Program Planning: Community Nutrition Assessment

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Program Planning Community Nutrition Assessment

• 2005

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Program Planning Basics

• Systematic process
• Continual feedback and evaluation
• Cyclical based on increasing understandings of
  the true nature of the situation and the
  effectiveness of interventions.
• Starts with an assessment of the current
  situation

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Process Evaluation Adjustment
Assessment
Prioritize
Analyze problem and propose model to address
Develop Intervention goals, objectives,
implementation plan
Outcome evaluation
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Why Do Assessment?
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Community Nutrition Assessment

• Anchors program/intervention in the reality of
  the community
• Essential part of ongoing process
• Needs assessment
• Designing and implementing services
• Evaluation
• Improving programs and services
• Includes community and stakeholders as fully
  active participants

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Community Nutrition Assessment

• Based on assets more than deficits
• Helps to integrate nutrition programs into
  community-based health programs and plans

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Successful Community Assessment Includes

• Understanding current conditions of families and
  individuals
• Evaluating local capacities for supporting health
  and nutrition needs
• Building community support for implementing
  changes

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Models and Protocols for Community Assessment

• Planned Approaches to Community Health (PATCH)
  CDC
• Assessment Protocol for Excellence in Public
  Health (APEXPH) NACHO (National Association of
  County Health Officials)
• Moving to the Future Developing Community Based
  Nutrition Services ASTPHND (Association of
  State and Territorial Public Health Nutrition
  Directors)

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Strategic Planning for Initiatives to Address
Local Health Efforts

• Community Assessment
• Organize a community planning group
• Define community boundaries
• Gather information
• Statistical profile
• Qualitative data
• Community Resources

Agency for Health Care Policy and Research
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Strategic Planning, cont.

• Analyze Information
• Common issues
• High risk individuals
• Unmet needs
• Prioritize
• Develop and implement community health plan
• Monitor and evaluate community health plan

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Steps to Assessment

• Convene a planning group
• Define community
• Identify Community Assets
• Identify Perceived Needs
• Build Demographic Profile
• Analyze Community Health Status
• Analyze Community Nutrition Status
• Identify Community Resources and Service
  Utilization
• Identify common issues and unmet needs
• Prioritize

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Community Nutrition Planning Group
Responsibilities

• Collect data and information
• Identify health needs and gaps in service
• Set priorities
• Develop a plan
• Help to implement interventions
• Assist in evaluation
• Of assessment, planning, and intervention process
• Of impact of intervention

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Community Nutrition Planning Group Potential
Members

• Community leaders
• Consumers
• Health and Nutrition Service providers
• Health organizations
• Schools
• Political office holders or their staff
• Fitness professionals
• Representatives from greater community health
  planning groups

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Define the Parameters

• Public Health Nutrition Assuring conditions in
  which people can be nutritionally healthy
• Community A community is any group sharing
  something in common

Community Tool Box
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Community Description

• Geographic boundaries
• General history
• Key people and leaders
• Demographics
• Financial economic information
• Important issues
• Morale and involvement levels
• Key allies and rivals
• Unspoken rules and norms
• Attitudes and opinions
• Strengths and shortcomings

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Identify Community Assets

• Physical structure, place, business
• Concerned citizens
• History of successful efforts
• Organizations
• Individual and group skills
• Communications systems
• Relationships

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Identify Perceived Needs

• WHY?
• To understand public opinion
• To become aware of needs the planning group
  doesnt know about
• To gather support expand group expertise
• To make decisions about priorities
• To plan programs in ways that will be acceptable
  to stakeholders

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How do we assess perceived needs?

• Listening sessions
• Public forums
• Key informant interviews
• Needs assessment survey or survey of concerns

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Demographic Profile

• Economic status income, employment, below
  poverty
• Education levels
• Age and gender
• Race ethnicity
• Social factors homelessness, immigration
  status, family composition, TANF utilization

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Community Health Status

• Causes of Mortality
• Hospital discharge data
• Disease prevalence data
• Food bourne illness reports
• Years of potential life lost
• Infant mortality

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Community Nutritional Status

• Pregnancy related
• weight gain in pregnancy
• Pre-pregnancy weight
• Anemia
• Disease prevalence HIV/AIDS, cardiovascular
  disease, diabetes
• Activity levels (BRFSS)
• Food intake fat, fruits vegetables (BRFSS)
• Dental health
• Food/dieting related behaviors (YRBS)
• Food Security (BRFSS)

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Community Resources Service Utilization

• What resources are available?
• To what extent are people using them?
• Sources of Information
• Citizens
• Service providers
• Tools
• Existing data
• Interviews
• Surveys

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Examples of Community Nutrition Resources

• Food assistance programs (WIC, Basic Food, etc.)
• Grocery stores with high quality produce
• Food Service with health promoting food options
• Educational programs
• Media
• Profession and non-profit organizations
• Nutrition counseling

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Criteria for defining/prioritizing community
problems

• Frequency
• Duration
• Scope or range
• Severity
• Perceptions
• Root causes (but why?) ability to impact root
  causes (effectiveness of interventions)
• Barriers to resolutions
• Political and financial support

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Group Work Roles

• Assign roles within a breakout group
• Mayor who has lead the charge for a comprehensive
  strategic plan for economic development that
  includes recreation and attracting active
  retirees.
• County Health Officer a family practice MD who
  is a strong advocate for breastfeeding
• Bicycle Alliance member
• Anti hunger and farmers market advocate
• School administrator
• Nutritionist from the local health department

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Group Work Develop Problem List

• Brainstorm nutrition physical activity related
  issues problems that arise from these data
• Choose 5 issues that are of interest to all
  stakeholders
• Prioritize these issues using criteria in these
  slides
• Establish the one issue or problem that all
  stakeholders will be comfortable working on for
  the next two weeks

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Community Inventory Moses Lake

• Factors that affect nutrition and physical
  activity choices
• June - August 2002

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Moses Lake

• Agricultural community
• Recreation destination
• Population 14,953 in 2000 census
• Unemployment rate 8.5 (2001)
• 2,246 cases of food assistance ( MRDA, Oct 2001 )
• 33 population increase from 1990-2000
• Workforce primarily agriculture Increasing food
  processing and industrial manufacturing base
• 48 school children eligible for free or reduced
  lunch

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Ethnic Distribution
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Interviews with Nutrition and Physical Activity
Professionals
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Top Health Concerns

• Obesity
• Poor nutrition
• Diabetes
• Smoking
• Unplanned pregnancy
• Poor medical compliance among minorities

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Perceived Barriers to Accessing Healthy Food and
Physical Activity

• Healthy food
• Lack of education
• Lack of recognition/concern for food choices
• Cultural attitudes
• TIME- easier to access fast/junk food
• PA
• Lack of awareness/perceived need
• Difficult to get people interested/time factors
• Poverty/poor nutrition
• Language issues
• Decreased emphasis on PE in school

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Readiness for Change andLevel of Interest

• Level of interest medium-high interest
• Awareness strongly represented in need to
  educate through schools, starting early
• Infrastructure- Moses Lake/Grant County have
  strong community health programs
• Perceived readiness to change- medium to high
• Community level exposure- festivals and summer
  recreation- based activities may reach large
  numbers

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Solutions/Priorities for Change

• Increase nutrition and PE curriculum requirements
• Increase staffing to implement programming,especia
  lly
• In schools and existing food programs
• Increase access for all members of community
  through riverwalks, lengthier bike paths,
  schools indoor walking programs (inclement
  weather)
• Promote active lifestyles for families Free
  exercise
• Coordinate community resources to make healthy
  lifestyle changes happen ( coalition-building!)
• Promote positive media campaigns

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Interviews with Community Leaders
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Is obesity a problem?

• 5/10 reported that it was a visible problem
• Not perceived as unique to ML
• Due to sedentary lifestyle and fast foods
• Concern because see in children in schools

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Perceived Levels of Physical Activity

• 9/10 believe that lack of physical activity is a
  problem in Moses Lake
• Dont see people exercising (but I do)
• Fairly active community
• Poor community people dont know that there are
  free opportunities for recreation here
• There is a general lack of facilities in rural
  towns in general
• Same as nation as a whole

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Perceived Problems due to Poor Diet

• 9/10 thing that poor diet is a problem in Moses
  Lake
• Heavy use of fast foods (5)
• Rushed lifestyle (3)
• Poverty
• People dont know how to cook

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Awareness of Nutrition and Physical Activity
Programs in Community

• 7/10 were aware of some
• Private health clubs and weight loss programs
• Hospital classes
• School classes
• City Parks and Recreation, skate park, pool,
  skating rink
• Programs for Seniors

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Community Inventory Goals

• Assess factors which affect nutrition physical
  activity choices in Moses Lake
• Assist AC members to determine what project(s)
  are appropriate for the community

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Healthy Communities, Healthy Living Planning
Document Based on State Plan for Nutrition and
Physical Activity

• Enhanced opportunities for recreation physical
  education
• Increased access to healthy foods
• Assurance that transportation, urban planning,
  public safety systems support active lifestyles

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Key Community Documents

• City of Moses Lake Planning Commission
  Recommended Comprehensive Plan
• Parks, Recreation, Open Space Plan
• Community Streets Utility Standards
• Municipal Code for Major Subdivisions
• Just Data Grant County Health District
  Community Assessment Data
• Draft VISION 2020 Strategic Plan
• A Description of Grant County Population -- The
  Changing Face of Grant County -- August 2001

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Community Resources

• Police Department http//www.moses-lake.com/polic
  e/
• Parks and Recreation http//www.mlrec.com/
• School district http//www.moseslakeschools.org/
  
• Chamber of Commerce http//www.moseslakechamber.o
  rg/
• Moses Lake Information http//www.moses-lake.com/
  
• Grant County Economic Development Council
  http//www.grantedc.com/
• Samaritan Healthcare http//www.samaritanhealthca
  re.com/
• Moses Lake Community Health http//www.mlchc.org/
  
• Moses Lake Clinic http//www.wvclinic.com/locatio
  ns/MLC.asp
• Port of Moses Lake http//www.portofmoseslake.com
  /
• Columbia Basin Herald http//www.columbiabasinher
  ald.com/
• Aging and Adult Care of Central Washington
  http//www.aaccw.org
• Grant County http//www.grantcounty-wa.com
• Grant County Health District http//www.grantheal
  th.org/

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CI Committee Members

• Anne Henning
• Becky Meyer
• Bev Shuford
• Brenda Teals
• Caren Jacobson
• Dave Helms
• Debe Nuss
• Diana McKinsey
• Emily Dufault
• Fernando Alvarez
• Jane Kim

• Judi Ellis
• Laure Grammer
• Lori Barlow
• Lori Moholt
• Mary Falconer
• Mary Talcott
• Ryan Hopkins
• Spencer Grigg
• Teri Carpentier
• Tracy Fisher
• Tim Varney

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Methods
Community Action
Info / Training
Development
Pre-work
Recruitment
Sample audit

• Walkability
• Map of physical environment
• Non-section specific research

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Methods
Community Action
Info / Training
Development
Pre-work
Recruitment
Sample audit

• Sample audit presented at 1st AC meeting
• Call for volunteers to assist in finishing the
  section-specific audit
• Follow-up recruitment post 1st AC meeting via
  phone / email

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Methods
Community Action
Info / Training
Development
Pre-work
Recruitment

• Forms and instructions for assessment
• Segmentation of ML
• Technology for summarizing results
• Information and training

Sample audit
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Methods
Community Action
Info / Training

• Roll call
• Segmentation of ML
• Process overview
• Size of task

Development
Pre-work
Recruitment
Sample audit
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Methods

• Sections
• Data collection
• Continued follow-up / cheerleading by email
• Trouble-shooting
• Evaluation

Community Action
Info / Training
Development
Pre-work
Recruitment
Sample audit
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1. Recreation physical education
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1. Recreation physical educationSchools

• School district has a written policy requiring
  P.E. K-12
• P.E. per week
• Elementary 60 minutes
• Middle 250 minutes
• High school 450 minutes
• School district has started to implement the
  Health Fitness EALRs

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1. Recreation physical educationFacilities

• Community Schools serves to interface with the
  public regarding public use of buildings,
  community improvement classes, school-related
  volunteer activities
• All school with indoor rec facilities are
  available based on priority areas
• 1st School activities
• 2nd Parks n Rec
• 3rd Other programs
• All schools with outdoor rec facilities
  available to the public after priority areas have
  been accommodated

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1. Recreation physical educationProgramming

• Organized athletics
• Aquatic Center
• Cal Ripken
• Yoga
• City of Moses Lake Walking Program
• Walk Across Washington
• Spring Festival
• Kayaking
• Kickboxing
• Karate
• Thai Chi
• Special Olympics
• Physical activity strengthening
• Dancing
• Skate Park

• ? Parks Recreation Facilities
• ? Parks Recreation Facilities
• ? Parks Recreation Facilities
• ? The Learning Center
• ? Moses Lake City Hall
• ? Moses Lake
• ? Parks Recreation Facilities
• ? Parks Recreation Facilities
• ? Parks Recreation Facilities
• ? Marital Arts Academy
• ? Marital Arts Academy
• ? Parks Recreation Facilities
• ? Hospital
• ? Senior Center
• ? Parks Recreation Facilities

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2. Access to healthy foods
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2. Access to healthy foodsBreastfeeding

• Samaritan Hospital is not considered a Baby
  Friendly Hospital by BFHI standards supported by
  WHO / UNICEF
• ML does not have an official Breastfeeding
  Friendly program for workplaces business, but
  . . .
• Moses Lake Clinic
• Community Health
• Hospital
• ASMI
• Mothers breastfeeding in ML
• Early postpartum ? 90
• At 2 months ? 50
• At 6 months ? 20
• At 1 year ? - -

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2. Access to healthy foodsFarmers market CSA

• Columbia Basin Farmers Market
• Saturday AM mid-June through late October
• Wednesday PM mid-July through mid-September
• ML Grant County farmers represented
• 1 farmer sells apples resells oranges to MLSD
• 5-A-Day message promoted
• Food bank receives inkind donations from local
  processing plants houses the Gleaning program

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2. Access to healthy foodsFood Security

• Poverty status in Grant County, 1999
• 13 of families
• 17 of individuals
• Food assistance
• Food Bank
• Free reduced breakfast lunch
• WIC
• Congregate home-delivered meals

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2. Access to healthy foodsFood Security Seniors
60 population for county was 11,220
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2. Access to healthy foodsFood Security Schools
1998-2001 Grant county 50.7 WA State 31.2
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2. Access to healthy foodsSchools Lunchline

ES no food vending, but Fruitopia no a la carte
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2. Access to healthy foodsSchools Lunchline

• How congruent are breakfast lunch programs with
  Dietary Guidelines for Americans?

• Scale 1not well at all to 5 extremely well
• 50 of ES had 5s!
• Possible association with low SES
• 5 star salad bar
• Nutrition education

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2. Access to healthy foodsGrocery stores
markets
Quality scale 1 poor 2good 3excellent
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2. Access to healthy foodsEating establishments
Healthful food and beverage options include
low-fat, low-calorie, nutrient-dense foods
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2. Access to healthy foodsConvenience stores

• 11 stores assessed
• 9.7 healthful food options
• 1 store with bicycle facilities

• 9 stores
• 2 stores
• 1 store

1-25 car parking 101 car parking 26-50 car
parking
Healthful food and beverage options include
low-fat, low-calorie, nutrient-dense foods
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2. Access to healthy foodsProgramming

• Diabetes class
• WIC / MSS
• Breastfeeding class
• Food Assistance
• Congregate meals
• Home delivered meals
• Weight loss
• Extension Family Nutrition Education Program
  (EFNEP)
• Farmers Market

• ? Hospital
• ? Community Health
• ? Moses Lake Clinic
• Food Bank / Community Services of Moses Lake
• Home and Community Services Offices
• ? Senior Center
• ? Senior Center
• ? TOPS
• ? WSU Cooperative Extension
• ? Civic Center

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3. Infrastructure built environment
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3. Infrastructure built environmentZoning,
permitting, land use
Incorporated land 6843 acres Unincorporated
land 13,361 acres
Land use / zoning maps available in the Comp Plan
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3. Infrastructure built environmentLand use
housing distribution

• Coding encouraging activity-friendly and
  mixed-use communities are encourages in the City
  of Moses Lake Comprehensive Plan

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3. Infrastructure built environmentPublic
works supporting PA

• Miles of street
• Miles of street with sidewalk on at least 1 side
• Proportion of streets with sidewalk on at least 1
  side
• Miles of bikepath, separated from roadway
• Miles of shared path (bikeped) available

• 267 miles
• 97 miles
• 36.3
• 1.9 miles
• 8-foot 1.7 miles
• 10-foot 23.5 miles

Sidewalks of all widths, except for those in the
central business district, are available for
bikeped transportation
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3. Infrastructure built environmentWalkability

• 27 walks taken
• 16 sections
• Individual scales 1 awful to 6 excellent
• Overall scale

26-30 Celebrate! 21-25 Celebrate a little . .
. 16-20 Okay, but needs work. 11-15 Needs a lot
of work 5-10 Call out the NG . . .
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3. Infrastructure built environmentWalkability

• Sidewalks
• Street crossings
• Traffic driver behavior
• Safety
• Appeal
• Overall score
• Scale

26-30 Celebrate! 21-25 Celebrate a little . .
. 16-20 Okay, but needs work. 11-15 Needs a lot
of work 5-10 Call out the NG . . .
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3. Infrastructure built environmentWalkability

• Sidewalks
• Street crossings
• Traffic driver behavior
• Safety
• Appeal
• Overall score
• Scale

26-30 Celebrate! 21-25 Celebrate a little . .
. 16-20 Okay, but needs work. 11-15 Needs a lot
of work 5-10 Call out the NG . . .
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3. Infrastructure built environmentBikeability

• 23 rides taken
• 14 sections
• Individual scales 1 awful to 6 excellent
• Overall scale

26-30 Celebrate! 21-25 Pretty good . . 16-20
Okay, but not ideal. 11-15 Poor call the
mayor! 5-10 Oh dear . . .
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3. Infrastructure built environmentBikeability

• Safety
• Surface
• Intersections
• Drivers
• Ease
• Overall score
• Scale

26-30 Celebrate! 21-25 Pretty good . . 16-20
Okay, but not ideal. 11-15 Poor call the
mayor! 5-10 Oh dear . . .
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3. Infrastructure built environmentBikeability

• Safety
• Surface
• Intersections
• Drivers
• Ease
• Overall score
• Scale

26-30 Celebrate! 21-25 Pretty good . . 16-20
Okay, but not ideal. 11-15 Poor call the
mayor! 5-10 Oh dear . . .
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3. Infrastructure built environmentSchools
walk / bikeability
Moses Lake end of the year enrollment 6395

No schools in New fire station,
Gillete park, or Cascade valley sections
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3. Infrastructure built environmentSchools
walk / bikeability
Moses Lake end of the year enrollment 6395

No schools
in Pelican pt, Montlake park, or Westlake
sections
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3. Infrastructure built environmentParks
walk / bikeability
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3. Infrastructure built environmentParks
walk / bikeability
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3. Infrastructure built environmentPedestrian
/ bike safety 2001
Block watch program within city limits 66 areas
are involved.
Community oriented policing in county.
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