How does Healthcare Management carry out the positive impact on adolescent health in Hong Kong?
Abstract
Adolescent health is of primary importance in many, if not all, health care organizations. The period of adolescence is a complex one which requires careful attention, given the fact of the myriad of changes that occur in the individual at that time. With that knowledge in mind, this paper seeks to examine how healthcare management carried out the positive impact on adolescent health in Hong Kong. This is done through a study. A discussion on what the adolescence stage is all about is given in the first part of the paper so that the readers will have an understanding of the background of the participants in this study.
This study utilizes a particular meta-analysis which will have to employ the use of case study methodology of qualitative research. Rather than using large samples and following a rigid protocol to examine a limited number of variables, case study methods involve an in-depth, longitudinal examination of a single instance or event: a case. The sample is (N=100) comprising of 50 parents and 50 adolescents within the process of designated healthcare services provision provided to them separately. The mean age of the group will range from 10-21 years old for the adolescents and their parents. A survey questionnaire will be used to point out to the comments and experiences of parents and adolescents with regards to the satisfaction of services being provided to their children.
CHAPTER 1 – BACKGROUND TO THE STUDY
Adolescent-focused research such as health care management of this age group has lead to significant improvements in the understanding of adolescent health, as well as the development of innovative healthcare interventions for this vulnerable population. This paper attempts to find out how health care management carry out the positive impact on adolescent health in the area of Hong Kong.
To start off, a discussion on what the adolescence stage is all about will be given to provide a background of these participants in the study. Adolescence, which extends from the time the individual becomes sexually mature until eighteen – the age of legal maturity, is characteristically an important period in the life span, a transitional period, a time for change, a problem age, a time when the individual searches for identity, a dreaded age, a time of unrealism, and the threshold of adulthood.
Adolescence is the period in human growth between the ending of childhood and the attainment of full physical development. During this period, anatomic development and glandular changes culminate in puberty, at about the age of puberty ( 2004). The age range for adolescence generally is defined as 10-21 years of age. Three age subgroupings are recognized: early adolescence (10-14); middle adolescence (15-17); and late adolescence (18-21) (1990). Human growth patterns generally are predictable, but each adolescent follows his or her own unique timetable. Based solely on chronological age, adolescents vary widely in their size, metabolic rate, and physical development. For example, one could view a group of early-adolescent males age 14 years and note vast differences in height, weight, physical appearance, and pubertal changes.
Within life span, adolescence represents a time of enormous development and change. The pathways approach to understanding adolescent development not only recognizes variations, but also accounts for individual differences. The approach describes both normal and atypical patterns of development, synthesizing environmental and individual factors to explain patterns of development and psychological and behavioral outcomes (1993). This approach offers an explanation for the variety of antisocial behaviors occurring during adolescence, such as substance abuse, and serves to set behaviors in the context of the adolescent period.
As with physical development, psychosocial and cognitive development also can vary widely during adolescence. The gradual and variable development of social and emotional maturity, as well as an increasing sense of self and development of autonomy, characterize adolescence. Researchers must consider adolescents’ decision-making and information-processing capacities and their relative stage of self-determination in managing their participation in studies.
Meanwhile, the important social changes in adolescence include increased peer group influence, more mature patterns of social behavior, new social groupings, and new values in the selection of friends and leaders and in social acceptance. Peer pressure influences some adolescents toward anti-social behavior, especially adolescents whose parents offer little supervision (2004).
As the child enters adolescence, he or she develops the capacity to think in terms of the self, and to evaluate others. This new-found ability refers to social cognition, which is defined as the thinking that people display about the thoughts, feelings, motivations and behaviors of themselves and others (1996). Prior to the adolescent period, the child is not able fully to appreciate the psychological aspects of a person, such as their inner qualities, beliefs and characteristics. This progression means that the individual develops a self concept which is increasingly abstract, psychological and coherent. Additionally, the adolescent has an increasing ability to be introspective, and to assess and reflect on his or her personal characteristics. This has important implications for the adolescent’s view of the social world and his or her place within it.
The major changes in morality during adolescence consist of replacing specific and moral concepts with generalized moral concepts of right and wrong; the building of a moral code based on individual moral principles, and the control of behavior through the development of conscience (2004).
Working from a holistic understanding of young people’s daily lives and lived experience carries with it several implications. Primary among these is that institutional settings – particularly the school setting – do not have to be the most “logical” (nor even the best) means of establishing communication with young people.
Relationships between the adolescents and members of their families tend to deteriorate in early adolescence, though these relationships often improve as adolescence draws to a close, especially among adolescent girls and their family members. Children in their early teens are in a stage of identity and role confusion, if based on Erickson’s theory of psychosocial development. According to , the chief task of adolescence is to resolve the conflict of identity versus role confusion. The desirable outcome is a sense of oneself as a unique human being with a meaningful role to play in the society. The active agent of identity formation is the ego, which puts together its knowledge of the person’s abilities, needs, and desires and of what must be done to adapt to the social environment.
The search for identity is a lifelong search, which comes into focus during the adolescence and may recur from time to time during adulthood. Erickson emphasizes that this effort to make sense of the self and the world is a healthy, vital process that contributes to the ego strength of the adult. The conflicts that are involved in the process serve to spur growth and development (1996).
In both sexes the physical changes are associated with emotional and mental development. The rapid growth at this time is likely to make heavy demands on the adolescent, and adjustment to every change that is happening to his or her body is a process that is often difficult. Reactions to situations are apt to be keener and more immediate; feelings, whether of joy or depression, to be more intense at this stage than in the past (1996).
During adolescence, the teenagers still hasn’t reached their peak development – physical or mental. At this stage, teenagers are still undergoing cognitive development. Cognitive skills and development include at least three sub-areas: sensorimotor skills, concept development, and preacademic skills. Sensorimotor skills are motor movements that individuals make in interacting with the environment. As described by Piaget, these motor movements progress through a series of stages that culminate in a primitive ability to think or symbolize ( 1993). Concept development refers to the understanding of the notions of the world. Preacademic skills include those behaviors that are necessary for beginning instruction (1996).
Parents, during this period, may be alarmed at what appears to be erratic growth and rapidly shifting moods in their children who would want love and attention one minute and then likes to be left alone the next. However, if the proper foundation of love and security has been laid during infancy and childhood, the adolescent years can be productive and rewarding for both parents and children. By gradually preparing the child for the physical changes that will take place, including giving him the necessary information in life, the shock and onset of awakening maturity can be minimized (2004).
Even with understanding and sympathy, the adolescent will often still be subject to tensions, rebellion, and conflicting emotions. The period of adolescence may demand a large measure of patience and tolerance from the parents. Faced with hostile parental attitudes, the growing child may develop feelings of insecurity that find understandable but often undesirable outlets ( 1996).
While the adolescent may rebel against authority in the home, acceptance and approval by his group is of paramount importance to him. Few influences will shake him from conformity to teen-age standards and values. The changes from dependence upon parents and home to identification with his peer group is a natural process in the process of maturing for the adolescence ( 1996).
The proper attitudes on the part of the parents can be of immeasurable help in assuring that the period of adolescence is a significant and meaningful step towards maturity. Children who develop secure attachment relationships with their parents are at an advantage cognitively, socially, and emotionally compared to peers who have not developed secure attachments. Within the family law arena, the relationship between a parent and child is a sign determining residential placement and reunification ( 2002).
Relationships with parents are the foundation upon which children define themselves as adequate, and develop the capacity to have meaningful and intimate relationships throughout their lives. Children’s relationships with their mother or father are determined by the quantity and quality of care offered by each parent and the repeated presence across time of the parent in the child’s life ( 1996).
A child’s affectional “bond” is determined by five factors: 1) persistent; 2) enduring; 3) linked to a specific person (not interchangeable with anyone else); and 4) emotionally significant. The child must also 5) maintain proximity to or contact with the significant person because distress will likely be experienced at involuntary separation. The attachment bond that forms between a child with his or her parent includes these five criteria, plus an additional critical factor, which is the child’s pursuit of security and comforting in the relationship. Seeking security is the defining feature in the parent-child “attachment bond” (2002).
In one study, interviews with nurses and other hospital staff who participated revealed the complexities of treating adolescents with medical conditions such as diabetes and identified a number of the issues that were considered central to forming positive relationships with young people. These issues were staff and young people being honest with each other, working in partnership both as a multidisciplinary team and with young people, involving parents, and meeting information needs, including discussing complications of diabetes (2003).
Members of staff in this study also talked about balancing the sometimes conflicting roles of encouraging young people to improve their control while allowing them to take an increasingly central role in their own care. They tread a fine line between ensuring that young people are aware of the consequences of poor glycaemic control and not threatening them or, perhaps more dangerously, frightening them away from clinic appointments altogether (2003).
Staff were clear that there was little point in imposing unrealistic goals on young people but rather attempted to work together with them to encourage health enhancing behaviours. A successful regimen is one that allows the young person to achieve good control and to live without unreasonable restrictions. This is likely to be more effective than a rigid one which the young person with diabetes finds too onerous and so does not stick to. Staff have to know enough about the young person’s lifestyle and capabilities to help them fit treatment around what is feasible for each individual. However, young people themselves (with the support of their families) have to be prepared to take on the responsibility of managing diabetes on a daily basis (2003).
This study supports the need for autonomy in adolescents. Autonomy in decision making regarding health issues is a set of skills that develops as part of self-care agency. Adolescence is an important time to begin fostering this autonomy. Providing health-promoting care to adolescents must occur in the context of developmental considerations, legal concerns, and ethical principles. Implications for health care providers include developing trust with the adolescent, teaching the family how to enable the adolescent’s self-care, considering the use of advance directives, protecting the rights of minors and parents, implementing confidentiality guidelines concerning the adolescent’s care, and formalizing the processes of consent/assent and dissent for health care (2000).
An ability to make good decisions about one’s health care promotes healthy behaviors across the lifespan. Helping adolescents develop as individual agents of self-care is one step toward helping them learn to make good health care decisions (1995). Although an adolescent’s care is best provided within the context of family, health promotion information and services that require confidentiality on the part of the provider are an important dimension of adolescent care. When given adequate information relevant to health care decision making, most adolescents are able to make decisions about their own health care (2000).
For any person, regardless of age, to be considered competent to make health care decisions, four primary tests of legal competency must be satisfied: (a) evidence of choice; (b) reasonable outcome of choice (such choice that a reasonably prudent person might make); (c) rational reasons (the preference was selected by a rational reasoning process); and (d) understanding (comprehension of the risks, benefits, and alternatives to treatments) (1998).
Cognitive and social factors motivate and reinforce an adolescent to experiment with risk-taking behaviors, such as substance abuse. These psychological factors are embedded within teenagers’ development, and are important because they are able to explain much of the risk-taking behavior that characterizes some adolescent development patterns. Substance abuse, and more typically its onset, is predominantly an adolescent phenomenon, occurring within the context of huge physical and psychological changes (1985). Although risk-taking and health-compromising behavior is not just confined to adolescence, the onset of many behavioral patterns which occur in the teenage years can, in some cases, be used to predict the progression of further problematic substance abuse and greater risk taking.
Experimentation is important for young people, and should not be considered as delinquent or maladjusted development. Nonetheless, it is important to recognize the context in which the onset of experimentation occurs, because experimentation can lead to habitual use of substances such as tobacco, with various psychological and social factors combining to provoke the progression from experimentation to further drug use (Botvin and Wills, 1985). Whatever the behavior, or substance, similar developmental changes are occurring which can account for the motivation and maintenance of these behaviors, which have important implications for health education.
In summary, it has been argued that the adolescent experiences physical, cognitive and social changes. Changes in school correspond with changes in friends which complicates their social interactions. Physical changes in terms of puberty can result in significant psychological influences, depending on whether the youngster is an early or a late developer (1990). Moreover, pubertal changes and hormonal levels can increase self-consciousness and affect mood and behavior (1986). Cognitive processes are under-developed, and the young adolescent does not have the benefits of experience upon which to base decisions. Cognition is also evidently influenced by a number of illusions about the social world and the inclination of the adolescent to be overly concerned with others’ opinions of them, making them prone to normative influences. (1991) suggest that health-compromising behavior, such as smoking, can also be seen as a coping response to the social anxieties of adolescence, rather than irrational behavior.
It is therefore important to recognize that the issues and phenomena surrounding the discussion of stages of development which follow cannot be universally applied and generalized to the entire adolescent population. Current conceptualizations have evolved from early theorizing which attempted to identify universal descriptions of development. It is now widely accepted that variability is the dominant feature of development. Individual differences have become a recent focus in developing various pathways of personal development (1993).
Attending to the variety of adolescent experiences necessarily speaks of an engagement with them, of a dialogue. Indeed, when reassessing health and health promotion strategies and management for young people, an important question is that of participation and representation. Consideration of age and levels of cognition is vitally important in health care management, while taking full notice of what young people say and how they say it. Involving the adolescents in health promotion is a laudable but largely ineffectual exercise if young people’s understandings of health and attitudes to health promotion and preventative health care are not explored.
CHAPTER 2 – RESEARCH PROPER
2.1 STATEMENT OF THE PROBLEM
The research proposal implies the use of service provision in meeting the needs of adolescents. Parents frequently emphasized the importance of having a range of flexible services in order to meet the needs of individual adolescents and their families. Within this, priorities for services in health care organizations included routines and consistency, the importance of planning placements and ongoing communication with families, high staffing levels and appropriate environments as this was very much the ideal; in reality the majority of families using services had little choice.
Indeed, health care providers were very aware that they are currently providing only what they can afford rather than what is actually needed by adolescents. The most frequently requested types of services were sitting services, play schemes, family based short breaks and befriending schemes. The study clearly demonstrates not only a general need for more healthcare services but that provision is inequitable and largely focused upon those with the most obvious, practical needs and how this brings a positive impact to adolescents in Hong Kong. The proposal should recommend not only more and better-funded services but also a greater understanding of adolescents, with knowledgeable and well-trained healthcare staff to meet the whole spectrum of needs.
2.2 METHODOLGY
This particular meta-analysis will have to employ the use of case study methodology of qualitative research. Rather than using large samples and following a rigid protocol to examine a limited number of variables, case study methods involve an in-depth, longitudinal examination of a single instance or event: a case. They provide a systematic way of looking at events, collecting data, analyzing information and reporting the results. As a result the researcher may gain a sharpened understanding of why the instance happened as it did, and what might become important to look at more extensively in future research. Case studies lend themselves to both generating and testing hypotheses (2006).
Thus, case studies should not be confused with qualitative research and points out that they can be based on any mix of quantitative and qualitative evidence (2002). Aside, those studying the case are led to a specific point in time and circumstance where they become a ‘participant’ in the case. (2002) The case study offers a method of learning about a complex instance through extensive description and contextual analysis. The product articulates why the instance occurred as it did and what one might usefully explore in similar situations as these can generate a great deal of data that may defy straightforward analysis. (2002)
2.3 SURVEY QUESTIONNAIRRE
The survey questionnaire will point out to the comments and experiences of parents and adolescents with regards to the satisfaction of services being provided to their children. The case study will give a wider reflection as to what are the instances of the services they have received in support to their parents perspectives if the services for them denotes a sense of satisfaction that will imply a success factor for the service or is it a failure and amicably investigate why some services fail in meeting the needs of the people concerned. The basic methodology requires that the data from satisfaction reports through a survey for parents, adolescents, and support groups in terms of a likert scaling technique.
2.4 SAMPLE
For the case study, the sample (N=100) comprised of 50 parents and 50 adolescents within the process of designated healthcare services provision provided to them separately. The mean age of the group will range from 10-21 years old for the adolescents and their parents. The background of the participants will be predominantly working class. Parental consent for participation in the study will be obtained beforehand.
For the survey questionnaire, the sample should also then comprised of (N=100) parents/guardian of those adolescnts as the participants should be involved in a survey to identify critical issues of service provision and be conducted in group settings during their free hours. Thus, giving relevance to the services provision their affected parties have acquired in the healthcare setting in Hong Kong.
Quantitative research uses methods adopted from the physical sciences that are designed to ensure objectivity and reliability. These techniques cover the ways research participants are selected randomly from the study population in an unbiased manner, the standardized questionnaire and the statistical methods used ( 1992). The strengths of the quantitative paradigm are that its methods produce quantifiable, reliable data that are usually generalizable to some larger population. Quantitative measures are often most appropriate for conducting needs assessments or for evaluations comparing outcomes with baseline data. ( 1992)
This paradigm breaks down when the phenomenon under study is difficult to measure or quantify. The greatest weakness of the quantitative approach is that it decontextualizes human behavior in a way that removes the event from its real world setting and ignores the effects of variables that have not been included in the model (1992). Qualitative research methodologies are designed to provide the researcher with the perspective of target audience members through immersion in a culture or situation and direct interaction with the people under study (1992). Qualitative methods used in social marketing include observations, in-depth interviews and focus groups. These methods are designed to help researchers understand the meanings people assign to social phenomena and to elucidate the mental processes underlying behaviors (1992).
2.5 INSTRUMENTATION
The case study instrumentation is to gather factual information from case studies to be presented with the goal of supporting valid research as to how healthcare management carried out the positive impact on adolescent health in Hong Kong. The case study is crucial since, it will give a sense of reflection awareness for those people carrying out the services used and in a way will impart society awakening to possibly change certain provision systems that centers on the specific services that will be a factor in sorting out acceptable solutions to the arising problems involving adolescents.
For the survey questionnaire, the instrument appropriate would be the likert scaling which includes scales from one to five based in the response choices for the service satisfaction survey designed in the form of question statements which would assist in gaining wider insights as to why services may be failing in meeting the needs of adolescents. The statements are rated on a scale of 1 (strongly disagree) to 5 (strongly agree). Like for example below, although the satisfaction level varies among the first three statements, the fourth statement tends to rate as “strongly disagree.” In addition to rating the statements, parents are given an opportunity to provide comments about their experiences.
2. 6 The Questionnaire
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
2.7 ETHICAL CONSIDERATIONS
For the ethical considerations, it is important to address certain issues within the ethical standards of services designed for adolescents and for careful review of the involved services as there is the need to improve accountability and integration of adolescent’s services. Settings and services may need to be reminded of their duties to take reasonable steps to ensure that the subjects of research are not placed into substantial disadvantage for the purpose of conducting the research to ensure that involved parties in research are able to participate. Thus, there is a need to address certain ethical issues geared towards the realization of the proposed study within its consent, confidentiality and access to the organizations in order to carry out the process of research.
For the process of having consent, it is important that the researcher must provide a formal letter of consent being addressed directly to the respondents and the people responsible for reaching out to those subjects needed for the research completion. The consent letter must contain original signatures and cannot contain any restrictions, conditions, or stipulations. Any restrictions or conditions must be kept separately between the parties involved. The consent letter must simply state that consent is given to a person to use his profile and other relevant information for the purpose of realizing the research purpose it serves.
Example of consent letter (the letter must be signed by the researcher and the involved party):
I, _________________, researcher of the proposed research would ask consent to ________________, respondent to give his/her own views and answers to the research questionnaire as enclosed for this particular research.
Dated: _________
_________________, the researcher
In terms of confidentiality, it is a must for the researcher to assure all the involved people, organizations and parties involved for research that confidentiality of information, research findings and results is deemed very important and be kept confidential from all elements not involved in conducting the research and must ensure the respondents right to change, cancel any information important for research as the researcher adheres to the fact that confidentiality of information is a top priority and that any involved parties should not be forced to give any information for the sake of research validity. The researcher ought to provide a formal confidential letter if needed in the process.
For access to the organizations, it is crucial that the researcher will ask for a formal letter of approval deemed towards asking permission to allow the researcher in gathering and acquiring only the relevant information needed for research that the organization can directly or indirectly provide. The approval letter should state what the research is all about and for whom the research is done and all the important details there unto.
2.8 ANALYSIS/STATISTICAL CONSIDERATION
For the purpose of statistical ways and its analysis, the likert scale method produces means and standard deviations for the responses given. It also prints the minimum and maximum value. Likert scale questions are appropriate to print means for since the number that is coded can give us a feel for which direction the average answer is. The standard deviation is important as it give us an indication of the average distance from the mean. A low standard deviation would mean that most observations cluster around the mean. A high standard deviation would mean that there was a lot of variation in the answers. A standard deviation of 0 is obtained when responses to a question are the same. Henceforth, prior to computing a scale that is the mean of a series of questions, first assign points to each question so that the reverse wording questions will be assigned the opposite number of points than the positively worded questions. The median is known as a measure of location it tells where the data are.
All the exact values to calculate the median are not necessary to be known; changing the smallest value to an even smaller one or the largest value to a larger one would make no effect or changes on the median value. This goes to say that the median does not use all the information in the data, therefore the median can be perceived as less efficient than ones which use all values of data such as the mean or average. In order to calculate the mean, all that needs to be done is to add up the observed values and divide this by the number of them. The next step is to divide by the total number the total of the values obtained to give a mean.
The process is conveniently expressed by the following symbols:
The range is considered an important measurement, since figures at the top and bottom of the range shown the findings which are furthest removed from the generality. In spite of that, the range does not give much clue of the spread of observations regarding the mean. The standard deviation is defined as a summary measure of the differences of every observation from the mean. When the differences are all added up, there would be an exact balance of the positive and the negative making their sum zero. In addition, the squares of the differences are added. This sum of the squares is then divided by the number of observations given the mean of the squares. Next, the square root is taken to bring the measurements back to the first task where units that are started with.
2.9 TIME FRAME AND BUDGET
The plan in carrying out aspects of the research proposal strategic programs will be implemented:
1 DECEMBER
2 JANUARY
3 FEBRUARY
4 MARCH
5 APRIL
A. Meet with supervisor and finalize proposal
B. Meet with supervisor and finalize proposal
C. Academic literature review
D. Professional literature review
E. Case Analysis/Survey Interview design
F. Other fieldwork and data collection
G. Data analysis and writing reports
H. Complete temporary draft/Prepare final draft
2.10 GANTT chart
The Gantt chart below will show possibilities as to when the task process for the research will be completed. It is a useful tool for planning and scheduling projects. It assesses how long a project should take, determine the resources needed and lay out the order in which the task need to be carried out. In the Gantt chart presented, it shows that the researcher will have to meet every specific task with the purpose of completing the research study in line with the proposal study involved. Gantt charts are useful when the project under way. It helps in monitoring its progress and immediately sees what should have been achieve at a point in time, and can therefore take remedial actions to bring the project back on course.
Table 1: Gantt chart for Proposed Research
The results of this endeavor would show that several trends in healthcare management carry positive impacts on adolescent health in Hong Kong. The most important implications for the results can be twofold – more awareness for the public and more programs from health care organizations with respect to health care for adolescents. Health care organizations can focus on communicating messages designed to help people understand the vulnerability of this age group and initiate the basic precautions which can be taken to help adolescents throughout Hong Kong.
Additionally this endeavor can also create more attention from the media. The media, by broadcasting the best health care management practices, or the lack thereof, can significantly contribute to the problem of healthcare management regarding the issue of adolescents.
CONCLUSION
As health promotion, disease prevention, and health management programs for adolescents develop, information on health perceptions of this young generation will become increasingly important. The promotion of health in its myriad forms is underpinned by several disciplines, including those drawn from the sciences and from the human sciences. The development that undergoes in an adolescent also largely affects programs that are designed for them. The abundance and diversity of literature on adolescent social and health behavior demonstrates that explanations can be categorized in a number of ways. Aspects of an adolescent’s development can usefully inform the approaches to health management. An understanding of the context of adolescent behavior provides an insight into the factors that motivate and maintain health-compromising behavior. It raises the question of whether some health education programmes are too narrowly focused on predetermined behavioral change, and whether in the pursuit of physical health targets, healthy development is being jeopardized for young adolescents.
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