Community Health and Population-Focused Nursing

Primary Community and Resources It Has

I spent community hours evaluating resources accessible for people beginning with pregnant women and ending with elderly citizens. The initial meeting was held with the representative from the Miami-Dade County Health Department. The agent informed me that the choice of focus areas is contingent on the CDC findings of Healthy People 2020. The representative mentioned that the issues were disseminated from the federal government to the state level and further to every county. The counselor emphasized that the necessary judgments had been done at the county level, and that specific needs were addressed with the relevant approaches. Findings were later passed on to federally supported providers, which allowed focusing on the issues at the individual level within facilities.

The classes I attended were held at a federally funded health center, Jessie Trice Community (JTC). At the JTC, I had an opportunity to watch nutrition lessons for pregnant women. The major reason for instruction was to teach those patients about proper nutrition prior to giving birth in order to prevent infant and childhood obesity. Additionally, future mothers from low-income families were recommended the WIC program. Almost all of the attendees were females, but there was one male participant.

Another crucial class I observed at the JTC was called food and vegetable prescription. Advertisements of that campaign could be seen all around the hospital. The program’s referrals were grounded in BMI and were also based on survey results. The class was created for children and parents so that they could be instructed about the healthy diet. A personal meeting of patients with the nutritionist preceded the class. Next, they attended the program for twelve weeks, where they were educated on preparing healthy and quick meals. At the end of the course, each attendee received a free bag of fresh vegetables and fruits.

Other important classes suggested at the JTC were focused on patients suffering from hypertension or diabetes and on senior citizens. The specialist responsible for those projects informed me that the attendance was rather high in the beginning, but it usually fell by the end of the 12-week period. On the average, 10-15 individuals would start the class, and only 23-5 would complete it. The majority of students were of African American or Caribbean descent. The most common reasons for quitting a class were the lack of interest when incentives were no longer offered, transportation difficulties, safety issues in the neighborhood, and the frequency or duration of classes. What concerned the number of participants, it was most likely low due to insufficient advertising. In particular, there were many posters inside the clinic, whereas there were none outside of it.

To analyze the situation with school-aged children, I communicated with the director of activities at Miami Jackson Senior High School. The population of that neighborhood was composed of nearly 85% of Hispanic children and 15% of African American ones. From the director, I found out that for all children in Miami-Dade County, physical activity lessons were compulsory starting with elementary school and up to high school. She also told me that there were no fried foods offered in the dining-room, but snack machines had chips and baked Cheetos.

The next thing I inquired about was whether children had nutrition classes. The director of activities said that students learned about nutrition at anatomy and physiology lessons, as well as at science lessons. However, she failed to explain how the mentioned courses could help children to become aware of healthy food choices. Also, I attended a physical training lesson and communicated with the teacher. She told me that there were 52 children in the class, which was twice as many as a regular class had. Upon observing a lesson, I realized that the majority of schoolchildren were not engaged in physical activities. Moreover, some of them could be seen drinking soda or eating snacks. The teacher said that because of a large number of students, her main duty was not teaching but making sure that they did not fight.

Another valuable piece of experience was gained through visiting Our Kids, the leading foster care agency in the county. I aimed to evaluate how healthy nutrition problem was handled among the mentioned population group. The nurse supervisor explained that obese children did not receive support from a nutritionist because such services were not compensated by Medicaid. However, there were classes on healthy eating habits and exercises for which foster parents could sign up their children. At those classes, they used to analyze the basic nutrition with the help of “my plate” approach. I noticed that many of the parents were obese and required support, too.

The next observation was at Key Biscayne K-8, where I watched a nutrition class conducted by the health department nurse to 5-6-year-olds. Children were taught to drink up to 8 cups of water daily. A pre-test and post-test were performed, the latter demonstrating better results. Still, my observation allowed concluding that those children’s eating habits would not alter dramatically. The nurse said that if a child’s BMI was too high, a letter was sent to parents encouraging them to take their child to the pediatrician. However, when I witnessed a conversation between the nurse and one of the parents, I realized that the latter did not care much about BMI and obesity. The dietician of the school’s cafeteria told me that they cooked food in accordance with Miami-Dade County guidelines. They had vegetables and fruits, baked chicken with brown rice, white bread, and low-fat ice-cream. During the observation, most children did not eat vegetables and did not seem to enjoy the food in general.

The next stage was going to a park in a low-income neighborhood in West Perrine. There, I observed physical activities, the majority of participants being African American children. I had an opportunity to communicate with the founder of the project, who informed me that it had been sponsored by the Alfred Family Foundation. The campaign’s leader explained that initially, it was a program aimed at breast cancer prevention started because of his sister’s health issue. However, they added other health problems to their agenda, obesity prevention being one of them. The class, which was free of charge, was held each Saturday between 1 p.m. and 4.30 p.m. Various age groups of schoolchildren joined the project initiated by the foundation. I could observe girls working with the trainer and boys playing soccer.

Trainers were children’s role models because they were of the African American descent. The campaign’s benefactor supplied children with protein bars and Gatorade. Instructors were in good shape, and children expressed the desire to be like their trainers and have “big muscles.” Parents admitted that children liked the project very much, and it was a great way of encouraging them to exercise. The time for classes was rather suitable, and the location was extremely convenient. When some of the parents could not attend, they could easily ask their neighbors to look after their child. One woman told me that her child had lost weight as a result of the program.

I also visited the health department, where I noticed a magazine featuring a chef on the cover. The caption read, “inspiring the world one chef at a time.” I reached that chef and was invited to a class dedicated to healthy eating. I could notice a significant disparity between the food prepared at that class and at the JTC health center. The ingredients were a little more expensive, but the dishes tasted much better.

The next important meeting was with the behavioral professional who specialized in children with autism. Because the population in the group was highly unique, each child received a personalized health plan. Autistic children are very ritualistic, so the preparation of a plan for each of such individuals required a thorough in-depth investigation. I was able to observe the evaluation of a child and the creation of a treatment plan by the specialist.

For older citizens aged 65 and more, I went to a nursing home located in a low-income neighborhood. There, I communicated with the nutritionist who told me about their meal plan. Upon speaking with residents, I realized that did not enjoy the meals at the nursing home. Moreover, they also admitted that they were offered no health-promoting exercises. When I attended a more upscale nursing home, I found out that they had no formal exercising program, but there were dancing nights. Residents of that nursing home seemed to like their food, giving particular preference to milkshakes.

My next destination was a community gym Youfit, which was a 24-hour health center. I went there to watch a Silver Sneaker class ─ a class for elderly citizens that can be accessed through the insurance plan. The project was designed to encourage elderly people to engage in physical activities. As a result, it was hoped that senior citizens would gain better control over their health. The eldest person I saw there was 95 years old, and he was in surprisingly good shape. Other attendees were 68 years old and more, and they tried to do everything, following the instructor. The trainer informed me that many of the members had cardiovascular issues, diabetes, or a history of hip or knee surgery. She emphasized that the mentioned issues had been taken into consideration when creating the plan of exercising.

All participants seemed happy about the program, and they attended the lessons regularly. Upon my inquiry, I found out that they did not receive any nutrition education. However, I was able to notice an instructor working with some people individually. I found out that trainers used to instruct some attendees about nutrition and obesity. I could see that the trainer measured the BMI of new customers and offered them nutritional support. I was told that such lessons cost about $15 per hour, and they were held two times weekly and lasted an hour. The instructor said that the lessons were advertised through word of mouth, and anyone from the community could apply for them.

The next gym I visited was in a middle-class neighborhood. There, I watched the classes and facilities available for the population. As I noticed, the majority of members were Hispanic, with only a few being African Americans. The age range was from 17 to 55, and there were both men and women. Upon the consideration, almost all customers had a normal BMI. Females were not exactly skinny, but they seemed to be in good shape and healthy. Males reported that they did not consider skinny women attractive or healthy. The gym’s manager said that they were advertising their services by different means to engage new members. I was also informed that there had been a rise in membership over the past few years due to people’s health consciousness growing. The gym did not have a dietician, but personal trainers offered their services to customers. However, the price, which constituted $40 per hour, was unacceptable for the majority of members.

All of the gyms that I attended were equally equipped. Still, in high-income neighborhoods, there are more gyms and alternative facilities and projects, such as kickboxing classes. Also, these localities offered Orangetheory fitness programs that involve measuring the heart rate to reduce weight. The aim of such a program is staying within the “orange” heart rate at which weight is beginning to disappear. Such classes cost nearly $100 monthly and involve three sessions per week.

With the aim of observation, I also attended grocery stores. I was able to note a remarkable disparity between more affluent neighborhoods, where a wide choice of fruits and vegetables was offered, and low-income localities, where opportunities were not so numerous. In one of the high-income localities’ grocery store, I even observed a healthy cooking class. Meanwhile, in low-income neighborhoods, there were few fresh vegetables and fruits. In one of such places, I could see flies around the seafood showcase. There were many products that were not very nutritious but had a high calorie intake.

Fundamental Causes

Nowadays, there can be noticed a growing concern and awareness that health problems are caused not so much by medical care as by social determinants of health. These determinants include physical, economic, social, and other circumstances impacting people’s health in which individuals work, study, live, or play. Some of the most dramatic and expensive health issues in the US are driven by such social determinants as food insecurity and poverty. In low-income families, children suffer from obesity, lead or tobacco exposure, food insecurity, and poor oral health. Some of the most common problems of this population group are the short stature or low birth weight (American Academy of Pediatrics, 2015, p. 77).

The rate of food insecurity in Hispanic and African American households is twice as high or even higher than in average Caucasian families: 27% and 25% as related to 11%. Such a disparity is conforming with the generally recognized varieties in obesity, hypertension, and diabetes among the mentioned groups. According to the CDC, the prevalence of obesity is 51% higher in African American population than in white population. For Hispanics, the rate is 21% higher than for whites. Results of the American Public Health Association’s research indicate that food-insecure families do not tend to limit their food intake but, rather, start relying on several basic products with poor quality. It is mentioned that to avoid hunger and sustain enough energy, individuals from impoverished households consume much cheap and high-calorie food that has very low quality (“Understanding hunger and obesity and the role for school-based health care,” 2011).

Evidence-Based Practice

The initiative that I would like to analyze from the point of view of evidence-based practice is the Kidz Bite Back campaign. This project aims at managing the problem of childhood obesity with the help of social marketing and prevention methods, paying particular attention to obesity prevention. Kidz Bite Back employs a comprehensive approach by joining five projects into one large campaign the target population of which is composed of children aged 9-11 and their parents. The five elements incorporated in the campaign concentrate on the largest triggers of childhood obesity, and they are:

• school environment;
• video game and television industries (Couch Potato companies);
• fast food and junk food industries (Big Fat industries);
• the effect of cultural norms;
• parents and household.

This fundamental project inspires children to challenge Couch Potato companies and Big Fat industries. Also, the campaign raises parents’ responsibility for their children’s health and weight. All elements of the program have been assessed independently and formally. The effectiveness of the project’s impact on changing behaviors, opinions, and attitudes of the target population has been proved. The methods included in the campaign are compelling and engaging. They have been inspired by the national “Truth” project aimed at fighting against teenage smoking.

The Kidz Bite Back campaign has been highly esteemed by the College of Public Health at the University of South Florida. Findings are nationally noteworthy, with most parents noticing that their children have started to consume fewer soft drinks and less junk food (72%). Other significant outcomes of the campaign are the reduced time spent on watching TV and playing games (68%), the increased consumption of vegetables and fruits (56%), and the elevated rate of physical activity (51%).

Establishing Data

The incidence of childhood obesity if the USA is disquieting. The prevalence of this health condition is reported to have increased by more than 10% over the last forty years (Cunningham, Kramer, & Narayan, 2014). The danger is specifically high for children living in low-income families (Gibbs & Forste, 2014). According to statistics, 16.9% of children and teenagers living in the USA in 2011-2012 suffered from obesity (Ogden, Carroll, Kit, & Flegal, 2014). The most vulnerable of them are those from African American and Hispanic origin (Ogden et al., 2014). Bad dietary preferences and insufficient physical activity are viewed as the main triggers t childhood obesity (Sahoo et al., 2015; Xu & Xue, 2015). As a result, the project will be concentrated on altering dietary habits raising physical activity levels of the children belonging to the target group.

Every fourth child in the USA aged 5-10 has high cholesterol, high blood pressure, and other alarming signs of heart disease. According to statistics, around 80% of young people that are overweight at the age of 10-15 will be obese at the age of 25. In minority groups, statistics are worse since they are affected by obesity 2-4 times as much as Caucasians. The present generation of children is expected to be the first one in the country’s history to be outlived by their parents. The major reason for such a phenomenon is obesity (Kidz Bite Back, 2011). Data provided by Florida Department of Health (2015) indicate that in 2014, students at middle and high schools in the state have a higher rate of obesity than young people in the country on average: 14.6% and 12.4%, respectively.

The Aim of the Social Media Campaign

The purpose of the campaign is the reduction of childhood obesity in Miami-Dade County for African American and Hispanic children from a low-income families background by 10 % by 2030. Because the health of children is the primary concern for their parents, the project will aim at reaching out for both of these population groups. The program will serve to suggest data approved by a dietician specifically for the selected target group.

Social Marketing Interventions

Out of a vast selection of obesity-reduction programs, diet interventions occupy a prominent place (Wang et al., 2015). Also, scholars remark that there is high productivity in health video games in changing children’s perspectives on food consumption (Lu, Kharrazi, Gharghabi, & Thompson, 2013). The combination of the two mentioned features has led to the idea of designing a diet-focused intervention grounded in social marketing mechanisms. Thus, the campaign will involve two methods: a video game app (for children aged between 3 and 12) and a trivia game (for adolescents aged between 13 and 17).

Rationale

The choice of interventions is related to children’s interests based on their age. The first reason for selecting games as methods is that they are more engaging than lectures. Also, when a child plays a game, he or she does not realize how serious the project is and, therefore, will not be afraid to participate in it. That is why two games were chosen for the campaign: a video game for younger children and a trivia game for older children. The ultimate goal behind the interventions is encouraging the target population to consume healthy food.

Social Media Platforms

In order to reach the target population’s attention, such social media platform as Twitter and Facebook will be employed. By using these websites, the campaign’s leader will be able to gain the attention of older participants as well as that of younger participants’ parents. The selected websites are among the most popular social platforms in the USA (Oh & Syn, 2015). Both Facebook and Twitter offer many opportunities for sharing data, receiving feedback, and encouraging others to visit the page of the campaign. Thus, the selection of platforms may be explained by the opportunity to invite a large number of users to the project. Even if one is not a member of the target population, he or she may know someone interested in such a program and send them a link to the campaign’s page. As a result, more and more individuals will be aware of the ways to help children suffering from obesity.

Advantages of Social Media Platforms

Benefits of using the two identified platforms are reflected in the table:

Benefits for the Target Population from the Health Message

The target population can gain several advantages from the health message. Firstly, children will be instructed about healthy food in the comfortable environment since they will be participating in the intervention from home. Also, much time will be saved both for children and parents since they will not need to commute. One more advantage is that there will be no stigmatization or teasing of the project participants since no one will know that they are engaged in the program. Another important feature is that along with playing a game, every child will receive valuable education. Lastly, it will be possible for participants to create chat groups and arrange diet and fitness challenges.

Best Practices for Social Media

The following approaches are considered to be most effective when implementing a social media program:

1. making a plan (structuring the project’s work in a way that will not leave any areas uncovered);
2. joining the parts (arranging the work of all constituents and making sure that there is a correlation between them);
3. paying attention and learning (accumulating feedback and making necessary corrections to enhance the work);
4. keeping in mind security aspects (making sure that data on the project’s webpage is reliably secured);
5. revising (reviewing losses and gains regularly, assessing achievements and altering negative aspects).

Roles and Responsibilities of Stakeholders

The project involves several groups of stakeholders, each of them fulfilling different duties and roles. The main participants are the community health nurse (the leader of the campaign), children suffering from obesity, their parents, the fitness instructor, the dietician, and the IT specialist. The responsibilities of the fitness instructor and dietician involve creating the plan that will promote obesity rate reduction in the target population. These specialists will also be accountable for designing the trivia game for the older group of children. The IT specialist will be responsible for creating the video game for younger children. Also, this stakeholder will design Twitter and Facebook pages for the project’s advertisement. The duties of parents will consist of encouraging their children to take part in the project and also controlling the process. The role of children will incorporate joining the intervention, getting acquainted with the educational information, and employing it in practice to change their dietary and physical activity habits. The project’s leader will hold responsibility for launching all processes and supervising them.

Potential Partnerships

To make the project more recognizable, it is crucial to arrange partnerships with the organizations that have similar objectives. Thus, the potential public link may be arranged with the Health Department of Miami-Dade County. At the private level, the collaboration with the main children’s hospital in Miami-Dade County, Nicklaus Children’s Hospital, may be arranged. The hospital has Facebook and Twitter accounts, which, along with the word-to-mouth methods, could help in sharing the information about the project.

The Timeline of the Implementation

1. Meeting for the first time to talk over the points that will be incorporated in games (September).
2. Designing the healthy diet and physical activity plan (the first two weeks of October).
3. Creating the trivia game and the video game (the last two weeks of October).
4. Designing Twitter and Facebook pages (the first week of November).
5. Popularizing the campaign through the collaboration with the Miami-Dade County Health Department and Nicklaus Children’s Hospital (the first week of November).
6. Inviting social media users to join the program (the second and third weeks of November).
7. Launching the two games for the primary users (the fourth week of November).
8. Introducing the games to other participants (December).
9. Accumulating feedback and scrutinizing results (December-January).

Assessment

The evaluation of the project’s success will be carried out by comparing children’s vital signs prior to and after the intervention. Such measurements as heart rate, physical activity, and body mass index will be taken into consideration. Besides, the project’s leader will assess and analyze the children’s and parents’ level of awareness at the beginning of the intervention and after it (GreenMills, Davidson, Gordon, Li, & Jurkowski, 2013). The intervention will be counted as successful in case the knowledge and vital signs of the key stakeholders are enhanced in the end.

Measurable Tools

The assessment of the intervention’s effectiveness will be carried out with the help of such tools:

• a pre- and post-intervention quality-of-life survey;
• the acceptance of behaviors suggested by the project;
• the heart rate and BMI measurements before and after the intervention;
• physical activity of the participants prior to and after the program.

Implementation Costs

Launching the project will require some expenses, which at this point are approximate and will be further regulated. It is expected that participants will carry out some duties as volunteers. Furthermore, if the intervention proves to be successful, the team is hoping to engage some sponsors in it. The approximate total cost of the implementation is $9,500. The rough calculation of costs is the following:

• $2,500: to buy equipment for creating the games and applications;
• 6,000: to pay salary to professionals engaged in the campaign;
• 1,000: for equipment and paperwork dedicated to arranging the cooperation with partners.

Thinking About Social Media Marketing

The support of the project in social media marketing is invaluable. With the promotion on Twitter and Facebook, it will become possible to share data about the intervention, as well as its goals and achievements. Moreover, social media marketing will enhance the communication between the key stakeholders. This approach is rather helpful due to employing evidence-based practice examples. It appeals to children and has the potential to alter their behavior, which is the ultimate purpose set by the community health nurse.

Considering the Future Nursing Practice

The proposed social media project will be rather helpful in the future nursing practice. The campaign will enhance the establishment of professional managerial skills, as well as other crucial abilities. Comparing participants’ data before and after the intervention will promote evidence-based practice. The project will also enhance the participation of the target population by reducing obstacles and eliminating the stigmatization. The use of media will lead to a healthier community with lower obesity rates. Exploiting social media platforms to affect healthy nutrition will revolutionize the nursing practice and bring beneficial outcomes for the population.