Liver Disease Prevention and Management Campaign for Elderly Indigenous People in Kimberley

This report suggests a health promotion project that would focus on conducting a community education campaign for the elderly indigenous people, residing in Kimberley, on liver disease prevention and management. The Aboriginal and Torres Strait Island individuals demonstrate an increased susceptibility of suffering from different kinds of liver diseases, owing to high levels of ALT in blood, obesity, alcohol consumption, and hypertension.

Running head: GRANT APPLICATION
Assignment 2 Primary Health Care
Name of the Student
Name of the University
Author Note

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Executive summary
Health promotion encompasses the process of allowing individuals to increase their control
over their health, by improving it. It does not merely focus on individual conduct, rather
sheds light on a range of environmental and social interventions that are imperative for the
promotion of optimal health and wellbeing. This report suggested that the Aboriginal and
Torres Strait Island individuals demonstrate an increased susceptibility of suffering from
different kinds of liver diseases, owing to high levels of ALT in blood, obesity, alcohol
consumption, and hypertension. The report discusses a health promotion project that would
focus on conducting a community education campaign for the elderly indigenous people,
residing in Kimberley.

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Table of Contents
Project Title................................................................................................................................4
Health Issue................................................................................................................................4
Project description......................................................................................................................5
Objectives...................................................................................................................................7
Strategies....................................................................................................................................8
Budget estimate..........................................................................................................................9
Time line estimate....................................................................................................................10
Evaluation................................................................................................................................10
Working in partnership............................................................................................................11
Sustainability............................................................................................................................11
References................................................................................................................................13

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Project Title
Liver disease prevention and management campaign for elderly indigenous people
residing in Kimberley, Australia.
Health Issue
Liver disease are typically inherited and/or occur due to several factors that are
responsible for causing damage to the liver such as, alcohol consumption or viral attack.
There are several pathways that result in liver injury, of which most eventually result in the
onset of cirrhosis, which is primarily a late-stage liver illness (Feldman, Friedman & Brandt,
2015). According to Williams et al. (2014) cirrhosis most characteristically progresses as a
consequence of long-lasting liver infection (hepatitis). Reasons for hepatitis comprise of
infections (hepatitis C or B), alcohol consumption and/or and fatty liver disease
(steatohepatitis). Government reports suggest that liver disease had been identified as the 11th
leading reason for several premature deaths in 2010-2012, in Australia (AIHW, 2019).
Furthermore, an estimated 2 out of 3 premature death were found to occur among males in
2012 that accounted for roughly 69% of the population. The rates of premature death that
occurred due to liver disease also demonstrated a reduction by 48%, over thirty years, from
1982. The deaths recorded in the past years do not comprise of those that occurred due to
liver cancer that accounted for an additional 889 deaths in 2012. Onset of liver disease has
often been categorised as a major risk factor for the incidence of liver cancer.
Time and again it has been found that the Aboriginal and Torres Strait Islander
individuals are also at higher risk of liver illness, predominantly hepatitis B. The Aboriginal
male and female death rates were found to be approximately 3 and/or 5 times, in 2008–2012,
when compared to the non-Indigenous men and women, respectively. Alanine
aminotransferase (ALT) refers to an enzyme that is found in the liver, and facilitates the

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metabolism of food to energy in the liver. Research evidences state that an upsurge in the
levels of ALT in bloodstream occurs due to damage or disease of the liver (Molleston et al.,
2014). According to reports from the Australia Bureau of Statistics (2014) 16.5% of the
Aboriginal and Torres Strait Islander people demonstrated irregular or elevated ALT levels in
their blood in 2012-13. Additionally, this was concomitant with increased rates among males,
when compared to their female counterparts (19.9% equalled with 13.3%).
Following consideration of the underlying age differences into justification, reports
suggested that the Aboriginal and Torres Strait Islander persons were approximately one and
a half times probable as non-Indigenous people to have increased levels of ALT in
bloodstream, with a rate ratio of 1.4, thus signifying their high risk of suffering. Owing to the
fact that elevated levels of ALT was more common among indigenous people who resided in
remote locations (21.8%), compared to those living in urban areas (15.0%), socio-
demographic factors were also found to play an important role in the development of the
disease. Increased body fat and hypertension have also been identified as risk factors for the
condition. Obese indigenous people manifest a three times likelihood of having liver disease
than the underweight or normal weight Australians (25.5% vs. 8.6%) (ABS, 2014). This calls
for the need of promoting awareness amid the indigenous people, on the effective prevention
and management of liver diseases.
Project description
The primary purpose of the program is to develop a community education campaign
that will educate the elderly indigenous people living in Kimberley on liver disease,
specifically focusing on the risk factors and the prevention and/or management strategies.
This will facilitate enhancement of the health and wellbeing of the target population in the
long run. The concept has been adopted from the Ottawa Charter for Health Promotion that
places a due focus on education, equity, social justice, peace, and shelter (WHO, 1986).

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Approximately 4.5-9.5% people are affected by cirrhosis on a global basis. It has been
estimated that around 50 million individuals in the world would be affected by chronic
diseases of the liver (Worldgastroenterology.org, 2018). The project will work towards
increase the availability of accurate and pertinent information among the target indigenous
population for preventing the high rates of liver disease among the elderly Aboriginals and
Torres Strait Islanders living in Kimberley, thus improving their health and enhancing their
overall quality of life. The major strength of the program can be accredited to the fact that it
will help in creating an influence at multiple levels such as, personal, environmental and
community, thereby contributing significantly to the improvement of the health outcomes in
Kimberley. Strengths can also be associated with its wider reach, role in increasing public
awareness on the risk factors, enabling the indigenous people to assess lifestyle alterations
that would be conducive to their health, and foster local health promotion development
activities. However, some weaknesses of the program are uncertainty regarding change in
behaviour of the audience, and generation of fear arousal.
The project will be built in accordance to the visions of the Kimberley Aboriginal
Health Planning Forum (KAHPF), the primary aim of which is to improve the health
outcomes for all Aboriginal and Torres Strait Islanders in Kimberley region, Western
Australia, through a synchronised method to the preparation and conveyance of primary
health services. Assistance will be taken from the forum members of the KAHPF in
formulating the education campaign that will specifically target the indigenous population of
Kimberley (Kimberley Aboriginal Health Planning Forum, 2019). The education campaign
will seek help from the KAHPF Chronic Disease Committee for identifying the possible
champions and partners of the program. The primary message for the campaign would be,
“Dearest Liver”, where there would be several community based scanning and screening
events for promoting good health of the liver, and raising awareness among the people. The

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project will also seek help from the Wunan Foundation for offering a range of practical
advises on reduction of the risk factors for hypertension, and obesity amid the indigenous
Australians, which in turn would decrease their blood ALT levels, and subsequently lower
the risk of liver disease (Wunan Foundation, 2019).
The campaign would also encompass delivery of comprehensive information on the
little lifestyle changes that would bring about momentous differences in the health of the
liver, thus helping the indigenous people reduce the premature death rate. Locally, the
government of Australia has established the Indigenous Australians’ Health
Programme (IAHP) for consolidating the four fundamental health domains namely, maternal
and child health, Northern Territory health, primary health care, and the Aboriginal and
Torres Strait Islander Chronic Disease Fund (Department of Health, 2018). Thus, the
education campaign will be in alignment with the government regulations and policies. The
project is also in alignment with the goals of the National Primary Health Care Strategic
Framework that aims to improve access and reduce inequity in primary health care
(Commonwealth of Australia, 2013).
Objectives
The first objective is to formulate and implement a community educational campaign
in English and Creole, for delivering necessary information on liver disease causes, risk
factors, signs and symptoms and prevention strategies. The campaign will encompass vast
details on the different types of liver disease that range from slight injury to chronic scarring
(cirrhosis) and liver fibrosis. The educational program will also educate the indigenous
Kimberley residents on the importance of the liver organ and the factors that might result in
potential liver damage. The educational campaign will be conducted over a period of three
months (1 hour sessions), twice every week and will also comprise of brochures. These
campaigns will be conducted across primary health centres, and aged care services.

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The second objective of the campaign would be to increase the access of the
indigenous residents of the Kimberley community to appropriate amenities that would help in
effective management of liver diseases (Department of Health and Ageing, 2010). This can
be accomplished by holding an event with the government key stakeholders for helping them
understand the need of allowing the indigenous population get similar access to healthcare
facilities, alike their non-indigenous counterparts. Evaluation of the campaign will be
measured by keeping a track of the number of people who have attended the campaign on
each day, in addition to the number of brochures that have been disseminated. Recording data
of liver diseases from the district register prior to, and after the campaign (six months follow-
up) will help in assessing the success of the campaign, thus informing future campaigns.
Strategies
Some of the major strategies that would be adopted for effective implementation of the
program are given below:
 Preliminary research and setting of the goals- This would include identification of the
problem (liver disease), the target audience (elderly indigenous people living in
Kimberley), the behaviour or parameters that are intended to be changed (obesity,
alcohol consumption, hypertension, diet, sedentary lifestyle), and the expected
outcomes (low incidence and prevalence rates) (McMillan & Ziegelstein, 2014).
 Engagement of the major stakeholders- Stakeholders would comprise of the
organisations and individuals who are affect by or have an interest in the program and
its outcomes (Andriof et al., 2017).
 Audience research- Talks will be initiated with the potential indigenous people to
understand their views on the disease, the barriers they face in healthcare, and their
principal foundations of information.

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 Strategic and premeditated planning- Interpreters having excellent command over
both the languages will be hired. They will assist two educators who will implement
the project (Austin & Pinkleton, 2015).
 Implementation- Four aspects that will be taken into consideration are namely, (i)
explaining the existing problem that needs to be changes, specifying the goals of the
campaign, holding bi-weekly sessions for describing the change strategies, role
modelling, creating content for brochures, explaining the outcomes of the campaign.
 Evaluation of the campaign- This would encompass continuous measurement of the
goals during the campaign, followed by collection of feedback from the stakeholders,
and reviewing success of the program (Pierce et al., 2017).
 Continuing ongoing awareness
Budget estimate
Factors Estimate
Brochures $850
2 educators/project coordinators $100 per hour (*2), $800 per month (*2),
$2400 for three months (*2= $4800)
Interpreter $1000 for three months
Campaign set up costs (including all
resources)
$1000
Evaluation costs during and after the
campaigns
$500
Travel costs $100
Total $8250
Table 1- Budget estimate for the project

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The total budget estimate will be kept near $8500, including the evaluation costs for
the follow-up evaluation.
Time line estimate
Stage Duration
1
month
2
wks
3 months 6 months 2
wks
Planning
Gaining
approval from
authorities
Launching the
campaign
Follow-up
evaluation
Reporting
Table 2- Gantt Chart
The total time required for the project (including follow-up) is 11 months.
Evaluation
There is a need to measure whether the campaign was implemented in the accurate
manner, and its immediate outcomes in the target population. Development of a written
report that contains a detailed description of the challenges encountered and the strategies
employed to overcome them would help in the process. Effective evaluation has been
identified as a core component of public education campaign. A track will be kept of the
number of people who had been audience to the campaign, and the number of brochures

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distributed during the project. Data collection will inform future operations and support
judicious use of resources. The knowledge and awareness of the target audience on liver
disease will be checked before, immediately after and six months following the campaign.
This will be conducted by launching three pre- and post-campaign surveys, backed by
assistance from the educators, and volunteers (Hollier et al., 2016).
Outcome evaluation will comprise of comparing the incidence and prevalence rates of
liver disease in the district before and six months after the project. This will help in assessing
any kind of behavioural change, change in policies, and attitudes. Feedback will also be taken
from the stakeholders on the strategy of the health promotion project, and alternative
approaches for its implementation. Evaluation of outcomes might also encounter language
barriers, which requires the help of interpreters (Baum & Fisher, 2014). Ongoing feedback
will help in gaining an insight into needs and preferences of the target population, thus paving
the way for recommendations.
Working in partnership
The major partners would be the Wunan Foundation, KAHPF, IAHP, and the regional
Department of Health. While the Wunan Foundation will promote establishing contacts with
the indigenous population residing in Kimberley, KAHPF will provide funds and assistance
from the chronic disease committee. Funds will be gained from the Department of Health and
IAHP that work towards promotion of indigenous health. They will also help in selection of
suitable places that would be feasible for conducting the campaign.
Sustainability
Following the initial funding, continuing funds can be collected by stakeholder
engagement. At the end of three months, the campaign resources and additional brochures
will be handed over to primary health workers, and aged care service worker, for reaching a

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wider audience. The educators will also remain in contact for guiding them for future
activities.

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References
Andriof, J., Waddock, S., Husted, B., & Rahman, S. S. (2017). Unfolding stakeholder
engagement. In Unfolding stakeholder thinking (pp. 19-42). Routledge.
Austin, E. W., & Pinkleton, B. E. (2015). Strategic public relations management: Planning
and managing effective communication campaigns. Routledge.
Australia Bureau of Statistics. (2014). Liver Function. Retrieved from
http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4727.0.55.003~2012
-13~Main%20Features~Liver%20Function~132
Australian Institute of Health and Welfare. (2019). Liver disease. Retrieved from
https://www.aihw.gov.au/getmedia/a088f80f-fcdb-4c5d-aa00-ca776bd7f792/phe199-
liver.pdf.aspx
Baum, F., & Fisher, M. (2014). Why behavioural health promotion endures despite its failure
to reduce health inequities. Sociology of health & illness, 36(2), 213-225.
Commonwealth of Australia. (2013). National Primary Health Care Strategic Framework.
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https://www.health.qld.gov.au/__data/assets/pdf_file/0027/434853/nphc_strategic_fra
mework_final.pdf
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System Australia’s First National Primary Health Care Strategy. Retrieved from
http://www.nationalplanningcycles.org/sites/default/files/country_docs/Australia/
6552_nphc_1205.pdf

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Department of Health. (2018). The Indigenous Australians’ Health Programme. Retrieved
from http://www.health.gov.au/internet/main/publishing.nsf/Content/indigenous-
programme-lp
Feldman, M., Friedman, L. S., & Brandt, L. J. (Eds.). (2015). Sleisenger and Fordtran's
gastrointestinal and liver disease: pathophysiology, diagnosis, management. Elsevier
Health Sciences.
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Hickman, M. (2014). Addressing liver disease in the UK: a blueprint for attaining

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