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Running Head: EVIDENCED-BASED INTERVENTIONS

Evidence-based Community Interventions for Hillsborough County


Narjess Yazback
University of South Florida

EVIDENCED-BASED INTERVENTIONS

Evidenced- Based Community Interventions for Hillsborough County


Hillsborough County is located in the State of Florida with an estimate population of
1,277,746 widespread over a land area of 1051 square miles. This yields a population density of
1206 people per square mile. Cities located in this county include Tampa, Brandon, Riverview,
Temple Terrace and Plant City. With a 4% rural setting, Hillsborough County is mostly
urbanized (Hillsborough County, 2014). In terms of employment, three major employers are
education services and public administrations; these include (1) School District of Hillsborough
County, (2) MacDill Airforce Government, and (3) Hillsborough County Government. A number
of healthcare services such as Tampa General Hospital and St. Josephs Hospital are categorized
within the top 15 major employers of the county (Largest Employers, 2011). Regardless of
these opportunities, the Countys rate of unemployment is at 8.5%, which is nearly equal to that
of the state of Florida at 8.6 % (County Health Rankings, 2014). Based on the United States
Census Bureau (2014), 16.5 % of the Hillsborough County population lives below the poverty
level compared to 15.6 % in Florida. In terms of education, the Census Bureau (2014) displays
that 86.4 % of the Hillsborough County population age 25+ hold a high school diploma
compared to 85.8% in the state of Florida. In Hillsborough where the majority of the population
is Caucasian, 5% are not proficient in English compared to 9% in Florida. In further observation
of the County, positive and negative health factors will be examined followed by suggested
primary, secondary and tertiary interventions, including a written health proposal to target the
health issue of overweight amongst the population.
Hillsborough County has both positive and negative health indicators. Based on the
statistics acquired from the Florida Department of Health (2014), a major strength in
Hillsborough County is access to exercise opportunities which is at a high of 87% exceeding that

EVIDENCED-BASED INTERVENTIONS

of the state at 78%. Another strength includes the availability of 1,274 primary health care
physicians in Hillsborough alone compared to 1,426 in Florida. In addition to primary health care
providers, there are 2,097 dentists available in Hillsborough County surpassing the 1,981 in the
State of Florida. Two of these statistics display more positive results than the states average.
Having adequate access to exercise opportunities can decrease the risk of obesity and morbidity,
and having a sufficient number of healthcare providers can allow for widespread opportunity of
care for the community.
In Hillsborough County, the statistics show that many health indicators are worse than
the states average. Three important weaknesses are (1) Infectious syphilis cases reported at a
rate of 10.7 per 100,000 in Hillsborough with a worsening trend throughout the years as opposed
to 6.7 in Florida, (2) adults with diagnosed high blood cholesterol constitute 38.9% of
Hillsborough county compared to 38.6 % in Florida, and (3) adults who are overweight consists
of 39.4 % of the Hillsborough county population compared to 37.8% in Florida ( Florida
Department of Health, 2014).These health indicators share a few things in common, they all
consist of some modifiable risk factors that the patient might not be aware of. Educating the
community members and applying primary interventions could help reduce the incidence of each
of the indicators above. These indicators can also contribute to complications and further
deterioration of health if left untreated.
According to the United States Department of Health and Human Services (HHS),
Healthy People 2020 (2014), the nation has experienced an overall increase in the overweight
and obese population. Presently an estimate of 1 in 3 adults and 1 in 6 children are obese. Being
overweight can eventually lead to obesity, and places one at an increased risk for some of the
leading causes of death such as type 2 diabetes, heart disease and stroke. Worsening health

EVIDENCED-BASED INTERVENTIONS

conditions and complications brought on by overweight and obesity also increase overall medical
costs (HHS, Healthy People 2020, 2014). Despite the high percentage (87%) of access to
exercise opportunities in the county of Hillsborough, the incidence of overweight and obesity is
still present. Based on the importance of these factors and their possible repercussions, the topic
of being overweight and that of obesity will be further explored as a priority health issue.
In order to provide the most optimal care for an individual the nurse must be aware that
multiple factors can affect ones health. HHS, Healthy people 2020 (2014) has developed the
determinants of health model which is made up of five key categories that affect a patients
health. These categories include economic stability, education, social and community context,
health systems, and neighborhood environment. By using the determinants-of-health model, the
community health nurse is able to consider many of the underlying factors that can possibly
impact ones health, and develop specific interventions to target the problem. Multiple factors
such as human biology, lifestyle, behavior and environment can contribute to excessive weight
gain in a person; these are summed up as genetic and non-genetic contributors.
As described by the Center of Disease Control and prevention (CDC, 2011), although
genetic disorders such as Bardet-Biedl syndrome and Prader-Willi syndrome may directly cause
obesity, genes are not the sole cause of excess weight gain and obesity, and do not always
determine future health of the patient. According to an article by Hill and Throwbridge (1998),
despite obesity having strong genetic determinants, the genetic composition of the population
does not change rapidly. Therefore, the large increase in [obesity] must reflect major changes
in non-genetic factors (p.571). Non-genetic factors such as a sedentary lifestyle, lack of
exercise, and the types of food available in the surrounding environment all play a role in this
health issue. Communities, homes, and workplaces can all influence peoples health decisions.

EVIDENCED-BASED INTERVENTIONS

Because of this influence, it is important to create environments in these locations that make it
easier to engage in physical activity and to eat a healthy diet (CDC, 2011, para.1). Lifestyle can
play a large role in weight gain because it encompasses a multitude of factors such as daily
routine, diet, exercise, sleep schedule, and social support among others. For instance, a study
including data from 28,000 children and 15,000 adults conducted at the University of Warwick
indicated a significant increase in obesity in both groups when affected with sleep deprivation
(American Obesity Treatment Association, n.d.). Lastly, it is important to remember that
illnesses such as Cushings disease and use of treatment steroids and antidepressant may also
result in weight gain (CDC, 2011).
Based on the selected county weakness, the following nursing diagnosis has been
developed: High prevalence of overweight among residents of Hillsborough County related to
lack of sufficient physical activity, lack of education on possible complications, poor nutrition,
and increased abundance of restaurants and fast food establishments as evidenced by Florida
Charts and Healthy People 2020 statistics. According to the Minnesota Department of health
division (MDH, 2001), a primary intervention is used to promote health and prevent problems
before they develop. In Hillsborough County, a primary intervention addressing the issue would
be to promote early health education throughout the schools by providing a specific health
education course, and healthy lifestyle education involving risk factor modifications from
healthcare providers. Schools can create environments supportive of students efforts to eat
healthy and be active by implementing policies and practices supporting healthy eating and
regular physical activity and by providing opportunities for students to learn about and practice
these behaviors (CDC, 2014, para.1). The recipients of this prevention would be the community
and individual. As a primary intervention, this would be geared towards healthy people to

EVIDENCED-BASED INTERVENTIONS

prevent them from becoming overweight. As described by the CDC (2011), weight gain can be
prevented by choosing a lifestyle that includes good eating habits and daily physical activities.
The role of the community health nurse would be to partner up with community members and
school board officials in order to provide health education and resources on a healthy lifestyle
and implement changes. The community nurse would also develop multiple strategies to reach
various types of learners.
Based on the levels of prevention model, secondary level of prevention focuses on an
already affected population and aims to stop or reverse the problem before complications occur
(MDH, 2001). A possible secondary intervention for overweight individuals would be to
implement daily physical activity to facilitate weight loss, as well as healthcare screenings in the
community in order to diagnose risk-for or possible complications such as high cholesterol
levels, Hypertension, and pre-diabetic stage early. This secondary intervention allows for a
warning and push for lifestyle changes in the individual. Educating the community about self
weight monitoring, BMI calculations and healthy nutrition as an addition to the intervention
could promote health in an affected population (CDC, 2011). According to HP020 (2014) eating
a healthy diet and staying physically active can decrease the risk of acquiring various conditions
such as heart disease and diabetes. The role of the community nurse would be to provide
community assessments, explain the importance of health issues to the community, and develop
programs and services that cater to the population at risk (Anderson and McFarlane, 2011, p.19).
A tertiary prevention targets an existing condition or problem and aims to limit further
damage (MDH, 2001). In this case the recipients of a tertiary intervention would be overweight
individuals of Hillsborough County with weight-based health complications. Healthcare workers,
community nurses, community members and families of overweight individuals could

EVIDENCED-BASED INTERVENTIONS

collaborate to ensure frequent health examinations, provide healthy eating guidelines and diet
education, and increase awareness and knowledge of different methods of exercising available in
order to stop further deterioration of health status. Based on an evidence report from the National
Heart, Lung and Blood Institute (1998), weight loss plays an important role in lowering blood
glucose levels, total cholesterol levels, and elevated blood pressure in an overweight patient
diagnosed with type two diabetes, dyslipedemia, or hypertension respectively. As part of the
intervention, education on managing the following conditions: diabetes, cholesterol,
hypertension, and coronary artery disease could be provided to prevent knowledge deficit
complications.
In dealing with a population, health policies are oftentimes encountered. A health policy
provides the laws, guidelines, and goals regarding the health of citizens and determines the
healthcare they receive. Examples of well known programs that are guided under health policy
include Medicaid and Medicare (Anderson and McFarlane, 2011, p.121.). In response to a 38.5%
overweight rate in Hillsborough County exceeding the state rate of 37.8%, a health policy
proposal to provide a healthy lifestyle education course throughout Hillsborough schools
available for both schoolchildren and adults of the community has been developed. The proposal
will employ a primary level of prevention method with a goal to better educate the public, and
prevent a further increase in Hillsboroughs overweight rate. This policy will also promote
decrease overtime by enhancing availability to preventative education. The lifestyle education
course will include physical activity tutorials, healthy nutrition options and resources, teachings
for self weight management and BMI monitoring, as well as teachings on weight-associated
disease complications. The lifestyle education course will also serve as a link to nearby available
resource centers in Hillsborough County. In order to reach a bulk of the population, this course

EVIDENCED-BASED INTERVENTIONS

will be required for the students attending the given school, and it will be available free of fee for
the members of the community. Daytime classes could be added to the students curriculum, and
both evening and morning classes could be offered for adults of the community to sign up.
In order to put this policy into action, the general game plan would involve
collaboration from healthcare providers, funding sources, community members and school board
officials. Initial action would require reaching out to various healthcare workers and presenting
the problem as well as the proposed solution in order to create a team. A randomized controlled
trial may be necessary to collect data over a period of time to determine if the intervention is
worth implementing. If a significant positive change is seen, documented proof could then be
presented to school board officials to implement the intervention, and funding resources may
become available through fundraising and different healthcare associations interested in the
subject. Funding resources would be an extremely important part of this health policy as it would
be a non-profit based program for the community.
By providing health and lifestyle education in schools at no cost and enabling community
members to sign up in the same determined environment throughout Hillsborough, the
underserved population is considered. Primary prevention reaches out to a population before a
problem occurs. In this case, using education as a primary prevention and making it easily
accessible for the community may enhance the populations health overall and reduce the
incidence of overweight and obesity overtime in Hillsborough County.

EVIDENCED-BASED INTERVENTIONS

References
American Obesity Treatment Association. (n.d.). What causes obesity? Retrieved June 25, 2014,
from http://www.americanobesity.org/causesOfObesity.htm
Anderson, E.T., & McFarlane, J. (2011). Community as Partner: Theory and Practice in
Nursing. (6th. ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Center for Disease Control and Prevention. (2011). Healthy weight: Its not a diet it is a lifestyle.
Retrieved from http://www.cdc.gov/healthyweight/calories/other_factors.html
Center for Disease Control and Prevention. (2014). Nutrition, physical activity, and obesity:
School health guidelines to promote healthy eating and physical activity. Retrieved from
http://www.cdc.gov/healthyyouth/npao/strategies.htm
County Health Rankings & Roadmaps. (2014). Hillsborough. Retrieved from
http://www.countyhealthrankings.org/app/florida/2014/rankings/hillsborough/county/outc
omes/overall/additional
Hill, J., & Trowbridge, F. L. (1998) Childhood obesity: future directions and research priorities.
American Academy of Pediatrics, 101, 570-574
Hillsborough County, Florida (FL). (n.d.). Hillsborough County, Florida detailed profile.
Retrieved June 23, 2014, from http://www.city-data.com/county/Hillsborough_CountyFL.html
Florida Department of Health. (2014). County health status summary. Retrieved from
http://www.floridacharts.com/charts/DisplayHTML.aspx?ReportType=1341&County=29
&year=2012&tn=24
Largest Employers on the West Coast of Florida. (2011). Largest Employers on the West Coast
of Florida (Tampa - Naples). Retrieved from
http://suncoastemployers.com/#hillsborough

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Minnesota Department of Health Division of Community Health Services. (2001). Public Health
Interventions: Application for Public Health Nursing Practice. Retrieved from
http://www.health.state.mn.us/divs/opi/cd/phn/docs/0301wheel_manual.pdf
National Heart, Blood and Lung Institute. (1998). Clinical guidelines on the identification,
Evaluation and treatment of overweight and obesity in adults: the evidence report.
Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK2009/
United States Census Bureau. (2014). Hillsborough County QuickFacts from the US Census
Bureau. Retrieved from http://quickfacts.census.gov/qfd/states/12/12057.html
United States Department of Health and Human Services, Healthy people 2020. (2014).
Nutrition, physical activity, and obesity. Retrieved from
http://www.healthypeople.gov/2020/LHI/nutrition.aspx