Programs highlight success

Health education strategies aimed at changing individual behavior are still some of the most effective public health measures. A Wednesday morning Annual Meeting session on “Back to Our Roots: Health Education Works” highlighted several successful community programs.

For example, California’s Westminster Free Clinic and Community Care Center created a cardiovascular risk reduction program for its low-income Hispanic families. The Corazones Sanos (Healthy Hearts) program is a public health-medical model that includes an endless list of services and activities. Participants are required to take part for at least one year.

As part of the program, the clinic not only provides education and health care services, but gives out fruits and vegetables each week, teaches yoga and Zumba classes in Spanish, provides child care, offers classes in relaxation and art therapy, and hosts a grief and loss support group. All clinic services are free.

High school students are heavily involved in creating and running the program. They staff the child care center, do medical assessments and advocate for the community. When the clinic asked local Hispanic markets to offer some healthier options, many said “no” at first, said session presenter Lisa Safaeinili, executive director of the clinic. But when community teenagers did the asking, the stores got involved, offering items such as wheat tortillas and almond milk. Eighty-nine percent of Hispanic markets in five cities continued to carry three or more heart-healthy food options after three years.

The teenagers also created an effort in which they put stickers on shelves in local Hispanic markets. Green stickers indicate healthy options for people with diabetes, while red stickers indicate good choices for people with cardiovascular disease or high blood pressure. The teens teach the same healthy messages to the kids in the child care program, primarily through games and songs.

“I highly recommend you consider involving youth [in education programs],” Safaeinili said. “It’s what our patients love. It’s what our doctors love.”

Program participants receive prize tickets for attending classes and activities, which can be redeemed for household items or gift cards at the end of each quarter. To get participants to return at the end of their program so that the clinic can collect post-program data, the clinic offers $10 gift cards to Target. Organizers tried other incentives, such as kitchen towels, but found cash worked the best, Safaeinili reported.

One-year data outcomes found that:

74 percent of participants drank more than four glasses of water a day, a 56 percent improvement from baseline;
71 percent exercised more than two times a week for 30 minutes, a 50 percent improvement;
60 percent ate four to five servings of fruits and vegetables three or more days a week, an 11 percent improvement;
72 percent had knowledge of healthy eating habits, a 38 percent improvement; and
83 percent regularly monitored their blood pressure, a 42 percent improvement.
Across the country, in four Appalachian counties in eastern Tennessee, public health professionals wanted to create a culturally competent program for people to self-manage their Type 2 diabetes.

To do so, they held six focus groups, three in urban areas and three in rural ones. There were 42 participants, all living with Type 2 diabetes. The mean age was nearly 66 years old, and the groups were 66 percent women. Twelve percent were uninsured, while 15 percent were on public insurance. Fifty-eight percent of participants were married.

The focus groups identified three important areas to concentrate on for their diabetes health: nutrition, internal factors and contextual factors. Focus group participants talked the most about nutrition, including access to and affordability of healthy foods, as well as food planning, preparation and cooking. An example of such discussions — the difficulty of refusing unhealthy foods at church and social gatherings and the prevalence of sweet tea in the South.

“In people with diabetes that was an area of concern — how can they have sweet tea using healthier options?” said session presenter Soghra Jarvandi, assistant professor and community health specialist at the University of Tennessee.

When discussing contextual factors, such as outside support, wives were identified as more supportive of healthy decision-making and food options than husbands were. When talking about health care, one participant said they wished that instead of doctors telling them, “you’ll be OK if you take this medicine,” they would teach them healthy ways that would eventually help them stop taking the medicine altogether.