LotusHouseInterventionFinalPaper

RunningHead:LOTUS HOUSE HEALTH INTERVENTION
Lotus House Health Intervention
NUR 440 Population-Focused Nursing
Rose Anstral, Jaime Bruynell, Sherrille Cardona, Erica Echevarria,
Lindsey Forté, Chelsea Michaels, Carol Okonkwo, Vanessa Raymond

LOTUS HOUSE HEALTH INTERVENTION 2
Part I. Assessment and Analysis
A. Describe your target aggregate
Our target aggregate is composed of homeless women residing at the Lotus House in
Overtown. Overtown has been historically based off a blend of cultures, “going to overtown” for
specific foods. It has primarily consisted of African Americans of lower socioeconomic status. When I-
95 was being built, a hurricane struck, and the people of the town were forced out of their homes,
forcing them to live on the street or under the interstate.
Map of Overtown. Overtown’s boundaries include: North 20th St on the south boundary,
North 5th street on the north boundary, Miami River/SR 836/Florida East Coast Railway on the East,
and W 1st Ave on the West (see map below).

Overtown is composed of a series of Census Tract numbers, consisting of 28, 30, 31, 34, and 36 (see
map below).
Race/Ethnicity. Predominantly Black (83%), followed by 16.39% Hispanic, and 10.8% White
(See Table 1).
Income. The median family income for Overtown is drastically lower than the incomes of the
county and state ($15,287). In comparison, the median family income for Miami-Dade county is
$49,000, and the median family income for the state of Florida is $46,036. Just over half of the
population in Overtown are considered to be below the Federal Poverty limit ($15,930 for a family
household of two and $20,090 for a family household of three). As of 2013, the unemployment rate of
Overtown was 14.8%, compared to the 2013 unemployment rate of the City of Miami at 9.6% and the
federal unemployment rate of 7.4%. (See Table 2).

Housing. Upon observation, Section 8 housing was painted various bright colors. What is
referred to as the “Concrete Jungle,” consists of older Section 8 homes with concrete windows. Bars on
many windows were observed, which poses a safety concern in the event that there is a fire. Many of
the homes displayed unit room air conditioning, which posed another safety issue as this increases the
susceptibility of break-ins and robberies. The majority of the homes were older and outdated, which
poses a health risk for respiratory infections and lead poisoning. Graffiti is very common, as are chain-
link fences. An abundance of abandoned homes were observed, which offer an easy hideaway for
illegal drug use, prostitution, rape, etc. Statistically speaking, the number of housing units in Overtown
(5,011) as well as the percent of owner occupied units (9%), are both drastically lower than compared
to the county (56% owner occupied units) and state (67% owner occupied units) (Sylvester
Comprehensive Cancer Center, 2015). (See Table 2).
Shopping. Upon observation, a lot of small side stores were noted. Residents are forced to
walk or take the bus or metro in order to get to any major stores. Three main stores were observed:
Overtown Food Market, 3rd Ave Market, and “The Meat Store.” Overtown could be considered a food
desert. Malnourishment and obesity is a common issue, as there are not many places to buy food, and
because the corner stores that located in Overtown are very limited on the supply of food. The corner
stores in Overtown offer scarce selections of fresh fruits and vegetables: onions, apples, potatoes,
bananas, and other fruits and vegetables that would not spoil quickly. The majority of fruit and
vegetables were canned, and there was no leafy greens offered. A popular food item at the corner store
was meat, but the selection they offered were cheap pork cuts, farm-raised tilapia, dark meat chicken,
and high fat-content beef.
Transportation. The main forms of transportation observed were bikes, the Overtown Trolley,
the bus systems and walking. If there is a health concern (child running a fever), and they don’t have a
car, they most likely call 911 for transportation - even if it is not necessarily a medical emergency.
Overtown residents use the ER for non-emergent health concerns, and they in turn don’t receive follow

up care since the ER is not a primary care visit. This also creates longer wait times for other patients in
the ER that are there for emergent health concerns. The non-emergency calls to 911 is a waste of
emergency resources, and takes emergency responders away from potentially more urgent cases in the
area. Health concerns in Overtown include lack of continuity of care and abuse of emergent health care
systems.
Recreation Areas. Some resources for recreation include the Overtown Youth Center and
Gibson Park, which is new and beautiful but very underused by the target group. Barriers to the
recreation areas being used include no time due to working, violence in the area, and crime prevalence.
This type of sedentary lifestyle can lead to cardiovascular disorders, obesity, mental health disorders,
anxiety, stress, and depression.
Hazards. Some hazards observed included broken down houses, chain-link fences, illegal
dumping, very few streetlights, and poor pavement and roads. If there are street lights, the light bulbs
have been shot out as Officer Lanier said, “the residents like it dark” because the darkness allows the
residents to engage in illicit behaviors with reduced risk of consequences. Some environmental hazards
include flooding and contaminated water. This puts residents in dangerous living situations, and at risk
for common illnesses, including E. Coli and Hepatitis A. During a hurricane, electricity is restored by
priority, meaning hospitals, and wealthier areas have their power restored first, so safety is another
concern. Water pipes in the town are older and outdated.
Street People. Upon observation, many homeless people were noted, as well as people
drinking on the streets and various crowd gatherings. This sets the perfect stage for alcohol abuse as
well as other addictions, because if everyone else is doing it, people won’t think anything is wrong
with doing the same. A lot of older people were seen (most likely unemployed). Kids were seen
walking the streets unaccompanied by adults; rather, they walked in packs together. A lack of police
force presence was also noted.

Pets/Animals. Stray animals were seen roaming the streets. Dogs are used for protection and
safety in the area, but if the owners can’t afford to pay for the dog anymore, they let them go. No
facilities for pets were seen.
Religion. The churches noted were predominantly Baptist churches, which is associated with
African American race.
Services. Upon observation, HIV testing trucks were noted. This is extremely useful, as Miami
Dade County has a drastically higher proportion of HIV positive people as compared to the rest of the
state (Professional Research Consultants, 2013). No urgent care centers were seen, and Jackson
Memorial Hospital is the closest hospital, located 1.4 miles away from Lotus House. Jefferson Reaves
Sr. Health Center is the only health center in the area, but it has limited hours and sliding scale rates
based off of income. If there is a common problem, they are only treating the symptoms, rather than
focusing on continuity of care. With lack of facilities for people to follow up on their health concerns,
issues are probably not being resolved, and diseases aren’t being treated properly.
Health and Morbidity. As reported by Mr. Fred Johnson, some common health concerns that
are prevalent in the area include HIV/AIDS, Hepatitis C, syphilis, TB, diabetes, cigarette smoking, and
mental illness. Narcotic and heroin use is also a major issue as reported by the women in Lotus House.
Schools. Schools noted in the area include Booker T. Washington High School on 6th Ave,
Gibson Charter School (K-8), Paul Larrence Dunbar (K-8), and two elementary schools, one of which
has no windows.
Politics. No political signs were seen in the area.
How does this aggregate compare to others? Overtown is predominantly comprised of
minorities with the percentage of African-Americans 60-70% higher than that of both the county and
Florida as a whole. Overtown also has a large amount of poverty when compared to the city of Miami
as well as the state of Florida. The median household income is drastically lower than Miami and that

of Florida as well (refer to Table 2). The unemployment rate is over 50% higher when compared to
Miami and Florida.
Table 1: Population Race Distribution
Census Tract Community County State
# % # % # % # %
White
477
10.8% 4,882 35.4 396762 15.6% 14109162 75%
Black 3670 83.11% 7,607 55.2 480201 18.8% 2,999,862 16%
Hispanic 724 16.39% 5, 180 37.6 1653390 64.9% 4,223,806 22.5%
Asian 4 0.09% 204 1.5 40515 1.6% 454,821 2.4%
Native
American
21 0.48% 12 0.1 4092 0.2% 71,458 0.4%
Other 116 2.63% 71327 2.8% 681,144 3.6%
Source of Evidence:
http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=bkmk
Table 2: Socioeconomic Measures
Source of Evidence: American Community Survey 2013 5 year estimates, Tables B19013,
B15003, S2301, S1701, S2701, S1601, S1101
B. Describe Your Key Informants.

Ms. Rai Johnson
Ms. Rai is the director and an alumna of Lotus house. As a former resident of Lotus House, she
has valuable insight of what it means to be homeless in Miami.The reason why we picked her is
because she lived in overtown and experienced homelessness herself. We believe she would be able to
give us more insight reflecting the windshield survey that was conducted for overtown. She also has
direct access to the current residents on a daily basis thus is highly aware of the health issues that they
face each day. We also was able to get more insight of the overall health of the overtown population
which reflected on the health issues we saw for our windshield survey. She stated that her being an
alumna is one of the key aspects of the organization that is beneficial, because the residents see her as a
role model who has dealt with and overcome some of the same things they are dealing with. In
addition, the organization uses a holistic approach, which benefits the residents as well. Her views on
the women that live there is that they cope just like anyone else – providing emotional support for each
other. Some of the health issues that she notes are most critical include unplanned pregnancy,
depression and the use of tobacco/smoking. One of the coping mechanisms that she sees amongst the
women is projection of anger and frustration upon their children or others. She expressed that there are
resources available to the women to learn new coping skills, however it is up to the women to take the
initiative and use these resources to their advantage.
Mr. Fred Johnson
For our second key informant, we decided to use Fred Rodriguez. Fred is a recently retired
Lieutenant/Paramedic for the City of Miami and Overtown fire department. Fred came to know the
community very well in his 30 years of service and this is why we choose him as a key informant. Fred
had extensive knowledge about the population’s environmental and behavioral determinants, such as
the lack of medical care and insurance available, conditions of their homes and the increased incidence
of HIV/AIDs and STD’s due to risky behavior. He transported many clients from houses, apartments,
grocery stores and the streets to Jackson Memorial Hospital or University of Miami Hospital

(previously known as Cedar’s Hospital). Fred mentioned that the major health issues in the community
were lack of primary healthcare/insurance, drug and alcohol abuse, HIV/AIDS & Hepatitis B/C,
domestic violence and violence on the streets such as gunshots and stabbings. Since many of the
people in the community lack primary healthcare and insurance, he mentioned that many times the
calls he received were clients who just needed transportation to the emergency department. Many of
the clients use the emergency department as their primary healthcare provider due to their low-income
status. Because of this, there was a lack of continuity of care, which resulted in recurring visits to the
emergency department. Fred became familiar with many of his client’s because they were “frequent
flyers”, meaning they were repeatedly calling into the fire department for transportation to the
emergency department. Fred went into many houses and apartments during his time as a
firefighter/paramedic. He described the housing conditions as small, rundown, old, smelling of mold,
and dirty. There was usually no central AC and there were more residents than bedrooms in the
houses/apartments. He also experienced some culture and language barriers with the large Haitian
population in Overtown.
Lotus House Client (alias Joanne)
For the purpose of the interview, our interviewee has requested to remain anonymous so we
assigned her the alias Joanne. Joanne is one of the homeless women that lives at Lotus House. She was
chosen as a key informant because she has lived in Overtown for over 12 years and she was very open
to talking about her experience living in Overtown. Joanne knew what it was like to grow up homeless
because she was in foster care as a child in California before she decided to move to Overtown. We felt
like it was important to choose her as a key informant versus the other women living in the shelter
because of her experiences living in Overtown. She had firsthand experience with drug abuse and risky
sexual behaviors, which helped us in developing our nursing diagnosis. She started the conversation
talking about her health concerns and asking for advice because she had an extensive medical history.
She had found out that she was HIV positive (as well as suffering from endocarditis and infected with

MRSA). Her HIV has since progressed to AIDS. She told us she realized that she developed all these
issues from “shooting up heroin” and sharing needles with her friends in Overtown and that her that
was a turning point in her life because she felt like she was going to die and that she never wanted to
“shoot up heroin “ever again. She had also worked as a prostitute but insisted that she always practiced
safe sex and used condoms so this is not how she contracted HIV. She expressed her wishes that there
was a needle exchange program in Miami for her friends that are still using drugs because she knows
that while they are not going to stop at least this could help them stay healthy and not transmit HIV and
other infections amongst themselves. Another concern she expressed is the lack of knowledge amongst
the community about how HIV is contracted. She said that some of the women in the shelter with
children didn’t want her around their kids because they were scared she was going to pass HIV along
to them. She ended her interview by stating that she was happy with living at Lotus House because she
felt like it was her “safe space.” She stated that you don’t want to be out in the streets of Overtown at
night because it is not safe and detrimental things like drug use, shootings and prostitution is what
happens. Joanne states that she is in a much better place now and that she is happy with the resources
and help that Lotus House has given her and she wouldn’t be where she is if it weren’t for Lotus
House.
Officer Lanier
For our 4th key informant we chose to use Officer Lanier. We chose to use him because not
only is he a police officer in the area but also because he was born and raised in Overtown. Crime,
such as prostitution, squatting, and drug use, is rampant in the Overtown area so we decided it would
be good for us to get a perspective from a police officer who deals with these issues on a daily basis.
Officer Lanier was an especially insightful key informant because he was able to speak on how he has
seen the neighborhood progress over the years. He felt that he has a personal connection with the
community in addition to wanting help restore Overtown to what it once was. Officer Lanier indicated
that Overtown was a community of people that used to look out for each other but how over time it has

progressively declined as crime has increased. The major concerns that he feels afflict the city are
drug use and prostitution that he often finds being conducted in the abandoned buildings that also
house the homeless. Secondly, the absence of job opportunities in the community leads many to resort
to illegal lifestyle choices in order to provide for their income. Thirdly, he stressed his issues with the
lack of utilization of available resources by the community, such as the HIV/STI mobile testing clinic.
He addressed a shortage of police enforcement in the community expressing that at times there may
only be one to five patrol units for the entire community every shift. He specified that if there was
more community and educational involvement we could see an improvement in Overtown.
C. Describe 3 Social Determinants of Health for your target aggregate
Psychological Determinants. The health issue related to this determinant was substance abuse
and smoking. The specific determinants to our aggregate of Lotus House were the ability to cope with
stress because there limited options available to manage the stress and no mental health resources.
Since being homeless is a very stressful situation most of the women turn to smoking to help alleviate
the stress and some go to substance abuse to help forget about their situation. This we were able to see
through our observations and our windshield survey. Also from conversing with the women at Lotus
House many were telling us that they were bipolar and that a lot of them were depressed because they
had a sense of hopelessness. In the actual community of Overtown the presence of stress was due to
the low income environment, limited transportation options, the presence of gangs, limited
employment options, limited school options and after school options for the children. Also through
conversing with the women they talked about how big drug abuse is throughout Overtown and that the
common drugs they used were heroin and opioids. Also through our key informants we were told that
the community of Overtown has a low level of support from Miami City officials.
Environmental Issues. The health issues related to the environmental determinants were
smoking, substance abuse and needle use, which can lead to HIV and Hepatitis C and STIs. Through
observation and our windshield survey we saw that a lack of street lights can be unsafe for pedestrians

which puts them at risk of being hit by cars, it can be unsafe for women because it can lead to rape, its
unsafe for children because they sometimes wander the streets alone and overall makes it easier for
crime to take place. From driving through Overtown you can tell the roads have poor infrastructure,
which makes driving more dangerous. There is also lack of air conditioning, which can be a health
concern when it comes to the extreme temperatures in Miami. This makes it easier for mold to grow
which can lead to major health concerns, the air filters are old and not replaced which can lead to
respiratory issues, and the lack of central AC can make it easier for break-ins to occur. The houses are
run down which can lead to a risk of lead poisoning since the homes are very old and falling apart.
There are also a lot of abandoned houses, which makes it easier for people to conduct illegal activities
such as drug use, prostitution and rape. Also from driving through Overtown one can tell that there is a
lack of parks and places to exercise and the one or two parks that are in Overtown are always empty.
Also there is a lack of areas for the people to congregate instead you just see them roaming the streets
or hanging outside their houses. Also in Overtown there is lack of grocery stores, which makes it hard
for people to get foods and the stores that they do have available are loaded up with cigarettes and
alcohol. Also in these small makes there is little to no availability to healthy foods such as fresh fruits
and vegetables. In Overtown there is a high crime rate, most which are stabbings, gunshots and
robberies. Also the schools have very few windows because when there were windows it was a major
safety risk for the children. With the crime rate being high it poses a threat to children because they are
constantly walking home alone from school because there parents are either working or not around.
Behavioral Determinants. The health issue related to this determinant is the prevalence of
STIs, unprotected sex, HIV and unplanned pregnancy. From observation and communication with the
residents there is a big prevalence of substance abuse. The biggest sellers at the corner stores are
tobacco and alcohol along with lotto tickets. Our key informant Officer Lanier told us that most of the
calls that the police department responds to are either drug related or prostitution. Many of the parks in
Overtown are used to sell drugs or to engage the drug activity. Also in Overtown there is a big

prevalence of STIs and risky behaviors. Ms. Rai, another key informant, stressed how the spread of
STIs is a problem at Lotus House and asked us to address these issues in our health fair. Officer Lanier
also mentioned that HIV is a big problem in the community because many people engage in needle
activity when they do drugs such as heroin. HIV can also be contracted through the high incidence of
sexual activity as well. Officer Lanier also mentioned that the few parks and facilities that are available
in Overtown are not being used. He mentioned that these facilities and parks are equipped with
basketball courts and gym equipment and aren’t serving their purpose since people aren’t using them.
D. Describe the top 2-3 health problem/need(s) you are addressing
The top health problems that we are addressing are unplanned pregnancy/contraceptive use,
HIV/STD transmission, smoking cessation, and nutrition. Based on the results from our key informant
interviews and windshield survey, we believed that these were the most important health issues
affecting the woman of Lotus House that we wanted to address. These health issues were prioritized
over other issues we saw because in speaking to the women of Lotus House, these were issues that
affected them the most and what they wanted to learn more about. We gave more weight to the Key
Informant Interviews because we felt as though the information gathered from them applied more
directly to the woman of Lotus House than, say, the windshield survey, which was a lot of our
subjective interpretation of what we saw through our “windshields”. Using the Key Informant
Interviews helped in making our final decisions on what health problems/needs were important to
focus on. The health needs/problems were then prioritized according to how much we felt they
impacted the lives of the women at Lotus House as well as evidence-based interpretations we made
based on statistics that we found about the correlations between homelessness and unplanned
pregnancies as well as HIV and STD transmission and contraction. And to be perfectly honest, we held
Ms. Rai’s concerns, which were unplanned pregnancy amongst the women and HIV/STD prevention,
very high in our prioritization because we felt she knew the needs of the women at Lotus House better
than anybody as she is one who deals with every single woman that enters into that organization.

Assessment of Problem Identification. One of the health problem/needs we are addressing
(and one that we deemed the top prioritized issue) is unplanned pregnancy. From speaking to the
woman of Lotus House and Fred Rodriguez, unplanned pregnancies seem to be a large concern in the
aggregate. Many women verbalized not planning their pregnancies and having lack of
knowledge/resources for contraceptive use. Fred mentioned transporting many homeless pregnant
women from the streets who had no primary care OB/GYN and no prenatal care. Due to their lack of
resources, many of these women would give birth on the streets or call the fire department to transport
them and give birth in the emergency department.
Our second issue, which can be tied into the issue of unplanned pregnancy, is the transmission
of HIV and other STIs such as chlamydia, syphilis, gonorrhea, and herpes simplex 1 and 2. Joanne
spoke about her own struggle with HIV and how she acquired it by needle sharing when she was an IV
drug user. While she stated that in her time working as a prostitute she used condoms to prevent the
transmission of the disease, Officer Lanier relayed his experience with prostitution in the area and
stressed the issue of the spread of HIV as well as other STIs in that way. Officer Lanier also talked
about multiple situations he has come across in his time as a police officer in which he was responding
to reports of squatting in abandoned buildings and would enter into a scene of a mosh pit of drug users,
dirty needles, unprotected sexual activities and domestic violence. The CDC states, that the use of
drugs and alcohol in conjunction with sexual activity greatly increases the likelihood of acquiring HIV
or an STI.
Another issue that needs addressing is nutrition. From observing the women of Lotus House,
the people on the streets of Overtown, and statistical information, a large majority of these people are
considered obese. From talking to the women, this issue seems to root from lack of knowledge,
dissatisfaction with the food provided at Lotus House, as well as lack of resources (income, stores to
purchase food at). We selected this health issue because not only is it a common recurring issue in

Lotus House, but also because it is an issue that can be easily improved upon with some basic
education on affordable, yet adequate nutrition and exercise.
We will also be addressing smoking among the women. Ms. Rai stressed that she thinks
smoking cessation teaching is something that is imperative for our health fair in that it plays a role in a
lot of the other issues the women face such as obesity, diabetes, and difficulty dealing with stress. We
also found in our windshield survey that the top sellers in the corner store are cigarettes and alcohol,
which implies it is also an issue in the larger community.
Strengths and Weaknesses of the Community. The strength of the community is that there
are organizations, such as Lotus House, that offer assistance to homeless women and their children.
These organizations also try to educate women on the use of contraception methods to prevent
unplanned pregnancies. The weakness of the community is that it is still a very low-income
community, making it difficult to acquire affordable contraception. The community is also a very high-
crime, dangerous area, and is not very ideal for the safety of children, especially homeless children.
Officer Lanier stressed that there are many resources in the community (HIV testing mobile unit, job
acquisition agencies, parks, youth center, etc.), but that the community under utilizes them. We
decided not to include an asset map in our assignment because it was made clear to us that the people
in the community are aware of the assets available to them but underutilized them. Lotus House also
does a very good job of referring the women to necessary services and helping them acquire them so
we thought our asset map was not necessary.
E. Community Health Nursing Diagnoses
1. Female homeless population in Overtown at risk for unplanned pregnancies related to lack of
knowledge of contraception use and lack of access to contraceptives (condoms & birth control) as
evidenced by (a) 37% of homeless women reported not knowing how to obtain contraception and
(Nowosielski, 2005) (b) 42% of homeless women reported not knowing how to use contraception
methods (Nowosielski, 2005)

2. Female homeless population in Overtown at risk for sexually transmitted infections
(including HIV) related to self-report during key informant interviews of unsafe sex practices and lack
of knowledge of appropriate barrier techniques to avoid transmission as evidenced by (a) 228 new
cases per 100,000 of HIV infections amongst women in Miami-Dade county and (b) 30 new cases per
100,000 of syphilis amongst women in Miami-Dade County and (d) 772 new cases per 100,000 of
gonorrhea amongst women in Miami-Dade County in 2014 (Floridahealth.gov Epidemiological Profile
for Miami-Dade County)
3. Female homeless population in Overtown at risk for smoking/tobacco use related to stress as
evidenced by the majority of the women smoking, self-report of inability to cope without smoking (a)
studies supporting that high tobacco/smoking is much more common among homeless people than in
the general population (Didenko and Pankratz, 2007); (b) studies linking smoking as one of the top
disabling conditions, secondary to mental illness, that contributes to chronic homelessness (Dept. of
Children and Families, 2013).
4. Female homeless population in Overtown at risk for obesity related to lack of knowledge
about obesity and proper diet as evidenced by lack of food resources in the area stated by key
informant interview with Officer Lanier.
Part II. Outcome Criteria Identification and Planning the Health Intervention
A. State the overall program goal
We want women of Lotus House (and any other women from the community who participate) to
be better informed about common health issues pertinent to their community and will be able to
verbalize small changes they can make to improve their overall health status. Taking into account
our windshield surveys, key informant interviews, and time spent conversing with the women of
Lotus House, we hope that our prioritized health concerns and their corresponding interventions
will leave a measurable and lasting effect on this community. We would like to reach at least 50%

of our 11 objectives in the health fair.
B. Describe the intervention plan [include all teaching topics or health fair topic areas]
Unplanned Pregnancy/Contraceptives. Unplanned pregnancies was our number one priority
because many of the women that live in Lotus House have children with no means of being able to
provide for them. One study found that about three fourths (73%) of pregnancies among women
experiencing homelessness were unintended at the time of conception (Gelberg, Lu, Leake, Andersen,
Morgenstern, & Nyamathi, 2008). For our interventions we decided to educate the women about
different forms of contraception and provide them with a list of women’s health clinics where they
could go to receive contraception. For the health fair we decided to combine our booth the STI/HIV
Prevention booth because we like it would work well together because we were promoting safe sex
with women. To help evaluate our interventions we gave them women pretest/posttest asking the same
questions seeing what their knowledge was before the health fair and see if they learned from the
information we provided for them.
For our first intervention we decided to educate the women about different forms of
contraception, the pros and cons of each, and which method would be the best for them. We also
taught them about the times of when they should take their birth control and on the importance of
taking it at the same time everyday. We then had a bulletin board, that the school provided for us in our
of toolkits, which showed different forms a contraception. It had information about female and male
condoms, different forms of birth control like the pill, transdermal patches and Nuva ring, and the
implants that one could get that last for 5 years or more. We also showed them a model of Nuva ring
and how one would apply it and remove it because according to research, “42% of homeless women
reported not knowing how to use contraception methods” (Nowosielski, 2005). We also mentioned to
them how the IUD, which needs to be implanted by a health care provided is the best option for
homeless women according to research. “The long-lasting methods are easy for homeless women;
there are no follow-up visits or anything to carry or remember to use” (Healing Hands 2012).

For the second intervention we provided the women with a list of Women’s Health Clinics in
proximity to Lotus House of where they could go to obtain contraception at reduced prices. According
to research, “37% of homeless women reported not knowing how to obtain contraception”
(Nowosielski, 2005) We also figured this information would be useful for them because once they
leave Lotus House they will be provided with information of where to go to obtain contraception they
can lower their risk of an unplanned pregnancy.
STI/HIV Prevention. While unplanned pregnancy is our #1 priority STI and HIV transmission
goes hand-in-hand with that issue. For our first intervention we will use a pre-test/post-test to evaluate
how much the women already knew about STIs and HIV and how much we were able to teach them by
talking to them and showing a poster board addressing common myths and misconceptions about the
spread of these infections. We wanted to address these myths because Joanne (our key informant)
stressed the lack of knowledge among the women at Lotus House on how infections, especially HIV,
are spread. We then modeled our second and third interventions, the condom race and insertion of a
female condom on a model, on a program in Atlanta called Healthy Love (Painter, Herbst, Diallo &
White, 2014). This program used highly interactive interventions to teach heterosexual black women
about effective strategies for the prevention of contracting or transmitting HIV and other STIs. They
had success with their program so we decided to model some of our interventions off of their ideas.
We also wanted to stress the female condom intervention because it is an option not well known to
many women and it is a very good one that puts the woman completely in control of protecting herself.
Smoking Cessation. There are many health hazards associated with smoking. In order to
address this health issue, we have designed three interventions to educate the residents of Lotus House
and to provide them with resources of where to go to attain help with smoking cessation. Our first
intervention is to educate the women on the known associated risk and complications of smoking.
Using a poster presentation, we will provide information on the health illnesses associated with
smoking, i.e. cancer and respiratory disease. In order to evaluate this intervention we will provide the

attendees with a pre- and post-test to determine the effectiveness of our teaching. Our SMART
objective for this intervention is that 80% of the women at the lotus house health fair will increase their
knowledge on the complications associated with smoking by 10% increase on post test at the end of
the health fair.
Our second intervention is providing the women with alternatives stress relief therapies to
smoking. We will educate the women about alternative therapies to quitting smoking; such as
meditation, yoga, and relaxation techniques to relieve stress. As support, we will a video of simple
relaxation tricks that can be done in any environment. We will provide the ladies with brochures that
includes alternatives stress relief techniques. Our SMART objective for this intervention is that 80% of
the women at the lotus house who attended the health fair will be able to do return demonstration on
one stress reducing technique to help reduce their use of tobacco as a stress reliever by the end of the
health fair.
Our last intervention is providing pamphlets with information about support programs located
near the community that provide help with smoking cessation. We will provide the residents of Lotus
House with a brochure that will include where they can go to obtain help in addition to the alternative
stress relief techniques. Our SMART objective for this intervention is that 80% of the women at the
lotus house health fair will take a pamphlet about support programs for smoking cessation by the end
of the health fair.Through these interventions we hope that the women who attend the health fair will
receive enough education to try and stop smoking.
Nutrition. For the nutrition booth we have three different health interventions for the women at
Lotus House. The interventions included educate the women on recommended daily food portions,
educate the women on an affordable and nutritious recipe, and educate women on fat and calorie
content in relation to exercise.
Our first intervention is to educate the women on recommended daily food portions. Using the
tool kit model, we will use a matching game to have the women guess what portions are recommended

for each food group compared to common items, like a deck of cards or a baseball. Example: The
women will match a 3 oz serving size of chicken breast to the visual of a common item, which is a
deck of cards in this scenario. This intervention is needed in the community because there is a major
lack of knowledge on proper portion sizes to maintain a healthy diet. The women verbalized that they
regularly eat large plates of pasta or high amounts of butter, which is not a well-balanced meal. This
intervention addresses the health issues identified, as it will teach the women to balance their meals
and portion sizes of each food group.
Our second intervention is to educate the women on an affordable, nutritious recipe. We will
pass out recipe cards to the women, as well as directions specifying where they can obtain these
ingredients. Using a display board, we will portray pictures of the ingredients and finished product, as
well as a map showing where the market is located. This intervention is needed in the community
because the women have verbalized that they don’t like the food at Lotus House, so they end up going
to get fast food because it’s affordable and easy to access. Educating these women will show them that
cooking tasty, yet healthy and affordable meals is something that is very possible and attainable, and a
much better option than eating fast food.
Our third intervention is to educate the women on fat and calorie content in relation to exercise
and weight loss. We will provide them with a pre-test that asks about calorie and fat content to test
their previous knowledge. We will then show the women what 1 and 5 pounds looks like using models
form the tool kit, as well as pictures of what adipose tissue looks like in the human body. We will also
use a display board to educate them on different exercise methods to burn different amounts of
calories. This intervention is important because upon observation, majority of the women at Lotus
House are overweight or obese. Physically showing these women what fat looks like will hopefully be
an eye-opening experience, and will make them more inclined to choose healthier options. Providing
them with easy exercise options will show them that staying fit can be done right in their own
backyards.

C. SMARTObjectives and Evaluations
Unplanned Pregnancy/Contraception.
1. Educating on contraceptive use
a. Intervention: Pre-test about common birth control methods (condoms, pills,
IUD’s, female condoms, etc.) and how they are used/effectiveness.
Information will be given on the different types of birth control methods,
how to use them, and the pro’s and cons of each.
b. SMART Objective: 75% of the women at Lotus House who participate in
the pretest pertaining to different types and uses of birth control will score at
least 1 point higher on the post test by the end of the health fair.
c. Evaluation: compare pre and post test scores
i. Can you name 3 methods of birth control, and if so list them
ii. True or false: You don’t have to take birth control at the same time
every day
iii. True or False: I can take an IUD in and out by myself
iv. Can you name 2 locations to obtain free or reduced price birth
control?
2. Education of access to contraceptives
a. Intervention: Provide women with information on resources to obtain free or
reduced cost birth control.
b. SMART Objective: 75% of women at Lotus House will take a pamphlet on
resources for obtaining free or reduced birth control and verbalize how to
obtain free or reduced birth control by the end of the health fair.
c. Evaluation: verbalization of where and how to obtain birth control.

STI/HIV Prevention.
3. Dispelling myths about HIV/STIs
a. Intervention: Pre-test about common HIV and STI myths and
misconceptions, followed by information (pamphlets, videos, poster, etc)
about the different STIs/HIV prevention, prevalence, and stereotypes
followed by a post-test (of the same questions) about the information
b. SMART Objective: 85% of women who attend the fair and participate in the
pre-test, educational section and post-test will get at least one more question
correct on the post-test than they did on the pre-test by the time they leave
the health fair
c. Evaluation: compare pre-test scores to post-test scores
i. Can you get HIV for shaking hands with somebody who has it? Yes
or No
ii. True or False? HIV is the same thing as AIDS
iii. What is the most reliable form of STD prevention?
1. birth control pills
2. 1 sexual partner a year
3. condoms
4. Female Condom Use
a. Intervention: Ask the women to demonstrate use of the female condom on a
vaginal model before being shown, then we will demonstrate proper use on
the model and have them do a return-demonstration of proper insertion
b. SMART Objective: 85% of women who attend the health fair and participate
in the demonstration and education portion of the booth will be able to return

demonstrate proper insertion and removal of a female condom on the vaginal
model before they leave the STI/HIV booth
c. Evaluation: watch the women perform the insertion and removal of the
female condom on the vaginal model before and after the informational
portion of the activity and mark their health fair passport
5. Male Condom Use
a. Intervention: Male Condom Race! We will ask the women to demonstrate
putting a condom on a penile model. If they demonstrate correctly we will
have them race against another woman and try to put it on the models
correctly in the shortest amount of time. If they do not correctly demonstrate
originally we will show the women how to apply the condom correctly and
then have them participate in the race
b. SMART Objective: 85% of women who attend the fair and participate in
the condom race will be able to correctly apply a condom to the penile
model in under a minute and report feeling comfortable and confident about
applying a condom correctly and efficiently by the time they leave the
STI/HIV booth
c. Evaluation: watching and timing the male condom race and marking the
health fair passport
Smoking Cessation.
6. Complications associated with smoking
a. Intervention: Pretest and posttest about smoking to assess the women’s
knowledge on known associated risk/complications of smoking followed by
a poster presentation of known complication associated with smoking to
support/compare their pretest answers.

b. SMART objectives: 80% of the women who attend the fair and participate
in the pre-test interactive section will verbalize known associated
complication with smoking by the end of the health fair
c. Evaluation: compare pre-and post-test to determine effectiveness of
teaching
i. True or False? Smoking is the leading cause of lung cancer
ii. True or False? Smoking is only harmful if you smoke 20+ years
iii. True or False? Electronic cigarettes are better for your health than
regular cigarettes
7. Alternatives therapies to smoking
a. Intervention: Educating poor and homeless women about alternative
therapies to quit smoking (Nicotine gum/patch, meditation, relaxation
techniques to relieve stress etc.)
b. SMART objectives: 80% of the women who attend the health fair will be
able to verbalize exercise techniques to help reduce stress by the end of the
health fair
c. Evaluation: The women will use return demonstration of the relaxation
techniques that are incorporated in the health fair
8. Support program for smoking cessation
a. Intervention: Advocating and referring poor and homeless women to social
support groups for smoking cessation
b. SMART objectives: 85% of the women at the lotus house health fair will
take a pamphlet provided of support programs for smoking cessation with
95% of the women verbalizing understanding of the importance of of the
information provided by the end of the health fair

c. Evaluation: All women who attend the booth will obtain a brochure which
contain information about free and inexpensive smoking cessation courses
and hotlines. They will verbalize that they understand that they are receiving
this information and will contact one of the facilities mentioned in the
brochure for further assistance.
Nutrition
9. Educate on recommended food portions
a. Intervention: Ask the women to guess the daily-recommended portion of
each food group with a matching game. The women will match 5 food
categories with their correlating portion sizes. For example, 3 oz of meat will
be matched to a deck of cards.
b. SMART Objective: 75% of the women participating at the nutrition booth
will be able to correctly match four out of the five food groups to the
correlating portion sizes by the end of the health fair booth.
c. Evaluation: Compare knowledge and understanding of portion size during
the guessing game and after the return demonstration. Women will guess
four out of the five match portions correctly.
10. Educate on affordable nutritious recipe
a. Intervention: Provide the women with a recipe card for a nutritious, yet
affordable meal that they could cook, as well as the address to the nearest
grocery store where they could obtain the ingredients.
b. SMART Objective: 90% of women participating in the health fair will take a
recipe card and verbalize how they can get access to ingredients on the
recipe card by the end of the health fair.

c. Evaluation: Keep track of how many women are able to correctly verbalize
where they can get the ingredients, as well as how many women took recipe
cards.
11. Educate on fat and calorie content
a. Intervention: Pre-test about how many calories are in a pound and forms of
exercise that burn different amounts of calories. Show the women what 1
and 5 pounds look like (models from tool kit), as well as pictures of what
adipose tissue looks like internally. Educate them on exercise methods to
burn different amounts of calories and pounds.
b. SMART Objective: 75% of women who participate in the nutrition
education section of the health fair will score an 85% or higher on the pre-
test/post-test by the end of the health fair.
c. Evaluation: Compare pre and post-test scores.
i. How many calories are in 1 pound?
1. 1500
2. 2500
3. 3500
4. 4500
ii. How many calories are burned in 30 minutes of walking?
1. 10
2. 40
3. 100
4. 500
iii. How many calories are burned in 30 minutes of jogging?
1. 100

2. 300
3. 600
4. 1000
Part III. Evaluation Report
A. Describe the evaluation plan/process
Each of our booths had a pre-test and post-test component that we used to evaluate the
effectiveness of our teaching. Many of the other interventions had components that we had to watch
while interacting with the participants and record (i.e. watching the women put on the condoms after
we taught them how to do it correctly and then recording that the objective was met or not met). In
summary, the methods used to evaluate the interventions for each of our objectives were a combination
of pre- and post-test, return demonstrations, and verbalization from the participants that they
understood the key information that were discussed throughout the health fair.
Our overall goal was that 50% of our objectives would be met by the end of the health fair. In order
to consider whether an objective was met, we counted whether the post-test objectives were met for
each objective on the health fair passport towards this measure as well as had specific criteria we were
looking for in our other interventions during the fair. By doing so, we would be able to effectively
measure whether our interventions were effective.
Of the eleven objectives being measured, five (45.5 %) objectives were met. Our outcome criteria
were not met. Some of the deficits in meeting our objectives were due to the participants not filling out
the health fair passports completely. We do believe that based on our interactions with the women,
most of the women did verbalize understanding. However due to time constraints and oftentimes
patience level of the participants, the forms were not filled out efficiently to demonstrate this
understanding.

We suggest that in future events such as these, we have more volunteers to help ensure that the
participants respond to each question. With our limited numbers, we were unable to check that each
form was fully completed to the participants’ best capabilities. Also, with more volunteers, we would
have been able to ensure that the forms were completed before handing out the incentives. A second
suggesting is allowing all participants to complete all of the pre-test before attending the booths; this
may help with the flow of traffic and also allow the participants to feel as if their “work load” is lessen
and therefore they may be more likely to finish filling out the forms.
Most of our interventions were appropriate for our aggregate; except for the male condom activity.
Many of the women who did not agree to participate in the male condom activity expressed that they
were “too old to learn how to use a condom” or that they were a lesbian and therefore did not need to
learn. However, there were those who expressed that they were simply uncomfortable with practicing
how to put on a condom out in the open. We believed that is where most of the issue lied and for future
considerations, we suggest providing the option for the participants to choose between using fruits
instead of actual penis manikins; which may encourage them to participate and see it more as a game
then as something to be ashamed of.
Also, we could provide some sort of barrier between this activity and the fair to provide the illusion
of privacy, which may make the participants more comfortable and less intimidated. Surprisingly, there
were no problems with the female condom because it was a new idea for many of the women. Most of
the women expressed interest in using it as a form of protection and many did not know it was even an
option.
Only 45.5 % of our objectives were met, therefore from a statistical perspective our interventions
were not effective (see table 2 and 3 in appendix). However, the majority of our participants’
demonstrated understanding and appreciation for the interventions presented. It is difficult to
accurately measure the effectiveness of interventions based on the health fair passports alone. To better
capture this information accurately we suggest a more qualitative method in the collection of this

valuable data. For example, we found it to be easier to simply ask the participants the questions rather
to have them fill out a form. Thus, if we had enough volunteers, we would have been able to interview
the participants and thus collect more information on what they learned. We believe that a combination
of this method and the health fair passports would have been more accurate.
We served 25 people, between the ages of 19 to 84 years of age. 16 out of the 25 women who
participated do have health insurance. 20 out of 25 of the participants did need follow-up care in
regards to smoking cessation and/or contraceptives. We provided a list of community resources that
would further assist the participants in receiving the help they may need. The cost associated with the
overall project was $63.93 (see table 1 in appendix for itemized budget breakdown). We also received
donations of sandwiches, ice cream, children’s books, tooth care supplies, and a speaker as a raffle
prize. The cost of this project would not affect replication, as our health fair was highly affordable.
The overall strengths of our health fair include the amount of women who participated in the health
fair and the environment and lay out of the fair. In regards to the environment, we had music in the
background which kept the mood of the fair pleasant and also we had a “kid section” which was highly
effective in keeping the children distracted so their mother’s could focus on the learning at the booths.
Thanks to donations we were able to provide the children with books to read, coloring books, and ice
cream. In addition, the participants expressed that the educational materials we provided were well
written and appreciated. Many of the women learned for the first time about female condoms and birth
control and we were really proud of that and account that as a strength of our fair.
The overall weaknesses of our health fair include limited staff, limited space and too much
paperwork. We did not have any volunteers to help us in the fair. It was challenging for us because
many of the staff had to do multiple jobs, such as translate, traffic control, registration, health report
collection, incentives and food handouts, management of the “kid section”, on top of our booths duties
of health education. In addition, many of our participants were not interested in completing all of the
paper work nor did we have a designated area for them to fill out the pre-test before visiting the booths.

It would also have been prudent for us to recruit translators to help the non-English speaking
participants interact with the fair.
In conclusion, we were very pleased with how the health fair turned out. We were happy to give
the women some pertinent information to help them lead healthier lives while also giving them a fun
and lighthearted couple of hours to enjoy.

Appendix
Table 1: Itemization Budget Breakdown
Items Price Quantity Total
Napkins $0.4/20 napkins 3 $1.2
Poster boards white $0.2/board 4 $0.8
Construction Paper $0.2/20 contraction paper 1 $0.2
Tablecloths, green $2 for 2 green tablecloths 3 $3
Tablecloths, orange $3 for 2 orange tablecloths 2 $3
Gift bags $12 for 11 gift bags 1 $12
Water bottles (24) $5.99/24 bottles 2 $11.98
Bag of Ice $2.50/1 bag of ice 1 $2.50
Bananas (5) $0.85 for 1 stalk of bananas
which contained 5 bananas
5 $4.25
Gift Card $25.00 1 $25
Total Price of items requested $63.93
Table 2: Pre-/Post-test Data
Booth # of women who
attended
Pre-Test scores Post test scores Test results and
corresponding
objective
Smoking
Cessation
25 out of 25 of the
women who
attended the health
fair participated in
this booth
2/3 2/3 2/3 2/3 3/3 4/4 4/4 4/4 4/4 4/4 23/25 (92%)
Corresponding
objectives: 1 &
3
MET
1/3 2/3 2/3 2/3 1/3 4/4 4/4 4/4 4/4 3/4
2/3 2/3 2/3 2/3 2/3 4/4 2/4 3/4 4/4 4/4
3/3 1/3 2/3 3/3 2/3 4/4 4/4 4/4 4/4 2/4
1/3 3/3 1/3 3/3 3/3 4/4 4/4 4/4 4/4 4/4
STI/HIV
Prevention
24 out of 25
women who
attended the health
this booth
2/3 1/3 1/3 3/3 2/3 3/3 3/3 1/3 3/3 2/3 16/24 (66.7%)
Corresponding
objective: 1
Not Met
1/3 1/3 3/3 2/3 3/3 2/3 1/3 3/3 2/3 3/3
3/3 2/3 1/3 3/3 3/3 3/3 2/3 1/3 3/3 3/3
2/3 2/3 3/3 1/3 2/3 3/3 3/3 3/3 3/3 2/3
2/3 2/3 |3/3 | 3/3 2/3 3/3 | 3/3 | 3/3
Unplanned
Pregnancy/
Contraceptives
22 out of 25
women who
attended the health
this booth
2/4 3/4 2/4 2/4 3/4 3/4 4/4 3/4 2/4 4/4 14/22 (63.6 %)
Corresponding
objectives: 1 &
2
Not Met
2/4 2/4 4/4 3/4 1/4 2/4 2/4 4/4 3/4 3/4
3/4 2/4 1/4 3/4 2/4 4/4 3/4 1/4 4/4 3/4
1/4 3/4 2/4 4/4 4/4 1/4 4/4 2/4 4/4 4/4
2/4 3/4 4/4 4/4
Nutrition 22 out of 25
women who
attended the health
this booth
1/3 0/3 2/3 2/3 1/3 2/3 2/3 3/3 3/3 2/3 21/22 (95.5 %)
Corresponding
objectives: 3
MET
0/3 1/3 1/3 2/3 0/3 2/3 3/3 2/3 2/3 3/3
0/3 0/3 2/3 0/3 1/3 2/3 3/3 3/3 2/3 2/3
1/3 2/3 0/3 1/3 3/3 2/3 3/3 2/3 2/3 3/3
2/3 1/3 3/3 3/3

Table 2 presents the results of each pre- and post-test completed during the health fair. Each box on the
pre-test score column corresponds to a post-test score based on the same location in which it is placed.
The shaded boxes on the post-test represents the tests that did not meet the objective by gaining a
higher score when compared to its responding pre-test. The last column represents the test results of
test scores who met the objective of scoring higher on the post-test, the corresponding objectives of
these test, along with whether the objectives were met.
Table 3: Post-Test Objectives Data
Smoking Cessation
# Attended: 25
STI/HIV Prevention
# Attended: 24
Unplanned
Pregnancy/Contraceptive
# Attended: 22
Nutrition
# Attended: 22
Objective 1
23/25 (92%)
MET
Objective 1
15/24 (62.5 %)
NOT Met
Objective 1
13/22 (59.1%)
NOT Met
Objective 1
15/22 (68.2%)
NOT Met
Objective 2
24/25 (96%)
MET
Objective 2
17/24 (70.8 %)
NOT Met
Objective 2
14/25 (63.6%)
NOT Met
Objective 2
21/22 (95.5%)
MET
Objective 3
23/25 (92%)
MET
Objective 3
14/24 (58%)
NOT met
Objective 3
21/22 (95.5%)
MET
This table is a visual of our health fair passport results, which represent each objective and whether or
not they were met. There were a total of 11 objectives, of these 5 (45.5%) were met based on the
parameters set in our SMART objective section. For detail information of each SMART objective and
the parameters, refer to Part 2 Section C.

References
2013 PRC Miami-Dade County Community Health Needs Assessment Household Survey Report.
(2013). Retrieved September 7, 2015, from http://www.healthcouncil.org/wp-
content/uploads/2013/12/2013_PRC_Miami_Dade_County_CHNA_Report_Reduced.pdf
AIDS. (n.d.). Retrieved September 20, 2015, from http://www.floridahealth.gov/diseases-and-
conditions/aids/surveillance/epi-profiles/index.html
American Fact Finder. (2015). Retrieved September 7, 2015, from
http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=bkmk
Department of Children and Families (2013) “Council on Homelessness 2013 Report”. Available from
http://www.dcf.state.fl.us/programs/homelessness/docs/2013CouncilReport.pdf
Didenko, E. and Pankratz, N. (2007). “Substance Use: Pathways to homelessness? Or a way of
adapting to street life?” Visions: BC’s Mental Health and Addictions Journal, 4(1), 9-10.
Available from http://www.heretohelp.bc.ca/
Healing Hands, A Publication of the HCH Clinicians Network (Fall 2012). Retrieved September 17, 2
015 from http://www.nhchc.org/wp-content/uploads/2012/10/Fall2012HealingHands.pdf
Nowosielski, C. (2005, December). Improving Contraceptive Health Care in Homeless Women.
Retrieved on September 17, 2015 from
https://research.wsulibs.wsu.edu/xmlui/bitstream/handle/2376/3743/C_Nowosielski_01067381
9.pdf?sequence=1
Painter, T., Herbst, J., Diallo, D., & White, L. (2014, April 18). Community-Based Program to Prevent
HIV/STD Infection Among Heterosexual Black Women. Retrieved September 20, 2015.
http://www.cdc.gov/mmwr/preview/mmwrhtml/su6301a4.htm
Sylvester Comprehensive Cancer Center. (April 2015). Community Profile: Overtown, FLorida.
Retrieved September 20, 2015. http://sylvester.org/documents/Overtown.pdf

References cont.
Wiley, J. (2009, June 9). Nursing intervention for smoking cessation. Retrieved September 27, 2015,
from http://www.ncsct.co.uk/usr/pub/nursing-interventions.pdf

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