Running head: CT 7 COMMUNITY REPORT 1

Census Tract 7 Community as Partner Report

Jillian Weber, Shannon Merz, Carolina Ley, Kylie Newman

The University of Arizona College of Nursing

CT 7 COMMUNITY REPORT 2

Census Tract 7 Community as Partner Report

A key component of population health nursing is conducting a community assessment to

determine strengths and needs and develop a relevant program to address such issues. The

authors referenced in the title page of this report conducted a community assessment of Census

Tract (CT) 7 over a five-week period from January to February 2018, which included windshield

surveys, key informant interviews, and collection of demographic information. Based on the data

collected, strengths and stressors were compiled to create a Priorities of Care (POC) Table and

formation of a community nursing diagnosis. Upon this, we developed a Health Education

Project for a population within this community.

Community Nursing Assessment

Community Core

To begin assessing a community, one must first look at the core and what makes it

unique. Anderson and McFarlane (2015) identify the core of a community as the people who live

there including their history, specific characteristics, values, beliefs, and wants. An important

feature of the core to consider is the demographics. The majority of CT 7 is comprised of

individuals who identify as White, which is closely comparable to Pima County as a whole. The

next largest ethnic group consists of those identified as Latino/Hispanic which comprises a larger

proportion of the population compared to Pima County. Interestingly, there are a greater amount

of those within the Asian race compared to Pima County and a drastically smaller population of

Native Americans compared to Pima County. Overall, this CT is relatively older with a majority

of individuals being older than age 20, with a smaller proportion being teenagers or younger in

comparison to Pima County. Furthermore, approximately a quarter of CT 7 is bilingual, thereby

reflecting the diverse population and Southwestern culture found here in Tucson. As we
CT 7 COMMUNITY REPORT 3

conducted our windshield survey, the diversity of this community was even more apparent as we

identified various ethnic food stores and restaurants as well as a wide variety of religious

centers/churches ranging from Baptist to Scientology. Now that we had a relative grasp on the

community core, we began to assess the various subsystems starting with the physical

environment extending from 9th and 10th St. to the North, Country Club Blvd. to the East, 21st

St. to the South, and Highland and Cherry Ave. to the West (Pima County Health Department

Public Health Nursing Community Profile CT 7, 2018).

Physical Environment

As described by Anderson and McFarlane (2015), assessing the physical environment of

the community is the equivalent of conducting a physical assessment on a patient to identify

areas of concern. CT 7 is a high-traffic community with much diversity. As we conducted a

windshield survey through the CT, we noticed nearly 20 vacant buildings along Broadway

Boulevard (Blvd), several buildings and structures with graffiti, no new construction, and a high

population density relative to size. The noise level was predominantly high surrounding business

areas located along Broadway Blvd., and an indistinct smell of exhaust fumes and food were

present. Neighborhoods on the other hand, were calm and quiet, with well-kept lawns and plants.

A substantial portion of the homes found in this community are at least 50-year-old single family

homes. One key feature we noted through observation was poor pavement conditions throughout

the CT. There were a multitude of potholes and uneven areas in high-transit streets that can

jeopardize safety for members of this community (Pima County Health Department Public

Health Nursing Community Profile CT 7, 2018).

Health and Social Services

In addition to physical environment, access to health and social services greatly impacts
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the overall health of any community. With regards to CT 7, this access is even more imperative

as a prominent transient population exists that requires accessible and affordable care. One

strength for this community is its proximity to Banner University Medical Center-Tucson, which

serves as Southern Arizona’s only Level One Trauma Center. There are also many mental health

service clinics/agencies located either within or directly outside this CT such as: CODAC, La

Frontera, Innersenses, Child and Family Resources Inc., and Watershed Addiction Treatment

Program Center. There was no long term or assisted living facilities in the CT. With

consideration to urgent care facilities, there was only one within the CT, FastMed Urgent Care.

Other services include: three integrative medicine clinics, Safeway and Walgreens pharmacies,

various private dental/medical practitioner offices, The Diaper Bank of Southern Arizona,

Teenage Parent High School, and The American Red Cross (Pima County Health Department

Public Health Nursing Community Profile CT 7, 2018).

Education

Education is a vital component of the community and provides valuable insight. CT 7

falls under the Tucson Unified School District and has six schools including public, charter, and

private schools. One of the education facilities in this community was a Native American school,

however, the Native American population for this census tract is significantly lower than that of

Pima County. Of significance, the Teenage Parent High School (TAP) is a public school that

offers childcare services for students continuing their education, providing flexibility and support

for young parents. The closest library to this community is Himmel Park Library, which is

outside of CT 7, providing many resources to the community such as printing, education, family

activities, and many others. Overall, there is a higher percentage of individuals with a Bachelor’s

Degree or higher compared to that of Pima County (Pima County Health Department Public
CT 7 COMMUNITY REPORT 5

Health Nursing Community Profile CT 7, 2018).

Economics

Resource allocation and relative wealth of a community are components of the economic

subsystem in the community-as-partner model (Anderson & McFarlane, 2015). During our

windshield survey, we observed multiple restaurants, fast food chains, and gas stations. In

addition, there is a large shopping mall center with stores, supermarkets, restaurants, and a

theatre located east of this CT. Statistically, the median household income for CT 7 is lower

compared to that of Pima County as well as the percentage of single female householders. An

interesting characteristic of this community is the percentage of individuals with no health

insurance coverage which is like that of the county (Pima County Health Department Public

Health Nursing Community Profile CT 7, 2018).

Transportation and Safety

The ability of community members to navigate their way around and feel safe also affects

their overall health. CT 7 is a busy section of Tucson, hence, there are multiple methods of

transportation providing easy access for community members and those in surrounding areas.

Such methods include the Sun Tran bus network which has 29 bus stops within this CT. In

addition, there are multiple bike paths that run through and around the area, thereby, providing

an easy alternative to driving. With regards to safety, the CT is patrolled by Tucson Police

Department and the nearest fire station is the Tucson Fire Department Station No. 3 which lies

approximately one mile from the center of the CT. There exist considerable amounts of drug

abuse in the area which correlates with high crime rates. Also of concern, heavy traffic is a

hazard within the area due to poor road conditions and limited crosswalks. Furthermore, we

noticed sparse street lamps within the residential part of the CT, especially off main roads (Pima
CT 7 COMMUNITY REPORT 6

County Public Health Department Public Health Nursing Community Profile CT 7, 2018).

Recreation

The major hub of recreational activity resides outside of this CT at the nearby Reid Park.

Reid Park is open all day, every day and includes popular sites such as: a rose garden, duck pond,

dog park, child playgrounds, the zoo, picnic areas, and Arroyo Chico Park (greenway). Other

parks within the tract include Cherry Park and the Rincon Vista Sports Complex, although, they

are not open for public use. Interestingly, we did not observe any neighborhood centers and there

was only one gym that is open just six days a week (Pima County Public Health Department

Public Health Nursing Community Profile CT 7, 2018).

Politics and Government

Given this CT is within city limits and in a central location, there are many small

neighborhoods throughout. City wards, county districts, and most state legislative representatives

are politically affiliated with the Democratic Party. The two United States Congressional District

Representatives are Raul Grijalva and Martha McSally, Democrat and Republican respectively.

During the windshield survey, we noticed several political signs throughout the neighborhoods

depicting support and integration of refugees and immigrants, protecting lives of minority

groups, and political campaign posters and bumper stickers on parked vehicles (Pima County

Health Department Public Health Nursing Community Profile CT 7, 2018).

Communication

Communication is a critical aspect of community health nursing as it serves as an outlet

to inform the community of current events, resources, and other vital information. In this CT, we

noticed one of the main sources of information distribution is the Arizona Daily Star Newspaper,

which gets delivered to homes regularly. Little to no bulletin boards were observed in
CT 7 COMMUNITY REPORT 7

neighborhoods and inside businesses providing resources or health information. There were no

payphones, however, a handful of businesses in this CT offered free wireless internet to their

customers (Pima County Health Department Public Nursing Community Profile CT 7, 2018).

Community Nursing Diagnosis

Community Strengths

Through interviews, observations, and internet resources we discovered CT 7 has

multiple strengths that are beneficial to the community. The first of these are the many

partnerships and outreach programs targeting a wide variety of the CT population. An example is

the partnership between TAP and the Pima County Health Department (PCHD). PCHD

transports a mobile clinic to the high school to provide information and services regarding birth

control (Teen Parent High School Teacher, personal communication, January 26, 2018). Another

strength of the community was its diversity. The windshield survey provided great insight as

there were signs in the community welcoming people of different races and backgrounds

including signs such as “Black Lives Matter” and “Refugees Welcome” posted in yards. A third

strength of this community is its easy access to transportation. While conducting the windshield

survey, we observed multiple bus stops, bike paths, and walking paths. These were all easily

accessible to the community which makes getting places safer and easier (Pima County Health

Department Public Health Nursing Community Profile CT 7, 2018).

Community Stressors

Along with strengths, we also identified many stressors within the CT, which were also

highlighted by multiple key informants. One of the main concerns of the community was

substance abuse, which was brought up multiple times during key informant interviews. The

Safeway manager mentioned that used needles are often found in the bathroom (Safeway
CT 7 COMMUNITY REPORT 8

Manager, personal communication, January 26, 2018). Other key informants mentioned

substance abuse as a significant problem within the community, thereby, highlighting the

significance of this issue. Limited health literacy is also a concern in this CT as identified by

several key informants such as the TAP educator and a firefighter. The firefighter elaborated that

there is a drastic need to educate the community regarding when to contact emergency services

as they receive a high volume of nonemergent calls (Firefighter, personal communication,

January 26, 2018). Lastly, mental illness and homelessness are of significant concern for this CT

based on our windshield survey and various key informant interviews such as the Safeway

Manager and Himmel Park Librarians. The librarians mentioned the need for more resources

pertaining to the homeless population (Himmel Park Librarians, personal communication,

January 26, 2018).

Nursing Diagnosis

After analyzing the stressors of this community, we categorized them within a POC Table

to establish our priorities and highlight the greater needs of the community. Refer to Appendix A

for the complete POC Table. According to the assessment findings from the windshield survey,

key informant interviews, and POC Table, we determined our Health Education Project (HEP)

would target teenage parents at TAP with the overall goal to improve health literacy by educating

them on negative effects and alternatives to screen time. Refer to Appendix C for picture of HEP.

We then constructed our nursing diagnosis as risk for impaired child development among

children related to limited health literacy and lack of knowledge regarding the negative effects of

screen time as evidenced by key informant reports of cellphone and tablet use with children.

Community Nursing Plan

Good Goal and Proposed Intervention

CT 7 COMMUNITY REPORT 9

Prior to planning our intervention, we composed a Good Goal which was to increase

teenage parents’ knowledge regarding the effects of screen time on the development of their

child and alternative activities to initiate instead. Since young children and the U. S. population

are exposed to increasing amounts of technology and associated screen time, we proposed the

active learning health education project during a health class at the Teenage Parent High School

to address the composed goal. The date on which this is to occur is still being determined by

TAP staff.

Evidence-Based Support from the Literature

To make our health education intervention more effective, we searched for evidence that

highlighted the best way to teach teenagers. As a result, we found a level four article that was

applicable to our target population. According to this article by Johnson and Barrett (2017),

promoting active learning in place of simple presentations/lectures involves the students to

critically think, collaborate, and reflect on their actions. This enables students to interact with the

material being taught, thereby, resulting in deeper learning and overall understanding.

Healthy People 2020 Support

Our proposed intervention and topic falls under Healthy People 2020’s fourth

Overarching Goal to “Promote quality of life, healthy development and healthy behaviors across

all life stages” (U.S. Department of Health and Human Services. Office of Disease Prevention

and Health Promotion. Healthy People 2020, 2018a). We decided the most relevant goal was

under the topic Educational and Community-Based Programs. Within that topic, we found that

Objective 4.3 was most applicable as it stated the goal was to increase the proportion of schools

that provide health education related to growth and development to promote personal health and

wellness (U.S. Department of Health and Human Services. Office of Disease Prevention and
CT 7 COMMUNITY REPORT 10

Health Promotion. Healthy People 2020, 2018b).

SMART Objectives

We formulated three SMART objectives to evaluate the health education presentation.

First, by the end of the presentation, 80% of teenage parents will be able to list at least four

alternative activities to help reduce their child’s screen time. Secondly, by the end of the

presentation, 80% of teenage parents will be able to state the recommended screen time for their

individual child. Lastly, 80% of teenage parents will be able to identify at least two negative

effects too much screen time has on their children by the end of the presentation. These

objectives were evaluated utilizing the survey found in Appendix B.

Program Plan

The program plan for the project consisted of five program activity statements and one

additional activity to evaluate the project. The first program activity was that we would meet

with the health teacher of TAP at the school and discuss possible topics for the presentation by

February 2nd. By February 8th, we would have a date coordinated with the TAP educator to

present our HEP. By February 15th, our goal was to have our teaching outline and presentation

board approved by our public health nursing instructor. On February 16th, we planned present

our teaching project at TAP at the predetermined time. That same day, participants were

expected to complete the same survey before and after the presentation to determine the amount

of knowledge obtained through the active learning activity.

Collaborative Efforts

We collaborated with many community partners including the PCHD, Public Health

Nurses (PHNs), the TAP health educator, and our public health clinical instructor throughout the

duration of this project. The PHN referred us to TAP as she had previously identified a need for
CT 7 COMMUNITY REPORT 11

health education among this specific population. In addition, she provided materials beneficial to

our HEP from the PCHD. When we met with the TAP health educator, we brainstormed various

relevant topics for our HEP. Our clinical instructor guided us through our program planning by

checking our progress periodically and revising materials to enhance health literacy. She also

provided a poster board and printed out essential materials needed for our HEP.

Level of Prevention

The level of prevention addressed in this project was primary prevention. According to

Community as Partner, primary prevention targets a generally healthy population to improve the

well-being to make them less vulnerable to stressors such as disease and dysfunction through

health promotion (Anderson & McFarlane, 2015). Our health project targeted generally healthy

teen parents with the goal of teaching them about the adverse effects of too much screen time on

their kids through a health promotion program. The population of children were at risk but had

no disease so according to the natural history of a disease they are in the stage of susceptibility

(CDC, 2012).

Resources and Constraints

During this project, many resources were readily available. For one, we had a large space

available to us at TAP to present our materials to the students. Another great resource we had

were materials to create our visual aid for the project and baby books we could give to the

students to utilize with their child at home. Some constraints we had included lack of attendance

to our presentation as no one showed up to class the day of due to weather conditions. We also

faced the constraint of timely communication between the TAP health educator and our group,

thereby, making it challenging to implement our HEP.

CT 7 COMMUNITY REPORT 12

Implementation and Evaluation of Community Nursing Intervention

In community health and program planning, unexpected events are not uncommon. This

creates a challenge to present information to the target audience. In our situation, adverse

weather conditions made it difficult for teenage parents to attend class, causing us to reschedule

the presentation for a later date. At this time, we are unable to evaluate the effectiveness of our

evaluation, however, we did create a four-question survey to be taken before and after the

presentation to assess changes in knowledge according to the information presented. The

questions assessed their knowledge on the recommended screen time for young children,

alternative activities to screen time, and negative effects of excessive screen time on a child’s

development. Refer to Appendix B for sample survey.

Conclusion

The Community as Partner Project was an educational experience for the students as well

as the public. During this experience, we learned to keep an open mind when approaching the

community and be willing to explore places we have not been before. We were able to learn a

vast amount about the community we live in, the opportunities, and services available.

Recommendations would be to include a back-up plan location if we were suddenly unable to

present at our planned location. We have disseminated what we learned about CT 7 by presenting

this project and distributing this report to the PCHD, relevant PHNs, and Tucson Unified School

District. As previously mentioned, we were unable to disseminate our HEP information due to

unforeseen scheduling constraints.

CT 7 COMMUNITY REPORT 13

References

Anderson, E. T., & McFarlane, J. (2015). Community assessment: Using a model for

practice. In E. T. Anderson, & J. McFarlane (Eds.), Community as partner: Theory and

practice in nursing (7th ed., pp. 167 ̶ 208). Philadelphia: Wolters & Kluwer.

Centers for Disease Control and Prevention [CDC]. (2012). Section 9: The natural history and

spectrum of disease. Retrieved from

http://www.cdc.gov/ophss/csels/dsepd/ss1978/lesson1/section9.html

Johnson, H. A., & Barrett, L. C. (2017). Your teaching strategy matters: How engagement

impacts application in health information literacy instruction. Journal of the Medical

Library Association. doi: 10.5195/jmla.2017.8

U.S. Department of Health and Human Services. Office of Disease Prevention and Health

Promotion. Healthy People 2020. (2018a). About healthy people. Retrieved from

https://www.healthypeople.gov/2020/About-Healthy-People

U.S. Department of Health and Human Services. Office of Disease Prevention and Health

Promotion. Healthy People 2020. (2018b). Educational and community-based programs.

Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/educational-

and-community-based-programs/objectives
Running head: CT 7 COMMUNITY REPORT 14
Appendix A

Priorities of Care Table

Community Identified in Severity of

Community Nursing Availability Applicable

Total score
health concern Pima outcome(s)
expression students’ of resources HP2020 Ideas for nursing intervention
or problem, County’s without
of interest in ability to relevant for Determinant (Use Minnesota Wheel)
(stressor, risk Health effort to
addressing address addressing of Health
factor, need, Needs address
problem2 problem problem category
determinant) Assessment1 problem

Lack of street
1 0 0 1 1 Physical Advocacy: Write a letter to the city council 3
lights
Environ regarding the addition of street lamps in
Tucson neighborhoods.

Social Collaboration: Partner with organizations in

Substance Environ the community such as the Needle
2 4 2 2 2 12
Abuse Exchange Program to help address the
negative impact of substance abuse in the
community.

Health Health Teaching: Address the limited health

Limited health
1 4 2 2 1 Services literacy need at the Teenage Parent High 10
literacy
School by providing a one-hour health
education class.

Biology and Screening: Screen high-risk individuals for

Mental Illness 2 4 1 2 2 11
Genetics mental health issues and explore early
prevention measure/coping skills with such
individuals.

Note. 1 Score 1 point if consistent with report findings as a concern in Pima County. Score 2 points if 1 of Pima County’s 4 priority areas: Anxiety and Depression; Substance
abuse; Injuries and accidents; Diabetes. From “Pima County Health Needs Assessment Snapshot”. 2Community Expression of Interest (second column) is double weighted to
emphasize its importance. Key: 0 = low, 1 = moderate, 2 = high. Adapted from “Community Health Diagnosis in Nursing” by M. A. Muecke, 1984, Public Health Nursing, 1, p.
31; and “Community Assessment and Evaluation” by G.F. Shuster, 2010, in M. Stanhope and J. Lancaster (Eds.) Foundations of Nursing in the Community, Communitcy-Oriented
Practice, 3rd ed., p. 232. St. Louis: Mosby/Elsevier/Evolve.
Running head: CT 7 COMMUNITY REPORT 15

Appendix B

Survey
1. What is the most screen time babies under 2 should have?

a. 1-2 hours per day

b. 0 hours per day

c. 30 minutes per day

d. 1 hour per day

2. What is the most screen time children over 2 should have?

a. 1-2 hours per day

b. 3 hours per day

c. 4-5 hours per day

d. 7 hours per day

3. How can screen time hurt your child?

a. _____________________________

b. _____________________________

c. _____________________________

4. Circle the things you can do instead of screen time.

Reading Using mirrors Singing

Dancing Video Games Painting

Walking Watch movie Instagram

Computer Going to the zoo Dress-up

CT 7 COMMUNITY REPORT 16

Appendix C