Program Planning: Community Nutrition Assessment

2005

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

Assessment

Prioritize

Analyze problem and propose model to address

Develop Intervention goals, objectives, implementation plan

Outcome evaluation

Process Evaluation & Adjustment

Why Do Assessment?

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

Community Nutrition Assessment:

• Based on assets more than deficits

• Helps to integrate nutrition programs into community-based health programs and plans

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

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)

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

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

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

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

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

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

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

Identify Community Assets

• Physical structure, place, business

• Concerned citizens

• History of successful efforts

• Organizations

• Individual and group skills

• Communications systems

• Relationships

Identify Perceived Needs

• WHY?– To understand public opinion– To become aware of needs the planning

group doesn’t know about– To gather support & expand group expertise– To make decisions about priorities– To plan programs in ways that will be

acceptable to stakeholders

How do we assess perceived needs?

• Listening sessions

• Public forums

• Key informant interviews

• Needs assessment survey or survey of concerns

Demographic Profile

• Economic status: income, employment, % below poverty

• Education levels

• Age and gender

• Race & ethnicity

• Social factors: homelessness, immigration status, family composition, TANF utilization

Community Health Status

• Causes of Mortality

• Hospital discharge data

• Disease prevalence data

• Food bourne illness reports

• Years of potential life lost

• Infant mortality

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)

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

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

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

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

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

Community Inventory Moses Lake

Factors that affect nutrition and

physical activity choices

June - August 2002

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

Ethnic Distribution

White 77%

African American 2%

Other 21%

Hispanic 25%

Interviews with Nutrition and Physical Activity Professionals

Top Health Concerns

• Obesity

• Poor nutrition

• Diabetes

• Smoking

• Unplanned pregnancy

• Poor medical “compliance” among minorities

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

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

Solutions/Priorities for Change

• Increase nutrition and PE curriculum requirements• Increase staffing to implement programming,especially

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

Interviews with Community Leaders

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

Perceived Levels of Physical Activity

• 9/10 believe that lack of physical activity is a problem in Moses Lake– Don’t see people exercising (but I do)– Fairly active community– Poor community & people don’t 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

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 don’t know how to cook

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

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

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

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

Community Resources• Police Department: http://www.moses-lake.com/police/ • Parks and Recreation: http://www.mlrec.com/ • School district: http://www.moseslakeschools.org/ • Chamber of Commerce: http://www.moseslakechamber.org/ • Moses Lake Information: http://www.moses-lake.com/ • Grant County Economic Development Council: http://www.grantedc.com/ • Samaritan Healthcare: http://www.samaritanhealthcare.com/ • Moses Lake Community Health: http://www.mlchc.org/ • Moses Lake Clinic: http://www.wvclinic.com/locations/MLC.asp • Port of Moses Lake: http://www.portofmoseslake.com/ • Columbia Basin Herald: http://www.columbiabasinherald.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.granthealth.org/

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

Community Action

Info / Training

Development

RecruitmentPre-work

Sample audit

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

Methods

Community Action

Info / Training

Development

RecruitmentPre-work

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

Methods

Community Action

Info / Training

Development

RecruitmentPre-work

Sample audit

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

Methods

Community Action

Info / Training

Development

RecruitmentPre-work

Sample audit

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

Methods

Community Action

Info / Training

Development

RecruitmentPre-work

Sample audit

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

Methods

1. Recreation & physical education

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

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

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

2. Access to healthy foods

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 - -

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

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

2. Access to healthy foodsFood Security: Seniors

June July

Meals Seniors Meals Seniors

Congregate

1142 251 1088 237

Home-delivered

1194 58 1215 55

60+ population for county was 11,220

2. Access to healthy foodsFood Security: Schools

Free Reduced Enrollment

% receiving

ES 1398 369 3072 57.5%

MS 618 186 1525 52.7%

HS 511 167 1798 37.7%

TOTAL 2527 722 6395 50.8%

1998-2001 Grant county 50.7%; WA State 31.2%

0

0.25

0.5

0.75

1

1.25

1.5

Choc High fatsnacks

Soft drinks Low-fat milk F & V H2O

ES MS HS

2. Access to healthy foods2. Access to healthy foodsSchools: LunchlineSchools: Lunchline

*

ES no food vending, but Fruitopia; no a la carte

2. Access to healthy foodsSchools: Lunchline

Rating

ES 4.4

MS 3.3

HS 3.5

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

Scale: ‘1not well at all’ to ‘5 Scale: ‘1not well at all’ to ‘5 extremely well’extremely well’

50% of ES had 5’s!50% of ES had 5’s! Possible association with Possible association with

low SESlow SES 5 star salad bar5 star salad bar Nutrition educationNutrition education

Fruits / veggies?

Quality Health promotion

Bike facilities

Frank’s Market

Grocery Outlet

2.5 (18)

Safeway 2.0 (25)

Super 1 1.6 (26)

2. Access to healthy foodsGrocery stores & markets

Quality scale: “1 = poor”; “2=good”; “3=excellent”

Number ‘Healthy’ label?

Average # healthy options

Bike facilities

Fast food14 5 5.1 1

Sit-down13 2 11.3 0

Both5 0 7.4 0

2. Access to healthy foodsEating establishments

Healthful food and beverage options include low-fat, low-calorie, nutrient-dense foods

2. Access to healthy foodsConvenience stores

Healthful food and beverage options include low-fat, low-calorie, nutrient-dense foods

11 stores assessed11 stores assessed 9.7 healthful food options9.7 healthful food options 1 store with bicycle facilities1 store with bicycle facilities

9 stores9 stores 2 stores2 stores 1 store1 store

‘‘1-25’ car parking1-25’ car parking‘‘101+’ car parking101+’ car parking‘‘26-50’ car parking26-50’ car parking

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

3. Infrastructure & built environment

05

10152025303540

% o

f are

a

Incorp Unincorp

3. Infrastructure & built environment3. Infrastructure & built environmentZoning, permitting, & land useZoning, permitting, & land use

Incorporated land = 6843 acres; Unincorporated land = 13,361 acres Land use / zoning maps available in the Comp Plan

Manuf / Trailers

13%

Single66%

Multiple21%

3. Infrastructure & built environment3. Infrastructure & built environmentLand use: housing distributionLand use: housing distribution

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

• 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

3. Infrastructure & built environment3. Infrastructure & built environmentPublic works supporting PAPublic works supporting PA

Sidewalks of all widths, except for those in the central business district, are available for bikeped transportation

3. Infrastructure & built environmentWalkability• 27 walks taken• 16 sections• Individual scales ‘1 awful’ to ‘6 excellent’• Overall scale

Sidewalks

Crossings

Drivers Safety rules

Pleasant

Overall

Average Score

3.7 4.0 4.1 4.1 3.9 19.7

26-30 Celebrate!26-30 Celebrate!21-25 Celebrate a little . . .21-25 Celebrate a little . . .16-20 Okay, but needs work.16-20 Okay, but needs work.11-15 Needs a lot of work11-15 Needs a lot of work 5-10 Call out the NG . . . 5-10 Call out the NG . . .

• Sidewalks• Street crossings• Traffic & driver

behavior• Safety• Appeal• Overall score• Scale

0

5

10

15

20

25

30

Basinhomes

Larsonbase

New firestation

Gilletepark

26-30 Celebrate!26-30 Celebrate!21-25 Celebrate a little . . .21-25 Celebrate a little . . .16-20 Okay, but needs work.16-20 Okay, but needs work.11-15 Needs a lot of work11-15 Needs a lot of work 5-10 Call out the NG . . . 5-10 Call out the NG . . .

3. Infrastructure & built environmentWalkability

• Sidewalks• Street crossings• Traffic & driver

behavior• Safety• Appeal• Overall score• Scale

0

5

10

15

20

25

30

Pelicanpoint

Knollsvista

Montlakepark

Gardenheights

26-30 Celebrate!26-30 Celebrate!21-25 Celebrate a little . . .21-25 Celebrate a little . . .16-20 Okay, but needs work.16-20 Okay, but needs work.11-15 Needs a lot of work11-15 Needs a lot of work 5-10 Call out the NG . . . 5-10 Call out the NG . . .

3. Infrastructure & built environmentWalkability

3. Infrastructure & built environmentBikeability• 23 rides taken• 14 sections• Individual scales ‘1 awful’ to ‘6 excellent’• Overall scale

Safety Surface Inter-

Sections

Drivers Ease Overall

Average Score

3.3 4.1 3.9 4.0 4.0 19.3

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

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

0

5

10

15

20

25

30

Basinhomes

Larsonbase

Cascadevalley

GuffinEccles

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

3. Infrastructure & built environmentBikeability

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

0

5

10

15

20

25

30

Pelicanpoint

Montlakepark

Gardenheights

Westlake

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

3. Infrastructure & built environmentBikeability

3. Infrastructure & built environmentSchools & walk / bikeability

Schools # students % 1 mile

% walk /

bike

Bike

facilities

Basin homes

Longview 524 36% 15%

Larson base

North

Larson hts

CC

322

377

60%

85%

40%

65%

Guffin eccles

Discover

Midway

Frontier

252

86

661

23%

3%

10%

4%

8%

10%

Moses Lake end of the year enrollment: 6395 No schools in New fire station, Gillete park, or Cascade valley sections

3. Infrastructure & built environmentSchools & walk / bikeability

Schools # students % 1 mile

% walk /

bike

Bike

facilities

Knolls vista Knolls vista

369 62% 45%

Garden hts Garden hts

HS

461

1672

48%

5%

20%

2%

Moses Lake end of the year enrollment: 6395 No schools in Pelican pt, Montlake park, or Westlake sections

3. Infrastructure & built environmentParks & walk / bikeability

Parks Bike facilities

Parking

Basin homes

- - -

Larson base - - -

Fire station - - -

Gillete park Gillete

Cascade valley

Cascade ’76-100’

Guffin eccles

McCosh

Carl T. Ahlers

‘101+’

3. Infrastructure & built environmentParks & walk / bikeability

Parks Bike facilities

Parking

Pelican pt - - -

Knolls vista Knolls vista ‘1-25’

Montlake park

Montlake ’26-50’

Garden hts - - -

Westlake ML Community

‘101+’

3. Infrastructure & built environmentPedestrian / bike safety 2001

Pedestrian Bicycle

Collisions 6 5

Injury 1 None

2 Possible

2 Evident

1Disabling

1 None

2 Possible

2 Evident

Vehicle type 5 pickup or panel

4 pickup or panel

1 Lrg truck

Violation 5 Driver only

1 Ped only

3 Driver only

2 Ped onlyBlock watch program within city limits – 66 areas are involved. Community oriented policing in county.