G.I.F.T.
(Get into Fitness Today) trains and deploys community lay health workers to disseminate health information to their community
at weekly support groups. Research has shown community health workers can improve health status and reduce risk factors,
especially in at-risk populations. The original target populations were the predominant Hispanic and African-American
communities in Hillsborough County. Now the program has been expanded to the whole county.
The goal of the GIFT program is obesity and chronic disease prevention through
increased physical activity and improved nutrition.
During the first year of the GIFT program 13 groups met weekly
and 169 people were educated on BMI, portion control, the benefits of exercise, and eating fruits and vegetables. Twenty-one
participants lost weight and 117 engaged in regular exercise. Many of the groups met in churches, resulting in a changed
culture in the church community. Several of the churches indicated celebrations and dinners now include whole grains, baked
meats and many fruits and vegetables with very little fried foods, refined grains, pastries and cakes that used to be plentiful
at celebrations.
A countywide community health survey completed in 2006, indicated that obesity was the number
one health problem in our county. Printed surveys, focus groups and personal interviews with area healthcare providers
and policy makers revealed that the overwhelming majority felt the obesity problem has a great impact to the overall health
of our county population.
Having utilized lay health workers to disseminate health information on heart attack
and stroke prevention and considering the disparities that exist in chronic disease rates, particularly heart disease and
diabetes, lay health workers providing information on reducing and preventing obesity would have a positive effect on these
disease rates. In addition the lay health workers can encourage personal responsibility in lifestyle changes, and foster
sustainability as the community accepts ownership.
The theoretical model of Stages of Change is the framework that
guided implemention of GIFT. Many people reached through outreach efforts with medical providers or through WIC are
likely in the pre-contemplation or contemplation stage. Materials used, developed by the registered dietitian in health
promotion and education, assisted individuals in clearly perceiving their problem (consciousness raising) and emphasized the
self-help and social support that would be provided (social liberation). It has been documented that to those who are
pre-contemplators, doctors make a difference. Therefore medical provider referrals are seen as important in recruitment.
Healthcare providers are encouraged to refer patients to GIFT classes with referral forms.
As the participants
joined the GIFT groups they moved to preparation and then action stages, as evidenced by the health changes they made.
Maintenance is achieved through use of the facilitators for GIFT groups. The facilitators keep the group cohesive and
continue to encourage participants and keep them accountable to sustain health changes and meet new health goals.
GIFT groups are facilitated by paid lay health workers who are recruited, trained, supported and monitored by
Health Department personnel. They network with local facilities to provide sites for weekly support groups. The
groups provided social interaction and support to promote behavioral changes.
Hillsborough County Health
Department staff and lay workers have worked with faith-based organizations, worksites, senior citizen centers and schools
(for parent and staff participation). The parents, staff members of schools, church leaders and active seniors receive
training on how to facilitate GIFT groups in addition to materials. The health department provides ongoing support in
materials, data collection, assistance with “special events” and registered dietitian counseling. These
relationships allow health department staff to support many groups throughout the county, one of the largest in the state,
both in population and geographically.
Sustainability will be accomplished through member’s success in their
GIFT groups. As successes are shared, more individuals will join or establish GIFT groups. This “group”
formation is convenient because it can be at any time or location that meets the needs of the participants. As self-facilitated
groups grow, the need for paid health department personnel to work as lay health workers drops. Materials have been
created in house and can be duplicated. There is potential for funding through grants. Social network theory keeps
the groups going by the connection they have to each other in making changes in their health.
Evaluation has been
measured by health changes made in the GIFT class participants which have included weight loss, lowered blood pressure, lowered
glucose and behavior changes including increased fruit, vegetable and water intake along with increased physical activity.
The evaluation is provided by a post-test, goal setting contract, and food diaries for evidence of health changes.
Data is collected by a survey at the week six of each GIFT program; and by measures of weight and blood pressure in participants
at the beginning and end of the six week session.
Individuals are weighed, measured and have blood pressure and
body fat measured at the beginning and end of the six week program to assess improvements. A questionnaire is given
to participants at the six week point asking if other health improvements have been made or if any knowledge has been gained.
The questionnaire asks about any changes in behavior such as increased exercise or fruit and vegetable intake.
Food
diaries are now collected and returned each week to the program manager and the changes are tracked from the beginning to
the end of the program to assess adoption of the healthy habits people have made.
Outcomes from the first 6 months
of the GIFT program were the following:
* 13 GIFT support groups led by 5 lay health workers
met objective
* 169 participants educated on health topics to prevent chronic disease
* 21 participants lost weight
* 117 engaged in regular physical activity
Currently there
are 14 lay health workers trained to lead GIFT groups with new groups starting regularly. There are ten GIFT groups
currently meeting weekly or bi-weekly in Hillsborough County, learning about health and improving their risk factors to decrease
their risk of chronic disease and obesity.
If you have a location where you meet regularly with family, friends,
coworkers or neighbors, and want to learn how to get healthier and lose weight, we can put you on the path to success. This
program is coordinated by a registered dietitian with support from health educators. Healthcare providers are encouraged to
refer clients. We’ll respond with feedback on their progress (813) 307-8071.
Article by:
Barbara E.
Roberts, MS, RD, LD/N
Public Health Nutrition Consultant
Health Promotion and Education
Florida Department of Health - Hillsborough County
Improve your
cholesterol while getting more fit.
High density lipoprotein (HDL) cholesterol
is a type of cholesterol that helps protect against the formation of fatty plaques in our arteries. A higher amount of HDL in our bodies helps reduce our risk of cardiovascular disease.
In the fall FPHA newsletter you can find a nutrition section article regarding healthy cholesterol levels, foods to avoid, and foods to focus on to help maintain a healthy cholesterol balance. The article mentions increasing your HDL cholesterol
“good cholesterol” through regular physical activity. Eating certain foods can help lower our
low density lipoprotein (LDL or “bad”) cholesterol but it does not raise our HDL cholesterol. Physical
activity is a proven way to raise our HDL cholesterol levels. The current recommendation for physical activity
is 30-60 minutes most days of the week for adults.
As
health professionals and promoters of public health we should be promoting physical activity along with a healthy diet as well as model these same behaviors. Physical activity doesn’t have to
be running 10 miles a day or spending an hour at the gym before or after work; there are some
easy things we can all do to help increase our overall daily movement. One of the easiest things to do
is take the stairs instead of the elevator. If you work for a company/organization that has multiple floors
in the building try designating one day a week as “Take the Stairs Day” for everyone. You can
also stand while talking on the phone or begin a morning walk break each day. We should encourage our co-workers
to join in and help create a healthier work environment. When you park at in a
parking lot, don’t circle around to find the closest slot to the building, instead park at a distance so you actually
have to walk to reach the store. In doing so, not only will you increase your physical activity opportunity,
your car will take less abuse from shopping carts and wayward car doors as you will find the slots aplenty.
I would like to tell you about what the Hillsborough County Health Department is trying
to do to improve our health. Our wellness program is currently in the process of developing a wellness
challenge for its employees. This challenge doesn’t just focus on regular check-ups at the doctor
or making healthier choices while at the vending machine, it will also promote having regular activity breaks during meetings
and opportunities for physical activity outside of the work place. We also
have a few employees coordinating athletic teams. A softball league will begin in January 2009 and casual
softball pick-up games will begin in the next month or two. Bowling leagues have also been discussed for
employees looking for a different opportunity.
I hope other counties will follow suit and start up their own teams in their local communities. Maybe
in the future we can have small softball tournaments at our annual conference or a light-hearted game of sand volleyball.
We are the promoters of public health and the promotion should begin
with ourselves, our families, and our co-workers. If we don’t take
care of ourselves how can we take care of others?
Jennifer Waskovich,
MS, RD/LD
Public Health Nutritionist Supervisor
HCHD
Contributor: David Kastensmidt
The nutrition section met on July 31, 2008 to discuss our plans for the new year of FPHA. Twelve
members attended this meeting. The section expressed a need to make membership our biggest priority.
Twanna Gould and Marian Gaines will take the lead in increasing membership in our section but all attendees agreed
that we should communicate with local dietitians to increase our diversity. One suggestion was to contact
the Cooperative Extension offices to invite their dietitians to join the Florida Public Health Association. Public
health is not just the county health departments and working together with dietitians and nutritionists from other backgrounds
will only help to strengthen the role nutrition has in our communities.
As
a section, Nutrition has not played a large part in FPHA in the past. This year is going to change.
We have a number of members who are very passionate about their jobs and the field of nutrition and we feel we can
make a difference. Our new Nominating Committee Representative, Heather Huffman, is an IBCLC (Board Certified
Lactation Consultant) so breastfeeding and nutrition will be a major focus area this year. We have section
leaders from a number of different counties which will help to expand communication and best practices throughout the state.
Keep checking back to the website for updated information and events throughout the
state. We would like to encourage any FPHA and nutrition members to send us questions, comments, and best
practices and to share with us any events that may be going on in their area. We want to celebrate what
we do and share with others the importance of our field.
Send questions,
comments, and event information to Jennifer Waskovich at: jennifer_waskovich@doh.state.fl.us.
Thanks for your commitment to public health.
Jennifer
Waskovich
Nutrition Section Chair
Chair: Heather Huffman, MS, RD, LD/N, IBCL
Nassau CHD
P.O. Box
595
Hilliard,
FL 32046 T:
904-845-2660 ext. 5385
F:
904-845-4076
Email:
heather_huffman@doh.state.fl.us
