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Preventive Health Project

BACKGROUND  The National Community Center of Excellence in Women’s Health (CCOE) at Kokua Kalihi Valley (KKV) has expanded and enhanced an already existing preventive health project focusing on Diabetes/Obesity targeting the area of Public Education/Outreach (Goal 4) of CCOE program. The primary enhancement/expansion of the project has been an increase in exercise classes from three (3) to five (5) sessions each week, adding a greater diversity of exercise/dance opportunities for community residents, and relocating these classes to the more convenient and accessible location of the Kalihi Valley District Park. Building a strong and effective partnership with the District Park and conducting on-going surveys with exercise class participants to improve the quality and diversity of exercise classes are two additional enhancements and improvements to KKV’s existing preventive services offered prior to this preventative health project. 

KKV is fully aware of the immense benefits of providing preventive health services for the community it serves. From its inception 32 years ago, KKV has worked to alleviate the underlying causes of health problems in the community and to work pro-actively with community residents (particularly women) and empower them to address and overcome the conditions contributing to their poor health outcomes.

Kokua Kalihi Valley ’s preventive health services have been provided to a service population that is predominantly female, low-income, and of Asian/Pacific Island (API) ancestry. These health services are geared to reduce, control and prevent the primary health problems affecting this particular service population (primarily Filipino, Samoan, Hawaiian, Micronesian and other Pacific Islander women). These health problems include high rates of diabetes mellitus, overweight/obesity, and conditions associated with overweight/obesity such as cardiovascular diseases and hypertension. Diabetes is diagnosed in KKV’s predominantly API clients at three times the rate of state and national averages; hypertension at two times the rate of state averages. KKV has been focusing increasing preventive health efforts on combating the extraordinary rise in obesity and diabetes in the United States, which has created a deadly combination that increases heart disease risk by two to five times.

KKV has developed preventive health and social services over the last five years aimed at controlling and reducing diabetes and obesity in Kalihi Valley through a variety of measures. KKV has joined the Diabetes and Cardiovascular Health Disparities Collaborative of the Bureau of Primary Health Care, and partnered with the State of Hawaii , Department of Health, Diabetes and Chronic Disabling Diseases Section to develop the most up-to-date preventive programs available. KKV has made comprehensive health screenings, referrals and follow-ups for women and the use of evidence-based guidelines for diabetes as two of its six Health Plan goals for the last year. KKV has also developed a comprehensive diabetes education, screening and referral program over the last two years with funding from the National Asian Women’s Health Organization and the National Institute of Health. All these efforts are geared to support Kalihi Valley women in overcoming unhealthy behavior patterns associated with diabetes and obesity.

INFRASTUCTURE FOR THE PREVENTIVE HEALTH PROJECT

The CCOE at KKV has been implementing the program goal of “Public Education and Outreach” with an emphasis on prevention and/or reduction of illness and injuries that appear controllable through increased knowledge that leads to modification of behavior.  Existing public education and outreach to underserved women in Kalihi Valley in the past three years of KKV CCOE program include the following main activities: 1) Women’s Health Education workshops; 2) Women’s Health Maintenance Groups; 3) Health Promotional and Health Screening events in the community; and 4) Monthly Outreach activities into isolated pockets of the community. These activities specifically target at-risk women populations for chronic diseases such as diabetes, obesity or have other cardiovascular health conditions. The overall goal of these activities is to prevent chronic diseases and improve the health conditions of at-risk and high-risk women in Kalihi Valley through behavior changes that include more physical activity and better dietary habits.

Women’s Health Education workshops consist of a 2-hr. Health talk on exercise and nutrition provided once a month to three different ethnic groups (Samoan, Filipino and Chuukese), with a total of approximately 100 women participating each year. Women’s Health Maintenance Groups include three exercise groups a week which have varied over the past three years with activities including low impact aerobics, Belly Dancing, Yoga, walking, chairobics, aerobics and Dancercize (Ethnic Dance Exercise), with an average of 12-15 women attending each session. Health Promotional and Health Screening events have occurred at over 15 community locations during the last two years, with free diabetic screenings now open every Friday at the KKV health center. Monthly outreach activities have occurred throughout Kalihi Valley and have been conducted in partnership with churches, temples, schools, public housing associations and state parks.

In addition, KKV has screened approximately 450 womens health center users and community members for diabetes during the 2002-2003 fiscal year. Seventy percent of these women participated in at least one educational workshop focusing on diabetes prevention and control. These educational sessions included 1) Diabetes Overview; 2) Health Maintenance: Physical Activity, Stress Management, and Goal Setting; 3) Sick & Travel Management, Mouth, Feet, and Eye Care for People with Diabetes; 4) Healthy Eating: Meal Planning, Shopping Strategies, and Supermarket Tour with cooking demonstrations.  

PREVENTIVE HEALTH PROJECT COMPONENTS

KKV  enhanced its Public Education/Outreach activities by increasing the amount of exercise classes offered to at-risk or high-risk diabetic and overweight women in Kalihi Valley from three exercise classes a week to five exercise classes a week and by relocating all exercise classes from KKV’s Resource Room at a public housing complex to the Kalihi Valley District Park.

When the proposal for the preventive health project was first developed, KKV’s weekly exercise classes include a belly dancing class, a yoga class and a dancercize class. KKV  changed  this offering to a twice weekly walking group and a twice weekly aerobics class and a twice weekly chairobics class, with at least one group exercise opportunity each day of the week, from Monday through Friday. KKV will continue to modify the types of exercise classes being offered in order to attract and retain the highest number of at-risk diabetic and overweight women in the community as possible. These activities will be modified as needed considering a combination of participation rates, community interest and staff resource availability.

KKV relocated the Aerobic and chairobics classes to the Kalihi Valley District Park . This move was made based on the assumption that the Kalihi Valley District Park is much more familiar to the vast majority of Kalihi Valley residents, making it more convenient and accessible for all exercise class participants and those who are interested in attending classes. The Park is also in more “neutral” territory for residents of Kalihi Valley ’s three different public housing projects.

KKV will be worked closely with the Kalihi Valley District Park Superintendent, and other Park personnel, to ensure all logistical matters are covered, roles and responsibilities clearly understood, and up-to-date promotional information is circulated on a regular basis. KKV utilized the Kalihi Valley District Park ’s Calendar of Events schedule promote KKV exercise classes at the Park to Kalihi Valley residents as fully as possible.

KKV will continued to recruit at-risk or high-risk diabetic and overweight clients and community residents to participate in exercise classes through currently established methods. These methods include direct referrals for all medically-diagnosed diabetics from KKV’s certified Nutritionists/Dieticians, direct referrals for all at-risk overweight and diabetic women clients screened through the CCOE comprehensive screening process, and through promotional information and recruitment provided to non-health center users in Kalihi Valley through monthly outreach activities and community screenings and promotional events.

Success of the enhanced program has been measured by the numbers of participants involved in the different activities.

STEPS TO PROGRAM IMPLENTATION

The first step to implementing this program at KKV was to identify and hire a program organizer. This person would coordinate the exercise activities and their recruitment. Also staff time was needed to draft and submit reports. The timing of the grant perfectly coincided with the hiring of a staff nutritionist who had a background in fitness and the ability to write reports. This program was integrated into her job description. She had been responsible for program reporting and organization.

Step two was assessing current activities and deciding what was working and what was not working. It was decided, based on level of participation, to cancel the Yoga and Belly Dance activities and implement Dancercise classes and couple of days per week. This class proved difficult because of the different levels of capability of the participants and the Dancercise class broke into two different classes, Chairobic for those with limited ability and Aerobics for those wanting a more strenuous workout totaling classes per week.

Step three was to move the classes to the District Park . This involved creating an Memorandum Of Understanding with the park management and arranging transportation from KKV’s main health center to the District Park for those with limited mobility and arranging storage for program supplies. Once these things were in place, the classes were held in the district park.

An additional activity for those not interested in classes was also implemented in the form of a walking group. An MPH intern spent 12 weeks at KKV in the summer of 2005 and led walking groups 2 days per week.

PLANS FOR SUSTAINING THE PROGRAM AFTER FUNDING ENDS

Prior to completion of the prevention program grant period, all activities have been assessed and plans for sustaining successful activities put in place. Based on participant feedback and participation rates, Chairobics will be continued twice per week, Aerobic will be continued once per week and the walking group will not be continued.

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