Part 1
Health Promotion Proposal: Elementary School Age Obesity
The goal of this project is to establish the major factors contributing to the increasing numbers of school-aged children been diagnosed with childhood obesity and its co-morbidities and recommend meaningful ways to stave off this alarming health problem in the present and future generations.
Interventions to Address the Goal
The role of the healthcare sector is to ensure the quality of health and wellbeing of every person in the society (Rice et al., 2013). Increasing numbers of obese children in the U.S. raise a health risk that requires quick intervention from health care stakeholders such as the government, the public and private regulators, providers, and human service agencies. The prevalence of obesity among the young generation has increased significantly from 1971 to 2011; hence, obesity becomes the leading health concern among American parents (Anonymous, 2015). Understanding factors that contribute to elementary school-age obesity helps in establishing the most significant intervention for the problem.
Health care stakeholders like the World Health Organization have established a number of programs aimed at promoting the quality of life and well-being of young children. According to the World Health Organization (WHO, 2012), the World Health Assembly established a global strategy that outlines different interventions aimed at preventing obesity in 2011. The World Health Assembly proposed a series of actions to address the issue that included developing sustainable tools for all states to determine and establish priority areas. Tools recommended aimed at utilizing population-based approaches for preventing childhood obesity (World Health Organization (WHO), 2012). The following project utilizes population-based approaches that focus on the population, the environment, and stakeholders (government, the public, and private regulators, providers, and human service agencies) in developing interventions that address the health promotion goal.
The First Lady, Her Excellency Michelle Obama, introduced the “Let’s Move 1!” initiative that aimed at establishing solutions to the problem of obesity in the young generation. The initiative started by the First Lady required efforts from the public, the government, and human agencies to meet healthcare goals. The First Lady employed comprehensive strategies that ensured every child born in the US gets into the path of a healthy future by providing parents with helpful information, promoting environments that support healthy living, ensuring schools offer nutritional foods choices, and ensuring every family can access healthy food (Thompson and Carman, 2015). Similar to the First Lady's initiative, the following intervention aims at creating strategies for preventing elementary school-age obesity in the U.S. The proposed intervention follows three primary steps namely: Process, Output, and Outcome as explained below.
Process: The following part involves collaboration between all stakeholders including health professionals (specialists, physicians and nurses), nutritionists, parents, and the government in establishing an effective solution. The main issues addressed include diet education by health providers and diet experts, the role of parents in ensuring children practice good eating behavior, and the role of government in controlling the consumption of foods that cause obesity.
Output: The output section explains the available resources from stakeholders that promote the implementation of the process. These include supportive policies, effective programs, and supportive environment.
Outcome: The project outcome must fulfill the health promotion goal. The outcome will have significant impacts on the society, economy, health, and the school environment.
The success of the intervention plan requires effective monitoring, surveillance, and evaluation to address all elements.
Importance of the Project Relevance to Student’s Future Advanced Roles
Nursing learning institutions equip nursing students with appropriate skills and knowledge, which among them is the promotion of the health and wellbeing of the people in the society. The project plays a critical role in influencing future careers of nursing students because it equips them with relevant practical skills and evidence-based knowledge for promoting quality health outcomes in the society. On the other hand, the project assists students in advancing their nursing career by making them campaign for good health practices by engaging in health promotion campaigns. The project gives the student an opportunity to promote changes that influence healthcare outcome. Obesity increases risks for many chronic diseases that cause high mortality rates today such as diabetes. Equipping nurse students with ideas on how to prevent the problem helps them transfer knowledge to other students and promote collaborations that help prevent future occurrences.
Plan for Identifying Needed Data and Information to Creating the Project
The success of the project requires a thorough analysis of relevant data and information related to factors that lead to elementary school-age obesity. The plan assists in developing a deeper understanding of the target population.
Steps One: Identifying the area where the project will be implemented.
The project will take place in Florida. Ten elementary schools will be randomly selected to take part in the process.
Step Two: Collecting information about the population size, age group, sex, socioeconomic status, ethnicity, and habitat.
The population consists of elementary school age children from ten selected schools in Florida age 4 to 14 years. The sample will comprise of all genders with equal representation. Additionally, the population will be classified based on the family background, ethnicity, and physical location.
Step Three: Gathering literature about the prevalence of the problem and relating it to the target population.
A comprehensive literature review will focus on the impact of elementary school-age obesity on the child's present and future life, factors contributing to the high prevalence of obesity among elementary school-age children, and possible interventions that have succeeded in solving a similar issue.
Step Four: Collecting relevant data related to factors contributing to the occurrence of the phenomenon developing information from it necessary in creating the project.
The main data collected include the number of obese children in the selected sample size, the eating behavior of the child, family background including parents’ education level and socioeconomic status, and state nutrition guidelines.
PART 2
Comprehensive Review of Literature and Data Sources Relevant to the Question
The elementary school-age overweight that leads to creates significant impacts on the present and future life of the child. Childhood obesity leads to diabetes that affects the health of a child and interferes with the normal schooling procedure because of frequent hospital visits. Additionally, the child experiences challenges engaging in sporting activities and interacting with peers. Moreover, obesity leads to psychological disorders such as mental health problems because of depression if not managed at earlier stages (Brauser, 2012). According to the CDC (2015), U.S. has experienced rising cases of obese children for the last 30 years. Naticchioni (2013) tested the above statement by conducting an investigation to determine the relationship between obesity and academic achievement of school-age children. The study aimed at determining the relationship between the child’s weight and academic performance. The study utilized a narrative review approach where the investigator established the relationship between weight status, nutrition, and academic performance of a child. Nine studies were utilized in the review where a comprehensive search of evidence took place using academic searches and ERIC. The study outcome revealed obesity affects the child’s cognitive ability; hence, impairing the learning process leading to poor grades. However, the study had limitations because of the originality of the data used creating research gaps.
Johnston et al. (2014) revealed a significant impact of pediatric obesity on both physical and psychosocial behavior of a child. The research's main purpose was to determine the impact of pediatric obesity on school grades. The study took place in 41 elementary schools in southeast Texas. A cross-sectional design was utilized using surveys and questionnaires to collect relevant data. 835 students were investigated where 37 were underweight, 135 overweight, 186 obese and 477 had normal weight. Results show a positive relationship between children grades and pediatric obesity (Johnston et al., 2014). The study recommended the introduction of school-based nutrition programs to help change eating habits of children. Second, the government should intervene by introducing regulations for schools to follow Dietary Guidelines for Americans (Naticchioni, 2013).
The rise in the prevalence of obesity in the US has raised many concerns today (Anonymous, 2015). Karp and Gessel (2015) conducted a study to investigate effective prevention interventions for children obesity. The study aimed at creating changes in the way people address the issue of childhood obesity to create improvements in the health of the children. In the study, Karp and Gessel researched on the current government's effort to prevent school-age obesity. Numerous clinical trials were performed that recorded data on prevention and treatment. The outcome of each trial was assessed using the BMI, percentage body fat, and skinfold thickness. The outcome of the study showed fewer impacts on childhood obesity prevention and treatment programs among school-aged children. Karp and Gessel (2015) recommended the use of evidence-based policy changes by researchers and clinicians to improve children's health. The study assists in meeting the goal of the project by assisting identify gaps in prevention and treatment strategies through introducing policies that allow parents and teachers to take care of children’s health in school.
Data Sources Relevant to the Question
The data needed for the project will come from government statistics, Center for Disease Control and Prevention (CDC), World Health Organization (WHO), local health care facilities, and elementary schools. The data included the number of obese children less than 15 years of age in California between 2013 and 2015, prevalence of other healthy risks such as diabetes among children in this age group, and children performance.
Evidence of Synthesis and Review of Literature
Obesity has become a national epidemic that requires an effective intervention to help protect the future of the country. Evidence shows that obesity affects the performance of elementary school age children. The impact will have a significant outcome on the future social and economic status of children when they become adults. The government and other stakeholders have done little to address the epidemic because outcomes from studies show an increasing prevalence of obesity among American school-age children. The study by Karp and Gessel revealed a lack of effective interventions to address the problem.
The lack of adequate resources and knowledge to develop strategies interferes with the effectiveness of planned interventions. Evidence shows that the researchers and clinicians have created many interventions to address the issue of elementary school-age obesity, but the lack of effective legislations and health promotion goals prevent the success of these interventions. Despite the time and high cost of government revenues on planning and implementing health promotion programs for addressing the issue, the long-term benefits justify risks.
Theoretical Framework
Psychological theories of human behavior can easily apply in the following context by assisting establish an effective process that would help achieve the project goal. The project utilizes the Environmental Research for Weight Gain Prevention (EnRG) framework (Appendix 1) applying the theory of planned behavior. The framework considers four primary elements that make up an intervention to address elementary school-age obesity by addressing the behaviors of children, parents, teachers, and the government.
The application of the framework in the intervention
The theory of planned behavior plays a critical role in developing different nutritional education interventions that promote health and wellbeing of people. The theory assumes that conscious decisions and believes determine the nutritional behavior of an individual. Different factors including sensory perceptions, hunger, and perceived palatability of foods affect dietary behavior and determine the choice of food. Additionally, the food environment that determines the physical, economic, social, and political environments represented by accessibility, affordability, social appropriateness, and regulations respectively influence dietary behaviors and food choices. The EnRG model integrates these elements into a framework for easier analysis and development of an intervention plan. The framework relates dietary behavior to physical activity with environmental responses (such as meal patterns) and personal rational decision-making driven by cognitions. The framework helps plays a vital role in creating an effective nutritional educational program for children, parents, and teachers while considering environmental and dietary factors causing elementary school age obesity.
Potential Intervention Derived from the Review of Literature
Proposed intervention:
The review of the literature revealed two major factors that contribute to the high prevalence of elementary school-age obesity. These are the child's environment and the diet. The proposed intervention uses evidence-based research to determine the role of environmental components (physical, socio-cultural, economic, and political) and dietary behaviors in elementary school-age obesity. The outcome of the investigation leads to an integration of a cultural specific strategy focusing on creating a nutritional guideline procedure for children to prevent these components and behaviors. All schools will prepare nutritional guidelines for different meals taken in school and engage children in nutritional lessons. Parents will be required to attend a nutritional guideline education platform organized by nutritionists, health providers, and private regulators to educate them on the best nutrients to include for their children meals. The program will be happening once every two months for three years.
PART 3
Summary of the Intervention Plan
The need for an effective health promotion plan becomes imperative with the increasing prevalence of chronic diseases such as obesity caused by poor nutrition and lifestyles (Kozica, Lombard, Hider, Harrison, and Teede, 2015). The proposed intervention plan aims at integrating culturally specific strategies that incorporate environmental components and dietary behaviors to change the individual cognitions associated with beliefs and intentions. The following intervention has a much significant in reducing and preventing elementary school-age obesity because it composes of school-based, home-based, and community-based and environment-level approaches. These approaches combine diet and physical activity to achieve an excellent outcome. According to the Agency for Healthcare Research and Quality (2013), a combination of home and school interventions programs focusing on diet and physical exercise have significant improvements in children's weight outcomes; hence, help prevent and control elementary school-age obesity.
On the other hand, the link between an individual and the environment influences the outcome of a health and nutritional management program (Dietary Guidelines Advisory Committee, 2015). The intervention encompasses the community-based and environment-level approach that focuses on the social, environmental factors such as social networks, support systems, and the physical environment. Community leaders will undergo continuous training on how to guide parents and members of the community within their jurisdiction about healthy eating habits for school age children.
Potential Formative and Summative Approaches to the Intervention
Formative Approach
During the formative approach, a combination of measures will be obtained and judgments made before the implementation of the intervention plan. The main data obtained during this approach include the current state of elementary school age children regarding weight, performance, and nutrients taken. On the other hand, the formative approach will include a pilot evaluation that tests the implementation of the intervention plan in a selected institution. Findings of the formative approach to evaluation help in creating recommendations for improving the main evaluation process.
Summative approach
The summative approach to evaluation happens after the implementation of the intervention plan. The main information collected from the summative approach includes the quality of the intervention, impact to the target population, outcomes, and benefits it creates to the society. The outcome of the summative approach will be used as a guideline for the final evaluation plan.
Detailed Evaluation Plan
Interventions for solving public health problems are complex and demand context. Health intervention programs play a critical role in establishing an entry point for addressing these challenges and promoting critical thinking among stakeholders (Hawe, 2015). The evaluation plan plays a role in monitoring and documenting the implementation of the intervention to determine its suitability in meeting the health promotion goal. The evaluation plan for the proposed intervention addresses tools, processes, and data analysis techniques used. Additionally, the plan will follow these key steps.
Step I: Identifying specific goals and objectives
The problem is already identified and the purpose of the health promotion plan highlighted. The intervention will be communicated to all stakeholders for discussion and development of the implementation plan. The goal of the evaluation plan is to establish the effectiveness of the intervention in achieving the health promotion goal.
Step II: Reviewing the success of other interventions addressing a similar problem
Different interventions have differing policy options depending on the purpose and sector of the project. Reviewing research on other interventions assists in determining major approaches and policies utilized during the evaluation process. Scientific research tools such as interviews, questionnaires, and surveys will be used to gather evidence from research done. The evaluating team will collect data from different institutions to establish how they managed to evaluate their intervention; challenges met, and recommendations made. The following plan will focus on filling gaps identified from the review.
Step III: Outlining the work of the intervention plan
A review of research from other programs leads to the development of policy guidelines and approaches towards the evaluation process. The following step involves the creation of an outline of events that lead to the implementation of the evaluation process and achievement of evaluating goals. Logic models and theoretical models acts as guidelines for the evaluation process that involves a few pilot schools.
Step IV: Data collection
The success of the evaluation plan requires a look at the raw data obtained from stakeholders involved in implementing the intervention plan. The data collection process will involve gathering a team of researchers to collect data about the effectiveness of the intervention. The process will take place within five years after the implementation of the intervention to give the target group more time to adapt to changes. The collected data will be analyzed using modern statistical analysis tools. The analysis will investigate the impact of the intervention on the target group regarding weight loss, changes in eating habits, individual performance, general school performance, and change in the community health status.
Step V: Communicating results
Findings from the evaluation plan will be communicated to all schools. The pilot study will be a replica of the overall impact of the intervention. Results will also be communicated to the government and appropriate ministries and departments for further analysis and policy development.
References
Agency for Healthcare Research and Quality. (2013, June). Childhood obesity prevention
programs: Comparative effectiveness review and meta-analysis. Effective Health Care Program. 115, 1-18.
Anonymous. (2015). Overweight children. American Heart Association. Retrieved 6 June 2016
Brauser, D. (2012, Feb 03). Obesity, mental illness ‘dangerously linked’. Medscape. Retrieved 9
June 2016 from http://www.medscape.com/viewarticle/758035
Dietary Guidelines Advisory Committee. (2015). Food environment and settings. Retrieved 31
May 2016 from http://health.gov/dietaryguidelines/2015-scientific-report/09-chapter-4/
CDC. (2015, Aug. 17). Childhood obesity facts. Retrieved from
https://www.cdc.gov/healthyschools/obesity/facts.htm
Hawe, P. (2015). Lessons from complex interventions to improve health. Annual Review of
Public Health, 36, 307-323.
Karp, S. M., & Gesell, S. B. (2015). Obesity Prevention and Treatment in School-aged Children,
Adolescents, and Young Adults—Where Do We Go from Here? Primary Prevention Insights, 5, 1–4.
Kozica, S. L., Lombard, C. B., Hider, K., Harrison, C. L., and Teede, H. J. (2015). Developing
comprehensive health promotion evaluations: A methodological review. MOJ Public Health, 2(1), 1-9.
Naticchioni, K. (2013). The relationship between obesity and academic achievement of school-
Age children. Senior Honors Projects, paper 9.
Rice, T., Rosenay, P., Unruh, L. Y., Ginneken, E. (2013). United States of America health
system review. Health System in Transition, 15(3), 1-467.
Sleddens, E. F., Kroeze, W., Kohl, L., & Kremers, S. (2015). Determinants of dietary
behavior among youth: An umbrella review. International Journal of Behavioral
Nutrition and Physical Activity, 12(1), 7-29.
Thompson, K., & Carman, T. (2015, May 3). A healthful legacy: Michelle Obama looks to the
future of ‘Let’s Move’. The Washington Post. Retrieved 25 May 2016 from https://www.washingtonpost.com/lifestyle/food/a-healthful-legacy-michelle-obama-looks-to-the-future-of-lets-move/2015/05/03/19feb42c-b3cc-11e4-886b-c22184f27c35_story.html
World Health Organization. (2012). A population-based approach to childhood obesity
prevention. Switzerland, Geneva: WHO Document Production Services
APPENDICES
Appendix 1: The Environmental Research for Weight Gain Prevention (EnRG) framework (Source: Sleddens et al., 2015)
