cyberbullying, parents are encouraged to openly discuss what happened and the childs role in the situation. It is necessary to ke ep these lines of communication open to prevent future instances of cyberbullying. Parents are further encouraged to inform school officials and law enforcement of potential abuses of electronic communication. The school officials are trained to take the appropriate actions in dealing with bullying behavior and may provide useful suggestions. Since cyberbullying is often an extension of pre-existing traditional bullying at school, it is important that parents are willing to communicate with the school officials (Juvonen Gross, 2008). In cases involving threats of violence, sexual content, and other illegal activities parents should notify law enforcement. Internet service providers and cell phone companies can be used to provide evidence to report illegal and malicious content (Cox Communications, 2009). Even if these companies are able to obtain transmissions parents should encourage their children to save all e-mail and text messages that contain harmful content to further support criminal investigations. In addition, when a parent informs the community that the ir child has been a target of cyberbullying, it would likely make other parents more willing to monitor their childs electronic transactions. In order to fully grasp the complexities of electronic communication parents should create a presence online by using social media for their own uses. By parents creating a Facebook or MySpace page of their own, it may create a disincentive for children to engage in cyberbullying. This will familiarize parents with this type of communication and give them a chance to keep an eye on their childs internet activity. Most social networking sites provide tips for parents and children on internet safety, user agreements and how to report pages with malicious content. These pages are then removed and offenders are denied access. The more time that a parent spends educating themselves on electronic communication, the more tools they will have in preventing cyberbullying. Conclusion The best way to address and prevent the issue of cyberbullying is to take the appropriate measures when children are still in school. Providing them with the tools of how to be respectful and the consequences of cyberbullying will dissuade them from engaging or continuing these behaviors in adulthood. Educators and parents must be willing to take a stronger stand against this form of harassment and challenge the idea that bullying of any kind is a normal part of growing up. We have reached the point where we can no longer claim unfamiliarity with technology. We must be willing to embrace electronic communication to gain a better understanding of the issue. Computer and electronic competence are the most effective tools in combating cyberbullying.

Can Yahoo Still Attract Tech Workers?

Can Yahoo Still Attract Tech Workers? Travis Bell Susan Knapp Presentation Techology organization are likewise searching for approaches to better theirself and their representatives. The interest for brilliant new workers in this field is high yet this is the point at which they keep running into issues. Managers are attempting to keep the product specialists they have and having issues with contracting new ones. With techolongy changing each day and consistently these organizations are discovering it is difficult to pull in the workers they require in this innovation world. It is not about getting new workers it is likewise about keeping the ones you have. These workers are searching for more pay and in the event that they discover it in another organization they may very well stopped and accept the other position. Audit/Investigation of the Case There are a wide range of organizations in the innovation world that is having these issues. Yahoo is one of those organizations and is one of the most seasoned web look organization. Starting today, Yahoo is not only a web index, they have moved into publicizing, news, and email. At the point when a recently crisp granduate understudy comes into the workforce the are seeking work for the most needed organization in innovation. Yahoo is no longer that and the representatives they do have are beginning to leave to different organizations. Yahoo has been battling with the technique for development for quite a while and there must be a few changes. The supply for work is going to new organizations like Google and Microsoft. Yahoo will need to roll out improvements in the organization to get the new understudy intrigued into the organization once more. With regards to the request they are searching for some representative and the workers they have are leaving as well. The methodology the y are utilizing is quite recently not working. Searching for newcomers will be hard for Yahoo. They will need to make quick move and roll out a few improvements within the organization. This will help with the workers they do have. The primary enormous stride would redesign the organization. Yahoo is by all accounts an organization that is passed its prime, Some may state. Making the present workers glad will get the organization great surveys and the representatives wont go to different organizations searching for an occupation. Strengthing the organization will prompt to better inward enlisting of workers. Susan Burnett, Senior compete leader of ability and association advancement, has begun on making a situation in which workers can learn new attitudes to help better themselves and the organization. These representatives with new attitudes can now climb and have more duties. The distinctive systems and preparing she is doing will reinforce Yahoos inward recuiting and may even help with getting new representatives. Another work er is not going to work for an organization if the employyes they as of now have are not cheerful. Beginning inside the organization first is ideal. Recuiting the correct representative straight out of school to come and work at Yahoo will take some imagination. Begin by utilizing a procedure in which the school will have the capacity to get some awesome expertise in an organization that has been around for quite a while. Yahoo is a built up organization and is searching for new thoughts from new faces in the organization. Additionally select in schools or colleges that cover data innovation and building projects or degree. Another point is to express Yahoo is searching for new worker to assist and develop with the organization. Synopsis and Conclusions With the free market activity of work changing not only for Yahoo but rather for all innovation organizations, they will need to think of an approach to keep the representatives cheerful and attract new agents. This will help in strengthing the team. Upbeat representatives work increasingly and fulfill different representatives. Yahoo has a major stride in front of them however putting their best foot forward and selecting in the opportune place will get yippee back on track. References Noe, R. (2013-01-17). Fundamentals of Human Resource Management, 5th Edition. [Kaplan]. Retrieved from https://kaplan.vitalsource.com/#/books/0078095654/ Yahoo! executive links learning to growth. (2017). Svenonia Blog. Retrieved 30 January 2017, from https://svenonia.wordpress.com/2011/08/31/yahoo-executive-links-learning-to-growth/

Man-of-war :: essays research papers fc

Man-of-War The Portuguese man-of-war if a member of the Kingdom Animalia, phylum Cnidaria(1), class Hydrozoa, order Siphonophra, the genus Physalia, and the species Physalia(2). The man-of-war is not an actual jellyfish, but a Siphonophor. Also the man-of-war is not a single organism. It is made up of many different organisms that work together. These organisms are called polyps. The Portuguese man-of-war is usually found in the Northern Atlantic gulf stream. It can also be found in the tropical and subtropical regions of the Indian and Pacific Oceans. The man-of-war will usually travel in groups, that may contain up to one thousand members. The main portion of the man-of-war's body is an oblong gas-filled bladder. The bladder is usually nine to thirty centimeters long, and is a translucent pink, blue, or purple. On top of the bladder is a crest. This is to catch the wind, and move the man-of-war along. Below the bladder, hang long stringy tentacles, that can reach a length of up to fifty meters. The tentacles are made-up of three different types of polyps. The names of these three polyps are: dactylozooid, gonozooid, and gastrozooid. The polyps are the parts that: capture prey, digest prey, and reproduce. The dactylozooids have cells called nematocysts(3). The nematocysts release a toxin(4) into anything that they come into contact with. The gastrozooids then attach to the dead/stunned victim, and spread over it. They digest it, and transfer food to the rest of the man-of-war. Last, the gonozooids create other polyps. The means by which the man-of-war reproduces, however, is not yet understood. The fish Nomeus gronvii lives among the tentacles of the man-of-war. This fish, which is eight centimeters long, is mostly immune to the man-of-war's toxin. It will eat the tentacles, which will grow back, as its main source of food. Although it is mostly immune to the man-of-war's toxin, the man-of-war will sometimes end up eating it. The enemies of the man-of-war are the Nomeus gronvii, and the loggerhead turtle. If you were to get stung by a man-of-war, you would experience a very painful sensation where you got stung. The toxin that the man-of-war uses blocks nerve conduction. This causes a severe systematic syndrome. This is accompanied by a fever, possibly shock, and interference with heart and lung functions. Bibliography "Portuguese man-of-war," Encyclopedia Britannica. 1988, University of Chicago: Vol. IX, p.634-35 "Portuguese man-of-war," Animal Kingdom. 1972, United States of America: Vol. XVIII, p.88-93 Caras, Roger. Venomous Animals of the World. United States of America: 1974, p. 17-18 hillside.sowashco.k12.mn.us, http://hillside.sowashco.k12.mn.us/kaipo/invertebrate/welcomeinv.html, United States of America: hillside.sowashco.k12.mn.us, 1997 Microsoft Encarta 1996. Silicon Valley Ca., Microsoft Corporation, 1997

Grapes Of Wrath :: essays research papers

Okies Vs. Californians   Ã‚  Ã‚  Ã‚  Ã‚  The Grapes of Wrath, by John Steinbeck, is a novel depicting the Okies migration to California during the period in history known as The Dustbowl. In this novel Steinbeck attempts to display the tensions between the Okies and the Californians. This display can be closely compared to today’s tensions between citizens born in the US and the Immigrants. Great pieces of literature are timeless in the lessons they teach and the controversy they portray.   Ã‚  Ã‚  Ã‚  Ã‚  The tensions between the Okies and the Californians were heated, as are most tensions dealing with land and immigration. The Okies wanted only two things: food and land. â€Å"†¦the new barbarians wanted only one thing – land and food: and to them the two were one.† The â€Å"barbarians† only moved out to California to escape the treacherous conditions of Oklahoma and surrounding states suffering from the Dustbowl; the were attempting to create a better life for their families. The Californians wanted all the luxuries in life, they were living in a land free of Dustbowl worries. â€Å"†¦the Californians wanted many things, accumulation, social success, amusement, luxury, and a curious banking security†¦Ã¢â‚¬  The Californians had already established the conditions that the Okies were in search of. They were now attempting to attain extras, and feared that the arrival of the Okies would halt this endeavor. The Okies motives wer e much nobler than the Californians’; but the Californians still felt that the Okies had no right to invade their land. â€Å"And whereas the wants of the Californians were nebulous and undefined the wants of the Okies were beside the roads, lying there to be seen and coveted†¦Ã¢â‚¬  The Californians did not know what they wanted; their dreams were very unclear. The Okies intentions, on the other hand, were very clear and important.   Ã‚  Ã‚  Ã‚  Ã‚  This tension still exists today between Immigrants and US born citizens. Immigration is a constant topics of discussion among politicians, and the US population as a whole. US born citizens become tense with the arrivals of Immigrants; the US citizens are attempting to achieve their American Dream; these Immigrants are, in their minds, and obstacle on their path to success. Like the Californians in the Grapes of Wrath; the Americans have already attained their needs and are attempting to secure luxuries.

Motor Cyclists Essay

Psychological and social factors influencing motorcycle rider intentions and behaviour Barry Watson Deborah Tunnicliff Katy White Cynthia Schonfeld Darren Wishart Centre for Accident Research and Road Safety (CARRS-Q) Queensland University of Technology August 2007 Psychological and social factors influencing motorcycle rider intentions and behaviour i Published by: Postal address: Office location: Telephone: Facsimile: E-mail: Internet: Australian Transport Safety Bureau PO Box 967, Civic Square ACT 2608 15 Mort Street, Canberra City, Australian Capital Territory 1800 621 372; from overseas + 61 2 6274 6440 02 6274 3117; from overseas + 61 2 6274 3117 atsbinfo@atsb. gov. au www. atsb. gov. au  © CARRS-Q, Queensland University of Technology 2006 To encourage the dissemination of this publication, it may be copied, downloaded, displayed, printed, reproduced, and distributed in unaltered form (retaining this notice). Subject to the provisions of the Copyright Act 1968, no other use of the material in this publication may be made without the authorisation of the Queensland University of Technology. ii Psychological and social factors influencing motorcycle rider intentions and behaviour DOCUMENT RETRIEVAL INFORMATION Report No. RSRG 2007-04 Publication date August 2007 No. of pages 152 ISBN 978 0 642 25564 8 ISSN Publication title Psychological and social factors influencing motorcycle rider intentions and behaviour Author(s) Barry Watson, Deborah Tunnicliff, Katy White, Cynthia Schonfeld, Darren Wishart. Organisation that prepared this document Centre for Accident Research and Road Safety Queensland University of Technology GPO Box 2434 Brisbane QLD 4001. Sponsor [Available from] Australian Transport Safety Bureau PO Box 967, Civic Square ACT 2608 Australia www. atsb. gov. au Project Officer John Collis Reference No. Aug2007/DOTARS 50323. Abstract This report documents two studies undertaken to identify and assess the psychological and social factors influencing motorcycle rider behaviour. The primary aim of the research was to develop a Rider Risk Assessment Measure (RRAM), which would act as a tool for identifying high-risk riders by assessing rider intentions and self-reported behaviour. The first study (n = 47) involved a qualitative exploration of rider perceptions utilising a focus-group methodology. This study identified six key aspects of rider behaviour considered to influence safety: motorcycle handling skills; rider awareness; riding while impaired or not; and the tendency to bend road rules, push limits, and ride at extreme speeds or perform stunts. Study two (n = 229) was survey-based and examined the psychological and social factors influencing these behaviours, utilising the theory of planned behaviour (TPB) and other relevant psychological constructs, such as sensation seeking and aggression. This study indicated that risky rider intentions were primarily influenced by attitudes and sensation seeking, while safer intentions were influenced by perceived behavioural control. While intentions significantly predicted all six types of behaviour, sensation seeking and a propensity for aggression emerged as significant predictors, particularly for the volitional risk-taking behaviours. The measures of intention and behaviour comprising the RRAM were not found to be significantly correlated with self-reported crash involvement, possibly indicating shortcomings in the measurement of crashes. However, significant correlations were found between the components of the RRAM and self-reported traffic offence involvement. While further work is required to refine and validate the RRAM, it represents a potential tool for informing and evaluating motorcycle rider safety countermeasures. Keywords Motorcycle safety, theory of planned behaviour, sensation seeking, aggression Notes (1) (2) ATSB reports are disseminated in the interest of information exchange. The views expressed are those of the author(s) and do not necessarily represent those of the Australian Government or the ATSB. Psychological and social factors influencing motorcycle rider intentions and behaviour iii CONTENTS Executive summary EXECUTIVE SUMMARY Background Motorcycle riding is rapidly increasing in popularity in Australia, attracting a much wider demographic of people than in decades past. Unfortunately, whilst the overall number of road deaths in Australia has generally been reducing, the proportion of motorcycle-related fatalities has been rising in recent years. Further, the proportion of motorcycle-related fatalities in Australia is unacceptably high compared with other OECD countries. To reduce motorcycle-related fatalities on Australian roads, there is an urgent need to consider motorcyclists as distinct from other road users. This program of research facilitates the understanding of safety issues from a motorcyclist perspective and provides important information on factors influencing safe and unsafe rider intentions and behaviour. The aims of this program of research were to: †¢ develop a better understanding of the psychological and social influences on rider behaviour in an Australian context; †¢ guide the development of future motorcycle safety countermeasures; and †¢ develop a tool (the Rider Risk Assessment Measure – RRAM) to inform the evaluation of motorcycle safety countermeasures, particularly in the area of training and education. To achieve these aims, two particular studies were undertaken: a qualitative study of motorcycle rider perceptions utilising a focus-group methodology and a survey-based quantitative study of selfreported rider intentions and behaviour. Both studies were underpinned by a theoretical framework drawing on the theory of planned behaviour (TPB), identity theory, social identity theory, and other relevant psychological concepts such as sensation seeking and aggression. Key findings Study 1 explored motorcyclists’ perceptions relating to ‘safe’ and ‘risky’ riding and the different personal and social factors that influenced their behaviour. A total of 43 people participated in this study, either as part of a focus group or as an interviewee. This exploratory process revealed six types of behaviours which were commonly believed to influence the safety (or riskiness) of motorcycle riding. These six behaviours are discussed below. Two behaviours were identified as being particularly essential to rider safety. The first was the necessity of being able to handle the motorcycle proficiently and skilfully. The second related to the need for riders to maintain a high level of concentration whilst riding and to stay aware of the changing road environment. In contrast, there was some debate about the inherent safety or riskiness of the two next behaviours commonly identified. Firstly, some riders believed that obeying the road rules was essential to their safety, whilst others reported that it was often necessary to break the road rules in order to stay safe. Secondly, the definition of what constituted ‘riding whilst impaired’ differed amongst riders. Most riders agreed that ‘drinking and riding’ was dangerous. However, for some, even one alcoholic drink before riding was considered dangerous, whilst others would ride after drinking provided they did not consider themselves to be over the legal BAC limit. Some riders stated that riding when viii Psychological and social factors influencing motorcycle rider intentions and behaviour they were tired was dangerous; however, fatigue was not considered a serious safety issue for many participants. Two further behaviours identified by participants were often associated with their accounts of crash involvement, yet not seen as intrinsically ‘unsafe’ by most riders. The first of these was the concept of ‘pushing your limits’. Most riders interviewed appeared to enjoy pushing the limits of their ability on a motorcycle. Whilst agreeing that pushing the limits too far was dangerous, pushing them to a point that tested a rider’s abilities was often reported to facilitate safety as this process developed a rider’s skill. The second behaviour that was often mentioned in connection with crashes was extreme riding (e. g. , performing stunts and riding at extreme speeds). The act of perfecting a stunt was often reported to result in the crashing of the motorcycle, although these crashes were usually accepted as a normal part of the learning process. Once perfected, performing stunts did not appear to be considered an intrinsically unsafe behaviour, unless performed in traffic or other unpredictable situations. A sizable minority of both male and female participants reported riding at extreme speeds. These riders often argued that they could ride extremely fast, safely, on public roads provided certain conditions were met (e. g. good visibility, minimal traffic, weather, road, and motorcycle maintenance). Study 2 involved 229 active motorcyclists who completed a questionnaire assessing: their riding intentions and self-reported behaviour; the psychological and social factors influencing these intentions and behaviour; and their self-reported involvement in road crashes and traffic offences over the last two years. The questionnaire was structured around the six types of rider behaviour identified as important in Study 1. Key results of this study are discussed below. In order to obtain an insight into the factors underpinning both ‘safe’ and ‘risky’ behaviour, the six areas of interest were operationalised as three ‘safer’ behavioural intentions (i. e. handle the motorcycle skilfully, maintain 100% awareness, not ride impaired) and three ‘riskier’ intentions which represented more volitional risk-taking (i. e. bend the road rules, push the limits, perform stunts or ride at extreme speeds). Hierarchical multiple regression analyses were then performed to assess the influence of different psychological and social factors on these intentions. These analyses indicated that a greater proportion of variance could be explained in the case of the riskier riding intentions [R2 ranging from 57% – 66%] than the safer riding intentions [R2 ranging from 22% – 36%]. The TPB construct of perceived behavioural control (PBC) significantly predicted all three ‘safer’ intentions, while attitude was a significant predictor of the three riskier intentions. In terms of the social influences, the TPB construct of subjective norm (which assesses the influence of others considered important) proved a relatively weak predictor of behaviour. However, the measure of specific subjective norm (i. e. the influence of the people that someone rides with) emerged as a significant predictor of three of the six intentions. Over and above this, a propensity for sensation seeking was found to be significant predictor of the three risky intentions. Overall, a similar pattern of results emerged when the self-reported behaviours of the participants were examined. Firstly, while the various psychological and social variables examined in the study significantly predicted all six behaviours, considerably larger amounts of variance were explained for the three volitional risk-taking behaviours, i. e. bend road rules to get through traffic [R2 = . 67], push my limits [R2 = . 59] and perform stunts and/or ride at extreme speeds [R2 = . 69]. Secondly, the results were largely consistent with the tenets of the TPB, with intentions proving a significant predictor of all six behaviours. Thirdly, sensation seeking, along with rider aggression, emerged as a strong predictor of all six behaviours. Indeed, together, these two variables accounted for between 7 – 20% of additional variance in the six behaviours. Not surprisingly, these two variables accounted for relatively large amounts of additional variance in the ride while impaired [R2 ch = . 20] and the perform stunts and/or ride at extreme speeds [R2 ch = . 15] variables. Unfortunately, no significant correlations were found between the various measures of intention and behaviour operationalised in Study 2 and the self-reported crash involvement of the participants. It Psychological and social factors influencing motorcycle rider intentions and behaviour ix is possible that this indicates that the six behaviours of interest, in reality, do not have a close relationship with crash involvement. However, this conclusion does not seem consistent with either the findings of Study 1 or the research evidence reviewed in Chapter 2. More likely, the findings highlight shortcomings in the size of the sample and/or the way that crash involvement was measured in the study. In particular, given that crashes are relatively rare events, crashes were measured over a two year period in order to ensure that (some) participants would have experienced a sufficient number of crashes to facilitate the analyses. However, this raises the possibility of recall problems that may have reduced the accuracy and reliability of the data, while the two year period may have been too long to accurately reflect the current intentions and behaviour of the participants. In contrast, the majority of the intention and behaviour measures were found to be significantly correlated with self-reported traffic offence involvement. In particular, significant associations were found between self-reported traffic offences and the three ‘riskier’ intentions examined in the study (i. e. those relating to more volitional risk-taking, namely, bend the road rules, push my limits and perform stunts and/or ride at extreme speeds). In addition, significant associations were found between traffic offence involvement and five of the six self-reported behaviours examined (the only exception being for awareness errors). These results don’t necessarily confirm the inherent ‘riskiness’ of the behaviours examined, since engaging in an illegal behaviour may not always result in a crash. However, they do provide prima facia evidence supporting the validity of the intention and behaviour measures developed in this study. Strengths and limitations of the research This program of research featured a number of strengths. Firstly, it was firmly grounded in theory; secondly, it utilised both qualitative and quantitative methods to obtain a broad insight into the factors influencing motorcycle rider behaviour; thirdly, the design of the research was informed by input from active motorcyclists; and finally, it adopted a balanced approach to motorcycle safety by examining both safe and risky riding intentions and behaviour. Nonetheless, the program of research also had a number of limitations. Both Studies 1 and 2 consisted of participants primarily recruited from South East Queensland. In addition, the participants were volunteers who were generally older in age. As a result, the samples used in this research may not be representative of Australian motorcyclists in general, but instead reflect a subset of older, primarily recreational, riders. This should be borne in mind when interpreting the results. Furthermore, a number of other potential limitations in the Study 2 questionnaire design emerged during the analysis of the results. These included the way that fatigue was grouped with alcohol and drugs to assess intentions and behaviour relating to riding while impaired and, as noted above, the manner in which crash involvement was measured. Implications of the research At a theoretical level, this program of research has confirmed that the predictive utility of the theory of planned behaviour (TPB) can be substantially improved by the addition of other variables. In particular, this research demonstrated that subjective norm (SN) was a relatively weak predictor of intentions and that the specific subjective norm (SSN) (i.e. assessing the influence of those people that someone rides with) performed relatively better as a measure of social influence. Moreover, both sensation seeking and the propensity to ride aggressively proved significant predictors of all six behaviours examined, over and above the TPB and other social influence variables. The findings relating to sensation seeking are consistent with previous research in the traffic psychology area. x Psychological and social factors influencing motorcycle rider intentions and behaviour. However, the results relating to aggression warrant more attention, since this variable proved a relatively stronger predictor than sensation seeking of the error-based behaviours (i. e. handling errors and awareness errors), the ride while impaired behaviour, and the perform stunts and/or ride at extreme speeds behaviour. This suggests that the propensity to ride aggressively has a broader influence on rider behaviour, which is not limited to the more volitional risk-taking types of behaviours. At a practical level, this program of research has identified a number of ways to enhance current motorcycle safety countermeasures, particularly in the area of rider training and education. Most particularly, it has identified a range of psychological and social influences on rider intentions and behaviour that appear to be beyond the scope of current skills-based approaches to motorcycle training and education. Consequently, further work is required to develop and trial new approaches to rider training and education that more effectively address the attitudinal and motivational influences on riding, both of a personal and social nature. To assist in this process, this research has undertaken the first steps in the development of the Rider Risk Assessment Measure (RRAM). This tool is intended to act as a means of identifying high-risk riders by assessing their intentions and self-reported behaviour (in relation to both ‘safe’ and ‘risky’ riding). While further work is required to refine and validate the RRAM, it represents a tool that can be used in a variety of ways to enhance motorcycle safety countermeasures, including informing the design and content of training programs and evaluating the impact of different  initiatives on rider behaviour. Psychological and social factors influencing motorcycle rider intentions and behaviour xi ACKNOWLEDGEMENTS The authors would like to acknowledge the funding support provided by the Australian Government, through the Australian Transport Safety Bureau’s (ATSB) Road Safety Research Grants Programme. The development and conduct of this study has involved the contribution of a large number of people. While it is difficult to acknowledge all the individuals that have contributed, the authors would like to thank: †¢ †¢ Mr John Collis from the ATSB for his ongoing advice and support; those people who assisted us organise the focus groups, from organisations such as Queensland Transport, Motorcycle Riders Association Queensland, Ulysses, and Q-Ride providers; personnel from the Queensland Police Service, particularly the Logan and Brisbane West Districts, who assisted in the distribution of the pilot and main questionnaires at various motorcycle events; The ongoing support for motorcycle research from Morgan and Wacker Pty Ltd; and the assistance of Morgan & Wacker Motorcycle Training Centre, particularly Mr Fred Davies, in the finalisation and distribution of the Study 2 questionnaire.   xii Psychological and social factors influencing motorcycle rider intentions and behaviour GLOSSARY OF TERMS AND ACRONYMS ABS ATSB BAC Australian Bureau of Statistics. Australian Transport Safety Bureau [formerly Federal Office of Road Safety (FORS)]. Blood Alcohol Concentration. In Australia, the legal amount of alcohol that may be present in the blood is 0. 05% if the driver or rider is on an unrestricted licence. It is usually measured either by a police breathalyser or a by a blood test (see also Over the limit). A person who identifies with, and belongs to, an organised outlaw motorcycle club. Club members ride motorcycles and often wear jackets with ‘patches’ which identify the club they belong to (Veno, 2002). A motorcycle enthusiast. May or may not belong to a motorcycle club (Krige, 1995a). Centre for Accident Research and Road Safety – Queensland. A study design which collects data on the perceptions or behaviours of subjects at one point in time, as opposed to a longitudinal.

Principles and Policies of Health Promotion

Annex 1 â€Å"MSF & prevention†Ã‚   17 2 1. Introduction Historically, MSF is involved with IEC (Information, Education and Communication) activities or project since almost 10 years. It mainly started in 2 parallel directions: Within the HIV/AIDS vertical project developed before the introduction of ART? e used to develop prevention project to reduce the spread of infection in the general community and amongst target groups (mass communication campaign to change the behaviour of the community) Within the Water, Hygiene & Sanitation project, hygiene promotion activities were developed to promote the use of the water & sanitation facilities in the communities but also to adapt the behaviour of the pop in regards to these facilities – In April 2006, an IEC workshop was organised in the OCB in order to structure the IEC activities on the field1. From there the I. E.C activities have been redefined and a change of the terminology to Health Promotion was adopted. This change in terminology was adopted to avoid misunderstanding and confusion with the activities of communication department but also to fall within the framework of our medical activities. This policy paper is written in order to explain why MSF is involved in Health Promotion and to set a framework for the Health Promotion activities; it’s not a guide on the implementation of the activities. It will continuously evolve with the experiences gained over time. 2. Some Health Promotion definitions . 1 From WHO Health promotion is the process of enabling people to increase control over, and to improve 2 their health. Health promotion represents a comprehensive social and political process, it not only embraces actions directed at strengthening the skills and capabilities of individuals, but also action directed towards changing social, environmental and economic conditions so as to alleviate their impact on public and individual health. Participation is essential to sustain health promot ion action. – The Ottawa Charter identifies three basic strategies for health promotion.These are: – advocacy for health to create the essential conditions for health indicated above; – enabling all people to achieve their full health potential; – and mediating between the different interests in society in the pursuit of health. These strategies are supported by five priority action areas: – Build healthy public policy, – Create supportive environments for health – Strengthen community action for health, – Develop personal skills – and Re-orient health services 1 2 For more information see report on the IEC workshop 2006- Genevieve Loots & Ann Wouters Reference: Ottawa Charter for Health Promotion.WHO, Geneva, 1986 3 2. 2 From John Hubley, â€Å"Communicating Health† John Hubley is presenting the HESIAD model which involves 3 different components into health promotion ? â€Å"Health promotion component is being u sed to draw attention to the need for educational & political action to improve health† 3 Health promotion Health education: Communication directed at individuals, families and communities to influence: Awareness/knowledge, decision making, beliefs/attitude/empowerment of individual and community action/behaviour change community participationService improvement : improvement: Improvement in quality & quantity of services: services Accessibility Case management Drug supply Counselling Staff attitudes Outreach Social marketing Advocacy: Agenda setting and advocay for healthy public policy Policies for health Income generation Removal of obstacles, discrimination, inequalities, gender barriers Fig. Components of health promotion (HESIAD)4 3 4 J. Hubley, Communicating health- An action guide to health education and health promotion- p. 2 J. Hubley, Communicating Health- An action guide to health education and health promotion-p. 15 4 3. 3. 1 Health Promotion within the OCB Defini tion As an emergency medical humanitarian organisation, the definition of health promotion, as state by WHO (process of enabling people to take control over their health ) is too wide for MSF actions. It involves a lot of development ideas for example poverty elimination, literacy and general education, social programs, income generating activities, etc.Therefore, within OCB, we are limiting Health Promotion as a set of activities of health education and health services improvement5 that are intending to develop better the use of health care services (patients & population). The population HP approach is focusing on communities to promote our health structures and to control the epidemics in the population. The patient HP approach is focusing on patient and on the adaptation of the health care to the cultural behaviours and practices of the population where we are working. Example of health promotion activities: 1.HP activities for population – Investigate health-seeking beha viour Promotion of available health services Create health-risk awareness about cholera, ebola for example Assure user friendliness clinic Patient education on HIV & TB to improve adherence (= treatment literacy) Providing patient-adjusted information on health-issues Stimulate self-management of chronic patients (empowerment) 2. HP activities for patients In most of the old â€Å"IEC called† project, the Health Promotion component should be re-orientated towards a support of patients (instead of community) n order to help them to reinforce or adapt a set of behaviour to get better & get more adapted care. In different organisation as well as in MSF sections you will easily hear different names for the Health Promotion activities such I. E. C (Information, education & communication), B. C. C (behaviour change communication), health communication, health education, patient education, etc. But they all aim at reinforcing knowledge and skills related to health (disease, treatmen t & prevention) in order to allow the patient to take decisions & actions towards his health.Health Promotion encourages comprehensive interventions that combine approaches such as anthropology, sociology, education, training and communication for healthy behaviour adaptation; for more information on Behaviour change model, please refer to M. Varasso â€Å"Behaviour Change towards HIV/AIDS† and the Health belief Model6. 5 Services improvement could be: – Improvement in the content of the services: e. g improvement of the patient education – Improvement in the accessibility of the service: e. g timing, location & introduction of home & community visits – Improvements in the acceptability of services: e. enforcement of confidentiality, use of women field staff, use of lay field staff, involvement of persons from the target community John Hubley – Communicating Health- An action guide to health education and health promotion- p. 15 6 Health Belief Mod el (HBM) is a psychological model that attempts to explain and predict health behaviors. This is done by focusing on the attitudes and beliefs of individuals 5 3. 2 Key principles for Health Promotion 1. Health Promotion activities should always be integrated and serving the medical objective of the project.It must be considered as a transversal approach integrated in the different activities of the project; it is not a project in itself. In a logical framework of a project document it should be situated at the level of activities, expected results and indicators. 2. As a particularity, Health Promotion focuses on the health communication with individuals (it's not a health problem in itself). That is why it applies to different: – diseases (HIV, TB-treatment, malaria, etc), – subgroups (children, young women, patient HIV+), – attitudes/habits that we want to influence (access to services & care, promotion of healthy behaviour, etc) 3.The MSF's understanding of the population, perception of the illness 7 and the health seeking behaviour are essential in order to offer and to improve the development of our health services. It’s an essential step to start any kind of Health Promotion activities, it's necessary to understand how the population is functioning before defining health messages adapted to the culture of the population and patients. 4. The activities of Health Promotion will vary from one project to another and will always need to be adapted to the context. 5.The Health Promotion/education activities should be done in priority within our health structures addressing patients & care takers in groups or individually 6. Health Promotion activities can also be done at the communities’ level with specific objectives: To promote our services: attract people in our structures and explain our services to communities (promotion of the services for victims of sexual violence in the community, promotion of our vaccination sites, etc) To prevent epidemics spreading: when there is an outbreak of cholera, hemorrhagic fever, malaria, measles, etc. e should inform the communities at risk how the disease is transmitted, how to prevent getting the disease and what to do in case of the contraction of the symptoms To monitor a health situation: in some context it can help the project to develop a component of community health worker or home visitor network to collect health surveillance information (mortality, morbidity, MUAC, vaccination, etc) To ensure access of the vulnerable group to our structures: when a population/village/specific group identified is not coming to our structure and they are at high risk of specific health problem 7 DISEASE is the definition of a health problem by a medical expert, ILLNESS refers to the experience of the problem by the patient; and SICKNESS is the social role attached to a health problem by the society at large. 6 3. 3 Roles and profiles: Ideally, we should send different pro files to be in charge of the HP activities; the first phase should have in priority an anthropologist or sociologist who will analyse the cultural behaviour of the population; followed by a social communicator person who will design a health communication strategy.However, this rarely happen and one person is usually in charge of the different steps of the HP activities. 3. 3. 1 Anthropologist's role in a project: To understand the risky practices of the target group linked to the transmission of a illness, for example: to collect information on the behaviour and the cultural practices of the pop. linked to the spread of HIV/AIDS; to get information on cultural burial procedure-linked to Ebola; etc To determine the health seeking behaviour of a target population ? Why are the pop not coming to our health services?Where do they go for care? Linking with Traditional healer? Sorcery, Witchcraft? To get a better analyse of cultural barriers in the population: perception of a health prob lem by the target group, organisation of the society, power, decision maker, etc. To analyse the knowledge, attitude and practices on a disease or health problem (KAP survey) To analyse and understand how MSF is perceived in the population But also at the level of the service provider, to analyse and understand the staff attitude towards patients/diseases To study the conception of illness Etc. ? He/she will then apply findings into practical recommendations for the project but also for the development of health messages. The anthropologist is NOT going to solve all your problems in the project; he needs to have a clear job description. The field needs to identify what they want to analyse and understand and how it will improve their medical activities. It’s essential to be specific. He is part of the medical team and need constant discussion with the medical team/field coordinator.It’s possible to require specifically an anthropologist for several months to undertake a qualitative survey. But often, the expatriate health promoter will also have a degree in Anthropology or Sociology (or Social Sciences); it’s more likely to have one expatriate in charge of everything. Rem: For the moment MSF is sending anthropologist too late in the stage of the project design; it would be useful to use the anthropologist’s competences at some early phase of the project (explo mission or starting of a new project).In project by choice, the sending of an anthropologist can really provide key information on the context, the population and the link with MSF (in 2008 we have send anthropologist in Niger and Lubutu). 3. 3. 2 Health Promoter's role in a project Your health promoter could have a communication or nursing or educational background depending of what is available and which profile is best suiting the project.To collect data's about the target population To set up the strategies for the HP activities according to the objectives of the project T o recruit (if not yet done) and train/coach a team of national health promoter To define the priorities of the health messages according to the risk practices and the health seeking behaviour analyse To adapt the content of the messages according to the culture & target pop (importance of pre testing the materials) To understand how MSF is perceived in the population 7 – To develop (or re-use) communication materials (educational games, pictures, osters) and to choose appropriate channels of communication To monitor the HP activities (including participation to the Annual Review Operation exercise) To evaluate the understanding of the health messages by the beneficiaries and adapt the content of information He/she is part of the medical team and need constant discussion with the medical team/field. Because the HP activities should be integrated in the project, the expatriate presence on the field should be seen as a temporary phase in order to leave the activities in the hand s of national staffs (when available) who usually know better the cultural behaviour of the target pop. nd have easily access to communities. 4. Why is MSF involved in Health Promotion? Health Promotion activities are usually linked to disease preventive 8 activities. To give information and to â€Å"coach† or educate persons on different health topic & measures is an essential element to avoid individual getting sick, to recognize earlier symptoms and come to be treated but also to ensure patients following treatment procedures. Health Promotion activities want to ensure preventive behaviour in term of health.Prevention's level and activities9 It’s important to differentiate 4 levels of prevention where MSF actions put in place will be variable but also where the Health Promotion activities will differ. Primordial prevention: level zero of prevention: Activities aiming at decreasing societal vulnerability, lowering individual risk through contextual interventions. Exa mple of activities= poverty reduction, decreasing stigma & discrimination, HIV awareness for the general public, etc.So it concerns risk reduction of a health problem at population (societal) level and MSF will never intervene at this level of prevention. Primary prevention: covers all activities designed to reduce the occurrence and the transmission of an illness (disease free). Primary prevention methods are used before the person gets the disease. ? Reduction of the incidence & prevalence of health problem Example of activities done by MSF= immunisation, improve water supply, family planning services, use of condom, prophylaxis during pregnancy, etc.Secondary prevention: activities aimed at the recognition of early signs of disease and search for treatment before it become serious. Secondary prevention avoids that infection become illness. ? Reducing the morbidity Example of activities = testing of HIV, medical consultations, treatment, vaccination 8 Disease prevention covers mea sures not only to prevent the occurrence of disease, such as risk factor reduction, but also to arrest its progress and reduce its consequences once established.Reference: adapted from Glossary of Terms used in Health for All series. WHO, Geneva, 1984 Primary prevention is directed towards preventing the initial occurrence of a disorder. Secondary and tertiary prevention seeks to arrest or retard existing disease and its effects through early detection and appropriate treatment; or to reduce the occurrence of relapses and the establishment of chronic conditions through, for example, effective rehabilitation. Disease prevention is sometimes used as a complementary term alongside health promotion.Although there is frequent overlap between the content and strategies, disease prevention is defined separately. Disease prevention in this context is considered to be action which usually emanates from the health sector, dealing with individuals and populations identified as exhibiting ident ifiable risk factors, often associated with different risk behaviours. 9 Disease prevention- definition of WHO For more information on â€Å"Prevention and MSF†, please refer to the doc in annex 1. 8 Tertiary prevention: Targets the person who already has symptoms of the isease and it includes behaviours that are involved in treatment & rehabilitation (person is already sick) The goals of tertiary prevention are: – prevent damage and pain from the disease – slow down the disease – prevent the disease from causing other problems – give better care to people with the disease – make people with the disease healthy again and able to do what they used to do Example of activities: treatment, patient education, emotional support etc. ? Reduction of the morbidity, suffering & mortality 9 Risk: Population: General Theoretical risk Healthy population ? ? Specific High Risk ?Healthy ind. ? Early signs ? Diseases ? Death Infected ind. ? Patients (sick) ? Death/handicap Intervention MSF Never or through partners Polio eradication, HIV awareness, etc Not systematic Prevention activities Vaccination, Vector control, HP, Family Planning, etc. Always Supportive & curative Testing, consultation, treatment, screening, health Education, etc. Always Curative & palliative care Emotional support, treatment, patient education etc. Primordial prevention Primary prevention (Incidence & prevalence) Secondary prevention (Morbidity) Tertiary prevention (Morbidity& mortality) Depending of the project’s objectives, MSF can be involved with variation at the different levels of prevention. 10 5. Health promotion as a transversal axe Health promotion was set up as a transversal axe into the Operational prospect in 2008 and in 2009 Health Promotion is integrated into the â€Å"Prevention† transversal axe. It means the HP activities should be considered into the different operational fields of intervention but also in the others transversal axes (Women health, nutrition, etc). 5. 1 Health Promotion activities to consider per health problem Some Health promotion activities to consider . Analyse & understand the risky practices increasing the transmission of HIV/AIDS amongst the population/community & patients 2. Understand the reasons of not coming for testing, for PMTCT (Health seeking behaviour, Stigma) 3. Measure the knowledge, attitude and perception of HIV/AIDS in target group 4. Promote of the services for families members, children and partners 5. Empowerment of patient (patient education on disease & preventive measure, treatment literacy, support group, PLWHA expert, etc) 6. provide support to adherence in health structure and in the community 7.Ensure HIV services adapted to your target group of patients 8. Collaborate with Traditional healer, TBA, 1. Analyse and understand the disease perception (fears and stigma) & knowledge in the pop. 2. Promotion of services for TB families & care givers 3. Provide patie nt education & treatment literacy 4. Support to adherence 5. Train health staff on infection control measure 1. Analyse and understanding the disease knowledge and preventive measure 2. Promote the use of the mosquito nets with patients & communities during the season 3. Training on recognition of symptoms 4.Promotion of the use of our services 5. Develop the component of malaria volunteers 1. Analyse and understand the disease perception and the risky behaviour in the community increasing the transmission 2. Measure the knowledge, perception & attitudes of the pop. towards the disease 3. Disseminate information on the preventive & disease control measures to the general population 4. Collaborate with key leaders of the community ? visit of the isolation unit 5. Educate of the patients and families (and neighbour) in order to decrease fears & stigma of the patients 6.Participate to burials to ensure the respect of the tradition (orientation of the body, traditional beliefs, etc). 10 Health thematic HIV/AIDS Reference documents/books 1. HIV/AIDS OCB Policy 2008 â€Å"chapter on prevention and empowerment & autonomy of PLWH† 2. Patient support in HIV/AIDS – draft MSF OCB 2008 3. DVD Health Promotion communication materials – HIV/AIDS thematic – OCB 2007 4. Patient Support for HIV Infected children- 2008 D. Goetghebuer & K. Bosteels TB 1. Adherence strategy for TB treatment- MSF OCB 2008 2. DVD Health Promotion communication materials – TB thematic – OCB 2007 1.DVD Health Promotion communication materials – malaria thematic – OCB 2007 Malaria Infectious diseases 1. FVH guideline internationalHealth Promotion & Anthropology chapter 2. Ebola, culture & politics : the Anthropology of an Emerging disease10 3. Cholera Health Promotion technical briefs 4. DVD Health Promotion communication materials – cholera, Ebola, Rift Valley fever, †¦ OCB 2007 Ebola, culture & politics: the Anthropology of an Emerg ing disease, Barry S Hewlett and BonnieL. Hewlett 11 Some Health promotion activities to consider 1.Analyze and understanding the cultural barriers of the use of the services or understanding the reasons of delivering at home or the KAP on FGM, etc. 2. Promotion of services (ANC, FP, PMTCT, delivery, abortion, sexual violence). 3. Integrated health education for mothers on different reproductive health subject 4. Home visitors to refer ANC visit, follow up of sexual violence 5. Collaboration with TBA – information on dangers of deliveries and referral of complicated cases 6. Collaboration with women groups 1. Analyse of the perception of the malnutrition in the pop 2.Understanding cultural practices or beliefs increasing malnutrition of children 3. Analyse the cultural factors in a famine context 4. Nutritional education to mothers – develop peer mothers + appetite test 5. Nutritional education to men 6. Defaulter tracing support- community support 1. Analyse of the pe rception of mental health problem in the community 2. Promotion of mental health services 3. De-stigmatization of mental health problems 1. Analyse and understand the concept of violence in the context (cultural versus contextual violence, definition of violence, cultural profile of victims, etc). . Promotion of the services 3. Working with key actors in the community 1. Understanding of the concept of vaccination, fears & taboos about vaccines. 2. Promotion of importance of the EPI 3. Promotion of day of the vaccination campaign, site of vaccination, type of vaccines, etc Health thematic Women health Reference documents 1. DVD Health Promotion communication materials – Women Health – OCB 2007 Nutrition 1. Anthropological report from Niger- Lieselotte 2008 2. DVD Health Promotion communication materials – OCB 2007 Mental Health Violence 1.Mental Health Policy OCB 2008 Link with Brazil Medical Unit Vaccination Niger 2008 Tanganika 2008 12 5. 2 Minimum package of Health Promotion activities There are minimum Health Promotion activities to be integrated in all projects: – Analysing of the disease/illness perception and knowledge of the target population – Promotion of MSF health services (usually at the beginning of the project or when new health activities is being developed) – Health education/patient education/treatment literacy in order to ensure that patients understand the symptoms, how to prevent & how to treat his disease . 3 Health Promotion within Operational Field of intervention Field of intervention I: Assistance to population in violent setting Particularities for this operational field of intervention are: The Health Promotion activities are done primary to get closer to the community, to get information on the context, the population but also on their security, on the living condition and on the access to health care. Health Promotion activities in this field are oriented towards collection of information, investigation and promotion of our services.Several experiences11 have shown good results in developing a home visitor’s network; they seem key persons to get closer to your community and gain trust. Usual HP activities done at the community level with home visitors or community health worker are collection of data (mortality, birth, morbidity, on specific thematic such violence or sexual violence) at household level, defaulter tracing activities (nutritional or others program), promotion of MSF services and health information on a specific disease (ex. malaria explanation because malaria season).In some context, there is a need to extend these communities activities further and push for a move of the civil society in the non acceptance of the problem (Similela and Seruka- sexual violence projects). HP activities in the medical infrastructure = health education on different health topic done by the medical staff or health educators Field of intervention II: Extreme health ga p Particularities for this operational field of intervention are: Health Promotion activities and anthropological components should be more often considered.In post conflict, under served general pop & exclusion there is space and time to gather key information about the population and their health seeking behaviour and it would help to develop the medical strategy of the project. Key activities to consider: -Analyse of the risky behaviour & needs of population in term of health & analyse of Health Seeking Behaviour -Look for the correlation needs of pop & offering of medical services -Promotion of MSF services -Health education in medical infrastructures -Consider the possibility to develop some HP activities in the communities to increase patient/individual’s empowerment 1 In refugee camps, we often develop network of home visitors. Since 07 In Darfur, we launched several network of HV in city the capitalisation of the network in Kebkabya will be done in 2009. 13 Field of i ntervention III: Epidemics and endemics See table with health thematic p. 11 & 12 Particularities: Health Promotion activities should be integrated in every disease Field of intervention IV: Assistance for victims of natural catastrophes Particularities are: the Health Promotion activities are usually integrated into Watsan activities (Hygiene promotion) or linked with mental health activities.The concept of home visit is very important to reinforce link with population. 14 6. Some definitions Health education12 comprises consciously constructed opportunities for learning involving some form of communication designed to improve health literacy, including improving knowledge, and developing life skills which are conducive to individual and community health. Reference: modified definition- WHO Health education is not only concerned with the communication of information, but also with fostering the motivation, skills and confidence (self-efficacy) necessary to take action to improve he alth.Health education includes the communication of information concerning the underlying social, economic and environmental conditions impacting on health, as well as individual risk factors and risk behaviours, and use of the health care system. Thus, health education may involve the communication of information, and development of skills which demonstrates the political feasibility and organizational possibilities of various forms of action to address social, economic and environmental determinants of health.Patient education13 â€Å"The patient education is a process, integrated in the process of care, including a series of activities organized awareness, information, learning and psychological and social assistance on the disease, treatment, care, organization and hospital procedures, health behaviours and those associated with the disease, to help the patient (and his family) to understand the disease and treatment, care work, take charge of his state health and foster a retu rn to normal activities†Patient support 14 The component of Patient Support covers all the activities aiming at supporting the patient in front of his disease and his treatment, beyond the purely medical aspects of care. The patient support is a continuum of progressive, personalised or peer-supported activities addressed to the patient, and going on all along the program. Rem: for the moment within MSF, we are using the component of Patient support for HIV and TB.Main objectives for all HIV patients are: – To understand and accept his HIV status or disease 12 13 From Health Promotion glossary DECCACHE A. et LAVENDHOMME E. , Information et Education du Patient : des fondements aux methodes, De Boeck Universite, Bruxelles, 1989, p. 45 14 For more info, refer to the draft â€Å"Patient Support document for HIV/AIDSâ€Å" written by B. Laumont & G. Loots in the OCB. 15 To recognize the consequences of the disease in his everyday life – To adapt his behaviour (way of living) – To be involved in and adhere to his treatment To achieve all these objectives, the patients have to go through 3 complementary processes: 1- Educative process ? Patient Education This is about the patient understanding – the infection and the evolution of the disease – the transmission of the disease – the risky behaviours to avoid – the treatment This includes the following activities: Health Education, Health talks, Treatment Literacy 2- Process of emotional adaptation?Emotional Support This is about the patient – dealing with the loss of his self-image and the loss of the good health – dealing with the stress caused by the evolution of the disease, the perspective of death, the uncertainty of the future and the reduction of capacities – dealing with the relational changes with his close relationships and occupational environment – dealing with the improvements and the changes brought by the treatment This includes the following activities: counselling (individual & group), support groups 3- Process of adaptation to socio-economic consequences?Social Support This is about helping the patient to solve his social problems in order to improve his good adherence to treatment – risks of precariousness: financial resources, incapacity, loss of employment – risks of isolation, stigmatisation by family and community This includes the following activities: social consultation, home visits, networking, etc †¦ The Patient Support can be provided through 4 different types of activities: – Individual sessions: individual counselling (pre-test, post-test, follow-up, adherence, etc), social consultation – Group sessions: Health Talks, Educational talks, ART preparation sessions, Support Group, etc – Group activities: expression and creative activities, party, celebration, excursion, etc – Community and Family level actions: Home visits, Home Based Care , Defaulter prevention, Defaulter tracing, Community activities, etc Empowerment for health15 In health promotion, empowerment is a process through which people gain greater control over decisions and actions affecting their health. A distinction is made between individual and community empowerment. Individual empowerment refers primarily to the individuals’ ability to make decisions and have control over their personal life.Community empowerment involves individuals acting collectively to gain greater influence and control over the determinants of health and the quality of life in their community, and is an important goal in community action for health. 15 From Health Promotion glossary 16 7. – Bibliography  « Anthropologues et ONG: des liaisons fructueuses?  » ; Humanitaire – Hors Serie; Numero 4Automne/hiver 2007 ; editer par Medecins du Monde  « Communicating Health- an action guide to health education and health promotion  » John Hubley- 2004  "Applied Health Research, Anthropology P. Boonmongkon, P. Streefland, M. L. Tan, etc. â€Å" Health Promotion glossary† WHO CDC, Prevention â€Å"Education pour la sante, concepts, enjeux, planifications†, Jacques A. Bury  « Information et education du patient, des fondements aux methodes  », A. Deccache et E. Lavendhomme of Health and