Health Promotion-HS 490 Need Assessment Assignment- 100 points

Purpose and Scope

Arthritis is a condition that causes inflammation and pain in a person’s joints. It mostly
affects adults above the age of 40 and can be very painful. According to the CDC, it is the
leading cause of disability in the United States for working adults (Arthritis Related Disabilities,
2021). Osteoarthritis (OA) is the most common form of arthritis and is the wearing down of
cartilage in joints which causes bones to rub together. Not only will this lower the quality of life
for the individual, but since it is the greatest disability in working Americans, it also costs the
economy. Healthy People 2030 has the goal of increasing the proportion of adults with arthritis
who get counseling for physical activity and to increase the proportion of adults who do enough
aerobic physical activity for substantial health benefits. Although prevention studies are rare,
research shows that exercise can be used to reduce the symptoms of OA and may aid in
preventing its onset.

Quality of Life and Social Assessment

Kootenai County in Idaho contains major cities such as Coeur ‘d Alene, Post Falls, and
Hayden. As shown by figure 1, The majority of the residents have at least a high school
education and most have at least some college experience. North Idaho College is located in
CDA which explains the higher rates of education. The median income is $64,936 with around
10% of residents living below the poverty line. Most residents live in the city, but around a
quarter of the residents live in rural areas. There is access to both outdoor and indoor recreational
activities throughout the year. 90% of residents are insured, but those in the age range to work,
18-64, are less insured than those of a retirement age. The majority of residents are Caucasian
with drastically fewer Hispanic, African American, and Asian American residents.

Figure 1
Percentag
e of Averag
Factors   Population e
Race    
  White 90.93%  
  Black 0.27%  
  Asian 0.80%  
  Hispanic or Latino 5.04%  
Area      
  Rural 26.43%  
  Urban 73.57%  
Insurance    
  Uninsured under 65 11.10%  
  Uninsured 9.86%  
$64,93
Median Household Income   6
 Poverty   9.50%  
Physical Fitness Centers Per 100K   16.92
Education    
  No High School Diploma 6.46%  
  High School 27.00%  
  Some College 29.40%  
  Associates Degree 10.60%  
  Bachelors Degree 17.70%  
Graduate or Professional
  Degree 8.80%  

(US Census, 2020) and (Community Needs, 2023)

Epidemiological Assessment

OA is one of the most prevalent conditions that cause disability. According to the
Osteoarthritis Action Alliance (OAAA), 32.5 million adults in the US have OA. Figure 2 shows
that the number of people diagnosed with OA is expected to increase as the population increases
and grows older (OAAA, 2022). Right now, OA has a total cost of $136 billion from lost
earnings and medical expenditures which averages to a direct cost of $11,000 per American per
year. Because it causes sedentary behavior, OA has also comorbidities with other diseases such
as CVD. Having OA increases a person’s chances of mortality from all causes by 55% (OAAA,
2022). OA is harmful not only to the economy, but also to the individual. Pain and stiffness in
the joint are often excruciating and can lead to many other diseases and death. The HP goals of
increasing the number of individuals who participate in regular aerobic exercise and who receive
physical activity counseling for their OA are great goals for reducing the burden on individuals
with OA.
OA is one of the leading causes of disability. According to Sparkmaps, Kootenai County
has a higher rate of disability compared to Idaho and the United States in general (Community
Needs, 2023). According to the public health division of the Bureau of Vital Records and Health
Statistics, Kootenai county’s leading cause of accidental death is also falling which is increased
in populations with OA (Bureau of Vital Records, 2023). Looking into programs that reduce OA
could bring Kootenai’s disability rate down to the national level or lower. There is also a racial
disparity with OA. Hispanic individuals as well as non-Hispanic black individuals are more
likely to develop OA compared to white individuals. According to figure 1, Kootenai county has
a very low minority population. OA prevention efforts should involve working with these groups
to ensure they are also able to benefit from the program.
Figure 2

(OAAA, 2022)

Health Behavior Data

There are several risk factors for developing OA. According to the CDC, they include age,
gender, injury, obesity, genetics, and race (CDC, 2020). Older individuals have less of an ability
for their body to repair and are therefore are more at risk for an overuse injury. Women are more
likely to develop OA as well as blacks and Hispanics. Obesity is a risk factor because an
individual with more mass will have more pressure placed on their joints. Injury can lead to OA
even if it is not directly. Walking unevenly due to pain from an injury can put uneven pressure
on the knee joint. This uneven pressure can wear the cartilage in the area down at an accelerated
rate. Risk factors relating to Kootenai County are displayed in Figure 3. The average age in
Kootenai County is when most people begin to get the symptoms of OA. Exercise for this group
is important before the disease progress far enough to require surgery.
The main method of treatment and management of OA is physical activity. The CDC
recommends both exercise and weight loss for OA (CDC, 2020). Exercise puts force on cartilage
and bone cells which causes them to create new tissue faster. Not only will exercise help increase
connective tissue, it can also aid in weight loss and tissue strengthening. Both of these will
minimize excess stress through the joint and reduce injury.

Figure 3
Factors   Percentage Average
40.4
Age   years
<18
  years 22.60%  
 18-65
  years 57.90%  
>65
  years 19.50%  
Sex      
  Male 49.80%  
  Female 50.20%  
Obesity   29.50%  
Inactivity   19.10%  
(US Census 2020) and (Community Needs 2023)

Environmental Data

The two most important environmental factors for Kootenai County are the economic
environment and the physical environment. As shown in Figure 1, Kootenai has many more
gyms than Idaho and the US in general compared to its population. It also has many parks in
town and outdoor areas outside of town. The figure also shows that 10% of residents live below
the poverty line. Although there are gyms, they are usually expensive and require long contracts
for reduced rates. Also, the parks are in town, but many would be difficult to get to by walking.
Residents need to drive for most of the activities in Kootenai County. Stores, parks, and housing
are often spread out and many busy streets make walking and biking dangerous. I would like to
obtain more information on how many residents own cars and can pay for gas. I also want to
know how many can afford a gym membership or feel they have the time to exercise after work.
I could find answers to these questions with a survey which would reach the most people.

Identifying the Program Purpose

In their article titled “Health promotion: The Impact of Beliefs of Health Benefits, Social
Relations and Enjoyment on Exercise Continuation,” Nielsen et al. look at 28 middle-aged and
elderly men and divided them into either a group that played football on a team and ones that
preformed spinning or CrossFit on their own. They found that exercise involving a team made
participants more likely to continue compared to the perception the exercise would make them
healthier (Nielsen et al., 2014). The article shows that a sense of community can be much more
powerful than informing a population of the benefits of exercise. Interventions that involve the
community will be longer lasting than simply raising awareness of the risks and outcomes.
Another article from Dolor et al. looked at the perceptions of both physicians and patients
of weight loss and physical activity. With nearly 600 patients, they found patients had high
expectations of weight loss. They expected to cause the weight loss through an increase in
physical activity and few were comfortable with changing their nutrition (Dolor et al., 2010).
Because obesity is a risk factor for OA, the article shows that exercise may be an easier change
for individuals to make in order to lower their body fat compared to a change in diet. The
increased motivation for exercise combined with a mode of exercise that involves a community
will keep participants continuing with the program.
I would want to utilize a focus group to discover the knowledge and attitudes residents of
Kootenai County have toward exercise and increasing the safety of bike and walking paths in
their cities. The previous article from Nielsen et al. shows the importance of the community. I
want to have community specific questions and concerns while also learning their exercise
beliefs. At one of the meetings, I would also want to see representation for racial minorities in
the community to ensure the project also benefits them. This collection type would reach fewer
people and be time consuming, but the answers will have the detail required for the project.
Creating more parks in the city that residents can reach by bike or foot as well as paths
to those locations will encourage increased physical activity. Not only will the parks create a
space for activity, but the travel to the location can be more active. Jobs that give employees
discounts for local gyms would also enable people to increase planned exercise. An increase in
the sense of community as well as a decrease in body fat as well as improvement in health
markers and OA symptoms are reinforcing factors for continued participation.

Validating Needs and Conclusion

Increasing Kootenai County’s physical activity will help to improve health and reduce the
onset of OA. Many of the spaces for exercise are already built, so the first step is to create safe
paths for people to travel to them. Without paths, economically disadvantaged residents who do
not have access to transportation will be blocked from many areas for physical activity. Once
paths are created, encouraging businesses to provide employees with discounts to gyms will
allow people to choose the mode of exercise that they enjoy most. Having exercise they find
rewarding and building a sense of community with events at local parks will keep people
motivated and allow them to receive the health benefits.

Assessment Team

Women and racial minorities are the most at risk for developing OA and therefore should
be involved in the project. Additionally, those below the poverty line as well as people who work
physically demanding jobs need to be considered. Focus groups to discuss issues they face
should meet later in the evening to avoid conflicting with work and family. There should also be
meetings throughout Kootenai county, so participants have less distance to travel. This project
will need the support of the community and lawmakers in order to pay for and oversee building
projects for bike lanes and sidewalks. Additionally, business owners will be needed in order for
employees to receive discounts. With these stakeholder’s help, we can help to encourage the
people of Kootenai County to increase their aerobic exercise, and increase the number of people
with OA who participate in physical activity.

References

1. Bureau of Vital Records and Health Statistics . (2023, February). Idaho Vital Statistics:
Mortality 2021. Idaho Department of Health and Welfare. Retrieved March 10, 2023, from
https://publicdocuments.dhw.idaho.gov/WebLink/DocView.aspx?
id=25158&dbid=0&repo=PUBLIC-DOCUMENTS&cr=1

2. CDC. (2021, October 12). Arthritis Related Disabilities and Limitations. Centers for Disease
Control and Prevention. Retrieved February 10, 2023, from
https://www.cdc.gov/arthritis/data_statistics/disabilities-limitations.htm#:~:text=Arthritis
%20affects%20a%20person's%20overall,work%20disability%20among%20US%20adults.
3. CDC. (2020, July 27). Osteoarthritis (OA). Centers for Disease Control and Prevention.
Retrieved March 10, 2023, from https://www.cdc.gov/arthritis/basics/osteoarthritis.htm

4. Community Needs Assessment. SparkMap. (2023, February 9). Retrieved March 10, 2023,
from https://sparkmap.org/report/?REPORT=%7B%22name%22%3A
%22Standard+Report%22%2C%22style%22%3A%22sparkmap-free%22%2C
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%22countylist%22%3Afalse%2C%22statelist%22%3Atrue%2C%22ziplist%22%3Afalse
%2C%22tractlist%22%3Afalse%2C%22map%22%3Atrue%2C%22breakout%22%3Atrue
%7D%2C%22indicator%22%3A
%5B0%2C1%2C2%2C3%2C4%2C6%2C9%2C12%2C18%2C19%2C43%2C44%2C52%
2C54%2C62%2C67%2C73%2C75%2C77%2C78%2C80%2C128%2C146%2C161%2C2
27%2C234%2C290%2C292%5D%2C%22location%22%3A%7B%22type%22%3A
%22county%22%2C%22show_county%22%3Atrue%2C%22show_state%22%3Atrue
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%22county%22%2C%22id%22%3A%5B%2216055%22%5D%2C%22name%22%3A
%5B%22Kootenai+County%2C+ID%22%5D%7D%7D

5. Dolor, R. J., Østbye, T., Lyna, P., Coffman, C. J., Alexander, S. C., Tulsky, J. A., Brouwer, R.
J., Esoimeme, I., & Pollak, K. I. (2010). What are physicians' and patients' beliefs about
diet, weight, exercise, and smoking cessation counseling? Preventive Medicine, 51(5),
440–442. https://doi.org/10.1016/j.ypmed.2010.07.023

6. Nielsen, G., Wikman, J.M., Jensen, C.J., Schmidt, J.F., Gliemann, L. and Andersen, T.R.
(2014), Football as health promotion. Scand J Med Sci Sports, 24: 66-75. https://doi-
org.uidaho.idm.oclc.org/10.1111/sms.12275

7. OAAA. (2022, October 12). OA Prevalence and Burden. Osteoarthritis Action Alliance.
Retrieved March 8, 2023, from https://oaaction.unc.edu/oa-module/oa-prevalence-and-
burden/

8. U.S. Census Bureau quickfacts: Kootenai County, Idaho. The United States Census Bureau.
(2020). Retrieved March 10, 2023, from
https://www.census.gov/quickfacts/fact/table/kootenaicountyidaho/PST045221