Heart Disease Final: Britni Overall, Brittany Holcomb, Emily Gibson

KINS 6503 – Health Program Planning

Project – Final Submission

Problem: Eliminate chronic disease in Gwinnett County, Georgia, USA

Topic: Cardiovascular disease

Part I - Introduction and Planning Model

A. Overview of the Health Problem and the Community

i. Community

Chronic disease is a rising concern worldwide. According to the CDC, “chronic diseases

are defined broadly as conditions that last one year or more and require ongoing medical

attention or limit activities of daily living or both.”1 The majority of the deaths worldwide are due

to chronic diseases such as heart disease, cancer, chronic lung disease, stroke and type 2

diabetes.2 In 2015, Georgia had 6.3 million people with at least one reported chronic disease,

and 2.5 million with three or more chronic diseases.3 “Chronic disease could cost GA $64.6

billion in medical costs and an extra $26.8 billion annually in lost employee productivity.”3

Through better prevention and treatment, we could save 34,500 lives in GA.3

In the U.S., heart disease is the leading cause of death for both men and women of most

ethnicities.4 Cardiovascular disease “includes all the heart and blood vessels, including ischemic

heart disease, stroke, congestive heart failure, hypertension and atherosclerosis. High blood

pressure, high LDL cholesterol and smoking are key risk factors for heart disease. About half of

Americans have at least one of these three risk factors”.5 Gwinnett County is no exception with

heart disease being the number one cause of death for adults aged 45-74 years old.6 A study

done by the American Heart Association looked into the knowledge of women of different races

and their attitudes about cardiovascular disease. According to this study, Non-Hispanic African-

American women had higher trust in their physician (87%) about cardiovascular disease while

Non-Hispanic Caucasian women and Hispanic women had lower levels of trust (78% and 72%
Heart Disease Final: Britni Overall, Brittany Holcomb, Emily Gibson

respectively). Hispanic women felt as though preventative and treatment options were culturally

insensitive or disrespectful.7

Gwinnett County, located in the northeast suburbs of Atlanta, is the second largest county

with a population of 907,135.8,9 The median resident age is 53.2 years, 27.5% are below 18

years of age and 9.3% are 65 and older.8,10 The male to female ratio is relatively similar with

51.1% female and 48.9% male.8 Gwinnett is a diverse county composed of 38.5% Non-Hispanic

white, 26.5% Non-Hispanic African American, 20.8% Hispanic and 11.9% Asian.8 8% is not

proficient in English and 34% of the population, 5 years and older, speak a language other than

English at home.8 “Heart disease is the leading cause of death for most racial/ethnic groups in

the U.S., including African Americans, Hispanics, and Whites. For Asian Americans or Pacific

Islanders and American Indians or Alaska Natives, heart disease is second only to cancer.”1 In

GA, 3.8% of African-American women have cardiovascular disease while 5.7% of Caucasian

women are affected by the disease.11

Education and income are closely tied with better health. The median household income in

Gwinnett is $61,865 but 13% of individuals live below poverty level and 28% of children live in a

household headed by a single parent.8,12 24.1% of children live in households with

Supplemental Security Income, cash public assistance income or Food Stamp/SNAP benefits.12

In Gwinnett, the unemployment rate is 4.7% but 87.5% of people 25 years old or older with a

high school degree or higher and those with a bachelor’s degree or higher is 34.9%. 8,13

Although the community is thriving, healthy, and ranked fifth overall in the state, the

residents of Gwinnett are still faced with challenges that influence an unhealthy lifestyle.8 18% of

the residents are uninsured, 14% of adults smoke, 28% of adults are obese and 21% are

physically inactive.8 Gwinnett’s physical environment, all places where we live and work, ranked

76th out of the 159 counties in GA.6 The county has an average of 18 grocery stores per

100,000 population which is lower than the nationwide average of 21 per 100,000.6 It is also

estimated that 8% of low-income residents live more than a mile from a grocery store compared
Heart Disease Final: Britni Overall, Brittany Holcomb, Emily Gibson

to 6% nationally.6 There is also a high density of fast food restaurants, 80 per 100,000

population, compared to the national average of 60 per 100,000.6 Nutrition and diet is greatly

affected by the correlation between the number of grocery stores in a neighborhood as well as

the number of fast food restaurants. With greater access to fast food restaurants than grocery

stores, residents are exposed to high fat and high caloric diets that lack the recommended

nutrition. This correlation can lead to obesity and other health related problems.

Access to recreation and fitness facilities is another factor that can affect someone’s health.

Gwinnett has an estimated 0.11 recreation/fitness facilities per 1,000 residents, which is better

than the national average of 0.07 per 1,000 but 88% of residents drive their car to the park.6

Having better access or closer parks could allow more people to walk to the parks instead of

driving. “The Gwinnett Neighborhood Leadership Institution focus group stated that the county’s

biggest threat was inadequate transportation (public transit, sidewalks, and safe bicycle lanes).

Commute times are not any better. On average, people in Gwinnett have a commute time of

32.1 minutes which is higher than the U.S. average of 25.3 minutes and 3.66% of the Gwinnett

workforce have “super commutes” in excess of 90 minutes.14.

ii. Extent of the problem

Worldwide, cardiovascular disease (CVD) is the number one cause of death, with more

people dying annually from CVD than from any other cause.15 It was reported that in 2015 that

an estimated 17.7 million people died from CVDs, representing 31% of all global deaths.15 Not

only is cardiovascular disease the number one cause of death worldwide, but according to the

Georgia Department of Public Health, it is also the single leading cause of death in GA,

accounting for more than 20,000 deaths per year.5 The CVD death rate in GA was 12% higher

than the national rate in 2003.16 In 2003, it was reported that Gwinnett was the fourth highest

county with 833 deaths due to CVD, following behind Fulton County with 1,850 deaths, DeKalb

County with 1,293 deaths, and Cobb County with 1,155 deaths.16

iii. Causes
Heart Disease Final: Britni Overall, Brittany Holcomb, Emily Gibson

There are several causes that are contributing to the cardiovascular disease problem in

Gwinnett. Obesity, gender, and hereditary factors all play a role in one's risk of developing

cardiovascular disease in their lifetime as well as where a person my live, work, learn or play.17

It is also known that employment and education levels can influence poverty and access to

healthy foods which greatly affect one's’ health.

Chronic diseases, like cardiovascular disease, are preventable but adults in GA are

overweight or obese (66%), eat less than 1 fruit a day (43%), eat less than 1 vegetable a day

(24%) and smoke cigarettes (19%).3 People have always thought that women are “protected”

from heart disease because of their estrogen, but once a woman goes through menopause,

their risk of cardiovascular disease is the same as a males.17 Genetics play a role in the risk of

heart disease because it has been found that heart disease can run in some families.17 These

same factors are contributing to the prevalence of heart disease is Gwinnett.

B. Priority Population

“Cardiovascular disease is the number one killer of women, causing 1 in 3 deaths each

year. That’s approximately one women every minute!”18 Cardiovascular diseases are the

leading causes of death for both African-American and Hispanic women.4 Of all women, 90%

have one or more risk factors for cardiovascular disease.19 However, 80% of cardiovascular

events can be prevented with education.19 In this program, our team will be targeting a “mommy

and me” group of females ranging from 18-40 years old. Mothers tend to care for others and

end up neglecting themselves causing their health to deteriorate. By providing these women

with information and education on making healthier choices while caring for their children, we

can decrease the number of women affected by this disease.

C. Planning model

For cardiovascular disease in Gwinnett, among mothers aged 18-40 years old, the Healthy

Communities Planning model would be best. Gwinnett has the second largest population in GA,

and one of the most diverse populations, therefore a level of flexibility is needed to plan a health
Heart Disease Final: Britni Overall, Brittany Holcomb, Emily Gibson

program.8 Having the flexibility to change what needs to be addressed, based off of actual

community response, will be highly beneficial to the development and implementation to a

health program. As the program progresses through the stages of the Healthy Community

program a broader range of ideas will be developed and a higher feeling of “program ownership”

will facilitate community involvement.20 The Healthy Community Model will also teach the

community how to become healthier with the resources it already has. Examples of this are

community centers, free classes that hospitals or clinics provide to community members, health

fairs sponsored be major organizations (American Heart Association), fundraiser 5Ks, etc.20

Although the Healthy Communities Planning model will be chosen for this process, the

PRECEDE-PROCEED Model is something that would work as well.21 There is a large sense of

community involvement in this planning model; however it is not the bases of the program. This

model does not allow for as much flexibility as the Healthy Community Model and with such a

large group like Gwinnett, more flexibility would be beneficial. Another reason this model was

the second choice for implementation is that the needs assessment determines what the factors

are that cause the issue. However, Healthy Communities allows the participants to choose what

factors are the most important for them to work on.20,22

A third choice for a program planning model would be MAPP. Although this model is

great for mobilizing partnerships, we feel like the Healthy Communities Planning model allows

more room to make adjustments.

Part II - Partnerships and Planning

D. Partner organizations

The goal of our health promotion program is to eliminate cardiovascular disease in Gwinnett

County. Involving local organizations is necessary in order to help us reach that goal. One

organization that came to mind is the Gwinnett Young Men's Christian Association (YMCA). The

Gwinnett YMCA area of focus is “improving the nation’s health and well-being”.23 The YMCA

offers a variety of programs for children and adults. They can provide insight on what has
Heart Disease Final: Britni Overall, Brittany Holcomb, Emily Gibson

worked and hasn’t for the programs they offer as well as expertise in the area of physical

activity.

A second organization we plan to utilize is Live Healthy Gwinnett. Live Healthy Gwinnett is

“designed to encourage and engage Gwinnett County residents to invest in personal wellness

while focusing on four major areas: Be Active, Eat Healthy, Get Checked and Be Positive. They

take a proactive approach to address the preventable chronic illness that impact Gwinnett

County through education. Be Active Gwinnett, a recreation center on wheels, provides

underserved youth located in play deserts who have limited access to structured activities, the

opportunity to be physically active outside in a play-safe environment!”24 This partnership will

allow feedback and insight on activities kids can do with limited resources and help us reach the

underserved population.

Gwinnett Medical Center’s Mission is “to provide quality health services to our community.”25

This local hospital deals with CVD on a daily basis and would be a great source for our project.

Involving them in our planning process will allow us to have expert advice and services.

Gwinnett Coalition for Health & Human Services would also be a beneficial organization to

partner with. Their goal and mission is to “Facilitate collaboration that improves the well-being of

the community by identifying needs and resources, setting priorities, planning solutions,

focusing on results, and educating and motivating the community to action.”26 They will be able

to help us engage the community to take action as well as provide community connections that

we may not have thought of.

Gwinnett County Parks and Recreation would be another beneficial resource when planning

and implementing our program. Their mission is “in partnership with our citizens, Gwinnett

County Parks and Recreation provides high quality, broad-based parks, facilities, programs, and

services creating a sense of community, enabling a safe and secure environment, and

enhancing Gwinnett quality of life.”27 We will be able to promote their services to our priority
Heart Disease Final: Britni Overall, Brittany Holcomb, Emily Gibson

population and help increase their utilization numbers. They can also provide expertise on

different exercises that our mothers and children can participate in.

Lastly, we would include the Girl Scout Troop 17603 Leader, Jessica Preble. She would be

able to provide us with insight on what our priority population needs and wants. She will also be

our point of contact for disseminating information to the parents and children about our

upcoming class. Jessica can also help us solicit to other Troops about our class.

E. Planning

i. Planning Committee

With any program planning, it is important to start with a planning committee. These

members will have a vested interest in eliminating chronic disease in their county. They will also

help with the creation of creating the program, overseeing the implementation and evaluation.

With the following organizations and individuals, we will be able to create and deliver a program

that is beneficial to Gwinnett.

Our planning committee will consists of: Jessica Preble (Girl Scout Troop 17603),

Nazanin Weck (Gwinnett County Parks & Recreation), Pat Baker (Gwinnett County Health &

Human Services), Kimberly Nelson (J.M. Tull- Gwinnett Family YMCA), Destiny O’Loughlin

(Gwinnett County Transit), Mary Hudgins (Gwinnett Medical Center), Ellen Gerstein (Gwinnett

Coalition for Health & Human Services), Tanisha Pressley (Live Healthy Gwinnett), Amanda

Jackson (Georgia Department of Public Health), Chief Russell Knick (Gwinnett County Fire and

Emergency Services), and Annie Valenty (Children’s Healthcare of Atlanta). All of these

individuals play a key role in promoting healthy behaviors in Gwinnett County by focusing on

physical activity, eating healthy, and personal well-being.

ii. Planning Process

We decided to use the Healthy Communities Planning model because it aims to involve

citizens and community officials to make becoming a healthy community a priority and to pursue

that goal by involving community members in identifying and addressing the issues most
Heart Disease Final: Britni Overall, Brittany Holcomb, Emily Gibson

important to them.28,29 The steps we will follow are: 1) Mobilize key individuals and organizations

by utilizing our key partner organizations (refer to section D. Partner organizations) and planning

committee members (refer to section E.i. Planning Committee) 2) Assessing community needs,

strengths and resources. We will conduct a focus group consisting of individuals from our

priority population, our partners and planning committee to determine what changes they would

like to see in Gwinnett to help eliminate chronic disease, in particular heart disease and how we

can help with that change. We will also discuss what resources the community has and doesn’t

have to help determine the extent of our program. 3) Plan for action. We are planning to

implement our program during a weekly Girl Scout troop meeting on November 28th, 2018. We

will do a short and informal PowerPoint presentation discussing what CVD is, the causes and

health risks of it, and ways to reduce one's risk of developing it through healthy eating and

exercising. We want to get the girls and moms moving, so after the presentation we are going to

show them fun and easy exercises they can do together or alone, at home without any

equipment. To encourage participation, we are going to give away small prizes such as healthy

snacks, coloring books, colored pencils, etc. 4) Implement the action plan. In order to implement

our program, we thought it would be best to coordinate an email meeting with each of our

partner organization directors. In this meeting we will discuss the different activities that we have

come up with as a team in order to plan for our event. 5) Track progress and outcomes. To

determine our participants’, increase in knowledge we plan to do a pre-test and post-test for the

mothers consisting of 9 questions that has been developed by Gwinnett Medical Center. In

order to track how successful our overall event is, we are planning on creating a paper survey to

hand out to all participating mothers to fill out with their daughters. In this survey we will ask

them: 1) did they enjoy the event, 2) how likely are they to incorporate the exercises into their

daily lives, 3) what were their top 3 exercises, 4) what were their top 3 takeaways from the

presentation, and 5) to rate their overall experience from 0-5 with 0 being that they strongly

disliked the event and 5 being that they loved the event. Some other ways in which we can track
Heart Disease Final: Britni Overall, Brittany Holcomb, Emily Gibson

and evaluate the success of this health promotion plan can be the basic practice of observation.

Through observing and just watching what the participants in the program are acting like, we

can learn a lot about the way that our program is going. For example, if the children and

mothers in the program are huffing and puffing and rolling their eyes from boredom with our

activities, then we need to be able to see that our program is not being seen as effective. If we

are observing anything like this in the duration of our program, we will have to make appropriate

adjusts to ensure the effectiveness of our program.

iii. Communication Plan

Throughout the planning of our program, we have decided on a few strategies that we

will use to communicate with the partnership to ensure they stay informed and involved. We will

pilot our program with a Girl Scout Troop and expand it further later on. In order to promote our

program, we are first going to speak with the Girl Scout troop leader to inform her of our plan

and determine a time and date for the program to take place. Once the time and date has been

decided, we will be able to have weekly email meetings to send out constant alerts and

reminders of changes or revisions. To ensure there is an open line of communication between

everyone, we plan to send out emails twice a week prior to the event, and then one week before

the event we will plan to email and call. Lastly, a few days before our event we plan to send out

a group text asking if anyone has any questions or concerns. The constant communication will

allow us to be fully prepared for the event.

We hope that other organizations, like the YMCA, will take this program on and promote

it further. Since our priority population is low income mothers we have to be strategic with our

methods as they may not have some of the technology or means as compared to higher income

mothers. TV, radio and newspaper PSAs, flyers for mailboxes and organizations, and social

media promotions may be the best way to reach our priority population. These methods are

relatively cheap, if not free, and will not require a ton of work for our partners.

Part III - Project/Program Design

Heart Disease Final: Britni Overall, Brittany Holcomb, Emily Gibson

F. Theories

Intrapersonal Level Theories focus primarily on individual health behavior, so planners must

be able to explain and influence the behavior of individuals in order for this to benefit the

community. One of the theories that is used to explain and modify behavior is the Stimulus

Response Theory, which reflects the combination of classical conditioning, instrumental

conditioning, positive/negative reinforcement, positive/negative punishment and aversive

stimulus.29 As a team, we have selected this particular theory to give an opportunity for the kids

to participate in our activities during the cardiovascular disease presentation while receiving a

small incentive. For example, during our presentation we will have the kids do an activity that

goes along with the presentation and if they compete the activity, they will get a small prize.

The Theory of Planned Behavior is another intrapersonal level theory. It incorporates the

dimension “perceived behavioral control” as a determinant of intention.29 The theory looks at

asking “can I do this?”29 Our team believes that this theory would be beneficial because if people

believe that they are in control and that they can do something, they will be more likely to do it

and make a change. If children believe that they can be active and that they can be involved in

improving their health, they will be more likely to participate. If they do participate in our

cardiovascular disease presentation/activity and physical activity portion, then they will become

more active and in response also become healthier. If people believe that they can live healthy

lives, then they will be more determined to reach their goals.

The Elaboration Likelihood Model (ELM) of Persuasion is designed to explain how

persuasive messages aimed at changing attitudes were received and processed by people.29

The ELM of Persuasion proposes that modifying attitudes or other judgements can be formed

as a result of high degree of thought (central process route) or a low degree of thought

(peripheral process route).29 We decided to incorporate this theory into our project because we

believe that we can change the way kids portray physical activity. After participating in our

activities, we will provide the participants with a short survey asking them if their view of physical
Heart Disease Final: Britni Overall, Brittany Holcomb, Emily Gibson

activity has become more positive and whether or not they will continue to be physically active

at home.

G. Goals and Objectives

Goal 1: Reduce the incidence of heart disease in Gwinnett County by educating mothers and

their children about risk factors and measures to prevent heart disease.

Obj. 1.1: After completion of our class, 90% of the participants will be able to identify a

cause of heart disease.

Obj. 1.2: After completion of our class, 90% of the participants will be able to identify three

risk factors for heart disease.

Obj. 1.3: After completion of our class, 90% of the participants will be able to identify how

much exercise is recommended to help prevent heart disease.

Obj. 1.4: After completion of our class, 90% of the participants will be able to explain what

high cholesterol is and what causes it.

Goal 2: Reduce the incidence of heart disease in Gwinnett County by educating mothers and

their children about the importance of physical activity.

Obj. 2.1: After completion of our class, 90% of the participants will be able to describe 3

reasons why physical activity is important to incorporate into their daily life.

Obj. 2.2: After completion of our class, 90% of the participants will be able to correctly

demonstrate different exercises (push-up, sit-up, jumping jack, lunges).

Obj. 2.3: After completion of our class, 100% of the participants will be provided a take

home sheet of different exercises they can do at home with their family.

H. Program Description

We decided on Health Communication, Health Education, and Community Mobilization as

our strategies to address heart disease in women in Gwinnett. According to the CDC, Health

Communication is the study and use of communication strategies to inform and influence

individual's decisions that enhance health.30 Health communication can be used as various
Heart Disease Final: Britni Overall, Brittany Holcomb, Emily Gibson

forms such as written and verbal communications.30 This strategy will help change our

participants’ knowledge and/or behaviors as well as create awareness about heart disease and

the importance of exercise.

Health Education, as described by the World Health Organization, is any combination of

learning experiences created for communities and individuals improve their health by gaining

knowledge and influencing attitudes.15 It builds knowledge, skill and positive attitudes about

health. Health education is often visible; educators will often use activities and skill building

groups in order to explain health education.15 It teaches mental, physical, emotional, and social

health. We decided to use Health Education because we are using a presentation and different

hands on activities to inform the participants about heart disease and to demonstrate how to

properly incorporate exercise into their daily routine to prevent heart disease. We can also use

these activities to get the kids and parents excited to exercise and to do something together as

a family. With our program we think having activities is the best way for our priority population to

learn and live healthier lives.

According to the CDC, “Community Mobilization engages all sectors of the population in a

community-wide effort to address a health, social, or environmental issue. It empowers

individuals and groups to take some kind of action to facilitate change.”31 Gwinnett is full of

members and organizations who want to get involved in the community. Community

Mobilization is a way that we can encourage these individuals and groups to get involved and to

start making a difference in their own lives, families’ lives, and their community. By using this

plan, community members will be equipped with material and information about heart disease

and how to start or continue physical activity to reduce their risk of heart disease after our

program.

Our program will take place during a weekly meeting for Girl Scout Troop 17603 in Gwinnett.

We will begin our program by splitting the mothers and kids up. The mothers will hear a lecture

from a Gwinnett Medical Center employee about heart disease, what to look out for and what to
Heart Disease Final: Britni Overall, Brittany Holcomb, Emily Gibson

do to prevent it. Before the lecture, we will ask the mothers to fill out a pre-test and then after

the lecture we will have them fill out a post-test. This will be our way to measure any increase in

knowledge. While the mothers listen to the lecture, the kids will participate in four different

coloring activities about the heart and healthy food choices. We will also discuss why it is

important to eat healthy and exercise at such a young age.

After the lecture and coloring activities have been completed, the mothers and kids will join

back up and participate in an exercise game that they can do at home. The exercise routine will

be led by a certified personal trainer. To start, everyone will begin by warming up. After the

warm up, the mothers and kids will play a red light, green light game. The trainer will

demonstrate an exercise and ask the participants to do it. When the trainer says red light, the

participants will stop doing the exercise and when the trainer says green light, the participants

will start doing that same exercise again. There will be a total of 6 exercises (jumping jacks, frog

jumps, clap jacks, side to side jumps, and mountain climbers) that will last for 45 seconds each.

The next game that the mothers and kids will participate in is called jump or drop. Once

again, the trainer will demonstrate an exercise and then ask the participants to do it. When the

trainer says jump, the participants will jump and when the trainer says drop, the participants will

squat and touch the floor. Each exercise (high knees, alternating lunges, punches, plank,

skipping in place, and squat hold) will last for 45 seconds.

During the exercise portion there will be modification options available to keep everyone

moving. We will wrap up the class by asking the mothers to fill out an evaluation with their child

to let us know what they thought of the program. This will allow us to make modifications to

future classes. We will also provide the participants with take home exercise routines and a

goodie bag filled with pencils, erasers, stickers, a bouncy ball, and chalk.

Part IV – Implementation and Evaluation

I. Implementation

a. Personnel
Heart Disease Final: Britni Overall, Brittany Holcomb, Emily Gibson

Our PowerPoint presentation was provided by Gwinnett Medical Center. We were fortunate

enough to have a staff member from the cardiac unit come to our program and give the

presentation. Having someone with this sort of expertise was very beneficial to our event.

We also stayed in contact with the Girl Scout troop leader, Jessica, in regards to picking a

date and time as well as a location. She also helped us with letting us know how many mothers

and children would be at the event. All of our marketing and communication efforts went through

her. The week of the event Jessica gave us a better idea of how many participants to expect.

We were told to be prepared to offer our program to 12 kids and 12 mothers. Jessica played a

vital role in our introduction and keeping the kids engaged.

Our team (Emily Gibson, Brittany Holcomb, and Britni Overall) were also critical personnel.

We worked with the kids on the coloring activity worksheets and guided the exercise portion of

the program. Without all of the hard work from each member, our program would not have been

successful.

b. Equipment

For our program we needed equipment for our PowerPoint presentation. The room that we

utilized did not have a computer or projector, so we used one of our own. We also printed

handouts of the PowerPoint in case of technical difficulties and for the mothers to make notes

on. During the exercise portion the participants did not need any equipment because all of the

exercises were done by using the participant’s body weight. The exercises were made available

to the participants, so they can then do them at home.

We tried to minimize the amount of equipment needed for our program to make it easier to

implement throughout the county. If equipment for the PowerPoint cannot be provided, the

presentation can be done without the visual. Having less equipment for the program allows it to

be done anywhere and at any time.

c. Supplies
Heart Disease Final: Britni Overall, Brittany Holcomb, Emily Gibson

Our program did not require a lot of supplies. The main thing was printing of the PowerPoint

slides, pre/posttest, evaluation, and the children’s worksheets. All of the printed materials were

done by one of our group members. We also purchased items from the Dollar Store for the

children’s goodie bags. These items included pencils, erasers, stickers, a bouncy ball, and

chalk. Lastly, we had a first aid kit in case of any minor injuries during the exercise portion.

d. Facilities

Our event was held at a community clubhouse in Grayson, GA, provided by the Girl Scout

troop. Since we have kept our program to minimal equipment and supplies, it can be offered

almost anywhere.

e. Marketing and Promotion

Promotion is what most people think about when they hear the word marketing but this is

just one component of the overall marketing mix (product, price, place and promotion). 29

“Promotion is the communication strategy, including the message and associated visuals or

graphics as well as the channels, used to let the priority population know about the product, how

to obtain or purchase it, and the benefits they will receive.”29 Our main form of marketing was

directed through Jessica, the Girl Scout troop leader. We provided her with a flyer that included

the date, time, location and purpose/reason for our event. She then sent it out to all of the

mothers to encourage them to come and participate. This also allowed us to get a final

headcount of the number of people who would be attending.

f. Incentives

Our team made it known to the children that if they participated in our program they would

be provided a small goodie bag at the end. Two members of our team bought brown paper

bags, pencils, erasers, stickers, a bouncy ball, and chalk to give out at the end of the event. This

encouraged the children to stay engaged during the program. We also included a print out of

exercises they could do at home with their families. The children and the mothers will be able to

use what they learned from our program and apply it in their everyday life at home.
Heart Disease Final: Britni Overall, Brittany Holcomb, Emily Gibson

J. Evaluation

One of the evaluation strategies our team used to determine if our cardiovascular disease

program was successful or not was impact evaluation. Impact evaluation is the way we assess

the goals and objectives that we met during our activity. We measured the impact evaluation

through a pre and posttest.32 We administered the pretest to the moms before our program took

place. This survey was created and developed by Gwinnett Medical Center. It consisted of 9

multiple choice questions. 1. Which of these is a cause of heart disease? 2. What can happen if

blood flow in an artery is blocked or greatly restricted? 3. Three risk factors for heart disease

can't be controlled. Which of these are they? 4. What is considered "high blood pressure"? 5.

Why can smoking lead to heart disease? 6. How much exercise is recommended to help

prevent heart disease? 7. Your risk for heart disease rises if your body mass index (BMI) is

more than 24.9. Why? 8. Drinking a moderate amount of alcohol is considered safe for your

heart. What can happen if you drink more? 9. Which of these is a classic symptom of a heart

attack? The posttest was the same as the pretest, and we administered it at the end of our

presentation.32 When comparing the pretest results with the post test results, the post test

results indicated that overall our program was indeed successful, and our goals were met.
Heart Disease Final: Britni Overall, Brittany Holcomb, Emily Gibson

Process evaluation allows a person to evaluate how they are going to deliver the program

and how well they delivered the program.32 We delivered this evaluation through a short survey

for the moms and daughters to complete at the completion of our program. The survey

consisted of 8 questions. The first four are circling their answer on a scale from strongly disliked

to strongly liked, and N/A. The last four questions are short answer which will evaluate their top

3 exercises, the top 3 takeaways from the presentation, how likely they are to continue/start

incorporating exercise into their daily routine, and lastly any other comments they had.33

The first survey question asked if the participants liked the presentation, 56% strongly liked

it while 44% liked it. The second survey question asked if the participants enjoyed the exercise

portion, 66.7% strongly liked it while 33.3% liked it. The third survey question asked how likely

the participants would incorporate exercise into their daily lives, 66.7% said it was strongly likely

they would incorporate exercise into their daily lives while 33.3% said it was likely they would.

The fourth question of the survey asked the participants how they would rate their overall

experience, 56% strongly liked while 44% liked it. None of the participants responded with a

negative or neutral response to these questions. All the participants had a top three preference

for the exercises and had their own three takeaways from the presentation. The last question

was comments or feedback; the main response from the comments was “Thank you,” followed

by “great presentation”, and lastly one comment that a participant left is “thankful to know that

after 5 smoke free years her risk of cardiovascular disease will be the same as a nonsmoker”.

Formative evaluation is when a person evaluates a current situation going on and makes the

changes that are needed.32 From the start of the program it was evident that the girl’s attention

spans were short, and they were going to finish the coloring packet too quickly. After observing

this, we decided that it would be best to move the girls into a connecting room away from the

moms and presentation and play games with them. Two of us went into the room with the girls

and played heads up seven up and Simon Says while their moms listened to the presentation

given by our other group member. We also had the girls write something they were thankful for
Heart Disease Final: Britni Overall, Brittany Holcomb, Emily Gibson

and what they wanted for Christmas as an effort to try and keep them entertained. Throughout

the program we were constantly evaluating what was going on and adapted it to ensure our

program could be as successful as possible.34

K. References

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8. Georgia. County Health Rankings Roadmaps: Building a Culture of Health, County by

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Heart Disease Final: Britni Overall, Brittany Holcomb, Emily Gibson

http://www.countyhealthrankings.org/app/georgia/2018/measure/factors/82/map. Accessed

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9. Georgia Counties by Population. Georgia Demographics by Cubit Website.

https://www.georgia-demographics.com/counties_by_population. Published March 2018.

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sheets/detail/cardiovascular-diseases-(cvds). Accessed September 10, 2018.

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Disease%20Report.pdf. Accessed September 10, 2018.

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facts/. Accessed September 18, 2018.

Heart Disease Final: Britni Overall, Brittany Holcomb, Emily Gibson

18. Facts about Heart Disease in Women. Go Red for Women Website.

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development/logic-model-development/main

23. The YMCA. Retrieved from https://www.ymcaatlanta.org/about-the-ymca/. Accessed

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Heart Disease Final: Britni Overall, Brittany Holcomb, Emily Gibson

26. Gwinnett Coalition for Health & Human Services. Retrieved from

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ecreation. Accessed October 14, 2018.

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https://www.cdc.gov/std/Program/pupestd/Types%20of%20Evaluation.pdf. Accessed

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implementation. Accessed November 30, 2018.

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125. Accessed November 30, 2018.

Heart Disease Final: Britni Overall, Brittany Holcomb, Emily Gibson

Teamwork

Britni Overall - 33.33%

Brittany Holcomb - 33.33%

Emily Gibson - 33.33%