Initiative to Reduce Adult Obesity in Howard County, Maryland: Part 2 Academic Paper)

Initiative to Reduce Adult Obesity in Howard County, Maryland (Part 2 Paper)

Abstract

Obesity is an abnormal or excessive fat accumulation that risks health (World Health Organization (WHO), 2020). Obesity is a major risk factor for chronic diseases, including cardiovascular diseases such as heart disease and stroke, which are the leading causes of death worldwide (WHO, 2020). Nearly 25% of Howard County residents are obese (Scarfone, 2012). The Healthy Parks and Healthy People (HPHP) initiative is an evidence-based strategy to promote physical activity and foster society’s understanding and appreciation for the role of parks and open areas. This paper discusses the implementation of HPHP in Howard County to improve the health of the residents. Adults 18 years and older were targeted. To meet this goal, the following objectives were addressed: 1) By May 2021, 70% of adult residents who are obese or have the risk factor for obesity will enroll in the HPHP program; 2) By August 2021, 80% of the participants will report the use of parks at least twice a month; 3) By December 2021, there will be a 20% reduction in the prevalence of obesity among adult residents in Howard County. The MAP-IT planning framework was used to guide the implementation of the program. The Health Believe Model was used to pilot strategies to meet the objectives. This paper further discusses the evaluation of the program after its implementation.

Keywords: Obesity, adult, physical activity, Healthy Parks, Healthy People, Health Belief Model, evaluation.

Program Goal and Objectives

An estimated 1.5 million adult Marylanders are overweight, and an additional 1.3 million adult Marylanders are obese (35.3% and 29.6%, respectively) (Maryland Department of Health and Mental Hygiene (MDHMH), 2017). Nearly 25% of Howard County residents are obese (Scarfone, 2012). Preventing overweight and obesity are the priority of the MDHMH Center for Chronic Disease Prevention and Control (MDHMH, 2017). The Healthy Parks and Healthy People (HPHP) initiative is an evidence-based strategy to promote physical activity and foster society’s understanding and appreciation for the role of parks and open areas. Healthy Parks Healthy People’s goal is to improve community residents’ well-being through the use of parks and outdoor settings (Maryland Department of Natural Resources, 2020). The HPHP initiative would be implemented in Howard County to improve the health of the residents through the regular use of parks and public areas. The target population is adults 18 years and older who are obese or predisposed to obesity and living in Howard County, Maryland. To meet the goal of HPHP, the following objectives will be addressed: 1) By May 2021, 70% of residents who are obese or have a predisposition to obesity will be enrolled in the HPHP program; 2) By August 2021, 80% of the participants will report the use of parks at least twice a month; 3) By December 2021, there will be a 20% reduction in the prevalence of obesity among Howard County Residents.

Program planning

The MAP-IT planning framework will serve as a guide to implementing the HPHP program. The MAP-IT framework involves the mobilization of partners, assessment of the community’s needs, creating and implementing a plan to reach the objective, implementing the plan, and tracking the community’s progress (HealthyPeople.gov., 2020). The first step will be to mobilize key individuals and organizations into a coalition. Healthcare and social services providers who have a stake in creating healthy communities and contributing to the process would be mobilized. Roles would be identified, and partners would be assigned responsibilities. This will help partners to remain involved in the program. Healthcare and social services providers will be tasked with screening individuals for the program and enrolling residents with a predisposition to obesity and those with known diagnoses of obesity into the program. The providers will also be tasked with encouraging residents to take advantage of the parks in their area to increase physical activity. The second step will involve the assessment of needs and assets (resources) in the community to get a sense of what can be done. Both the state and local data will be collected to have an accurate picture of the community’s needs and what the program will focus on, which will serve as baseline data and a guide to track progress.

The third step will involve developing a stepwise plan for implementing the strategies to meet the initiative’s objectives. Healthcare providers and social services providers will be trained on effective physical activity counseling and the values of parks through online education or in-person meetings. Likewise, the providers will be tasked with creating awareness and providing residents with education and instruction on the HPHP initiative. The fourth step will involve implementing the strategies and creating a point of contact to ensure things are being done. An office will be designated to keep the initiative on track, and staff will be made available for enrollment, support, and stakeholders’ training. The fifth step will entail evaluation to measure progress. There will be a partnership with the local health department to help with data tracking.

Follow-up phone calls and appointments would be used to encourage participation. Providers will be used to achieve this and to help participants achieve self-efficacy. Likewise, cues to action will be achieved through organizing community-wide campaigns and events aimed at educating everyone on the importance of participating in the HPHP initiative. Programs will be designed to hold on certain days of the week to provide free, introductory, and accessible park programs for first-time or infrequent park users in the community. The goal is to provide a welcoming experience for individuals.

Behavioral Change Model

The Health Belief Model was used as a change model to guide the activities and implement the strategies for objectives 1 and 2. The Health Belief Model (HBM) suggests that six constructs predict health behavior: risk susceptibility, risk severity, benefits to action, barriers to action, self-efficacy, and cues to action (Jones et al., 2015). According to the HBM, people are more likely to take action to prevent illness if they feel they are susceptible to a condition (perceived susceptibility) if they believe the condition would have potentially serious consequences (perceived severity), if they believe that a particular course of action would reduce the susceptibility or severity of the condition (perceived benefits) and if they perceive few negative effects related to the health action (perceived barriers). Additionally, HBM scholars suggest that self-efficacy (the belief that one can complete the behavior of interest despite considered barriers) and cues to action, such as factors in one’s environment, can impact the final action one takes (Jones et al., 2015). All aspects of the community will be considered potential intervention targets.

Individuals who are obese and lead a sedentary lifestyle, and have a predisposition to obesity would be more likely to participate in the HPHP initiative if they are aware of the associated risks of obesity (such as stroke, diabetes, hypertension, coronary heart disease, osteoarthritis, and certain types of cancer; breast, colorectal, kidney, and endometrial). Likewise, the community as a whole would be willing to support and encourage the participants if they perceive an overall benefit to the community and state. According to the Maryland Department of Health and Mental Hygiene (DHMH, 2014), the State of Maryland could save up to $13,836,000,000 by 2030 if BMI were lowered by 5%. Participants and residents would be more willing to partake in the initiative if they have an understanding of the program if they understand that the cost of taking action will be far better than the cost of having the disease, and if they perceive that the action has no untoward effect on health.

The program would continue to enhance existing partnerships and coordinate with other agencies to identify opportunities for enhancement and expansion of the program and support other programs aimed at reducing the prevalence of obesity in Howard County. Programs such as the Maryland Farmers Market Association would be leveraged to improve healthier food access in retail and community venues in the community. Participants would be encouraged to continue with physical activity through the use of the parks and to add new activities available in the parks with the hope that the rates of obesity and obesity-related risk such as hypertension, diabetes, and coronary artery disease will decrease and that people will live longer and healthier lives.

Evaluation

The goal of the HPHP initiative is to encourage the use of available parks and community spaces to engage in healthy behaviors. The local health department in Howard County and the Howard County Recreation and Parks Department will be used to track participation and progress in the program. Data on the number of residents who used the parks would be collected from the county parks department at the end of the implementation and during the evaluation phase. Information on the community’s overall health, including the prevalence of obesity in the community, will be obtained from the local health department. It is expected that 70% of the residents who are 18 years and older, who are obese or have risk factors for obesity, will have been enrolled in the HPHP program by May 2021. It is equally expected that 80% of the participants will report the use of parks and outdoor spaces at least two times a month. Likewise, it is expected that by December 2021, there will be a 20% reduction in the prevalence of obesity among Howard County residents.

References

Healthy Parks, Healthy People. Maryland Department of Natural Resources. (2020). https://dnr.maryland.gov/publiclands/pages/healthyparks.aspx#:~:text=%22Healthy%20Parks%20Healthy%20People%22%20is,western%20Maryland%20and%20Caroline%20County.&text=The%20overall%20goal%20of%20the,in%20stress%2Drelieving%20outdoor%20settings.

HealthyPeople.gov. (2020). Program Planning. https://www.healthypeople.gov/2020/tools-and-resources/Program-Planning

Jones, C. L., Jensen, J. D., Scherr, C. L., Brown, N. R., Christy, K., & Weaver, J. (2015). The Health Belief Model, as an explanatory communication research framework, explores parallel, serial, and moderated mediation. Health communication, 30(6), 566–576. https://doi.org/10.1080/10410236.2013.873363.

Maryland State Department of Health and Mental Hygiene. (2014). Public health needs assessment. https://pophealth.health.maryland.gov/Documents/Maryland%20Public%20Health%20Needs%20Assessment%202014.pdf

Maryland Department of Health and Mental Hygiene. (2017). Report on Diabetes and Obesity Initiatives and Funding. https://phpa.health.maryland.gov/Documents/Diabetes-and-Obesity-Initiatives-and-Funding-2016-Report.pdf

Scarfone, A. (2012). Nearly 25% of Howard County is Obese, Data Show. https://patch.com/maryland/elkridge/speak-out-is-obesity-a-concern-in-howard-county