Nutrition and Physical Activity in Smyth County, VA

Examining Approaches to Combat Obesity in Rural Areas

May 4, 2015Sarah Vacher

Introduction To The Practicum

Smyth County Community Hospital (SCCH)

◦ Dietitian: Mary Riggins

Health Trust at SCCH

◦ Subcommittee: Nutrition Action Network (NAN)

Charged with creating the Family Fitness Challenge (FFC)

Practicum in Smyth County

31% of Smyth County is obese (BMI ≥ 30)

Obesity is a significant public health concern associated with:◦ Heart Disease◦ Stroke◦ Diabetes◦ Cancer

Increases hospital LOS

Medical Costs

Why Nutrition and Physical Activity?

Place: Why Smyth County?

Smyth County ranked 123/133 counties/cities in VA for overall health

Smyth County females ranked middle 50% nationally in obesity; males poorest 25%.

Rural areas have highest rates of preventable hospitalizations

Low per capital income, persistent high poverty rates, high unemployment rate make it an at-risk county

Often underserved

Significant barriers to positive health behaviors

Cultural norms in these areas may foster poor nutrition and physical activity habits

Why are communities like this important?

Overview of Approaches from the

Literature

Ecological Approach◦ Multilevel

approach◦ To enact change,

interventions should target all levels of influence

What does the research say?

Utilize Gatekeepers

◦ Gatekeepers can provide information to individuals from outside with access and relevant information to their communities

◦ Someone on the inside

◦ Important to have someone who knows the culture and preferences in your target population!

What does the research say?

Reciprocal determinism

The individual, the environment and the individual’s behavior all interact to influence

each other in a dynamic manner

Social Cognitive Theory (SCT)

Methods for Pilot Program

Six Week Family Oriented Weight Loss Program

◦ 2 nights per week

◦ 2 separate locations

Chilhowie/Sugar Grove

◦ 90 minutes total 45 mins PA; 45 nutrition

What was the Family Fitness Challenge?

Chilhowie Site◦ Location: Chilhowie Community Center◦ September 8, 2014 – October 26, 2014◦ Tuesdays and Thursdays 6:00 -7:30

Sugar Grove Site◦ Location: Sugar Grove Combined School◦ October 6, 2014 – November 14, 2014◦ Mondays and Wednesdays 4:30 – 6:00

Class Dates and Locations

◦ Word of Mouth

◦ Flyers in local businesses, doctors’ offices, the

Wellness Center, and the hospital

◦ Radio interview on local station

◦ Short ad in local classifieds newspaper

◦ Back-To-School Night

Recruitment

Preferred families with at risk of or diagnosed with:◦ Diabetes◦ Hypertension◦ Heart Disease◦ Overweight/Obesity

Originally wanted 1 adult and 1 child per family◦ In practice allowed anyone in family

Eligible Families

Incentives and Labs Offered

LABS/MEASUREMENTS INCENTIVES

HbA1C Lipid Panel

◦ Cholesterol◦ LDL◦ HDL◦ TG

Height Weight BMI

Gift Certificates to Farmers Market Free vegetables from community

garden Seeds/Planters Balls Salad Bowls Fit Bands One month registration at

Wellness Center

Validated Questionnaire◦ Used to evaluate published school based

interventions

Used to gauge knowledge at baseline

Used the parent version and the child version

SPAN: School Physical Activity and Nutrition Survey

USDA Program ◦ Be Healthy Be Active◦ Community Workshops

CATCH Kids Club◦ Stop, Go, or Whoa Foods

Curricula Used

Food City Lifetime Wellness Center Local Churches Mount Rogers Health District Smyth County Chamber of Commerce Sprouting Hope Virginia Tech Center for Public Health and Research

Collaborating Organizations

Participant DataResults from Initial Labs and Measurements

1 2 3 4 5 6 7 80

10

20

30

40

50

60

Initial Adult BMI

BMI

Participant

BMI

1 2 3 4 5 6 7 80

50

100

150

200

250

300

350

Adult Weight: Pre and Post Program

Weight (lbs) BeginningWeight (lbs) 6 Wk Post

Participants

Wei

ght

(lbs

)

1 2 3 4 5 6 7 8 90

20

40

60

80

100

120Children BMI Percentile

BMI PercentileParticipant

BMI P

erce

ntile

1 2 3 4 5 6 7 80

1

2

3

4

5

6

7

Adult HbA1C

Participants

%A1

C

1 2 3 4 5 6 7 80

50

100

150

200

250

300

350

Cholesterol

Cholesterol

Participants

Chol

este

rol (

mg/

dL)

Feedback From Pilot Program

Results from Practicum

Overall

SUCCESSES ROOM FOR IMPROVEMENT

People reported that they both enjoyed the program and learned from it

Involved parents and children

Overall adults lost an average of 5 lbs in six weeks

Better ways to get the word out

More people involved in actual implementation

Follow the curriculum more closely

Overall organization

Fidelity to the program

Telephone Feedback from Participants n=8

WHAT THEY LIKED WHAT THEY DIDN’T LIKE

Liked separate classes for parents and children at the same time

Liked the cooking/healthy eating

Physical activity Bob/Mary –

knowledgeable Incentives

Locations (Chilhowie)

Length of classes

Fall season

Time (for 4:30 class)

CapstoneFocus Group

Location: Saltville, VA

Participants: ◦ Active community members◦ Ex: pastor, teachers, coaches

Duration: 1 hour conversation with 6 people

Focus Group

10 Open Ended Questions Led by a trained focus group moderator Snacks and refreshments provided Audio Recorded Each participant compensated with $15

Wal-Mart gift card Transcribed verbatim for thematic coding

Focus Group Methodology

Focus Group Methodology

Strengths Limitations

2 individuals extracted themes from transcription data

Independently identified consistent themes

Cannot look for consistency across groups (1 focus group)

Individuals were involved in community already

Utilize community gatekeepers◦ Ideally should be someone who:

everyone knows doesn’t preach makes it fun and picks fun activities “walks the talk” has credibility has the ability to get the word out

Themes from Focus Group: Characteristics of Program

Leaders

Reach parents through children Schools as primary location Group activities

◦ Biking, zumba, walking, “old fashioned fun” Provide childcare for participating parents

◦ Ex: Homework help Marketing: People need to know about it

Themes from Focus Group: Logistics of Program

Should not be administered online

Emphasis of healthy habits on a budget

Give the families choices ◦ When they go, the rigor of activities, where they

go

Focus on positives

Themes from Focus Group: Program Content and Presentation

Capstone Literature Review

Successful Approaches from Other Under Served Rural Areas

Focus on key components in program selection:◦ Content◦ Delivery channel◦ Available resources for replication

Community-Based Participatory Research (CBPR)

Delivering interventions through Cooperative Extension infrastructure

Telephone counseling

Successes from the Literature

Lessons LearnedRecommendations for Smyth County

Choose content relevant to population◦ Healthy foods that are inexpensive ◦ Healthy foods that do not require travel to obtain◦ Positively framed alternatives to their current

methods of food preparation

Involve community champions from the start◦ People who are well known◦ People who are well liked◦ People seen as role models ◦ People who are known as experts

Recommendations

Continue to foster collaborative partnerships between: ◦ Community leaders◦ Institutions of higher education

Ex: Virginia Tech Emory and Henry

◦ Any other individuals or organizations willing to provide resources Community gardens Local grocery stores Local health practitioners Churches Cooperative extension

Recommendations

Sincere thanks for all of your support throughout my practicum and capstone experiences. VT CPHPR Dr. Hosig Mary Riggins HealthTrust at Smyth County Community

Hospital

Acknowledgements

Adult Obesity Facts. (2014, September 9). Retrieved May 2, 2015, from http://www.cdc.gov/obesity/data/adult.html

Bandura psychology is a good research paper topic for psychology enthusiasts. (2015, March 10). Retrieved May 2, 2015, from http://blog.questia.com/2015/03/bandura-psychology-is-a-good-research-paper-topic-for-psychology-enthusiasts/

Caprio, S., Daniels, S. R., Drewnowski, A., Kaufman, F. R., Palinkas, L. A., Rosenbloom, A. L., ... & Kirkman, M. S. (2008). Influence of race, ethnicity, and culture on childhood obesity: implications for prevention and treatment.Obesity, 16(12), 2566-2577.

CATCH | Coordinated Approach To Child Health. (n.d.). Retrieved May 2, 2015, from http://catchinfo.org /COUNTY PROFILE: Smyth County, VA. (n.d.). Retrieved May 3, 2015, from http://www.healthdata.org/sites/default/files/files/county_profiles/US/County_Report_Smyth_County_Virginia.pdf

Hooper, M. B. (2014). Selection of an Evidence-Based Pediatric Weight Management Program for the Dan River Region (Doctoral dissertation, Virginia Tech).

Perri, M. G., Limacher, M. C., Durning, P. E., Janicke, D. M., Lutes, L. D., Bobroff, L. B., ... & Martin, A. D. (2008). Extended-care programs for weight management in rural communities: the treatment of obesity in underserved rural settings (TOURS) randomized trial. Archives of internal medicine, 168(21), 2347-2354.

Michael and Susan Dell Center for Healthy Living. (n.d.). Retrieved May 2, 2015, from https://sph.uth.edu/research/centers/dell/project.htm?project=3037edaa-201e-492a-b42f-f0208ccf8b29

Simons-Morton, B., McLeroy, K. R., & Wendel, M. (2011). Behavior theory in health promotion practice and research. Jones & Bartlett Publishers.

Zoellner, J., Motley, M., Wilkinson, M. E., Jackman, B., Barlow, M. L., & Hill, J. L. (2012). Engaging the Dan river region to reduce obesity: application of the comprehensive participatory planning and evaluation process. Family & community health, 35(1), 44-56

References

QUESTIONS?