Local Links:  The Washington State Community 
Nutrition Assessment Education Project
 

blueball.gif (905 bytes)Clark County
The Heart Healthy Community Program

rainbow1L.gif (2251 bytes) 
| Return to Case Studies Home Page | | Return to Home Page | | Return to Table of Contents |
 

Methods

| Phase I | | Phase II | | Implementation |
  
Assessment of BRFSS Data 

The local health jurisdiction conducted a local BRFSS in 1996. The survey included 587 residents who were reached through random digit dialing. The committee examined the results from BRFSS questions that applied to heart health with a focus on behaviors. The nutrition related questions included those related to: 

  • Fruit and vegetable consumption 
  • Weight control 
  • Preventive counseling services 
  • Tobacco use 
  • Physical activity
See BRFSS results for Clark County. 

Phase I

Assessing Physician Counseling Behaviors

Data from BRFSS and surveys of physician services were the primary sources of assessment information in the first phase of the committee's work. The committee surveyed local physicians to determine the level of physician counseling on risks and personal health changes for tobacco and exercise. Addresses were obtained from the Washington State Department of Licensing. The survey was only one page and a reminder post card was sent to non-respondents. Fifty four percent of physicians responded to the survey, and 51 percent of the mailed surveys were returned and usable. Tobacco counseling exceeded expectations, but results indicated that counseling on physical activity was sporadic. 

Implementation of Phase I Interventions

This assessment lead to a decision about the first intervention the group was going to plan. The group decided to focus on physician counseling about exercise as a first initiative. A group of local physicians were trained using the PACE Physicians' Assessment and Counseling for Exercise module. PACE is a CDC funded, non-profit project that is based at San Diego State University. It is based on a stages of change model, and provides materials to support assessment and counseling about physical activity by primary care health providers and medical support staff. 

Phase II

Analysis of BRFSS data found that lower income respondents had health behaviors that increased risk of heart disease, and the committee decided to focus their work on this population. This prompted another kind of community assessment process to identify the barriers to healthy eating in low-income families in Clark County. 
  

Focus Groups

The project coordinator, Theresa Cross, MS, RD, conducted five focus groups with members from the targeted population. The focus groups were composed of previously existing groups. 
  • 2 groups of residents of low income housing, mostly older people 
  • 1 parent support group that met at the YMCA 
  • 2 parent education groups conducted by the Clark College Early Childhood Development Department 
The assessment and research unit at the health district helped with the development of the focus group plan. All participants signed consent forms. The groups were convened for 45 minutes each. Focus group questions and results are found in the following files: 

Key Informant Interviews

Project coordinator, Theresa Cross, MS, RD, also conducted these. Ms. Cross spoke to WIC personnel, staff of parent education and support groups, cooperative extension personnel, and Housing Authority staff. 
  

Implementation of Phase II Interventions

Fact Sheets 

The information from focus groups and key informant interviews was used to develop a series of "fact sheets" that could be given to low income families. These sheets were designed in collaboration with a graphic artist and printed by an industry partner. The project also produced bright posters and refrigerator magnets. 

Heart Health materials were distributed at the following places: 

  • Head Start Centers 
  • Park and Recreation programs for children operating in schools with high enrollments of low-income students 
  • Schools 
  • Cooperative extension programs operating in areas with low-income families 
  • Mailings for Basic Health Plan enrollment 
  • WIC sites 
  • Health District sites 
  • The Vancouver Housing Authority 
  • As part of grocery store promotions targeting fruits and vegetables that were conducted by volunteers from the Southwest Washington Dietetics Association
Activity Groups 
 
In addition to distributing information about fruit and vegetable intake, Kid's Fitness classes were established by the Department of Parks and Recreation. In the next project cycle the group plans to work with the Vancouver Housing Authority to organize walking groups. Participants will walk or do other forms of exercise that can be converted into mile-walking equivalents. Friendly competition between housing sites will be used promote the walking groups. 
 
back to top Evaluation & Lessons Learned
 
 
Back to Home Page 
Back to Table of Contents 
Last revised: 04/20/99
Comments: Donna Johnson (djohn@u.washington.edu) 
http://depts.washington.edu/~commnutr/cases/clark/c-methods.htm