Background/Significance: Watonwan is ranked 44 out of 87 counties in Minnesota, indicating poor health outcomes. According to the County Health Rankings, 31% of adults report a BMI above 30. Sugar-sweetened beverages (SSBs) are associated with increased risk of diabetes, cardiovascular disease, and obesity (Boston Public Health Commission, n.d.). The purpose of this project was to partner with worksites, community businesses, health care organizations and schools to implement policies and environmental changes that aim to reduce access to SSBs such as soda, sports drinks and sugary juices and increase access and consumption of water. This project reached specific target populations, including low-income individuals and families, Latino community and youth.
Theoretical/Conceptual Framework: The CDC Community Health Assessment aNd Group Evaluation (CHANGE) tool was utilized for evaluations in community at-large, community organizations, schools, worksites and health care sites. CHANGE is a data collection tool and allowed for a preliminary snap-shot of the current policy and helped shape an action plan for desired systems and environmental change strategies around sugar-sweetened beverages (Centers for Disease Control & Prevention, 2010). Each site was assisted in developing an action plan outlining the steps to implement their project, utilizing components of the Media, Access, Point of Decision Information, Price, and Social Support & Services (MAPPS). The CHANGE and MAPPS tools were successfully implemented with public health and clinical nurses, community leaders, nurse researchers and nursing students to impact and change behaviors.
Methods: The CDC’s Community Health Assessment aNd Group Evaluation (CHANGE) tool was used to identify community organizations interested in implementing policy, systems and environmental changes within their organizations. Each site was assisted in developing an action plan outlining the steps to implement their project, utilizing components of the Media, Access, Point of Decision Information, Price, and Social Support & Services (MAPPS) tool (Cash, 2014).
Results: Policies were developed and implemented at the sites. Policies focused on decreasing access to high sugar beverages and increasing access to water.
Media: Media was utilized to promote healthy drinks while reducing access to unhealthy beverages. The team developed a Rethink Your Drink video in collaboration with nursing students and State Department of Health: https://www.youtube.com/watch?v=5kWs-1muUfo. Social media and flyers were used to promote community educational activities such as community events, school events, grocery store booths, health fair, and Early Childhood & Family Education classes.
Access: Increased access to water fountains at schools by installing hydration stations. Provided BPA-free water bottles to students and teachers. Established employee wellness program policies. Hospital revised general requirements for patient tray service policy to reduce patient access to SSBs. Manufacturing plant eliminated 100% fruit juices in vending machines. Provided large water jugs for fruit and vegetable infused water access at restaurant.
Point of Purchase: Developed labeling and signage to educate consumers about SSBs. Added traffic light signage and changed vending machines facing. Educational banners, signs, and documents present at sites. Dietician assisted changes in gas station.
Price: Price adjustments were encouraged to influence consumer purchasing.
Social support/social norm: Campaigns were utilized to inform and educate the community. Provided financial support to assist with policy, systems, and environmental changes.
Conclusions: The CHANGE tool was an effective tool to help identify interested partners, current policies, desire for systems and environmental changes within the sites, as well as tracking progress of the plan. The tool is recommended to assist communities in the development of a plan to improve health outcomes through policy development and implementation. The CHANGE and MAPPS tools can be used by leaders, decision makers, practitioners, and educators to facilitate the improvement of population health and change social norms.