Promoting Use of Nutrition and Physical

Activity Community Resources Among Women

in a Family Planning Clinic Setting

Dudung, Ratri, Syifa, Triko, Witri

FOCUS OF PAPER

Promotion of community resources among low-

income women, aged 18–44 years, who used family

planning services at a local health department

TYPE OF INTERVENTION

No intervention in this research only formative

research

Where was the study conducted?• Conducted in Greenville, North Carolina, a mid-

sized town located in Pitt County, which is in the eastern part of the state.• Participants were recruited from the health

department family planning clinic waiting room.

Subject of the Study• women aged 18–44 years, who were using

reproductive health services at a Title X family planning clinic at the Pitt County Health Department.• Eligibility criteria : included females aged 18–44 years,

English-speaking, not currently pregnant,a patient at the health department, and current resident of Pitt County• The key informants interviewed were identified by

the health department director and by snow-ball sampling

FOCUS POPULATION : Low-income women, aged 18-44 yrs

The MAIN Finding

Participant Characteristic

Nutrition and Physical Activity Resources

Nutrition Community Resources• Farmer’s market• Nutritionist at PCHD• Breastfeeding support

group

Physical Activity Community Resources

• School track• Local recreation centers• Parks

• mothers more likely to use a community resource when it was not expensive or they had an incentive (e.g., 10% discount); transportation wasprovided or it was conveniently located close to home; and the venue was family friendly.• key informant barriers to women accessing/using resources: lack of knowledge of the resource location, transportation barriers, and economic barriers

Existing Community Resource Guides & Needed Community Resources• Existing community resources

Guides :

a walking trail guide available on the country planning department’s website

a resource guide for the Council on Aging and related programming

and a resource guide for parents which included information ranging from health insurance to children’s educational opportunities

• Needed Community Resources :greater access to fresh fruits and

vegetables in the rural areas of the county via corner store initiatives

cooking, budgeting, and gardening classes

more diabetes self-management counselors

grocery store tours a demonstration garden and/or

satellite farmers’ market at the health department

a YMCAimproved bicycling infrastructure more places with playgroundsa community pool

Participants’ Suggestions for Improving the Community Resource Guide

Key Informants’ Perspectives on Improvingand Promoting Use of Community Resources & Use of Social Media to Promote Use of Community Resources• Key Informants’ Perspectives on Improving

and Promoting Use of Community Resources : Adding information about weight loss and chronic disease management programs, the local food literacy pro-gram, master gardeners information, and information about bus routes.Creative outlets for promoting the guide among patients. (included dis-playing it on an interactive computer kiosk in the health department waiting area, featuring guide resources in a coupon book, adding the guide to waiting room reading materials, and using local media)

• Use of Social Media to Promote Use of Community Resources : the participant suggestion to include the guide on a website and the key informant suggestion to have an interactive computer kiosk in the waiting room featuring community resources, participants made no further suggestions regarding use of social media or cell phones specifically for community resource promotion

5 Priority Action in Health Promotion

: HP aspect dicussed in the paper

Create supportive environment• In order to support community resource guide among low income

population (include various nutrition and physical activity) It is necessary to have information and available community and health department

resources

Sources of information about nutrition and physical activity resources according to participants

Create supportive environmentavailable community and health department resources

‘‘Farmers’ Market—ours is not in a very good location. The farmers set up their own stands around town so I am not sure they even use the farmers’ market.’’ (Key Informant 04)

Farmer’s market Nutritionist at PCHD

‘‘I met with a nutritionist here at the health department.’’ (Patient 05)

Breastfeeding support group

‘‘ ’Cause they [health department] sent out letters to women who breast-feed.’’ (Patient 15)

School tracks

‘‘...the track, school track for walking ‘cause I like to walk.’’ (Patient 14)

Local recreation centers/fitness programs

‘‘The C.M. Eppes Recreation Center is right across the street from the house I stay in.’’ P02

Parks

‘‘I go to parks a lot ’cause of my daughter. And ... I walks with her.’’ P07

Develop personal skillsa print version of a community resource guide listing various nutrition and physical activity resources was created (In previous work) to encourage healthy behaviors among low-income, midlife women aged 40–64 years,

Environmental factors

Although low-income neighborhoods may pose barriers to healthy behaviors, they may also have health-promoting environmental features (i.e. walking trails). A potential effective intervention strategy is to help individuals identify and overcome neighborhood barriers by making use of community resources that support a healthy diet and physical activity.

Jilcott, S. B. et. al. 2007. A guide for developing intervention tools addressing environmental factors to improve diet and physical activity

Strengthen community action for health

Weakness• Convenience samples used for both study participants and

key informants• The location of the interviews (the health department)• The authors did not track the number of women

approached• Standard instruments were not used• The lack of use of standard instruments• Purposive and snowball sampling used for key informants

Strength• Sufficiently large sample size (for a qualitative study) of local

resident participantsTransportation and access barriers to resources such as the

farmer’s market and other healthy food options.

• Quality control was enhanced by having all interview transcripts double-coded by independent coders.

Interesting Information (1)• Identifying the nutrition and physical activities

resources---and weight them in term of priority program• Find out the needed community resources—low

cost gym, greater access to fresh fruits and vegetables---community pools• Feedback from the participant about the CRG

which can make the CRG better and acceptable. Use outlets to promot the guide• Use of social media

Interesting Information (2)• All of those describes the quality of FGD and

availibility of resources—learn how the good quality FGD can be gathered• Participant suggestion to CRG describe “what we

think good sometime no good in their way”—need assesment is better to increase acceptability• Using advance tech (social media) describe that the

promotion must be flexible in term of information channel

A guide for developing intervention tools addressing environmental

factors to improve diet and physical activity

Jilcott SB, Laraia BA, Evenson KR, Lowenstein LM, Ammerman AS.Author information

Department of Nutrition, Schools of Public Health and Medicine, University of North Carolina in Chapel Hill, North Carolina, USA.

AbstractLow-income populations have an elevated risk of obesity and associated chronic diseases. Environmental factors influence health behaviors that contribute to obesity. Although low-income neighborhoods may pose barriers to healthy behaviors, they may also have health-promoting environmental features (e.g., produce stands, walking trails). Thus, a potentially effective intervention strategy is to help individuals identify and overcome neighborhood barriers by making use of community resources that support a healthy diet and physical activity. The authors describe the formative research process undertaken to develop two community-focused intervention tools to complement a clinic-based cardiovascular disease risk-reduction program for underserved women. Literature review, community exploration, and examination of Internet and print resources contributed to development of a neighborhood assessment with tip sheets and a community resource guide. These tools were finalized using community members' feedback. This formative process can serve as a guide for other health promotion programs to create and use similar tools.