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Capstone presentation vacher

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

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Capstone presentation vacher

  1. 1. May 4, 2015 Sarah Vacher
  2. 2.  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)
  3. 3.  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
  4. 4.  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
  5. 5.  Often underserved  Significant barriers to positive health behaviors  Cultural norms in these areas may foster poor nutrition and physical activity habits
  6. 6.  Ecological Approach ◦ Multilevel approach ◦ To enact change, interventions should target all levels of influence
  7. 7.  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!
  8. 8. Reciprocal determinism The individual, the environment and the individual’s behavior all interact to influence each other in a dynamic manner
  9. 9.  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
  10. 10.  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
  11. 11. ◦ 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
  12. 12.  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
  13. 13. 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
  14. 14.  Validated Questionnaire ◦ Used to evaluate published school based interventions  Used to gauge knowledge at baseline  Used the parent version and the child version
  15. 15.  USDA Program ◦ Be Healthy Be Active ◦ Community Workshops  CATCH Kids Club ◦ Stop, Go, or Whoa Foods
  16. 16.  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
  17. 17. Results from Initial Labs and Measurements
  18. 18. 0 10 20 30 40 50 60 1 2 3 4 5 6 7 8 BMI Participant Initial Adult BMI BMI
  19. 19. 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
  20. 20. 0 20 40 60 80 100 120 1 2 3 4 5 6 7 8 9 BMIPercentile Participant Children BMI Percentile BMI Percentile
  21. 21. 0 1 2 3 4 5 6 7 1 2 3 4 5 6 7 8 %A1C Participants Adult HbA1C
  22. 22. 0 50 100 150 200 250 300 350 1 2 3 4 5 6 7 8 Cholesterol(mg/dL) Participants Cholesterol Cholesterol
  23. 23. Results from Practicum
  24. 24. 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
  25. 25. 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)
  26. 26. Focus Group
  27. 27.  Location: Saltville, VA  Participants: ◦ Active community members ◦ Ex: pastor, teachers, coaches  Duration: 1 hour conversation with 6 people
  28. 28.  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
  29. 29. 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
  30. 30.  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
  31. 31.  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
  32. 32.  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
  33. 33. Successful Approaches from Other Under Served Rural Areas
  34. 34.  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
  35. 35. Recommendations for Smyth County
  36. 36.  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
  37. 37.  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
  38. 38. 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
  39. 39. Adult Obesity Facts. (2014, September 9). Retrieved May 2, 2015, from http://www.cdc.gov/obesity/data/adult.html Bandura psychology is a good research paper topic for psychology enthusiasts. (2015, March 10). Retrieved May 2, 2015, from http://blog.questia.com/2015/03/bandura-psychology-is-a-good-research-paper-topic-for-psychology-enthusiasts/ Caprio, S., Daniels, S. R., Drewnowski, A., Kaufman, F. R., Palinkas, L. A., Rosenbloom, A. L., ... & Kirkman, M. S. (2008). Influence of race, ethnicity, and culture on childhood obesity: implications for prevention and treatment.Obesity, 16(12), 2566-2577. CATCH | Coordinated Approach To Child Health. (n.d.). Retrieved May 2, 2015, from http://catchinfo.org/ COUNTY PROFILE: Smyth County, VA. (n.d.). Retrieved May 3, 2015, from http://www.healthdata.org/sites/default/files/files/county_profiles/US/County_Report_Smyth_County_Virginia.pdf Hooper, M. B. (2014). Selection of an Evidence-Based Pediatric Weight Management Program for the Dan River Region (Doctoral dissertation, Virginia Tech). Perri, M. G., Limacher, M. C., Durning, P. E., Janicke, D. M., Lutes, L. D., Bobroff, L. B., ... & Martin, A. D. (2008). Extended-care programs for weight management in rural communities: the treatment of obesity in underserved rural settings (TOURS) randomized trial. Archives of internal medicine, 168(21), 2347-2354. Michael and Susan Dell Center for Healthy Living. (n.d.). Retrieved May 2, 2015, from https://sph.uth.edu/research/centers/dell/project.htm?project=3037edaa-201e-492a-b42f-f0208ccf8b29 Simons-Morton, B., McLeroy, K. R., & Wendel, M. (2011). Behavior theory in health promotion practice and research. Jones & Bartlett Publishers. Zoellner, J., Motley, M., Wilkinson, M. E., Jackman, B., Barlow, M. L., & Hill, J. L. (2012). Engaging the Dan river region to reduce obesity: application of the comprehensive participatory planning and evaluation process. Family & community health, 35(1), 44-56
  40. 40. QUESTIONS?

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