Presentation based on my capstone project, the culmination of my education and research at Virginia Tech as a Master of Public Health candidate.

1. May 4, 2015
Sarah Vacher

3.  Smyth County Community Hospital (SCCH)
◦ Dietitian: Mary Riggins
 Health Trust at SCCH
◦ Subcommittee: Nutrition Action Network (NAN)
 Charged with creating the Family Fitness Challenge
(FFC)

5.  31% of Smyth County is obese (BMI ≥ 30)
 Obesity is a significant public health concern
associated with:
◦ Heart Disease
◦ Stroke
◦ Diabetes
◦ Cancer
 Increases hospital LOS
 Medical Costs

7.  Smyth County ranked 123/133 counties/cities
in VA for overall health
 Smyth County females ranked middle 50%
nationally in obesity; males poorest 25%.
 Rural areas have highest rates of preventable
hospitalizations
 Low per capital income, persistent high poverty
rates, high unemployment rate make it an
at-risk county

8.  Often underserved
 Significant barriers to positive health
behaviors
 Cultural norms in these areas may foster poor
nutrition and physical activity habits

10.  Ecological
Approach
◦ Multilevel
approach
◦ To enact change,
interventions
should target all
levels of influence

11.  Utilize Gatekeepers
◦ Gatekeepers can provide information to individuals
from outside with access and relevant information
to their communities
◦ Someone on the inside
◦ Important to have someone who knows the culture
and preferences in your target population!

12. Reciprocal determinism
The individual, the environment and the
individual’s behavior all interact to influence
each other in a dynamic manner

15.  Six Week Family Oriented Weight Loss
Program
◦ 2 nights per week
◦ 2 separate locations
 Chilhowie/Sugar Grove
◦ 90 minutes total
 45 mins PA; 45 nutrition

16.  Chilhowie Site
◦ Location: Chilhowie Community Center
◦ September 8, 2014 – October 26, 2014
◦ Tuesdays and Thursdays 6:00 -7:30
 Sugar Grove Site
◦ Location: Sugar Grove Combined School
◦ October 6, 2014 – November 14, 2014
◦ Mondays and Wednesdays 4:30 – 6:00

17. ◦ Word of Mouth
◦ Flyers in local businesses, doctors’ offices, the
Wellness Center, and the hospital
◦ Radio interview on local station
◦ Short ad in local classifieds newspaper
◦ Back-To-School Night

18.  Preferred families with at risk of or diagnosed
with:
◦ Diabetes
◦ Hypertension
◦ Heart Disease
◦ Overweight/Obesity
 Originally wanted 1 adult and 1 child per
family
◦ In practice allowed anyone in family

19. LABS/MEASUREMENTS INCENTIVES
 HbA1C
 Lipid Panel
◦ Cholesterol
◦ LDL
◦ HDL
◦ TG
 Height
 Weight
 BMI
 Gift Certificates to Farmers
Market
 Free vegetables from community
garden
 Seeds/Planters
 Balls
 Salad Bowls
 Fit Bands
 One month registration at
Wellness Center

20.  Validated Questionnaire
◦ Used to evaluate published school based
interventions
 Used to gauge knowledge at baseline
 Used the parent version and the child version

21.  USDA Program
◦ Be Healthy Be Active
◦ Community Workshops
 CATCH Kids Club
◦ Stop, Go, or Whoa Foods

22.  Food City
 Lifetime Wellness Center
 Local Churches
 Mount Rogers Health District
 Smyth County Chamber of Commerce
 Sprouting Hope
 Virginia Tech Center for Public Health and
Research

23. Results from Initial Labs
and Measurements

24. 0
10
20
30
40
50
60
1 2 3 4 5 6 7 8
BMI
Participant
Initial Adult BMI
BMI

25. 0
50
100
150
200
250
300
350
1 2 3 4 5 6 7 8
Weight(lbs)
Participants
Adult Weight: Pre and Post
Program
Weight (lbs) Beginning
Weight (lbs) 6 Wk Post

26. 0
20
40
60
80
100
120
1 2 3 4 5 6 7 8 9
BMIPercentile
Participant
Children BMI Percentile
BMI Percentile

27. 0
1
2
3
4
5
6
7
1 2 3 4 5 6 7 8
%A1C
Participants
Adult HbA1C

28. 0
50
100
150
200
250
300
350
1 2 3 4 5 6 7 8
Cholesterol(mg/dL)
Participants
Cholesterol
Cholesterol

29. Results from Practicum

30. SUCCESSES
ROOM FOR
IMPROVEMENT
 People reported that
they both enjoyed the
program and learned
from it
 Involved parents and
children
 Overall adults lost an
average of 5 lbs in six
weeks
 Better ways to get the
word out
 More people involved in
actual implementation
 Follow the curriculum
more closely
 Overall organization
 Fidelity to the program

31. WHAT THEY LIKED WHAT THEY DIDN’T LIKE
 Liked separate classes
for parents and
children at the same
time
 Liked the
cooking/healthy eating
 Physical activity
 Bob/Mary –
knowledgeable
 Incentives
 Locations (Chilhowie)
 Length of classes
 Fall season
 Time (for 4:30 class)

32. Focus Group

33.  Location: Saltville, VA
 Participants:
◦ Active community members
◦ Ex: pastor, teachers, coaches
 Duration: 1 hour conversation with 6 people

34.  10 Open Ended Questions
 Led by a trained focus group moderator
 Snacks and refreshments provided
 Audio Recorded
 Each participant compensated with $15
Wal-Mart gift card
 Transcribed verbatim for thematic coding

35. Strengths Limitations
 2 individuals extracted
themes from
transcription data
 Independently
identified consistent
themes
 Cannot look for
consistency across
groups (1 focus group)
 Individuals were
involved in community
already

36.  Utilize community gatekeepers
◦ Ideally should be someone who:
 everyone knows
 doesn’t preach
 makes it fun and picks fun activities
 “walks the talk”
 has credibility
 has the ability to get the word out

37.  Reach parents through children
 Schools as primary location
 Group activities
◦ Biking, zumba, walking, “old fashioned fun”
 Provide childcare for participating parents
◦ Ex: Homework help
 Marketing: People need to know about it

38.  Should not be administered online
 Emphasis of healthy habits on a budget
 Give the families choices
◦ When they go, the rigor of activities, where they go
 Focus on positives

39. Successful Approaches from
Other Under Served Rural
Areas

40.  Focus on key components in program selection:
◦ Content
◦ Delivery channel
◦ Available resources for replication
 Community-Based Participatory Research (CBPR)
 Delivering interventions through Cooperative
Extension infrastructure
 Telephone counseling

41. Recommendations for Smyth County

42.  Choose content relevant to population
◦ Healthy foods that are inexpensive
◦ Healthy foods that do not require travel to obtain
◦ Positively framed alternatives to their current methods
of food preparation
 Involve community champions from the start
◦ People who are well known
◦ People who are well liked
◦ People seen as role models
◦ People who are known as experts

43.  Continue to foster collaborative partnerships
between:
◦ Community leaders
◦ Institutions of higher education
 Ex: Virginia Tech
Emory and Henry
◦ Any other individuals or organizations willing to provide
resources
 Community gardens
 Local grocery stores
 Local health practitioners
 Churches
 Cooperative extension

44. Sincere thanks for all of your support
throughout my practicum and capstone
experiences.
 VT CPHPR
 Dr. Hosig
 Mary Riggins
 HealthTrust at Smyth County Community
Hospital

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46. QUESTIONS?