Running head: EVIDENCE-BASED COMMUNITY INTERVENTIONS

Evidencebased Community Interventions for Putnam County, Florida

Krista Caprio
University of South Florida

EVIDENCE-BASED COMMUNITY INTERVENIONS

Evidence-based Community Interventions for Putnam County, Florida

The County of Putnam is located in northeast Florida about 90 miles north of Orlando.
Putnam is Floridas most industrial rural community with a population of 73,263 people
(University of Wisconsin Population Health Institute, 2015). In Putnam County, 78% of
residents older than 25 have a high school diploma. Eighty five percent of Florida residents
account for that same population. The percent of families below poverty level in Putnam County
is 17.2%, and unfortunately this number is increasing. Nine percent of families are below
poverty level in Florida (Florida Department of Health, 2015). Georgia Pacific LLC a paper
product manufacturer, St. Johns River Water Management, and St. Johns River State College are
three major employers in Putnam. Putnam County also has a variety of health care systems.
Some of the services available are nursing homes, mental health centers, womens resource
centers, Putnam County Health Department, and Putnam Community Medical Center. The data
collected from the Florida Department of Health (2015) showed that 80.4% of Putnams
population is Caucasian; this may be why only 3.8% of the population older than 5 do not speak
English, but in Florida the same population accounts for 11.8%. This paper will examine
community strengths, weaknesses, and relating factors that pose a threat to the health of Putnam
Countys residents. Based on one community health issue, a population diagnosis and evidence
based interventions will be formed and discussed. Lastly, in relation to the population diagnosis,
a health policy will be created and analyzed.
Putnam County has many strengths that influence the health status of its community.
According to University of Wisconsin Population Health Institute (2015), Putnam Countys food
environment index ranked 5.6 on a scale of 0-10 (10 being the best); Florida was ranked at 7.
This shows that Putnam has access to healthy food options. Healthy food will help create a
healthy community. Another strength of this population is prenatal health. The countys records

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show that per 1,000 women, 73 received prenatal care in their first trimester; Floridas statistic is
80 women per 1,000 (Florida Department of Health, 2015). Though the countys rate is low
compared to Florida, it was one of the higher recorded rates among the counties. Early prenatal
care will improve the chances of a healthy pregnancy. In Putnam County, a high percentage (6477%) of people with diabetes have annual eye, foot, and A1C testing; in Florida the numbers are
closely related- 75-77% (Florida Department of Health, 2015). These tests are essential in order
to maintain health and prevent complications in a person diagnosed with diabetes. The strengths
of Putnam County help keep the residents in this community healthy.
Although Putnam County has various strengths, it also has weaknesses that can
negatively affect the health status of the community. Sexually transmitted infections (461 per
100,000 people) in Putnam County are an increasing trend (University of Wisconsin Population
Health Institute, 2015). Such a high number of sexually transmitted infections (STIs) can
threaten the health of this community. STIs have been linked to many conditions such as pelvic
inflammatory disease, chronic pain, increased risk of human immunodeficiency virus (HIV), and
neurological disorders (Watkins & Lee, 2014). The recorded rate of domestic violence is also a
health risk in this community. Floridas rate of domestic violence is 572 per 100,000 people and
Putnams is 944 (Florida Department of Health, 2015). Domestic violence can lead to physical
and mental health issues such as post-traumatic stress disorder, depression, anxiety, and suicide
(Dillon, Hussain, Loxton, & Rahman, 2013). Furthermore, Putnam has a high rate of adult and
childhood obesity. According to University of Wisconsin Population Health Institute (2015),
Putnams adult obesity rate is 33% and Floridas is 26%. When looking at the Florida
Department of Health (2015), 18.1% of middle school children in Putnam County have a body
mass index at or above the 95th percentile; this was the third highest percentage in the state
recorded for 2012. As a result, the priority health issue of this paper will be the increasing rate of

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obesity in children and adults in Putnam County. As indicated by Healthy People 2020, the goal
will be to reduce the proportion of adults and children who are obese. Obesity is an important
issue to focus on, because addressing this problem will have an effect on other issues occurring
in Putnam County, for example, the high rate of heart disease, lack of access to exercise
facilities, and the recorded rate of poor overall health. The weaknesses of Putnam County need
to be addressed in order to improve the health of the community.
What elements influence the health of a community or an individual? The Determinants
of Health Model indicates that factors such as social and economic environment- social support
and income, physical environment- clean water and air, and a persons individual characteristicsgenetics and behavior- all play a part in determining a populations health status. Knowing this,
a community health nurse can use the model to examine a health issue and develop interventions
specific to a population. In terms of this paper, one of the determinants that contribute to the
health issue of obesity in children and adults is genetics. The strongest predictor of obesity in
children is parental obesity; this doubled the risk of obesity in children younger than 10 (Zlot,
Newell, Silvey, & Arail, 2007). The lack of access to exercise facilities and violence in the area
is also contributing to the obesity rate. For every 100,000 people in Putnam County, 820
reported violent crimes (Florida Department of Health, 2015). This county ranks the second
highest in Florida for crime. A study that investigated barriers and enablers of physical activity
identified that socio-environmental factors, such as lack of exercise facilities and neighborhood
crime, were impeding physical activity (Shuva et al., 2013). Putnam Countys rate (33%) of
physical inactivity is adding to the priority health issue as well. Floridas rate of physical
inactivity is 23%, but Putnams trend seems to be worsening (University of Wisconsin
Population Health Institute, 2015). Sedentary lifestyle is a risk factor for disease; prolonged
physical inactivity increases the risk of illness and death from chronic disease such as diabetes

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and obesity (Shuva et al., 2013). All things considered, a fitting population diagnosis would be,
adults and adolescents of Putnam County are at risk for chronic diseases from obesity, related to
genetics and sedentary lifestyles, as evidence by the worsening trends of physical inactivity and
obesity.
Several interventions can be implemented that will address the health issue of childhood
and adult obesity. Education on health and lifestyle habits, for example, nutrition and physical
activity would be a primary intervention. Health teachings in a primary care setting would
promote health at an individual level. Education strategies- implemented by discussion and
written materials- would aim to increase knowledge and change behaviors. Evidence showed
that a reduction in weight resulted from educational health promotion programs aimed at
improving nutrition and physical activity (Anderson et.al., 2009). This intervention would be
geared toward health care providers of Putnam County. The community health nurse would
follow up on this intervention by visiting the at risk individuals identified by the physician. Her
job would be to discuss health teachings with the patient and evaluate the behavior changes that
are being implemented a week after their initial visit with the primary physician. A secondary
level of prevention would be screening for obesity in schools and in the workplace; this would
affect people at a community level. Screening would identify groups of children above the 95th
percentile and adults with a body mass index above 30. After screening, the community health
nurses would further carry out this intervention by referring these groups of people to treatment
or counseling since obesity can lead to other chronic illnesses. This would help to reduce the
impact of obesity and risk for other chronic diseases. Funding sources and public officials would
need to be involved in order to carry out this intervention. According to the U.S. Preventative
Services Task Force (2013), there is sufficient evidence that screening for obesity improves
health outcomes and other risk factors. A community support group funded by the local hospital

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for obese individuals would be a tertiary level of prevention. Members of the community would
gain access to this program through recommendation from their primary provider as well as
through community advertisement. The community health nurse would help to develop this
group by contacting community members such as local schools, businesses, and private
healthcare offices where the group could be advertised. In addition, the nurse would have to
seek out a location in the community where the group could be held such as a church. This
community organization intervention would help obese individuals identify common problems
and implement strategies for reaching goals they collectively set. The group would help
individuals- adults and children- deal with consequences via support from others. Furthermore,
through group discussion, the nurse would assess their compliance in terms of nutrition choices
and lifestyle improvement; she would also be able to provide support and suggestions to the
group members such as using spices to season food instead of salt. Peer based interventions
facilitate positive health care outcomes in terms of quality of life, self-efficacy, symptom
management, and selfcare (Webel, Okonsky, Trompeta, & Holzemer, 2010). Implementing
these evidence-based interventions will help to reduce the impact of obesity in Putnam County.
Developing health policies will improve health outcomes. Policies help to reduce
unhealthy environments as well as authorize events in a population that support community
health. It is essential that healthcare providers are aware of healthcare issues and policies.
Informed healthcare providers are able to advocate for their patients and develop policies in
order to improve healthcare as well as patient health status. Adults and adolescents of Putnam
County are at risk for chronic diseases from obesity, related to genetics and sedentary lifestyles,
as evidence by the worsening trends of physical inactivity and obesity. Children- over the age of
six- and adults of Putnam County will be screened for obesity on admission to schools and large
places of employment. The goal of this health policy is to identify obese individuals in order to

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provide early treatment interventions to decrease their risk for chronic disease. Schools will
provide instruction on healthy nutrition and lifestyle behaviors for children. Adults will receive
health education and referrals for treatment after being screened at their place of employment.
Follow up will be conducted by the employers in order to ensure the referrals are appropriate for
each identified individual. The stakeholders that would be affected by this plan are public
officials, health care providers, community members, and funding sources. Public officials and
health care providers would support this health policy. Having the support of public officials
would permit this policy to be held in schools and large places of employment. Health care
providers would influence this policy by enabling its implementation, because they would be the
ones doing the screening. Community members would also be supportive, because the program
would help to lower their risk for disease. Having support from the community would help
influence the passing of this health policy. Funding sources may be an opposing force. Lack of
funds to pay for screening tools or employees could prevent the policy from being implemented.
It is important to show employers the benefits of having healthy employees in order to gain their
support and funding for this policy. Having healthy employees will decrease absenteeism and
increase productivity. By implementing this health policy, employers are able to target the
unhealthy employees, promote health maintenance, and lower their overall health insurance
costs. In order to carry out the policy, the number of schools and large places of employment in
Putnam County will have to be collected. Before presenting the plan, the necessary screening
tools as well as funding, employment, and how teachers will be certified in order to educate
children on healthy lifestyles must be identified. When proposing the health policy, a public
official and the Putnam County School Board would be approached first. The levels of obesity
in Putnam County are increasing- especially in children, and heart disease is the major cause of

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death. Providing screening services to this undeserved population in schools and places of
employment will help to identify obese individuals who are at risk for disease. This health
policy will enhance population health by providing education and treatment to facilitate lifestyle
changes, thus improving overall quality of life.
This paper introduced Putnam County, Florida. It reviewed strengths and weaknesses of
this county compared to Floridas numbers and focused on one health priority- the increasing rate
of child and adult obesity. Factors that contributed to this health issue such as genetics,
community violence, and sedentary lifestyle were discussed and supported. A population
diagnosis was developed; adults and adolescents of Putnam County are at risk for chronic
diseases from obesity, related to genetics and sedentary lifestyles, as evidence by the worsening
trends of physical inactivity and obesity. When addressing this diagnosis and the priority health
issue, three interventions were established in order to decrease the impact of obesity on the
community- education for health promotion, screening to identify at risk individuals, and
community support groups to monitor treatment and compliance. A health policy was developed
based on one of the interventions. Children- over the age of six- and adults of Putnam County
will be screened for obesity on admission to schools and large places of employment. The steps
in order to carry out this policy were examined. Overall, this health policy would increase
Putnam Countys health status by providing the tools to decrease the risk for disease and improve
their quality of life.

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References
Anderson, L.M., Quinn, T.A., Glanz, K., Ramirez, G., Kahwati, L.C., Johnson, D.B., . . . Katz,
D.L. (2009). The effectiveness of worksite nutrition and physical activity interventions
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Medicine, 37(4), 340-357. doi: 10.1016/j.amepre.2009.07.003
Dillon, G., Hussain, R., Loxton, D., & Rahman, S. (2013). Mental and physical health and
intimate partner violence against women: A review of the literature. International
Journal of Family Medicine, 2013, 1-15. doi: 10.1155/2013/313909
Florida Department of Health. (2015). County health profile. Retrieved from
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Shuval, K., Hebert, E.T., Siddiqi, Z., Leonard, T., Lee, S.C., Tiro, J.A., . . . Skinner, C.S. (2013).
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University of Wisconsin Population Health Institute. (2015). County health rankings. Retrieved
from www.countyhealthrankings.org
U.S. Preventative Task Force. (2012). Screening for and management of obesity in adults: U.S.
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Watkins, K., & Lee, J.E.C. (2014). Narrative review of barriers to the secondary prevention of
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Webel, A.R., Okonsky, J., Trompeta, J., & Holzemer, W. (2010). A systematic review of the
effectiveness of peer-based interventions on health-related behaviors in adults. American
Journal of Public Health, 100(2), 247-253. doi: 10.2105/AJPH.2008.149419
Zlot, A., Newell, A., Silvey, K., & Arail, K. (2007). Addressing the obesity epidemic: A
genomics perspective. Preventing Chronic Disease, 4(2), 1-6. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1893129/
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