Public health and health promotion a case study on obesity

Introduction

In the recent era of globalisation, health promotional activities and policy documentation are playing crucial role in order to improve the life style of the individuals and support the social communities across the globe to maximise their wellbeing. The health care professional and policy makers try to improve activities related to health promotion in the society in order to promote healthy life style as well as improve their wellbeing in long run (Newman et al., 2016). Through the health promotional activities and policy documentation, the health care professionals aim at supporting the individuals and sharing the important information to tackle the health care issues. The aim of the study is to analyse the particular issues, where most of the people in the recent years are suffering from. The major health issues in the recent era of globalisation is obesity, where the people are suffering through weight gain and other obesity related problems which further deteriorate the living condition as well as the physical and mental health of the individuals. It is hereby the role of the health care policy makers such as World health Organisation (WHO), Public Health England (PHE) and National health Service (NHS) to develop health promotional activities in the society so that he individuals can raise concerned about leading healthy life style and stay healthy to improve their standard of living. The care professionals and soil policy makers are also efficient to develop the policy implication and executive the ethical code of conduct in the health care system in order to manage safety and security of the individuals in the society, who are suffering from obesity. .

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Public health issue

The major public health issue, where most of the people across the globe are suffering is obesity. The individuals face physics and mental health issues, related to obesity. Obesity is medical condition in which excess body fat has accumulated to the extent and it has adverse effects on the heath condition of the people. It is defined as body mass index (BMI) where the health care professionals try to assess the condition of the patient through calculating BMI rate. BMI rate under 18.5 is considered as underweight, 18.5 to 24.9 are considered as normal, 25.0 to 29.9 are considered as overweight. The BMI rate 30.0 and above is considered as obesity, where the people are suffering from excess weight and it has adverse impacts on the physical and mental health condition. As per the estimation, in 2020, 83% men and 72% female are overweight or obese, which is a great concern of the policy makers and health care professionals as it has several negative impacts on the health condition and it further deteriorates the standard of living of the individuals. On the other hand, the obesity rate in the UK in the year of 2017 was 28.7% people are obese and further 35.6% people are overweight. It is increasing over the period of time, where there are huge numbers of population, who are suffering from obesity. The major health impacts of obesity are hypertension, liver diseases, kidney disorder, heart diseases, mood disorders, cancer risk, the risk of dyslipidemia, refractive disorders and type II diabetes, which are major health disease from which the people may suffer in long run due to obesity. On the other hand, it has also mental health impacts where the mental issues are related to negative self worth, lack of motivation, social isolation, insomnia, social stigma, helplessness, severe depression, anxiety, stress disorder, mood swing leading to bipolar patients and self consciousness (Walter et al., 2018). These are the major mental issues, where the individuals are suffering from due to obesity. Hereby, the numbers of people suffering from obesity is increasing at a rapid rate across the globe and it further raise serious health issues, including physical and mental. There is serious health issues which may affects the standard of living of the individuals and it further deteriorate the mortality rate of the country. On the other hand, the percentage of people suffering from mental health issues is also increasing over the years, where the people are suffering from depression, insomnia and anxiety disorder.

Determinants of health

There are different determinants of health which have crucial impacts on the physical and mental health condition of the individuals. The major determinants are economic stability, health care system, education, personal health care plan, neighbour and environment as well as social and community context. The economic status has crucial impacts on the health condition, where there are some people who cannot access healthy food and thus deteriorating the health condition. The social condition and health care practice among the individuals are also playing crucial role for the heath issues. Apart from that, personal habit is playing a serious role affecting the health condition. In this regard, the major causes of obesity among the people are physical inactivity, overeating, bad food intake habit, genetics, a diet with high carbohydrates, medications, frequency of eating, psychological factors and also there are other diseases for which the people are suffering from obesity such as polycystic ovary syndrome, hypothyroidism, insulin resistance, and Cushing's syndrome (Waters et al., 2018). Hence, the other determinants of the health issue of obesity are bad food intake habit, lack of proper dietary plan, physical inactivity, and lack of daily exercise, which raises the issue of obesity among the peo

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The Legal and Ethical Framework for Medication Management

For prescribing the medication the guidelines of NICE and national policies of Medicine and Healthcare Product Regulatory Agency (MHRA) are followed. In 1964 MHRA and the Commissions on Human Medicines inaugurated the yellow card scheme to report any side effects of medications. Moreover, the National Reporting and Learning System (NRLS) was organised in 2010 by the National Patient Safety Agency for monitoring the aspect of patient safety in England and Wales. In the year, 2014 NHS, England and MHRA jointly issued an alert namely the Patient Safety alert improving medication error reporting and learning to improve the quality of the reported data and also to minimize the medication error. The drug aspirin should not be administered with blood-thinning agents such as clopidogrel or warfarin as this might result in bleeding problems. Consultation with the physician is advised before the administration of aspirin with medication for pain and inflammation such as prednisolone and ibuprofen. According to NIH, consultation should be made with the physician before the administration of aspirin in case of elderly and peptic ulcer patients. Moreover, updates had been observed from the legal bodies as mentioned by the Irish Medicines Board Act, Act No. 3, 2006 and Medicinal Products Regulations 2007 (SI 201 of 2007) for granting the permission to nurses concerning the prescription of medicines. According to the 2007 regulation guidelines, Personal Identification Number (PIN) should be provided within the prescription. The legal guidelines for the prescription and administration of medicine were formulated by the Medicine Act, 1968 by following the NMC code, 2007. Aspirin is an over the counter medication in the UK. The best practice guidelines by MHRA for sales regulation of the pain relief medicines should be controlled for a maximum of two packs per transaction. Training should be conducted on staff regarding the restrictions and the way of dealing with customers who want to buy more quantities of drugs. These restrictions are implemented as there is evidence that people sometimes use large quantities of medicines in an impulsive manner. Therefore, restrictions on the availability of the medication will eventually reduce the number of hospital admissions and death associated with accidental or impulsive overdose. As per law the maximum pack size of pain relief medications in the general sales outlet consist of 16 tablets. More than 32 tablets can be prescribed after consulting a pharmacist and it is considered to be illegal to sell 100 tablets of aspirin at one retail transaction. According to the UK Medicine Control Agency, aspirin use is banned under the age of 16 years because it is associated with Reye's syndrome which is a rare but fatal disorder among children and adolescents (ABA, 2000; ABA et al, 2005; Bulechek, et al, 1999; Nursing Board, 2000; Alexis, et al, 2013). The trade name of the drug is aspirin and the generic name is acetylsalicyclic acid (ASA). According to NIH, aspirin was recommended by the clinician for the cardiovascular-related disease at a low dosage on everyday basis. It is evident that the use of drug aspirin can prevent recurrent stroke or heart attack. However, recently few researches have reported that the daily use of aspirin is associated with increased risk of bleeding. In the United Kingdom, aspirin is used as a pain killer and is available as the over the counter medication. It is also used to treat the symptoms of flu and to control the fever. Therefore, aspirin was considered as the chosen drug for the present study (Leonards, et al, 1965). Aspirin can be stored at room temperature (20 C to 25 C) and in a sealed container to avoid excess heat and moisture. The medication should be kept beyond the reach of children. According to the guidelines of the UK, unnecessary medication should be returned to the chemist or pharmacy for safe disposal. It should not be flushed down the toilet and also should be disposed of into the dustbins as pets, children and other people can access the medicines and can also accidentally consume the product. Therefore, the most preferred way of disposal of medicine is through medicine take-back programme (Leonards, et al, 1965). The preferred route of administration of aspirin is via the oral route as a short-acting tablets or delayed-release tablets. However, it should also be noted that the drug aspirin should not be chewed as it increases the chances of stomach upset. For the antiplatelet therapy, 75 -100mg of aspirin is recommended after the myocardial infarction. For the acute ischaemic stroke patients, an initial 300mg dose of aspirin is administered for 2 weeks. Similarly for the patients of transient ischaemic attacks 75 -100mg of aspirin is administered as a replacement of clopidogrel. On the contrary, it is also stated that aspirin should not be administered longer than 10 days if it is self-prescribed (Ramsay, 1999). The most common associated side effects of aspirin is severe nausea, vomiting, pain in the stomach, blood with cough or vomiting, rapid breathing and seizures. The daily dose of aspirin may increase the chance of bleeding stroke, gastrointestinal bleeding and other medication-induced allergies. The nurses also have certain roles to play before the administration of aspirin. They should evaluate pyrexia and pain one hour prior to the administration of the aspirin. If the drug is applied for a long term, then nurses should monitor the functioning status of liver and kidney along with ototoxicity. The list of other medication should also be considered before the administration of aspirin as ibuprofen and other NSAIDs such as naproxen or diclofenac cannot be administered together as it may cause intestinal bleeding and ulcers (Silagy, et al, 1993; Hochain, et al, 2000; Stevenson, et al, 1996). The Patient Group Directions (PGD) is a legal structure that permits some of the registered health professionals for supplying and administering certain medications to a specified group or a predefined group of patients without the consultation of a prescriber. It is a written instruction specifying the sale, supply and administration of the concerned drug in a clinical situation. As per the guidelines of NHS, the drug aspirin 300mg can be considered within PGD in case of the emergency treatment for the chest pain in acute coronary conditions. The PGD of aspirin 300mg excluded those patients, who are sensitive to aspirin, have active bleeding problems or major bleeding disorders such as Haemophilia, had a history of acute bronchospasm due to the use of aspirin and for the pregnant patients. The drugs that are excluded from PGD include all unlicensed medications and radiopharmaceuticals (Kaufman, et al, 2010). Self-administration of medication (SAM) is described as when the individual within home care can look after their condition and can administer their medicines. The nursing staff should consider the opinion of the person regarding the choice of the medicines and also the associated risk with it. The advantage associated with SAM is that the individual can receive the new drug therapy under the supervision of nursing and pharmacy staff who will provide the necessary required information to the patients and about the ways of taking drugs before the patient is discharged from the hospital. The disadvantages associated with SAM that the pharmacists have to dispense the medicines in different bottles which is a labour-intensive task. Moreover, some patients perform incorrect diagnosis, may miss their medication or sometimes impulsively administer an overdose of medicine which may result in the associated adverse reactions. The drug aspirin is suitable for the use in SAM scheme. Therefore the nurses should educate the patients and the families about the medication, adverse reactions, the significance of dosage and adherence to strictness to prescription. Written instructions should be provided with the verbal communications and the family or carers of the patient should also participate in the SAM (Manias, et al, 2004). .

Policy documentation

There is national and international policy framework to support the individuals suffering from obesity. The heath care professionals including WHO, PHE and NHS and other local professionals and care givers are collaborating with each other for better understanding about the health issues, among the individuals so that they would be able to develop proper planning and create policy and legislations for supporting the individuals and tackling the issue successfully. The primary aim of WHO is to monitor the health issues and address the causes of obesity is as behavioural and socioeconomic factors. The organisation is efficient to restructure the policy documentations in order to support the individuals suffering from obesity. As per the Global Status report, it is a non-communicable daises and WHO was successful to develop European Food and Nutrition Action Plan 2015-2020. The WHO European Food and Nutrition Action Plan 2015-2020 is effective to review the policy documentation and monitor the quality of food and nutrition of ultimate promotion of the health and wellbeing across the social communities. Investing in children: the European child and adolescent health strategy 2015–2020 is another international policy taken by WHO, which aims at investigating the nutrition and food value of the children, where they provide proper support and share the important information to guide the children in the society. In order to tackle the issue of child obesity this legislation is effective for the organisation to promote healthy life style and improve the quality of food and nutrition intake among the children (World Cancer Research Fund International, 2013). Action Plan for implementation of the European Strategy for the Prevention and Control of No communicable Diseases 2012−2016 is also appropriate to take corrective measures for promoting healthy life style and supporting the individuals for better management of their physical and mental health. In this regard, the policy framework convention of international treaty is established for developing proper guidelines, principles and value, where the regulating speech is important (Witten, 2016). The government of the UK as well as other countries across the globe focus on restricting the marketing on children and other firms of commercial promotion which may attract the children for having high calories and sugar related food

Regulation on the use of nutrition and health claims for advertisement is also restricted in the market where the government put proper restrictions of wrong promotional activities related to health claims and nutrient values in the food items. The government of the countries across the globe are also concerned about the standard of nutrition labelling, calorie labelling in the restaurants, public awareness campaign and nutrition counselling in the primacy care. These are the major policies implemented in the economy to support the individuals and help them to reduce their weight in order to mitigate the dangerous impacts of obesity on physical and mental health (Gov.UK. 2015). In addition to this, there is regulating conduct in the countries, where the government encourages proper set up of the nutrient and food based standard as well as the use of measures to address affordability of the food items is also conducted in the economy, so that the people can access the fresh food items rather than preservative one. The government also focuses on measuring the nutrient value and quality of the food items through reformulation, calorie reduction, agriculture and supply chain subsidy and incentives as well as protein size limits which are playing crucial role to improve the quality of food in the economy. Healthy retail environment management is also another initiative taken by the policy makers and health care organisations to support the retail food management system so that the quality of the food items can be improved. There are other international health policies through which the government as well as the WHO and other health care institution try to be collaborative and cooperative for better management and tackling the issue of obesity. Labelling is the international policy where the nutrient list needs to be attached in the proper instruction. Marketing is another strategy of the health care providers where there is restriction on television advertisement of unhealthy food items to reduce the amount of advertisement, which raises the activities of convincing evidence based advertisement influencing the food preferences and purchase behaviour of the customers in the society. The government also provides subsidy to the useful and healthy products which further reduce the market price of the products and further attract the audiences at the market. It is necessary for the organisation to set lower price for the healthy food products to attract the customers and improve the healthy food consumption behaviour in long run. The UK government is one of the successful agencies to support the people suffering from obesity. The PHE initiated the programme named chage4life to introduce intervention plan and the promotional activities are encouraging the public of the England. The aim of the program is to support the individual to tackle the issue of obesity in the England. The program is already successful, where over the 1 million customers has subscription of attending the program and the success rate is also high, where the government influence the individuals of England for healthy eating habit and healthy life style. On the other hand, the government released calorie reduction strategy, where food industry needs to reduce 20% calories from their food tens within 2024. It is also effective initiative, taken by the government of the UK to support the individuals and influence them to manage healthy food habit and low calories food intake. On the other hand, in the year of 2014-2015, NHS has spent £6.1 billion on overweight and obesity-related ill-health, which is also another effective initiative taken by the NHS to tackle the issue of obesity (WHO, 2020a).

Health promotional activities

There are many health and social care organisations who try to develop health promotional activities with proper management of the guidance provided by the national and international care professionals and guidelines, provided by WHO (Conte et al., 2017). School setting is the program for promoting healthy life style. In order to tackle the health issue of obesity, it is necessary to change the behaviour of the children and improve their understanding about healthy food intake. In this regard, the government try to arrange school setting program as well as restrict the consumption of high calorie food at the school. There are many schools primary and secondary, which restrict the children to take high calories food at school, which further helps them to consume healthy food items and improve their concern about healthy eating behaviour. Hence, school intervention program is arranged by the help of the local health care organisation and the government to raise awareness among the children and also among the parents to stay healthy and improve their activities in daily life for reducing the chance of being obese. On this context, it is also effective strategy for the school authorities to increase the school play activities and ground related games which further influence the students to take active part and improve their daily activities and this further improve their health condition and reduce the chance of obesity. Weight management program is also necessary to be introduced at the school, which is

also effective for the children to manage their weight through proper dietary planning and improving health food consumption behaviour (Hearn et al., 2017). In addition to this, multi-component school-based intervention is another important planning, which is effective to increase the food intake habit, where the policy makers influence the students to increase the consumption of fresh fruits and vegetables which are good for health. Intervention related to restriction of high calories food, soft drinks also influence the students for managing their food intake behaviour and lead a healthy life further (WHO, 2020b). On the other hand, counselling at primary care is another health promotional intervention which is also fruitful for the social communities across the globe. It is necessary for the health and social care professionals to arrange counselling session for the patients who are coming for primary check up. It is mandatory for arranging counselling so that they can overcome the issue and mitigate the chance of diabetes and their health problems. In the counselling session, it is the role of the counsellor to share important information related to obesity, first of all, it is necessary to share the consequences of obesity among the people and adverse impacts of obesity on the physical and mental health. Apart from that it is mandatory to provide proper advice to stay healthy and in this regard, the counsellor must influence the individual about leading healthy life style through healthy food habit. The speech therapy in thy counselling session is also mandatory where the counsellor is successful to manage the patients and improve the quality of life. In this regard, the policy framework is implemented and the counsellor aims at creating values for the patients by proper empowerment and developing patient centred care (Johnson, 2017). The counsellor also tries to respect the individual and improve integrity and transparency during the counselling the session, the counsellor also tries to maintain accountability and provide equal treatment to all the patients which are effective for successful health promotion. The counsellor also focuses on influencing the patients and advice them to conduct daily exercise and other activities to engage in the society and lead the healthy life successfully (WHO, 2020c). It is essential to improve the dietary planning of the individuals, who are suffering from obesity and for this, the counsellor must provide the information about the healthy food items, avoiding the high calories food, soft drinks and preservative food as well as the information related to healthy food items, fresh fruits and vegetable content are helpful for the individuals to increase their concern and manage their dietary plan successfully. There is also great role of the dietician

in supporting the patient coming for primary check up. In order to mitigate the chance of other serious physical and mental health consequences, it is mandatory to develop dietary plan for the patients, it is necessary to develop individual dietary plan where the patients can improve their life style and eat the healthy food items. In this regard the dietician needs to empower the patient and develop patient centred care plan for them before the dietary plan, it is important for the dietician to acknowledge the life style of the patient, the food items available in the locality, demographic and cultural background, economic status and personal preferences, which are mainly the social determinants of health. Without acknowledging theses information, it is difficult for the dietician to develop the dietary plan (Samara, Andersen and Aro, 2019). For this, developing patient centred care s mandatory for the dietician to make effective patient diagnoses and develops care plan and dietary chart for improvement of the health condition of the individuals. In this context, the health promotional activities are hereby beneficial, where the counsellor at the primary care and the dietician are playing crucial role to manage the individuals, who are suffering from obesity in the society. Television advertisement is another strategy for successful heath promotion, where the government and the WHO share effective information for the benefit of the society. The social communications can improve their understanding and knowledge about healthy life style. There are other treatment of managing obesity, medication without any side effects, and other guidelines, which are necessary to be shared through the televisions advertisement. The policy makers and the health care institutions also focus on promoting the low calorie food items which also influence the individuals to take food as per proper calorie so that they can tackle the issue of obesity. On the other hand, there are some public organisations across the globe, which provide guidelines to stay healthy and intake low calories food, fresh fruits and vegetables to stay healthy and improve the standard of living of the individuals. On the other hand, the health promotional strategy of social media promotion is also effective for influencing the individuals and raising awareness among the social communities across the globe. In the recent era of globalisation, social media such as Facebook, YouTube, twitter and Blogs are playing important role for enhancing two way communications which further helps to share important messages to stay healthy (Bullivant et al., 2019). There are social media advertisement of the private and public health care organisations to support the individuals with proper guidelines for managing obesity. On the other hand, there are some mobile application and YouTube videos, for free

dietary plan which also influence the individuals to control their calories intake and increase the healthy food habits. Additionally, there are some mobile application and also YouTube videos from the private institutions or public sponsored gym which provide free advice about free hand exercise at home, which is one of the effective ways in the recent years to stay healthy and tackle the issue of obesity. Apart from that, the health care professionals try to influence the social communities for better life style through dietary plan, daily exercise and other activities to stay healthy. Arranging health campaign is another important health promotional activity apart from the policy documentation, where the social workers try to provide the message of healthy life style and improving standard of living condition among the people across the social communities. There are any health promotional campaigns which are free for the individual to attend for improving their awareness about the health issue of obesity and under the practice through which the problem of obesity can be mitigated among the individuals (Lavie et al., 2018). In the recent years, there are also some paid campaigns which deliver individuals care plan for staying healthy and influencing the people to improve healthy food habit to manage their health condition and overcome the issue related to obesity. Increasing the healthy food consumption, doing the home exercise, school setting system as well as participation in the social activities is effective for the people to tackle the issue and improve their physical and mental health condition. It also helps to improve behavioural change activities, where the behaviour of the individuals is also changing over the time, where the counsellor and the health professionals influence the people by giving proper advice and sharing the important messages with them to stay healthy and maximise their wellbeing in long run (WHO, 2020c).

Conclusion

Through the above discussion, it has been explored that obesity is one of the major issue in the recent era of globalisation, where most of the individuals across different social communities are suffering from obesity due to unhealthy lifestyle, bad food habit, lack of exercise, and daily activities, laziness and lack of awareness to stay fit and healthy. It is the role of the health policy makers and health professionals and social workers to develop proper intervention planning in order to support the individuals for tackling the issue of obesity. The international and local policy documentation related to obesity are contributing factor where the WHO as well as PHE, NHS and local professionals are collaborating with each other to influence the social communities to stay healthy and improve their standard of living. On the other hand, the health promotional activities through school setting, counselling at primary care, providing dietary chart, social media promotional activities, social media health care campaign as well as the online website and mobile application for diet plan and exercise at home are effective intervention for influencing the individual to manage their heath condition and tackle the issue of obesity so that they can improve their food intake habit, stay healthy and maximise their standard of living.

Reference List

Bullivant, B., Denham, A.R., Stephens, C., Olson, R.E., Mitchison, D., Gill, T., Maguire, S., Latner, J.D., Hay, P., Rodgers, B. and Stevenson, R.J., 2019. Elucidating knowledge and beliefs about obesity and eating disorders among key stakeholders: paving the way for an integrated approach to health promotion. BMC public health, 19(1), pp.1-10. Conte, K.P., Groen, S., Loblay, V., Green, A., Milat, A., Persson, L., Innes-Hughes, C., Mitchell, J., Thackway, S., Williams, M. and Hawe, P., 2017. Dynamics behind the scale up of evidence-based obesity prevention: protocol for a multi-site case study of an electronic implementation monitoring system in health promotion practice. Implementation Science, 12(1), p.146. Gov.UK., 2015. Policy paper 2010 to 2015 government policy: obesity and healthy eating. [online] Available

https://www.gov.uk/government/publications/2010-to-2015-government-policy-obesity-and-healthy-eating/2010-to-2015-government-policy-obesity-and-healthy-eating

Hearn, L., Miller, M., Campbell-Pope, R. and Waters, S., 2017. Preventing overweight and obesity in young children: synthesising the evidence for management and policy making. Johnson, K., 2017. Smoking, alcohol and obesity: Health promotion opportunities relevant to acutely ill vascular and urology patients. Links to Health and Social Care, 2(2), pp.52-65. Lavie, C.J., Laddu, D., Arena, R., Ortega, F.B., Alpert, M.A. and Kushner, R.F., 2018. Reprint of: healthy weight and obesity prevention: JACC health promotion series. Journal of the American College of Cardiology, 72(23), pp.3027-3052. Newman, L., Ludford, I., Williams, C. and Herriot, M., 2016. Applying health in all policies to obesity in South Australia. Health promotion international, 31(1), pp.44-58. Samara, A., Andersen, P.T. and Aro, A.R., 2019. Health promotion and obesity in the arab gulf states: Challenges and good practices. Journal of obesity, 2019. Walter, L., Dumke, K., Oliva, A., Caesar, E., Phillips, Z., Lehman, N., Aragon, L., Simon, P. and Kuo, T., 2018. From tobacco to obesity prevention policies: A framework for implementing community-driven policy change. Health promotion practice, 19(6), pp.856-862. Waters, E., Gibbs, L., Tadic, M., Ukoumunne, O.C., Magarey, A., Okely, A.D., de Silva, A., Armit, C., Green, J., O’Connor, T. and Johnson, B., 2018. Cluster randomised trial of a school-community child health promotion and obesity prevention intervention: findings from the evaluation of fun ‘n healthy in Moreland!. BMC public health, 18(1), p.92. WHO, 2020a. Policy. [online] Available at:

http://www.euro.who.int/en/health-topics/noncommunicable-diseases/obesity/policy

on 1 may 2020]. WHO, 2020b. Childhood overweight and obesity. [online] Available at: https://www.who.int/dietphysicalactivity/childhood/en/ [Accessed on 1 may 2020]. WHO, 2020c. Controlling the global obesity epidemic. [online] Available at: https://www.who.int/nutrition/topics/obesity/en/ [Accessed on 1 may 2020]. Witten, K., 2016. Geographies of obesity: environmental understandings of the obesity epidemic. London: Routledge. World Cancer Research Fund International, 2013. LAW AND OBESITY PREVENTION: Addressing some key questions for the public health community. [online] Available at: https://www.wcrf.org/sites/default/files/WCRF-International-Law-and-Obesity-Prevention.pdf [Accessed on 1 may 2020].


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