Stop Obesity: Baton Rouge, Louisiana’s Health Promotion Plan

Final Term PaperRachel Franklin

December 21, 2013

MPH 585: Programming and Evaluation in Public HealthMadeline Angela Meyer, Ph.D

Table of Contents

Introduction

Needs Assessment Logic Model

Strategic Plan

Program Objectives and Measurable Outcomes

Budget Worksheet

Marketing

GANTT Chart

Program Evaluation Plan

Evaluation Chart

Program Strategies Summary References

Community Health Promotion Program for Obesity

Introduction

It is no surprise in this day and age that obesity is one of the most

pressing issues in public health in the United States. State’s prevalence of

obesity range “from 20.5% in Colorado to 34.7% in Louisiana in 2012 (CDC,

2013).” Obesity can lead to heart disease, diabetes, stroke, certain types of

cancer, and many other preventable diseases (CDC, 2013). The most

shocking aspect of how pressing obesity is how preventable it is. There are

many known “causes” of obesity including poor nutrition, lack of physical

activity, reduced physician visits, etc. The problem is that the environment

has become such that there is less physical activity involved in activities of

daily living and far less “healthy” food available and far more “unhealthy”

food available through processed foods, hormones in produce/livestock, and

chemicals in our produce. All of these aspects play into the obesity

epidemic. This is what makes the real challenge for public health workers.

How does one start to change a culture whose view of “normal” has changed

so much so that any changes made to improve the environment to enhance

healthy behaviors may not be accepted, because they are far less “easy” to

utilize than the current environment?

The changes start by identifying the real needs within a community.

This is found through the needs assessment, where we find out about the

community: what makes them tick, how they live their lives, what things go

into their lack of physical activity and poor nutrition? All of these things need

to be identified, in addition to a thorough examination of the environment so

that real changes can be made to see real results and a lowered prevalence

of obesity. The biggest changes will be seen from environmental changes.

Needs Assessment

The mission is to reduce the prevalence of obesity in the city of Baton

Rouge, Louisiana.  This city has one of the highest rates of obesity in the

United States and is within the state with the highest prevalence of obesity

nationwide (CDC, 2013).    The vision is to be seeing a great deal of

environmental, policy, and social norm changes within this local community

that changes the behaviors of its citizens so that they are making good and

healthy choices in order to prevent their risk of obesity, and further, prevent

their risk of other chronic conditions as a result of obesity. 

The long-term goal for this program is to reduce the obesity

prevalence in the city of Baton Rouge, Louisiana.  According to F as in Fat, a

project funded by the Robert Wood Johnson Foundation, Louisiana comes up

short on various steps that they can take to inform their citizens and make

proper nutrition choices available to them.  This includes enforcing a sugar-

sweetened beverage tax, making free drinking water available to all schools,

and adding in menu labeling laws.  There are already a great deal of efforts

in place to increase physical activity, but Louisiana, as a state falls short in

enforcing policies and creating better access for proper nutrition(F As in Fat,

2012). This would be a prime opportunity for a specific objective; to

implement some sort of law that would require restaurants to label their

nutrition content on their menu, so that the people are informed of what

their food contains and, therefore, make healthy choices. According to data

gathered in East Baton Rouge County in Louisiana, the county has higher

rates of soda consumed per capita, more fast food restaurants per capita,

and less pounds of fruits and vegetables consumed per capita than the rest

of the state (FindTheData, 2008).  Reducing the rate of soda consumption in

this county would be a good objective for the campaign.  

Within this county, nearly half of its citizens (47%) are African

American, and this could be leading to health disparities (FindTheData,

2008).  Oftentimes, obesity is seen in minority populations, and this could be

contributing to the higher obesity rate within the county of East Baton

Rouge.  A great deal of youth spend too much time in front of screens, do not

engage in physical activity, and almost half do not participate in sports or

after-school physical activities (Pennington Biomedical Research Center,

2008).  Suggestions have been made to produce efforts that encourage

youth to be more active both in school and outside of school.  In this

program, I would propose an effort that has local youth teaching other youth

(high school teaching middle-schoolers or elementary aged children) how to

be active and engaging in fun activities with them during school.  This type

of intervention would be great to identify an objective from.

Logic Model

The logic model that would make the most sense for my topic is PRECEDE-PROCEED.

This model has eight specific phases and various steps within each phase. The first half of this

model is known as PRECEDE, which includes the first four phases: (1) Social Assessment, (2)

Epidemiological Assessment, (3) Educational & Ecological Assessment, and (4) Administrative &

Policy assessment and intervention alignment. This is the initial work involved in the planning

process, before the implementation takes place, hence the name PRECEDE. The last half of this

model is known as PROCEED, which includes the last four phases: (5) Implementation, (6)

Process Evaluation, (7) Impact Evaluation, and (8) Outcome Evaluation (McKenzie, Neiger,

Thackeray, 2013).

The flow of how this logic model works is what makes it so appropriate for my

campaign. My campaign is Stop Obesity: An obesity prevention strategy for Baton Rouge,

Louisiana. The PPM has a very thorough assessment that looks at not just the statistics to

demonstrate the need but what is happening around the population of interest: the

environment, the health disparities, the policies, etc. This logic is what fits my campaign. My

campaign is not merely an educational strategy. It encompasses environmental and policy

change with an educational aspect. This is what has been proven to be effective and what is a

large part of the Center for Disease Control and Prevention’s strategies to reduce and prevent

obesity and weight gain in all populations. A lot of these strategies are environmental such as

complete streets campaigns (that improve walkability and bikability within communities), and

healthy food retail improvements (making healthy food more accessible to all populations)

(State of Louisiana’s Department of Health and Hospitals, 2013).

Inputs Outputs Outcomes -- Impact

Activities Participation Short Medium Long Partner

organizations: city staff and non-profit organizations

Direct/in-kind funding: grants from CDC/other organizations

Advisory Team: group of stakeholders and planning committee members that will be involved with delegating tasks and keeping all informed of new information

Data collected through various sources within the assessment

Coalition/Advisory Team

Surveillance system

Data collection Planning effort –

taking the information gathered and putting it together to determine the needs, assets, strength, weaknesses, etc.

Develop partnerships/networks with necessary organizations or partners.

Awareness of need/true status of obesity in Baton Rouge

Education within the communities through schools, city gatherings, workplace happenings, etc.

Reduction in obesity rates

Increase in policies that improve environment that promotes healthy behaviors around physical activity and nutrition.

Better understanding of proper nutrition and recommended amount of physical activity among citizens.

Assumptions External Factors People do not know how to eat properly (types of foods, proper portions,

etc.). That most people do not get a good amount of physical activity in their

daily lives.

Income/racial disparities Environment that supports poor nutrition Environment that is not supportive of an active lifestyle (walkability,

bikability, safe neighborhoods, etc.).

Program Objectives and Measurable Outcomes

Goals and objectives set the tone for evaluation of a campaign and

after identifying the needs within a community, it’s important to identify the

changes that are hoped to come from implementation of interventions. This

involves setting the goals and objectives for the campaign and it is important

that they be Specific, Measurable, Attainable, Realistic, and Time Sensitive or

(SMART, for short). Along with that is defining how these goals and

objectives will be measured as, oftentimes, this is something that may start

before these goals are defined through pre-testing or obtaining the

necessary information through a proper needs assessment.

The long-term goal for this program is to reduce the prevalence of

obesity in the city of Baton Rouge, Louisiana. This is found through state-

wide data obtained by the Centers for Disease Control. This will be

measured by obtaining the most recent data previous to the implementation

phase of the program and then one year from implementation and as often

as possible to show change. As stated before Louisiana is failing in many

efforts to improve the nutrition of the citizens of its state.  One objective is

that by 2018, there would be a city ordinance for Baton Rouge in place that

requires all chain restaurants to label the nutrition content on their menus.

This will be measured by keeping score of what measures are in place city-

wide, county-wide, and state-wide to identify any ordinances in place around

nutrition labeling and again after implementation until one such law exists.

Along with labeling nutrition, this program would like to see true

change in behaviors and this can be seen through a specific type of behavior

and one that is far too common in the state of Louisiana and in East Baton

Rouge County. A second objective for nutrition is that by 2017, the rate of

soda consumption per capita in East Baton Rouge County by at least 10%.

This will be measured by obtaining pre-test information available through

county or state data and as often as can be obtained one year or more after

implementation of the program.

Now that some objectives have been stated in regards to the general

public, it’s important to look at some real prevention efforts that involve

instilling positive health behaviors in the youth in Baton Rouge. In regards to

reaching the youth in Baton Rouge, one objective is by 2017, the number of

youth getting vigorous physical activity will increase by at least 5%. This will

be measured by doing a pre-test measuring how often youth get physical

activity and what type of activity is both by observation and by a

questionnaire that is given to them and their parents. The same

questionnaire will be administrated to the same amount of individuals as was

done in the pre-test one year after implementation and every year thereafter

to monitor change.

Budget Worksheet

Amount CommentsRevenue/SupportContribution

Gifts 50,000This is an estimation of a realistic amount for this type of program.

Grants 800,000This is an estimation of a realistic amount for this type of program.

Participant feeSale of curriculum material

Total Income 850000

ExpendituresDirect CostsPersonnel

Salary & Wages 180,000

One part-time and two full-time staff over 2 years in addition to administrative hours for this program

Fringe Benefits 6,000Rough estimate of benefits for 2 full-time staff

Consultants 100,000Supplies

Instructional Materials ,000

Brochures, handouts, posters, etc. for team members and the community

IncentivesMeeting Costs 3,000

Equipment 4,000

Laptop for full-time staff as well as pens, notebooks, use of copier, paper, ink, etc.

Travel 25,000Postage 5,000

Advertising 300,000TV, radio, and the possibility of billboards

Total of Direct Costs 623000Indirect Costs 50,000

Total of Indirect Costs 127,500Total Expenditures 750,500

Balance 99,500

Net to be used for any unaccounted costs or need for any temporary work or extra advertising.

Marketing

Beginning, January of 2014, will be the start of the implementation process, with a goal

date of all implemented activities done by September of 2014. Getting the marketing strategy

in place, however, started before this date. This involved establishing the four P’s of marketing:

product, price, placement, and promotion. The product, of course is this program and the

various objectives that are hoped to be accomplished through the implementation of the

program. The price is the cost to the targeted audience; be it, their time, some of their

freedoms in terms of policy changes. An example would be restaurants having to take more

time and give up some of the freedom they have had to start labeling their food for their

consumers. The placement is where and to whom this program will take place. This is within

the schools and the general public within the city of Baton Rouge, Louisiana. Promotion is the

final “P” of marketing and this involves how this program will be promoted and through what

measures and channels.

Promotion begins January of 2014, and it begins with a small planning process, that

starts during the months leading up to January. This is where it is established how the program

will be promoted. This was decided early on in some ways by bringing on board many

community members and decision-makers into the team and committee involved with the

program. There is already buy-in by doing this from the community and now it begins

discussing how the “word” will get out to the rest of the community. One of the goals is to use

word of mouth advertising. This involves identifying those key figures within the communities

by segmenting the audience into specific groups so that those “important leaders” of those

segmented groups could be identified and utilized to help spread the word about the program

so there is more trust in the community. Along with getting the community involved is getting

the decision-makers on board as well, especially considering there is an objective to get policies

implemented. This involved getting city/county commissioners, the mayor or other elect

officials on board so that there is buy-in from those individuals and representation of legislative

officials. Getting these people on board helps for there to be better recognition and support

from those individuals as well as gaining the trust of the community.

Promoting this program will involve using media and specific channels to inform the

community of the program and what the specific goals of it are. This will be through television,

radio, and possibly billboards, depending on what is identified as best-practices in this

community and that will be found out through the assessment and some focus group

participation within the community. The delivery will be through developing specific messages

for each segmented group within the community based upon what they value and what is

important to them so that the messages can be heard by all members of the community and

received in a positive way.

Implementation will begin by establishing groups within the team who will be tasked

with specific aspects of each objective. One group may be focusing on the objective for the

youth in the school system. Another may be focusing on the policy changes that are hoping to

be met. Another may be focusing on changing habits among the community around soda

consumption. Within these groups, there will be specific messages created for each segmented

group and those messages will be created by the groups within the teams, which will include

the decision makers and the community members involved. It is important that these people

be involved in this process so that there is trust gained among the community and among

decision-makers, because there is representation from these groups.

Within these teams there will be tasks delegated to each member of the group. This

is so that no one person is left with it all. There will be a team lead who will be tasked with

checking in on each team member to make sure that the specific tasks are being completed

and following the appropriate timeline. A Gantt chart below represents an example of one

of these groups’ specific tasks and the timeline by which they should be completed.

Objective: The # of children getting vigorous physical activity outside of school will increase from ____ to _____.

Tasks Team Member

Start Date Duration Due Date

Plan/Design Program

All January 3, 2014 4 weeks February 1, 2014

Recruitment of teachers/school board members

Team members 1-3

February 2, 2014 2 weeks February 15, 2014

Recruitment of parent involvement

Team members 2&3

February 10, 2014

2 weeks February 28, 2014

Writing of Program All March 1, 2014 13 week July 1, 2014Establishing Evaluation Measures

Team members 5-8

June 1, 2014 5 weeks July 10, 2014

Pre-testing All August 15, 2014 2 weeks August 30, 2014Implementation All September 1,

201440 weeks June 1, 2014

Program Evaluation Plan

Formative Elements

Justification Addressed through identifying partnerships made and how it can be justified based off of needs assessment information

Evidence Addressed by establishing evidence that similar programs have been effective and research identified that establishes it is evidence-based

Capacity Identified by establishing team member’s education/knowledge base through current employment or education or their background

Resources Identified through budget analysis Consumer-Orientation

Identified through SWOT analysis and ensuring that characteristics are taken into account before implementation

Multiplicity Addressed through the establishment of goals and objectivesSupport Identification of partnerships and resources currently available in the

community that will support interventionsInclusion Identification through team members, stakeholders involved, and other

community organizations/members.Accountability Established through follow-up of GANTT chart.

Adjustment Established through documentation of previous meeting minutes or results from focus groups/qualitative data and how changes were addressed.

Recruitment Identified through member engagement and documentation of the use of appropriate channels.

Reach Identified through community participation: numbers and areas of community where participation is seen/documented.

Response Identified through reach documentation (number of participants and number of areas of community or neighborhoods affected).

Interaction Identified through post-test information asking how the interactions of staff/team/stakeholder were with community members.

Satisfaction Post-test information asking how services were delivered and whether they were satisfactory and for further feedback or suggestions

Process Evaluation

Fidelity Use of GANTT chart and documented follow-up activities.Dose Identified through number of documented activities through program.

Recruitment Identified through member engagement and documentation of the use of appropriate channels.

Reach Identified through community participation: numbers and areas of community where participation is seen/documented.

Response Identified through reach documentation (number of participants and number of areas of community or neighborhoods affected).

Context Identified through assessment that is performed prior to implementation and each year thereafter.

References

Associated Press (2013). Lousiana, Mississippi are most obese states in the country, survey says. Retrieved November 14, 2013, from http://www.nola.com/health/index.ssf/2013/08/louisiana_mississippi_are_most.html

Centers for Disease Control and Prevention (2013). Overweight and Obesity: Adult Obesity Facts. Retrieved November 3, 2013 from http://www.cdc.gov/obesity/data/adult.html

F As in Fat (2012). The State of Obesity: Louisiana. Retrieved November 10, 2013 from http://fasinfat.org/states/la/

Find the Data (2008). East Baton Rouge County, Louisiana: Obesity Rates and Fast Food Comparison. Retrieved November 10, 2013 from http://county-food.findthedata.org/l/1127/East-Baton-Rouge

McKenzie, J.F., Neiger, B.L., & Thackeray, R. (2013). Planning, Implementing, & Evaluating Health Promotion Programs. Boston, MA: Pearson Education, Inc.

Pennington Biomedical Research Center (2011). Charting the Course for 2020: 2011 Louisiana’s Report Card on Physical Activity & Health for Children & Youth. Retrieved November 10, 2013 from http://www.pbrc.edu/report_card/2011/pdf/2011%20LA%20Report%20Card%20Long.pdf

State of Louisiana’s Department of Health and Hospitals (2013). Nutrition, Physical Activity and Obesity Prevention in Louisiana. Retrieved November 10, 2013 from http://www.dhh.louisiana.gov/index.cfm/page/952