Running head: COMMUNITY PREVENTATIVE HEALTH IMPROVMENT

Community Preventative Health Improvement

David A Lepin
University of South Florida

COMMUNITY PREVENTATIVE HEALTH IMPROVMENT

Community Preventative Health Improvement

Introduction
A community health improvement plan is a tool used to mitigate health discrepancies
within a specific community. It is a systematic approach in which health care providers, social
workers, and leaders of the community work together to address the health issues relevant to the
community. In order to establish what those needs or discrepancies are, the targeted community
must first be assessed. While assessing the community, one must consider what kind of risks
these health needs create. For example, if obesity is a common condition within a community, it
is important to consider what health conditions it can create. Furthermore, creating a successful
community health improvement plan involves highlighting the contributing factors and using
them as a guideline to overcome the community health needs.
Background and Purpose
The selected target population for this health improvement plan includes the adult
residents of Marion County. According to the University of Wisconsin Population Health
Institutes County Health Rankings & Roadmaps (2016), 29% of adults in this county have a
body mass index of 30 or more. That means that an estimated one-third of the adults in Marion
County are obese. The adults in this study include those ages 20 or older. The University of
Wisconsin Population Health Institutes County Health Profile (2016) also reveals that obesity in
Marion County exceeds the average in Florida and the United States. The World Health
Organization (2016) reports overweight and obesity are major risk factors for a number of
chronic diseases, including diabetes, cardiovascular disease and cancer (para. 2). This data is
significant and indicates a need for intervention.

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Healthy People 2020 is a directive from the U.S Department of Health and Human
Services that provides guidelines to help enhance the overall health of Americans (U.S.
Department of Health and Human Services, para. 1). It encompasses four goals to help achieve
this mission. For this community health improvement plan, three of those goals will be
addressed. Those goals are as follows: attain high-quality, longer lives free of preventable
disease, disability, injury, and premature death. Create social and physical environments that
promote good health for all. Promote quality of life, healthy development, and healthy behaviors
across all life stages (Overarching goals section, para. 1). The residents of Marion County that
are obese are living with a preventable disease. In addition, conducting a Windshield Survey will
reveal that Marion County is not an environment that promotes good health. These contributing
factors can be managed by educating the target population about obesity, and also by promoting
physical activity.
Interventions
Promising Practice Plan
The promising practice plan that will be implemented in Marion County for this
community health improvement plan involves educating Marion County residents on obesity in a
non-stigmatizing way, and by encouraging weight loss. Before any other intervention is
accomplished, the residents of Marion County must first be educated on the risk factors,
prognosis, and the treatment of obesity. This education must be non-discriminatory and sensitive
to the communitys ethics so that they are receptive to the information. One study by Puhl,
Luedicke, and Peterson (2013) showed that the participants experienced less motivation and selfefficacy when presented with materials that were perceived as stigmatizing (Discussion section,
para. 1). The purpose of this study was to evaluate the publics perceptions of health campaigns

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related to obesity. A randomized controlled trial was conducted among 1,085 adults who were
randomly assigned to view materials that were previously considered either stigmatizing, or nonstigmatizing from a public survey. The materials that the participants were presented with
included billboard and magazine advertisements, television commercials, and educational
websites related to obesity. Regardless of the participants age, sex, political orientation, or
weight, educational materials that were considered as stigmatizing did not promote lifestyle
behaviors that are conducive to correcting obesity. Additionally, this study shows that a
community health improvement plan that is considered non-stigmatizing will help improve the
chances of success.
In conjunction with non-stigmatizing obesity related education, weight loss must also be
encouraged. This can be accomplished by exercise programs and dietary changes. The
fundamental cause of obesity and overweight is an energy imbalance between calories consumed
and calories expended (World Health Organization, 2016, What Causes Obesity, para. 1).
Eating foods lower in calories and exercising so that more calories are depleted will help the
obese residents of Marion County lose weight. One study by Shaw, Gennat, ORourke, and Del
Mar (2006) suggest that exercising exclusively reduces weight, but exercising coupled with
dieting reduces the most weight (Primary outcomes section, para. 2). This study was a systemic
review of multiple randomized controlled trials. Participants in these reports were all overweight
or obese, and therefore are relevant for this community health improvement plan. Furthermore,
all of the studies used were outpatient studies. Participants were randomly selected through local
media outlets and through community survey questionnaires. Interventions that were
implemented included different forms of exercises. These exercises included things like walking,
jogging, dancing, and rowing for three to five days a week for at least three months. Other

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studies in this systemic review incorporated low fat and low calorie diets in their interventions.
Regardless of the intervention utilized, the plethora of trials used in this study show a direct
correlation between exercising and weight loss.
The goal of this community health improvement plan is to provide the residents of
Marion County the opportunity to live healthier lives by reducing obesity rates. The reports
referenced above by Puhl, Luedicke, and Peterson (2013), and Shaw, Gennat, ORourke, and Del
Mar (2006) were effective. Both reports promote dieting and exercise for weight loss. Using
these models in Marion County will reduce obesity rates and help achieve the goals of Healthy
People 2020. In order to mirror these results, healthcare workers and community leaders must
work together to maximize the greatest potential for full participation. One way to do this is by
using the Community Health Worker model. Hughes, Yang, Ramanathan, and Benjamins (2016)
report that this model has been used to combat disparities in healthcare access by utilizing
community members as healthcare liaisons to promote improved community health (Abstract
section, para. 1). This study proved that this model can be successfully used for public health
intervention to improve community health. Using this door-to-door method can help bring
awareness to the epidemiology of obesity in Marion County. The goal of this report was to
evaluate the affect that Community Health Workers had on community based diabetes
intervention. The results showed statistically significant results in favor of the Community
Health Worker model (Results section, para. 2). Likewise, the community health improvement
plan that will be implemented in Marion County should use the Community Health Workers
model to educate residents on obesity and promote dieting and exercise.
Measureable Objectives

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To ensure the success of this plan, there must be measureable objectives. The residents
that will participate in this community health improvement plan will be weighed weekly along
with checking their body mass index. According to the Centers for Disease Control and
Prevention (2015) people who lose weight gradually and steadily (about 1 to 2 pounds per
week) are more successful at keeping weight offyou need to reduce caloric intake by 500-1000
calories per day to lose about 1 to 2 pounds per week (What is healthy weight loss section, para.
2). This goal of losing one to two pounds per week is achievable and will be appointed to each
participant. Another measureable objective that will help evaluate this community health
improvement plan involves measuring the participants knowledge and attitudes related to
physical health. One aspect of this community health improvement plan involves educating the
community about obesity in a non-stigmatizing way. This will help them be more receptive to the
educational material, and motivate them to participate in these interventions. This objective can
be evaluated by surveys and questionnaires. These surveys and questionnaires will be used after
the participants receive information about the comorbidities associated with obesity, and also
evidence-based treatment options.
Resources
There are multiple resources located in Marion County that can assist in the successful
completion of these objectives. In the city of Ocala there are several gyms and weight loss
centers that have weight loss programs. Symphony Healthcare Inc. provides a medically
supervised weight loss program. Participants are eligible to visit and consult with a Nurse
Practitioner twice a week. There they receive nutritional counseling and assistance with meal
planning. Coaches are also available for guidance with exercises and motivational support.
Another aspect of this program involves medications and supplements that help promote weight

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loss. Participants can pay out of pocket for this program, and some health insurances are
accepted for financial assistance.
Along with weight loss programs, Marion County residents can also receive obesity
related education at their local primary care clinics. There are bariatric specialists that can help
make recommendations for these specific participants, and they can safely monitor their progress
from a professional medical standpoint. Additionally, Marion County offers several whole food
stores and farmers markets. Many of these stores offer free dinner menus that provide
information on healthy and organic meal preparations. Participants should utilize these stores for
healthier food choices. Furthermore, throughout Marion County there is a considerable number
of recreation centers, gyms, and public parks. Public parks and recreational centers offer
residents free resources to engage in physical activity. Marion Oaks is a subdivision within Ocala
that has four basketball courts, two tennis courts, a one-mile running track, a weights and
aerobics room, and a playground for children at the recreation center.
Application
This community health improvement plan will consist of several different elements. First,
the Community Health Worker model will be used to bring awareness to this plan and to register
participants. Volunteers and assistance from local health wellness businesses will be utilized for
this process. During these door-to-door encounters volunteers will take this opportunity to
inform Marion County residents on the prevalence of obesity, and the treatment options available
within the local communities. This is an example of primary prevention given that it consists of
health promotion. The obesity related information given to the local residents must contain nonstigmatizing information. With this information the residents that choose to participate will be
given the opportunity to engage in weight loss programs, like the one at Symphony Healthcare

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Inc. Once participants are registered for weight loss programs, their progress must be
documented to conduct proper evaluation. Primary care providers and weight loss program
managers will be held accountable for the participants results. They should document the
participants goals and weight loss on a weekly basis. Subjective data should be attained from
interviews and feedback questionnaires. Similar to other reports, data will be collected and
compiled after three and six months of intervention. Along with primary care providers and
weight loss program managers, this community improvement plan should involve participation
from community leaders. Community leaders can help provide donations from sponsors or create
fund raisers. This financial aid can be used to provide funds for educational pamphlets and
videos. Additional funds can be allocated to provide incentives to participants and program
managers.
Recommendations
Although studies have shown that these interventions do reduce obesity rates, there are
some gaps within this community health improvement plan. According to the University of
Wisconsin Population Health Institutes County Health Rankings & Roadmaps (2016) 80 percent
of residents in Marion County have access to exercise opportunities, and 24 percent are
uninsured. This poses some obstacles if this community health improvement plan is
implemented. In order for this plan to be successful participants need access to exercise and
preventative healthcare. One recommendation would be to designate funds exclusively for the
uninsured and unemployed. That way they can also participate in this plan. Unfortunately,
financial assistance is not a guarantee and creates another gap for this plan. It is imperative that
community leaders and program managers coordinate to overcome this obstacle. Community
leaders can also work with state leaders to improve the access to exercise opportunities within

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the county. To accomplish this the community health plan should recommend building more
recreation centers, gyms, or wellness centers.
Conclusion
In conclusion, this is a very complex community health improvement plan. It requires
organization and logistics from community leaders, primary care providers, and weight loss
program managers. Obesity is a prominent issue in Marion County and there is a need for
intervention. Studies have shown that providing non-stigmatizing obesity related education,
engaging in exercise, and dieting all contribute to weight loss. The proposed community health
improvement plan needs to use this comprehensive approach by including all of these aspects.
Doing so will help the residents of Marion County achieve the goals set for by Healthy People
2020.

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References
Centers for Disease Control and Prevention Losing Weight. (2015). Retrieved November 03,
2016, from http://www.cdc.gov/healthyweight/losing_weight/index.html
Hughes, M. M., Yang, E., Ramanathan, D., & Benjamins, M. R. (2016). Community-Based
Diabetes Community Health Worker Intervention in an Underserved Chicago Population.
Journal of Community Health, 41(6), 1249-1256. doi:10.1007/s10900-016-0212-8
Puhl, R., Luedicke, J., & Peterson, J. L. (2013). Public Reactions to Obesity-Related Health
Campaigns. American Journal of Preventive Medicine, 45(1), 36-48.
doi:10.1016/j.amepre.2013.02.010
Shaw, K. A., Hanni G. C., ORourke, P., Del Mar, C. (2006). Exercise for Overweight or Obesity.
Cochrane Library. doi: 10.1002/14651858.CD003817.pub3
Symphony Healthcare Inc. Weight Loss - Phentermine, hCG, Fat Burning Injections (2016).
Retrieved November 03, 2016, from http://shcocala.com/weightloss/
University of Wisconsin Population Health Institute County Health Rankings & Roadmaps.
(2016). Retrieved November 5, 2016, from
www.countyhealthrankings.org/app/florida/2016/rankings/marion/county/outcomes/overa
ll/snapshot
U.S. Department of Health and Human Services About Healthy People. (2016). Retrieved
November 01, 2016, from https://www.healthypeople.gov/2020/About-Healthy-People
World Health Organization Obesity. (2016). Retrieved November 03, 2016, from
http://www.who.int/topics/obesity/en/
World Health Organization Obesity and overweight. (2016). Retrieved November 03, 2016,
from http://www.who.int/mediacentre/factsheets/fs311/en/

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