Community assessment case study


Community assessment case study
Community Assessment Applied
The Community
PHASE ONE: DEFINING THE COMMUNITY
You are employed as a public health nurse by the Midway Health Department. One of your duties is to perform a community assessment. The health department annually identifies a health concern that it would like to address through a community assessment. This year, it has chosen the increasing incidence of obesity as the health concern to be investigated. Your task is to complete a community assessment of Midway by looking for indicators that influence the incidence of obesity within the community.
PHASE TWO: ASSESSMENT
A. Data Gathering
First, you conduct an Internet search to find information about your community. Through your Internet search, you gather the following information:
Population of Midway
• Total population: 10,000
• Ethnic composition:
• White—8000
• African American—1500
• Hispanic—500
• Median age: 37 years
• Population groups:
• Under 15 years—20%
• 15-24 years—17%
• 25-44 years—28%
• 45-64 years—21%
• Over 65 years—14%
• Income:
• Median household—$31,550
• % community below poverty level—10%
• 2000 children attend school (K-12)
• Attendance rates:
• National—79%
• State—85%
• Local—93%
• Free and reduced-price lunch eligibility
• 35% of students are eligible
• Involvement in extracurricular activities
• 80% at middle school level
• 75% at senior high school level
Prevalence of Overweight Children
• National—20%
• State—22%
• Local—25%
Adult Obesity Prevalence (BMI greater than 30)
• National—32%
• State—35%
• Local—34%
Causes of Death Related to Chronic Disease
• Heart disease:
• National—29%
• State—31%
• Cardiovascular accident (CVA)
• National—10%
• State—11%
• Diabetes
• National—2%
• State—2%
B. Data Generation
After the previous information has been collected, you begin to generate your own data about the community. You choose to complete a windshield survey and to interview key informants to generate additional information.
Windshield Survey
You choose to complete your windshield survey at 1:00 p.m. on a warm and sunny Sunday afternoon. You hope that by performing your assessment at this time, if weather conditions are favorable, you will be able to see people out in the community.
• Many families are out in the community together. Some are playing outdoors in backyards, some are going for walks or bike rides on the bike trail, and others are doing yard work.
• Sidewalks are located along major streets in the community (well maintained).
• There is at least one vehicle in most driveways.
• The condition of the residences and businesses appears to depend on where you are in the community. Those that are near the trailer homes appear to have more litter surrounding them and are not as well kept as those that are located in the newer section of the community.
• Two distinct areas of the community:
• Ranch-style homes built after 1950
• Congregate area of trailer homes in poor repair
• Three convenience stores
• Six fast food restaurants
• Two family-style restaurants
• One grocery store
• One video rental store
• Elementary, middle, and high schools
• One health clinic (one physician and one nurse practitioner practice)
• Eight churches
• Two golf courses (one public and one private)
• Scenic bike trail (in good repair)
• Indoor public swimming pool (accessible to public year round)
• Two city parks (appear to be well maintained)
• One has a baseball diamond
• One has a soccer field
Informant Interviews
You select four key informants (elementary school physical education teacher, park and recreation director, restaurant owner, and church minister) to interview about their perspectives regarding obesity in Midway. Before meeting with the informants, you prepare a list of questions.
1. Are you aware of the increasing prevalence of obesity in the nation?
a. If informant answer is no, provide information about this problem, and educate the informant about its rate of increase over the past 30 years.
2. Do you think obesity is a problem in this community? Why or why not?
3. Given that several studies have determined that overweight children have a high tendency to become obese adults, do you think this community is doing enough to prevent obesity in children? Why or why not?
4. What resources are available in the community to promote healthy lifestyles?
5. What barriers in the community hinder the individual who wishes to maintain a healthy lifestyle?
6. Tell me what you know about the lifestyles of the residents of Midway, based on interactions that you have with them.
Interview With Elementary School PE Teacher—35-Year-Old White Female
1. Are you aware of the increasing prevalence of obesity in the nation? Yes
2. Do you think obesity is a problem in this community? Why or why not? Yes, I have seen a change in the population that attends the elementary school over the past decade. I have been teaching PE at this school for the past 10 years; I would have to say that children are considerably less active now than they were 10 years ago. This lack of activity has caused young children to have considerable problems controlling their weight.
3. Given that several studies have determined that overweight children have a high tendency to become obese adults, do you think this community is doing enough to prevent obesity in children? Why or why not? The community has not really been doing much to prevent children from becoming obese. Currently, PE is offered to the elementary school children two or three times per week for 30 minutes each time. This seems to be barely enough time to get children organized in an activity and definitely does not provide them with adequate cardiovascular exercise. Some of the children complain about doing activities in PE that make them sweat, and they say they would rather be at home playing video games.
The frequency of opportunity and the duration of time that students engage in PE should be increased to help deal with this problem. The community in general seems to be ignoring this problem. You may hear parents say things about overweight kids, but no one is really addressing the issue.
4. What resources are available in the community to promote healthy lifestyles? The fact that the city swimming pool is open year round is an asset to the community. Regular swimming and water aerobics classes are available there for all community members. Also, two city parks in town are in good condition. A variety of play equipment is available in these parks for children to use. One park has a soccer field and the other has a baseball diamond. These are used by children on a regular basis when weather conditions are favorable. Also, the recent addition of a bike trail in the community has proved helpful in promoting physical activity.
5. What barriers in the community hinder the individual who wishes to lead a healthy lifestyle? One barrier is the a la carte lunch program that is provided for school-aged children. If children don’t like what is being served for lunch, they can choose to buy pizza, chips, candy, etc., for lunch; this does not promote healthy eating. I don’t believe that children are responsible enough to make their own choices about what they should eat on a daily basis.
Another barrier is that the community does not have a recreation center. There is no central location in the community for promoting wellness and providing opportunities for physical activity. Also, many children come from homes where both parents work. Parents may not have time to participate in physical activity with their children outside of school; this limits children’s opportunities to engage in healthy lifestyle patterns.
6. Tell me what you know about the lifestyles of the residents of Midway, based on interactions that you have with them. As I mentioned before, in many of the families in this community, both parents are employed either full time or part time. This limits the amount of time that is available for recreation. When I talk to students, I get the sense that they are not learning that exercise is an important lifelong habit. I am guessing that many of their parents do not exercise on a regular basis. When the weather is nice, I see a lot of families out together using the bike trail. Knowing many people in this community and their busy schedules, I would guess that families in this community eat fast food at least one time per week, if not more often.
Interview With Park and Recreation Director—50-Year-Old White Woman
1. Are you aware of the increasing prevalence of obesity in the nation? Yes
2. Do you think obesity is a problem in this community? Why or why not? Yes, the children and families that I serve in the community appear to be more overweight than they were several years ago. Also, interest from the community in the programs that I organize seems to have decreased over the past several years. The number of youth in the community who sign up to participate in the outdoor soccer and baseball/softball leagues is declining.
3. Given that several studies have determined that overweight children have a high tendency to become obese adults, do you think this community is doing enough to prevent obesity in children? Why or why not? Yes, this community has several resources in place for children in this community. However, not many children choose to use these resources. We have given children every possible opportunity to be active. I coordinate activities for children and families throughout the entire calendar year. I believe that ample opportunity exists for all children to participate and be active.
4. What resources are available in the community to promote healthy lifestyles? Resources available in the community include programs from the Park and Recreation Department, swimming pool, parks, and the bike trail. The community is safe; there is very little crime here. Children should be able to be outside and exercise on a regular basis. If parents don’t have money to send their children to the programs that are offered, several organizations offer scholarships for children so they can attend.
5. What barriers in the community hinder the individual who wishes to lead a healthy lifestyle? Adults are probably faced with some barriers. There is no exercise facility in the community that is accessible to the public. Adults must engage in exercise in their homes or outdoors. I think the school gyms could be used for organized exercise programs, but as far as I know, that is not happening right now.
People in this community are hard workers. In many families, both parents work; their busy lives create barriers to staying physically active and promoting physical activity for themselves and their children.
6. Tell me what you know about the lifestyles of the residents of Midway, based on interactions that you have with them. The population I serve appears to be mainly the white community. I am not sure why the minority groups choose not to participate. As I mentioned before, it appears that the families are hard working, but because of this, they may feel that they are too busy to have an active/healthy lifestyle.
Interview With Restaurant Owner—60-Year-Old White Man
1. Are you aware of the increasing prevalence of obesity in the nation? Yes
2. Do you think obesity is a problem in this community? Why or why not? Obesity is definitely a problem in this community. I see it on a daily basis when customers come into the family diner that I own. I have noticed a difference in the past decade; there are definitely more overweight people in our community today.
3. Given that several studies have determined that overweight children have a high tendency to become obese adults, do you think this community is doing enough to prevent obesity in children? Why or why not? No, this community should be doing much more to prevent obesity in children. Look at the billboards and the advertisements that children see every day. Everywhere they look, another ad is telling them that they should eat their food, play their video games, or watch their television shows.
All of the fast food restaurants offer high-fat foods geared for kids. Who wouldn’t want to go out to eat and get a toy with their meal? It is my experience that children do not like to come to my family diner for a meal because it is too boring, and there isn’t enough entertainment involved in the experience.
4. What resources are available in the community to promote healthy lifestyles? I’m not sure if there are many resources available in the community to promote healthy lifestyles. There are several fast food restaurants in town, as well as a couple of family-style restaurants. Convenience stores and pizza places are other places where community members stop to get food. I’m not sure that the food industry does a good job of promoting healthy lifestyles. It seems that everything is about things being quick and convenient. Sometimes, being healthy is not a quick and convenient thing to achieve.
5. What barriers in the community hinder the individual who wishes to lead a healthy lifestyle? I mentioned quite a few barriers earlier. One major barrier is the amount of time that people have in a day. I have noticed a decline in the number of people who come into my restaurant during the past decade. I suspect they are choosing fast food over my restaurant because it is quicker.
6. Tell me what you know about the lifestyles of the residents of Midway, based on interactions that you have with them. I think convenience is a major factor in all choices that residents in the community make. If it can’t be done quickly, I think many of them think that then they just won’t do it. Another thing I have noticed is the demands of the consumer in my restaurant. It is important that portion sizes for the meals are big. Customers are disappointed if the meal isn’t “big enough” for them. They don’t want to leave hungry. They are paying me to deliver a service to them, and if I want to stay in business, I need to meet their demands.
Interview With Church Minister—40-Year-Old African American Man
1. Are you aware of the increasing prevalence of obesity in the nation? Yes.
2. Do you think obesity is a problem in this community? Why or why not? I don’t think I have noticed a change in the congregation that I serve. However, there is a large amount of media attention being given to this issue, so I would have to guess that it is probably a problem in our community as well.
3. Given that several studies have determined that overweight children have a high tendency to become obese adults, do you think this community is doing enough to prevent obesity in children? Why or why not? I am not aware of any specific programs out there to keep children active because I do not have any children living at home. I would hope that children are receiving the necessary physical activity that they need both during and after school. Children who attend my congregation love to run and play, but I am not sure whether they have the opportunity to engage in organized activities in the community.
4. What resources are available in the community to promote healthy lifestyles? I know the swimming pool is open year round; that is a benefit to the community. There is programming for adults like water aerobics that happens there on a regular basis.
The retired persons in my congregation have started a walking program, and they walk on the bike trail several times each week. I think this is a great resource for them to have. However, I don’t know how many people outside of our congregation know about this.
We have several restaurants in the community. Community members can go to these restaurants and make healthy food choices if they are unable to prepare a meal for themselves at home.
5. What barriers in the community hinder the individual who wishes to lead a healthy lifestyle? I think a major barrier is the lack of communication within the community. I think there may be several resources out there, but the community has not done a good job of letting the entire community know what is going on. Also, I think everyone is too busy. No one wants to take the time to do things that might be a healthier option for them.
6. Tell me what you know about the lifestyles of the residents of Midway, based on interactions that you have with them. My interactions with residents in the community occur mainly at the church; these interactions happen several times each week. The congregation that I serve is primarily an African American, working class population. Family is very important to the members of my church. Families do many things together within the community.
C. Data Interpretation
After you have collected the data, you analyze the findings. You look through the data to find out whether you have collected adequate information to obtain a complete picture of the community. You review the data you have collected to identify recurrent themes. You identify the strengths and weaknesses of the community, so that you can draw some conclusions.?
Prevalence of Overweight Children
• National
• State
• Local
Topic Area: Physical Activity for Children
Data Gathered
Data Generated
Interpretation:
Conclusion:
Topic Area: Nutritional Patterns for Children
Data Gathered
Data Generated
Interpretation:
Conclusion:
Adult Obesity Prevalence (BMI greater than 30)
• National
• State
• Local
Causes of Death Related to Chronic Disease
• Heart disease
• National
• State
• Cardiovascular accident (CVA)
• National
• State
• Diabetes
• National
• State
Topic Area: Physical Activity for Adults
Data Gathered
Data Generated
Interpretation:
Conclusion:
Topic Area: Nutritional Patterns for Adults
Data Gathered
Data Generated
Interpretation:
Conclusion:
Other Significant Data
On the basis of the community assessment, you are able to draw the following conclusions:
Strengths of the Community
Areas for Improvement in the Community
Recommendations?



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