Promoting Use of Nutrition and

Physical
Activity Community Resources
Among Women
in a Family Planning Clinic Setting
Dudung, Ratri, Syifa, Triko, Witri
FOCUS OF PAPER
Promotion of community resources among low-
income women, aged 1844 years, who used family
planning services at a local health department
TYPE OF INTERVENTION
No intervention in this research only formative
research
Where was the study
conducted?
Conducted in Greenville, North Carolina, a mid-
sized town located in Pitt County, which is in the
eastern part of the state.
Participants were recruited from the health
department family planning clinic waiting room.

Subject of the Study
women aged 1844 years, who were using
reproductive health services at a Title X family
planning clinic at the Pitt County Health Department.
Eligibility criteria : included females aged 1844 years,
English-speaking, not currently pregnant,a patient at
the health department, and current resident of Pitt
County
The key informants interviewed were identified by the
health department director and by snow-ball
sampling


FOCUS POPULATION : Low-income women, aged 18-44 yrs
The MAIN Finding
Participant Characteristic
The majority of participants interviewed
were African American (80%), and the
mean (standard deviation) age was 23.8
(5.4) years (ranging from 1838 years).
Over 85% reported coming to the
health department 25 times per
year for various services, with a
mean travel time of 18.2 (11.8)
minutes to the health
department.
The majority had finished high
school (24%) or some college
(48%), and were single (67%) or
divorced/separated (10%).
Fifty percent were employed. The majority
reported grocery shopping at
two regional chain supermarkets, a discount
food club, and a discount su-perstore.
Women mentioned frequenting the
following types of restaurants: steak
houses, American, fast food, Chinese,
buffet, and seafood restaurants.
Among the five key informants
interviewed, three were health
department employees. The other
two worked in health promotion at
the hospital and senior center.
Nutrition and Physical Activity
Resources
Nutrition Community
Resources
Farmers market
Nutritionist at PCHD
Breastfeeding support
group
Physical Activity Community
Resources
School track
Local recreation centers
Parks
mothers more likely to use a community resource when it was not
expensive or they had an incentive (e.g., 10% discount); transportation was
provided or it was conveniently located close to home; and the venue was
family friendly.
key informant barriers to women accessing/using resources:
lack of knowledge of the resource
location, transportation barriers, and economic barriers
Existing Community Resource Guides &
Needed Community Resources
Existing community resources
Guides :

a walking trail guide available on
the country planning departments
website
a resource guide for the Council
on Aging and related programming
and a resource guide for parents
which included information ranging
from health insurance to childrens
educational opportunities
Needed Community Resources :
greater access to fresh fruits and
vegetables in the rural areas of the
county via corner store initiatives
cooking, budgeting, and gardening
classes
more diabetes self-management
counselors
grocery store tours
a demonstration garden and/or
satellite farmers market at the
health department
a YMCA
improved bicycling infrastructure
more places with playgrounds
a community pool
Participants Suggestions for Improving the
Community Resource Guide
CRG appearance themes : Add more colors, Use colored
paper, Add a relevant title, Categorize the guide, Change
font style, Add pictures, icons, graphics.
CRG content (Key themes) : Add testimonials and
inspiring quotes, Emphasize relevant information,
Add information about potential discounts
CRG placement (Key themes) : Add information on
bus routes and provide contact information for
Resources, Health department, Doctors offices,
Grocery stores and Restaurants, Schools, libraries,
gyms, Churches, Provide CRG to women in
breastfeeding support Group, Add CRG to a website
Key Informants Perspectives on Improving
and Promoting Use of Community Resources &
Use of Social Media to Promote Use of Community
Resources
Key Informants Perspectives on Improving
and Promoting Use of Community Resources :
Adding information about weight loss and chronic disease
management programs, the local food literacy pro-gram, master
gardeners information, and information about bus routes.
Creative outlets for promoting the guide among patients. (included
dis-playing it on an interactive computer kiosk in the health
department waiting area, featuring guide resources in a coupon
book, adding the guide to waiting room reading materials, and using
local media)
Use of Social Media to Promote Use of Community Resources :
the participant suggestion to include the guide on a website and the
key informant suggestion to have an interactive computer kiosk in
the waiting room featuring community resources, participants made
no further suggestions regarding use of social media or cell phones
specifically for community resource promotion

5 Priority Action in Health
Promotion
Build healthy
public policy
Create
supportive
environment
Strengthen
community
action for health
Develop
personal skills
Reorient health
services
: HP aspect dicussed
in the paper
Create supportive environment
In order to support community resource guide among low income
population (include various nutrition and physical activity)
It is necessary to have information and available community and health department
resources
Sources of
information
health
department nutritionist
doctors
office
library
city hall
senior
center
grocery
store
church
school
Internet
television
word of
mouth via
family and
friends
Sources of information about nutrition and physical activity resources according to participants
Create supportive environment
available community and health department resources
Farmers Marketours is not in a very good location. The farmers set up their
own stands around town so I am not sure they even use the farmers market. (Key
Informant 04)
Farmers market
Nutritionist at PCHD
I met with a nutritionist here at the health department.
(Patient 05)
Breastfeeding support group
Cause they [health department] sent out letters to women who breast-feed.
(Patient 15)
School tracks
...the track, school track for walking cause I like to walk. (Patient
14)
Local recreation centers/fitness
programs
The C.M. Eppes Recreation Center is right across the street from the house I stay
in. P02
Parks
I go to parks a lot cause of my daughter. And ... I walks with her.
P07
Develop personal skills
a print version of a community resource guide listing various
nutrition and physical activity resources was created (In previous
work) to encourage healthy behaviors among low-income, midlife
women aged 4064 years,
Low-income
populations
Low
health
behaviour
elevated risk
of obesity
associated
chronic
diseases
Environmental factors
Although low-income neighborhoods may pose barriers to healthy behaviors, they may also
have health-promoting environmental features (i.e. walking trails). A potential effective
intervention strategy is to help individuals identify and overcome neighborhood barriers by
making use of community resources that support a healthy diet and physical activity.
Jilcott, S. B. et. al. 2007. A guide for developing intervention tools addressing environmental factors to improve diet and
physical activity
Strengthen community action for
health
Weakness
Convenience samples used for both study participants and
key informants
The location of the interviews (the health department)
The authors did not track the number of women
approached
Standard instruments were not used
The lack of use of standard instruments
Purposive and snowball sampling used for key informants
Strength
Sufficiently large sample size (for a qualitative study) of local
resident participants
Transportation and access barriers to resources such as the
farmers market and other healthy food options.

Quality control was enhanced by having all interview
transcripts double-coded by independent coders.
Interesting Information (1)
Identifying the nutrition and physical activities
resources---and weight them in term of priority
program
Find out the needed community resourceslow
cost gym, greater access to fresh fruits and
vegetables---community pools
Feedback from the participant about the CRG
which can make the CRG better and acceptable.
Use outlets to promot the guide
Use of social media
Interesting Information (2)
All of those describes the quality of FGD and
availibility of resourceslearn how the good
quality FGD can be gathered
Participant suggestion to CRG describe what we
think good sometime no good in their wayneed
assesment is better to increase acceptability
Using advance tech (social media) describe that the
promotion must be flexible in term of information
channel

A guide for developing intervention tools
addressing environmental factors to improve
diet and physical activity
Jilcott SB, Laraia BA, Evenson KR, Lowenstein LM, Ammerman AS.
Author information
Department of Nutrition, Schools of Public Health and Medicine, University of
North Carolina in Chapel Hill, North Carolina, USA.

Abstract
Low-income populations have an elevated risk of obesity and associated chronic
diseases. Environmental factors influence health behaviors that contribute to
obesity. Although low-income neighborhoods may pose barriers to healthy
behaviors, they may also have health-promoting environmental features (e.g.,
produce stands, walking trails). Thus, a potentially effective intervention strategy is
to help individuals identify and overcome neighborhood barriers by making use of
community resources that support a healthy diet and physical activity. The authors
describe the formative research process undertaken to develop two community-
focused intervention tools to complement a clinic-based cardiovascular disease
risk-reduction program for underserved women. Literature review, community
exploration, and examination of Internet and print resources contributed to
development of a neighborhood assessment with tip sheets and a community
resource guide. These tools were finalized using community members' feedback.
This formative process can serve as a guide for other health promotion programs
to create and use similar tools.