Running head: OSCEOLA COUNTY

Osceola County: Evidence- based Community Interventions

Kellycha Santos, RN Student
University of South Florida
Community Health Nursing

OSCEOLA COUNTY

Osceola County Community Interventions

The purpose of this paper is to discuss the strengths and weaknesses of Osceola County
in comparison to the state of Florida. In the county of Osceola the priority health issue would be
obesity in the Hispanic population. Primary, secondary and tertiary prevention methods will be
tailored to fit the needs of the community and a health policy will be proposed in order to combat
the epidemic of obesity.
Geographic Location
Osceola County is located 59.8 miles north east of Tampa Florida with a total area of
1,506 square miles (Choose Osceola, 2008). Osceola County is composed of the cities of
Kissimmee, St. Cloud and the towns of Celebration, Poinciana, and Harmony. While there are a
vast majority of rural areas, within recent years more urban areas have been introduced. In 2014
the population in Osceola County was estimated to be around 310,211 as compared to the state of
Florida which was said to be 19,893,297 (Florida Charts, 2015). The three major employers in
Osceola County are the Osceola County School District with 6,000 employees, followed by the
Walt Disney Company with 3,700 employees and lastly Wal-Mart Stores Inc with 2,730
employees (Choose Osceola, 2008). The health care systems most prevalent in the county of
Osceola are Florida Hospital Kissimmee and Celebration, Osceola Regional Medical Center and
the Osceola County Health Department (Florida Commission on Human Relations [FCHR],
2007)
Population and Socioeconomic Factors
In Osceola County, the majority of the population classifies as Hispanic (46.3%),
followed by Caucasian (39.6%), African American (12.8%), and Asian (3%).The percent of
people living below poverty is rated as 17.9% while the average for the state is 16.3%. The
persons over 25 years old with a high school diploma are 84.4% as opposed to the state
percentage which is 85.3% (Florida Charts, 2015). The percent of the population over the age of

OSCEOLA COUNTY

5 that do not speak English very well is 18.8% in Osceola County and 11.7% in the state of
Florida (Florida Charts, 2015).
Analysis of Data
Strengths
The strengths of Osceola County in comparison to the state of Florida are as follow. The
number of AIDS cases in a three year rate per 100,000 residents in the county of Osceola is 10.9
as opposed to that of the state which is 14.8 (Florida Charts, 2015). This indicates that
individuals are taking the necessary steps to protect themselves from sexually transmitted
diseases and are taking proactive steps in comparison to the state level. Another strength of
Osceola County is the percent of pregnant females receiving prenatal care in the first trimester.
The average in Osceola County is 81.4 compared to the state of Florida which is 79.8 (Florida
Charts, 2015). Beginning prenatal care in the first trimester prevents low birth weight babies,
congenital defects and premature deaths in infants.
The last strength for the county of Osceola would be the percent of adults who engage in
heavy or binge drinking in comparison to the state level. In the state of Florida 17.6% of adults
reported heavy or binge drinking as opposed to Osceola who reported 13.3% (Florida Charts,
2015). This is considered a strength because there are a lower number of individuals who will
suffer long term consequences of heavy drinking such as cirrhosis or sudden death due to driving
under the influence.
Weaknesses
The weaknesses of Osceola County sadly outweigh the strengths. The most concerning
weakness for Osceola County is the 29.9% of adults who could not see a doctor at least once a
year due to cost as opposed to 20.8% in the state of Florida (Florida Charts, 2015). Due to
individuals not being able to afford health care because of financial concerns, many of their
medical conditions go unnoticed, often realizing when it is too late. Yet another weakness would
be the percentage of adults with hypertension who currently take high blood pressure medicine.

OSCEOLA COUNTY

65.5% of individuals with hypertension take blood pressure medications as opposed to 79.4% in
the state of Florida (Florida Charts, 2015). The cost of healthcare along with the cost of
medications is often too much for individuals and as a result they are not compliant which leads
to further complications in following years. The percent of adults who are obese in Osceola
County is 31.9% as opposed to 26.4% in Florida (Florida Charts, 2015.. Obesity can lead to
major complications such as heart disease, diabetes and stroke (National Institutes of Health
[NIH], 2012). With individuals not being able to afford healthcare they cannot regularly go to the
doctor to receive the necessary aid they need in combating the growing issue of obesity in our
society.
Priority Health Issue
According to the Centers for Disease Control and Prevention (CDC, 2015), more than
one third of adults in the United States are obese. Obesity is a growing epidemic occurring
widely in the United States affecting all genders, races and ages (Laddu, Dow, Hingle, Thomson,
& Going, 2011). The vast majority of the population in Osceola County is of Hispanic origin and
the numbers keep rising as there are an increasing number of Puerto Rican individuals moving
from the island to the city of Kissimmee. The CDC estimates 42.5% of Hispanics to be obese;
this can be attributed to poor eating choices, lack of healthcare and socioeconomic status (CDC,
2015).
Obesity in Hispanic individuals is a priority of health that needs to be addressed in
Osceola County and measures need to be taken so that individuals do not develop co-morbidities
as a result. These co-morbidities include heart disease, stroke, type II diabetes and certain types
of cancers if not treated properly (Laddu, Dow, Hingle, Thomson, & Going, 2011). The leading
causes of death in Osceola County are heart disease, stroke, diabetes and cancer; many of these
conditions are exacerbated if not caused by obesity and can be prevented with proper screening,
teaching and education (Florida Charts, 2015).

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Community Health Models

Determinants of Health
When looking at a communitys overall health and health habits there is much more than
just personal choice. As a community health nurse there must be an understanding that multiple
factors come into play when trying to develop interventions for a population. In order to plan
appropriate interventions the community health must look at an individuals lifestyle,
environment, socio economic status, genetics and the health system surrounding them (TruglioLondrigan, & Lewenson, 2013).
As stated above, 31.9% of individuals in the county of Osceola are deemed obese. In this
particular population one of the many factors contributing to the priority health issue is the health
system. Within recent years 29.9% of individuals in Osceola County could not go to the doctor
due to the cost. Only 69.4% of individuals in the county had healthcare and furthermore, only
62.9% had a checkup within one year (Florida Charts, 2015). With this being said, the population
is not getting screened for obesity and if they are obese they do not receive education or
checkups that they need.
The lifestyle of the population also contributes to the issue of obesity as 58.9% of
individuals report being inactive or sedentary. Only 14.6% of the population reports having at
least one serving of fruits daily (Florida Charts, 2015). The Hispanic population is quite known
for eating unhealthy fattening and fried foods; being in an environment where others do not care
what they are putting into their body leads one to adapt to that lifestyle and conformity.
Individuals who have a low socioeconomic status oftentimes cannot afford healthier foods and as
a result turn to fast foods high in fats and with no nutritional value. Lack of transportation and
lack of grocery stores in the area also are areas in the environment that affect the priority health
issue of obesity.
Negative Nursing Diagnosis

OSCEOLA COUNTY

Due to the vast majority of Hispanics in Osceola County, the population subgroup for this
paper is Hispanics. According to the CDC (2015), 42.5% of Hispanics are obese; obesity puts
individuals at risk for heart disease, heart attack, stroke, type II diabetes and even death. These
individuals report sedentary lifestyles, poor eating habits and lack of doctor visits. The risks
mentioned above are being evidenced by an increasing number of individuals being diagnosed
with high cholesterol (37.2%), hypertension (14.2%) and diabetes (14.2%) while decreasing
percent of individuals who did not have a checkup within the past year. Major causes of death in
Osceola County are related to heart disease (195.7), diabetes (21.1) and stroke (31.1) all of which
are potential complications of obesity and all which have been increasing within the past 5 years
(Florida Charts, 2015).
Community Based Interventions
Primary Prevention
Primary prevention focuses on avoiding the development of disease by encouraging
health promotion activities and measures (Ard, 2015). In the primary prevention of obesity, the
Hispanic population would be the target recipient. The focus would be to decrease the number of
new cases and this can be done mainly by providing education to those adults who are not yet
obese but have the potential to be (Laddu, Dow, Hingle, Thomson, & Going, 2011). Additional
interventions would be to alter behaviors such as unhealthy diets, addressing disease risk factors
such as a sedentary lifestyle. Education would be provided in the form of pamphlets and
brochures handed out in doctors offices, educational institutions and community events.
Community events in Osceola County are very prevalent and oftentimes are geared to the
Hispanic population, for this reason these events would be an excellent opportunity to raise
awareness and provide education. The stakeholders involved would be the community members
as they are the ones the information is geared towards; public officials as their approval would be
needed to participate in community events; and healthcare providers as their consent would be

OSCEOLA COUNTY

needed to distribute the pamphlets and brochures. The role of the community health nurse would
be to assist these events, educational institutions and doctors offices to provide additional
teaching, personalize the interventions as needed and to answer any questions.
Secondary Prevention
Secondary prevention is geared towards lowering the rate of cases in the community by
slowing the progression of obesity. Secondary prevention would be geared toward the individual
level by initiating measures to control the risk factors such as BMI, waist circumference, and
elevated cholesterol (Ard, 2015). Individuals would regularly be screened periodically in order to
assess additional risk factors and to monitor existing ones. Once this information is obtained, it
will then be evaluated by the healthcare provider and community health nurse and proper
treatment will be selected. As stated above, the stakeholders in secondary prevention would be
the community members as they are the ones receiving screening, surveillance, diagnosis and
treatments; and the healthcare providers as they are selecting treatments such as increased
physical activity and diet modifications. The role of the community health nurse would be to
provide the screening to the individuals and document as needed, and follow up with the patient
in terms of compliance.
Tertiary Prevention
Tertiary prevention aims to reduce the impact of obesity by reducing complications and
improving the individuals quality of life (Ard, 2015). Interventions in tertiary prevention include
monitoring the compliance of the individual in terms of diet plans, lab results and weight
management. Other interventions include monitoring the plan of care per patient and ensuring
that it is effective. The most important intervention would be to prevent further negative impact
on the patients overall health. The stakeholders involved would be the comm. unity members
and individuals as they are the main focus of the interventions; and the healthcare providers as

OSCEOLA COUNTY

they provide monitoring and treatments. The role of the community health nurse would be to
provide support to the patient and track the progression of the disease.
Health Policy
According to the World Health Organization (WHO, 2015), a health policy outlines the
priorities and expected roles of various groups and builds consensus while informing people.
With every health policy, decisions are made followed by plans and actions to achieve health
care goals within a particular society. In this case, obesity is affecting Hispanics at a high rate
and there is no health policy to establish targets or outline priorities.
The rising number of obese individuals is a cause for concern in Osceola County; one
that needs to be tackled immediately. Due to the increasing rates of obesity and the lack of
knowledge, a health policy would aid not only the community members but also public officials,
legislators, health care providers and funding sources. The proposed health policy would focus
on the Hispanic population in Osceola County and would screen them for obesity by obtaining
BMI and waist circumference. After screening individuals they then would be interviewed to
assess the risk factors in their environment or lifestyle and teaching would then be provided to
address the modifiable risk factors and those that need further treatment.
With this particular health policy secondary prevention would be primarily used as the
health policy would target those individuals already at risk. The intervention chosen would be to
form a community event with the help of public officials, local health care providers and local
funding sources. In this community event, the community members would come out and get
screened for obesity by non-invasive BMI screenings and waist circumference measurements.
After, being screened the individuals would then receive further teaching or recommended
treatment options by the community health nurse. The desired goal would be for the community
members to leave the event more informed on the potential causes and dangers of obesity and
how to modify their lifestyles.

OSCEOLA COUNTY

Supporters and opponents for the proposed health policy can be community members,
public officials, legislators and funding sources. Community members may welcome the idea of
improving their health while others may see it as a burden or a bother. Public officials and
legislators would be in charge of approving the event if the community was deemed interested in
an event like this. Funding sources would either choose to support the health policy by providing
their aid or deny the health policy by refusing to fund the community event. In order to
implement the community event all the above mentioned stakeholders would need to be on
board.
The first steps toward presenting the health policy proposal would be to meet with local
healthcare providers and get them on board to provide their services and their nurses to come out
to the event. The healthcare providers would be in charge of providing screening and teaching
the community members about obesity. After having the support of the healthcare providers the
next step would be to present the proposed health policy to legislators and public officials.
Research would be conducted prior to presenting to them to find out current interventions being
made and how our health policy would be of better benefit to the community. The last step after
going to the legislators and public officials would be to meet with funding sources in order to
have them provide their services and their help with planning the community event.
The proposed health policy would provide screening for the community members and
further educate them on the dangers of obesity in the Hispanic population. If successful, the
health policy would bring awareness to this population subgroup that have little to no knowledge
on the epidemic that is obesity. By making them aware of the dangers, Hispanics can make
changes to their lifestyles that will along the line enhance the overall population health of
Osceola County.
Conclusion

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In conclusion, obesity is a nationwide issue that is affecting thousands of people and the
numbers continually are increasing. In Osceola County, the rates of obesity are higher than that
of the state of Florida and the majority of the obese population is Hispanics. In order to target
this issue the first step would be to admit that there is a problem. Primary, secondary and tertiary
prevention must then be implemented within the community members in order to provide
education and stop the progression of disease. Knowing the weaknesses and strength of the
county, a health policy can then be assembled for the county of Osceola.

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References
Ard, J. (2015). Obesity in the Us: What is the best role for primary care. British Medical Journal,
3, 5. doi: http://dx.doi.org/10.1136/bmj.g7846
Centers for Disease Control and Prevention. (2015). Adult obesity facts. Atlanta, GA: U.S.
Department of Health and Human Services
Choose Osceola. (2008). Facts and Statistics. Retrieved from:
http://www.chooseosceola.com/economicdevelopment/232-118119/major_employers.cfm)
Florida Charts. (2015). County and State Profiles. Retrieved from:
http://www.floridacharts.com/charts/QASpecial.aspx
Florida Commission on Human Relations. (2007). Healthcare Services. Retrieved from:
http://fchr.state.fl.us/fchr/outreach/community_resource_map/district_3/osceola_county/h
ealth_care_services
Laddu, D., Dow, C., Hingle, M., Thomson, C., Going, S. (2011). A review of evidence-based
strategies to treat obesity in adult. Nutrition in Clinical Practice, 26, 5. doi:
10.1177/0884533611418335

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National Institutes of Health. (2012). What are the Health Risks of Overweight and Obesity.
Retrieved from: http://www.nhlbi.nih.gov/health/health-topics/topics/obe/risks#
Truglio-Londrigan, M. & Lewenson, S. (2013). Public Health Nursing: Practicing PopulationBased Care. Burlington, MA: Jones & Bartlett Learning.
World Health Organization. (2015). Health Policy. Retrieved from:
http://www.who.int/topics/health_policy/en/

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