Francis Anthony B.

Losloso
MAN-AHN
Oncology Nursing

Activity 2: Program Evaluation

Evaluation is vital in determining success or failure of a designed program.

According to Ralph Tyler (1942), it is the process of determining whether predetermined
educational objectives have been achieved. It is used to measure effectivity of methods
of instruction in achieving its objectives. It can help educators and program designers
understand, verify and increase the impact of program on participants. It may also help
in improving delivery mechanisms to be more efficient and less costly, identifying
strengths and weakness for improving the program and fully examining it for duplication
in the future. In the field of nursing oncology, it is important for us nurses to give
emphasis on health education that may promote health and prevent development of
disease such as cancer.

Smoking is the single largest preventable cause of disease and premature death.
It is associated to many non-communicable diseases as well as cancer. It does not only
affect the active smokers, but also those who are exposed to secondhand smoke.
According to the American Cancer Society and colleagues (2011), almost half the
deaths (48.5%) from 12 different types of cancer combined are attributable to cigarette
smoking. It includes cancer of the lung, larynx, oral cavity/ throat, esophagus, bladder,
liver, colon and rectum, stomach, pancreas, kidney, cervix and acute myeloid leukemia.
Every year, there are about 20,000 smoking-related deaths in the Philippines wherein
approximately 10 FIlipinos die every hour due to tobacco-related diseases (SEATCA,
2007).

In the Philippines, the program “Yosi Kadiri” was first launched in the 1990s in
support of the anti-smoking campaign. It was then followed by several programs that
have been implemented to fight smoking such as the Clean Air Act of 1999 wherein
smoking inside a public building or an enclosed public place including vehicles and
areas outside private residences are prohibited. The WHO Framework Convention on
Tobacco Control Article 8: Protection from Exposure to Tobacco Smoke was ratified in
the Philippine Senate in April 2005 thus, became binding and part of the law of the land.
The Tobacco Regulation Act of 2003 known as the RA 9211 was promulgated to
regulate the packaging, use, sale, distribution and advertisements of tobacco that aims
to promote a healthful environment and spread awareness regarding the health risks
and negative effects of tobacco. This was strengthened by the Administrative Order No.
2014-0037-A wherein use of templates of graphic health warnings in cigarette packages
was implemented in pursuant to Republic Act No. 10643 entitled “An act to effectively
instill health consciousness through graphic health warnings on tobacco products” and
was approved on July 15, 2014. It was followed by Republic Act No. 103511 known as
“An act restructuring the excise tax on alcohol and tobacco products” and in 2017,
President Duterte signed Execute Order 26 known as the nationwide smoking ban that
prohibits smoking in all public places in the Philippines. These include schools,
hospitals, clinics, government offices, food preparation areas, public transportation and
more. Several campaign advertisements, signages and infographics was made to fight
smoking but still, there are a lot of people who engage in tobacco use. Now, the
Department of Health in partnership with WHO launched phone and mobile-centered
support services to help Filipino smokers quit tobacco. Quitline is a hotline that smokers
can call to help them initiate or continue quitting the use of tobacco products.
Nevertheless, it all boils down to one major program and that is the smoking cessation
program.

Program: Smoking Cessation Program

Vision: Reduced prevalence of smoking and minimizing smoking-related health risks.

Mission: To establish a national smoking cessation program (NSCP).
Objectives:
The program aims to:
1. Promote and advocate smoking cessation in the Philippines; and
2. Provide smoking cessation services to current smokers interested in quitting
the habit.

Program Components:
The NSCP shall have the following components:
1. Training
The NSCP training committee shall define, review, and regularly recommend
training programs that are consistent with the good clinical practices approved by
specialty associations and the in line with the rules and regulations of the DOH.
All DOH health personnel, local government units (LGUs), selected schools,
industrial and other government health practitioners must be trained on the policies and
guidelines on smoking cessation.

2. Advocacy
A smoke-free environment (SFE) shall be maintained in DOH and participating
non-DOH facilities, offices, attached agencies, and retained hospitals. DOH officials,
staff, and employees, together with the officials of participating non-DOH offices, shall
participate in the observance and celebration of the World No Tobacco Day (WNTD)
every 31st of May and the World No Tobacco Month every June.

3. Health Education
Through health education, smokers shall be assisted to quit their habit and their
immediate family members shall be empowered to assist and facilitate the smoking
cessation process.
4. Smoking Cessation Services

LEVEL OF DRUGS/
STAFFING Intervention Package EQUIPMENT
CARE MEDS

• Risk assessment/ Risk

screening (Note: Use
Risk Assessment Form)

• Assess for Tobacco

PRIMARY Use
• Risk Assessment
LEVEL
• If smoker, do Brief Tool

BHW

I. Barangay Intervension Advice (5 None • Quit Contract

RM
Health A's) See Attached  

Station Protocol
• Referral Form
• If non-smoker,
Congratulate and
advice continue Healthy
Lifestyle activity

Above Plus

• Quit Clinic

(Use DOH Protocol or

other suggested
Patient Assessment
protocols e.g.
Tool:

Motivational Interview,
• Stages of
SDA Protocol, etc. as
change

available)

• WHO Mental
• DOH Protocol
Health Checklist

provides:

• Motivation and
• Assessment of
Confidence to
client's Smoking
quit

History, Current
PRIMARY • Use of • Smoking History
Smoking Status
LEVEL
Nicotine and Current
and Readiness to
II. RHU
Replacement Smoking Status

Above Plus
stop smoking

 
therapy • Self-test for
Nurses Doctor • Planning for
SECONDARY particularly reason for
s and other clients Readiness
LEVEL
Nicotine smoking (Horn's
health to stop smoking

 
patch and Smoker's Selt-
personnel • Quit day:
 
Nicotine test)

Pharmacologic,
TERTIARY Gum is • Fagerstrom
Psychological and
LEVEL advocated Nicotine
Behavioral
Dependencetest

Interventions

• Self-test on
- Identifying and address
Readiness to
triggers for going back
stop smoking

into smoking

• Previous
- Dealing with cravings to
attempts to stop
smoke

smoking

- Managing withdrawal
Form: 

syndromes

• Quit Contract
• Monitoring and
Prevention of
Relapse

Quit Lines
5. Research and Development
Research and development activities are to be conducted to better understand the
nature of nicotine dependence among Filipinos and to undertake new pharmacological
approaches.

There are many factors that affect the success and failure of a designed
program. Creating a good instructional design is very important for which it is the
structural foundation that will hold the entire program. Logistics must be considered in
evaluation. However, it does not only rely on the design itself but as well as the the
participants desire to seek and create change. The smoking cessation program is highly
individualized in which despite different efforts has been implemented to stop smoking
for the past years, a lot of people still smoke tobacco. According to an article of quit.org,
there are 3 common reasons why people smoke; 1. nicotine addiction, 2. situational
triggers such as smoking with relatives, friends or during occasions and 3. emotional
triggers when stressed, bored or upset..

Relating it to Nola Pender’s Health Promotion Model, it focuses more on the

person’s ability to care for his/herself since the program gives emphasis in prevention
and promotion of well-being. In her model under the cognitive-perceptual factors, it is
said that individuals who place high value on health are more likely to seek it in which
perception of his/her own ability to improve his/her health status can motivate the desire
to attain optimum health. It is important for the facilitators to assess whether the
participants tried to do something about smoking cessation if it is their first time and if
not, their progress. According to Kaplan and Comles as cited by Pender, 1987,
individuals will engage first in activities such as relaxation and exercise that would result
in noticeable changes in well-being as initial steps on the pathway leading to complete
cessation of smoking.

Based on the country’s 2015 Global Adult Tobacco Survey (GATS, 2015), 7 out of
10 FIlipino smokers would like to quit tobacco. The quitline program are within reach of
every individual due to its accessbility with the use of technology. It enabled numerous
possibilities in effectively bridging communication gap between people that may improve
heal care delivery systems to address the burden of tobacco use. However, it is also
important to consider that those people behind the quitline program are health care
professionals, or if not, atleast well-trained and qualified to assist in smoking cessation.
Every individual’s belief that an activity or behavior that is difficult or unavailable may
influence his/her intention to engage in it given the availability of resources, busy call
line, distance of clinics, human resource, time and the nature of activity. Participants
positive experience may increase their well-being and improved their health status and
can be used to reinforce the value of good health and promote more extensive changes
in lifestyle. All government agencies and some private sectors have already done their
part through advertisements, packaging, infographics and even environmental control
through smoking bans in public places, it is now the participants turn to be motivated
and take initiative to stop smoking. According to GATS, 2015, there are now 1 million
fewer smoker in the Philippines and there are real demand for smoking cessation
services as tobacco control programs are strengthened. It all boils down to the
participants willingness to go through the program with behavioral modification to stop
smoking.

References:
https://www.doh.gov.ph/sites/default/files/basic-page/Philippines%20-
%20Revenue%20Memo%20No.%2016-2012%20-%20national.pdf
https://www.doh.gov.ph/smoking-cessation-program
http://www.philcancer.org.ph/wp-content/uploads/2014/06/NO-SA-YO.pdf
https://www.doh.gov.ph/sites/default/files/basic-page/
Philippines_20160209_Implementing%20Rules%20_%20Regs%20of%20RA%2010643
_WL_EN.pdf
https://www.doh.gov.ph/sites/default/files/basic-page/Philippines%20-%20Rep.
%20Act%20No.%209211%20-%20national.pdf
https://www.doh.gov.ph/sites/default/files/basic-page/Philippines%20-%20Order%20No.
%202014-0037-A%2C%20Amd_ing%20GHW%20Template%20-%20national.pdf
https://www.doh.gov.ph/sites/default/files/basic-page/Philippines%20-
%20Sin%20Tax%20Reform%20Act%20-%20national.pdf
https://www.doh.gov.ph/node/10254
http://www.wpro.who.int/philippines/publications/module5.pdf