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Healthy People 2020 is the initiative supported by the U.S. Department of Health and Human Services that is oriented to improving the health status of the nation (Healthy People 2020, 2015). The Public Health Nursing Assessment Tool (PHNAT) is developed according to the concepts reflected in Healthy People 2020 to assess the current needs of the population and to propose the further implementation of programs effective to address the identified issues (Trujillo-Londirgan & Lewenson, 2013, p. 64). The planning, implementation, and evaluation of programs are expected to be realized with references to the MAP-IT framework where the main focus is on mobilizing, assessing, planning, implementing, and tracking the program (Healthy People 2020, 2015). One of the prioritized issues reflected in the Healthy People 2020 project and in the needs assessment of the community in Collier County, Florida, is the problem of obesity in adult population (The Health Planning Council of Southwest Florida, 2013, p. 12). The Community Health Improvement Plan proposed in the community as the program to address the issue of obesity should be discussed in the context of the MAP-IT framework and with references to the planning and evaluation model presented in the PHNAT tool.
The Community Health Improvement Plan
One of the topics reflected in Healthy People 2020 project is Nutrition and Weight Status. In relation to Collier County, the health authorities focus on accomplishing the objective NWS-9: “Reduce the proportion of adults who are obese” (Healthy People 2020, 2015, para. 8). In 2010, the percentage of obese adults in Collier County was 22.40%, and following the objectives of Healthy People 2020 project, it was important to decrease significantly these numbers because there was no observed progress in the community since 2007, when the percentage of obese persons was 22.00% (The Health Planning Council of Southwest Florida, 2013, p. 13). The Community Health Improvement Plan (CHIP) is designed in order to address the main health issues in the community, including obesity, access to care, chronic diseases, unsafe sex, and communicable diseases.
In this context, the CHIP is rather effective to address the problem of obesity in adult population, to achieve the objective, and to improve the health status of the community because of determining the solution of the overweight issues as the priority in Collier County (Sacher, Kolotourou, Chadwick, Cole, & Lawson, 2010, p. S62). According to the PHNAT, the proposed interventions can be realized at the levels of individual and family, community, and system (Trujillo-Londirgan & Lewenson, 2013, p. 98). The Department of Health in Collier County focused on the community level of practice and proposed the coalition building as the approach to address the issue of obesity in adults. Thus, the Department of Health in Collier County determined the target audience including adults with BMI more than 30, formulated the goal as the decrease of the percentage of obese adults in the community, and initiated the creation of the CHIP Coalition for formulating further recommendations for the community.
The MAP-IT Framework
According to the MAP-IT framework, the first stage of the program development process is the process of mobilizing individuals and representatives of organizations in order to build a strong coalition. The Department of Health in Collier County took responsibility for inviting the representatives of Florida Department of Health, Health Care Network of Southwest Florida, and Health Planning Council of Southwest Florida for creating the CHIP Coalition. Following the MAP-IT framework, the second stage was the assessment of the community’s needs. Obesity was identified as one of the most problematic health areas in Collier County (Alfano-Sobsey, Ledford, Decosimo, & Horney, 2014, p. 376; Jack & Holt, 2008, p. 51; The Health Planning Council of Southwest Florida, 2013, p. 12). Furthermore, it was determined that the community had the limited resources to address the problem according to the objectives stated in Healthy People 2020 project. It was found that more attention should be paid to educating the community’s representatives regarding the principles of healthy eating and diet in order to decrease the percentage of obese persons in the community.
The next stage is planning. The CHIP Coalition planned to propose actions that could be effective to decrease the rates of obesity in adults in the community. As a result, the CHIP Coalition proposed the action steps including the quarterly meetings in order to formulate recommended actions and the development of reports on activities appropriate for the citizens of Collier County (Morrison-Sandberg & Johnson, 2011, p. 14; Ogden, Carroll, Kit, & Flegal, 2014, p. 807). The plan of action also included the statement about the leadership and responsibility of the CHIP Coalition to implement and monitor the program. Thus, the part of the Community Health Improvement Plan related to the issue of obesity was planned to be realized during the period of January 2014 – September 2015.
The phase of implementing the plan also included steps regarding the monitoring of the success in completing the set tasks. Much attention was paid to the progress in developing reports as a result of the planned meetings that were conducted quarterly. The implementation was realized by the leaders of the CHIP Coalition in cooperation with the Department of Health in Collier County, and the monitoring was realized with the focus on participation of representatives of Florida Department of Health, Health Care Network of Southwest Florida, and Health Planning Council of Southwest Florida.
The final phase of the program development and realization that can be discussed with references to the MAP-IT framework is tracking and evaluation (Ziebarth, Healy-Haney, Gnadt, Cronin, & Jones, 2012, p. 262). The analysis and evaluation of the data collected in December 2014 demonstrated that the coalition followed the plan of defining recommendations for the community in order to contribute to overcoming the problem of obesity in Collier County. The final recommendations proposed for the community are expected to be announced in September of 2015.
Conclusion
The Community Health Improvement Plan implemented in Collier County for addressing the problem of obesity in the community can be discussed as the effective intervention if the leaders responsible for completing the program implement all the action steps within the set time framework. Furthermore, much attention should be paid to the further evaluation of the program’s effectiveness with references to measuring the percentage of adults in the community who suffer from overweight or obesity. The main focus should be on proposing efficient recommendations in order to reduce the current number in 22.40% of obese persons in the community according to the objectives of Healthy People 2020. These recommendations should be implemented at the community level, involving not only individuals but also organizations in the process of improving the weight status in Collier County.
Summary
Health needs and objectives indentified as priorities in the communities’ health programs and plans are usually determined as a result of assessments conducted with the help of the PHNAT, and they are reflected in Healthy People 2020 (Healthy People 2020, 2015). The paper provides the discussion of the Community Health Improvement Plan (CHIP) designed for Collier County to address the obesity issues among other health priorities in the context of the MAP-IT framework that was proposed by Healthy People 2020, and for which the PHNAT is developed. Following the assessment, planning, and evaluation stages presented in the PHNAT, it is possible to classify the CHIP as the program based on building coalition and implemented at the community level.
According to the MAP-IT framework, the CHIP was developed and implemented according to five steps proposed within the model (Trujillo-Londirgan & Lewenson, 2013, p. 64). Much attention was paid to mobilizing, assessment, and planning steps. The leaders of the developed CHIP Coalition invited representatives of Florida Department of Health, Health Care Network of Southwest Florida, and Health Planning Council of Southwest Florida; assessed obesity in the community as the priority; and planned action steps based on development of recommendations for all the categories of the adult population in Collier County. Implementation and evaluation steps were planned according to the set time framework. Much attention was paid to the monitoring of the CHIP Coalition’s activities and their progress in relation to developing recommendations on reducing the obesity rates in the community. Evaluation was realized with references to the analysis of reports and previously formulated actions for the adult population to decrease weight.
References
Alfano-Sobsey, E., Ledford, S., Decosimo, K., & Horney, J. (2014). Community health needs assessment in Wake County, North Carolina: partnership of public health, hospitals, academia, and other stakeholders. North Carolina Medical Journal, 75(6), 376-383.
Healthy People 2020. (2015). Web.
Jack, K., & Holt, M. (2008). Community profiling as part of a health needs assessment. Nursing Standards, 22(18), 51-56.
Morrison-Sandberg, L., & Johnson, K. (2011). Obesity prevention practices of elementary school nurses in Minnesota: Findings from interviews with licensed school nurses. The Journal of School Nursing, 27(1), 13-21.
Ogden, C., Carroll, M., Kit, B., & Flegal, K. (2014). Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA, 311(8), 806-814.
Sacher, P., Kolotourou, M., Chadwick, P., Cole, T., & Lawson, M. (2010). Randomized controlled trial of the MEND program: a family-based community intervention for childhood obesity. Obesity, 18(1), S62-S68.
The Health Planning Council of Southwest Florida. (2013). Collier County Florida: Health assessment. Web.
Trujillo-Londirgan, M., & Lewenson, S. B. (2013). Public health nursing: Practical population based-based care. Burlington, MA: Jones and Bartlett Learning.
Ziebarth, D., Healy-Haney, N., Gnadt, B., Cronin, L., & Jones, B. (2012). A community-based family intervention program to improve obesity in Hispanic families. WMJ, 111(6), 261-266.
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