NEEDS ASSESSMENT 1

Needs Assessment

Tobi Zaccheaus Ajisekola

(UOSCA131119-009)

UOS-IND-M-100-15160

Evi Apostolou

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Needs Assessment

Health has had several definitions that keep changing depending on the context.

However, one standard definition remains. The World Health Organization defines health as the

complete state of wellbeing, including physical, social and mental aspects, and not just the

absence of a disease or infirmity (Healthknowledge.org.uk, 2020). This means that there is more

to health than just being physically sick. The model by Dahlgren and Whitehead gives a

summary of some of the factors. From the center going outward are age, sex, and constitutional

factors; individual lifestyle factors; social and community networks; a variety of issues such as

housing, education status, health services; and general socioeconomic, cultural and

environmental conditions (Shokouh et al., 2017 p. 435). All these agents come together to

determine whether a person is ill or well.

Health needs assessment involves systematically finding out what healthcare needs a

certain population has and making the necessary essential changes to ensure that those identified

needs are met. It is very essential to the planning of health care service delivery. It consists of

epidemiological, comparative and corporate approaches. Epidemiological approaches consider

sources of the current situation, current management, and its cost-effectiveness. Comparative

approaches make comparisons of different populations. Corporate approaches take into

consideration the views of stakeholders to develop policies (Public Health Action Support Team,

2020, p. 1).

A health needs assessment is important in public health. The steps involved help to guide

public health action. Step one is about identifying stakeholders, the population of choice, and

available resources. Step two is about gathering relevant data. Step three is about prioritizing the

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important and urgent first. Step four is implementation and step five is monitoring and

evaluation. All these steps are about getting to know what is best so that it can be implemented.

An action is taken when a health problem has been identified. With an assessment, there is an

opportunity for bringing actual change (Public Health Action Support Team, 2020, p. 1). This

paper discusses the health need of a specific population and how it can be addressed.

Discussion

Population Definition

The number of pregnant women in society keeps increasing by the day. This includes

those in both extremes of age, but still within the reproductive years. Pregnant women require

special care during their gestation period for successful delivery. Healthy living mothers and

babies are the product of good care before, during and after pregnancy. It is a challenging period

physically, emotionally and mentally. Hormones are flaring during the first trimester, resulting in

nausea, vomiting, heightened sense of smell, emotional outbursts, among many other challenges.

The symptoms improve over time for most women as they get into the second and third

trimesters. Maintaining a healthy lifestyle is important for such women. They need support from

the family and friends to cope with all the pressure they feel during pregnancy. It makes them

feel like they are cared for, and they are not alone in the process (Poon et al., p. 22).

Profiling of the Population

A vulnerable population among pregnant women is pregnant teenagers. Most of them are

primigravidas, still in school, and probably having a baby was not among their many plans. They

are also mostly dependants, living with their parents or guardians. Most do not even know what

parenting is. This group has several needs, especially physical, emotional, spiritual and financial.

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Society expectations are usually that a teenager will study, probably be disciplined, work hard

towards becoming somebody great in the future, but definitely not to get pregnant while still at

home. Most of them are at home, living with their parents who also have expectations for them,

and getting pregnant is never one of them (Abbott and Reynolds, 2017, p. 45).

Key Health Priorities

Financial needs come about as a result of the fact that the teenager is going to be a parent.

This means that they have to go for antenatal clinics, keep themselves healthy, eat pregnancy-

friendly food, avoid overworking themselves, among many other things that pregnancy calls for.

Most of the requirements require finances. For instance, antenatal hospital checkups require that

the mother-to-be has enough for fare and for the bills she may have to pay for at the hospital. The

supplements to use during pregnancy sometimes cost money. Eating healthy and making it a

daily routine can be costly. Planning for delivery also requires saving cash in case of emergency

and buying the necessary requirements for the baby before it arrives (Abbott and Reynolds,

2017, p. 45-46).

Physical needs are mostly about the health of the baby and the mother. They are supposed

to keep themselves healthy by getting the necessary immunizations, complying with antenatal

visits, sleeping under treated mosquito nets, taking blood supplements, taking time off to relax,

among several other body requirements. Being teenagers, they are probably in school and hardly

have time to ensure they do all these things (Abbott and Reynolds, 2017, p. 45-46).

Emotional support is also important during pregnancy, especially for teenagers. Because they

were not physically ready for conception, they need emotional support every step of the way.

Probably they got it out of rape, or just out of experimentation, but it becomes a burden in their

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emotions. They need to be psychologically prepared for what is about to happen to them,

especially every stage of change that they will be going through. They need reassurance that they

are not alone but have people who will walk the journey with them. Most of the partners they

had sex with hardly ever want to take responsibility, hence most emotional support is from

family and friends (Abbott and Reynolds, 2017, p. 45-46).

Spiritual concerns are dependent on the societal background and upbringing of the child.

In most religions and societies, pregnancies out of wedlock are considered a vice, and it may take

a lot of convincing for the girl to feel confident in herself. However, it is important to try as

much as possible to support them spiritually so that they feel like they still to matter, and that

they should not let go of their self-esteem (Abbott and Reynolds, 2017, p. 45-46).

Priority Health Concern

As discussed above, there are four major health concerns for the pregnant teenager. These

are the spiritual, physical, financial and emotional aspects. These four come together to ensure

that this particular teenager either successfully or unsuccessfully goes through pregnancy. It

should be noted that all these types of needs have one thing in common- the psychological

aspect. This makes mental health a priority need for pregnant teenagers. It is a very small need

but has the biggest and most severe repercussions. From the article by (Abbott and Reynolds,

2017, p. 46), a diagrammatic representation is made of the social problems affecting teenagers.

These are four interlocking circles linking teenage pregnancy with alcohol and drug use,

domestic abuse and mental health (Abbott and Reynolds, 2017, p. 46). From this, mental health

seems to be a bulky aspect since domestic abuse leads to mental health problems and drug use is

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a component of mental problems the teenager is undergoing. Therefore, addressing mental health

issues in teenaged pregnant girls is a priority health concern.

Implications

Mental Health Concerns

Hodgkinson, Beers, Southammakosane, and Lewin, (2014, p. 114) identifies that

pregnant teenagers are at risk of the many mental disorders that exist today. These mental

illnesses arise due to the many factors arise from them just being teenagers. The amount of

pressure that arises from the fact that a teenager is pregnant usually creates a mental imbalance in

them. They had not planned, they had probably not intended, but it happened. Some of them

even use contraceptive medication or devices but still end up getting pregnant. Some attempt to

abort to avoid the consequences and still a good number fail in these attempts, especially in low

and middle-income countries. It is usually very difficult to begin explaining to the caregivers

how the pregnancy came to pass. It is evident that they go through some form of psychological

torture, especially when they choose to keep the pregnancy.

Common mental health problems that such teenagers encounter include post-traumatic

stress disorder (PTSD), drug and substance abuse, and depression (Hodgkinson et al., 2014,

p.114). From, the article by Hodgkinson et al., (2014), a review on mental health conditions in

pregnant teens in the United States, about 16%-44% of pregnant teenagers suffer from

depression as compared to 5%-20% in the non-pregnant mothers. 19% of those aged between 15-

19 years reported having thought of committing suicide, 9% had attempted and a range of 15-

30% of suicidality was observed. An approximated 11-52% are substance abusers. Almost 50%

were suffering from PTSD ((Hodgkinson et al., 2014, p.115). When it comes to using mental

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health services, it is difficult because of the financial implications it presents. The study notes

that 50% present with behaviors of concern out of which only 25% or less are in any form of

mental health therapy or treatment (Hodgkinson et al., 2014, p.116).

These mental disorders have a number of effects on the mother and the baby. Kendig et

al, (2017, p. 272) state that perinatal mood and anxiety disorders are very common in women of

reproductive age. According to the article, one out of 7 women suffer from perinatal depression

(60% with a pre-existing comorbid mental disorder, 80%of which are anxiety disorders). 13-21%

of women experience prenatal anxiety with 11-17%persisting to postpartum (Kendig et al, 2017,

p. 273). From the article by Corcoran, (2016, p.21), one of every five teenagers suffers from a

mental health disorder, with a 7.5% 12-month prevalence and an 11% lifetime prevalence in

depression. The consequences of leaving such disorders untreated include poor medication

adherence, poor nutrition in pregnancy, substance and alcohol use, loss of resources, worsening

of medical conditions and infanticide (Kendig et al, 2017, p. 272-273). The study by Herba et al.,

(2016, p. 984) shows that maternal depression during pregnancy causes changes in how the

placenta works leading to stress reactivity which induces epigenesist in the fetus. This article

also identifies poor feeding habits as a result of depression leading to nutritional deficiencies in

the fetus. This depression continues to escalate when the child is born and there are financial

insecurities and the idea of being a mother (Herba et al., 2016, p. 984-987).

Evidence-Based Interventions

Health care providers should be able to diagnose mental health disorders in pregnant

teens. This is the first step in helping them. Trust is built when the health worker is not

judgmental of the teenager. A research that was done by Harrison et al, (2017, p. 210), showed

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that pregnant teenagers seeking medical attention were more open and trusting to health care

providers who did not judge them for being pregnant at such an early age.

A certain study that was done by Jantacumma, Powwattana, Lagampan, and

Chansatitporn, (2018, p. 30) was testing a model of health for pregnant teens in Thai (MQLTPT).

From the hypothesized model, depression and health literacy are affected indirectly where there

is domestic violence or stressful life events without social support. Social support affects the

quality of life directly and indirectly by depression and health literacy. Health literacy and

depression have a direct effect on the quality of life (Jantacumma, et al, 2018, p. 33). Results led

to the modification of the model to remove the direct link between depression and health literacy

and to include a direct link from social support to quality of life (Jantacumma, et al, 2018, p. 37).

High social support was associated with high health literacy and a decreased level of depression,

with a good quality of life. Family support was found to be the most important as they removed

risk factors for depression, with support from the friends/boyfriend being second in line to

reducing depressive symptoms (Jantacumma, et al, 2018, p. 34). From this study, it is evident

that supporting teenagers helps them to be emotionally stable for pregnancy.

Pregnant teen mothers can also be taught on stress management. This will help them to

cope through the pregnancy by significantly reducing their stress levels to manageable. In cases

of trauma, they can be coached through trauma-specific psychoeducation that helps them to

readjust back to normal life. Emotional self-regulation is also an element that teenagers can learn

so that they can control the highs and lows of pregnancy. All these methods of helping teenagers

have been found to be beneficial in helping them to go through pregnancy with successful

outcomes (Freed, and SmithBattle, 2016, p. 84-89).

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With the above proven methods, public health action can be directed towards creating

awareness on the mental health needs of pregnant teenagers. Creating public awareness helps

sensitize the society not to judge them but to instead, support them where possible. This way, the

stigma created by public discrimination can be minimized. Family-centered approaches to care

can also be considered. This is to include the parents of the teenager as well as the father of the

unborn baby in the care of the pregnant teen for best outcomes. Resources can be directed

towards mental health education in the community to help pregnant teens to cope with the

challenges of pregnancy as well as prepare for parenthood. They can also be advised on

preventing recurrence of pregnancy so that they can focus on education and independence

(Freed, and SmithBattle, 2016, p. 84-89).

Conclusion

Conducting a health needs assessment now and then is important in public health. It helps

to identify gaps in care that need to be attended to. It also helps in knowing where public health

action is performing well (Public Health Action Support Team, 2020, p. 1). In this essay,

pregnant teenagers are a vulnerable population whose mental health is very important for

successful pregnancy outcomes (Kendig et al, 2017, p. 273). Supporting them in the course of

pregnancy helps to reduce mental illnesses that arise from anxiety and stress, especially

depression ((Jantacumma, et al, 2018, p. 34). Such mothers also benefit greatly from

psychotherapy and general education in pregnancy and motherhood because they are naïve and

have almost no idea what to expect except what they know from hearsay. Clarifying expectations

to them helps to relieve anxiety. This way, the maternal and child outcomes will be good as a

result of great antenatal care (Freed, and SmithBattle, 2016, p. 84-89). Ultimately, addressing the

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mental health needs of pregnant teenagers reduces the risk of adversities associated with mental

illnesses during pregnancy.

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References

Abbott, L. and Reynolds, J., 2017. Complex social factors affecting pregnancy and childbirth in

teenagers; a case study. MIDIRS Midwifery Digest.

Corcoran, J., 2016. Teenage pregnancy and mental health. Societies, 6(3), p.21.

https://doi.org/10.3390/soc6030021

Freed, P. and SmithBattle, L., 2016. Promoting teen mothers' mental health. MCN: The

American Journal of Maternal/Child Nursing, 41(2), pp.84-89. DOI:

10.1097/NMC.0000000000000216

Harrison, M.E., Clarkin, C., Rohde, K., Worth, K. and Fleming, N., 2017. Treat me but don't

judge me: a qualitative examination of health care experiences of pregnant and parenting

youth. Journal of pediatric and adolescent gynecology, 30(2), pp.209-214.

https://doi.org/10.1016/j.jpag.2016.10.001

Herba, C.M., Glover, V., Ramchandani, P.G. and Rondon, M.B., 2016. Maternal depression and

mental health in early childhood: an examination of underlying mechanisms in low-

income and middle-income countries. The Lancet Psychiatry, 3(10), pp.983-992.

https://doi.org/10.1016/S2215-0366(16)30148-1

Hodgkinson, S., Beers, L., Southammakosane, C. and Lewin, A., 2014. Addressing the mental

health needs of pregnant and parenting adolescents. Pediatrics, 133(1), pp.114-122. DOI:

https://doi.org/10.1542/peds.2013-0927

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Jantacumma, N., Powwattana, A., Lagampan, S. and Chansatitporn, N., 2018. Predictive Model

of Quality of Life among Thai Pregnant Teenagers. Pacific Rim International Journal of

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