Team 2 Program Plan

Team 2 Program Plan:
Happy Heart, Happy Life
“One small step for you, one large improvement for your heart”
Garret Veldhuizen, Arlynna Mitchell (idle), Maddie Callahan, Megan Tsong & Riley Quincy
HPS 350 - University of Arizona
December 10, 2019

HAPPY HEART, HAPPY LIFE 1
Table of Contents Page

List of Tables………………………………………………………………………… 2
List of Figures……………………………………………………………………….. 2
Introduction …………………………………………………………………………. 3
Literature Review ……………………………………………………………………
The Problem Statement ……………………………………………………………..
Theoretical Framework for the Program Plan …………………………………….
Program Description ………………………………………………………………...
Program Implementation Plan ……………………………………………………...
Program Evaluation Plan …………………………………………………………....
References …………………………………………………………………………….
Appendices …………………………………………………………………………….
Appendix A: Slide during Blood Pressure Demonstration at First
Program Meeting………………………………………………………………
Appendix B: Happy Heart, Happy Life Program Flyer……………………..
List of Tables
Table 1: Table 1: Timeline for Planning, Implementation, and Evaluation…………….
List of Figures
Figure 1: Age Adjusted Incidence of Stroke/Heart Attack by Race and
Sex, Ages 45-74, 1987-2001……………………………………………………………
Figure 2: African American Senior Citizens Heart Disease - Problem Map…………..
Introduction
The community health needs assessment for Pima County reveals both the
strengths, and areas that need improvement, to advance the health status of Pima County.
According to the 2018 community health needs assessment, Pima County ranks fourth out
of the 15 Arizona counties primarily due to the fact that Pima County is first for clinical
care and second for health behaviors. (Pima County, 2018). Although there are bright
spots in the health status of Pima County, there are many areas which could use
improvement. The community health needs assessment highlights four necessary health
needs that should be considered priorities for Pima County. These include
anxiety/depression spectrum disorders, substance abuse/dependency, injuries/accidents,
and diabetes. Another important takeaway from the needs assessment is that the leading
cause of death among all Pima County residents it attributed to cancer and heart disease.
For residents of Pima County who are looking for resources, the Pima County website
provides several different means to gather information. Under the health tab on the
website, there are several links to a variety of health resources such as health clinic
locations, preventive, behavioral and sexual health sources.
The target population for this program is African American senior citizens over the
age of 65, including immigrant populations, all socioeconomic classes, and geographical
locations within Pima County. The program is open to all African American senior
citizens who currently have heart disease or exhibit risk factors for heart disease
(hypertension, diabetes type 2, high cholesterol, etc). The program is inclusive to all
African American senior citizens in Pima County regardless of residency or duration of
time spent in Pima County.

There are many diseases affecting a wide spectrum of people on the range of
chronic and non-chronic illnesses. However, there are common trends that affect specific
subpopulations and ethnic groups. For African Americans who are 65 and over (senior
citizens), heart disease is a chronic health issue that severely affects them. The leading
cause of death for both African American males and females is cardiovascular disease;
accounting for 31.4% and 32.9% of total deaths for African American males and females,
respectively (American Heart Association, 2015). The Arizona Department of Health
Services reported that the African American cardiovascular disease (CVD) risk profile is
41.2% higher for African American seniors as compared to the state average for all
ethnicities. Figure 1 shows that the incidence of stroke and/or heart attack due to chronic
heart disease is much higher for African American males and females at all ages compared
to white males and females (American Heart Association, 2015). These national trends
hold true for the African American senior citizen population in Pima County, and are the
driving factor for why they will be our target population for this program.
Figur
e 1: Incidence of stroke and heart attack by race and sex per 1000 people aged 45-74
between 1987-2001 (American Heart Association, 2015).
Approximately 4% of African American senior citizens are living in poverty in Pima
County with “the median personal income for older African American men is $23,026
and $14,633 for women” (ACL, 2015). Not only does income affect their socioeconomic
status, but so does the level of education these individuals have attained. The
Administration for Community Living states that in the year 2014 around 84% of African
American senior citizens had graduated high school despite the fact that 4% of the
population was living in poverty but less than half of these individuals had obtained a
college degree (ACL, 2015). With less than 50% of African American senior citizens in
the U.S. receiving a higher education level than high school, 6.3% of African Americans
over the age of 65 were unemployed in the year 2018 throughout the county (Bureau of
Labor Statistics, 2019).
Heart Disease and diabetes are two of the five most common reasons for mortality of
the African American population in the U.S. and this can be due to the cultural aspect of
“Soul Food” (Lee, 2018). It is a cultural tradition for some African American senior
citizens to have social interactions with family and friends that is centered around soul
food (Lee, 2018). Soul food consists of fried chicken, fried fish, sweet potato pie,
macaroni and cheese, corn bread, and other “foods typically high in fats”, grease, and
sugars that all cause obesity which is a risk factor of heart disease (Edwards, 2003). One
ethnic characteristic when it comes to the heart health of African American senior citizens
in Pima County is that 85% of the African Americans aged 65+ who live in Pima County
are born in the U.S. but around 20% of African American senior citizens in Pima County
are African natives (U.S. Census Bureau, 2019). Because a proportion of the Pima
residents who are elderly African Americans are not from the United States, they are faced
with the lack of English proficiency they face more stress due to lack of financial stability
and employment status (U.S. Census Bureau, 2019).
Nationally, the most common chronic conditions among the elderly African
American population are hypertension (85%), arthritis (51%), diabetes (39%), cancer
(17%), which are all precursors of heart disease which is prevalent among 27% of the
population (ACL, 2015). The prevalence of all the listed conditions, especially heart
disease, are significantly lower in other populations and this results in the African
American life expectancy age to be around 75 years old while other white Americans live
close to five years longer (ACL, 2015). On a national level, African American senior
citizens need more accessibility to affordable healthcare. In 2018 there were 639,000
fewer individuals aged 65 and above on the Medicaid insurance plan and around 20% of
this decline was due to older African American citizens (Bunis, 2019). Without health
care, individuals are unable to afford medical attention, which results in about 1 in 5
people without insurance missing out on needed care (Bunis, 2019). In the state of
Arizona, around 28% of African American senior citizens have type 2 diabetes. The health
needs of the targeted population include affordable primary prevention care screenings to
monitor their A1C and better manage their blood sugar levels. Individuals in financial
distress are unable to afford primary prevention screenings. With managing and
monitoring glucose and A1C levels, African American senior citizens can prevent type 2
diabetes, a precursor to heart disease. In Pima County, 4% of the elderly African
American Population is living in poverty which can play a role in obtaining an unhealthy
diet. In Pima County there are a total of 38 census tracts identified as urban food deserts
(Tong, 2018). With the lack of food accessibility in Pima County, individuals who live in
low-income areas have more of a struggle in maintaining a healthy diet. Not obtaining a
healthy diet puts these individuals at a greater risk for obesity, diabetes, high cholesterol,
high blood pressure, all the precursors that lead to heart disease. Pima County needs more
affordable grocery stores spread out through the community to provide a healthier lifestyle
for African American senior citizens.
Literature Review: (Everyone Needs 2)
To determine the health issue for this program, a literature review was conducted. Data was
gathered from research journals, peer-reviewed articles, and government websites which pertain
to African American senior citizens. The task started with a given target population (African
American senior citizens), and through research, refine a specific health issue for the population.
Many health issues surfaced which affect this population, however, the data and reports for heart
disease complications in African American seniors raised severe concern.
There are a variety of different components that affect an individual's health outcomes. It
is often found that higher socioeconomic status correlates with reduced risk of chronic diseases
such as cancer, diabetes, and heart disease. This is relevant because it has been found that a
lifetime of health care disparities add up to increase the prevalence of heart related issues. For
the African American community specifically, they have a 25% higher chance of dying from
heart disease (Guy-Walls, Long, 2017). The American Heart Association (2015) states that the
prevalence of high blood pressure in African Americans is the highest of any race in the world.
Not only is high blood pressure more severe in African Americans, but it occurs earlier in life.
High blood pressure, obesity, and diabetes are the top three risk factors for the development of
heart disease; all diseases that African Americans are at a higher risk for as compared to other
racial populations. In order to address the prevalence disparity of heart disease it is important for
individuals to understand the risks and medical steps to take in order to address the issue.
Hypertension is the most common condition among adults over the age of 60, and among
that population, African Americans are affected at the highest rate (Still, Ferdinand, Ogedegbe,
Wright, 2015). Because the population of those people 60 and older is currently growing, it is
important for people at risk for hypertension to be aware of how to recognize and how to manage
it. Although African Americans are aware that they have a higher rate of hypertension, they still
have less controlled blood pressure. This is vital because, “lowering blood pressure substantially
decreases the rates of cardiovascular morbidity and mortality in older hypertensive patients”
(Still, Ferdinand, Ogedegbe, Wright, 2015). To improve the blood pressure of African
Americans, a great start would be with lifestyle and behavior changes. This can be a variety of
changes like dietary modification or incorporation of physical activity. The American Heart
Association suggests that African Americans check their blood pressure regularly, walk at least
30 minutes a day, and eliminate sugary drinks and desserts from the diet. These changes along
with recording blood pressure regularly would help reduce the disparity in heart disease for
African Americans.
The study conducted by Sundquist, Winkleby, and Pudaric (2001) analyzed how
race/ethnicity influences risk for heart disease in senior citizens between the ages of 65 and 84
for both men and women. In most areas of risk for heart disease, African American senior men
between the ages of 65 and 84 showed significantly greater risk than their White and Mexican
counterparts in the same age range (Sundquist, et.al., 2001). Their risk for physical inactivity,
hypertension, and current smoking was greater in African American men than both other races in
the study. This study, based on the data acquired, recommends a secondary intervention with
more intent to focus on the cultural and lingual differences within these groups in order to
account for the amount of disparity that is demonstrated.
In a different intervention, conducted by Butler-ajibade, Booth, Min, and Burwell in
2012, highlights the effectiveness of implementing programs that are integrated with the church
in the Southern belt, referred to by medical professionals as the “Stroke Belt” of the United
States. More organizations have begun to partner with the church within this section of the
United States because they play an integral part in the communal, economic, and social aspects
of the African American population. This is recognized as a relatively effective process and has
been ongoing for the past 30 years. This partnering with such an integral part of the community
has increased effectiveness of programs designed by health professionals to decrease risk for
incidence and prevalence of heart disease within this vulnerable population. This study
concludes that behaviors are more readily learned when they are taught by those in the
community that they trust in the case of African Americans located in this area. The primary goal
of this method is to ensure that the practices that are implemented and suggested by the program
are followed through with even after the termination of the program and this study demonstrates
that this is an effective method of program planning and implementation.
To combat the issue of a sedentary lifestyle, which research has shown to be a risk factor
for hypertension and later development of heart disease, the program Walk with a Doc (WWaD)
was started by David Sabgir, MD. According to Freeman (2014), 80% of heart disease is
preventable if a patient is doing aerobic exercises, such as walking, regularly for 30+ minutes a
day. The effectiveness of WWaD is rooted from the combination of health teaching with regular
exercise. It is a year-round program that provides an informal setting that makes participants
comfortable interacting with healthcare providers and the health and wellness team. WWaD
takes the medical office and formality out of the health conversation and allows patients to
witness their physicians “practicing what they preach.” This program has increased awareness of
risk factors for heart disease, while at the same time, decreasing the impact of heart disease by
walking regularly.
Health interventions and learning can become effective to lowering the influence of a
person’s disease. In a particular study it examined ways to reduce CVD(cardiovascular disease)
risk in mid-life and older African Americans, using a church based health approach. A particular
intervention used in this study was bringing in African American women who were 40 and older
from 16 churches. The main focus was creating a program focused on diet, exercise with
spiritual components. Activities in this program would include environmental approaches that
promote awareness (Ralston, et al., 2014), clinical learning that includes small group educational
sessions using culturally-tailored communications (Ralston, et al., 2014) and developing the
confidence to health behavior change (Ralston, et al., 2014). One year after the program was
implemented, it states how people made progress in adapting a healthy lifestyle such as diet,
making it successful compared to other groups in the church (Ralston, et al., 2014). Examples of
these results would include decreased body weight, blood pressure, reduced fat and sodium
intake. Based on the results of the program, having comprehensive community based approaches
involving the church can have positive effects for older African American male and females.
Racial and ethnic health disparities are a manifestation of already existing and reinforced
social boundaries that are constantly marginalizing black communities and individuals as well as
other minority communities. There are different cultural norms and expectations that, if not
recognized, can make or break an intervention. It is important to address this when designing a
health intervention with the intention of reaching the Black community community, and any
community rather, effectively and creating a long lasting positive impact. What’s critical in
addressing Black senior citizens is that the Black community is very close knit with family and
community laying at the foundation of their values. The structure of family is matriarchal with
women being often considered to take charge and often providing for the family. Another
foundational value found to be centered as a unifying cultural bond is the connection to the
church and religion. The Black community embraces this as a means of updating fellow
community members, implementing and encouraging already existing community interventions,
managing community crises, and socializing youth and old alike (Parrill, et.al., 2011). This
influenced the method of outreach and promotion that health professionals such as Fowler
implemented a mammography education and recruitment strategy program through and with the
assistance of the church as well as Falcone who partnered with the church to spread health and
safety for children through scripture (Parrill, et.al., 2011). Studies have found that information
relayed through more personal networks such as the pastor are much more likely to be received
positively than from someone outside of the community (Parrill, et.al., 2011). Through this data
as well as multiple other studies, it can be concluded that trust and community cooperation are
paramount in creating an intervention program for Black senior citizens and these components,
the intervention will inevitably be unsuccessful in achieving health goals and objectives.
Hypertension has been proven to be the most common risk factor that causes heart
disease among African American senior citizens in Pima County (Flack, Ferdinand, 2007). Heart
disease impacts the lives of these individuals so harshly due to the fact that the prevalence of
hypertension in African Americans is among the highest of any racial/ethnic group in the world
(Flack, Ferdinand, 2007). This knowledge will help the program, Happy Heart, Happy Life, as
implementation methods of health education for African American senior citizens on how to take
their own blood pressure, record it, and manage it. The program will also benefit from
understanding that up to 30% of all deaths in African American men and 20% of deaths in
African American women are due to hypertension (Flack, Ferdinand, 2007). Happy Heart,
Happy Life will educate participants on the risk factors for heart disease including risky behavior
habits and healthy eating habits. This research will ultimately drive the program to teach these
individuals healthy lifestyle habits that reduce the impact of heart disease such as proper physical
activity, a healthy diet, and controlling blood pressure levels (Kurian 2007).
Problem Statement: (Maddie)
In Pima County, there is an overarching issue regarding the prevalence of heart disease
among African American senior citizens aged 65 and older. According to the U.S. Department of
Health and Human Services, African American senior citizens are 30% more likely to die from
heart disease than non-Hispanic whites (OMH, 2016) and 66% of CVD deaths occur in people
age 75 and older (American Heart Association, 2013). African American senior citizens in Pima
County who expose themselves to the precursors of obtaining an unhealthy diet, smoking,
drinking alcohol, or lack engaging in physical activity can be putting themselves at risk for high
cholesterol, high blood pressure, obesity, and diabetes in which increases their overall risk for
heart disease and increases the severity of symptoms of heart disease that is already diagnosed.
These behavior risk factors are commonly observed by individuals in the county with a lower
socioeconomic level, the reason for heart disease being more prevalent in African American
senior citizens who are living in or near poverty levels. Contracting heart disease can result in
heart attacks, strokes, swelling in organs, and potentially death (American Heart Association,
2013).
African American senior citizens are prone to heart disease if they participate in the risk
factors of smoking, alcohol, not engaging in physical exercise, or if they have a pre-existing
condition such as diabetes, high blood pressure, high cholesterol, or obesity. If African American
senior citizens are recruited in to the Happy Heart, Happy Life program then the impact of their
diagnosed heart disease symptoms will be reduced.

Figure 2: African American Senior Citizens Heart Disease - Problem Map
Hypothesis
If the issue of heart disease in African American senior citizens were to be addressed,
then the impact of heart disease (specifically hypertension) will decrease in the participants of
the Happy Heart, Happy Life program.

Theoretical Framework for the program plan: (Garret)
In order to address the high prevalence of Heart disease in African American senior
citizens, a community organization health theory will be implemented. This is an example of a
change theory which “guides the health education specialists in developing meaningful health
interventions for defined health problems” (Parker, 2013). A community organization theory is
specifically one that requires the participation of a community to take action in order to change a
health problem. For reducing the impact of heart disease in African American senior citizens,
this is an applicable option because in order to reduce the impact of heart disease, participants of
the program have to engage in the proposed solutions to be successful.
A community organization theory approach will help drive each of the components of the
plan to reduce the impact of Heart Disease in African American senior citizens. This theory is
essential to guide the overall goal because in order to effectively reduce the impact that heart
disease inflicts, it is essential for participants to effectively practice the lifestyle
recommendations of the program plan and continue them for an extended period of time. This
theory will help drive the planning of the desired objectives because by having the community at
the center of the program, it will create an environment which promotes success and
accountability. This is important for achieving objectives because the values to be considered
successful are specific and having a strong community based program will encourage the
participants to make suggestions for the plan that they think will be effective. The methods will
be developed to require the participants to take part in activities. These activities will be designed
to not only reduce the impact heart disease has on an individual, but also to sound appealing for
the population we are targeting. The participation of the community is the only way for the
program to be successful, so the methods need to be enjoyable and effective. Once the methods
have been decided, a process of implementation will be decided on. This theory will guide the
implementation process because it is designed as a community project and has beneficial
intentions. This is important because when recruiting participants for the program, it is more
likely that establishments will provide information to the desired population if it is a program
that seems respectful and beneficial. For the evaluation portion of the program, it is likely that
the success or lack of, will be assessed in the Community Health Needs Assessment. This would
be an applicable method of evaluation because this assesses all aspects of health in the target
community and since heart disease is the leading cause of death, evaluation of success on this
program would be beneficial.
Program Description: (Everyone)
Statement of Purpose: The mission of the Happy Heart, Happy Life program is to combat
the issue of heart disease in African American senior citizens. Because of this, Happy
Heart, Happy Life will utilize lectures, demonstrations, health appraisals, and personal
improvement logs as primary intervention methods regarding risk factors for heart disease.
It is expected that this program will result in a decreased impact of heart disease for
participants by emphasizing the importance of healthy blood pressure (non-hypertensive
levels), proper nutrition/healthy eating habits, and getting a sufficient amount of exercise.
Goal: To reduce the impact of heart disease in African American senior citizens aged 65+
in Pima County.
I. Level 3 -Outcome Objective: Six months after the completion of the program, 70%
of the seniors 65+ who were actively enrolled in the program in Pima County will
display blood pressure levels less than 130/80 (non-hypertensive levels).
Method: Using a Personal Improvement Log, all participants will record their blood
pressure at least once a week. This is made possible due to the free stethoscope and blood
pressure cuff provided to all participants.
II. Level 2 -Behavioral Objective: One year after the completion of the program, 90%
of the program participants will report having their blood pressure measured
weekly during the past six months.
Method: Former program participants will prove to the program staff that they
have checked their blood pressure at least once a week using their Personal Improvement
Log that is provided at the first program meeting.
III. Level 2 -Learning Objective (Skill Development, Knowledge, and Awareness
levels): By the conclusion of the program in Pima County, 75% of the African
American senior citizens actively enrolled in the program will demonstrate skills
for reducing the impact of heart disease through a quiz.
Method: Participants will attend informational Heart Disease classes that will go
over lifestyle changes that can reduce the impact of heart disease.
IV. Level 2 - Impact Objective: By the end of the last program session, participants
blood pressure will decrease by 4 points for both systolic and diastolic measures.
Method: Baseline blood pressure measurements for all program participants will be
collected at the first program meeting and recorded in a “master blood pressure log” kept
by the program director. At the final program meeting, blood pressures will be collected
again, and compared to the baseline measurements for all participants.

V. Level 2 -Environmental Objective: By June 1, 2020, 80% of the participants who
fall <138% of the Federal Poverty Level will have access to walking trails and
recreation centers (YMCA).
Method: The Happy Heart, Happy Life program staff will not insert themselves
into building or creating access to walking trails and recreation centers. However, the hope
is that, through enrollment in the program, participants will themselves actively seek out
walking trails and access to recreational areas. To measure this, program staff will provide
a simple questionnaire at the first program meeting, followed by the same questionnaire at
the last program meeting; both questionnaires will ask “Do you currently have access to a
walking trail and/or recreational area whenever you want to use one?”
VI. Level 1 -Process/Administrative Objective: By January 1, 2020, 50 African
American senior citizens who reside in Pima County will be recruited to the
program.
VII. Level 1 - Process/Administrative Objective: By the end of the first program
meeting, all participants will successfully take their own blood pressure.
Method: Through the blood pressure educational demonstration (See Appendix A:
Slide during Blood Pressure Demonstration at First Program Meeting), participants will
be exposed to what is expected of them for the remainder of the program. At the first
meeting, participants will be provided a complimentary stethoscope and blood pressure
cuff due to the program's partnership with the American Heart Association.
VIII. Level 1 -Process/Administrative Objective: By the completion of the first program
meeting, baseline blood pressure tests will be conducted and recorded for all
African American senior citizen participants.

Method: Health Educators will take all program participants blood pressure on the
first meeting of the program, followed by participants taking their own blood pressure.
IX. Level 1 -Process/Administrative Objective: By the completion of the program, to
be considered as reliable impact results and used in program evaluation, African
American senior citizen participants must attend at least 80% of the program
meetings.
Method: Project staff will keep an attendance log for every activity and calculate
each participants total attendance at the completion of the program.
Research was compiled to determine the most effective intervention methods for
the African American senior citizen population. The Happy Heart, Happy Life program
will utilize lectures, demonstrations, health appraisals, and personal improvement logs as
primary intervention methods. The program staff believes that these methods will aid in
achieving the program’s overarching goal to reduce the impact of heart disease in African
American senior citizens over the age of 65. For a more in depth analysis of the Happy
Heart, Happy Life program methods, see the objectives.
Summary: Of the above stated intervention methods, the first program session of Happy
Heart, Happy Life will combine lectures, demonstrations, and personal improvement logs
to give an educational crash course to participants on taking blood pressure. Appendix A:
Slide during Blood Pressure Demonstration at First Program Meeting, is an example of
the type of slide the program staff will use during the demonstration and lecture portion of
the meeting.
Method: On the first meeting of the program, an instructional presentation on how to take
one’s blood pressure will be given to the participants. This presentation will be followed
up by handing out blood pressure cuffs, stethoscopes, journals, and writing utensil to the
participants. The participants will then attempt to take their own blood pressure, using the
presentation for reference and record their results three consecutive times in their journals.
Once they have all recorded their results, program staff will then go around to each
participant and individually take their blood pressure to check for accuracy and record a
baseline blood pressure for everyone. The program staff taking each members blood
pressure is crucial to make sure they are doing it correctly and for evaluation of the
participant’s progress once the program is completed.
Materials:
● 50 Blood pressure cuffs
● 50 Stethoscopes
● 50 journals
● Writing utensils
● Classroom to provide lecture
Program Implementation Plan: (Garret, Riley)

The target population for this program is African American senior citizens who
have heart disease and are looking to reduce the impact it has on their life. It is preferred
that the participants are engaged in the concept and are able to attend the majority of the
events. If there is a surplus of applicants, the 50 who report having more severe heart
disease symptoms and free time will be given priority.
In order to gather the 50 participants for the program, the program director will go
to local churches and ask the pastors to present the information about the program to the
intended population. The program director will give informational flyers (See Appendix B:
Happy Heart, Happy Life Program Flyer).
to the pastor to hand out after services. It is preferred that the pastors provide the
information directly to the desired population because they have a closer relationship with
the members of the church. The developed trust between the pastor and the African
American senior citizens is likely to be effective for recruiting participants as opposed to
the program director presenting the information. The flyer will have the contact
information of the project staff who will give them all the details about getting involved.
Another channel that will be used to recruit participants is the contacting of retirement
homes. The staff working at these homes have a good idea about which members may be
suffering more from heart disease and will provide these individuals with information on
the program.
c. Staffing needs to carry out health education program responsibilities and services
In order to carry out the necessary tasks for this program to be successful, staff will be
hired for different steps of the process. It will initially start out with the project director(s)
who will seek out members to form a planning committee. This planning committee will
have many of the pre-program implementation responsibilities such as conducting a needs
assessment, developing a hypothesis, goals and objectives. In the first year of the program,
the planning committee will also be responsible for reviewing policies and helping with
marketing the program. The project staff will be responsible for tasks that are more aligned
with direct implementation. First they will develop methods and activities that the
participants will take part in. Following the development of these, they will also help
market the program and recruit participants. At the end of year one the project staff will
also help with the pilot test and evaluation. Health educators will be the ones primarily
responsible for the pilot test and the project evaluator for the pilot evaluation.
The Beginning of year two will start with the project staff reviewing and revising the
program based off of the pilot test. They will then continue to recruit participants, if
necessary, and market the program alongside the planning committee. The project staff
will then work alongside the health educators for the phase in portion of the program and
then onto the total implementation. After the conclusion of the program, the project staff
will create the impact evaluation and the project evaluator will develop the evaluation
report. This report will then be distributed by the project director.
d. Facility and equipment needs to fulfill program objectives and services
We reached out to the American Heart Association
Because Healthy Heart, Healthy Life is partnering with churches, the program will provide
a small donation for rental space for program meetings.
Partnering with Frys food market, healthy food options will be provided for all program
participants at every meeting
e. Will there be pilot-testing, phasing in or total implementation? Explain
For the program Happy Heart, Happy Life, total implementation will not immediately
happen. First, one stage of phasing in will be utilized by program staff to have greater
control of the program. Phasing in will have half as many participants (25 instead of 50) to
allow program staff to get acquainted with the population at a smaller scale, and will be
held at a church instead of the YMCA to make participants feel more at ease. If all goes as
planned, phasing in will last for two months before total implementation will occur.
f. Timeline for implementing the program
Program Evaluation Plan
Personnel responsible for the program’s evaluation would be an external evaluator with
the ability to provide unbiased feedback. An example would include a consultant
evaluating a program for African Americans (65+ and older) and reducing risks of heart
disease. The functions would include analyzing the quality of the program and find areas
that need assistance. This can play a key role for the program to be effective for the
community. Additional infrastructure that is put into the neighborhood such as parks and
pathways will be evaluated and assessed by city officials in order to ensure they are up to
code and the by community members in order to measure the practicality of the structures
that are implemented.

For Objective I, the project evaluator will check blood pressure levels with
baseline checks, halfway checks, and checks at the termination of the program of blood
pressure by a community health physician, employed through El Rio Health Center on
behalf of each participant in the program. For objective II and VII, we will evaluate
whether or not the participants have consistently continued to monitor their blood pressure
by collecting and evaluating their log data that was given to them at the start of the
program. This data will be inputted into an online spreadsheet and evaluated by
statisticians and data specialists employed in program in order to ensure accuracy in the
evaluation progress. Objective III, the ability of our participants to demonstrate their
knowledge and skills gained in the program for heart disease management, program
participants will demonstrate the ability to take their own blood pressure, and access to
walking trails and recreation centers with a survey they are able to fill out themselves at
the termination of the program. The survey will be given through google forms where
they will be obligated to fill out their name and information in order to be individualized
and these data will then be evaluated by community health physicians. Objective IV will
be measured and evaluated through the data that are collected during the first session of
the program and the termination of the program. Objective V will be evaluated through
comparing survey results at the beginning and termination of the program. The baseline
blood pressure of participants in the beginning of the program will be compared to the
blood pressure scores throughout and at the end of the program through combining the
physician beginning and finishing blood pressure and the self recorded measurements of
participants throughout in order to evaluate Objective VIII. Lastly, Objective XI will be
evaluated by compiling data from the attendance logs in order to determine the level of
program participation.
Process evaluation: This can examine how well the program or activity being
implemented relates to the program plan. A health program for older African American
citizens regarding health disease, evaluating the method and activities used such as
prevention methods(lectures, physical activities, physical exams) used towards the
population participating in this program.
Impact evaluation: This can examine how it’s affects/impacts towards people
participating in the program. This can include how older African American are making a
change in their life. This can include short term changes such as increased physical
activity, or proof that the targeted population is controlling their health. This can include
lowering of blood pressure based on taking weekly blood pressure.
Outcome Evaluation: This can examine how the program is effective including
long term health changes. Based on the program for African American citizens 65 and
over in Pima County, evaluating the result of the intervention and the health status of the
population. Examples would include an increased percentage of participants completed
the program and the outcome of their health has lowered their chances of getting a
disease.
d. Timeline for the evaluation activities (this timeline may be included in the
implementation timeline)
At level 1 of the program objectives, this will be evaluated by a community member at the
halfway point of the duration of the program plan and at the finale of the program. This is
done by a member of the community in order to limit risk of conflict of interest and is
done at two points in the intervention in order to account for the housing process. Each
month, every participant will have their blood pressure checked by a physician and each
participant will be taught how to check and log their blood pressure weekly in order to
establish a trend. The purpose of evaluating participants once per month with a physician
is to ensure accurate readings as data can possibility skewed if blood pressure is taken
incorrectly in the home. A health professional will evaluate the skills of participants in the
program to reduce risks of heart disease at the termination of the program. They will be
interviewed about their comprehension of the recommendations and steps to take in order
to assess the effectiveness of the education methods used in the program intervention.
This is done at the end of the program in order to ensure that the promotional materials
have been retained in the duration of the study.
Key evaluation tools are the survey by those at the end of the program as well as
community members and staff who are able to accurately track progress of those involved
in the program. A small section of this is included with the program plan (See Appendix
C: Happy Heart, Happy Life Satisfaction Survey).
The audience that will receive the evaluation report is people who are working
within the program such as directors and staff members working in Happy Heart, Happy
Life that is being evaluated.The person who would deliver the report is the program
evaluator and be able to present their findings orally to the program. This can be known as
internal evaluators and external evaluators. In regards to the Happy Heart, Happy Life
program an internal evaluator can be a person such as the program director, since they
work closely with the designated staff and are involved in activities within the program.
An external evaluator can be a person that is new to knowing what the program provides
aside from the program director or staff. Based on the Happy heart, happy life program
this can be an individual who provides experience on a professional level. This evaluator
can be a person in a college/university graduate level, or an evaluator who is apart of a
professional organization such as the American Public Health Association. By providing
feedback from the internal and external evaluators this can determine the program’s
Happy Heart, Happy Life effectiveness for the targeted population being African
Americans 65 and older.
References
Abbott, L., Schluck, G. (2017). Exploring the intervention effect moderators of a
cardiovascular health promotion study among rural African-Americans. Retrieved from
https://onlinelibrary-wiley-com.ezproxy3.library.arizona.edu/doi/full/10.1111/phn.12377
Administration for Community Living. (2015). A Statistical Profile of Older African Americans.
Retrieved from. https://acl.gov/sites/default/files/Aging%20and%20Disability%20in
%20America/Statistical-Profile-Older-African-Ameri.pdf
American Heart Association. (2015). African Americans & Cardiovascular Disease. Retrieved
from https://www.heart.org/idc/groups/heart-
public/@wcm/@sop/@smd/documents/downloadable/ucm_472910.pdf
American Heart Association. (2015). African Americans and Heart Disease, Stroke.
Retrieved from https://www.heart.org/en/health-topics/consumer-healthcare/what-is-
cardiovascular-disease/african-americans-and-heart-disease-stroke
American Heart Association. (2013). Older Americans and Cardiovascular Disease. Retreieved
from https://www.heart.org/idc/groups/heart-
public/@wcm/@sop/@smd/documents/downloadable/ucm_319574.pdf
Bunis, D. (2019, September 12). Numbers of Americans Without Health Insurance Grows.
Retrieved from https://www.aarp.org/health/health-insurance/info-2019/older-americans-
not-insured.htm.
Bureau of Labor Statistics (2012). Pima County Quick Facts. Pima County Arizona (2019).
Retrieved from https://webcms.pima.gov/cms/One.aspx?portalId=169&pageId=161146
Butler-Ajibade, P., Booth, W., Min, D., Burwell, C. (2012). Partnering with the black
church: Recipe for promoting heart health in the stroke belt. ABNF Journal, 23(2), 34-7.
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com.ezproxy4.library.arizona.edu/docview/1017544957?accountid=8360
Edwards, G. (2003). The Cost of Soul Food. Retrieved from
https://www.medscape.com/viewarticle/453335_1
Flack, J., Ferdinand, K. (2007). Epidemiology of Hypertension and Cardiovascular Disease in
African Americans. Retrieved from
https://onlinelibrary.wiley.com/doi/full/10.1111/j.1524-6175.2003.02152.x
Freeman, A., Curran-Everett, D. (2014). How starting a patient education/fitness program can
improve health. Retrieved from https://search-proquest-
com.ezproxy4.library.arizona.edu/docview/1492668973?accountid=8360
Guy-Walls, P., Long, J. (2017). African Americans and Heart Disease. Retrieved from
http://ezproxy.library.arizona.edu/login?url=https://search.ebscohost.com/login.aspx?
direct=true&db=asn&AN=125985617&site=ehost-live
Kennedy, B. M., et al. (2007). Cultural characteristics of African Americans: implications for
the design of trials that target behavior and health promotion programs. Retrieved from
https://www.ncbi.nlm.nih.gov/pubmed/17985512.
Office of Minority Health. (2016). Heart Disease in Minority Health. Retrieved from
https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=19
Kurian, A. (2007). Racial and Ethnic Differences in Cardiovascular Disease Risk Factors.
Retrieved from https://ethndis.org/priorarchives/ethn-17-01-143.pdf
Lee, L. (2018). Nutrition and the African American Diet. Retrieved from
https://www.clintonnc.com/features/lifestyle/27515/nutrition-and-the-african-american-
diet
Parker, S. H. (2014). The practice and process of health education in health promotion.
Dubuque, IA: Kendall Hunt.
Parrill, Rachel & Kennedy, Bernice. (2011). Partnerships for health in the African
American community: moving toward community-based participatory research. Journal
of cultural diversity. 18. 150-4. Retrieved from.
https://www.researchgate.net/publication/221789766_Partnerships_for_health_in_the_Af
rican_American_community_moving_toward_community-based_participatory_research
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Americans: A church based longitudinal intervention project at baseline. Retrieved from
https://www-sciencedirect-
com.ezproxy3.library.arizona.edu/science/article/pii/S1551714414000317
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heart failure disease management programs: the challenges of describing and

synthesizing evidence on complex interventions. Trials, 12, 194. doi:10.1186/1745-6215-
12-194. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3174117/.
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of Hypertension in Older Persons: Focus on African Americans. Retrieved from
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Factors Among Older Black, Mexican‐American, and White Women and Men: An
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Appendices
Appendix A: Slide during Blood Pressure Demonstration at First Program Meeting

Appendix C: Happy Heart, Happy Life Program Flyer

Appendix C: Happy Heart, Happy Life Satisfaction Survey

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Team 2 Program Plan:

Happy Heart, Happy Life

HPS 350 - University of Arizona

December 10, 2019

Table of Contents Page

anxiety/depression spectrum disorders, substance abuse/dependency, injuries/accidents,

locations, preventive, behavioral and sexual health sources.

African American senior citizens in Pima County regardless of residency or duration of

time spent in Pima County.

respectively (American Heart Association, 2015). The Arizona Department of Health

Approximately 4% of African American senior citizens are living in poverty in Pima

Labor Statistics, 2019).

and employment status (U.S. Census Bureau, 2019).

diabetes, a precursor to heart disease. In Pima County, 4% of the elderly African

for African American senior citizens.

Literature Review: (Everyone Needs 2)

disease complications in African American seniors raised severe concern.

account for the amount of disparity that is demonstrated.

In a different intervention, conducted by Butler-ajibade, Booth, Min, and Burwell in

that this is an effective method of program planning and implementation.

person’s disease. In a particular study it examined ways to reduce CVD(cardiovascular disease)

community members, implementing and encouraging already existing community interventions,

Problem Statement: (Maddie)

diagnosed heart disease symptoms will be reduced.

Figure 2: African American Senior Citizens Heart Disease - Problem Map

the Happy Heart, Happy Life program.

Theoretical Framework for the program plan: (Garret)

citizens, a community organization health theory will be implemented. This is an example of a

the program have to engage in the proposed solutions to be successful.

disease inflicts, it is essential for participants to effectively practice the lifestyle

implementation process because it is designed as a community project and has beneficial

program would be beneficial.

Program Description: (Everyone)

participants by emphasizing the importance of healthy blood pressure (non-hypertensive

display blood pressure levels less than 130/80 (non-hypertensive levels).

pressure cuff provided to all participants.

weekly during the past six months.

Log that is provided at the first program meeting.

III. Level 2 -Learning Objective (Skill Development, Knowledge, and Awareness

for reducing the impact of heart disease through a quiz.

again, and compared to the baseline measurements for all participants.

V. Level 2 -Environmental Objective: By June 1, 2020, 80% of the participants who

recreation centers (YMCA).

VI. Level 1 -Process/Administrative Objective: By January 1, 2020, 50 African

VII. Level 1 - Process/Administrative Objective: By the end of the first program

Method: Through the blood pressure educational demonstration (See Appendix A:

meeting, participants will be provided a complimentary stethoscope and blood pressure

VIII. Level 1 -Process/Administrative Objective: By the completion of the first program

African American senior citizen participants.

IX. Level 1 -Process/Administrative Objective: By the completion of the program, to

be considered as reliable impact results and used in program evaluation, African

each participants total attendance at the completion of the program.

Heart, Happy Life program methods, see the objectives.

to give an educational crash course to participants on taking blood pressure. Appendix A:

Slide during Blood Pressure Demonstration at First Program Meeting, is an example of

participant’s progress once the program is completed.

● 50 Blood pressure cuffs

● Classroom to provide lecture

Program Implementation Plan: (Garret, Riley)

disease symptoms and free time will be given priority.

Happy Heart, Happy Life Program Flyer).

American senior citizens is likely to be effective for recruiting participants as opposed to

have many of the pre-program implementation responsibilities such as conducting a needs