General Anxiety Disorder

General Anxiety Disorder

Arnold School of Public Health, University of South Carolina

HPEB 300 Section 03

REDACTED, Erin Finnegan, REDACTED, REDACTED, & REDACTED

General Anxiety Disorder
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SOCIAL ASSESSMENT
Health Problem
Mental health is a topic that has been brought to the forefront of conversation in recent
years. According to the National Institute of Mental Health, approximately one in five
Americans are living with a mental health issue, with severity ranging from mild to severe
(National Institute of Mental Health [NIMH], n.d.). Generalized anxiety disorder (GAD) is a
common mental health issue in the United States, with approximately 6.8 million adults being
affected by the disorder each year (Anxiety and Depression Association of America [ADAA],
n.d.). This mental health issue is characterized by persistent worry pertaining to various facets of
life, and may or may not include finance, family, career, and relationship distress. Generalized
anxiety disorder is not to be confused with normal symptoms of anxiousness; people who are
dealing with GAD are said to experience symptoms such as excessive worry, insomnia,
irritability, difficulty concentrating, muscle tension, fatigue, and/or gastrointestinal issues more
days than not within the last six months (ADAA, n.d.). It is the persistence of these symptoms
that enable a diagnosis to be made. GAD onset can occur during any stage of life but is most
common during early adulthood (Stein & Sareen, 2015).
Quality of Life Indicator
Generalized anxiety disorder tends to go unrecognized, and many individuals may go
years before seeking treatment. Patients often present with physical symptoms such as headaches
or stomach issues, which are afflictions associated with the illness (Stein & Sareen, 2015). The
physical manifestations of GAD may interfere with day-to-day activity. People experiencing this
issue often face difficulty concentrating and inability to sleep, which inhibits productivity.
Further, comorbidities of the illness include physical symptoms, major depression, substance
abuse, and other mental health issues (Stein & Sareen, 2015). The association between
generalized anxiety disorder and physical comorbidities is relevant; there is evidence to suggest
that physical illnesses may lead to the onset of GAD, and the mental health disorder itself can
lead to the onset of physical illnesses (Sareen et al., 2006). Oftentimes, individuals suffering
from this anxiety disorder may use alcohol or other drugs to self-medicate, which has shown an
increase in the likelihood of developing a dependence to these substances (Robinson et al.,
2011). Finally, persons with GAD are more likely to self-harm or to commit suicide (Chartrand
et al., 2011). The comorbidities of generalized anxiety disorder demonstrate the ability for the
disease to interfere with multiple aspects of daily activity, therefore reducing the overall quality
of life for the individual experiencing the illness.
Primary Target Population
There is a very large number of people who may believe that anxiety is a normal response
to everyday stress. There are over 15% of adults that have experienced symptoms of anxiety that
either fit into the mild, moderate or severe categories (Terlizzi & Villarroel, 2020). Mental health
plays a large role in most people's lives whether we know it or not. Some people though, are
more likely to face generalized anxiety disorder rather than others. Anxiety disorders decrease
with age, starting with 19.5% for adults ages 18-29, 16.6% for adults that are within the ages of
30-44 years of age, and 15.2% among adults that are above the ages of 45 (Terlizzi & Villaroel,
2020). Females are more likely to experience symptoms of anxiety rather than men.
Approximately 19% of women—whether it was mild, moderate, or severe—have reported
symptoms of anxiety (Terlizzi & Villaroel, 2020). On the other hand, only 11.9% of men have
reported anxiety disorder symptoms (Terlizzi & Villaroel, 2020). Many people feel anxious or
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nervous when facing problems at work, school, etc. With that being said, our primary target
population will be females (all races) ages 18-25.
The Setting of Focus
It is very important to look into the specific regions where people are affected most by
generalized anxiety disorder in the United States. While there was not specific data regarding the
mental health disorder itself, there is evidence showing the highest and lowest rates of symptoms
of anxiety in each state. The data demonstrates that symptoms of anxiety are more common or
frequent in states in the south as opposed to states in the north (Centers for Disease Control and
Prevention [CDC], n.d.). According to the CDC (n.d.), states such as Florida, Georgia, South
Carolina and Alabama have some of the highest rates regarding symptoms of anxiety, with
Florida being at 29.4%, Georgia with 28.5%, South Carolina with 27.1%, and Alabama with the
highest at 33% of the population experiencing these issues. States in the north, such as Illinois,
Indiana, and Missouri, have some of the lower rates, with anxiety symptoms in Illinois falling at
26.5%, Indiana’s falling at 26.7%, and Missouri’s falling at 26.9% (CDC, n.d.). South Carolina
does not generally have the highest rates of anxiety symptoms; however, there is evidence of
anxiety symptoms being a significant concern in the state, leading us to choose this geographic
location for our setting of focus. As mentioned before, females have a higher rate of generalized
anxiety disorders with a rate of 19% as opposed to men, who have a percentage of 11.9%
(Terlizzi & Vilaroel, 2020). Based on this information—and our presence in Columbia, South
Carolina—we will be addressing generalized anxiety disorder rates with females ages 18-29 for
our target population in Columbia, South Carolina.

Key Stakeholders and Relationship with Program Planners

1. Health Education Specialists: It is important to have Health Education specialists as a
key stakeholder group to help create and implement an effective program to best target
our target population by using information gathered from research and other key
stakeholders.
2. South Carolina Department of Health and Environmental Control (DHEC)
representative: It is important to have a DHEC representative as a key stakeholder
because DHEC is the precedent setting/guiding governmental agency over the health and
wellbeing of residents in South Carolina.
3. USC University President, Michael Amiridis: It is important for the University
President to be a key stakeholder because he should have the best interest in his students'
well being, many of which are a part of our target demographic in Columbia, SC. He is
also a valuable resource when dealing with students because he has built relationships
with many student-community leaders that influence large proportions of the student
population.
4. Richland County School District One Representative: Within our specific age
demographic, there are many female students that are within this school district that are
affected by GAD. Having a representative of their schooling environment is important
because many 18 year olds spend eight hours actually in school as well as multiple
outside doing extracurriculars, homework, etc. that may impact their GAD.
5. Richland County School District Two Representative: With the same reasoning as
above, it is almost important to note that the 18 year old piece of our demographic grows
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into the 19-25 year old portion of our demographic, so acknowledging GAD in their lives
from as early as possible is important for our perception of the disorder.
6. USC Student Health Services (SHS) Counseling & Psychiatry representative: It is
important to have a representative from the department where many women with our
target demographic receive counseling and psychiatric care to learn about their methods
of treatment, what is effective, and what is not based on our target population.
7. USC SHS Women’s Health Physician/Nurse: As previously mentioned, it is important
to have a representative from where our target population receives care, specifically
Women’s health because multiple factors from women’s health can influence psychiatric
disorders and needs.
8. Female 18-25 years old not diagnosed with GAD living in Columbia, SC: It is
important to have a student from South Carolina without GAD as a stakeholder to be able
to represent the target population. Having a stakeholder that does not have the target
disorder will provide information regarding behaviors that should be addressed.
9. Female 18-25 years old diagnosed with severe GAD living in Columbia, SC: As
aforementioned, the target population being represented is crucial. With there being
multiple levels of severity for GAD having a representative of each will provide insight
into different behaviors that need to be identified and prioritized.
10. Female 18-25 years old diagnosed with moderate GAD living in Columbia, SC: As
aforementioned, the target population being represented is crucial. With there being
multiple levels of severity for GAD having a representative of each will provide insight
into different behaviors that need to be identified and prioritized.
11. Female 18-25 years old diagnosed with mild GAD living in Columbia, SC: As
aforementioned, the target population being represented is crucial. With there being
multiple levels of severity for GAD having a representative of each will provide insight
into different behaviors that need to be identified and prioritized.
12. Relatives of a female 18-25 years old who died from GAD: GAD is a disorder that has
many common comorbidities with other psychiatric disorders, which may lead to suicidal
thoughts or suicide (Nutt, et. al.). Having relatives of a victim of suicide within our target
population is imperative to learning about signs and behaviors that were expressed prior
to the event.
EPIDEMIOLOGICAL ASSESSMENT
Possible behaviors that Possible environmental Biological and other
contribute to the health factors that contribute to the factors that contribute to
problem health problem the health problem

● Excessive use of ● Low income ● Having

alcohol/substances (socioeconomic status) comorbidities such
(Adinolfi, 2022). can increase symptoms as Major Depressive
of GAD as it is a Disorder (MDD),
common worry (Johns Social Anxiety
Hopkins, 2023). Disorder (SAD),
● Not exercising/
Post-Traumatic
performing physical
Stress Disorder
activity
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(Henriksson, et. al., ● Lack of health (PTSD), sleep

2022). insurance increases disorders, etc. (Nutt,
symptoms due to et. al, 2006).
medications prescribed
not being covered
● Lacking coping
(NIH)
mechanisms
(Graves, et. al.,
2021).

Behavioral Factors
Noticing behavioral factors that can put an individual at risk or increase anxiety is
important to help control the symptoms. Exercise is an important behavior factor that can help
reduce anxiety symptoms. It’s shown that people diagnosed with generalized anxiety disorder
tend to be more sedentary (Harvard Health, 2019). Being inactive triggers anxiety to worsen
which is why it’s essential to engage in physical activity. Aerobic exercise is shown to be the
most helpful (Havard Health, 2019). According to Havard Health, studies have shown people
who are diagnosed with anxiety disorder that engage in high level physical activity are better
protected against developing anxiety symptoms. Those who are diagnosed with anxiety disorder
might rely on alcohol for a temporary pain reliever. Consuming an excessive amount of alcohol
or substances will trigger symptoms. Alcohol can also develop new anxiety symptoms, serious
distress, and induce panic (American Addiction, 2022). Moreover, the more alcohol that is
consumed then they are at higher risk of becoming dependent on alcohol. Changing these
behaviors of developing healthier coping mechanisms will ensure lower anxiety symptoms and
better control when individuals start to feel anxious. This will make day to day activities easier
each day for them.
Environmental Factors
There are many environmental risk factors that contribute to an increase of generalized
anxiety disorder. It’s important to be conscious of these risk factors to help find solutions to help
those individuals with generalized anxiety disorder. Socioeconomic status is a major risk factor
in regards to generalized anxiety disorder. In Richland County 43% of the population lives in a
single parent household (Fred,2021). Living in a single parent household might bring problems
with conflicts between parents, custody problems, health issues, etc. This will add stress to the
children which could spark a lot of anxiety in their lives. Richland County also struggles with
individuals having access to healthcare. About 11.3% of individuals living in Richland County
don’t have health insurance (RFA,2019). An individual with GAD who doesn’t have health
insurance is at a higher risk of severe symptoms. Individuals who lack health insurance would
have less access to medication and various therapies. A population that’s at a high risk due to
their environment are young adults. This specific population is at a high risk because they are
starting college and it’s their first time branching off from their parents' help. They are at a point
in their life where they need to experience adult roles which are stressful at first.
Biological Factors
Although there is limited data there are still biological factors that may contribute to the
development of general anxiety disorder (GAD). For this population, the most prevalent
biological risk factors are gender and age. The General Anxiety Disorder-7 (GAD-7)
General Anxiety Disorder
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questionnaire is used to screen for and follow up with patients with GAD (Nunes et al., 2022).
Higher GAD-7 scores and levels of anxiety are associated with females and younger ages (Nunes
et al., 2022). Younger females are considered one of the more at-risk groups due to the different
hormonal changes they go through compared to men. Race can be correlated to GAD but there is
not enough data to consider it a causation. Hispanics were found to have higher GAD-7 scores
while blacks were found to have lower GAD-7 scores (Nunes et al., 2022).
Priority Analysis Matrix More Important Less Important

More Changeable 1. Lack of exercise 1. High alcohol

consumption
Usually newly adapted

Less Changeable 1. Low socioeconomic 1. Having a single parent

status household
Usually more culturally ingrained 2. Not having health 2. Gender
insurance 3. Age
4. Race

Focus
Based on the research that has been done and the priority analysis matrix, the behavioral
factor that is the focus for preventing GAD is lack of exercise. The focus is to increase exercise
in females 18-25 years old, the population most affected by GAD in Richland County, South
Carolina. People with anxiety are shown to be more sedentary and aerobic exercise is shown to
be most helpful in lessening symptoms of anxiety (Harvard Health, 2019).
EDUCATIONAL AND ECOLOGICAL ASSESSMENT
The Educational and Ecological assessment can be found in Appendix A. There are
many different predisposing, enabling, and reinforcing factors that make for a high prevalence in
the rates of general anxiety disorders within a certain population. But, we will be focusing on
specific ones for each.
A predisposing factor can enable a person to believe or not believe the factor that is
happening before they even try it. When you have anxiety, exercise is not something you
generally want to participate in, however once you get the motivation to start, you will see it
really helps. The lack of knowledge that exercise can help ease or reduce symptoms of anxiety is
hard for one to believe if it does not work automatically. People are unaware about how much
exercise can benefit you. With that being said, people do not turn to exercising to reduce
symptoms because they do not give it a try. Doing 30 minutes of exercise only about 1 to 3 times
a week can reduce anxiety symptoms tremendously (Mayo Clinic, n.d.). This factor is important
in that if we educate people on the outcome of exercising and reduce anxiety symptoms people
are more likely to participate in them. Increasing information will be beneficial in women
increasing their exercise.
While exercise has anxiolytic effects, many people with anxiety related disorders or GAD
struggle to exercise due to a number of barriers both literal and perceived. This is an enabling
factor when it comes to educating women about exercise because studies have shown that
women have given examples of barriers to exercising that include ideas of embarrassing
themselves, being uncomfortable in the setting, pain induced by exercise, not having access to
“proper” equipment, becoming “bulky” or masculine-looking if they start exercising, avoiding
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exercise entirely, etc. (Mason, 2018). There are also multiple physical factors that could be
potential “scare” factors for women when performing physical activity like the fact that women
are 3 times more likely to tear their anterior cruciate ligament than men (U.S. Department of
Health & Human Services, n.d.).
Last but not least, a reinforcing factor takes place after the behavior. Feeling healthy
despite not engaging in physical activity is a reinforcing factor. When people believe there is
nothing wrong with them they more than likely will not engage in physical activity. Especially if
they are able to manage their anxiety symptoms in another healthy way they aren’t going to
bother trying to create another habit. Around two thirds of American adults do not engage in
physical activity because they are considered healthy (CDC, n.d). The reinforcing factor is within
this group who choose not to participate in physical activity, who believe that it would be
unnecessary. Therefore, we need to educate people more on the benefits of exercise and how
beneficial it is especially with those diagnosed with generalized anxiety disorder. We can teach
them this is another amazing way to help reduce anxiety symptoms.

PPP 2 START
Health Problem and Target Population
The health problem within the target population of females 18-25 years old in Richland County,
South Carolina is generalized anxiety disorder.
Mission Statement
Our mission is to provide effective support, education, and resources to individuals living with
generalized anxiety disorder. We are committed to promoting awareness and understanding GAD
in the community around us and advocating for access to quality mental health care.
Program Goals
To increase the number of females aged 18-25 years old in Richland County, South Carolina who
use physical activity as a method to reduce symptoms associated with GAD.
Process Objectives
● By October 31st, 2023, program planners will determine a location to hold GAD support
group meetings.
● Until March 1st, 2024, program planners will use at least 3 communication channels to
boost the GAD support group, including sharing social media posts, talking to other
mental health facilities, and attending local health fairs.
Impact/Learning Objectives
● After the eight weekly support group meetings are completed, participants will be able to
identify two methods of physical activity that they can use to reduce their levels of
anxiety, as reported on the end-of-session survey.
● In the end-of-session survey given at the eigtth and final support group meeting, at least
80% of participants will report at least one benefit of physical activity in reducing anxiety
symptoms.
Behavioral Objectives
● At least 80% of support group participants will bring one family member or friend to at
least one group meeting to serve as an accountability buddy.
● At least 80% of participants will attend at minimum 6 out of the 8 weekly support group
meetings.
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● At least 75% of participants will engage in physical activity as a method to cope with
symptoms of GAD at least 3 times a week for 30 minutes each throughout the duration of
the program.
Outcome Objective
● During July 1st, 2023, to June 30th, 2027, reported symptoms of anxiety among females
(all races) ages 18-25 in Richland County, South Carolina will decrease by 10% as
reported by the Richland County Health Department’s Community Health Assessment.
Theoretical Basis
To effectively educate the target population as to why exercise is a suitable means of
controlling GAD symptoms, they must first understand what could be prohibiting them from
taking action. The Theory of Planned Behavior is most suited for this program because it
addresses behavioral intention, attitude, subjective norm, and perceived behavioral control which
can help individuals address and combat barriers to beneficial actions.
The Theory of Planned Behavior is an extension of the Theory of Reasoned Action that
was developed in 1980 and used to determine the likelihood a person would perform a behavior
(Boston University School of Public Health (BUSPH)). The Theory of Reasoned Action assesses
the relationship between behaviors, attitudes, and intentions. The Theory of Reasoned Action
initially assumed that behavioral intention can be influenced by an individual’s attitude toward
the behavior and by beliefs of people around the individual who approve or disapprove of the
behavior (this is known as subjective norms). The Theory of Planned Behavior takes this
analysis a step further by including perceived behavioral control. Perceived behavioral control is
a construct that a person has surrounding their ability to control a specific behavior. This added
aspect argues that an individual will be more likely to perform a behavior if they feel they can
exert control over the action(s). Attitude is the factor used to predict and determine the
individual’s evaluation of the behavior either in a favorable or unfavorable light (BUSPH).
Behavioral intention is the motivation to perform a behavior that is influenced by the intention to
actually perform the behavior (BUSPH). The stronger the intention, the stronger the desire to
perform the action.
A study with our specific target population using the Theory of Planned Behavior (TPB)
could not be found, but a similar study that used TPB where there was a control group and an
exercise group made up of men and women with the average age of 67.5 years old for men and
66 years old for women. The study was performed to determine which factors specifically
affected the performance of exercise. The study determined that “feeling better after exercise”
was the main contributor to continuing the behavior. Using TPB the study resulted in an 85.5%
success rate in the completion of the 12-week exercise program (Ahmad, M.H., etc.).
Overall, the Theory of Planned Behavior is beneficial for our study because it can be used
to predict and explain behaviors of participants regarding generalized anxiety disorder and using
exercise as a means of treatment. The study mentioned above and others like it are reasoning
enough that this theory works for projects similar to ours with similar target populations and
anticipated outcomes.
Figure 2. Diagram of the Theory of Planned Behavior Model for Richland County’s Physical
Activity for Women with Anxiety Program (PAWAP).
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Objective Theory – Intervention Possible

Type construct Strategy Activities

Learning TPB Health Education ● Provide a support

Attitude Toward group to talk about
Behavior Health anxiety and ways to
Communication reduce it
● Promote support
group on social
media, through
mental health
facilities, and local
health fairs
● Completion of
pre-assessment to
measure level of
anxiety

Environment TPB Health ● Provide

Subjective Norms Communication opportunities for
physical activity
within the
community, group
walks, yoga, etc.
● Encourage bringing
a family member
who has also
suffered from
anxiety to support
group

Behavioral TPB Health Education ● Engaging in 30

Perceived minutes of physical
Behavioral activity
Control ● Encourage
participants to
attend 5 of 6 support
group meetings
● Completion of post
assessment to
measure reduction
in anxiety

PPP 3 START
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Health Problem, Target Population, and Setting

The health problem within the target population of females 18-25 years old in Richland County,
South Carolina is generalized anxiety disorder.
Resources
To plan, implement, and evaluate a program to address generalized anxiety disorder in
the target population of females 18-25 years old in Richland County, South Carolina, a range of
resources will be required. Personnel will include a program manager, program coordinator, a
licensed mental health professional, program facilitators, and trained volunteers to assist with
administrative tasks and outreach. The program manager will be required to hold at least a
master’s degree in a health promotion-related field, as well as have at least 2 years of work
experience overseeing a health promotion program. The program coordinator will be required to
have at least a bachelor’s degree in health promotion, education, and behavior, and have at least
1 year of background experience working with a health promotion program. Requirements for
the licensed mental health professional will include specialization or experience with anxiety
disorders as well as holding a valid LPC license in the state of South Carolina; preference will be
given to counselor’s that have experience working with young adult women. Finally, the program
facilitators must be certified health education specialists (CHES), and volunteers for the program
will likely be graduate or undergraduate students from the University of South Carolina who are
obtaining a degree in public health, a social science, or in another related field.
Space requirements will include private rooms or offices for staff, meeting rooms for
group support group sessions, and access to community spaces for outreach events and mental
health screenings. Equipment needs will include computers and software for record-keeping and
data management, audio-visual equipment for presentations and educational materials, and
therapeutic resources such as stress balls, guided meditation audio recordings, and relaxation
exercises. Supplies needed may include office supplies such as paper, pens, and folders; we will
also require printed educational materials such as brochures, pamphlets, handouts and
worksheets for support group sessions, as well as the pre-existing curriculum that we will
purchase and develop to fit with our priority population’s needs.
Funding for the program may come from various sources, including government or
private grants, individual or organizational donations, fees for services provided, or a
combination of these methods. The specific funding strategy will depend on the goals and scope
of the program, as well as the available resources and financial needs. All of this information will
need to be included in the budget form when planning and implementing the program to address
generalized anxiety disorder in females 18-25 years old in Richland County, South Carolina.
We are requesting $250,000 from the HPEB 300 Public Health Fund to fund a two-year
grant for the Physical Activity for Women with Anxiety Program [PAWAP].
Implementation Plan
Our program will utilize the necessary funding and resources in order to create a GAD
support group that focuses specifically on physical activity as a treatment method to reduce
symptoms of anxiety. To do this, the support groups will include informational sessions that
include sharing types of physical activity participants can engage in, the benefits of physical
activity for anxiety symptoms, and discussion of possible barriers to physical activity among
support group members.
To ensure that our processes meet the needs of the priority population, we will meet with
stakeholders 2 times a month for the first three months of the program. This will allow us the
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opportunity to mold our support group curriculum to the ways in which stakeholders believe it
will be most beneficial for our priority population. Each of the meetings will be 1 hour and 15
minutes in duration.
Hiring of the program manager program coordinator will begin alongside the start of the
program. The first three months of the program will involve hiring and training the program
manager and program coordinator. The program manager will be responsible ensuring the
effectiveness of the program by overseeing all aspects including stakeholder collaboration,
program development, scheduling, implementation, and evaluation of outcomes; the program
coordinator will be responsible for the intervention program itself by being involved in the
recruitment of participants, the implementation of the program, budgeting, and gathering
necessary data. These individuals will work together to ensure that the program is completed
effectively and efficiently, and that it is adjusted when necessary.
We plan on recruiting 2 support group facilitators from within our organization as well as
a mental health counselor from the University of South Carolina. In order to help save money
from our program budget, training of these individuals will occur within the organization. The
responsibility of these members will be to facilitate our pilot-test support group sessions as well
as our intervention group sessions. Their responsibilities will include disseminating information
regarding physical activity and anxiety treatment, distributing and collecting pre- and post-
program surveys, and establishing a comfortable environment for participants. During a
three-month period prior to the pilot-test of the support group, these individuals will be trained to
lead the support group sessions together based on the established curriculum.
Members from within our organization as well as volunteer research students from the
University of South Carolina will help to fulfill administrative roles associated with data
organization, budget management, support group promotion, and day-to-day tasks.
Once all key members involved in the execution of the support group are trained, a pilot
support group program will take place with a small group of individuals from the priority
population. This pilot-program will last 4 weeks of the program and will take place in the months
of December. Conducting our program during winter months, where physical activity may be
reduced and co-morbidities of GAD may worsen anxiety symptoms, will allow us to properly
assess whether the implementation of physical activity as a method to treat anxiety is effective in
our priority population.
Following the conclusion of our pilot-test, the program will be modified in order to
correct potential barriers, challenges, and shortcomings that were found during pilot-testing.
Modification of the program will be followed by the first full-implementation in the support
group sessions for the priority population. This will last 8 weeks and data will be collected and
evaluated during the duration of the sessions.
Conclusion of the first round of support group sessions will allow data collected from the
participants to be analyzed in order to assess areas for program improvement. It will also allow
us to determine whether the program is moving towards the goals and objectives that have been
established. The data analysis will be followed by stakeholder meetings to initiate and determine
appropriate modifications to be made to the program curriculum as well as our individual
processes for recruiting participants, training personnel, and gathering data.
Year 2 of the program is relatively similar to year 1, but it will begin by re-training the
support group facilitators and the University of South Carolina mental health counselor. This
period of training will ensure that the leaders of our support group are updated properly on
changes in the program curriculum as well as the meeting processes. While facilitators are being
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trained, marketing will begin to recruit members of our target population: females (all races) that
are 18-25 years old from Richland County, South Carolina who suffer from symptoms of
generalized anxiety disorder. While we are basing the curriculum off of treating generalized
anxiety disorder, we do not require that participants be already diagnosed; they must fall within
the target population and be experiencing symptoms of generalized anxiety disorder, such as
excessive worry, insomnia, or physical symptoms related to excessive worrying.
Conclusion of the second round of support sessions will be followed by data analysis, as
well as the development and distribution of a data report on the results of the program. A more
detailed program timeline can be found in Appendix A.
Marketing Plan
The target population of the program is females 18-25 years old in Richland County,
South Carolina who may be experiencing symptoms of anxiety. This is important to keep in mind
especially with marketing strategies as age, gender, socioeconomic status, race, and social norms
may impact how they receive information on a daily basis. The 18-25 year old age group can be
classified as Generation Z being born between 1997 and 2012 and is a generation filled with
digital natives because they have never known a world without internet, television, cell phones,
etc (Munsch, 2021). Because Generation Z has been exposed to technology from such a young
age, their attention is difficult to grasp when it comes to digital media marketing and getting the
loyalty of them is even more difficult (Munsch, 2021).
In a study performed by the Pew Research Center, following social media are used by
growing percentages of Gen Zers; 67% of Gen Z in the study use Tiktok and 62% use Instagram.
Other than YouTube, these were the social media platforms with the highest use and largest
increase from 2014-15 when the Pew Research Center initially collected data regarding social
media use (Atske, 2022). For that reason one of our marketing strategies would be to create a
Tiktok and Instagram account for our program and recruitment. We would use tiktok to create
not only video content with trending video styles and generate interest in the program by
specifically using hashtags to hopefully boost the chances of being shown on 18-25 year old
females in Richland County’s “‘for you pages''”. This, as well as an Instagram presence showing
behind the scenes, planning phases, and getting to know the staff and volunteers working
throughout the program to build online relationship with our audience will not only be used to
advertise to our specific target population, but also build trust with a topic such as Generalized
Anxiety Disorder which may be limited by stigmatization with the communities we are targeting.
Another method to recruit participants that we are planning on using is tabling at
universities within Richland County, South Carolina. The campuses we plan on tabling at include
University of South Carolina-Columbia, Columbia International University, Benedict College,
and Midlands Technical College. These four institutions will provide a diverse group of females
within the target age range whether undergraduate or graduate students if recruitment is
successful. Tabling is also often a free or low cost project where we can provide our own table or
students of each university can request space if they want to volunteer with our program. These
tabling events will take place in August of each year of our timeline. This is ideal because
students will be returning to their respective campus to begin classes and will likely be the most
active on campus during this month.
We also plan on providing incentives for participation in the program. Along with
providing fliers describing the program in layman’s terms including information like what the
program entails, what our focus is, and contact information as we are tabling at the universities
and colleges listed above, this includes having sensory items like stress balls at the initial tabling
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events and then also offering gift cards of a specific dollar amount that has not yet been decided
at the completion of the program.
Budget
The Budget Form for Years 1 and 2 of the program can be found in Appendix B.
Evaluation Plan
The Evaluation Plan contains a detailed breakdown of objectives throughout our program
including how each objective will be measured and where data for each objective will be
collected from. The Evaluation Plan can be found in Appendix C.
General Anxiety Disorder
Appendix A
Factor Type Factor
Predisposing 1. Thinking that engaging in
physical activity will make
a female look “masculine”
2. Lack of knowledge that
physical activity improves
symptoms of anxiety
Enabling 1. Not having the skills to
safely participate in
exercise activities.
2. The people around the
person with GAD attempt
to avoid confrontation and
make “accommodations”
that are not beneficial to
the person with GAD.
14
Explanation of relationship with
behavior
1. A common societal view,
especially for women, is
that engaging in physical
activity may cause the
individual to look “buff” or
“masculine”. This
perspective on physical
activity may deter some
women from engaging in
exercise for fear of looking
strong and potentially
being judged by others.
2. While it has been shown
that engaging in physical
activity helps to reduce
symptoms of anxiety, there
may be many individuals
who are unaware of the
extent of the benefits or
who are unaware of its
effects entirely. A lack of
knowledge surrounding the
effect of exercise on
generalized anxiety
disorder and anxiety
symptoms may prevent an
individual from turning to
this activity as a form of
relief and treatment.
1. Someone who does not
have the proper skill to
build up their endurance in
aerobic activity—perhaps,
running—may choose to
forgo engaging in this
activity altogether as a
result of discouragement or
wanting to avoid injury.
General Anxiety Disorder
Reinforcing 1. Feeling healthy despite not
engaging in physical
activity
2. Having friends who also
do not exercise
15
2. Generalized anxiety
disorder is not a disorder
that affects only one
person. When around a
loved one with GAD,
family and friends may not
know that they are
enabling anxious behaviors
by making
accommodations and
avoiding confrontation
with the person with GAD
rather than supporting
them, moving through the
issue. This could be due to
lack of knowledge about
anxious behaviors, feeling
uncomfortable or like they
are overstepping with the
loved one with GAD, etc.
1. Being able to manage
anxiety symptoms or
feeling a general sense of
“good health” despite not
engaging in any extra or
leisure time physical
activity may encourage
individuals who are doing
so not to start involving
themselves in exercise.
This may be reinforcing in
that, if someone does not
believe there is anything
“wrong” with them—either
in terms of overall health
or in terms of mental
health—they are not going
to go out of their way to
begin engaging in a
behavior that seems
unnecessary and that is
difficult to make a habit.
2. Another reinforcing factor
that may prevent people in
our target population from
General Anxiety Disorder
16

engaging in exercise is if
their friends also do not
participate in voluntary
physical activity. People
are largely influenced by
the people around them,
especially by those who
are closest. If perhaps an
individual’s close peers or
friend group does not
participate in physical
activity, then the person
might also not find a
reason to do it, as doing so
could take away from time
spent with friends.

Appendix B
Figure 1. Diagram of the Theory of Planned Behavior Model (Ajzen, I., 1991).
General Anxiety Disorder
17

Implementation Plan Timeline

Year 1 Tasks July Aug Sept Oct Nov Dec Jan Feb Mar Apr May June

Stakeholders meetings x x x x x x
Adapt support group curriculum x x x
Hire and train program manager x x x
and program coordinator

Recruit and train support group x x

facilitators and counselor

Market support group x x x

Recruit program participants x x x
GAD support group pilot sessions x
Modify program based on x x
pilot-test

Hold support group meetings x x

Collect and analyze data from x x
first round of program

Evaluation x x x x x x x x x x x x
Year 2 Tasks July Aug Sept Oct Nov Dec Jan Feb Mar Apr May June

Stakeholder meetings x x x
Recruit program participants x x x x
Market support group x x x
Hold support group meetings x x
Evaluation x x x x x x x x x x x x
Analyze data x x
Develop data report x x
Disseminate data report x

Appendix B

Budget Form for Year 1 and Year 2 of the program

Budget Form Year 1

General Anxiety Disorder
18

Category Amount Requested

Salaries and wages

Licensed Mental Health Counselor (part-time) $9,500
Program Manager (full-time) $60,000
Program Coordinator (full-time) $35,000
Total $100,000

Professional fees (contracts, consultant

fees)
Rent for Office Space $15,000
Total $15,000

Supplies and materials

2 Computers $3,000 ($1,500 each)
3 Laptops $3,000 ($1,000 each)
Projector $550
2 Speakers $100
Stress Balls $40
Meditation and Audio Recordings $100
Printer $120
Printer Paper $35
Printer Ink $120
Pencils $25
Pens $35
Internet $450
Filing Cabinet $200
Folders $120
Office Phone $100
Staplers/Staples $30
Fridge for Refreshments $500
Total $8,525

Other
Refreshments for Group Sessions $250
Snacks for Group Sessions $250
Gift Card Incentive for Participation $450
Total $950

Total Direct Costs $128,475

Budget Form Year 2

Category Amount Requested

General Anxiety Disorder
19

Salaries and wages

Licensed Mental Health Counselor (part-time) $9,500
Program Manager (full-time) $60,000
Program Coordinator (full-time) $35,000
Total $100,000

Professional fees (contracts, consultant

fees)
Rent for Office Space $15,000
Total $15,000

Supplies and materials

Stress Balls $40
Printer Paper $35
Printer Ink $120
Pencils $25
Pens $35
Folders $120
Staples $30
Total $405

Other
Refreshments $250
Snacks $250
Gift Card $300
Total $800

Total Direct Costs $120,205

Total 2 Year Budget $249,680

General Anxiety Disorder
20

Appendix C

Evaluation Plan

Objective / Level of Evaluation Key Indicator (Measure) When and How Data is
Collected

Process: Formative:
● Determine a
● By October 31st, 2023, location that is ● One free
program planners will accessible and community
determine a location to hold comfortable for the location that
GAD support group meetings. priority would serve as
population. adequate spaces
● Until March 1st, 2024, for support
program planners will use at ● Use at least 3 sessions.
least 3 communication different channels
channels to boost the GAD of communication ● 3 forms of
support group, including in order to communication
sharing social media posts, advertise the that include
talking to other mental health support group support group
facilities, and attending local program. information.
health fairs.

Impact (Learning): Summative:

● Participants should
● After the eight weekly support identify at least 2 ● Start-of-program
group meetings are methods of surveys
completed, participants will physical activity
be able to identify two ● End-of-program
that could reduce
methods of physical activity surveys
symptoms of
that they can use to reduce GAD.
their levels of anxiety, as
reported on the ● Participants should
end-of-program survey. note at least 1
benefit of physical
● In the end-of-program survey activity in
given at the eighth and final reducing physical
support group meeting, at symptoms of
least 80% of participants will anxiety.
report at least one benefit of
physical activity in reducing
physical anxiety symptoms.

Impact (Behavioral): Summative:

General Anxiety Disorder
21

● At least 80% of support group ● 80% of support ● Start-of-program

participants will bring one group participants surveys
family member or friend to at will bring at least
least one group meeting to one family ● List of attendees
serve as an accountability member or friend collected at each
buddy. to 1 meeting. of the 8 meetings

● At least 80% of participants ● 80% of ● End-of-program

will attend at minimum 6 out
of the 8 weekly support group
meetings.
● At least 75% of participants
will engage in physical
activity as a method to cope
with symptoms of GAD at
least 3 times a week for 30
minutes each throughout the
duration of the program.
participants will surveys
attend at least 6
support group
meetings.
● 75% of
participants will
engage in physical
activity 3 times a
week for 30
minute intervals.

Outcome: Summative:
● During July 1st, 2023, to June ● Symptoms of ● Richland County
30th, 2027, reported anxiety in Health
symptoms of anxiety among Richland County, Department
females (all races) ages 18-25 SC females (all Community
in Richland County, South races) ages 18-25 Health
Carolina will decrease by will decrease by Assessment
10% as reported by the 10%.
Richland County Health
Department Community
Health Assessment.
General Anxiety Disorder
22

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Name Contribution Read Over and Approve

Sierra Behrens

Erin Finnegan

Grace Martin

Mara Russell

Marah Savage