Running head: COMMUNITY INTERVENTIONS FOR WALNUTPORT 1

Community Interventions for Walnutport

Kathy Carte, Madison Pleasants, Megan Sorensen

Cedar Crest College

COMMUNITY INTERVENTIONS FOR WALNUTPORT 2

Abstract

This paper focuses on the utilization of epidemiology to identify priority problems in

Walnutport, PA and subsequently provide goals and community-based interventions in order to

eliminate barriers to reach optimal health. Previously collected data of Walnutport, PA revealed

a lack of nutritional resources and health seeking behaviors. This paper focuses on the

relationship of these determinants and the incidence of chronic disease within the community.

The host, environment, and agent relationship within the community is examined to help

formulate primary, secondary, and tertiary evidence-based interventions. Specific application of

these interventions are aimed towards assisting the public health nurse in creating a more

favorable environment throughout the community and to help break the cycle of disease.

Keywords: public, health, epidemiology, disease, interventions, goals

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Community Interventions for Walnutport

Public health nursing is a scientific study focused on the health distribution and

determinants of a community including their illness and disease (Stanhope & Lancaster, 2016).

Regardless of geographic location, public health depends greatly on epidemiology. According to

Stanhope & Lancaster (2016), epidemiology is, the study of the occurrence and distribution of

health-related states or events in specified populations, including the study of the determinants

influencing such states, and the application of this knowledge to control the health problems. By

utilizing epidemiology, community health nurses can identify frequency of diseases, recognize

patterns, eliminate barriers to disease control, provide education, and most importantly, develop

community-based interventions in order to provide optimal health and disease prevention for all

members of the community.

Priority Problem

The completion of the Data Collection Paper brought attention to the lack of nutritional

resources and healthcare available to residents of Walnutport, PA. The deficiency of nutritional

resources hinders health maintenance of the community thus having negative repercussions.

Substantial data supports the lack of nutritional resources and access to healthcare as the priority

problem. The supporting statistics are related to factors such as transportation, income level,

poverty rates, unemployment rates, education level, and preventable co-morbidities including

associated health behaviors.

Transportation plays a key role in the ability to access nutritious foods and healthcare.

While 90.6% of the population possess or operates a car, truck, van, or motorcycle as their

primary mode of transportation, 0.7% of individuals rely on public transportation. Public

transportation, specifically buses, relies on a set route with pre-determined stops forcing the
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travelers to utilize what stores are available. It is common for bus routes to follow main roads

where chain food restaurants typically exist, making them more accessible to those who use

public transportation. The ability to collect groceries and then successfully travel with them

poses as another obstacle to those using public transportation. In addition, 8.7% of the population

did not report using any mode of transportation. Research revealed the walkability score of

Walnutport, PA to be 31, proving that most errands require a car (Walk Score, 2017). This chain

of events creates a barrier to the individuals ability to access nutritious grocery stores and

healthcare centers. The community health nurse should consider how these individuals have

access to groceries or nutritious food outlets.

Income level influences a persons ability to afford wholesome groceries and healthcare

insurance. It is more financially reserved to purchase a pre-prepared meal from the McDonalds

on Main Street or utilize the local Dollar Store grocery selection than it is to travel to the

farmers market, which is approximately 15 miles away. Although the median household income

for Walnutport is $64,310, a portion of the community suffers financially. Those with income

below poverty level is 7.3% and those with income below fifty percent of the poverty level is

3.2%. It is also important to consider that the unemployment rate of Walnutport is 7.7%.

Husband-wife households comprise 53% of the community, with 17.5% of those households

having children under 18 years old. Therefore, more than half of the community has a family to

feed and over a quarter of those families include children and adolescents. Without sufficient

funds, a person simply cannot manage to pay for healthful foods, especially if there are many

family members to feed. There may be pressure on the family to purchase a higher quantity of

food rather than focusing on the quality of food.

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Educational attainment may be significant when considering the lack of nutritional

resources and related health care in Walnutport, PA. If an individual is not educated on healthy

eating habits and does not understand the importance of choosing nutrient dense foods, that

individual is at a higher risk of unintentionally avoiding nutritional resources, even if those

resources were available. In Walnutport, 7.04% of the community has less than ninth grade

education. Those individuals may never have had the opportunity to learn about the impact of

consuming the required dietary allowance, putting themselves at increased risk for developing

health problems.

Considering this data, the individuals of the community who are uneducated, financially

unstable, have existing disease processes, and rely on public transportation are the most

vulnerable. These factors interplay to contribute to the communitys lack of positive health

behaviors. For example, 17% of individuals admit to tobacco use and 88.8% admit to some

degree of alcohol use. In terms of exercise, 26% of families deny leisure time physical activity.

Some of the top ranked food establishments in Walnutport include pizzerias, ice cream parlors,

and fast food restaurants like Burger King, McDonalds, and Dunkin Donuts. These top ranked

favorites prove that the community enjoys dining at food establishments that lacks nutrient dense

food options. These health behaviors, along with lack of nutritional resources and healthcare

access have an impact on the communitys morbidity and mortality rate. An individual who does

not have prime access to nutritious food options and engages in negative health behaviors is at an

increased risk of developing chronic diseases. In Walnutport, heart disease comprises 30% of the

mortality rate and Diabetes Mellitus makes up 5% of the mortality rate. These two examples are

the result of unhealthy lifestyle choices influenced by lack of resources.

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Nursing Diagnosis

Walnutport, PA prominently shows ineffective health maintenance related to lack of

nutritional resources and related healthcare as evidenced by history of lack of health-seeking

behavior, lack of expressed interest in improving health behaviors, demonstrated lack of

knowledge regarding basic health practices, reported or observed inability to take responsibility

for meeting basic health practices in any or all functional pattern areas, and deficient financial

funds and/or other resources.

Goals

Healthy People 2020 identified one overarching goal that is congruent with the goal of

Walnutport, PA which is to attain high quality, longer lives free of preventable disease,

disability, injury, and premature death (U.S. Department of Health and Human Services, 2017).

Due to the prevelent ineffective health maintence expressed by this community, a multitude of

inteventions are required. The American Public Health Association made a formal statement in

2009 supporting community health workers to increase health access and reduce health inequities

(American Public Health Association, 2009).

Interventions

Primary Prevention

The primary level of prevention aims at preventing the occurrence of disease, injury, or

disability (Stanhope & Lancaster, 2016). Primary preventions for Walnutport, PA will be

focused on breaking the cycle of the disease process and reducing the incidence within the

community as a whole. The community health nurse helps people make lifestyle changes by

group/individual education and gathering the necessary resources to achieve optimum health

(Sommers, Johnson, Roberts, Redding, Churchill, & Elkins, 2013). Data obtained for
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Walnutport, PA revealed prevalent chronic heart disease and diabetes in comparison to

Northampton County. The importance of physical activity and proper nutrition has been

established in reducing rates of deaths from chronic diseases and should be a primary focus in

epidemiology interventions (Macera, 2010). Posting signs for healthy nutrition classes and

websites such as My Plate in various places throughout the community will prompt the

community to connect with the proper resources. Group classes and counseling can inform

individuals about low-fat diets and how the positive impact of physical activity can greatly

reduce the incidence of chronic disease (Stanhope & Lancaster, 2016). Community health nurses

can work with partners to create exercise programs, sporting events, daily walks, and other

physical activities to be held within the community. Healthy People 2010 concluded that healthy

lifestyles which include regular physical activity and appropriate dietary intake greatly reduce

the chances of developing heart disease, diabetes, stroke, osteoporosis, and obesity (Stanhope &

Lancaster, 2016).

Easy accessibility and affordability of primary interventions are significant factors in

increasing the likelihood of participation. This is especially momentous in Walnutport, seeing as

most residents rely on walking as their main means of transportation and 7.3% live below

poverty level. Partnerships can be created with neighboring communities, local farmers, or other

programs to bring the necessary nutritional items to Walnutport for utilization. This primary

intervention will assist familys chances of purchasing quality food items and aid in consumption

of a more favorable healthy diet (Macera, 2010).

Another area that primary prevention can offer specialized protection from unwanted

disease is water sanitation and supplemental fluoridation of those water supplies (Stanhope &
COMMUNITY INTERVENTIONS FOR WALNUTPORT 8

Lancaster, 2016). Scientific research has shown supplementing a water supply with fluoride is

safe and effective in the prevention of tooth decay by 25% (American Dental Association, 2017).

Fluoride is a major benefit to adults and children in decreasing tooth extractions, infections, and

pain (Center for Disease and Control, 2017). Fluoridation of the communitys water supply is a

cost effective way to help ensure good oral/dental health throughout Walnutport.

Educating children and adolescents about the dangers of smoking can help reduce the

chances of developing a chronic respiratory disease later in life (Sommers et al., 2013). Smoking,

second hand smoke, and any inhaled irritant can increase the chance for developing a multitude

of respiratory and heart disease (Ignatavicius & Workman, 2016). Data collection revealed that

individuals residing in Walnutport have a 43.2% chance of developing cancer based on the poor

air quality. This data confirms the residents are at risk even without practicing risky health

behaviors, such as smoking. Primary interventions should be aimed towards reducing the

initiation of tobacco and alcohol use among children, teens, and young adults (Stanhope &

Lancaster, 2016). These substances are proven to increase incidence of acute and chronic heart

disease or illness (Ignatavicius & Workman, 2016). The community health nurse can connect

with this aggregate group through school programs and youth groups. Coordinated school health

programs have the potential to help the younger population resist peer pressure and getting

involved in substance abuse and/or smoking (Macara, 2010).

All of these interventions reiterate the goal of primary prevention, which is to prevent the

initial occurrence of risky behaviors, disease, and/or illness (Sommers et al., 2013).

Secondary Prevention

People living with prevalent chronic conditions such as heart disease, cancer, diabetes,

stroke, and chronic lung disease account for 75% of healthcare expenditures in the United States
COMMUNITY INTERVENTIONS FOR WALNUTPORT 9

(Ahn, Basu, Smith, Jiang, Lorig, Whitelaw, & Ory, 2013). It is possible that some individuals

living in Walnutport, PA may be unaware that they have one or more chronic diseases because

they have not yet been diagnosed. An important role of the community health nurse is early

detection and prevention of complications of certain conditions. Secondary prevention involves

interventions intended to increase the likelihood that an individual with a disease will have that

condition diagnosed at a stage when treatment is likely to result in cure (Stanhope & Lancaster,

2016). Blood pressure screenings for individuals within the community, especially children and

adolescents, is an example of secondary intervention. Blood pressure screening for hypertension

in children and adolescents may provide community health nurses with early identification of

primary hypertension, leading to further interventions to reduce blood pressure during childhood

and adolescence, resulting in a reduced risk for cardiovascular events and death in adulthood

(Moyer, 2013).

Implementation of regular mammograms for women over the age of 40 is considered a

secondary prevention intervention that can be implemented in Walnutport, PA in order to

improve the quality of life for women. The aggregate group of women age 40 and over who live

in Walnutport have the potential to benefit from regular mammograms because early detection

and diagnosis of breast cancer has immense benefits. According to Starting (2012), women

whose breast cancer was not diagnosed by mammography were more likely to be diagnosed with

a stage II or higher tumor than were women in whom breast cancer was diagnosed by

mammography and were more likely to have a mastectomy, undergo surgery, radiation therapy,

chemotherapy and have poorer 5-year survival rates.

Individuals previously diagnosed with diabetes should be provided with secondary

prevention in the form of education on self-care techniques in order to address the continued
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needs and demands of their chronic disease. According to S. Shrivastava, P. Shrivastava, &

Ramasamy (2013), there is a four-fold increase in diabetic complications for those individuals

with diabetes who had not received formal education concerning self-care practices. Examples of

education topics for those with diabetes include healthy eating, being physically active,

monitoring of blood sugar, compliant with medications, good problem-solving skills, healthy

coping skills and risk-reduction behaviors (P. Shrivasta et al., 2013).

By implementing these secondary prevention interventions in Walnutport, PA,

community health nurses have the resources available for early detection and/or prevention of

complications of existing chronic disease experienced by individuals within the community.

Tertiary Prevention

Tertiary prevention comprises interventions intended at limitation of disability and

rehabilitation from disease, injury, or disability (Stanhope & Lancaster, 2016). As previously

stated, a significant portion of Walnutport, PA residences currently suffer from existing disease

processes which have the potential to be controlled and/or resolved with proper interventions. A

crucial aspect of disease management is medication therapy this is where the link between lack

of transportation and healthcare access is created. Transportation barriers lead to rescheduled or

missed appointments, delayed care, and missed or delayed medication use. These consequences

may lead to poorer management of chronic illness and thus poorer health outcomes, (Syed,

Gerber, & Sharp, 2013). Walnutport, PA may benefit from a community health center that

focuses on management of chronic diseases proved to impact communities greatly. The health

center may other services such as delivery of medications to the patients home, clients without

insurance can speak to a case manager directly, and proper dietary nutrients can be easily

sourced. By eliminating the barrier public transportation causes, chronic diseases can be
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managed by a local healthcare professional, as opposed to seeking care outside of the district.

Additionally, an increase in healthcare access and nutrient rich grocers enhances the advantages

of walkability within the community.

Furthermore, Stanhope & Lancaster (2016) stated the institution of occupational or

vocational rehabilitations in the community setting has immense health benefits while urging

patients to return to work. Occupational therapy (OT) aims to expedite maximum use of physical

mobility in relation to ones entire livelihood including work. Although OT impacts an

individuals return to work, pain-level and emotional well-being needs to be assessed with these

physical improvements (Desiron, Rijk, Hoof, & Donceel, 2011). By having a nursing

intervention based around collaboration, the community can connect with additional services

specific to their disease process. The ability to work is the driving force behind any economic

system.

Support groups are often utilized by patients with chronic diseases, as well as their family

members and/or caregivers. Within the community, supportive peer interventions range greatly

in format from small groups to cyber-based chats. Regardless of the format, all groups focus on

similar goals, including the emotional strain of chronic illness, disease management techniques,

and positive role modeling. The combined data concluded that clients and mentors with chronic

disease benefited from peer groups by expressing a sense of connection, experiential knowledge,

finding meaning, identifying isolation, sharing, helping, empowerment, changed outlook,

changed behavior, and changed knowledge (Embuldeniya et al., 2013). It is crucial for all the

expressed areas to be felt by the Walnutport, PA community.

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Evaluation

Although there will not be an evaluation completed for the goal of attaining a high

quality, longer life free of preventable disease, disability, injury, and premature death, this step is

important to improve and account for public health actions by using methods that are useful,

feasible, ethical, accurate (Stanhope & Lancaster, 2016). The aspects of evaluation include

relevance, adequacy, progress, efficiency, effectiveness, impact, and sustainability (Stanhope &

Lancaster, 2016). These aspects assist the community health nurse to evaluate the need for the

program, examine how well the program addresses the extent of the need, tracks the program

activities to meet program objectives, assesses the relationship between the program outcomes

and the resources present, considers the ability to meet program objectives and the results of

program efforts, analyzes the long-term changes in the client population, and judges whether or

not there is enough resources available to continue the program (Stanhope & Lancaster, 2016).

Conclusion

Walnutport, PA experiences lack of nutritional resources and access to healthcare

resulting from absence of reliable transportation, insufficient income, low educational status,

negative health behaviors, and unhealthy food options. The goal of attaining high quality, longer

lives free of preventable disease, disability, injury, and premature death can be accomplished

though primary, secondary, and tertiary prevention interventions. Through these interventions,

the community of Walnutport, PA has the potential to flourish into a healthy, active community.
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