This document summarizes the findings of focus groups conducted in Cobb County, Georgia to understand community members' perceptions of healthy behaviors and identify opportunities to increase healthy living. Six focus groups with a total of 58 participants from diverse backgrounds explored topics of healthy living, health communications, and community health. The key themes that emerged across groups were: 1) the need for more health education in the community, 2) challenges to healthy food choices, 3) issues with access to healthcare, 4) the importance of trust in healthcare providers, 5) the need for affordable healthcare options, and 6) the lack of local resources to support healthy living. The results informed the development of county-wide initiatives to address chronic diseases through improved access to healthy
Local Food Production - Addressing Food Security in Canada’s NorthNicholas Girard
This document provides a literature review on local food production and community food security in Canada's North. It discusses two main approaches: 1) Commercializing traditional/country foods which faces challenges around regulations, social acceptability, and infrastructure; and 2) Developing northern community greenhouses which have had some success improving access to fresh foods but face challenges related to resources, communities, marketing, and economics. The document examines current research and outlines these approaches and challenges to provide background for a proposed Master's thesis on supporting food security through community-based food production projects in the Inuvialuit Settlement Region of the Northwest Territories.
Brightpoint Health Leaders Address US Conference on AIDS on the need for Inte...lsolomon212
At the recent US Conference on AIDS, three leaders from Brightpoint Health: President and CEO Paul Vitale, Chief Clinical Officer Barbara Zeller, MD and Jessica Diamond, SVP Organizational Culture and Quality, discussed Brightpoint's evolution from an AIDS residential facility to a Federally Qualified Health Center; how health care models are being reinvented to drive efficiency and accountability and how Brightpoint has succeeded in tackling some of toughest challenges: how do we best implement change and how do we pay for it?
A comparative risk assessment of burden of disease and injury attributable to...Chuco Diaz
Background Quantification of the disease burden caused by different risks informs prevention by providing an account of health loss different to that provided by a disease-by-disease analysis. No complete revision of global disease burden caused by risk factors has been done since a comparative risk assessment in 2000, and no previous analysis has assessed changes in burden attributable to risk factors over time.
Exploring Unobserved Heterogeneity of Food Safety Behavior: A Meta-AnalysisNaiqing Lin, Ph.D.
Finding new gaps in a well established theory can be very challenging, traditionally we rely on well-established leaders in the theory to do an review, and point out the directions of future.
Recent development in Meta-analysis provided new possibilities to mathematically examine existing "theoretical system", therefore finding the bridges, this paper provided an example of how-to
This toolkit is designed to support climate change practitioners in the Pacific islands region to integrate gender into their programmes and projects. It is aimed at climate change professionals working in national governments, non-governmental organisations, regional and international organisations who are involved in managing and implementing climate change programmes.
While many of us are aware that gender does matter for sustainable development and climate change adaptation and mitigation, we may not know clearly how it matters, and what tools are available that can help to assess how it matters. Knowing is also not enough: we must apply this knowledge in a practical way when we design and implement activities, and ensure that we are capturing useful and important information through our monitoring and evaluation frameworks.
This toolkit provides advice at a practical level, to address these needs. The principles and practices proposed in this toolkit are based on many decades of experience in the integration of a gender perspective in sustainable development, natural resources management and disaster preparedness. The toolkit is divided into three parts. This introductory module explains why gender is a critical consideration in climate change programmes, projects and strategies, and clarifies some common misconceptions. Module 2 focuses on the links between gender and climate change in specific sectors (e.g. food security, water and energy); and uses sector-relevant case studies to explain how to take gender into consideration.
It also includes a module on disaster risk reduction recognising that these interventions should be factored into all climate change adaptation programmes and projects. These sector chapters can also be used as stand-alone documents for practitioners to guide their analysis in a specific sector. Module 3 is the ‘how-to’ section and will take you through the different phases of a typical climate change programme/project cycle, identifying potential entry-points for integrating gender in each phase and also includes a generic gender checklist that may be applied to programmes and projects. This toolkit will not make you a gender expert! However, it provides guidance along with links to other resources that can help strengthen your knowledge about gender and climate change.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
Apex Advisors is a national tax credits and incentives advisory firm that has performed over 10,000 studies since 2001. They have offices in Los Angeles, San Jose, and Alabama. Apex Advisors specializes in researching and securing various tax credits and incentives at both the federal and state levels, including research and development tax credits, green building tax deductions, and new markets tax credits. They have a team of 50 professionals with expertise in accounting, auditing, law, and previous experience with the IRS.
Cuando sangra el cobre. Historia de una lucha.Alfonso Pedro
Este documento describe la historia de la lucha de los mineros de Riotinto por mejores condiciones de vida y trabajo a través de la contaminación, represión, peligros y sacrificios que enfrentan en la mina, en contraste con las vidas de lujo de los poderosos propietarios de las minas. Resalta valores como la solidaridad, el compañerismo y el compromiso en su lucha continua.
Local Food Production - Addressing Food Security in Canada’s NorthNicholas Girard
This document provides a literature review on local food production and community food security in Canada's North. It discusses two main approaches: 1) Commercializing traditional/country foods which faces challenges around regulations, social acceptability, and infrastructure; and 2) Developing northern community greenhouses which have had some success improving access to fresh foods but face challenges related to resources, communities, marketing, and economics. The document examines current research and outlines these approaches and challenges to provide background for a proposed Master's thesis on supporting food security through community-based food production projects in the Inuvialuit Settlement Region of the Northwest Territories.
Brightpoint Health Leaders Address US Conference on AIDS on the need for Inte...lsolomon212
At the recent US Conference on AIDS, three leaders from Brightpoint Health: President and CEO Paul Vitale, Chief Clinical Officer Barbara Zeller, MD and Jessica Diamond, SVP Organizational Culture and Quality, discussed Brightpoint's evolution from an AIDS residential facility to a Federally Qualified Health Center; how health care models are being reinvented to drive efficiency and accountability and how Brightpoint has succeeded in tackling some of toughest challenges: how do we best implement change and how do we pay for it?
A comparative risk assessment of burden of disease and injury attributable to...Chuco Diaz
Background Quantification of the disease burden caused by different risks informs prevention by providing an account of health loss different to that provided by a disease-by-disease analysis. No complete revision of global disease burden caused by risk factors has been done since a comparative risk assessment in 2000, and no previous analysis has assessed changes in burden attributable to risk factors over time.
Exploring Unobserved Heterogeneity of Food Safety Behavior: A Meta-AnalysisNaiqing Lin, Ph.D.
Finding new gaps in a well established theory can be very challenging, traditionally we rely on well-established leaders in the theory to do an review, and point out the directions of future.
Recent development in Meta-analysis provided new possibilities to mathematically examine existing "theoretical system", therefore finding the bridges, this paper provided an example of how-to
This toolkit is designed to support climate change practitioners in the Pacific islands region to integrate gender into their programmes and projects. It is aimed at climate change professionals working in national governments, non-governmental organisations, regional and international organisations who are involved in managing and implementing climate change programmes.
While many of us are aware that gender does matter for sustainable development and climate change adaptation and mitigation, we may not know clearly how it matters, and what tools are available that can help to assess how it matters. Knowing is also not enough: we must apply this knowledge in a practical way when we design and implement activities, and ensure that we are capturing useful and important information through our monitoring and evaluation frameworks.
This toolkit provides advice at a practical level, to address these needs. The principles and practices proposed in this toolkit are based on many decades of experience in the integration of a gender perspective in sustainable development, natural resources management and disaster preparedness. The toolkit is divided into three parts. This introductory module explains why gender is a critical consideration in climate change programmes, projects and strategies, and clarifies some common misconceptions. Module 2 focuses on the links between gender and climate change in specific sectors (e.g. food security, water and energy); and uses sector-relevant case studies to explain how to take gender into consideration.
It also includes a module on disaster risk reduction recognising that these interventions should be factored into all climate change adaptation programmes and projects. These sector chapters can also be used as stand-alone documents for practitioners to guide their analysis in a specific sector. Module 3 is the ‘how-to’ section and will take you through the different phases of a typical climate change programme/project cycle, identifying potential entry-points for integrating gender in each phase and also includes a generic gender checklist that may be applied to programmes and projects. This toolkit will not make you a gender expert! However, it provides guidance along with links to other resources that can help strengthen your knowledge about gender and climate change.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
Apex Advisors is a national tax credits and incentives advisory firm that has performed over 10,000 studies since 2001. They have offices in Los Angeles, San Jose, and Alabama. Apex Advisors specializes in researching and securing various tax credits and incentives at both the federal and state levels, including research and development tax credits, green building tax deductions, and new markets tax credits. They have a team of 50 professionals with expertise in accounting, auditing, law, and previous experience with the IRS.
Cuando sangra el cobre. Historia de una lucha.Alfonso Pedro
Este documento describe la historia de la lucha de los mineros de Riotinto por mejores condiciones de vida y trabajo a través de la contaminación, represión, peligros y sacrificios que enfrentan en la mina, en contraste con las vidas de lujo de los poderosos propietarios de las minas. Resalta valores como la solidaridad, el compañerismo y el compromiso en su lucha continua.
La autora tomó varias fotografías de sí misma utilizando diferentes tipos de planos como el plano entero, primer plano, primerísimo primer plano, plano detalle y plano americano. Explica que eligió un fondo blanco para realzar los colores y que en los primeros planos y primerísimos primeros planos se enfocó en capturar expresiones y detalles de la cara.
LogixGRID cloud for logistics offers tools required by enterprises to better manage their logistics. LogixERP is a complete CLOUD based ERP. MATRIX mobility solution is a nextgen mobility platform which bring logistics operation on to Mobile.
The research, funded by CNR, suggests the creation of a corpus of data aiming at the rediscovery of the castle of Gerace (RC) and its links to the territory. The aim of the research is to establish a sampling of documents, materials, techniques and ideas, representing the "matter" of the monument. The final aim of the contribution is to safeguard and increase the value of the heritage, to realize the territory's potentialities that risk to get lost or to be "unexpressed" for the physical decadence of the castle. The study, starting from a historical-archive research, has dealt with the analysys of materials and the fenomena of deterioration. as well as using the most common instruments of survey and mapping, GPS stations integrated with Laser Scanner have been used. The acquisition of orthophotos has allowed to underiline many characters of the site, making possible to identify a wider range of anthropic anomalies; the 3-d modelling with laser scanner survey has permitted a global investigation of the area. The final elaboration of data will allow to examine several information layers especially those related to archaeological evidences, anthropic anomalies, landslide front and the risk of rock stability.
The document is a resume for Amanda E. O'Neill that highlights her experience in management, relationship development, leadership, and training. She has over 15 years of experience in sales, marketing, education, and management. Her core strengths include training, leadership, sales presentations, key account management, and customer relations. Her most recent experience was as an Instructional Support professional at Renaissance Middle School from 2014 to 2015.
The document discusses order picking in warehouses. It describes an X-shaped warehouse layout and compares the average distances traveled by workers in this layout versus a traditional layout. The X layout is modeled in MATLAB and the average distances for different input-output point combinations are calculated as the dimensions of the layout are varied. The results show that the X layout performs better, with lower average distances, when the warehouse length is large. There is potential to further optimize the X layout by adjusting parameters like the angle of inclination and number/location of input-output points.
This document discusses why research into intellectual and developmental disabilities takes a long time. It provides the example of research into Fragile X syndrome, which took over 70 years to fully understand the genetic cause and develop diagnostic techniques and treatments. The process involved many researchers making incremental discoveries over decades. Unexpected discoveries emerged along the way, such as how some "unaffected" males were at risk for other conditions. Effective interventions are still being sought. The document emphasizes that research is a collaborative, cumulative process that requires continued funding and support. It highlights some of the top scientists at the Vanderbilt Kennedy Center who conduct this important research.
Millionaire dating sites reviews is a professional review website for dating with exclusive user ratings which would be easy to find your millionaire match
Este documento describe los principales símbolos patrios del Perú: la bandera, el himno nacional y el escudo. Explica que la bandera peruana fue creada por José de San Martín en 1821 y adoptó su diseño actual en 1822. Luego, detalla que San Martín convocó a un concurso público en 1821 para elegir el himno nacional. Finalmente, señala que el escudo del Perú fue aprobado por el Congreso Constituyente en 1825 y ratificado en 1950.
El documento describe varias herramientas informáticas y web que pueden aplicarse a la educación y la enfermería. Explica las funciones básicas de Microsoft Word, Excel y PowerPoint para procesar texto, hojas de cálculo y presentaciones. También describe herramientas web como YouTube, Blogger y Facebook y cómo pueden usarse con fines educativos. Finalmente, resume las características y usos de Outlook, Prezi, Adobe Flash y otras herramientas.
Este documento propone declarar de interés de la Cámara de Diputados el libro "José Luis Cabezas, Fotografías". José Luis Cabezas fue un fotógrafo periodístico que retrató importantes figuras políticas y culturales hasta su asesinato en 1997. El libro recopila sus mejores fotografías y testimonios sobre su valiente trabajo defendiendo la libertad de expresión. Declarar el libro de interés parlamentario honraría la memoria de Cabezas y su lucha por la democracia en Argentina
Paul Windust is a partner at Berding | Weil LLP specializing in community association law, construction defect, real estate, and business litigation. He has over 25 years of legal experience representing homeowners associations, defending directors and management companies, and litigating construction defect claims, CC&R violations, and governance disputes. Some of his significant cases include settling a $50,000 per unit construction defect claim and obtaining a $165,000 attorney fee award for an association after a 3-week trial.
Community members and stakeholders in North Carolina provided perspectives on health equity as part of a statewide healthy environments initiative. Through focus groups and interviews, they discussed three strategies - farmers markets, shared outdoor spaces, and smoke-free housing. Two key themes emerged. First, "access" - how easy it is for communities to use resources. Factors like location, cost, and safety can create barriers. Second, "community fit" - whether a strategy aligns with community values and norms. Suggestions to improve equity focused on transportation, market hours, safety, and involving both smokers and nonsmokers in policy decisions. The views of community members and stakeholders can help shape culturally-relevant strategies to promote health and prevent chronic diseases
La autora tomó varias fotografías de sí misma utilizando diferentes tipos de planos como el plano entero, primer plano, primerísimo primer plano, plano detalle y plano americano. Explica que eligió un fondo blanco para realzar los colores y que en los primeros planos y primerísimos primeros planos se enfocó en capturar expresiones y detalles de la cara.
LogixGRID cloud for logistics offers tools required by enterprises to better manage their logistics. LogixERP is a complete CLOUD based ERP. MATRIX mobility solution is a nextgen mobility platform which bring logistics operation on to Mobile.
The research, funded by CNR, suggests the creation of a corpus of data aiming at the rediscovery of the castle of Gerace (RC) and its links to the territory. The aim of the research is to establish a sampling of documents, materials, techniques and ideas, representing the "matter" of the monument. The final aim of the contribution is to safeguard and increase the value of the heritage, to realize the territory's potentialities that risk to get lost or to be "unexpressed" for the physical decadence of the castle. The study, starting from a historical-archive research, has dealt with the analysys of materials and the fenomena of deterioration. as well as using the most common instruments of survey and mapping, GPS stations integrated with Laser Scanner have been used. The acquisition of orthophotos has allowed to underiline many characters of the site, making possible to identify a wider range of anthropic anomalies; the 3-d modelling with laser scanner survey has permitted a global investigation of the area. The final elaboration of data will allow to examine several information layers especially those related to archaeological evidences, anthropic anomalies, landslide front and the risk of rock stability.
The document is a resume for Amanda E. O'Neill that highlights her experience in management, relationship development, leadership, and training. She has over 15 years of experience in sales, marketing, education, and management. Her core strengths include training, leadership, sales presentations, key account management, and customer relations. Her most recent experience was as an Instructional Support professional at Renaissance Middle School from 2014 to 2015.
The document discusses order picking in warehouses. It describes an X-shaped warehouse layout and compares the average distances traveled by workers in this layout versus a traditional layout. The X layout is modeled in MATLAB and the average distances for different input-output point combinations are calculated as the dimensions of the layout are varied. The results show that the X layout performs better, with lower average distances, when the warehouse length is large. There is potential to further optimize the X layout by adjusting parameters like the angle of inclination and number/location of input-output points.
This document discusses why research into intellectual and developmental disabilities takes a long time. It provides the example of research into Fragile X syndrome, which took over 70 years to fully understand the genetic cause and develop diagnostic techniques and treatments. The process involved many researchers making incremental discoveries over decades. Unexpected discoveries emerged along the way, such as how some "unaffected" males were at risk for other conditions. Effective interventions are still being sought. The document emphasizes that research is a collaborative, cumulative process that requires continued funding and support. It highlights some of the top scientists at the Vanderbilt Kennedy Center who conduct this important research.
Millionaire dating sites reviews is a professional review website for dating with exclusive user ratings which would be easy to find your millionaire match
Este documento describe los principales símbolos patrios del Perú: la bandera, el himno nacional y el escudo. Explica que la bandera peruana fue creada por José de San Martín en 1821 y adoptó su diseño actual en 1822. Luego, detalla que San Martín convocó a un concurso público en 1821 para elegir el himno nacional. Finalmente, señala que el escudo del Perú fue aprobado por el Congreso Constituyente en 1825 y ratificado en 1950.
El documento describe varias herramientas informáticas y web que pueden aplicarse a la educación y la enfermería. Explica las funciones básicas de Microsoft Word, Excel y PowerPoint para procesar texto, hojas de cálculo y presentaciones. También describe herramientas web como YouTube, Blogger y Facebook y cómo pueden usarse con fines educativos. Finalmente, resume las características y usos de Outlook, Prezi, Adobe Flash y otras herramientas.
Este documento propone declarar de interés de la Cámara de Diputados el libro "José Luis Cabezas, Fotografías". José Luis Cabezas fue un fotógrafo periodístico que retrató importantes figuras políticas y culturales hasta su asesinato en 1997. El libro recopila sus mejores fotografías y testimonios sobre su valiente trabajo defendiendo la libertad de expresión. Declarar el libro de interés parlamentario honraría la memoria de Cabezas y su lucha por la democracia en Argentina
Paul Windust is a partner at Berding | Weil LLP specializing in community association law, construction defect, real estate, and business litigation. He has over 25 years of legal experience representing homeowners associations, defending directors and management companies, and litigating construction defect claims, CC&R violations, and governance disputes. Some of his significant cases include settling a $50,000 per unit construction defect claim and obtaining a $165,000 attorney fee award for an association after a 3-week trial.
Community members and stakeholders in North Carolina provided perspectives on health equity as part of a statewide healthy environments initiative. Through focus groups and interviews, they discussed three strategies - farmers markets, shared outdoor spaces, and smoke-free housing. Two key themes emerged. First, "access" - how easy it is for communities to use resources. Factors like location, cost, and safety can create barriers. Second, "community fit" - whether a strategy aligns with community values and norms. Suggestions to improve equity focused on transportation, market hours, safety, and involving both smokers and nonsmokers in policy decisions. The views of community members and stakeholders can help shape culturally-relevant strategies to promote health and prevent chronic diseases
Project Management
Yaumara Cano
Kaplan University
1
introduction
Clinical studies are purposed to help physicians and other interested parties to make health improvements on how issues are handles.
The United States currently faces a large number of health issues.
Obesity is among the common health issues that the country is facing, which requires intervention.
The country is currently the leading place with the largest number of people with this condition (Booth, Charlton, & Gulliford, 2016).
Obesity has been an issues of concern to many in the United States, mainly because the country is the leading nation in the world with the largest population of obese individuals.
The need to implement effectiveness and ensure that people regain their health is essential for the health industry of the country.
This presentation aims to present a research study on this issue and it provide recommendation of effective intervention measures that should be taken to address the issue.
2
Over view of the study
Obesity is currently affecting more than 37.9 percent of all the adults in the United States.
Annually, the government spends about 147 million dollars to address issues related to obesity only.
With this issue being extremely important, the study aims to obtain more information about the issue in the country.
The study then aims to use the findings that will be obtained to make recommendations of appropriate intervention strategies.
Statistical evidence clarify that obesity is a significant problem in the United States. Through this condition, more than 37.9 percent of the United States feel adverse negative effects, and are considered less healthy compared to other people.
This study has its main purpose being to make sure that effective strategies have been developed through which the issue will become less significant in terms of effect and money.
3
Clinical question definition (PICOT)
PICOT is a research explanation model which stands for people/population, intervention, comparison, outcome and time.
The population that is aimed to benefit from this study is both the young, the youths and the old who can obtain the condition of obesity (Mehta, Elo, Aromaa, & Koskinen, 2017).
The study facts and results are however based on data collected from people between the age of 20 and 30 years
The population under focus on this study is thus youths of between 20 and 30 years of age. This sample population was mainly chosen because it constitutes of the largest population of obese people in the country.
The study however aims at making sure that the identified research study respondents are randomly obtained from different areas and people living in different life styles.
4
Clinical question definition (PICOT)
Intervention that is intended for the patients is to provide recommendation that will help these patients manage to have their lives improved and recovering from the condition.
The study also aims to reduce the rate of pe.
Helping chronically ill or disabled people into work: what can we learn from ...StephenClayton11
This project has added to knowledge in five main areas:
It has mapped the range and types of policies and interventions that have been
implemented in Canada, Denmark, Norway, Sweden and the UK that may influence
employment chances for chronically ill and disabled people. By doing so it has added
to understanding about what has actually been tried in each country and what might be
considered in others.
It has refined a typology of the focussed interventions that have been identified, based
on the underlying programme logic of the intervention, which aids strategic thinking
about national efforts to help chronically ill and disabled people into work.
It has produced systematic reviews of the impact of the focussed interventions on the
employment chances of chronically ill and disabled people and demonstrated the use of
the typology in helping to interpret the results of the evaluations.
The project’s empirical analyses of individual-level data have identified how
chronically ill people from different socio-economic groups have fared in the labour
markets of the five countries over the past two decades. It has then tested these findings
against hypotheses about the impact of macro-level labour market policies on
chronically ill people to provide insights into the influence of the policy context.
The project has contributed to methodological development in evidence synthesis and
the evaluation of natural policy experiments. By studying a small number of countries
in great depth, we gained greater understanding of the policies and interventions that
have been tried in these countries to help chronically ill and disabled people into work,
against the backdrop of the wider labour market and macro-economic trends in those
countries. We then integrated evidence from the wider policy context into the findings
of systematic reviews of effectiveness of interventions, to advance interpretation of the
natural policy experiments that have been implemented in these countries.
Chapter 16 Community Diagnosis, Planning, and InterventionSergEstelaJeffery653
Chapter 16 Community Diagnosis, Planning, and Intervention
Sergio Osegueda Acuna MSN-FNP-BC
MRC
Nursing Process with communities
Population-focused health planning
Health planning is a continuous social process by which data about clients are collected and analyzed for the purpose of developing a plan to generate new ideas, meet identified client needs, solve health problems, and guide changes in health care delivery.
To date, you have been responsible primarily for developing a plan of care for the individual client.
History of U.S. Health Planning
The history of health planning in the United States has alternated between the federal and state governments.
Before the 1960s, health planning occurred primarily at the state level.
In the 1960s, health planning became a federal effort.
In 1966, the Comprehensive Health Planning and Public Health Service Amendment was passed to enable states and local communities to plan for better health resources.
In the 1980s, President Reagan aimed to reduce both the size of the federal government and the influence the federal government had on states. His administration eliminated the federal budget and planning requirements while encouraging states to make their own planning decisions.
History of U.S. Health Planning
In 1980, the Omnibus Budget Reconciliation Act encouraged the use of noninstitutional services, such as home health care, to fight escalating costs.
In 1983 the Prospective Payment System drastically changed hospital reimbursement, resulted in shorter hospital stays for patients, shifted care into the community, and placed greater responsibilities for care of relatives on family members
The federal Patient Protection and Affordable Care Act (Affordable Care Act) of 2010 requires access to health care for most Americans.
Rationale for Nursing Involvement in the Health Planning Process
Florence Nightingale and Lillian Wald pioneered health planning based on an assessment of the health needs of the communities they served
Both the American Nurses Association (ANA) (2007) and the American Public Health Association (APHA) (1996) state that the primary responsibility of community/public health nurses is to the community or population as a whole and that nurses must acknowledge the need for comprehensive health planning to implement this responsibility.
Nurses spend a greater amount of time in direct contact with their clients than do any other health care professionals.
Nursing Role in Program Planning
Planning for change at the community level is more complex than at the individual level.
Components to the client system have been increased, and more people and more complex organizations are involved.
Baccalaureate-prepared community/public nurses are expected to apply the nursing process with subpopulations or aggregates with limited supervision (American Association of Colleges of Nursing, 1986; ANA, 2007)
Planning for community change
To plan and implement programs at a commu ...
1. The study compared the effects of a 12-week team-based learning (TBL) diabetes education intervention versus traditional lecture-based education on patient outcomes. 57 patients were randomized into either the TBL or control group.
2. While both groups showed improvements in clinical markers and knowledge over time, the TBL group showed a significant difference in A1C levels compared to the control group at 6 months. The TBL group also showed significant improvements in systolic blood pressure and self-efficacy.
3. Overall, the study found that TBL patient education led to better retention of diabetes knowledge and some improved clinical outcomes compared to traditional lecture-based education, suggesting TBL is a useful approach for diabetes
American Heart Association Lifestyle Recommendations to Reduce.docxjesuslightbody
American Heart Association Lifestyle Recommendations to Reduce Obesity
Jane Doe
University
Project and Practicum
Summer 2022
Abstract
The prevalence of obesity and sedentary lifestyle complications are increasing at alarming rates, representing a common but preventable cause of severe medical complications like diabetes, cardiovascular diseases, and early mortality. This chronic condition has been for a long time a public health concern and social determinant. The Fitbit app offers a unique opportunity to enhance the efficacy of weight loss plans as it is used to track activity, monitor steps, heart rate, energy expenditure, sleep, and sedentary behavior. The integrative review focused on how the American Heart Association (AHA) Diet and Lifestyle recommendations and the Fitbit app are used as innovative solutions to reduce obesity in adult patients.
Research Methodology: A systematic review was conducted to identify research articles completed in the preceding 4-5 years centered on obesity care, diet, physical activity, activity trackers, and lifestyle implications.
Results and Discussion: The databases searched were Chamberlain Library, PubMed, and CINHAL. Initial searches yielded over 2000 articles, of which 45 were chosen and examined because they fit the integrative review's theme. The 15 papers most relevant to the PICOT question were studied in further detail and appraised using the Johns Hopkins Evidence Appraisal table. The studies reported positive physical activity outcomes.
Conclusions and Further Recommendations:This systematic review supported the effectiveness of the AHA Diet and Lifestyle recommendations to reduce obesity, and clinical use generalization is recommended. Fitbit app provides new ways to improve physical activity habits, and the easy availability of electronic devices may enhance their generalizability use.
Keywords: Obesity care; Obesity complications; Lifestyle recommendations; Obesity management; Physical activity intervention using Fitbit activity trackers.
Dedication
Thanks to my family for their unwavering support of this project; their cooperation means a lot to me. To my husband Armando, thank you for your love, understanding, and patience during this time. I credit my achievement to all of you for your unwavering love and belief in me.
Acknowledgments
First, I must acknowledge the help of all my professors who inspired, encouraged, and supported me throughout the DNP program. My heartfelt thanks to my teammates, without whom I would never have completed this phase in my life. Their encouragement has had a significant influence on my strong determination during this trip.
Contents
American Heart Association Lifestyle Recommendations to Reduce Obesity 1
Abstract 2
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Dedication 3
Acknowledgments 4
American Heart Association Lifestyle Recommendations to Reduce Obesity 6
Problem Statement 6
S.
This study examined clustering patterns and correlates of multiple health behaviors in middle-aged Koreans with metabolic syndrome. 331 individuals with metabolic syndrome completed surveys about sociodemographics, health behaviors, and psychological characteristics. The results showed that men were more likely than women to engage in multiple unhealthy behaviors like smoking and heavy drinking. Certain combinations of health behaviors like smoking and heavy drinking clustered together. Those with lower self-regulation were more likely to engage in unhealthy behaviors. The findings support examining multiple health behaviors together rather than individually to develop effective interventions for metabolic syndrome.
Quantitative/Mixed-Methods
American InterContinental University
March 27, 2018
Running head: QUANTITATIVE/MIXED-METHODS
1
QUANTITATIVE/MIXED-METHODS
2
Quantitative/Mixed-Methods
Abstract
Case studies which are done in the field of medicine work towards improving the health of the population. There are some of the parts contained in case studies which are abstract, results, limitations of results, conclusions, and applications. The common statistical methods used in research are descriptive numerical and qualitative thematic analyses. The results of the studies show that equal participation of individuals in the health sector will help boost public health. Limitations of results are that although some strategies may work towards improving health sector, not all of them are effective.
Public health is an important sector in any country for it directly affects the economy of the nation. There need to be certain ways which should be employed with the aim of supporting and improving public health. In this paper, I am going to examine 4 contemporary peer-reviewed articles which employ quantitative or mixed-methods concerning ways on how to improve the health of the public. The interest of the paper is to aid in achieving the best impact in public health sector via using programs which will improve health outcomes drastically. Enhancement of public health will in return help to improve the well-being of populations across the world. Public health awareness on how to avoid unhealthy lifestyles should be created.
In the articles, samples and populations used were appropriate for it showed the real representative of the population at hand. All the samples used in the 4-contemporary peer-reviewed articles fulfilled the rule of thumb hence making them appropriate. The samples used were suitable for they were used to estimate the population parameters for it stood for the entire inhabitants. The samples used were larger but not too large to consume more resources of money and time. The larger sample has helped to produce accurate results making the samples valid and appropriate. The appropriateness of the samples used in these articles, it has been proved via usage of target variance. In using target variance an estimate to be derived from the model eventually attained.
Each article which has been used includes having results, limitations of results, conclusions, and applications. The first contemporary peer-reviewed article is entitled, Refugee women’s involvements of maternity-care facilities in Canada: a methodical review using a description synthesis written by Gina MA Higginbottom, Myfanwy Morgan, Miranda Alexandre, Yvonne Chiu, Joan Forgeron, Deb Kocay and Rubina Barolia. The article was published 11 February 2015. The results show that there needs to have a healthier understanding of the aspects that produce discrepancies in availability, adequacy, and outcomes during parenthood care (Higginbottom, Morgan, Alexandre, Chiu, Forg ...
This document summarizes a study that explored exercise adherence and motivations in university students using mixed methods. Semi-structured interviews were conducted with 6 students and analyzed for themes around motivation, mood, and barriers to adherence. Survey data from 29 students' Exercise Motivation Inventory scores were also analyzed. Thematic analysis of interviews showed 3 major categories affecting adherence: motivation, mood, and barriers. The survey analysis found no significant results. The study concluded that motivations for adherence are diverse and all aspects of exercise experience should be considered in program design.
An innovative pilot project aimed at helping community groups lose weight and in return, rewarded by raising money for their local community cause. For every pound of weight lost a sterling pound was pledged to a community cause. After six months pounds lost were totalled by those who took part and community causes rewarded with the appropriate sterling equivalent. The project adopted a community development approach and was primarily focused on communities with the highest health and social needs in Somerset.
This summary describes a quasi-experimental study with a one-group pretest-posttest design that evaluated the effectiveness of an educational intervention on dietary guidelines for adults in Newton County, Mississippi. A convenience sample of 50 community-dwelling adults between 18-64 years old participated. Data was collected using the Health Behavior Survey before and after the intervention, which took place in a classroom and consisted of lectures and discussions. The study aimed to determine if the intervention increased awareness of a healthy, balanced diet and decreased risk for chronic disease, but only found a significant effect for some dietary behaviors and not others like physical activity levels.
The document summarizes a health needs assessment conducted in rural communities in Chiapas, Mexico. It provides demographic data showing that most residents are young, have low levels of education, work in farming or as homemakers, and have low incomes. It also reports on residents' self-reported health issues and living conditions. The study aimed to identify health, economic, and social needs to help guide a new healthcare project in the region. Local promoters were trained to administer surveys to gather data on residents' demographics, symptoms, nutrition, living standards, and physical measurements.
The Cochrane Library: Web 2.0 & phisical activity Giuseppe Fattori
This review analyzed 11 studies involving over 5,800 adults to evaluate the effectiveness of remote and web-based interventions for promoting physical activity. The results showed that technology-supported programs can help adults become more active, achieve recommended weekly activity levels, and increase fitness. Improvements were seen when interventions provided personalized support and feedback from professionals via phone, email, or written information. Gains in activity level and fitness were maintained for up to two years with no increase in injury risk. However, more research is still needed to determine the most effective long-term methods for specific groups.
Implementation science studies strategies for adapting and applying evidence-based interventions in real-world settings like schools, workplaces and healthcare facilities to improve population health. This field develops theories of implementation and evaluates measures of implementation success. Methods include stakeholder engagement, effectiveness studies, research synthesis and modeling to identify strategies for integrating evidence-based interventions into programs and policies. For implementation science to reach its full potential, the research paradigm needs to shift toward greater stakeholder input and reporting on external validity to improve relevance and guide decision makers.
CET is an evidence-based cognitive rehabilitation program for patients with schizophrenia. Several randomized controlled trials have found CET to be effective at improving cognitive functioning, social adjustment, and real-world outcomes for patients with chronic and early-course schizophrenia. Benefits were found to persist for up to 3 years after treatment. Specifically, CET was shown to significantly improve processing speed, social cognition, cognitive style and social adjustment for chronic patients, and cognitive style, social cognition, social adjustment and symptoms for early-course patients. CET participants also demonstrated better vocational and social engagement outcomes long-term compared to controls. The studies provide support for CET as an effective rehabilitation approach for improving cognitive and functional abilities in schizophrenia.
This document summarizes a study that evaluated the impact of a mini-grants program that provided funding to six churches in rural South Georgia to implement policy and environmental changes to promote healthy eating and physical activity. The study assessed changes in parishioners' (N=258) perceptions of their church's health promotion environment and whether any changes were associated with healthy behaviors. Key results included: 1) Perceived improvements in church nutrition environments were most strongly associated with decreases in unhealthy food consumed and stronger intentions to use physical activity resources. 2) Perceived changes in the physical activity environment were unrelated to behaviors. 3) The study suggests church environments may influence healthy behaviors at church but it is unknown if this extends to other settings.
F e a t u r eGetting on Target with CommunityHealth Advi.docxmydrynan
The GOTCHA project aimed to address health disparities in rural Mississippi through a community-based participatory research (CBPR) approach using community health advisors (CHAs). An interdisciplinary team developed an innovative CHA training curriculum in response to identified needs from community discussions. The training included a 35-hour core skills component to equip CHAs with comprehensive outreach skills, followed by disease-specific modules. The training employed popular education techniques grounded in adult learning theory to raise consciousness and empower community members for social change. The goal was to transform community health through grassroots efforts led by indigenous CHAs.
A pilot evaluation of the Family Caregiver Support Program.docxblondellchancy
A pilot evaluation of the Family Caregiver Support Program
Ya-Mei Chen a,*, Susan C. Hedrick b, Heather M. Young c
a School of Nursing, University of Washington, United States
b Health Services, School of Public Health, University of Washington, Research Career Scientist, VA Medical Center, United States
c University of Washington, Grace Phelps Distinguished Professor and Director of Rural Health Research Development, Oregon Health and Sciences University, United States
Evaluation and Program Planning 33 (2010) 113–119
A R T I C L E I N F O
Article history:
Received 26 November 2008
Received in revised form 30 July 2009
Accepted 8 August 2009
Keywords:
Family Caregiver Support Program
Program evaluation
Caregiver
Support services
A B S T R A C T
The purposes of this study were to evaluate a federal and state-funded Family Caregiver Support
Program (FCSP) and explore what types of caregiver support service are associated with what caregiver
outcomes. Information was obtained on a sample of 164 caregivers’ use of eleven different types of
support service. Descriptive and comparative analyses were used to detect the differences between users
and nonusers of caregiver support services. Six measures included were caregiving appraisal scale,
caregiving burden, caregiving mastery, caregiving satisfaction, hour of care, and service satisfaction.
Using consulting and education services is associated with lessening of subjective burden; using
financial support services is associated with more beneficial caregiver appraisal, such as better caregiver
mastery. The findings are practical and helpful for future caregiver service and program development
and evaluation and policy making for supporting caregivers. In addition, the evaluation method
demonstrated in the study provided a simple and moderately effective method for service agencies
which would like to evaluate their family caregiver support services.
Published by Elsevier Ltd.
Contents lists available at ScienceDirect
Evaluation and Program Planning
j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / e v a l p r o g p l a n
1. Introduction
An estimated 52 million Americans function as informal
caregivers of ill or disabled individuals, and 23 percent (22.4
million) of U.S. households are caring for a relative or friend who is
at least 50 years old (AARP, 2004; Coleman and Pandya, 2002). One
fifth of all family members of seriously ill patients have to quit
work or make another major life change in order to provide care,
and almost one third report the loss of their entire savings (GAO,
1994). Furthermore, financial or other unmet needs may impede
caregivers’ ability to function effectively, both in their own day-to-
day lives and in their role as an ongoing support system for their
patients (Kristjanson, Atwood, & Degner, 1995; Tringali, 1986). As a
result, the need to provide support to caregivers has gradually
gained societal attention, a ...
Running Head HEALTH NEEDS ASSESSMENT1HEALTH NEEDS ASSESSMEN.docxwlynn1
This document summarizes a health needs assessment that evaluated several measures used to assess public health, including mortality, morbidity, and disability rates. It discusses two completed needs assessments - the 2016 St. Mary's Community Health Needs Assessment and the 2015 Georgia Five Year Needs Assessment. The theories and approaches used in each assessment are described. The document also outlines how the results of needs assessments can be applied to health program planning and design.
Similar to 45-51 jGPHA-The role of perception (20)
Running Head HEALTH NEEDS ASSESSMENT1HEALTH NEEDS ASSESSMEN.docx
45-51 jGPHA-The role of perception
1. The role of perception in developing healthy lifestyles and community engagement
Anne Marie Coleman PhD, MPH,1
Anne Hicks-Coolick, PhD, MSW, MEd,2
and Agnes F. Brown3
1
Georgia Department of Public Health; 2
Associate Professor Emeritus, Kennesaw State University; 3Cobb and Douglas Public Health
Department
INTRODUCTION
For years, researchers have noted how individual
perceptions affect healthy behavior. Yun and Silk (2011)
showed how perceptions and social norms influence a
person’s ability to exercise regularly and maintain a healthy
diet. Peterson, Schmer and Ward-Smith (2013) observed
that attitudes and perceptions influence abilities of rural
women to participate in regular physical activity. An
individual’s perception of worksite support may impact
healthy behaviors (Lemon et al., 2009). In specific groups,
perception influences tobacco dependence (Reitzel et al.,
2012). Individual perception also affects preventive
behavior in cardiovascular disease (Claassen et al., 2012).
Furthermore, perception affects not only the health of
patients but the health of their family members (Mazor,
Goff & Alper, 2009). This study reports the methodology
used and the results and conclusions of focus groups in
Cobb County, Georgia.
The current report presents findings on the perceptions of
fifty-eight (58) participants in six focus groups in different
geographic locations countywide and describes how the
results were used to develop community interventions to
reduce chronic diseases.
Health Belief Model
The theoretical framework for this study is embedded in the
Health Belief Model (HBM). The HBM was developed on
the basis of a person’s readiness to change health-related
behavior as a result of perceived susceptibility, perceived
severity, perceived advantages, and perceived
disadvantages. In addition, this model explains how
perceptions and attitudes can be used in adopting healthy
behaviors. The basic theory undergirding the HBM is that
an individual will take a health-related action (e.g., going to
the doctor, screening, or exercise) if that individual feels
that a harmful health condition (in this case, obesity and
other chronic diseases) can be prevented. In addition, the
HBM is rooted in the individual’s belief that the
recommended intervention can be achieved successfully
(Boskey, 2008). Finally, the HBM concludes that if a person
believes a) there are benefits associated with a
recommended behavior; b) those benefits outweigh the cost,
time, and any other related factors of inconvenience; and c)
that it is possible to gain control of the disease at hand, then
it is possible to stimulate a positive health-related behavior.
Boskey (2008) noted how health is multi-dimensional, and,
to reach optimal health, certain factors, including biological
makeup, psychological processes, and the social
environment, should work together. The HBM has been
used to motivate the general public to engage in making
RESEARCH AND PRACTICE
ABSTRACT
Background: The Cobb and Douglas Public Health Department and the Cobb2020 partnership, sponsored by the Mobilizing
for Action through Planning and Partnering program, facilitated six focus groups in Cobb County to ascertain residents’
perceptions of healthy behaviors. The purpose of the research was to assist in the development of programs to increase healthy
behaviors.
Methods: Purposive sampling was used to choose fifty-eight participants, who were divided into six groups in different
geographic locations. The focus group questions concerned healthy living, health communications, and community health.
Qualitative data analysis techniques were used to generate themes and categories across and within groups.
Results: Six themes emerged: 1) need for education; 2) healthy food choices; 3) access to healthcare; 4) trust in health care
providers; 5) affordable healthcare; and 6) need for local resources. The results show how community members’ perceptions
regarding: a) policies that affect health, b) environments that promote healthier choices, and c) systems that allow individuals
to be health consumers influence healthy living and community engagement. Other findings note different perceptions
between those with and without health insurance. In addition, socio-economic status and ethnicity were seen as factors related
to the perceptions of participants.
Conclusions: The findings of this study informed a comprehensive, county-wide Community Health Improvement Plan. As a
result of these studies, Cobb & Douglas Public Health established, as two chronic disease prevention interventions, the
Cobb2020 Farm Fresh Market and, in the City of Kennesaw, the 100% Tobacco Free Parks and Cemeteries policy.
Keywords: focus group, healthy living, individual perceptions, health belief model
jGPHA (2015) Vol 5, No. 1
gapha www.jgpha.com 45 Journal of the Georgia Public Health Association
2. healthier choices regarding health as a way to decrease
health disparities (Glanz, Lewis & Rimer, 2002). Boskey
(2008) noted how researchers and scientists use the HBM to
predict health behaviors. This is imperative because healthy
behaviors (e.g., going to the doctor, screening, and exercise)
are linked to prevention of chronic diseases. In the present
study, qualitative research methods were used to collect data
about perceptions of local community members from Cobb
County, the third largest county in Georgia.
METHODS
During the summer of 2012, Cobb & Douglas Public Health
in Cobb County, Georgia, facilitated a series of six (6) focus
groups consisting of a total of fifty-eight (58) participants.
These focus groups were part of the Community Health
Improvement Plan of the Cobb2020 Partnership. Funding
for the focus groups was provided through a Community
Transformation Grant (CTG). Various professionals were
involved in the planning and implementation of the groups.
The group meetings were for two hours, including one hour
for a meal and the second hour for the focus group.
Sites and Participants
The focus group meetings were held in Cobb County,
Georgia, at various locations, including a) two community
recreation centers (n=9 and n=18); b) two apartment
complexes (n=9 and n=7); c) an apartment clubhouse (n=8);
and d) a church (n=7). Purposive sampling techniques
(Patton, 2002) were used to choose the participants for each
of the six groups. The groups had from seven to eighteen
participants for a total of fifty-eight (58). They included
three neighborhood civic groups, one group of volunteer
health care workers for the Hispanic population, and a group
of Hispanic parents. Participants were adults who largely
represented minority populations in Cobb County and
varied by gender, age, race, and socioeconomic levels (See
Tables 1-4).
N Black Hispanic White Other
Group 1 18 87% (n=15) 0 13% (n=2) 0
Group 2 9 100% (n=9) 0 0 0
Group 3 8 75% (n=6) 0 12.5% (n=1) 12.5% (n=1)
Group 4 7 71% (n=5) 0 29% (n=2) 0
Group 5 7 0 100% (n=7) 0 0
Group 6 9 0 100% (n=6) 0 0
TOTAL 58 60% (n=35) 22% (n=13) 10% (n=5) 2% (n=1)
Table 1. Percentage and Numbers for Races in Each of the Six Focus Groups
N Male Female Missing Data
Group 1 18 17% (n=3) 78% (n=14) 3% (n=1)
Group 2 9 33% (n=3) 67% (n=5) 11% (n=1)
Group 3 8 0 100% (n=8) 0
Group 4 7 29% (n=2) 57% (n=4) 14% (n-=1)
Group 5 7 29% (n=2) 71% (n=5) 0
Group 6 9 11% (n=1) 89% (n =8) 0
TOTAL 58 19% (n=11) 76% (n=44) 5% (n=3)
Table 2. Percentages and Numbers for Genders in Each of the Six Focus Groups
N 18-19 20-34 35-54 Over 55
Group 1 18 0 11% (n=2) 50% (n=9) 39% (n=7)
Group 2 9 0 11% (n=1) 55% (n=5) 34% (n=3)
Group 3 8 0 25% (n=2) 75% (n=6) 0
Group 4 7 14% (n=1) 14% (n=1) 72% (n=5) 0
Group 5 7 0 0 100% (n=7) 0
Group 6 9 0 67% (n=6) 33% (n=3) 0
TOTAL 58 1% (n=1) 19% (n=11) 60% (n=35) 17% (n=10)
Table 3. Percentages and Numbers for Ages in Each of the Six Focus Groups
jGPHA (2015) Vol 5, No. 1
gapha www.jgpha.com 46 Journal of the Georgia Public Health Association
3. N >$14999
$15000-
$24,999
$25000-
$49,999
$50,000-
$74,999
$75,000+ Missing
3%
(n=1)
Group 2 9 11% (n=1) 22% (n=2) 22% (n=2) 44% (n=4) 0 0
Group 3 8 25% (n=2) 12.5% (n=1) 25% (n=2) 25% (n=2) 0
12.5%
(n=1)
Group 4 7 14% (n=1) 28% (n=2) 14% (n=1) 28% (n=2) 14% (n=1) 0
Group 5 7 14% (n=1) 71% (n=5) 14% (n=1) 0 0 0
1% 33%
(n=1) (n=2)
6%
(n=4)10% (n=6)TOTAL 58 24% (n=14) 19% (n=11) 21% (n=12) 19% (n=11)
0
Table 4. Percentages and Numbers for Incomes in Each of the Six Focus Groups
Group 1 18 17% (n=3) 0 33% (n=6) 17% (n=3) 28% (n=5)
Group 6 9 66% (n=6) 0 0
Data Collection
Four of the focus groups were held in English; two were
held in Spanish and translated into English. During each
meeting, the leader asked seventeen (17) questions and
audiotaped the entire group interaction (see Appendix 1).
The researchers used two digital tape recorders to guarantee
that all responses were captured. One researcher asked the
questions, and the other took notes.
Data Analysis
The researchers used a general inductive approach to data
analysis as described by Thomas (2005). The audiotape of
each group was transcribed verbatim, and each transcription
was checked against the original tape to verify accuracy.
Recordings from the two focus groups conducted in Spanish
were translated into English for analysis. The two
researchers individually read and analyzed the content of the
six transcripts using coding for themes and categories within
groups. As a second step in the analysis, they negotiated and
identified themes, including similarities and differences
across groups. Ethnic and socioeconomic differences were
also analyzed. The findings were supported by quotes of the
participants.
Trustworthiness
Trustworthiness in qualitative data analysis includes
techniques to ensure that an account is rich, robust,
comprehensive, and well-developed (Cohen & Crabtree,
2006). A report from the Robert Wood Johnson Foundation
says that use of multiple analysts provides a check on
selective perceptions of the researchers and indicates blind
spots in interpretive analysis (Cohen & Crabtree, 2006). In
addition to researcher triangulation, the researchers used
stakeholder checks that allowed personnel from the health
department and other interested parties to comment on the
findings and, thus, to increase credibility (Thomas, 2004).
The focus group participants were invited to participate in
group discussions on the implications of the results. The
CTG Program Manager and Policy Analyst coordinated the
workshops in which findings were presented. The results of
the focus groups were made public on the Cobb2020
webpage (www.cobb2020.com).
RESULTS
Although the themes that emerged were similar across sites,
there were differences in perceptions depending upon
socioeconomic and ethnic characteristics in each group.
Participants from lower socio-economic neighborhoods
perceived more problems than those from other areas. Those
who had health insurance had fewer issues than those who
did not have insurance. The Hispanic groups had more
problems relative to their ethnicity than did other groups.
However, the differences notwithstanding, consistent
themes across groups were as follows: 1) health education,
2) healthy food choices, 3) access to healthcare, 4) trust in
health care providers, 5) affordable healthcare, and 6) need
for local resources.
Health Education
Many participants felt they were uninformed about health
issues in the community. Comments describing a lack of
communication to residents were seen in several responses
such as, “there are [health] events we don’t know about...”
and “… some people can’t go out; they can’t travel to those
places, or they can’t get there or … they may not have
internet service.” “If we just concentrate on educating the
community and having a marketing campaign [concerning
healthy living]…, I think it would work just as good as a
policy.” Another suggestion for educating the public was for
the community to develop and print a “...a manual [of health
related services]...to be provided so people would be
educated.” Another member of that group said, “However
you have to get it out… send it through the mail, drop it by
the doors.” Another suggestion was to use “billboards like
those for cigarettes but that speak of food; something like: if
jGPHA (2015) Vol 5, No. 1
gapha www.jgpha.com 47 Journal of the Georgia Public Health Association
4. you eat this type of food, you will have cholesterol
problems… something that alarms us.”
Healthy Food Choices
Living alone, having a fast-paced lifestyle, not being able to
pay the high cost for healthy food, and lacking space to
grow fresh vegetables emerged as factors contributing to
less healthy food choices. “… I’m single. If I go buy … fruit
and all this food, it will just go to waste. So then I find
myself going … [out to eat].” Another participant reported
the fast food restaurants with high fat menus were cheaper
and easily available in the community. Many mentioned that
eating healthy food is more expensive than eating unhealthy
food. One suggestion for saving money was [to buy] in bulk
when products were on sale. Several participants reported
the lack of space to garden as a limitation to healthy eating.
“There are no places for us to grow our vegetables, the
apartments are small, and there is no room for plant pots
either.”
Participants discussed the need for better food choices and
consistency in providing healthy food options in the public
school systems. One person described her concern about the
school's food options conflicting with what she is teaching
her children at home, “I worry about the schools because I
have some control over what happens in my house, I can
hide soda and give water to my family, take away chocolate
and feed them carrots, but at school children get ice cream
as a treat, this way whatever I do at home is worthless.”
Concern about vending machines and the products available
to students was discussed, “... a bottle of water costs more
than the soda,” and the food options include “a lot of bread.”
Access to Healthcare
Access to healthcare was a theme in all groups. Participants
described a need for services for the disparate population.
Some clinics that were available in the past are closed,
“They’ve closed health departments in certain areas. We got
a problem.” “The services that are available currently … are
not adequate to meet the needs of the many people in the
community.” One participant spoke of a dilemma regarding
a clinic that provides “healthcare for low income people.”
She explained the clinic is open two days a week and is free
with a local doctor seeing patients, but by two o’clock, the
line is so long many cannot get in. Another issue is related
to the length of time to get an appointment, “When you call
to make appointments at the health center, dates are very
far.” Furthermore, many agreed “the amount of time it takes
to get results back on labs or on procedures can be
extensive.” One participant described the reason he did not
like to seek care was the health system is too fragmented “...
you go to one doctor and then you go to a specialist here and
to another person. It just seems like it all don’t gel together
and it’s just a little cumbersome to me. I’m just afraid of it.”
Trust in Healthcare Providers
Many participants perceived a lack of trust in their
healthcare providers. They did not know if tests ordered
were always necessary, “Some of the recommendations …
(are not) necessarily best for us.” Some participants had
family members who could advise them or who could listen
to what the doctor said and either confirm or negate it. Some
believed there was a lack of confidence in the doctor's
knowledge of medications and treatment because, “...you
have to trust …your doctor knows the side effects of the
medicine and that he thinks … these effects are less
important than the illness.” The perception of mistrust was
also related to thinking that what the doctor charges and
prescriptions may not be necessary. For instance, one said
and others agreed, “The biggest problem is not having
confidence in the doctor.”
Some participants perceived they could not tell their doctor
everything “....because of your fear of what they’re going to
think about you or say or that they may say something to
someone else....” They discussed the limited amount of time
providers spend with patients and their worry that doctors
do not listen. One stated, “The doctor’s time with you is
getting shorter and shorter and shorter to a point where I
don’t even know if you get five minutes with the doctor.”
Others went on to say “...you don’t have time to ask your
questions or process what they’re saying to you.”
“....Healthcare provider-patient relationship is so strained
and so difficult that if you don’t take an advocate with you,
the chances are that the experience won’t be positive....”
Affordable Healthcare
While many participants reported that they had health
insurance coverage, each group had participants who did
not. All individuals acknowledged the importance of having
insurance coverage. “We cannot afford a doctor that will
charge us $400 just to see us, plus the medicines.”
Participants spoke of the dilemma they face when their
children are sick, “The free clinics take about 6 people in
the time. And if you are only taking 6 people and 150 need
health care... When I look at my baby’s face and I see my
baby sick and crying, you know what, I may take this
twenty dollars and put some joy in his life, ‘cause I gotta
wait seven months to get to that doctor… So you don’t
know what it’s like when you all always have healthcare
and when you don’t have healthcare.”
Need For Local Resources
The final theme identified in all groups was the need for
community resources to promote physical and emotional
health and wellness. Participants believed that local gyms
and church facilities would be helpful venues to promote
physical activity by giving access to community members
through joint-use agreements for their facilities. “We need a
gym around this area. Some churches have gyms and
exercise equipment …” “I’d like to have an exercise room
in my church parish.” “I believe the gyms should be open to
the community to go in and use that equipment. It’s sitting
there all weekend and all evening for free.” “Yeah, I think it
would be nice if schools opened up their outdoor facilities
like their tracks during the mornings and the evenings for
public use.” “There are no big parks around here. There are
some small green areas but no parks.” Participants also
noted having parks where smoking is prohibited as a need in
their local community. People smoking in the parks was
identified as a public health issue. Grocery stores with fresh
produce or farmers markets were noted as needs by
community members. “...There’s not a grocery store in the
community where I could shop.” “All you’ve got is
jGPHA (2015) Vol 5, No. 1
gapha www.jgpha.com 48 Journal of the Georgia Public Health Association
5. convenience stores around here. You don’t buy healthy
foods there.”
DISCUSSION
For this exploratory study, there are several limitations,
most of which are inherent in focus group research (Curtis
& Redmond, 2007). For instance, the convenience sampling
and small numbers of each group limit generalization to
larger populations. Participants consisted of those who were
active in the community and may not hold the same views
as people who are less community-oriented. Many of the
focus group participants were purposely chosen from
disparate communities, such as lower economic or Hispanic
areas. The views of these participants may differ
substantially from upper-middle-class and upper-class
individuals.
These results provide an opportunity to learn how local
community members perceive variables directly related to
making healthier choices and to being engaged in their
community. The focus group participants shared
information and how they perceived health, food choices,
healthcare providers, tobacco prevention, and education.
Public health professionals could apply the findings in
making decisions on how to target policy, systems, and
environmental changes towards chronic disease prevention
at the local level. The perceptions of people should not be
ignored in planning and developing interventions for
prevention of chronic diseases. Throughout this research,
participants explained how perceptions guided their
decision-making, leading to their lifestyle choices. The
information shared by the focus group participants reflected
their individual realities and may not represent the final
truth. What they perceived, however, was the driving force
in how they made choices regarding their health.
Thus, health education for community members is not
always clear; the message can be lost due to how it is
perceived. To implement policy and environmental changes
that lead to healthier lifestyle(s), health professionals need
to communicate in a language that local community
members can trust. Otherwise, barriers will prevent
individuals from accepting and implementing healthy
behaviors. Mass media campaigns should reach large
numbers of people and be culturally sensitive, keeping in
mind the diversity in the community. Since the roadmap to
healthcare looks different to each community member,
creating interventions where the access point is not
generalized could help build trust and open doors for people
to use the resources available to them.
Current Health Related Interventions
The Cobb2020 Partnership used the information from the
focus groups to design and implement the Farm Fresh
Market and worked to establish the 100% Tobacco Free
Parks policy for a city in Cobb County. Both interventions
are supported by evidence-based practices and, for
community members, present policy and environmental
change leading to sustainability. The goal of the Farm Fresh
Market is to provide access to fresh produce to local
community members of an identified food desert.
Evaluation results show that the market, implemented
during the summer of 2014, provided access to fresh
produce and increased the consumption of fruits and
vegetables. The goal of the 100% Tobacco Free Parks
Policy was to reduce exposure to second-hand smoke in a
local park system. As a result of collaborations with
community partners and local council members, the policy
was adopted during the summer of 2014.
Thus, community members should be included during the
planning stages of program and policy development. Their
contributions will ensure that public health practice(s) are
not only implemented but that sustainable lifestyle changes
are adopted. Community members should be partners, for
their contributions, unlike others, can help translate the
desired health outcomes, leading to decreases in morbidity
and mortality associated with chronic disease. As described
here, use of the Health Belief Model and learning from
community members allowed for successful implementation
of the two projects and, by engaging the community,
ensured sustainability.
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7. Appendix I
Focus Group Questions
1. What does being healthy or health mean to you?
2. Who is responsible for the health of a community?
3. What do you usually do when you get sick? Where do you go to get help? Who do you usually see? How do you pay for it?
4. What keeps you from seeking healthcare services when you need them? How could you prevent that from happening?
5. Tell me about your experience with getting an annual physical.
6. What kind of health services are still needed that we do not currently have in Cobb County?
7. How does weight affect a person’s health?
8. When you hear the word “overweight”, what does that mean to you? What about the word “obesity”?
9. How do you decide what to eat?
10. What helps you to “eat healthy”? What makes it difficult to do so?
11. What are some things that help you be active?
12. What keeps you from being active?
13. Tell me about how money influences what you choose to eat? How does it influence how active you are?
14. What do you think about insurance companies charging higher premiums to people who smoke or are overweight or obese?
15. What could we do in Cobb County to increase people’s health and healthy behaviors, like eating healthy, not smoking and
being more active?
16. What other health issues in your community are a concern to you?
17. What are some health related policies that if passed could make it easier for people to eat healthier and exercise more?
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