Beruflich Dokumente
Kultur Dokumente
2
Introduction
Needs Assessment
Phase1
Phase1inthePrecedeProceedmodeliscomposedofasocialassessmentandfocusesonquality
oflife(Mckenzie,Neiger,Trackeray,2013).Manychildrenwhoareobesehaveapoorquality
of life, thus creating low selfesteem. However, schools are capable of promoting physical
educationprogramsthatmayimprovequalityoflife(Story,Kaphingst,French,2006).Schools
that promote physical activities influence students to want to become fit and improve their
overallhealth.(Story,etal,2006).Withinphysicaleducation,itisimportanttoimprovethe
qualityoflifeamongstudentsespeciallythosewhoareconsideredobese,oratriskofbecoming
obese.Studentslearningaboutgeneralhealthandvariousphysicalactivitieswillboosttheir
knowledge,skills,andconfidencewithinthemselveswhichresultsinhigherselfesteem(Story,
etal,2006).
Phase2
PrecedeProceedPhase2entailstheepidemiologicalassessment,thisstepfocusesonspecific
healthissueswithinacommunityandusesdatatohelpidentifyhealthgoalsorproblemsthat
maydealwithPhase1(Mckenzie,etal,2013).Phase2includesgenetics,environmental,and
behavioralfactorsaswellasmorbidityandmortalitydata(Mckenzie,etal,2013).Accordingto
Centers for Disease Control and Prevention, In 20072008 almost 17% of children and
adolescentsaged219yearswereobese.Childhoodobesityoftentrackstoadulthoodand,inthe
shortrun,childhoodobesitycanleadtopsychosocialproblemsandcardiovascularriskfactors
such as high blood pressure, high cholesterol, and abnormal glucose tolerance or diabetes,
(CDC,2010).EnvironmentalfactorsfromPhase2playahugeroleonchildhoodobesitydueto
lackofphysicalactivityandlackofaccesstohealthierchoicesoffoods.Therearevarious
communitiesthatdonthaveparksorrecreationcenterswhichmakesitdifficulttoallowfor
physicalactivityamongchildren(CDC,2013).Insomeareas,specificallymoreofthelower
incomeenvironmentsthereislessaccesstohealthieraffordablefoods,causingchildrentohave
toresorttothelesshealthyfoodsthatarebeingsoldinsupermarkets,conveniencestores,and
fastfoodrestaurants(CDC,2013).Therearewaysinwhichobesityinchildrencanbeprevented
asstatedbyCountyofSanDiego,HealthandHumanServicesAgency(HHSA,2012)suchas
building safeenvironments such as parks and playgrounds forchildren that allow access to
exerciseandotherformsofphysicalactivity(HHSA,2012).Anotherfactorthatcanpotentially
helptheenvironmentisbyprovidinghealthierfoodoptionsinsupermarketsandaswellhave
farmersmarketsthathavefreshproduce(HHSA,2012).
BehaviorinPhase2ofthePrecedeProceedmodelfocusesontheactionsthataretaken
amongindividualsthatleadsthemtobeatriskofadisease.Therearebehavioralriskfactorsthat
leadtoobesityinchildren.InmiddleschoolsintheU.S,over50%ofthesecampusesprovide
sugarydrinksandfoodthatisunhealthyandisofferedforpurchase(HHSA,2012).Asaresult,
schoolagedchildrendrinkthesesugarybeveragesandconsumeunhealthyfoods,whichresults
inunhealthyweightgainandotherhealthcomplications.Advertisementsoflesshealthierfoods
arewidelyusedwithinnearlyhalfofmiddleschoolcampuses,whichpreventsstudentstomake
healthier decisions (HHSA, 2012). Advertising of non healthy foods influences a students
behavioronchoosingahealthieroptionbecauseitenticestheminchoosingsomethingunhealthy
oversomethingthatcanbenefittheirbodies.Anotherreasonfortheincreaseinobesityamong
childrenistheuseoftechnologysuchascomputersystemsandtelevision,becauseitcreatesa
sedentary lifestyle (HHSA, 2012). There are prevention strategies in order to change the
behavioramongchildrenwhoarebecomingobese.Parentsarecapableoflimitingthetimespent
ontechnologyto1or2hoursaday(HHSA,2012).Inaddition,parentscanensurethatany
childcarefacilityisservingtheirchildhealthyfoodsandarrangingsomesortofphysicalactivity
foratleastonehouraday(HHSA,2012).
GeneticsisanotherportioninPhase2ofthePrecedeProceedmodel.Geneticfactorsas
wellasfamilyhistoryplayalargeroleonobesityinchildren(HHSA,2012).Unfortunatelywith
geneticsthereisnopossibleprogramsthatcanbeusedtochangebiologicalfactors,however,it
ispossibletochangeachild'soutlookonunhealthyeatinginordertobenefitthemselves.By
educatingyoungstudentsabouthealthiereatinghabitsandinformingchildrenaboutriskfactors
thatpotentiallymayhappen,wecanencourageahealthyeatinglifestyle.Obesityleadstothe
riskofcardiovasculardisease(CVD)inchildrenanditmayincreaseachildsbloodpressureata
young age (HHSA, 2012). Diabetes is another risk factor that comes along with childhood
obesityaswellasvarioustypesofcancerthatmaydevelopinadulthood(HHSA,2012).There
areadditionalhealthproblemsthatmayleadtoobesityamongchildrensuchasbreathingissues
likeasthma,fattyliverdisease,jointproblems,andirondeficiency(HHSA,2012).Byeducating
studentsabouttheseriskfactors,wemaybeabletohelpmodifyeatinghabitsandencourage
morephysicalactivityconsideringgeneticscannotbechanged.
Phase3
Eating unhealthy food and lack of physical activity are often recognized during childhood.
Luckily, the home environment can encourage healthy habits and modify unhealthy habits.
Parentshaveadeepinfluenceonchildrenbypromotingpositiveprinciplesandattitudes,by
gratifyingorreinforcingparticularbehaviors,andbeinggoodrolemodels.Parentsarethepolicy
makersforthehome.AccordingtoStory,Kaphingst,andFrench,parentsmakedailydecisions
onfood,especiallyfoodsbroughtintothehome,andwhatmealsareeatenoutsidethehome.In
addition,theymayimplementnumerousrulesandpoliciesthatinfluencehowmuchdiverse
membersofthefamilycanengageinhealthfuleatingandphysicalactivity.
Parentsshouldencouragephysicalactivityinterests,andimproveanycircumstancesfor
themtoplayoutsideandbecomeinvolvedinbothrecreationalactivities,aswellasincorporating
anactivelifestyleintotheirdailyroutines.Furthermore,parentsshouldsetboundariesontheir
childrens TV viewing and other leisure time such as video or computer game playing.
AccordingtoWechsler,Mckenna,Lee,andDietz,besidesparents,schoolsplayasignificantrole
becauseover95percentofyoungpeopleareenrolledinschools.Schoolshavetheabilitytofit
manyintotheschoolday,andmustbalancestateandlocalresources,priorities,andneedsfor
education(Story,etal,2006).Schoolscanencouragestudentstoparticipateinphysicalactivity
throughtheirschoolprogramssuchasrecess,classroombasedphysicalactivity,recreational
sportsclubs,interscholasticsports,andphysicaleducation.Theseactivitieskeepchildrenactive
inschool,allowingthemtoparticipateinphysicalactivity.Physicaleducationcanhelpimprove
skills,developknowledge,andhaveconfidencetobephysicallyactivebothinandoutofschool
andthroughouttheirlives(Story,etal,2006).
Physicalactivityismoreeffectiveasapreventativemeasurethanatreatmentofobesity.
Lackofphysicalactivityatschoolorathomeinchildrenisoneoftheprimaryfactorsthatlead
to childhood obesity. There areways that the school andcommunities canoffer important
resourcesforthefamilies.Story,etal,(2006),statedthat,communities,families,schooldistricts,
andgovernmentatalllevelhadbegunassemblingtoassistfamiliestohaveanactivecommunity
by improving pedestrian and biking safety, adding crossing guards, mapping safe routes to
schools,formingsuchprogramsliketheWalkingSchoolBus,NationalWalkOurChildrento
SchoolDay,andanyothercampaignsthatpromotehealthylifestyle.
Program Goal & Objectives
Goal
The goal of our program is to reduce the prevalence of childhood obesity
amongst Latino and Black minorities in the Chula Vista area of San Diego,
California.
Objectives
increase self-efficacy amongst both children, and their parents, while also
promoting vicarious learning, considering children are likely to learn best by
observing the behavior of others.
Process Objective Activity
In order to fulfill our programs process objective, program planners and
trainers will take an inventory of all educational materials that will be
distributed throughout the Chula Vista Elementary School District for our
program. These materials will include age, and reading level appropriate
charts, pictures, posters, videos, models, and take home information packets
for parents. By taking an inventory of all our educational materials, we will
be able to measure how effective, or ineffective they were at the various
schools they were used at. Additionally, through this activity, we will be able
to establish a better relationship with the schools we are working with.
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and cartoon videos on what obesity really is, and the various health
problems associated with this disease. Moreover, our health educators will be
trained to associate being healthy with being cool, in order to allow the
children to learn vicariously through them, who will be perceived as cool
role models. Through this intervention, we will be able to expand our
participants knowledge and awareness of the consequences of obesity.
Behavior Objective-Activity 1
Our first activity to change behavior is a health communication strategy, in
which we will introduce our participants to healthier foods and eating habits
by
distributing
choosemyplate.gov
plates
that
clearly
demonstrate
recommended healthy foods and ideal daily serving sizes. With these plates,
children will be able to take them home to their families, and use them as a
guide for how much food is healthy to eat per meal. By providing this health
tool for children, we will be able to increase their self-efficacy to change how
much food they are eating, and more importantly, to change what types of
food they are eating.
Behavior Objective-Activity 2
Our second behavior change activity is to further educate children about
changing their eating habits by live food and cooking demonstrations in
class. Local farmers market representatives will bring in samples of fresh
organic fruits and vegetables, in order to teach the participants about the
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12
We want to show the parents of our participants that cooking healthier meals
is not only beneficial for their familys health, but it can also be very easy,
and more convenient than they think.
Environmental Objective Activities
For our environmental objective, we will utilize an environmental change
strategy in which our program will work with ten campuses of the Chula Vista
Elementary School District to ensure that their transportation services will
provide bus rides to participating children to and from local recreational
centers, and neighborhood parks after school. At the recreational centers and
parks, our program will offer free sporting activities, dance lessons,
gymnastic sessions, and swimming exercises, in order to provide our
participants with a healthy, adequate amount of physical activity. Through
this intervention, we want our participants to build their self-efficacy in
changing their usual sedentary afterschool behavior, to active, healthy
behavior, while still keeping it enjoyable for them. Additionally, children who
initially refuse to make use of our after school physical educational program,
will most likely learn vicariously from children who do participate in this
activity, and hopefully will decide to participate as well.
Outcome Objective Activity
Lastly, for our outcome objective, we would like to see all of our objectives
produce positive, successful results. By the time our participants are in the
7th grade, our program staff will measure BMI levels, cholesterol, and blood
13
Program Considerations
Resources
In order to achieve the goals and objectives of our Project Healthy Kids Chula
Vista program there are specific resources that are needed in order to have a
running program. Resources include program planners and trainers that
supply necessary materials to schools in the Chula Vista Elementary School
District. Another resource used will be guest speakers who were previously
obese and have changed their lives for the better. Farmers Market
representatives as well as grocery stores like Sprouts, will educate on
preparing easy nutritional foods and offering classes for healthy cooking. The
transportation services of the Chula Vista Elementary School District will
arrange for rides to and from recreation centers and parks. Kaiser
Permanente will allow the program to use their staff to measure BMI levels
among the children as well as educate on weight management and teach on
how to use a food log.
Marketing
PHKCV does not require the participants to pay for our services. Our
program will provide specific needs and aspiration for the children from
grades kindergarten to the 7th grade that are at risk of childhood obesity.
Some of the specific needs that our program will provide include educational
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PHKCV will offer the students and parents the education and
support they will need and will obtain data to find out what is important to
them. PHKCV will make it easier for at risk children to become healthy eaters
and practice good behavior because we will also offer counseling services.
Changing the children and parents unhealthy eating and physical activity
behaviors, will send a strong message to other people in the community.
Getting the community more involved will encourage more widespread
success. Lastly, our program will be promoted to other schools and and
communities by word of mouth, social networking websites such as
Facebook, and Twitter, and by utilizing local radio and TV news stations.
Additionally, marketing materials that will be handed out in the community
will include pamphlets, brochures, and mini information packets that are all
age appropriate, culturally competent, and relevant to our program.
Program Evaluation
Phase 6- Process Evaluation
In order to successfully process evaluate Project Healthy Kids Chula Vista
(PHKCV), our program planners will first interview key informants from similar
programs that have been successful in reversing childhood obesity in
neighboring communities. Fortunately, our program planners have close
connections with Ashley Hyman MPH, who is the coordinator/validation
sample coordinator of The Healthy Smiles Program in La Mesa, California.
Through interviewing Hyman, our program planners will be able to adopt
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some of the strategies and methods of her program, to aid in the success
and quality for our program. Additionally, our program will conduct a pilot
test with smaller focus groups from our population to evaluate the quality of
our interventions. However, before beginning our pilot tests, they must first
be presented and approved by our stakeholders. During our pilot tests, we
will have children and their parents participate in our food preparation
activities (behavior change interventions) in order to see how they like them.
After our pilot test, we will have parents and their children fill out surveys,
asking what aspects they liked about our activity, what they would want to
be included to our activity, and what areas we could improve. These surveys
will then be interpreted by our evaluators, and presented in our monthly staff
meetings. Each month, staff meetings will be held, in order to assess the
quality and effectiveness of the current methods we are using for our
program, while also allowing for suggestions, recommendations, and general
feed back from both program planners and participants. Lastly, our program
will recruit an expert panel, consisting of members from other successful
health
promotion
programs
like
The
Healthy
Smiles
program,
and
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collaborate with the primary care, public health, schools, and community
organizations working with the parents and participating children in a target
population. In order to evaluate our behavioral objectives we will take
surveys of what children and their parents have been eating before our
program began and after our program ended. Team members will educate
both participating children and parents on the recommended healthy food
and ideal serving sizes. Furthermore, we will create laminated charts to
discuss BMI level, cholesterol levels, and blood sugar levels with the
participants.
posters, and prescription pads in all exam rooms. Primary care physicians will
promote a greater commitment to quality improvement efforts. In order to
evaluate our environmental objective, we will be handing out questionnaires
to children asking about how they like the after school activities and bus
services. Changes will be tested on small scale to analyze their impact
before adding in the change on a larger scale. In further research for similar
intervention in the community, a number of evidence-based questionnaires
were reviewed from the literature to measure their healthy eating habits and
physical activity behavior.
Phase 8: Outcome Evaluation
By the end of the PHKCVs program, when the children reach the 7 th grade,
approximately 50% of the children who participated will have decreased their
BMI levels as well as cholesterol and blood sugar levels. With our target
population being minority children in the Chula Vista, San Diego area we
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concentrated our focus on the Chula Vista Elementary School District. This
district was chosen due to its low socioeconomic location and the amount of
minority students that attend these schools who are obese. The evaluation of
this program will consist of the long-term benefits such as further education
of healthier eating habits, increase of physical activity and decrease of
sedentary activity, as well as determining if the programs set goals were
made. By the end of the program we intend to decrease the prevalence of
obesity among minority children in the Chula Vista Elementary School district
by lowering the risk factors with education on both healthy eating and
physical activity.
and
strong
control
over
confounding
variables,
while
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donated to this program, will receive the evaluation from participants for
final assessments.
Conclusion
In conclusion, it is important to remember that we as public health
program planners, and evaluators need to design programs that are
effective, successful, and that meet all the needs of the communities we are
working with. Considering childhood obesity is a growing epidemic that is
impacting our youth worldwide, nationwide, and in our own city, it is crucial
that more programs like Project Healthy Kids Chula Vista are thought of and
implemented. By designing programs that target childhood obesity, we will
be able to work together ecologically to build healthier, safer, environments
that encourage physical activity, and promote healthy eating. Lastly, by
education and prevention, we will be able to instill in children and their
families the knowledge, and motivation that they need to reverse unhealthy
behaviors, and live healthier lives. Programs like Project Healthy Kids Chula
Vista will most definitely ensure a healthier Chula Vista, a healthier San
Diego, and ultimately a healthier world.
19
July 28,
2014
Parents of the
participants will have
attended 5 nutritional
meal-panning
July 28,
2020
Participants will be
aware of severity of
obesity
Participating schools
will provide
transportation for the
participating children
2017
Our Gantt chart covers the timeline of program objectives for Project Healthy
Kids Chula Vista
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References
CentersforDiseaseControlandPrevention(2010,December1).Obesityand
SocioeconomicstatusinChildrenandAdolescents:UnitedStates,20052008.
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CentersforDiseaseControlandPrevention(2013,April17).OverweightandObesity.
Retrievedfromhttp://www.cdc.gov/obesity/childhood/problem.html
CountyofSanDiego,HealthandHumanServicesAgency,PublicHealthServices,
CommunityHealthStatisticsUnit.(2012,January).ChildhoodObesityBrief.
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Criticalpathways2012.pdf
Edberg, M. (2015). Essentials of health behavior social and behavioral theory
in public health.
(2nd ed.). Burlington, MA: Jones & Bartlett Learning
McKenzie,J.,Neiger,L.B.,Thackeray,R.(2013).HealthPromotionsProgramsaprimer.
TheFutureofChildren.Story,M.,Kaphingst,K,M.,French,S.(2006).TheRoleof
SchoolinObesityPrevention.Retrivedfrom:www.futureofchildren.org
TheStateEducationStandard.,Wechsler,H.,Mckenna,M,L.,Lee,S,M.,DietzW,H.
(December,2004).TheRolesofSchoolinPreventingChildhoodObesity.
RetrivedonMay15,2014.Retrivedfrom:
http://www.cdc.gov/healthyyouth/physicalactivity/pdf/roleofschools_obesity.pdf