Assignment 2 Nurs 434

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Community Assessment and Diagnosis Hosnatul Ferdous Athabasca University Instructor: Yvonne Moore NURS 434 29-June-2016

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Community Assessment and Diagnosis According to Centers for Disease Control and Prevention (CDC) (2015), a community health assessment (CHA) refers to a “state, tribal, local, or territorial health assessment that identifies key health needs and issues through systematic, comprehensive data collection and analysis” (para 1). The main purpose of the community health assessment is to identify the positive and negative factors that have a huge impact on the health of the people and to develop strategies for community health promotion (Vollman, Anderson, & McFarlane, 2012). In this paper, I will conduct a partial community health assessment by using the Population Health Promotion model. I will identify and provide rationale for the selected aggregate, provide rationale for selecting the assessment model, present and complete an analysis of the assessment data of the aggregate, and identify and provide rational for the community diagnosis based on the assessment. Identifying Aggregate Stamler and Yiu (2012) define aggregate as a group of people who share common interests, demographics, cultural heritages, and socioeconomics and education levels. For this assignment, I have chosen the overweight or obese children or adolescents. CDC (2015), defines overweight as a BMI above the 85th percentile and below the 95th percentile, and obesity as a BMI greater than or equal to the 95th percentile for children and teens of the same age and sex. In Canada, the rate of obesity was 26% in 2004/2005 among children between 2 to 17 years of age (Shields, 2006, as cited in Kuhle, 2013). The rate of overweight or obesity is somewhat more common in boys than in girls (27 vs 25%), but in the recent year, the rate has been the same in both sexes (Shields, 2006, as cited in Kuhle, 2013).The rate of overweight or obesity also varies

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in different ethnic groups; 41% off-reserved aboriginal children are overweight or obese whereas 18% of Southeast Asian or East Asian children are overweight or obese (Shields, 2006, as cited in Kuhle, 2013). Overweight or obesity rate is more among children from middle class families than that of low income families (28% vs 25% in 2004/2005) ((Shields, 2006, as cited in Kuhle, 2013). “Nearly one third of children in Canada is considered have overweight or obesity (Roberts et al., 2012, as cited in Kuhle, Doucette, Piccinini-Vallis, & Kirk, 2015). According to WHO (2000), it is the greatest threat to public health in developed countries (as cited in Kuhle, 2013). Obesity has also been linked to serious health concerns including shorter life spans, increased health care costs, and increased risk of certain illnesses such as diabetes and heart disease. According to the Children Obesity Foundation (2015), in the recent decades, childhood overweight or obesity has been increasing steadily in Canada. The statistics show that children between the ages of two to 17 are mostly affected; among them, the rate of overweight and obesity is almost double (from 14 percent to 29 percent) among youth, aged 12 to 17 years (Public Health Agency of Canada, 2012, as cited in Children Obesity Foundation, 2015). There are multiple causal factors, such as readily available poor-nutrient food (fast food), costs of healthy food, and sedentary lifestyles, are associated with obesity, so an alteration of a single factor by individual approach is not enough to address the issue; a combination of lifestyle and behavioural modification is the key factor (Kuhle, Doucette, Piccinini-Vallis, & Kirk, 2015). Without an early intervention, obese children are more likely to become obese adults; therefore, “it is important for health care providers to recognize, treat, and prevent obesity in children and adolescents before obesity-related complications become severe and debilitating” (Faguy, 2016, p279).

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The Population Health Promotion model has been used for the community assessment. The goal of the model is to promote health and “improve sustainable health outcome of the community” by incorporating determinants of health, health promotion strategies, and primary healthcare principles (Stamler & Yiu, 2012, p.215). Rationale for Selected Assessment Model The model is ideally used for assessing, planning, intervening, and evaluating the health of the community (Stamler & Yiu, 2012). According to Registered Nurses Association of Ontario (RNAO), the childhood or adolescent obesity is strongly related to the determinants of health including socioeconomic status (poverty), Obesogenic environmental conditions (lack of resources for physical activity or healthy eating), and individual-level conditions (biologic influence) (2014). Assessment Based on Determinants of Health Socioeconomic Status Children living in a lower socioeconomic status are more prone to develop overweight or obesity. According to the Canada Community Health Survey (carried out by Statistics Canada) (2006), the obesity rate is 37.8% higher in children living in a low income family compared to 6.2% in high income. The obesity rate is 10.5% higher in the children whose parents haven’t completed high school than the children whose parents have completed high school (1.3%) (as cited in Burton & Phipps, 2009).

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To be healthy, it is important to eat more fruits and vegetables and be involved in different physical activities; however, eating healthy as well as being physically active is less affordable for a low income family (Burton & Phipps, 2009). The cost of high calorie food such as pop, chips, and other high calorie snacks is more than the nutrient dense healthy food such as fresh fruits and vegetables (Taylor, 2010). Taylor (2010) also noted that being physically active is expensive. Often, low income families find it difficult to be involved in physical activities like swimming, playing hockey, skating, or dancing; moreover, the lower-income neighbourhood may not have enough parks and recreating facilities and may not be safe for their users (Oliver & Hayes, 2005, as cited in Burton & Phipps, 2009). Environmental Conditions The environmental condition that is related to obesity includes food services in school cafeteria and/or vending machines and playgrounds and recreational facilities in schools and neighbourhoods where children can meet their daily physical activity requirement (RNAO, 2014). Promoting physical activities in school along with healthy food environment can enhance children’s health and healthy weight gain (RNAO, 2014). According to the Obesity Canada Clinical Practice Guidelines Expert Panel’s (2006) recommendation, to ensure a healthy physical environment for children, it is important to assess the physical education programs offered by schools along with their availability to the students and the quality and safety of the playground and recreational facility (as cited in RNAO, 2014). In many communities, lack of a safe walking or biking route to schools maybe a hindering factor for children’s healthy weight (CDC, 2012). Along with the physical environment, RNAO (2014) also recommends an assessment of a school’s food environment to promote the health of the children; the healthy food environment includes promoting Eating Well With Canada’s Food Guide in school cafeterias or canteen to

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determine options for healthy food choices and age appropriate serving size. The healthy food environment also includes the community's accessibility and affordability of healthy food such as fresh fruits and vegetables (Karnik, & Kanekar, 2012). Individual-level Condition (Behavioral Factors) Some behavioral factors including not performing regular physical activity and consuming high calorie food can also play a major role in developing childhood overweight or obesity; in other words, weight gain is common when the energy consumption is more than its expenditure (Karnik & Kanekar, 2012) . Children with sedentary lifestyle are more prone to develop overweight or obesity. The sedentary lifestyle includes watching television, playing video games, and/or working/studying on computers (Karnik & Kanekar, 2012)). Analysis of community assessment 

There are 15 schools under the Grande Prairie Public School District (2016) and 15 schools under the Grande Prairie Catholic School District (2016). Among them, three catholic schools, St. Clement, St. Patrick and St. Joseph High School, and two public schools, Avondale and Hillside, have started the Grande Prairie Schools Snack Program (GPSSP) where the students are provided healthy morning breakfast, fresh fruit midmorning snack, and a nutritious emergency bag lunch (Huffman, 2015). The goal of the program is to “alleviate hunger and educate children about healthy lifestyle choices” (GPCSD, 2016, para 1). According to CDC (2015), students who eat school lunches consume healthier food than those who don’t; school lunch serves lunch lower in

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unsaturated fats and salt and more fruits, vegetables, milk, and fibres. There are some organizations in the city of Grande Prairie that facilitate health and wellbeing of children and youth in the community:

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Be fit for life; Ever active schools; Alberta Health Services-health promotion coordinators; Health and physical education council-regional representatives; Active for life; Alberta healthy school community wellness fund; Healthy Alberta; ParticipAction-

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get moving get living; Alberta active living partners (GPRC, 2016). Children and adolescents should do at least 1 hour (60 minutes) or more of physical activity each day. According to the stats, some 93% of parents are not ensuring their kids get off the couch for at least 60 minutes a day. There are tons of activities that cost

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nothing but your time and perhaps a little energy. (Rinne, 2012). Average Family Income (2011 Census): $106,993 (City of Grande Prairie, 2016) Unemployment Rate (May 2016): 7.8% (City of Grande Prairie, 2016) The City of Grande Prairie has more than 600 acres of park areas that are operated and

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maintained by parks operations (City of Grande Prairie, 2016). According to Public Interest Alberta (2011), 63% of workers (>20 years of age) in Grande Prairie are earning less than $12/hour and are trying to pursue the post-secondary education to support their family (as cited in Haener, 2013).

Community Health Diagnosis Risk of developing overweight or obesity in children or adolescents (2 to 17 years) related to lack of healthy eating environment in schools is evidenced by only five out of 30 schools that are running the school snack program. I came up with a deficit community diagnosis based on my assessment. The school snack program facilitates the healthy eating environment for children by serving nutrient rich, low calorie food; it also follows recommended dietary guidelines to reduce the risk of developing overweight or obesity; on the other hand, school cafeteria or vending machine often serves food

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high in calories, sugar, and fat (CDC, 2009). Therefore, having limited school snack programs can be a risk factor for overweight or obesity. Conclusion Community health assessment is an important tool to facilitate health promotion of a community. In this paper, I have selected overweight or obese children or adolescent as aggregate because in Canada, the rate of obesity is increasing day by day. I have used the Community Health Promotion Model and selected three health determinants to carry out the assessment. The determinants include socioeconomic factor, environmental factor, and behavioral factor. After analyzing the assessment data, I have made a deficit diagnosis which will help me determine goals and interventions to promote the health of the community.

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Burton, P., & Phipps, P. Shelley Phipps. (2009). Low family income and the overweight status of Canadian adolescents. Retrieved from http://myweb.dal.ca/phipps/Burton_Phipps_Chapter.pdf Centers for Disease Control and Prevention. (2015). America’s schools make positive changes to create healthier school meals. Retrieved from http://www.cdc.gov/media/releases/2015/p0827-school-meals.html Centers for Disease Control and Prevention. (2015). Community health assessments & health improvement plans. Retrieved from https://www.cdc.gov/stltpublichealth/cha/plan.html Centers for Disease Control and Prevention. (2015). Defining childhood obesity. Retrieved from http://www.cdc.gov/obesity/childhood/defining.html Centers for Disease Control and Prevention. (2015). Nutrition standards for foods in schools. Retrieved from http://www.cdc.gov/healthyyouth/nutrition/pdf/nutrition_factsheet_parents.pdf Children Obesity Foundation. (2015). Statistics. Retrieved from http://childhoodobesityfoundation.ca/what-is-childhood-obesity/statistics/ City of Grande Prairie. (2016). City parks and boulevards. Retrieved from http://www.cityofgp.com/index.aspx?page=593 City of Grande Prairie. (2016). Quick statistics. Retrieved from http://www.cityofgp.com/index.aspx?page=756

COMMUNITY Faguy, K. (2016). Obesity in Children and Adolescents: Health Effects and Imaging Implications. Radiologic Technology, 87(3), 279-302 24p Grande Prairie & District Catholic Schools. (2016). Our schools. Retrieved from http://www.gpcsd.ca/Schools.php Grande Prairie Public School District. (2016). Our schools. Retrieved from https://www.gppsd.ab.ca/Schools/Pages/default.aspx Grande Prairie Regional College. (2016). Alberta organizations who support healthy school communities. Retrieved from https://www.gprc.ab.ca/community/bffl/partners.html Haener, M. (2013). A living wage for Grande Prairie: Background report. Retrieved from www.cityofgp.com/modules/showdocument.aspx?documentid=787712. Karnik, S., & Kanekar, A. (2012). Childhood Obesity: A Global Public Health Crisis. International Journal of Preventive Medicine, 3(1), 1–7. Kuhle, S. (2013). Determinants and consequences of childhood overweight in Canada. Dissertation Abstracts International, 74, Kuhle, S., Doucette, R., Piccinini-Vallis, H., & Kirk, S. F. L. (2015). Successful childhood obesity management in primary care in Canada: what are the odds? PeerJ, 3, e1327. http://doi.org/10.7717/peerj.1327 Registered Nurses Association of Ontario. (2014). Primary prevention of childhood obesity. Retrieved from http://rnao.ca/sites/rnaoca/files/Primary_Prevention_of_Childhood_Obesity_0.pdf Rinne, D. (2012). Childhood obesity rates not such a big mystery. Retrieved from

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COMMUNITY http://www.dailyheraldtribune.com/2012/03/14/childhood-obesity-rates-not-such-a-bigmystery Stamler, L. L., & Yiu, L. (Eds.). (2012). Community health nursing: A Canadian perspective (3nd ed.). Toronto: Pearson/Prentice Hall. Taylor, B. (2010). Poor and fat: The link between poverty and obesity in Canadian children. Retrieved from http://www.cbc.ca/news/technology/poor-and-fat-the-link-betweenpoverty-and-obesity-in-canadian-children-1.972762 2. Vollman, A. R., Anderson, E. T., & McFarlane, J. (2012). Canadian community as partner: Theory and practice in nursing (3nd ed.). Philadelphia: Wolters Kluwer | Lippincott Williams & Wilkins.

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