Running head: INFECTIOUS MONONUCLEOSIS: A HEALTH PROMOTION PROJECT

Infectious Mononucleosis: A Health Promotion Project

Lauren Smith
Auburn University/Auburn University Montgomery

INFECTIOUS MONONUCLEOSIS: A HEALTH PROMOTION PROJECT

Infectious Mononucleosis: A Health Promotion Project

Health-care providers want to promote health and prevent disease. Health promotion
consists of many things, yet health education is the main vehicle for delivery in this project. The
project leader used Auburn University Medical Clinic (AUMC) with a focus on college-aged
patients for the implementation of the project. The population of AUMC guided the project
leader to focus on Infectious Mononucleosis (Mono) due to the increased risk of transmission
and contracting Mono with being a college student. Along with a high risk, there were many
students being diagnosed and requesting testing for Mono over the summer and early fall at
AUMC. Due to the population, the clinic location, and the potential high demand of Mono
education, the project leader chose to address the health promotion need, provide the
implementation, and evaluate the effectiveness of the health promotion project on Infectious
Mononucleosis.
Description of the Problem
Infectious Mononucleosis is a viral infection caused most commonly by the Epstein Barr virus or the Cytomegalovirus (Willis, 1998). The virus is spread through saliva and mucus
which gives it the nickname of the kissing disease (Auburn University Medical Clinic, 2014).
Balfour et al. (2013) found that sexual behavior was a risk factor with deep kissing significantly
higher than those reporting no kissing. The highest risk of contracting Mono occurs in teens and
those in their twenties during high school and college. Mono has a long incubation period with
thirty to fifty days from the time of exposure to the onset of symptoms (Willis, 1998). Mono
symptoms generally begin with fatigue, fever, headache, myalgia, sore throat, and
lymphadenopathy. Decreased appetite, nausea, arthralgia, and a rash may accompany the other
Mono symptoms as well (AUMC, 2014). The enlargement of the spleen can go unnoticed by the

INFECTIOUS MONONUCLEOSIS: A HEALTH PROMOTION PROJECT

patient diagnosed with Mono; however, this is a major potential complication for Mono patients
due to the increased risk of rupture (Willis, 1998). Along with the presentation of these
symptoms, the health-care provider acquires a history and performs a thorough assessment on the
patient to make the diagnosis. The provider may then deem it necessary to collect a blood sample
for a complete blood count with differential and a Mononucleosis Spot test. The Mononucleosis
Spot test is not always accurate on the initial test and may have to be repeated in one to two
weeks after the development of symptoms (AUMC, 2014). A throat culture or liver enzymes may
be ordered to assist with the diagnosis of Mono (Willis, 1998).
Once the provider has confirmed the diagnosis of Mono the treatment plan must then be
established. Mono is a viral illness with no magic cure pill; therefore, patients must perform
symptom management. Adequate rest, increased fluid intake, acetaminophen or ibuprofen for
fever and aches, and salt water gargles are recommended for decreasing the severity of the
symptoms. If a secondary infection were to arise an antibiotic may be prescribed, but avoid
ampicillin to prevent rash. A steroid medication may be prescribed in the case of tonsillar
hypertrophy for the purpose of airway management (AUMC, 2014). Avoidance of lifting heavy
objects, vigorous exercise, and contact sports for at least the first four weeks after the onset of
symptoms is very important education to be provided to the patient to prevent rupturing the
enlarged spleen. Mono also affects the liver meaning that there should also be education about no
alcohol consumption for a minimum of three months (Dunphy, 2011).
It may take several months for the bodys immune system to overcome the virus. The
fever, sore throat, and fatigue usually subside after the first two weeks. After those initial
symptoms subside the contagiousness of Mono is decreased (AUMC, 2014). These lasting
symptoms, possible severe complications, and extensive contagiousness present an opportunity

INFECTIOUS MONONUCLEOSIS: A HEALTH PROMOTION PROJECT

for a health promotion project to increase the college student populations knowledge about
Mono specifically and also general health promotion activities to prevent other illnesses. Many
of the recommendations for prevention and treatment of Mono can be used for general health
promotion and well-being in these college-aged patients. These recommendations include getting
adequate rest, eating a healthy and balanced diet, limiting alcohol intake, achieving moderate
exercise most days of the week, performing good hand hygiene, and avoiding the sharing of
drinks, food, or eating utensils.
Description of Implementation
Multiple patients have been diagnosed with Mono over the last six months within AUMC
as experienced by the project leader. Many of these patients did not know what Mono was, how
it was transmitted, or how it was treated. Mono also appeared to be a hot topic among patients
and their parents requesting Mono testing. Mono is at highest risk of contraction during the high
school and college age; therefore, this clinic should be a great place to implement a Mono Health
Promotion Project. The project leader collaborated with an AUMC nurse practitioner to develop
a health promotion project that would be of benefit to the nurse practitioners practice, the
patients, and the community that AUMC serves. The problem of knowledge deficiency regarding
Mono was established and the plan to use brief in-clinic education and a brochure (see Appendix
A) was determined. Once the project leader completed the research and developed the brochure,
the medical director of AUMC was then contacted to approve the health promotion plan. The
medical director reviewed the brochure providing feedback to better educate the patients and
serve the clinic. The changes were made to the brochure and the project leader, nurse
practitioner, and medical director agreed on the delivery and timing of the project.

INFECTIOUS MONONUCLEOSIS: A HEALTH PROMOTION PROJECT

Auburn University Medical Clinic is a very fast paced clinic with limited time allowed
for extensive education. Therefore, the project leader formulated the health promotion project to
be adaptable so that they would receive education in-clinic and also have a brochure to take
away. The brochure also allowed for the opportunity to reach more than just the patient by the
project leader encouraging each patient to share the brochures with others. The in-clinic
education and the brochure were both aimed at health promotion with the focus of providing
awareness of what Mono is, how it is transmitted, and how each individual can avoid contracting
Mono.
Design of the Project
Articles were reviewed which looked at the use of health promotion brochures to
establish their usefulness and also to create the most visually appealing brochure. Harvey and
Fleming (2003) discuss the importance of knowing the audience when developing a brochure for
health promotion. They established that locally produced brochures offered a sense of pride and
identity which provided preference to locally produced brochures. Harvey and Fleming (2003)
found that picture and text box placement greatly influenced the audiences acceptance of the
brochure. Kools, Ruiter, Van de Wiel, and Kok (2007) also studied the use of brochures for
health promotion by using four different formats of brochures to develop the most accepted and
easily understood brochure. They stressed that a brochures design should allow for easy
information acquisition. This article used a multiple page brochure including a table of contents
with tabs, arrows, and the use of colors to distinguish which format was most accepted (Kools et
al., 2007).
In addition to the brochure, a generalized in-clinic education session occurred which
covered the key points of the brochure. The project leader orally covered background, risks,

INFECTIOUS MONONUCLEOSIS: A HEALTH PROMOTION PROJECT

symptoms, diagnosis, treatment, and prevention of Mono as well as general health promotion
awareness. All education and brochures were given by the project leader to ensure that there was
a standard and that the delivery and content was the same for each patient interaction.
Recruitment of patients consisted of college-aged young adults, male and female who presented
to AUMC for care. The project leader worked with two nurse practitioners to approach patients
about the health promotion project and to ask for their participation. The patients were informed
that it was for educational purposes, would only take a few minutes, and all data collection
would be unidentifiable. They were told that the health promotion project would consist of a
brief in-clinic education session with a brochure and followed by a six question survey which
they would complete alone in their clinic room. The goal of the project was to collect thirty
surveys within a timeframe of two weeks. A total of thirty patients were utilized with eighteen
females and twelve males. The majority (twenty-two) of patients were at AUMC for respiratory
related complaints with the remaining seeking care for gastrointestinal, dermatological, or mental
health concerns.
Delivery of the Project
Mitchell and Courtney (2005) discuss Knowles Adult Learning Theory and evaluate the
use of a brochure based on that theory. Knowles Adult Learning Theory focuses on the needs of
the learner with self-directed learning allowing the adults to be in control of their own learning.
Six elements make up the model of Adult Learning Theory which are a need to know,
responsibility for personal learning, the use of experience as a resource, the relatedness to ones
own life, the motivation to learn, and problem-centered learning (Mitchell & Courtney, 2005).
These six elements and the learning theory provide that adults need the information to be

INFECTIOUS MONONUCLEOSIS: A HEALTH PROMOTION PROJECT

relevant to their life and meaningful to their situation; therefore, providing a theoretical
framework for the health promotion project with the population of young adults.
As with the articles discussed above concerning brochure production, Mitchell and
Courtney (2005) ensure that their brochure based on Knowles theory was at adequate reading
level, was visually appealing, utilized suitable sized font, and had headings for the ease of
readability. The article states that the brochure provided a useful framework to utilize and
recommended the use of a brochure to become standard practice (Mitchell & Courtney, 2005).
Their article and brochure in the study was aimed at intensive care unit discharge transfer to
general medical floors; however, the use of a brochure based on Knowles Adult Learning
Theory was significant for this health promotion project. The six elements were incorporated into
the health promotion by tailoring the brochure to only have need to know information and
applying the topic and key points to their lives as college students. The brochure allowed the
patient to hold the responsibility for personal learning, the motivation to learn, and problemcentered learning focused on prevention of Mono.
Evaluation of the Problem
Evaluation of the health promotion project was completed by the use of a six question
survey (see Appendix B). The survey assessed the patients knowledge prior to education and
brochure as well as after the in-clinic education and brochure specifically concerning symptoms
and transmission of Mono. There was also a short answer question on the survey which asked for
the patient to name two health promotion activities they could perform to decrease their chances
of being diagnosed with Mono. Ten of the thirty patients had been previously diagnosed with
Mono. Eighty percent stated they knew Mono symptoms before education, and one hundred
percent stated that they knew symptoms associated with Mono after education. Ninety-three

INFECTIOUS MONONUCLEOSIS: A HEALTH PROMOTION PROJECT

percent prior to education increased to one hundred percent after education on how Mono was
transmitted. The short answer question on the survey allowed the project leader to evaluate what
stood out to the patients most as health promotion strategies. The most common answer was not
sharing drinks followed by washing hands and getting adequate sleep. Eating a balanced
diet and not sharing eating utensils and food were also common answers.
Conclusion
The survey allowed for evaluation of the in-clinic education accompanying the brochure
as a health promotion project with the purpose of preventing Mono in college-aged students at
AUMC. The culture of AUMC, the nurse practitioner, the Adult Learning Theory, and the
research on development of a brochure all influenced the design and delivery of this project.
Mono is an illness that can have decreased diagnoses by simply providing the education on
Mono viruses, their symptoms, and most importantly how to prevent Mono. By providing this
information to college-aged patients and giving them a brochure that would allow them to share
among their peers this project is able to deliver health promotion education. This was a very
small project that used a simple brochure, basic recruitment, uncomplicated data collection, and
straightforward evaluation within a small timeframe; however, this project provided that by
taking a few minutes to educate the patient on an illness and provide general health promotion
activities, providers can increase patients knowledge.

INFECTIOUS MONONUCLEOSIS: A HEALTH PROMOTION PROJECT

References
Auburn University Medical Clinic. 2014. Infectious Mononucleosis Education. Retrieved from:
Auburn University Medical Clinics education database.
Balfour, H., Odumade, O., Schmeling, D., Mullan, B., Ed, J., Knight, J., & ... Hogquist, K.
(2013). Behavioral, virologic, and immunologic factors associated with acquisition and
severity of primary Epstein-Barr virus infection in university students. The Journal Of
Infectious Diseases, 207(1), 80-88. doi:10.1093/infdis/jis646
Centers for Disease Control. 2014. Epstein-Barr Virus and Infectious Mononucleosis.
Retrieved from: http://www.cdc.gov/epstein-barr/about-mono.html
Dunphy, L.M., Winland-Brown, J.E., Porter, B.O., Thomas, D.J. (2011). Primary Care: The Art
and Science of Advanced Practice Nursing, 3rd ed. F.A. Davis: Philadelphia.
Harvey, H., & Fleming, P. (2003). The readability and audience acceptance of printed health
promotion materials used by environmental health departments. Journal Of
Environmental Health, 65(6), 22-28. Retrieved from:
http://eds.a.ebscohost.com.spot.lib.auburn.edu/ehost/
Kools, M., Ruiter, R., van de Wiel, M., & Kok, G. (2007). Testing the usability of access
structures in a health education brochure. British Journal Of Health Psychology, 12(Pt 4),
525-541. Retrieved from: http://eds.a.ebscohost.com.spot.lib.auburn.edu/ehost/
Goolsby, M. J., & Grubbs, L. (2011). Advanced assessment: Interpreting findings and
formulating differential diagnoses. Philadelphia: F. A. Davis.
Mitchell, M. L., & Courtney, M. (2005). Improving transfer from the intensive care unit: The
development, implementation and evaluation of a brochure based on Knowles Adult
Learning Theory. International Journal Of Nursing Practice,11(6), 257-268.
doi:10.1111/j.1440-172X.2005.00533.x
Willis, J. (1998). Mono: Tough for teens and twenty-somethings. FDA Consumer, 32(3), 32-35.
Retrieved from: http://eds.a.ebscohost.com.spot.lib.auburn.edu/ehost/

INFECTIOUS MONONUCLEOSIS: A HEALTH PROMOTION PROJECT

Appendix A
Cover of Brochure

Inside of Brochure

10

INFECTIOUS MONONUCLEOSIS: A HEALTH PROMOTION PROJECT

11

Appendix B

Mononucleosis Brochure Survey

Please circle the answer to questions 1 5. Please write short answers to question 6. This unidentifiable information will be used
for an educational project within the Primary Care Nurse Practitioners course.

1. Have you ever been diagnosed with Mono before?

Yes

No

2. Previous to the brochure, did you know what the symptoms of Mono
were?

Yes

No

3. Previous to the brochure, did you know how Mono was transmitted?

Yes

No

4. After the brochure, do you feel that you better understand the symptoms
of Mono?

Yes

No

5. After the brochure, do you feel that you better understand ways to
prevent getting Mono?

Yes

No

6. Name two health promotion things you can do to decrease your chances
of being diagnosed with Mono.

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Comments: ______________________________________________________
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Lauren Smith- Auburn University School of Nursing- Primary Care Nurse Practitioner Student