Tag Archives: health promotion

Community Assessment Practicum

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I have been working on a community health needs assessment for the coastal health district managed out of Savannah, GA.  This has been a very useful way to put all the skills we learned in both community health and public health nutrition directly into action.  While most of this effort has been on my own (necessary for my schedule), I do feel like I have learned a lot about the process and all of the data and statistics that are publicly available – again reinforcing what we have learned during the past couple of years in the program.  One of my goals has been to familiarize myself with the county public health agencies and programs in the area.  As such I have also been interning with the Director of Food and Nutrition for the all the schools in the county.  I have to say, I have enjoyed these brief interactions the most.  In the next couple of weeks I will be helping them to prepare for an audit of their adherence to the new federal guidelines for nutrition in schools.  Yesterday, I attended an all-day workshop with their district coordinator to assist them in getting ready for this audit.  I also hope to be able to spend at least one day shadowing in the local WIC clinic, but that has been difficult to arrange.  All in all, I have learned a lot this summer.

From John Spano: Nutrition and Wellness Education Symposium

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Hi All,
I began my practicum in September 2013 and will carry it over into the spring semester. As a community college biology professor teaching nutrition, I wanted to focus my efforts on nutrition and college students. To that end my practicum will focus on a one day Nutrition and Wellness Education Symposium to be held on March 21, 2014. A needs analysis indicates that students are not only lacking in general nutritional knowledge, but are unclear as to the role nutrition plays in chronic diseases such as heart disease, cancer and diabetes.

The educational symposium will serve to address those issues through scheduled speakers, informational tables and the screening of nutrition related documentaries. We currently have scheduled Patrick Stover, Ph.D., Professor and Director of the Division of Nutritional Sciences at Cornell University and Josephine Connolly Schoonen, PhD, RD, Assistant Clinical Professor of Family Medicine, Executive Director, Nutrition Division, Stony Brook University Medical Center, Director, Dietetic Internship Program. We are still in the process of firming up their presentation topics which will focus on the areas of the importance of nutrition education or nutrition and health related issues. We are also in discussion regarding a third speaker.

Work on the information tables is slow going with long delays in responses from potential participants. We will have tables for our documentaries, which currently are set to be “Forks over Knives” and “Genetic Roulette”. We are still awaiting licensing information from the producers. We will also be performing blood pressure screening through our nursing department and BMI analysis by current nutrition students. Our local branch of the Cornell Cooperative Extension has agreed to participate as well as the New York Chiropractic College School of Applied Clinical Nutrition Master’s program. We are also seeking participation for the local American Heart Association, American Cancer Society of Long Island and American Diabetes Association Long Island Chapter. There are many other potential participants in consideration.

We were off to a slow start since there was a tremendous amount of “red tape” in securing the space we wanted, which is quite large, for the date we wanted. We originally requested a date in April, which would provide plenty of time for planning. When all was said and done we finally got March 21. That cut approximately one month off of our planning time but it did position the event during National Nutrition Month, which was nice. The amount of coordination for an event of this size can be overwhelming. Fortunately, my site advisor, Professor Denise Deal, has a lot of experience with planning events such as this on our campus. Like myself, she is faculty member in the biology department, but she also serves as the advisor of our Biology Club, which currently has approximately 200 members. Denise has numerous contacts around campus and has been able to guide me through the detailed procedures to get things done.

My expectation is to have all speakers in place by the beginning of the spring semester as well as having all documentary licensing paperwork completed. I suspect that the informational tables will be a work in progress until the day of the event, but the more the better. We will obviously promote the event on campus and encourage our faculty to bring their classes, but we will also promote to other local colleges and universities. Also, since we are a “community” college, we will open it up to local community residents by promoting through various community organizations. We anticipate use of the college radio station and newspaper for promotion as well as the Long Island newspaper. That’s it for now! Hopefully things will move smoothly in the spring!
John Spano

WOW-Working on Wellness

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6/29/2013
It has been a very busy and exciting few weeks working on wellness at the Neponset Health Center. I created a survey to assess the employees needs and interest in worksite wellness and posted it on Survey Monkey as well as putting paper copies and a collection box in all the lunch rooms. Four pedometers were raffled as an incentive for completing the survey. Wellness Team members also promoted the survey at their departmental staff meetings. I did a great deal of campaigning urging staff to complete the survey on an individual level as well as participating in a number of staff meetings.
Comments from the staff are really encouraging, for example one woman wrote to me and said “I’ve worked here since 2004 and nobody has ever done anything for us before”. The dedicated email for the Wellness program has allowed employees to post their comments and suggestions for making the worksite healthier.
All the effort paid off and we got a total of 135 surveys returned which represents 62% of the total staff. According to my site supervisor this is the greatest response to any survey administered during her 24 year tenure in the organization. Seventy three surveys were answered on Survey Monkey and 52 on paper. It took some time and effort to aggregate the results which I presented to the Wellness Team at our second team meeting this past Thursday.
Some of highlights from the survey results are:
• 73% of respondents reported engaging in physical activity 3 or fewer times per week, with 24% reported no physical activity.
• 78% of respondents reported eating less than 5 fruits and vegetables daily, the majority, 45% reported eating 2 or fewer fruits and vegetables daily.
• Overwhelming, 73% of respondents indicated that they would participate in worksite wellness activities and 27% answered “maybe” (if they were interested in what was offered). No one responded that they would not participate.
• Weight and stress management were the most cited activities respondents would like to be available as part of a worksite wellness initiative.
• Yoga, stretching, zumba and walking groups were the physical activities in which respondents were most interested.
• The most cited reason for wanting to participate in worksite wellness activities was to feel healthier, meet and get to know more staff and team building.
Based on the survey results the wellness team decided to organize a virtual walk. I am going to plan this event and with the wellness team roll it out over the next few weeks.
During the past few weeks I have compiled a literature review on worksite wellness programs that focused on environmental and policy changes and specifically on studies based in smaller worksites similar to Neponset Health Center. I completed my summer practicum on worksite wellness reviewing a study which tested the effectiveness of a worksite intervention which focused on environmental and policy changes on weight-gain prevention.
Finally I am working on an environmental audit, there are several tools available but I have chosen to use the Checklist of Health Promotion Environments at Worksites (CHEW) tool as it is mentioned frequently in the literature and is one of the tools recommended by CDC. http://www.cdc.gov/nccdphp/dnpao/hwi/programdesign/environmental_audits.htm

Chugging along at TCC

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This month is flying by.  I’m making progress at TCC, and getting used to the chaos. I try to be on site as much as possible on my scheduled days, but have arranged with my preceptor that if there is no one I need to meet with and no desk/computer space available, I can do some work from home. I am working on ideas for the Healthy Lifestyles program. The department of Health Education (HEO) within TCC is working on “branding” itself throughout TCC. I want to tag onto that with their Healthy Lifestyles program.

We want to have different “layers” to the overall program, starting with consistent Healthy Lifestyle visual messaging throughout all the clinics. Every lobby/waiting area/exam room should have the same visual health promotion messages. They are already using MyPlate graphics & Re-think your drink signage. We want to add physical activity promotion & stress management messages.  The next layer would be something the clinic has been working on called “charlas”, which are basically short scripts -Sound bites or elevator messages, kind of – about each of those topics. These will be given to patients waiting in exam rooms by Community Health Workers (CHWs). CHWs are used widely by TCC. These encounters should encorporate a component of Brief Motivational Interview, to help the CHW focus in on which message is most relevant for the particular patient. Ideally, the CHW can keep some sort of documentation of what was discussed & where the patient seemed to be in terms of stage of change (Transtheoretical Model), then follow up on that subject the next time the patient is in the clinic.  The third layer would be a one hour individual educational interaction with a CHW addressing components of healthy lifestyle. This class will incorporate Motivational Interview (MI), strategies to assess and improve self efficacy, and problem solving. It is available to any interested patient, and is also something that MDs are encouraged to refer patients for .  This class is followed by monthly telephone follow ups for three months.

The COO of the clinic wants this program developed yesterday, and wants it all to be evidence based.  The challenge here is that the director of HEO (my preceptor) and all the CHWs are already stretched very thin, and there is actually not much research out there to use to call this program idea “evidence based”. There is research showing effectiveness of intense individual counseling, but the interventions studied are much more intensive in terms of number of counseling sessions and follow up than this program is staffed or funded for.

I am working on a literature review for this program, and on writing up my/our ideas for the overall content of the program. I also have been creating a visual “flip chart” for the one hour class, and revamping the content to incorporate MI. I’ve been working with the CHW who provides this class (she has already been doing it, but with no guidance or support) to get her input and to help her with MI technique and accurate but basic health information. We have been “practicing” the class together. I have also edited the “charlas” to have accurate nutrition information. On the side, I have edited the charlas for the diabetes CHW (these types of brief messages are used in different programs throughout the clinic – asthma, diabetes, dental care…  The crazy thing is that they are often scripted by the CHWs themselves, who are motivated & eager but have only the training provided to them by TCC, or by volunteers who usually have degrees, but not necessarily in health or nutrition. I made many revisions to the diabetes messaging and am very glad I was able to get my hands on it!)

TCC is a great organization, and has been providing a medical home to the medically homeless for decades. Their HEO Department has grown tremendously in the past couple of years and has multiple grants for health education that they are working under. A problem at present is that they have not added the organizational structure they need to support their growth. The HEO director is in the process of hiring a manager for HEO, and promoting a CHW to a “lead” position. Once all this is done, and everyone understands their roles & who to report to, things will hopefully start to run much more smoothly.

So that’s the story for now. Onward and upward.