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Running head: KNOW YOUR NUMBERS 1

Know Your Numbers: Hypertension Intervention in Phenix City, Alabama

Caroline Brent, Dani Burden, Leslie Franklin, and Maggie Hatcher

Auburn University School of Nursing

KNOW YOUR NUMBERS 2

Abstract

In the year 2010 heart disease was the leading cause of death in Alabama, as well as in Russell

County. Numerous factors are attributable to the morbidity and mortality of cardiovascular

disease, including unhealthy eating habits, physical inactivity, and obesity. Prevention and

maintenance of hypertension is critical in reducing these rates. Countless individuals are

unaware of their current health condition, especially with regards to high blood pressure; thus,

prevention and maintenance of this condition can be difficult. This intervention was located in

Phenix City, Alabama, and included all willing shoppers located at K-Mart on July 9, 2013. The

goal of this intervention was to assess blood pressure and health education on blood pressure

reduction in Phenix City, Alabama. This information is crucial in identifying, diagnosing, and

treating hypertension to prevent the development of heart disease. This intervention was

successful in monitoring and educating participants regarding their current blood pressure values.

Keywords: hypertension, blood pressure, intervention, Phenix City

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Know Your Numbers: Hypertension Intervention in Phenix City, Alabama

Introduction and Background

There are many preventable factors that contribute to making heart disease the leading

cause of death in the United States. High blood pressure is one of these conditions, and can

many times be a leading indicator for the development of heart disease. Healthy People 2020

recently developed a broad goal related to heart disease that states, “Improve cardiovascular

health and quality of life through prevention, detection, and treatment of risk factors for heart

attack and stroke; early identification and treatment of heart attacks and strokes; and prevention

of repeat cardiovascular events” (Office of Disease Prevention and Health Promotion, 2013). In

addition, Healthy People 2020 created specific objectives to assist in reaching this goal. The

objective that our intervention focuses on states that there needs to be an increase in the number

of adults who have had their blood pressure measured in the last two years, and can state if their

blood pressure was elevated, normal, or low (Office of Disease Prevention and Health Promotion,

2013). This objective allows for the education of a population with limited resources, and will

assist in the prevention of heart disease by creating awareness.

Our population of focus is Phenix City, Alabama. This city is approximately 25 square

miles in size, and located roughly 45 minutes east of Auburn, Alabama in Russell County

(Ingenuity Incorporated, 2013). In the year 2010, Heart Disease was the leading cause of death in

Alabama as well as in Phenix City. Approximately 35,879 Alabama residents fell victim to the

fatalities of Heart Diseases, 285 of which resided in Russell County (The Office of Primary Care

and Rural Health, Alabama Department of Public Health and The Alabama Rural Health

Association, 2013). In order to avoid Heart Disease, great emphasis is placed on maintaining a

healthy diet; however, thirty-nine percent of Russell County’s population is classified as obese

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(The Office of Primary Care and Rural Health, 2013). When observing Phenix City, lower

income housing is prevalent and many buildings are closed down or deteriorating. Six fast food

restaurants for friend chicken specifically are located within 2 miles of each other, with only one

healthy alternative noted. A community educator at the Regional Rehabilitation Center in

Phenix City acknowledges an information deficit regarding healthy food choices, as well as a

lack of accessibility to blood pressure machines in Phenix City as causes for concern (Regional

Rehabilitation Hospital community educator, personal communication, 2013). In addition to an

unhealthy diet, stress is a monumental risk factor related to heart disease. Stress is easily derived

from the many challenges life brings, including personal income, vehicle access, health care

access, and much more. In Russell County, 20.1 percent of the population is below the poverty

level, inevitably resulting in 28.8 percent of the population being eligible for Medicaid (The

Office of Primary Care and Rural Health, 2013). In comparison to the United States as a whole,

in which 15.9 percent of the population lives below the poverty level, there is a substantial

difference (The Office of Primary Care and Rural Health, 2013). Stressors such as those listed

enhance the possibility of living a high-stress lifestyle, which greatly contributes to the

development of hypertension and consequently Heart Disease. It is a priority to educate

population members on the risk factors of Heart Disease and how to eliminate them, as well as to

provide them with the opportunities needed to manage their care.

The leading employers of Phenix City include MeadWestVaco, the Phenix City Board of

Education, AlaTrade, the Russell County Board of Education, and Jack Hughston Memorial

Hospital (Phenix City Information Technology Department, 2011). However, while health

departments, clinics, and Jack Hughston Memorial Hospital are located in the city, access to

preventative care and health promotion appears to be insufficient. Secondary and tertiary care

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for the people of Phenix City is noted, but a lack of adequate primary care could be the

difference in a patient developing heart disease or managing his or her blood pressure. If this

population can recognize that their blood pressure is high, normal, or low, they are more likely to

seek medical care if it is in an unacceptable range. Our Healthy People 2020 Objective, mainly

to create awareness about blood pressure and to measure it in the population of Phenix City, is a

necessary and attainable objective in this particular location.

Community Assessment

We began our observation of Phenix City on the main highway, Highway 280, in order to

get a general idea on what to expect as we traveled further into school districts and

neighborhoods, (Appendix B). Immediately, we noticed the ease of access to, and the abundance

of, common stores such as the Piggly Wiggly grocery store, the Dollar General, K-Mart, and

Wal-Mart. These shopping centers were all located directly on Highway 280 and appeared to

attract many members of this population. Alongside these stores, we noticed an overwhelming

amount of fast-food chain restaurants: Kentucky Fried Chicken, McDonald’s, Burger King, and

Church’s Chicken, to name a few. What we did not notice were local restaurants and grills that

may provide people with healthier food options.

When speaking with a community educator at the Regional Rehabilitation Hospital in

Phenix City, we informed him of our Healthy People 2020 goal to increase the proportion of

adults who have had their blood pressure measured within the preceding 2 years and who can

state their blood pressure. The educator expressed to us that many community barriers preventing

the success of this goal are related to corporations and the food industry. The informant stated

that “companies need to hire employees and spend money towards efforts to accommodate the

health problems, and this includes researching how their product’s impact people’s health”

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(Community educator, personal communication, 2013). This educator suggests that fast food

restaurants should “display health facts next to the high fat and high sodium foods” in order to

educate the population on healthy food choices. Additionally, the educator stated, “facilitators

are currently pushing for fast-food restaurants to list calorie counts and the location of free blood

pressure machines on their food wrappers” (Community educator, personal communication,

2013). Providing accessible information to the population on such a prevalent issue would be a

big step in the right direction with regards to health promotion.

Among the residents of Phenix City, we observed a larger proportion of African

Americans present around the Highway 280 area. Almost all citizens observed shopping or

driving around the metropolitan area were African American. However, Caucasian prevalence

was noted as we traveled further into the “Historic Downtown District.” Although the

distribution of African Americans to Caucasians in Phenix City is relatively equal, 46.6 percent

African American and 50.5 percent Caucasian, they are unequally distributed in various parts of

the city (United States Census Bureau, 2010). It was apparent throughout the city that people

transported most prominently via cars, trucks, and SUV’s. There were no cabs, public buses, or

other means of public transportation noted, aside from city school buses. We did witness a small

number of African American individuals walking on the sidewalks in less populated areas of the

city, but we did not see individuals walking near the main highway and shopping centers. Most

of the sidewalks witnessed were deteriorating, posing many risks for danger as well as the

difficulty of use. In the few areas where we did note people walking, the sidewalks were on

streets populated with houses and schools, not on the main highway. The majority of the houses

we saw were located on small streets that were grid-like in nature, and either stood alone or were

duplexes. Both types of housing were dated, and did not have large or well-manicured lawns.

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There was very little evidence of animals in the city, as we were unable to identify fenced in

yards, people walking dogs, or stray animals. We also noticed that the majority of the houses we

saw had either an antenna or a satellite dish for cable and Internet access. We did not see any

major identified neighborhoods in the heart of the city.

Located close to many of the residents’ houses, as well as throughout the city, is public

schooling. We saw one pre-kindergarten school, six elementary schools, one middle school, and

one high school. There was no activity witnessed at any of the city’s school; however, it was a

Sunday so that was to be expected. The schools’ themselves do not have fields for sporting

teams, but we did notice recreational basketball courts and baseball fields close by. Near these

recreational fields, we found a small park that is not large enough to serve many purposes to

community members. We also noticed that throughout the community there is very little green

space for activities, and we did not observe any public workout facilities.

In addition to schools, we saw a small amount of service centers located throughout the

city. Such centers included a Child Development Center, Health Department, Social Services,

Human Resources, Public Safety, and recycling center. Service centers such as these are

beneficial to promoting the health of the community when utilized. In contrast, few primary care

physicians’ offices or clinics were noted in the metropolitan area. Common areas such as malls

and movie theatres were also sparse. We did take notice of one particular area in the city called

the “Downtown District” that included many local eateries, art galleries, and shopping boutiques;

however, this area was somewhat secluded and seemed to attract those with higher income. One

landmark of the city that is very easily accessible and of the highest prevalence is the church.

The church affiliations seen the most were the Baptist Church, Methodist Church, and Church of

Christ. Clearly, religion is of importance in this community; however, politics in Phenix City

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appear to lack in importance. We did not see any campaign posters or signs to guide our

suspicions of party affiliation.

Interpretation

According to Healthy People 2020, the leading modifiable risk factors for heart disease

are high blood pressure, high cholesterol, cigarette smoking, diabetes, poor diet and physical

activity, and overweight and obesity (Office of Disease Prevention and Health Promotion, 2013).

It is no coincidence that the risk factors for high blood pressure closely resemble those of heart

disease as a whole. As previously mentioned, the Phenix City, AL area has access to a large

amount of unhealthy fast-food restaurants in comparison to healthier alternatives. Reduced

access to healthy food options, in addition to the ease of availability to unhealthy restaurants,

certainly amplifies the risk factors for heart disease and hypertension. There is also a deficit in

available areas for physical activity. There is not a lot of grassy space available for recreational

activities in Phenix City. Also, the sidewalks throughout the town have not been kept up. With

sidewalks in the conditions we witnessed, it would be very challenging for walking, jogging,

pushing a stroller, or any other physical activities that are heart healthy and necessary to achieve

the health objectives for this community. Such conditions make it difficult for children and

adults to receive adequate exercise for their health maintenance, leading to the possible

development of health complications such as hypertension and heart disease. As mentioned by

Healthy People 2020, overall physical health plays a major role in the prevention of hypertension

(Office of Disease Prevention and Health Promotion, 2013). Consequently, a lack of exercise,

paired with an unhealthy diet and restricted access to health care, results in a very vulnerable

population (Office of Disease Prevention and Health Promotion, 2013).

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Not all assessment findings proved to be disadvantageous to the health of the community.

Jack Hughston Memorial Hospital is located in Phenix City, along with many other health care

facilities offering secondary and tertiary health care. These facilities provide the highest levels

of employment in Phenix City, as well as access to quality care and treatment. Additionally,

many chain pharmacies and grocery stores have blood pressure monitoring machines that are of

no expense to the patient. Having access to these facilities provides a means for the people of

the community to monitor blood pressure values at ease. However, it is difficult to estimate the

number of people who have access to this information. Placing the calorie counts and locations

of free blood pressure machines on food wrappers would improve the knowledge deficit

regarding risk factors and the prevention of high blood pressure.

Community-oriented Health Diagnoses

After completing a thorough assessment of Phenix City, we were able to identify several

community health disparities. Contributing factors to the community’s overall health include the

availability of unhealthy food choices, and a lack of appropriate areas for physical exercise.

Both of these factors influence weight management. Thirty-nine percent of Russell County’s

population is classified as obese (The Office of Primary Care and Rural Health, 2013). Obesity

is identified as a health problem in Phenix City, and is also a major contributing factor to

hypertension. We chose to focus our efforts on a primary nursing diagnosis that incorporates

hypertension. There is a risk for elevated blood pressure among families in Phenix City related

to lack of regular blood pressure screenings to identify hypertension, and a knowledge deficit

regarding healthy lifestyle behaviors and the risk factors of heart disease.

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Community Intervention

The idea for our intervention was derived from similar, impressing community

prevention programs implemented to screen for cardiovascular disease and risk factors, including

hypertension. Primary prevention, such as health screening, may be effective in reducing health

disparities and health costs by identifying chronic disease and their risk factors, and ultimately

reducing morbidity and mortality (K. Patel et al., 2010). The National Commission on

Prevention Priorities has identified hypertension screening as one of the most cost-effective

preventive interventions (Hill et al., 2012). Providing screenings for vulnerable populations in a

variety of public locations such as stores, worksites, and churches, allows people who may not

otherwise seek health care the opportunity to identify any potential health issues or reversible

risk factors (K. Patel et al., 2010). A mobile health clinic, using the Knowledgeable Neighbor

model, was created in Boston, Massachusetts to screen for and evaluate the rates of previously

undetected elevations in blood pressure, blood glucose, and total serum cholesterol levels. The

Knowledgeable Neighbor incorporates the idea that the van staff is there to assist the community

by educating them about their health and helping them locate resources they need (Hill et al.,

2012). A similar study in Nashville, Tennessee was successful in identifying and referring new

cases of hypertension and counseling others who were inadequately managing their condition.

The Nashville-REACH 2010 Project offered more than 3,800 community health screenings in

various public settings between July 2000 and May 2007 (K. Patel et al., 2010). In Britain, the

Healthy Hearts program offered a series of cardiovascular health screenings to several

communities throughout the area. These screenings were also successful because they revealed

that approximately half of attendees needed primary or secondary healthcare (J. Patel et al.,

2007). The leaders of both the Nashville and Britain health screenings notified the community


ahead of time by mailing out circulars and posting fliers in public areas (J. Patel et al., 2007; K.

Patel et al., 2010). A weakness of these studies was the difficulty in locating and following up

with previous clients, to determine the success of the intervention (Hill et al., 2012). Screening

for chronic conditions, as well as other primary prevention methods, is important in order to

educate participants about their health, and empower them to take control of it. Conducting

health screenings for chronic conditions, like hypertension, not only provides participants with

knowledge regarding their current health condition, but also referrals for treatment and

prevention of further complications.

The community intervention we chose targeted individuals who were unaware of their

blood pressure numbers, unsure of the meaning of hypertension, and lacking critical knowledge

of the impact hypertension has on the body as a whole. The slogan we adopted for our

intervention, “Know Your Numbers”, coincides with the Healthy People 2020 objective to

increase the proportion of adults who have had their blood pressure measured within the

preceding 2 years and who can state their blood pressure. For this intervention, we placed a table,

chairs, and a professional poster outside the exit doors at K-mart. We chose this location because

of the high amount of visitors noted daily, and the availability of this location within the city.We

then offered to take shopper’s blood pressure and provide education specific to hypertension and

heart disease. We developed a brochure to hand out which identified blood pressure values, and

explained the different ranges for normal, prehypertension, and stage I and II of hypertension. It

also lists places in the Phenix City, AL area that offer complimentary blood pressure monitoring

for the community. Such establishments include pharmacies, Walmart, and K-Mart. In addition,

the brochure offers a referral list of hospitals and clinics to visit if the patient’s blood pressure

becomes too high. It includes options for the medically uninsured, such as the Phenix City


Health Department. The Jack Hughston Memorial Hospital and Regional Rehab Hospital accept

Medicare and Medicaid patients, so we included these referrals for the convenience of the

participants. Lastly, Valley Healthcare Southside Medical is a convenient healthcare facility that

accepts private insurance, as well as some Medicare and Medicaid patients. The brochure

respondents could also find how high blood pressure affects the body as a whole, the risk factors

that increase blood pressure, and the measures that are necessary to reduce blood pressure. The

same chart describing the blood pressure ranges in the brochure is displayed on the poster, along

with a definition of blood pressure. After taking a person’s blood pressure we educated them on

whether their results were high or normal, discussed the contents of the brochure, and answered

any questions they had. As described in the previous health screening studies, our teaching

strategy was to educate participants about their health and offer resources that may help them

take control of their health.

In evaluating the outcome of our community intervention, we were surprised at the

response we received. Many shoppers were willing and eager to have their blood pressure

checked. The community members asked questions and listened to the education materials, with

a general interest in their health. Some shoppers stated they had already been diagnosed with

hypertension and continued to walk by, while others stated they had been diagnosed but were

still interested in having their blood pressure taken. Of the participants whose blood pressure

was elevated, most were interested in measures to lower it. Many participants were very

appreciative and took time to ask questions because they wanted to better understand their health.

As the intervention developed, we became more focused on properly educating patient’s on the

steps to take after recognizing their blood pressure value. Our initial goal was for participants to

state their blood pressure and recognize if their readings were within normal range. We then


added that the community members would be able to distinguish their numbers as falling in the

range of pre-hypertension or hypertension stage I or II. Those who allowed us to take their blood

pressure were able to state their results, and identify the appropriate category on the chart either

in the brochure or on the poster. This gave us the opportunity to educate participants on the next

steps in prevention and treatment of Hypertension. We considered this to be effective teaching.

While we considered our intervention to be successful, there are improvements that could

be made. If we had notified the community ahead of time by distributing flyers, a larger number

of participants may have been possible. Time and resources were limited, but we achieved our

goal of educating a small portion of the community on their blood pressure values.

Conclusion

Hypertension is many times a preventable risk factor for the development of heart disease.

By creating awareness regarding safe blood pressure values and methods of blood pressure

reduction, the number of cases of heart disease developing in Phenix City, Alabama can be

reduced. For future studies, we would suggest alerting the general area of the date of the

intervention ahead of time. This way, you get a larger population of willing participants.

Additionally, conducting blood pressure screening and educational health fairs approximately

once a month in the same area would ensure the heath of individual citizens could be monitored

and tracked effectively. One weakness of our intervention was the inability to track the

effectiveness of teaching on reducing blood pressure rates. Recording the name and value of

each individual every time would ensure proper tracking.

Regarding community efforts to reduce hypertension, many small efforts can be made in

order to improve the overall health of the population. First, education regarding healthier food

choices should be available. Nutritional facts should be presented for all food items in restaurants,


in order to allow citizens to make healthier choices. Also, blood pressure machines should be

more accessible to the general public. Adding machines to all stores with a pharmacy, as well as

assessing the proper functioning of these machines, will allow for an increase in regular blood

pressure screenings and awareness. Each of these suggestions would help to improve the overall

health, specifically regarding blood pressure reduction, of the general population. Hypertension

remains a serious concern in Phenix City, Alabama. Although we were able to educate members

of the population about the disease, our efforts will not be enough to improve the overall health.

A collaborative effort from the city, citizens, and healthcare providers must be given in the future

to ensure improvements are made.


References

Hill, C., Zurakowski, D., Bennet, J., Walker-White, R., Osman, J.L., Quarles, A., Oriole, N.

(2012). Knowledgeable Neighbors: A Mobile Clinic Model for Disease Prevention and

Screening in Underserved Communities. American Journal of Public Health, 102(3),

406-410. doi: 10.2105/AJPH.2011.300472

Ingenuity, Incorporated. (2013). Demographics. Retrieved from

http://www.phenixcityal.us/Default.asp?ID=6&pg=Demographics

Office of Disease Prevention and Health Promotion. (2013). Healthy People 2020. Retrieved

from http://www.healthypeople.gov/2020/default.aspx

Patel, J., Gunarathne, A., Lane, D., Lim, H.S., Tracey, I., Panja, N.C., Lip, G., Hughes, EA.

(2007). Widening access to cardiovascular healthcare: community screening among

ethnic minorities in inner-city Britain-the Healthy Hearts Project. BMC Health Services

Research, 7(192). doi:10.1186/1472-6963-7-192

Patel, K., Larson, C., Hargreaves, M., Schlundt, D., Wang, H., Jones, C., Beard, K. (2010).

Community Screening Outcomes for Diabetes, Hypertension, and Cholesterol

Nashville REACH 2010 Project. Journal of Ambulatory Care Management 33(2), 155-‐

162. doi: 10.1097/JAC.0b013e3181dd4619

Phenix City Information Technology Department. (2011). Labor Force. Retrieved from

http://www.phenixcityal.us/edo/Default.asp?ID=468&pg=Labor+Force

The Office of Primary Care and Rural Health, Alabama Department of Public Health and The

Alabama Rural Health Association, (2013). Selected health status indicators russell

county. Retrieved from Bureau of Professional and Support Services website:

http://www.adph.org/ruralhealth/Default.asp?id=1798


United States Census Bureau. (2010). Community Facts. Retrieved from

http://factfinder2.census.gov/faces/nav/jsf/pages/community_facts.xhtml#none


APPENDIX A NURS 3340 Professional Nursing Concepts Across Populations

Data Gathering: Community Statistics

Group 8: Maggie Hatcher, Dani Burden, Caroline Brent, Leslie Franklin

Date: June 6, 2013

Community: Phenix City

Internet searches will provide the information needed about your community. Complete the following table with brief statements or bullet points and indicate where you found the information. This is a worksheet; the data is summarized in Phase One of the community assessment. Category Describe community characteristics Website or

other resource

Overview of community

1) History, type (urban, suburban, rural): Before 1820 the city of Girard was established in part of the area that is now known as Phenix city. It was named for a young Philidelphia philanthropist and slave dealer, Stephen Girard. In 1846 a railroad was built. In 1883 The City of Phenix city was first incorporated as the Town of Brownville and in 1889 the name was officially changed to Phenix City, named for the Phenix Mills in Columbus, GA. In 1923, the cities of Girard and Phenix City were consolidated with a total population of 10,374. Phenix City is a rural community.

2) Description (location, topography, size): Phenix City is located in Russell County in east Alabama along the west bank of the Chattachoochee River, which forms the boundary between Alabama and Georgia. The city encompasses 25 square miles.

3) Leading industries, occupations: Leading industries include manufacturing, retail trade, health care and social assistance; accommodation and food services; and construction. Leading employers include MeadWestVaco, the Phenix City Board of Education, AlaTrade, the Russell County Board of Education, and Jack Hughston Memorial Hosptial.

4) Governmental Structure (Mayor/city council): The city is governed by a five member council, which is made up of the Mayor and council members who have been elected to serve a three-year term. The City

http://www.phenixcityal.us/Default.asp?ID=5&pg=History http://www.phenixcityal.us/edo/Default.asp?ID=468&pg=Labor+Force http://www.phenixcityal.us/Default.asp?I


Manager is head of the administrative branch of the city government and is responsible for proper administration of all city affairs. The City Clerk manages all records for the city and is also the city’s Chief Election Official.

D=3&pg=City+Leadership

Population profile

• Total population: • As of 2010 the population was 32,822; the latest

estimated population as of July 1, 2011 is 33,804.

• Age distribution, median age: • The median age is 33.1 • The median age for females is 35 • The median age for males is 31.1

• Sex distribution: • Total males: 15,336 (46.7%) • Total females: 17,486 (53.3%)

• Race/Ethnic composition: • The city is made up of whites (50.5%), Black of

African Americans (46.6%), Hispanic or Latino (4%), and smaller percentages of Asian, American Indian

• Income; Educational level: • The median household income is $34,700 • Education level:

i. 81.3% of the population are high school graduates or higher

1. Of that 81.3%: a. 31.1% are high school

graduates b. 26.2% have some college

education, but no degree c. 11.3% have a Bachelor’s

degree ii. 16.2% of the population have received a

bachelor’s degree or higher iii. 18.7% do not have a high school

diploma

http://factfinder2.census.gov/faces/nav/jsf/pages/community_facts.xhtml

Health indicators

• Leading cause of death (overall and in your target population): The leading cause of death in Alabama in 2010 was Heart Disease. The leading cause of death in

http://www.adph.org/ruralhealth/asse


Russell County in 2010 was also Heart Disease. • Leading causes of morbidity (incidence & prevalence

rates) • Healthy People 2020 objective– is there information

to compare your community to the goal? Healthy People 2020 objective: Increase the proportion of adults who have had their blood pressure measured within the preceding 2 years and can state their blood pressure.

ts/Russell13.pdf http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=21

Community Health Facilities & Resources

• Health systems-acute care and emergency services: o Jack Hughston Memorial Hospital

• Home health, long-term, rehabilitation, hospice, mental health, etc.:

o Regional Rehabilitation Hospital o Hospice: VistaCare Hospice, Columbus

Hospice of Alabama • Ambulatory, outpatient services:

o Russell County Health Clinic • Public health and social services:

o The Alabama Department of Public Health for Russell County is located in Phenix City.

o The Alabama Department of Human Resources for Russell County is also located in Phenix City.

• Special health or volunteer services related to your target population or HP 2020 objective:

o The Regional Rehabilitation Center

http://www.yellowpages.com/phenix-‐city-‐al/health-‐care?g=Phenix+City%2C+AL&q=health+care (http://www.dhr.alabama.gov/counties/county_results.aspx?id=Russell)

Other information related to your target population and HP 2020 objective? Health promotion and maintenance do not seem like priorities in this city. For the most part, there are fast food restaurants (especially KFC and Church’s Chicken). All these factors pose significant risk for heart disease and hypertension.


APPENDIX B NURS 3340 Professional Nursing Concepts Across Populations

Community Assessment: Windshield Survey

Element Description Summary of findings Housing Age of homes? General condition?

Signs of despair? Air conditioning evident?

The homes are very dated and not well-‐kept; most properties did not have manicured lawns.

Open space/Boundaries

Green space? Parks? Public or private open space? Are the boundaries natural or physical? Neighborhood identity?

There is a park in the outskirts of the city, but it is not very large and does not have many options for recreational activities. There is a small baseball field and basketball court. There is a major river that serves as a boundary to the city, but most other boundaries are man-‐made (buildings, roads, fences, etc.). There are no identified neighborhoods, just streets with the occasional house; most properties have small lawns Minimal green space in the community, mostly broken up concrete and narrow sidewalks.

“Commons” Where do people “hang out”? Welcoming to visitors or territorial?

Most of the residents of Phenix city travel to Columbus to “hang out” at places like the mall or movie theater. Some groups of teens were spotted in the parking lots of Walmart and also at the baseball field of the city’s park. For the most part, the people of the city seem territorial and unwelcoming. While visiting, we felt a definite lack of comfort. There are not many major “common areas” for gathering in the heart of the city. However, in the Downtown District, there are several boutiques and Art


galleries. Unfortunately, the Downtown District is more geared toward attracting those of the higher class. Thus, most of the people living in Phenix City do not spend much time there because there is an obvious separation of classes between the two areas.

Transportation How do people get around? Walk or car or public transportation? Is there a major highway

The most prominent means for transportation is by cars/trucks/SUVs. Some people walk. No buses/public transportation evident (other than the city school buses).

Service Centers Do you see social agencies, recreation centers, or signs of activity around schools?

Public Safety, Human Resources, Social Services, Health Department, Child Development Center. There is a recycling center. There is an old, un-‐kept baseball field. There was no activity around any of the schools; however, it was a Sunday.

Stores Where do people shop? Shopping centers? Neighborhood stores? How do they get there?

Phenix city has several Piggly Wiggly grocery stores, Many dollar General stores, a Walmart Super Center

Street people Who do you see on the street? Do you see anyone you wouldn’t expect? Along with people, are there any animals? Are dogs on leashes? Any stray cats of other animals?

There were several African American individuals walking on the sidewalks. Only one animal was seen, a dog. Its owner was walking it outside on a leash.

Race/ethnicity Which races are represented? Is the area integrated? Are there evidences of ethnicity – food stores, churches, private schools?

African Americans were observed most frequently in our assessment of Phenix City.

Religion Is there evidence of heterogeneity or homogeneity based on the churches?

Obviously, Phenix City is in the “Bible Belt”. Therefore, Baptist, Methodist, and Church of Christ were the most prevalent churches, as expected.

Health & Any evidence of acute or chronic Although there is no evidence of


morbidity illness? How far to nearest hospital or clinic?

acute or chronic illness, there is reason to believe that it is still an issue. The sidewalks are not very appropriate for walking/jogging or pushing a stroller, and there is no gym. Health promotion and maintenance do not seem like priorities in this city. For the most part, there are fast food restaurants (especially KFC and Church’s Chicken). All these factors pose significant risk for heart disease and hypertension. There is a small hospital within the city.

Politics Any political campaign posters/signs? Any evidence of predominant party affiliation?

No campaign posters/signs were apparent. There is no evidence of a particular party affiliation.

Media Any outdoor television antennas or satellite dishes? Is there a local newspaper?

Most houses had antennas. There were a few small satellite dishes. There is no local newspaper to our knowledge.


APPENDIX C NURS 3340 Professional Nursing Concepts Across Populations

Community Assessment: Interview

The following questions are provided as suggestions, but may differ based on your community, populations, and/or HP 2020 objective. This is just a brief interview and can be done conducted either personally or by phone call and lasting no more than 10 minutes.

Potential Questions Summary of answers What is your role in the community?

Community educator at the Regional Rehabilitation Hospital focusing specifically on stroke, including stroke prevention and treatment.

What do you believe are some strengths of the community?

Strengths related to the rehabilitation center and the community includes involvement and willingness to assist patients who lack funds to make changes in their lives after a stroke, such as church involvement and volunteering funds and time to build a ramp to make homes more accessible.

Are there areas of improvements in the community?

Encouraging the community to attend community outreach programs; many community members don’t understand the importance of their participation in the prevention and awareness programs until it is too late.

What are the major concerns of community members?

Care and what happens after the rehabilitation program. The patients and family members are concerned with the care they or their loved ones will be receiving after discharge.

Do you believe there is adequate access to health care? Yes, but getting the information is more difficult. Information regarding health care should be more readily accessible to patients and family members.

Specific to… (your target population)…are there any special concerns related to health?

Blood pressure awareness and access to blood pressure is important considering hypertension is the silent killer; Also community members should see their primary care physician on a regular basis to stay on top of their health.

We are focusing on the HP 2020 goal of…(identify your specific HP 2020 goal of interest). What are some

Barriers are corporations and the food industry; Companies need to hire


community barriers and facilitators to reaching this goal in this community?

employees and spend money towards efforts to accommodate the health problems and this includes researching how their products impact people’s health. Another barrier is access to blood pressure machines for community members to monitor their blood pressure. It should be easily accessible (she described Walmart as being a great example, but patients will only notice it when buying a prescription). She suggested finding places (such as Mcdonalds) where people go every day. She also suggested the idea of making learning easier, such as displaying health facts next to the high fat/high salt foods in the grocery store to help patients understand what they are putting into their bodies. Facilitators include the new push to list calories on fast food wrappers and also the location of free access to blood pressure machines but there need to be more.

Is there anything else you would like to add related to the community and health?

“Not that I can think of off the top of my head”

Documents

Know Your Numbers: Hypertension Intervention in Phenix ...adb0016.weebly.com/uploads/2/7/6/7/27675609/cap_paper_.pdf · Phenix City, Alabama, and ... restaurants should “display