Sarah Tuffield

Step 1- Big Picture- Purpose and Scope of the Assessment

The healthy issue that needs to be addressed is increasing the amount of awareness of
heart health in the community levels, specifically in the Boise, Idaho community. Heart disease
is the number one leading cause of death in the United States. Having a healthy heart and being
aware of the risks is important to living a long and happy life. Its important for people to know
how to recognize and act when something tragic like a heart attack occurs. The objective to heart
health awareness is increasing the amount of adults who are aware of the early signs and
symptoms of a heart attack to be able to prevent and help those who need the help. The goal for
targeting 20 year olds and up is because that age group is when adults are starting their life away
from their family and are learning to take care of themselves on their own. When you can learn
how to prevent and recognize early warning signs you can help yourself and others.
When coming into college you are mainly on your own and taking care of yourself is
hard. What we need to look at is what students are being taught about healthy eating habits, the
importance of physical activity and if theyre being taught about risks and early warning signs of
heart disease and major diseases that could affect them in the long run. If we dont look at whats
offered and how we are teaching students to take care of themselves we could have more people
in the hospitals for heart disease and heart attacks.

Step 2- Quality of Life and Social Assessment

When looking at the demographic data in the state of Idaho verse Ada County are similar
in some areas. The biggest area that I saw similarities were in the median age as well as the
percentage of a language other than English was spoken in the household. This showed me that
the quality of life in my area is not very diverse and is in the target population of 20 years and
older. What I found really interesting was that Ada County was either higher or lower than what
the state of Idaho was. This showed me that the quality of life in Ada County is above average
and is pretty comfortable in quality of life. I found it really interesting that the population
percentage between women and men was almost exactly 50% both sides. This relates to
increasing awareness about heart disease because men and women have different body types and
different measurements for what classifies at risk. Ada county has a pretty low uninsured
population at 11.11% of the population being uninsured. This could affect raising awareness
because one of the reasons people may not know the signs and symptoms as well as the risks is
because they cant afford or dont have insurance to cover doctor visits.
 Overall, Ada County has a good quality of life with areas that they could improve on to
make it even better. With raising awareness about early signs and symptoms for heart disease,
decreasing the uninsured population, decreasing the heart disease mortality rate and increasing
awareness about healthy eating and the importance of physical activity are the main focus areas
for Ada County and improving the lives of the people living there.

Demographic Data County State comparison

(Ada) (Idaho)
Median Age 35.8 35.5
Language other than English spoken at home 1.82% 2.08%
High school graduation 83.5% 80.6%
Bachelors degree 37.06% 25.86%
Median household income $ 69,792 $ 57,573
Persons below poverty 12.35% 15.47%
Population 417,501 1,616,547
Female Persons, Percent 49.97% 49.86%
Male Persons 50.03% 50.14%
Uninsured Population 11.11% 14.71%
Preventable Hospital Events 23.9 48.2
Heart Disease Mortality, Age-Adjusted Death Rate 141.1 152.7
(Per 100,000 Pop.)
No leisure time physical activity 15.6% 19.1%

Step 3-Epidemiological Assessment

Table 1

Table 2
Table 3

Table 4
 What I found when looking at the data was that adults ages 18 and up was at a low
risk for being diagnosed with heart disease and heart disease mortality rates. Ada county
and Idaho both had low percentage rates when compared to the United States data. I
looked at differences in heart diagnoses by race and ethnicity and found that Idaho was
close if not above the diagnoses of the United States as shown in table 3. This tells me
that while it appears and seems that heart diagnoses and risks for heart disease is low in
Idaho it is still a rising issue and concern and should be looked at changing. Through the
years it showed that disease mortality from 2003- 2014 has decreased and that Idaho has
had lower numbers throughout the years for heart disease mortality rates. This means that
we are doing something right but that there should be more we can do to reduce the
mortality rate for heart disease. From table one I was surprised to see that men had a
higher heart disease mortality rate than females. It appears that men are at higher risks for
dying from heart disease than females. When looking at ethnicity it showed that non-
Hispanic whites had the highest heart disease mortality rate. Heart disease mortality is
one way of looking at how important education of how to prevent and recognize signs
and symptoms of heart disease is.
While it seems that Ada County and the State of Idaho are at good rates for heart
disease mortality and are doing well with working towards prevention of heart mortality,
there are still the risk factors that contribute to heart disease. Idaho and Ada County
 should be looking towards prevention of heart disease risks. Some of those risks or
disparities include high cholesterol levels, high blood pressure, diabetes, physical
inactivity, tobacco use and too much alcohol consumption. These risk factors contribute
to heart disease and should be where we start looking for how to make changes.

Step 4- Health Behavior Data -This step identifies behavior and lifestyle risks for health issues.
The health behaviors that related risk of heart disease are unhealthy diet, physical
inactivity, obesity, too much alcohol, and tobacco use. Each of these behaviors can increase your
risk of having heart disease and increase your chance of dying from heart disease. With
unhealthy diet, eating too much salt can increase your blood pressure. Eating foods high in bad
fats such as trans-fat and cholesterol can increase the risk for atherosclerosis and contribute to
heart disease risk. Physical inactivity is just as it sounds. If you dont exercise you put your body
at risk for other heart disease risk factors such as obesity and high blood pressure. Obesity goes
hand in hand with unhealthy diet because if you dont eat right you can become obese. Too much
alcohol can also lead to high blood pressure but it can also contribute to the hardening of arteries
which increases your risk for heart disease. This is because when your arteries harden they allow
less blood flow to go through and put more pressure on the arteries until they break and can form
a clot which can lead to a heart attack or stroke if it becomes a moving clot. Everyone has been
told that smoking and tobacco use is bad because it can lead to lung cancer. It can also lead to
heart disease because when you smoke or use tobacco you decrease the amount of oxygen your
blood can carry which means your body tissues are getting less oxygen and it puts more strain on
the heart to deliver oxygen to the body. Being physically active can really help you decrease your
risk of heart disease. If you increase your physical activity you decrease many of the other risk
factors for heart disease. The simple way you can decrease your risk is to change these behaviors
but making a behavior change is never as easy as it looks or seems.
When looking at all of these behaviors that are risk factors for heart disease, I think that
physical inactivity, tobacco use, and healthy diet are the important factors to change. The health
behavior that I looked at the most was physical inactivity.

Looking at these two charts, I found that males were actually more inactive than females but I
also noticed that as people got older they were less likely to exercise, increasing their risk for
heart disease. I unfortunately couldnt find any Ada County data but from the State of Idaho data
shown above its clear that 25% percent of people arent getting enough exercise and we should
do something about it. Think about what could happen if we educated people on how to exercise
with different age groups and different styles of exercise. Some ideas to think about are if people
are aware of the physical activities available, if they have access to a physical activity center and
if they know how to exercise. If we can change the amount of people who are physically inactive
we can give them a better chance of not having heart disease and the risk factors for it.

Step 5- Environmental Data-

The most important environmental issues that are in the Ada County area would be access
to recreation and physical activity facilities and the aesthetic attributes of physical activity. If the
community has limited access to recreation and physical activity they will be less likely to work
out and reduce their risk of heart disease. Its stated that in 2010, 36.2% of Idaho lived within
half a mile of a park or recreational area. If people dont have access or areas that they can enjoy
activities then they will be less likely to want to participate in physical activity. Also if they dont
like the exercise they are doing they wont want to continue exercising and leading a healthy
lifestyle.
The second environmental change that needs to be fixed is the internal environment of
the community and the age groups. You must look at how social groups interact and their
personal beliefs and thoughts on physical activity. Also within these social groups you need to
look at their personal mentality on physical activity. With this they need to also look at the
education that is given to people and how much they know. They also need to analyze and create
a successful way to teach them this information and encourage them to follow that instead of
internal beliefs such as what their social group thinks about physical activity. What the people
you surround yourself with think influences your decisions more than most people think or
realize.
With environmental data I think surveys would be the best way to collect data. One
survey should be done on how many people in the community exercise at least three times a
week and how what they do for exercise. Within this survey they could look at intensity and
duration of exercise and how it affects their risk for heart disease. With this information people
would be more likely to be held accountable for their own personal fitness.
Another survey that would be beneficial is a knowledge survey. We need to know if
people know about physical activity and heart disease risk factors. This is important because we
want to know why people are physically inactive and whats stopping them from exercising at
least three times a week.
I think that interviews with people of different age groups would also be a good way to
collect data. This would help us to understand what barriers people face when working on being
more physically active in their community. If we can understand the barriers people face we can
then look at how to change them and reduce their risk of heart disease and work towards being
more physically active.

Step 6- Identifying the Program Purpose -This step answers the question what makes it easy
or hard to adopt healthy behaviors and what can be impact behavioral and environmental factors.
Use peer reviewed sources (empirical/experimental) 25 pts
Predisposing Factors-
Article 1: Patterns and Factors Affecting Physical Inactivity of Adults in a Regional City
Reference: Dassanayaka, J., Payne, W.R., Reynolds, M., and Turville, C. (2002). Patterns and
Factors Affecting Physical Inactivity of Adults in a Regional City. Journal of Science
and Medicine in Sport. 5, 113.

When looking at this article they mentioned that the biggest behavioral modification that
they believed need to be made was the attitudes toward exercise. With this individuals need to be
aware of proper physical activity knowledge and the benefits of physical activity for heart
disease. Among the barriers listed was lack of energy. This shows that educating people not only
on the importance of physical activity is needed but also that education on how to properly take
care of yourself, including sleep health and diet should be addressed as well. The article stated
that the most significant facilitators for physical activity were identified as: more leisure time,
access to low cost facilities, and activity being a common interest among ones friends (p 113).
With this being said an important behavior change that needs to be looked at is how people and
their friends view physical activity. If they see it as a negative and something they have to do
they wont enjoy and will be less likely to participate. If they have friends there to encourage
them and view physical activity as a positive change then maybe an increase in physical activity
can be achieved. Some students may not want to change their physical activity level or their
habits though and this is an important attitude that needs to be assessed.

Article 2: Health benefits of physical activity: the evidence

Reference: Bredin, S., Nicol, C.W., and Warburton, D. (2006). Health Benefits of Physical
Activity: The Evidence. CMJA. 174.
This article was extremely beneficial to my topic; it looked at the primary and secondary
prevention for all-cause and cardiovascular-related death. This was interesting to look at the
research they had done especially since it dealt with multiple studies and looked at the
correlation between physical activity and reducing the risk of cardiovascular-related death. In
primary prevention it was interesting to see that increasing your physical fitness decreased your
cardiovascular death risk. It was found by the authors that The effect appears to be graded, such
that even small improvements in physical fitness are associated with a significant reduction in
risk (CMJA). Not only did small improvements have significant reductions but the type of
exercise also played a part into reducing the risk of cardiovascular-related death. In another study
looked at by the authors it was found that as long as you were doing at least an hour of some
form of exercise, in this case walking, you would significantly decrease your risk. If we could
implement an increase in physical activity in the community it would help to decrease risk of
cardiovascular-related death.
Not only did the article look at primary prevention but also secondary prevention. The
authors looked at how physical activity could help adults who already have established
cardiovascular diseases. The article discussed how normally you were recommended to rest and
be physically inactive when diagnosed with heart disease but that isnt true. The article stated
that An energy expenditure of about 1600 kcal per week has been found to be effective in
halting the progression of coronary artery disease, and an energy expenditure of about 2200 kcal
per week has been shown to be associated with plaque reduction in patients with heart disease
(CJAM). Its incredible to see that even if youre diagnosed with cardiovascular disease,
improving your physical activity can help prevent your disease from getting worse and can help
to potentially make your disease better. It was interesting to see that the article looked at many
studies but found overall that regular physical activity is effective in helping with primary and
secondary prevention of cardiovascular diseases.
The main primary data we need to look at is the attitudes of the community towards physical
activity and the accessibility of physical activity centers. With this we need to see how they react
to suggestions of physical activity, influence of social groups, and personal belief about physical
activity. With this data it would show us why people think that physical activity wont help them
lead a healthier lifestyle and decrease risk of cardiovascular disease. Also it will show if people
know about the benefits of physical activity and how it relates to cardiovascular disease. With
this information we can then begin to bring knowledge to the community and other resources so
they can start to work on incorporating physical activity into their lifestyle in a healthy way.

Enabling Factors-What enabling factors are important to this topic: availability of

resources, services, standards, policies, etc. that help make the healthy choice easy and help
reject the unhealthy behavior? What needs to be changed, maintained, and abandoned?
When looking at enabling factors a big one is the accessibility to physical activity centers that
people in the community have and education about heart health and how physical inactivity is a
big risk factor. With these they should look into providing events that are free for the community
or at low cost to promote physical fitness as a way to reduce risk factors for many health
diseases. With this as well, physical activity centers should look at designating an hour to two
hour period per three days of the week that is free to the community and teaches people how to
properly exercise. A factor for physical activity in the community is the lack of knowledge about
physical activity and the proper way to exercise. The community doesnt provide many ways to
learn about how to properly exercise when lifting weights or learning how to run. When you
dont know how to do this, if you try on your own you can injure yourself and increase your
medical expenses. If community gyms or doctors offices had pamphlets or information websites
about exercise options and how to properly exercise it could help to increase the amount of
people who are physically active. I think a good resource to have would be free informational
trainings about the importance of physical activity, how to perform certain exercises properly and
the importance of taking care of your heart health. With this resource available they would be
able to ask questions and make changes if needed. Another enabling factor would be access to
fitness environment. About half the year there is snow on the ground which eliminated outside to
work out, as well as some people cannot afford a gym membership. For this to be changed the
gyms could offer a discount rate on certain days so they could work out and manage their
physical activity better. Another enabling factor is hospitals involvement in promoting physical
activity and reducing the risk of cardiovascular disease. I think an important resource they could
provide is the opportunity to learn about the risks of cardiovascular disease and how to improve
them. This would provide the community a chance to ask questions and learn how they can be
more physically active and improve their quality of health.

Reinforcing Factors If you know the community, discuss the people and community assets
that would reinforce your health topic positively. If you dont know the community, write
about the types of reinforcement that would help improve the health issue.
In the Ada County community there are many reinforcing factors that will help. The
main one is the hospitals and social support provided by the Ada County community. The
community tries to provide many opportunities to improve your physical activity levels by
having bike lanes on all the roads, trails to bike, walk or run on, and putting on events such as
fun runs and coming together as a community to support national days like walk to school day.
Hospitals can help by putting on some of the community events as well as providing seminars
about important health issues in the community and how you can prevent them. St. Lukes
Hospital is the main hospital in the Ada County community and provides seminars, classes and
events for the community to promote being healthy in your lifestyle including physical activity,
heart health and eating healthy. Another factor that is important is the gyms located in the Ada
County community, mainly the YMCA and Axiom. These gyms would be beneficial to helping
because they can help with discounts as well as advising on exercise plans, healthy eating and
providing knowledge on many aspects of health and exercise. The last reinforcing factor is
community support groups. These can help by holding people accountable to what they are
trying to change and encourage people to stick with the positive lifestyle change they are trying
to make. Its a great way to find people that you can relate to and draw support from when you
have a rough week or are struggling with sticking with your goal. These groups can promote
exercise and healthy eating within their community.
Steps 7- Validating needs and conclusion
The most important groups of people to target for increasing awareness of early warning
signs and symptoms of heart disease and heart attack and increasing physical activity to reduce
risk of cardiovascular disease in the Ada County community are the health care providers as well
as the support groups. Health care providers see the people on a regular basis and can help them
to find the right programs to improve their health lifestyle and incorporate physical activity into
their daily lives. The health care providers can provide them with knowledge and ways to make a
healthy lifestyle change.
The second group would be the support groups provided in the community. These can
help be a support system and a good resource for learning about ways to make a positive lifestyle
change to decrease risk of cardiovascular disease. If the support systems can be educated on
proper exercising and healthy diet choices they can transfer it to the people who attend their
support groups which would help those people feel better prepared and educated on ways they
can positively make a change. The support group leaders can provide an example and help the
people who attend know that they arent alone in their goal as well as someone else understands
what theyre going through.
The main predisposing factor that needs to be address is the attitude towards physical
activity and how social groups influence your attitude of physical activity. This needs to be
addressed because it is a main component of why people in the community are afraid to go to
gyms, dont know how to properly exercise or dont exercise because their social group doesnt
exercise. The most enabling factor that needs to be addressed is the access to resources. People in
the community need to have a safe environment that is affordable for them to practice healthy
physical activity. The reinforcing factor that is going to have the most impact is the support
groups because they can provide the most education and encouragement for the people trying to
make the positive lifestyle change.

Steps 8- Assessment Team

The people and organizations that are most affected are adults ages 18 and up who are at
risk for or already have cardiovascular diseases, American Heart Association, American Red
Cross, and the hospitals in Ada County such as St. Lukes and St. Alphonsus. All of these can
play a meaningful part in increasing awareness and promoting physical activity to help decrease
cardiovascular disease. Adults who are at risk or already have cardiovascular diseases can be
talking to their healthcare provider about ways they can improve their condition and how they
can make lifestyle changes to decrease their condition or the risk they are at. The American Heart
Association and American Red Cross can help raise awareness for heart health and the impact
that improving your quality of life such as physical activity and health diet can really decrease
your risk for cardiovascular disease. The American Heart Association puts on a fun run once a
year to raise awareness about the importance of heart health and the American Red Cross is
always providing blood drives to collect blood for hospitals and to help improve the lives of
other people in need.
Some of the barriers that should be consider are that the American Heart Association
might not be established in the Ada County community or is unavailable to provide fun runs and
awareness. We can overcome this by looking towards local hospitals and students who want to
help improve their community to overcome this barrier. Another barrier is the amount of time
available from the local hospitals and bigger associations involved in heart health. They are all
very busy and working on many different areas of health and health promotion. A way to
overcome this barrier is talking to them in advance and set a timeline for what youre wanting to
do and how they can help so they feel more like a part of the event than the event planner
themselves. A third barrier is participation from the community. Its always a worry that people
wont show up to make the event worthwhile but to overcome that barrier is to provide fun and
educational advantages to coming. Having swag items such as stress balls, informational
pamphlets, and even headphones or some nifty gadgets will intrigue people to check it out and
try something new. Marketing strategies will also play a big part in overcoming this barrier
because the more you market and spend time planning the better the outcome results should be.
The type of influencers that are needed for heart health are survivors and lifestyle
changers for heart health because they can relate to where the people participating are at and can
encourage them that what theyre doing for the event and making the lifestyle change is hard
work but a positive and worthwhile change to make. Other influencers are change making people
such as Oprah and Ellen Degeneres because they reach a wide variety of people and can really
influence them to try something new and make a healthy lifestyle change such as increasing your
physical activity.
References
Ayers, C.R., Das, S.R., Khera, A., Mathieu IV, R.A., McGuire, D.K., and Powell-Wiley, T.M.
(2012). Physical activity participation, health perceptions, and cardiovascular disease
mortality in a multiethnic population: The Dallas Heart Study. American Heart Journal.
163, 1037-1040
Bredin, S., Nicol, C.W., and Warburton, D. (2006). Health Benefits of Physical Activity: The
Evidence. CMJA. 174.
CDC, (2015). Heart Disease Behavior. Retrieved from U.S. Department of Health and Human
Services. Website: https://www.cdc.gov/heartdisease/behavior.htm
Center for Applied Research and Environmental Systems, Community Initiatives., and Institute
for People, Place and Possibility. "Community Commons." Community Commons. N.p.,
n.d. Web. https://assessment.communitycommons.org/CHNA/selectarea?
reporttype=libraryCHNA
Dassanayaka, J., Payne, W.R., Reynolds, M., and Turville, C. (2002). Patterns and Factors
Affecting Physical Inactivity of Adults in a Regional City. Journal of Science and
Medicine in Sport. 5, 113.
"Heart Disease and Stroke." Heart Disease and Stroke | Healthy People 2020. N.p., 2014