Young at Heart Senior Nutrition Program - Research Proposal Example

Young at Heart Senior Nutrition Program Proposal Reema Alsurayyi and The “Young at Heart Senior Nutrition Program” is the title of the name of the program. Its relevance is derived from the ultimate goal of this program which is to keep the heart young even when one ages. Justification for program The recent report released by the New York City Department of Health has indicated that hypertension cases are rife among African Americans as compared to the White Americans. According to the study it conducted, approximately 74% of African Americans aged 65 years and above have hypertension. This is as compared to 42% of whites in the same age bracket. Of this, African-American population that is hypersensitive about 68 % comes from Brooklyn with majority living on or around Flatbush Avenue. The hypertension prevalence is high in adults as compared to the youths. Among adults with hypertension, a majority, 81.9% did know that they have hypertension. Still the percentage could be raised as a preventive measure. Also among the hypertensive adults only 76.4% were currently taking their medication which is quite alarming (Dickson et al, 2006). A sensitization program is therefore necessary to enable these elders know when they are hypertensive and to adhere to their hypertension medication. (Van Dulmen, 2010). Prevention is always better than cure. The cost of hypertensive medications has increased exponentially and this has now become expensive to most people. It becomes much easier to take a proactive approach and educate the elderly on prevention. The study has also corroborated what Svetkey, Simons and Vollmer found in their research that the right diet is all that this population need in order to live a hypertension-free life (Svetkey, Simons and Vollmer, 1999). There is therefore, an obligation to increase hypertension awareness among the affected people and educate them about their food choices and change their lifestyles in order to decrease their susceptibility to this dangerous condition. The general goal The general objective of the “Young at Heart Senior Nutrition Program” is to decrease sodium intake among hypertensive participants. Specific Program Objectives By the end of the program, the seniors should be able to identify low and high sodium content food choices. By the end of the week 3, clients will be able to adapt one culture food to reflect lower sodium intake. Also, at the end of the 8th-week program, 50% of the participants will have internalized the USDA guideline for daily recommended sodium intake. Abstract The primary goal of the “Young at Heart Senior Nutrition program” is to decrease sodium intake in hypertensive participants among African American in seniors’ centre which located in Flatbush Ave. Excessive intake of sodium is a key cause of high blood pressure. There are other main causes but this one presents the most appropriate opportunity for taking proactive measures rather than reactive. Just like in the cases of other diseases and conditions, prevention is better than cure. Regulating sodium intake is effective both as a proactive and a reactive measure to those who already have the condition (Dickinson et al, 2006). It is also the most encompassing measure that most of these elderly people will identify with. The other possible measures towards reducing high blood pressure include weight reduction and reducing alcohol intake. They are equally effective but do not net as much hypertensive individuals as dietary management. Literature Review Hypertension is a condition where the blood arteries have a higher blood pressure. This may be caused by a host of factors, including high sodium intake, low calcium and potassium intake, low rate of physical activities, diabetes, stress, high alcohol intake and aging (Bodenheimer, Lorig and Holman, 2002). Considering these factors it is clear that the elderly people, especially those at 65 years and beyond, are very susceptible to acquiring this condition. The aforementioned factors make the arteries to constrict and in some cases deposit some fat and cholesterol in the arteries. This makes it harder for the heart to pump blood to every part of the body and this has dire consequences (Svetkey, Simons and Vollmer, 1999). Hypertension may cause death due to heart failure; it may also cause stroke, heart attack, kidney failure and other complications. Prevention, therefore, becomes imperative. Knowledge is power; people will not perish when furnished with knowledge because they become better placed during decision making. This information may not be accessible to all and therefore, those who have it are tasked with the obligation of sharing it. That is why such educative programs are needed in the societies where the affected or those in the danger of being affected can be educated and aid them make better decisions and lead better lifestyles. The Dietary Approaches to Stop Hypertension (DASH) report released in 1997 provided some useful insight towards hypertension management. It made huge ground breaking steps that greatly aided the hypertensive community. This report concluded; with certainty, that diet is an important determinant of blood pressure. Through the many studies conducted, taking a diet rich in fruits and vegetables yet has minimum sodium is the best action for reducing high blood pressure (Dickinson et al, 2006). African Americans are more susceptible to having this condition when they reach the age of 65 as compared to Hispanics and White Americans (Kumanyika, 1997). The reason for this ‘racial affinity’ of hypertension could not be identified with certainty, but possible reasons could be pointed out. The first was that more African Americans take fatty food than their counterpart; they also find it difficult to adhere to self-efficacy measures introduced by the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (Bosworth et al, 2008). These self-efficacy measures were provided in order to manage chronic diseases like asthma, diabetes and arthritis through self initiated actions. These actions included strict adherence to the medication prescribed, taking low sodium content diets, avoiding smoking either as a primary smoker or secondary, managing weight, and eliminating the use of tobacco. The study also found out that African Americans and White Americans smoke cigarette almost in the same measure. However, African Americans are disadvantaged in that their risk of second-hand or secondary smoking is higher than that of their counterpart. All these factors combine to make them more susceptible (Kumanyika, 1997). However, Africans Americans were seen to be more responsive to this dietary approach than the Hispanics and White Americans. For instance, their average blood pressure reduction after undergoing the program was 13.2/6.1 mm Hg on hypertensive Africans (Bosworth et al, 2008). This is the finding that informed the coming up with this program since with these remarkable results it is possible to reduce the need for antihypertensive medication significantly. Through inculcating African Americans with the need to embrace self-efficacy this elderly population will feel that actually this condition is manageable with little effort. Similar programs have been rolled out and proved effective in maintaining a healthy community having as less people suffering from hypertension as possible; there is no reason why this one should not achieve a similar target (Michele, 2009). Community Details Most African Americans who have hypertension live in Flatbush Ave, Brooklyn New York. Based on the data provided by the New York City government, 68% of the elderly, here referring to those who have 65 years and above, have hypertension. A significant number of school going children are obese, which pause a health risk by increasing their chances of having hypertension when they grow old. This intervention will target the elderly with the hope that the lessons learnt during the program will be passed on to others at home. As Michele points out, a good community program or any form of intervention should rather be both proactive and reactive and is driven by the hope that the community will maximally benefit from it (Michele, 2009). Program Plan The program will be rolled out for 8 weeks. In each week there will be a selected day in which the seniors will hold a 2 hour session. Below is the project plan, outlining the tasks, the weeks as well as the sessions. 8 Weeks: Session 1: Let’s Talk Salt! (getting started, video, “Salt Matters: Preserving Choice, Protecting Health, from CDC) Session 2: Reading Labels (reinforces information in video) Session 3: Soulful Cooking I (demonstration) Session 4: “DASH” to It! Session 5: Soulful Cooking II (demonstration) Session 6: To the Market We Go! Session 7: Soulful Cooking III (demonstration) Session 8: Slowing Down Fast Food This program will be rolled out for 8 weeks, which should be sufficient to attain the objectives. If need be one more lesson will be added stretching the program to nine weeks. The target population of the program is seniors, and the intervention happens in a senior centre. The program has been brought closer to net as many hypertensive seniors as possible. A continuous assessment test will be carried out weekly to see the progress in their understanding; this will be accompanied by interactive segments and short seminars at the end of each week. A lot of the seniors are experiencing decreased comprehension ability unlike when they were young; flashcards will be employed to visually aid them in identification of the various foods and to distinguish between those that have high sodium content and those that do not. A PowerPoint projection will be used during the whole program to clearly and creatively present the major points so that no one misses them. The seniors will attend some cooking classes and workshops where they will discuss together with the tutor and gets a hand-on approach on cooking the low-sodium content food. On the designated day of the first week, the seniors will be treated to a movie about salt from CDC and at the end will discuss the lessons learnt from the movie and to what extent they resonate with the ones they have in their lives. There will be a lot of demonstration to reinforce learning and behavioural change. Session 6 will be a field experience, the seniors will be taken to a supermarket and their label reading skills tested. The idea is to teach them to identify high sodium content commodities and fast foods. Design of the Program This project is modelled around the Social Cognitive Theory. This is a learning theory employed widely in the social health field. It states that people do not only learn by trying and either succeeding or failing, but also by observing. In fact, this theory suggests that most life lessons are learnt by observing others interactions and experiences. This theory is based on 5 constructs; i) Environment ii) Self regulation/ control iii) Behavioral capacity iv) Self efficacy v) Observational learning This theory acknowledges the effect the environment may have in shaping ones behaviour or experiences. The Young at Heart Program provides social support via the group setting, which meets regularly hence establishing an environment. The working in groups creates a community and through sharing of experiences learning is accelerated. Furthermore, the seniors become accountable to each other and they all benefit in the end. In order to determine the learning curve self-regulation will be tested. The choosing of the food materials during the cooking demonstrations and the intake of portions will be put on test. Behavioral skills and discipline will determine the learning curve. Behavioral capacity involves the ability to perform behavior. This will be measured by observing participation during food preparation; selecting low-sodium meal and during supermarket label-reading trip. Self-Efficacy involves the discipline to stick to medication and doing activities that minimize the risks of reinvigorating or accelerating the blood pressure. Individual confidence and problem-solving activities and group discussions are designed to enhance self-efficacy. This may include activities such as identifying from the cards which food materials have high sodium content, taking light physical activities sessions, weight managements and cooking demo participation. Observational Learning will majorly be enforced through cooking demonstrations. Management System The project will be headed by the project director, a community nutritionist, who needs to be a qualified dietician with a dietician certificate, masters or bachelors. He or she should also have some experience in interacting with the elderly in the community for at least 2 years. The goal of this program is to reduce sodium intake in the seniors and so the head of this project needs to have the expertise in the dieting area. The director should oversee the content creation, overall presentation, workshops and assessment; he or she can also handle the lessons if need be. Under the director there will be a manager, a Nutrition education promoter, whose task will mainly involve the logistics. This will include setting up the venue in the seniors’ centre on the day, there is a session. Since the program is taking place inside the seniors’ centre, there will be no need to sensitize them to attend through any form of publicity; this would have been handled by the manager. He should also have a bachelor or masters degree preferably in accounting or related field that will aid streamline his logistics operations. The manager will be required to arrange for procurement and transportation of the materials to be used during classes, presentation, practical and movie watching. He is also required to manage the personnel that will be offering the lessons and ensure time management. Lastly, there will be two volunteer nutrition education assistants who will implement the program. They will either lead or assists in giving the lessons and so they are expected to be good cooks. If they are skilled in the field of dietary the better placed the management system will be as it will accord the personnel some flexibility (Michele, 2009). Marketing Strategy This campaign is expected to be rolled out four times in four years. Since the hypertensive population is concentrated in the senior centres less publicity is needed. However all the elders need these lessons so posters with the young at heart messages will be placed in these centres weeks before the program commences. In Brooklyn, the program will be implemented in four senior centres and will be fully supported by the funding that this proposal seeks to source. Program Evaluation The program will be evaluated in three stages and perspectives. The formative evaluation will be carried out at the start of the program. Questionnaires and interviews will be conduct where the staffs and the participants will air their expectations on the program. This will help structure consequent programs. Impact evaluation is the second and the most crucial evaluation. This will measure behavioural change and content learnt. It is the objective of this program that by completion at least 50% of the participants should be able to identify foods that have high sodium content. They should be able to do this out of memory. The elders are also expected to have mastered the reading of labels on the products they purchase and enforce self-efficacy provisions intentionally. The last aspect of program evaluation will be summative evaluation. This evaluates the different components of the program, one at a time, in a bid to determine their effectiveness and make recommendations so that the next years’ program will be better. The different activities to be assessed may include the classes and mode of delivery, cooking demonstrations, group works and supermarket trips. Tentative Budget This budget will list the expected maximum figure for each item. It is however tentative and could change as and when the situation demands. (Amount in US Dollars) Budget (For four 8 week cycles) Direct Costs Salaries •      Nutritionist/RD (annual $55,000 /32 weeks)                                      $34,000 •      Nutrition Education Promoter (annual $45,000/32 weeks)                $28,000 •      Fringe Benefits (Medical Insurance, FICA and other taxes)             $7,400 Materials and Supplies •      Food                                                                                                    $900 •      Food prep equipment                                                                          $275 •      Utensils                                                                                               $85 •      Cleaning Supplies                                                                               $15 •      Stationery supplies                                                                              $250 •      AV equipment rental                                                                          $600 •      Participant education promotion gift                                                  $70 •      Bus transportation                                                                               $1660 TOTAL DIRECT COSTS                                                                       $73,255 Indirect Costs            (25% of direct costs)                                            $18,313.75 TOTAL COST                                                                                          $91,568.75 References Bodenheimer, T., Lorig, K., & Holman, H. (2002). Patient self-management of chronic disease in primary care. JAMA, 288, 2469-2475. Bosworth, H., Powers, B., Grubber, J., Thorpe, C., Olsen, M., & Orr, M. (2008). Racial differences in blood pressure control: potential explanatory factors. Journal of General Internal Medicine, 23, 692-698. Dickinson, H., Mason, J., Nicolson, D., Campbell, F., Beyer, F., & Cook, J. (2006). Lifestyle interventions to reduce blood pressure: A systematic review of randomized control trials. Journal of Hypertension, 24, 215-233. Du, S., & Yuan, C. (2010). Evaluation of patient self management outcomes in healthcare: A systematic review. International Council of Nurses, 57, 159-167. Kumanyika, S. (1997). Can hypertension be prevented? Applications of risk modifications in black populations. Diet Association, 7, 72-79. Michele, I. (2004). Health Program Planning and Evaluating: A Practical, Systematic, Approach for Community Health. New York: Jones and Bartlett. Svetkey, L., Simons, D., & Vollmer, W. (1999). Effects of dietary patterns on blood pressure. Subgroup analysis of the dietary of the dietary approaches to stop hypertension randomized clinical trial. Arch Intern Med, 159, 285-293. Van Dulmen, S. (2010). Moving forward to improve medication adherence. Patient Education and Counselling, 81, 145-149. Read More