Obesity Reduction In Low-Income Families Health Promotion Plan Research Proposals Examples

James Brown

MN505: Health Promotion and Disease Prevention in a Diverse Community
Health Problem
Diabetes and obesity are life-long diseases that demand on-going medical care and continuing support and self-management education if acute and/or long-term complications are to be prevented. The United States is faced with an increasingly serious obesity epidemic, which is especially prevalent among poor children and youths. According to Levine (2011) the heightened reliance on energy-dense foods (snacks, fast foods and caloric beverages) by youths and children has been repeatedly associated with heightened risks of excessive weight gain and obesity. The prevalence of obesity in the US rose sharply between 1999 and 2000, during which time the number of overweight adults (above 20 years) rose to 64%, with 30% being classified as obese. The association between obesity and low socioeconomic status has been well established by empirical evidence (Levine, 2011; Ogden, Lamb, Carroll, & Flegal, 2010).
The high proportion of Americans living in poverty heightens the risk. According to Levine (2011), 15.1% of US citizens lived in poverty by the close of the year 2010. With the 2007 global economic crisis, the number of people that fell into poverty increased to 46 million, which is the highest rate over the previous five decades. In a review of 3,139 counties in the country showed that the most poverty-dense counties were associated with higher obesity prevalence rates. Counties that had poverty levels of more than 35% had obesity rates of 145% more than wealthier counties. Ogden, Lamb, Carroll, & Flegal (2010) also found that low-income adolescents and children are more likely to be obese or overweight compared to those from wealthier backgrounds despite the fact that the relationship was not consistent across race and ethnicity. Similarly, children living in households led by a college graduate were least likely to become obese compared to households led by individuals with lower education. This study estimated that between 1988-1998 and 2007 to 2008, the prevalence of obesity among children increased across all education and income groups. This health promotion campaign hopes to activate the low-income families ability to make decisions that foster good health, by reducing the time spend on sedentary activities and the amount of unhealthy foods intake.

Population Vulnerability & Setting

The vulnerability of low-income families to obesity stems from multiple causal factors. To begin with, these populations live in regions that have limited access to fresh food supplies. Impoverished regions often lack full-service grocery stores and markets for fresh fruit, vegetable, whole grain and dairy supplies, which in turn limit them to shopping at convenience stores. Whenever accessible, fresh and healthy foods are relatively expensive. According to Levine (2011), 43% of poor families (income of less than $21,756) faced food insecurity i.e. they had inadequate food or were incapable of securing sufficient food. To optimize their spending, the poor spend on low nutrient and energy-dense foods. Further, upwards of 14% of counties in the US had at least 1 in 5 people that relied on the Supplemental Nutrition Assistance programs, with the countywide utilization of the program correlating with the respective rates of poverty. Effectively, many poverty-dense counties have people who struggle against hunger, are unable of accessing healthy food and have financial constraints in accessing healthy food. Inaccessibility and unaffordability of food is, however, unlikely to be the only reasons for the high prevalence of obesity among low-income families.
There is also an empirically established link between sedentary lifestyles to among other health problems, obesity, diabetes, generally poor health, premature death and metabolic diseases. People who lead sedentary lifestyles spent at least two hours inactive compared to the active population and expended less energy compared to active individuals. The sedentary populations are more prone to chronic metabolic diseases, obesity and cardiovascular diseases. Poor people have no access to gyms, public parks and other amenities that could encourage physical fitness. Impoverished neighborhoods have higher rates of crime, violence, heavy traffic, few pedestrian walkways, unsafe playgrounds and other barriers, which discourage people from venturing outside or engaging in other forms of physical activities. Children are most likely to engage in indoor sedentary activities such as watching television and playing video games. Addition, Thorp, Owen, Neuhaus, & Dunstan (2011) found that low-income families are least likely to engage in organized physical activities such as sports. This is in part why more than 50% of the county-to-county variance in obesity may be explained by the variance in sedentary lifestyles. Relatively poorer counties have proportionately higher (Levine, 2011; Thorp, Owen, Neuhaus, & Dunstan, 2011).

Literature Review

Obesity reduction programs are complex because they are influenced by a complex interplay among social, genetic, behavioural and environmental factors. The multifactorial nature makes it both difficult and resource-heavy. Programs that require behavioural changes are even more difficult (Salmon, et al., 2011; Masters, 2011). Behavioural change campaigns that create awareness about obesity and the effectiveness of lifestyle changes in preventing the diseases is are effective interventions that have been used previously in many other contexts.
According to Salmon, et al (2011), promotion of healthy lifestyles among children had statistically significant effect on the children’s self-efficacy in cutting back television viewing as well as their behavioural capability or TV viewing styles. This study sought to evaluate the effectiveness of strategies to encourage healthy behaviours involved teachers delivering lessons to discourage computer use and television viewing in favour of physical activity and other potentially mediating behaviours that resulted in behaviour change. Fifteen schools drawn from social-economically disadvantaged areas of Melbourne participated in a randomized controlled trial with teachers delivering six lessons to the treatment group. The lessons included strategies like self-monitoring, screen time budgeting and behavioural contracting, with the students completing self-report surveys both before and after the intervention. The results point to the effectiveness of different strategies in reducing unhealthy lifestyle elements. self-monitoring, screen time budgeting and behavioural contracting as well as other strategies that buidl on the patients’ self-care ability are very effcetive and efficient in promoting behaviour change and positive health outcomes (Salmon, et al., 2011; Raingruber, 2012).
National Obesity Observatory (2010) recommends a combination of multi-component interventions that focus on both activities and dietary changes in order to prevent and manage obesity. This report includes a range of the empirical research evidence to the effect that weight management strategies must include behavioural change that will lead to a reduction in sedentary lifestyles, better eating behaviour, and reduced energy intake. Further, it is recommended that dietary interventions are tailored to the individual needs and include on-going support by health care professionals. On the other hand, the physical activity component must emphasize activities that easily fit into the people’s daily activities (including cycling, dancing and walking) and tailored to the individuals’ preferences. Such interventions must be focussed on reinforcing the people’s capacity to change. The recommendations by the National Obesity Observatory (2010) are in line with Dorothea Orem’s self-care theory of nursing, which emphasize the individuals’ desire and capacity to take care of themselves. According to Orem, people have an inherent capacity to take care of themselves, with external care becoming necessary only when there is a deficit in their ability due to age, disease and other such factors.
The Guide to Community Preventive Services (2014) included a systematic study of behavioural interventions geared at reducing sedentary recreational activities among children below 13 years. The study found that the interventions resulted in a reduction in the total energy intake, reduced screen time by a median of 82.2 minutes and increase physical activity considerably. The body mass index decreased with the obesity prevalence reducing by a median of 2.3 percentage points. However, the sources included in this review, as indeed many other past studies ignore the fact that individual differences that affect behaviour, besides the fack that they tend to use the same methods. For instance, in Salmon, et al. (2011), the teachers that delivered the interventions modified materials to suit their contexts with potential consequences on the effectiveness of the strategies, despite the fact that these differences are not specifically addressed. Qualitative research methods are best placed to determine the individual differences that affect eating behaviours.

Health Promotion Theory

The health promotion campaign draws on the self-determination theory, which focusses on the intrinsic motivations behind choices made by individuals. This theory asserts that people are driven to achieve external rewards, which in turn fosters motivation that creates a sense of relatedness and security. They need a measure of competence, relatedness and autonomy that fosters self-initiated decision-making that would in turn lead to optimal functioning and growth. The needs by the low-income families to lead healthy and fulfilling lives are innate and transcend culture, race, gender and other characteristics. By equipping them with information on the danger that obesity presents and practical ways to overcome the danger, it is expected that the targeted population would have both the motivation and the competency to make effective decisions. According to Masters (2011) and Raingruber (2012), the behaviour of low income family members is likely to change positively and permanently, if the health promotion campaign promotes an intrinsic sense of responsibility and motivation. This should make for better decision-making and active effort to lead healthy and active lives especially among children and young adults. Further, since patients have the capacity os self-care according to Orem’s theory, the self-determination approach will ensure that this capacity is best leveraged in a way that gives the patients psychological need satiation and autonomous motivation.

Health promotion Plan

Vision: The low-income population are physically active, eat healthily, keep a healthy weight and live in an environment that is supportive of healthy lifestyles across their lifespan

Goal: To reduce the prevalence of obesity and obesity-associated chronic illnesses among low-income families

Interventions
Objective 1: To reduce the amount time spent doing sedentary activities among low-income families by 25% by the close of the year 2017
Strategies
Run public awareness campaigns in schools, workplaces, and public spaces on the effects of too much screen time
Discourage the use of sedentary commuting means such as cars and the train in favor of non-motorized transportation including walking, biking, using stairs, and telecommuting

Ask school authorities to integrate physical activity opportunities in school days (including recesses and active-filled classrooms)

Promote community-wide involvement in physically active activities such as joking, gym membership and sports
Promote key aspects of quality health education in schools and colleges (including assessment, curriculum, and teacher quality)
Encourage physical activity opportunities out-of-school (before, after, school holidays and summer breaks) e.g. by sponsoring sporting activities, kids activities, scout movement membership, field trips and other outdoor activities

Sponsor, support and promote physical activity opportunities in the low-income communities

In order to reach out to adults in the respective communities, the program will make use of the existent health care facilities. Nurses in the system will be used in the delivery of the messages and encouraging self-determined behaviour change. The nurses and other health care practitioners will:
Engage adults that they come in contact with through the course of their practice on the benefits of self-adapted health behavior change programs provided through the health care system, community organizations and workplaces
Engage the adults that they come in contact with in the course of their work on non-family social support initiatives provided though the health care system, community organizations, and workplaces

Encourage physical activity opportunities for adults within communities including:

Running fitness and health classes
Sports and recreational activities
Walk-to-Work Programs
Walk-to-Play programs
Provide, develop and/or sponsor diet planning resources for early childhood programs, childcare and elderly care facilities e.g. websites, books, and magazines
Objective 2: Increase the number of people who appreciate healthy eating and balanced diets among low-income families by 25% by the end of 2017
Strategies
Raise awareness of the nutritional benefits of fresh foods, fruits and vegetables by disseminating evidence-based information on the benefits through workshops, trainings and websites
Run coordinated healthy nutrition (such as the importance of a healthy breakfast and its effect on weight loss, breastfeeding, family meals and portion sizes) messages to schools, workplaces and public spaces
Run coordinated messages on the dangers associated with high energy, fatty foods or junk foods to schools, workplaces, and public spaces
Encourage active decision-making by children and adults on the nutritional value of foods, nutritional labeling on foods and advertising. According to Guide to Community Preventive Services (2014) and Ogden, Lamb, Carroll, & Flegal (2010), low-income communities are targeted by adverts that encourage poor eating habits, and due to their financial and locational limitations, they are more likely to buy junk foods

Evaluation of Objective 1 and 2

The objectives and outcomes will be evaluated by surveys of the target population and compared against the set outcomes and times. To begin with, a baseline survey will be conducted to determine the baseline values for each outcome set above. Subsequently, surveys will be conducted after every 12 months to determine the changes in the respective variables, compared to the baseline values, as well as the expected outcomes. Since three surveys will be conducted through the course of the project after the baseline survey, it is expected that 33%, 70% and 100% of the set outcomes will have been attained at the first, second and third surveys respectively. A contracted research firm will conduct the surveys.
Objective 3: Train upwards of 5000 teachers, childcare providers, school administrators, restaurant owners, community opinion leaders, grocers and other food vendors by the end of the year 2018 on evidence-based measures to avoid obesity, teach nutrition/physical health education and decision-making
Strategies

Mass recruitment of teachers at all levels and enrollment in training programs and workshops on evidence-based nutrition and physical education

Support/sponsor training programs geared at helping school personnel and other care providers to improve their core competencies in the provision of nutrition education.

Sponsor or support train-the-trainer programs

Identify, develop and/or sponsor diet planning resources for early childhood programs, childcare, and elderly care facilities
Evaluation
The evaluation of this objective is slightly different from objective 1 and 2. The records of professionals enrolled in training programs (workshops, seminars and other training events) sponsored/supported or facilitated under the program will be taken. Trainees who receive at least 24 training/workshop/event/lecture hours will be counted as having received training, after which they will be requested to complete evaluative surveys on varied aspects of knowledge imparted to them. Responses with more than 80% passing scores will be counted as having completed the training program.

Resources & Personnel

Nurses, teachers, school authorities and other health care practitioners
Nutritional and physical education teachers and specialists
Promotional literature and media including billboards, radio/TV, print media and affiliate websites
Steering team or committee
Sponsors and technical experts e.g. the American Heart Association, the American Diabetes Association and local public health authorities
Media industry
Timeline
Possible Barriers & Challenges
Behaviour change is a difficult and time-demanding activity. According to (Teixeira, Carraça, Markland, Silva, & Ryan (2012) and Masters (2011), the self-determination theory (SDT) distinguishes between extrinsic and intrinsic motivation in behaviour regulation, but emphasizes intrinsic motivation more because it is associated with inherent satisfaction, enjoyment, sense of achievement and excitement. However, attaining this motivation takes a long time and considerable persuasion, which means that in order to be successful, the program will have to implement the recommended strategies consistently and over long periods. Further, behavior change programs are encumbered by cultural and institutional barriers, which actively resist changes. For instance, fast food restaurants and other food vendors may act to defeat the program by cutting prices or increasing advertising spending (Herzig & Jimmieson, 2006; Herzig & Jimmieson, 2006). It may be necessary to require formal government regulations and even legislation to defeat the resistance, but even this takes a considerably long time.
Overcoming these barriers translates into massive resource demands (both human capital and financial resources). Since this program requires the involvement of numerous stakeholders, it is impossible to guarantee their continued involvement in the project over the long term. If key stakeholders e.g. sponsors pull out, then the program runs the risk of collapsing or failing to achieve its core objectives. It is even more difficult to recruit technical and financial sponsors as well as other stakeholders to participate in the program. This is easily the biggest challenge, which could derail the entire project if it proves impossible to overcome. Further, reliance on external contractors is a challenge because they need to be closely supervised and evaluated for their capacity, commitment and delivery of expected outcomes, because they do not necessarily have the goals of the program at heart.
References
Chronic Disease Risk Reduction Unit, Department of Health. (2014). Development of the Minnesota Plan to Reduce Obesity and Obesity-Related Chronic Diseases was facilitated. Minnesota : Minnesota Department of Health.
Guide to Community Preventive Services. (2014). Obesity Prevention and Control: Behavioral Interventions that Aim to Reduce Recreational Sedentary Screen Time Among Children. Washington, DC: Guide to Community Preventive Services.
Herzig, S. E., & Jimmieson, N. L. (2006). Middle managers’ uncertainty management during organizational change. Leadership & OrganizationDevelopment Journal Vol. 27 No. 8 , 628-645.
Levine, J. (2011). Poverty and Obesity in the U.S. Diabetes November vol. 60 no. 11 2667-2668.
Masters, K. (2011). Nursing Theories: A Framework for Professional Practice (Masters, Nursing Theories). Boston: Jones & Bartlett Learning.
Molineux, J. (2013). Enabling organizational cultural change using systemic strategic human resource management – a longitudinal case study. International Journal Of Human Resource Management, 24(8), 1588-1612.
National Obesity Observatory. (2010). Treating adult obesity throughlifestyle change interventions. NHS, www.thecommunityguide.org/obesity/RRbehavioral.html.
Ogden, C., Lamb, M. M., Carroll, M., & Flegal, K. (2010). Obesity and socioeconomic status in children: United States 1988-1994 and 2005-2008. NCHS data brief no 51. Hyattsville: National Center for Health Statistics.
Raingruber, B. (2012). Health Promotion Theories. Nw York: Jones & Bartlett Learning.
Salmon, J., Jorna, M., Hume, C., Arundell, L., Chahine, N., Tienstra, M., et al. (2011). A translational research intervention to reduce screen behaviours and promote physical activity among children: Switch-2-Activity. Health Promotion International 26(3), 311-321.
Teixeira, P. J., Carraça, E. V., 1Markland, D., Silva, M., & Ryan, R. (2012). Exercise, physical activity, and self-determination theory: A systematic review. International Journal of Behavioral Nutrition and Physical Activity 9:78 , Web. doi:10.1186/1479-5868-9-78.
Thorp, A. A., Owen, N., Neuhaus, M., & Dunstan, D. (2011). Sedentary behaviors and subsequent health outcomes in adults a systematic review of longitudinal studies, 1996-2011. Am J Prev 41, 207–215.