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Health Promotion Funding Proposal

Subject: Physiotherapy

Topic: Physical Activity And Healthy Eating Among Low-Income Women In Prabodhi Narendra Funding Proposal

Project Summary

The proposed program will be undertaken by Better Women Health Program and intends to address poor diet and inactive lifestyles among low income women in Prabodhi Narendra in Bihar, India, which makes them susceptible to obesity, overweight and diseases such as heart disease and diabetes. Under this program, twelve women will be selected from the target group and trained in order to equip them with the skills to carry out one-on-one personal encounters and group activities with their peers from the target area. Such encounters and activities will encompass health education on exercise and healthy eating.  The program is intended to take a period of three years, whereby intervention will start in September and end in August each year. The program needs a funding of $148,000 per year. It will be facilitated by Better Women Health Program’s staff, the trained women, collaborators and target community members.    


 

Identification of the Health issue

Better Women Health Program will develop, execute, and appraise a health promotion program as a response to the prevalence of physical inactivity, obesity and overweight, and diseases related to exercise and poor diet and complex health barriers among low-income women in Prabodhi Narendra, Bihar. The evidence-oriented approach utilizes community-based promotion of health and community empowerment and organization’s principles to deal with health issues and impart attitudes, behaviours, and knowledge from within underprivileged communities.  

The role played by physical activity and diet in reduction of chronic diseases and promotion of health for a range of situations is well founded. Research shows that diabetes, obesity, mental health, cancer, among other health conditions are highly influenced by activity level and diet. Obesity and overweight are clearly related to solemn health effects across all ages and undermine social functioning and mental health. Nationally, obesity amid adults is rapidly and clearly mounting among all sexes, ages, education levels, and races. Nevertheless, a bigger percentage of evidence shows that individuals with lower economic status, women, and minority groups bear an uneven burden of obesity, overweight and other related diseases (National Obesity Observatory 2011).  

Physical activity has a close relation with management of weight. A bigger percentage of adults in the India are not receiving the level of physical activity required to attain good health status. The proportion of people with inadequate exercise augments for women, minority groups, and people with low income or formal education levels. For example, about 71 percent of women report inactive lifestyles (Ng et al. 2009, p.34). In addition, adults aged between 18 and 44 years have a high likelihood of leading inactive lifestyles compared to elderly adults with 65 and above years. Considerably, these inactivity adult years have a high probability of overlapping with childbearing age among women. Research shows that, obesity and overweight have a likelihood of increasing poor childbirth results and pregnancy risk. As a result, before and subsequent to pregnancy might be crucial periods for interventions on healthy behaviour among women (Mandal et al. 2011, p.486).

There is concrete proof that people from minority groups, particularly minority women, have high chances of feeding on poor diet, be inactive, and show weight-related diseases like diabetes (Leung & Stanner 2012). The study by Leung and Stanner documents pregnant and low-income women’s perceptions regarding physical activity, diabetes, and health. The study recommends intercessions to promote supportive settings for high physical activity levels in the family, as well as the social environment in general, customized to the women lives’ reality. Most minority women tend to consider physical activity a treatment for disease instead of prevention. In fact, since low-income and minority women may not give high priority to undertakings that they consider as solely benefiting themselves, the Better Women Health Program puts positive lifestyle transformations in a domestic context. Under this context, the transformation evidently benefits the whole family and undertakings can easily encompass family members or children. Concurrently, this program will foster individual change as well as broader policy and systems change.

Among low-income women in Prabodhi Narendra, obesity and overweight problems have a close relation with poverty, cultural differences, language, information gaps, unreachable health care, along with lack of resources for promoting health, such as healthy, affordable food, and acceptable, safe exercise areas. This area is characterized by low educational attainment and health status, a big and growing population, and high unemployment and poverty levels. Moreover, over 30 percent of the area’s population do not have insurance covers, with the proportion of uninsured females and males being roughly equal (Mehta & Shah 2001, p.46). All such factors are linked to lower status of health generally, and particularly with obesity, inactivity, and related health conditions like diabetes and heart disease (Sproston & Mindell 2006).

In summary, lack of preventative and primary health care services is widespread in the target area, and so is a shortage of correct information regarding accessible health resources, as well as a universal incapacity to access the available services or resources. The region also has a shortage of health professionals. Language differences, economic status, and low education levels also makes a contribution to the poor health position of the residents. Often, most residents lack awareness of health services, are not aware of how to get services, or believe that seeking health services will report feeling mistreated or disrespected by health providers. Furthermore, getting transportation means to health facilities is a prevalent problem especially in the interior parts of Prabodhi Narendra.                              

Project description

Better Women Health Program provides services, information, and training on healthy lifestyles directly to low-income and minority women. It also establishes connections to accessible health care services through reliable peers and helps participants to overcome multiple obstacles to better lifestyles. As advocates and educators, the members of the program are capable of achieving impressive results since they share culture, experiences, and language with the members of the community they serve. The suggested intercession is an effective, innovative, and a holistic approach to community and individual health promotion. It is intended to specifically assist low-income, minority women to understand and enhance their personal health along with their families’ health, by feeding on healthy diet and sparing time to do exercises on a regular basis.

Similar to women in most cultures, Prabodhi Narendra’s women usually address their families’ health prior to addressing their personal health. Consequently, and since the rural women are more isolated compared to the males, the former may utilize their families’ scarce resources to tackle their children or other family members’ health issues. A member of Better Women Health Program may help a woman in other close family health issues, such as an ill child, prior to talking about the woman’s personal health, likely concern about obesity or overweight, and involvement in the program’s intervention. This way, the intercession will be able to address and influence a range of health problems or concerns, as may be necessary.

The suggested program will train, recruit, and help peer health tutors from the target group. Experience shows that peer tutors with identical socioeconomic status as the community members they serve are ideal for:

Ø    Addressing multiple and complex hindrances to health care services.

Ø    Advocating for better health services in place of the community members.

Ø    Changing social norms.

Ø    Empowering members of the community to alter conditions prevalent in the community that fail to support health.

Ø    Providing linguistically and culturally competent services.

Moreover, a mounting literature body espouses the formulation and execution of multilevel intercessions that involve working with target community groups to develop affirmative personal health behaviours, as well as uphold the behaviours through supportive policy and environmental level changes (Perez, Fleury, & Keller 2011, p.341).

Just like the Prabodhi Narendra’s women who have careers and families, most Better Women Health Program’s members struggle to attain a balance among competing demands. Thus, they constitute realistic and excellent role models showing the way women with several responsibilities may also spare time to foster better health, physical activity, nutrition, and better weight management both in their families as well as communities. The suggested program’s approach is considered to be effective since the members will not merely tell the target group that exercise and improved nutrition are beneficial to them. The members will make changes in dietary and engage in exercise alongside the women who will be involved in the program. Moreover, under the suggested intervention, women will work jointly to overcome former obstacles to healthy behaviours and to establish networks for social support. Research indicates that such networks may be crucial to lasting upholding of health changes in behaviour (Smith & Christakis 2008, p.405).

Project aims and objectives

Aim

Better Women Health Program aims at promoting the taking up of healthy ways of life among low-income women in Prabodhi Narendra region in Bihar. The aim will be achieved through the development, implementation, and evaluation of a community-based health promotion initiative in order to augment the incidence of healthy diet and exercise, as well as lessen prevalence of obesity and overweight amid the target group.

Project Objectives

Ø    To select, train, and oversee twelve women from within the target group to work together with the program’s members. For a period of sixteen weeks from December to March every year for the next three years, each of the women will finish 350 hours of experimental learning and training relating to exercise and healthy eating. Consequently, each woman will show individual changes in intended health knowledge, behaviours, and attitudes.

Ø    For fourteen weeks between January and March every year, the trained women will direct the intervention of healthy lifestyles among their peers residing in Prabodhi Narendra. Each group of two trained women will:

o   Carry out 20 personal encounters every week, recording a minimum of 1,400 individuals which they train for the exercise and healthy eating intervention and give face to face resource information, health education or follow-ups and referrals.

o   Organize and maintain three health groups within the locality, reaching a minimum of 180 women for twelve weeks. Each group will have a meeting once in a week with the trained women for an education and activity session for 75 minutes.

o   Support affirmative behaviour changes by collaborating with the participants and all other stakeholders in order to create policy and system modifications, such as improving access to healthier choices of food in local outlets and setting up acceptable, safe places for doing exercises in the region.

Ø    To develop a survey tool suitable to the target group to show the impact of the intervention on the knowledge, behaviours, and attitudes of participants in relation to affirmative, healthy behaviours. Administration of the survey will take place three times every year for three years: at baseline, end of the intervention for 12 weeks, and around six months subsequent to the baseline.

Ø    To assist participants check their personal exercise and healthy diet goals through the development of tools for personal goal-setting and tracking by the Better Women Health Program staff.

Ø    In the first and second year, the director of the program will carry out 1-2 focus groups among women in the target region in order to record community contribution and make suggested changes to the initiative when feasible and required.       

Project plan and budget

In this funding proposal, Better Women Health Program plans to carry out a 14-week health promotion program on matter relating to exercise and health eating, which are considered key to ensuring a healthy community. The project targets low income women in Prabodhi Narendra in Bihar, India. The program is intended to go for three consecutive years. The suggested program will be starting in September every year and ending in August. In order to successfully facilitate the program, the requested funding and which constitute the project’s budget is $148,000 per year.  

Implementation of the strategy

Work plan

Several viable policies will be used to get the forecasted yearly sample of 180 females. While some follow-up loss is likely due to the regular movement of a considerable percentage of target group and other factors, Better Women Health Program expects getting pre, post, as well as six-month tracking data from around 80 percent of the sample, that is 144 individuals. Consequently and during the three years, compilation of data will be done for 432 women. Tactics for obtaining the sample will include collaborating with community members to introduce the intercession and to gather data, and carrying out a practically responsive and culturally competent intervention. Other strategies will include providing meaningful community contribution’s systems, carrying out all activities in reachable locations at proper times, and trying to keep follow-up information and data of the program’s dropouts.  

Information on recruitment meetings will be distributed among the target group either towards the end of October or in early November. Interviews and placements in the program will be completed in November with a joint two-week training occurring at the beginning of December. All the selected and trained women will take part in this training, alongside collaborators and community partners. This way, they women will gain core competencies needed to fulfil their roles, create critical connections with area social and health services and contact people, and receive specific training on important subjects, such as leading healthy lifestyles. During the season, the twelve women will devote around 25 hours every week to carry out their roles, most of which they will spent facilitating particular community-based undertakings in the target areas.

At the same period, that is, between September and December every year, Better Women Health Program’s staff will develop, complete or revise data gathering instruments as well as tracking tools, and prioritize targeted community members together with community collaborators and other personnel. The staff will also prepare or buy educational equipment and supplies, and execute other start-up activities, such as making plans for the focus groups.

The program’s intense intervention and outreach part will start in January every year for three years. The trained women will be grouped into twos, after which they will go to talk with the targeted community members. With the guidance and support of the Better Women Health Program’s staff, the women will go home-to-home in targeted group completing individual meetings and recruiting other women for a period of 12 weeks. During this period, the women will give personalized health education, as well as any referrals for social or health care services or any suitable type of assistance. For around two weeks, these women will focus principally on undertaking individual encounters, discussing pressing health matters with participants, as well as recruiting women on exercise and health eating.

During the two-weeks, the women will collect community contribution and search and define suitable and reachable meeting locations, which may include present community centres, nearby schools, parks, neighbourhood streets, and churches. Existing joint relationships will back up the process, as Better Women Health Program’s staff and the trained women work towards developing and sustaining new relationships and establish locations and community groups for intervention.

After the first two weeks, group intervention will begin with each pair of the trained women directing three groups with a minimum of 12 women every week. Each pair will persist with completing personal encounters across the season in order to give follow-up, uphold high attendance levels, and if required, continue recruitment. Every weekly group intercession will entail group exercise, health education, and counselling on nutrition that will encompass demonstrations on healthy cooking, and practical conversations on eating healthy in terms of economic strains. The women will use group meeting forms in planning, documenting, and assessing the group’s education, and physical activity sessions. Moreover, these forms along with sign-in sheets will help in tracking attendance.

During each group session, participants will be given time to give feedback, proposals, or to look for individual support and advice from the trainers or fellow participants. Towards the termination of every program session, the Better Women Health Program’s staff will facilitate a minimum of one evaluation gathering. The end-of-season gathering will present the trainers with an opportunity to mull over the finished intervention undertakings and provide written or oral recommendations.   

Time table

The table below provides a yearly timeline for carrying out the suggested program. Where YR1, YR2 and YR3 are used, an activity relates to a specific year or several years.

Time Frame

Activity

Person in Charge

Monitoring Methods

September and October

1.      Assign program personnel

2.      Make announcements to collaborators and community about the program (YR1)

3.      Announce the positions for trainees in the local newspaper

4.      Identify and assess relevant survey and tracking instruments for individuals (YR1)

5.      Annual review and revision of group and personal encounter forms

6.      Complete follow-up survey for 6 months with participants of the former January-March session (YR2&YR3)

1.      Associate Director (AD)

2.      Program Director (PD)

3.      PD

4.      PD

5.      PD; Program Coordinator (PC)

6.      PC

1.      Staff Records

2.      Meeting records, minutes

3.      Newspaper copies

4.      Literature; review instruments

5.      Revised forms

6.       

November

1.      Recruitment meeting

2.      Carry out interviews and choose the 12 women; carry out baseline interviews

3.      Pre-test survey instruments and amend (YR1)

4.      Finalize personal monitoring instruments for assessing changes (YR1)

5.      Finalize training schedule for December; draft schedule for ongoing training

PD;PC

 

 

 

 

 

 

 

 

 

 

 

Collaborators; all staff

1.      Sign-in sheets

2.      Interview form; personnel records; notes

3.      Pre-tests and amended survey

4.      Finalize materials

5.      Training schedules

December

1.      Carrying out December training together with collaborators and all staff

2.      Evaluate training through participant input

3.      Plan scheduling of 1 or 2 focus groups

1.      PC;PD

2.      PC; PD; Trained women

3.      PD

1.      Sign-in; training records

2.      Recording of verbal evaluation; written evaluations

January, February, and March

1.      Start of intense outreach and recruitment (Initial 2 weeks)

2.      Start 12-week intervention for groups after the first two weeks

3.      Record all community undertakings

4.      Weekly supervision, and continued training, record keeping; feedback and problem solving

5.      Focus groups

6.      Finish 12-week sessions

1.      Trained women

 

 

2.      Trained women

 

 

3.      Trained women

4.      PC; Trained women

 

 

 

 

5.      PD

6.      PC; Trained women

1.      Individual meeting forms

 

2.      Group undertakings forms

 

 

3.      Group/individual meeting forms

4.      Training records; supervision notes; sign-in

 

 

 

5.      Notes; recordings; recommendations

6.      Completed surveys for 12 weeks

April and May

1.      Season-end evaluation; record oral and written feedback, individual changes and suggestions

2.      Tabulation of personal and group data

3.      Compiling and assessing participant suggestions and feedback

1.      PD; PC; AC; Trained women

 

 

 

2.      PD;PC

 

 

3.      PC;PD

1.      Evaluations; notes; recommendations

 

 

 

 

2.      Database; personal/group forms

3.      Reports; suggestions for coming year

June and July

1.      Assess suggestions for amendments to the plan of the program

2.      Assess equipment, materials and supplies for the coming outreach year; purchase new supplies

1.      AD; PD

 

 

 

2.      PC

 

1.      Revisions; meeting notes

 

 

2.      Inventory

 

August

1.      Plan for YR2’s 6-month surveys

2.      Implement any suggested changes

1.      PD; PC

 

2.      PD

1.      Data gathering plan

2.      Approved/Revised program plan

 

Evaluation of the strategy

Completed and tabularized group forms will give proof of meeting suggested project objectives. Particularly, the trained women will use personal meeting forms to record every direct health contact completed. The form will gather basic demographic data, topics covered, referrals given, actions taken and any needed follow-up. The completed forms will be handed over to the Project Director on a weekly basis. The director will review the forms and check any errors, necessary follow-up, and unresolved issues. Moreover, the director will go over the forms on a monthly basis to monitor progress in the achievement of set objectives and carry out quality assurance assessments. Similarly, forms for group activity will record group undertakings, attendance and locations. An appendage will be included  in the form for group activity to record discussions, actions, and activities relating to changes in the environment that foster healthy lifestyles for participants. These forms will be gathered and reviewed through a similar process as the personal encounter forms. A spreadsheet or database will be used to track the data in the two forms.

According to Sherwood et al. (2000), individual checking of exercise and eating may improve self-efficacy for such behaviours. Accordingly, the suggested program will formulate tools for setting goals and tracking for use by the participants. The tools will also be planned to assist women establish realistic changes appropriate for their lives. The suggested outcome objectives will be measured using a pre and post assessment that will be formulated or amended and administered verbally with small groups or individuals at the start of the program, at the end of the 12-week intercession, and at a follow-up of six months.                    

My role in the development and implementation of the strategy

During the development and execution of the strategy, I will take on the role of Projector Director, and I will be charged with a number of key responsibilities. In the first place, I will have five hours per week to carry out training, record keeping, problem solving, and individual support and training. In addition, I will assess the qualities of the suggested recommendations by the trainers taking into account information from an array of sources, such as focus groups, as well as implement the relevant recommendations before the start of the succeeding program year. Moreover, I will pose open-ended questions to all the twelve women as they enrol for training and towards the end of each program year in order to record reported behaviour changes and the program’s impact on them.      

Strategies for use in working together with others

In working with other people in the formulation and execution of the project’s strategy, I will use various strategies. First; I will involve different stakeholders to the proposed program such as other Better Women Health Program’s staff members, the 12 trained women, collaborators, and even participants in making decisions pertaining to things like meeting locations, meeting schedules, and survey methods. This will help enhance the effectiveness of the suggested program since the interests and opinions of different stakeholders will be taken into consideration (Griffiths, Maggs, & George 2007). Moreover, before I make decisions, especially regarding implementation of suggested changes to the program plan, I will consult the program coordinator, and associate director as to the appropriateness of the changes.  


 

Reference List

Griffiths, J, Maggs, H & George, E 2007, Stakeholder Involvement, Geneva, World Health Organization.

Leung, G & Stanner, S 2012, October 23, Is Diet to Blame for Poor Health of Minority Ethnic Groups in the UK? Retrieved May 4, 2013, from http://www.nutritionsociety.org/yournutrition/articles/diet-blame-poor-health-minority-ethnic-groups-uk

Mandal, D, Manda, S, Rakshi, A, Dey, R, Biswas, S & Banerjee, A 2011, Maternal obesity and pregnancy outcome: a prospective analysis, Journal of the Association of Physicians of India, 59 (8), 486-9.

Mehta, AK & Shah, A 2001, July, Chronic Poverty in India: Overview Study, CPRC Working Paper 7, New Delhi, India, Chronic Poverty Research Centre.

National Obesity Observatory 2011, May, Knowledge and attitudes towards healthy eating and physical activity: what the data tell us, Retrieved May 4, 2013, from http://www.noo.org.uk/uploads/doc/vid_11171_Attitudes.pdf

Ng, N, Hakimi, M, Minh, HV, Juvekar, S, Razzaque, A & Ashraf, A 2009, Prevalence of physical inactivity in nine rural INDEPTH Health and Demographic Surveillance Systems in five Asian countries, Global Health Action, 2 (10), 34-45.

Perez, A, Fleury, J & Keller, C 2011, Review of Intervention Studies Promoting Physical Activity in Hispanic Women, Western Journal of Nursing Research, 32 (3), 341–362.

Sherwood, N, Jeffery, R. French, S, Hannan, P & Murray, D 2000, Predictors of weight gain in the Pound of Prevention study, International Journal of Obesity Related Metabolic Disorders, 22 (2), 395-403.

Smith, KP & Christakis, NA 2008, Social Networks and Health, Annual Review of Sociology, 34 (1), 405–29.

Sproston, K & Mindell, J 2006, Cardiovascular disease and diabetes, Leeds, The NHS Information Centre.