Community Participation Report

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Report on Community Meetings on Obesity Prevention and Nutrition Centro Bienestar: Community Wellness for the West Side

Edgewood Family Network - Obesity Prevention and Nutrition

Founded by six mothers in 2002, Edgewood Family Network (EFN) is a grassroots, community-led network of 518 families living in San Antonio’s West Side. The network includes the 11th poorest community in the nation, the Edgewood Independent School District. Incorporated as a non-profit in December of 2005, EFN helps West Side residents overcome social and economic hardships through providing access to education, referral, and linkage to services and resources that will help them become self-sufficient and improve their quality of life and that of the community. EFN works together with public agencies, local businesses and neighborhood groups for the benefit and revitalization of Edgewood’s greatest asset, its people.

EFN Proposal to the Bexar County Community Health Collaborative
The Bexar County Community Health Collaborative requested proposals from the community to address priority community health concerns to support the Bexar County Health Assessment. EFN’s staff identified obesity as a priority concern because of the observed negative impact of obesity, heart-disease, and diabetes in the community. The perceived importance of obesity was not limited to its effects on the individual, but rather the cumulative emotional, physical, and financial stresses on families and communities dealing with chronic illness. These elements are seen to create a vicious cycle of poor health and hopelessness that extends to the greater community.

Working in the community led the promotoras of EFN to believe they should be working to support the social, mental, and physical health of the community. The idea of a Centro Bienestar (Wellness Center) emerged from the desire to support community members in working together in the pursuit and maintenance of wellness. This community-based resource will both promote healthy behaviors in the community and, through group activities, help strengthen community ties.

The objective of the project was to learn the opinions of area residents on this subject through a series of focus groups in the community. As part of the planning for health education classes on obesity and nutrition, EFN engaged in a strategic planning process. Afterwards, the promotoras held a series of eight platicas (community conversations) to determine the level of knowledge about prevention of obesity in the community.

Strategic plan goals:

1. To determine the barriers to good nutrition and adequate physical activity experienced by residents of the area that result in high rates of obesity
2. understand the needed health information;
3. To involve the study group in testing/adopting those behaviors to find out what works and what doesn’t work

“It is very important that we hear the families’ (residents of the area) opinions to the reason we cannot eliminate obesity in this area. It is very important to us to include the families in the process of establishing our Centro Bienestar to ensure the program has what they need and are willing to participate in.”

The EFN Strategic Well-Being Plan
Richard Alvarado assisted with the development of a logic-model style plan prior to data collection in the community. The plan identified four strategic directions:

1. “Communicating with the community” entailed conducting focus groups regarding nutrition and exercise in the community and the subsequent preparation of this report.
2. “Developing EFN programs and services independently and in collaboration with other service providers” describes the development of a comprehensive health program.
3. “Supporting individual positive change in life styles and promoting responsibility” again refers to hearing community members’ beliefs about what will help them adopt healthier lifestyles.
4. “Bringing about positive change in public policy” focuses on improving nutrition at schools.

Steps were identified for each direction, with timelines for accomplishing each step over the next year.

Learning from the Community — Platicas
Platicas are discussions that use a consensus-building method to identify concerns and establish priorities in community meetings. Promotora members of EFN were trained in conducting these meetings and in collecting both quantitative and qualitative data on the concerns, ideas, and priorities of meeting participants.

EFN hosted eight platicas with a total of 152 participants. The meetings were attended by members of all age groups and by both men and women. There were 110 female participants and 45 male participants. All age groups were well represented. Seventeen percent of the participants were Youths (under 18 years), 33% were Young Adults (18-35 years), 37% were Middle-Aged (36-55 years), and 15% were Elders (over 55 years).

Meetings were organized and conducted over approximately two weeks with recruitment coming from both direct contact with EFN staff and promotoras and via word-of-mouth within the Edgewood community.

The promotoras who facilitated and coordinated the platicas worked with staff from the Bexar County Community Health Assessment to analyze results of the meetings. Twenty categories were identified based on the responses provided during the platicas. Four major themes emerged from the categories:

1. Eat healthy (diet, nutrition, and cooking)
2. Exercise (including sports)
3. Community Resources (resources to improve the ability to exercise or improve diets)
4. Advocacy and support

The concepts of education and lifestyle were evident throughout the four major themes. The follow summary is a description of responses by age group that were provided within each of the categories.

The eat healthy theme includes the eat healthy and lifestyle, lifestyle, eat healthy, and education and eat healthy categories. These categories received 301 votes from participants indicating that they are a priority for preventing obesity. The bulk of the votes (229) indicated that eat healthy and lifestyle topics were a priority for young adults. People between 20 and 35 years old both need to care for their own bodies and help ensure that their children receive proper nutrition.

In this theme, 23 votes indicated that it is important for youth to eat healthier foods. Responses including increasing consumption of fruits and vegetables were given at multiple meetings. Other responses for youth were eat less junk food and eat less.

Interest in healthy eating was highest for young adults with 229 votes. Most ideas were general suggestions such as eat healthy foods which garnered 72 votes and eat healthy meals with 25 votes. Overall, smaller portions or eating less had 20 votes. There were 38 votes for responses with positive choice recommendations such as more fruits, vegetables, turkey or fiber. Dietary restrictions or avoidance were recommended in items receiving 51 votes total and included, do not eat carbohydrates, cut down on salt consumption, and eat smaller portions, no flour tortillas, no bread, no soda.

Eat healthy ideas for middle-aged people received 31votes. The suggestions offered tended to focus on dietary restrictions such as avoid sugars and fats, don’t drink soda, and don’t eat pizza. The two positive recommendations, with one vote each, were to cook with canola oil and to drink low fat milk.

Ideas to help elders with eating healthy received 17 votes. Offer healthier choices that cost less so they are affordable to everyone and low fat foods and not eating out were suggestions to help elders eat healthier.

Throughout this theme were suggestions that people in the Edgewood area need more education about how to shop, cook, and eat. Many of the suggestions indicated that to improve eating habits, residents will need to change eating behaviors. There were also suggestions that family and community support could be helpful in changing eating behaviors.

The theme of exercise (including sports) includes the categories exercise, lifestyle and exercise, sports, and education and exercise. These categories received a total of 127 votes, indicating that Edgewood residents felt these ideas are a priority for preventing obesity. Over half the votes (67) were for the ideas offered for young adults (20 to 25 years of age).

Ideas about exercise for youth primarily were to engage in sports with 16 votes. Interestingly the suggestion of shopping a lot got 8 votes. Other ideas for exercise for youth included jog around the field, running, and lift weights for a total of 5 votes.

Exercise for young adults primarily focused on the word exercise; this idea received 30 votes. Support for the ideas of play sports and sports competition each were supported with 12 votes. Walking as a means to prevent obesity received 7 votes. Suggestions to increase involvement around the home, do more yard work and house chores, got 6 votes. There were 3 votes for let’s do it, not just talk about it.

Suggestions to support middle-aged adults to exercise tended toward social strategies. Take dance classes received 7 votes. Other ideas included inviting neighbors and family to walk, play, bike, etc, and participate in sports. The exercise and don’t watch TV and exercise earned 13 votes together. Don’t sit for too long was also mentioned as a way to prevent obesity.

No suggestions were offered about exercise for elders.

The theme of community resources includes the categories community resources and education and community resources. These categories received a total of 112 votes, indicating that residents felt that improving community resources and education are priorities for preventing obesity in the Edgewood area. The largest number of votes (40) was for the ideas offered for middle aged adults (40 to 55 years of age). This was followed by ideas for young adults (35 votes) and elders (30 votes). This suggests that residents believe improving community resources would benefit most people living in the area.

Ideas for community resources offered for Youth were for more parks and playgrounds and gyms for kids.

For young adults ideas about community resources included having a children’s fitness center. The most popular ideas for young adults with 22 votes were to educate the community on obesity and educate oneself on diabetes.

The idea to improve community resources for the middle-aged group was to have a place to exercise at no cost (or an inexpensive gym). This idea was supported with 30 votes.

Suggestions about community resources for elders that were given the highest priority were related to nutrition education. Nutrition school was the idea that received the most votes (12). Other nutrition-related ideas received an additional 18 votes.

The theme of advocacy and support includes the categories advocacy, education and support, support, and lifestyle and support. These categories received a total of 31votes, indicating that some residents feel social and emotional support are helpful in preventing obesity. Some participants supported improving this community health concern through advocacy for various issues: no junk food in the schools, more exercise in school and more sports in school got 5 votes. Ideas about support were mentioned for middle-aged adults such as talk to someone about depression and family problems, all people should support each other, and have high self-esteem and love ourselves.

The concepts of education and lifestyle were consistently mentioned across the four major themes eat healthy, exercise, community resources, advocacy, and support as suggestions of how to prevent obesity. These ideas were included in earlier descriptions of the themes.

These include suggestions such as:

• Educate children on the topic of nutrition
• Learn more about obesity
• Seasonal nutrition classes
• Better education on the things that we eat and cooking better
• Decision making
• Be healthy
• Spend more time outside
• Self-motivation to exercise
• Self-control
• Don’t watch TV while eating
• Drink plenty of water
• Avoid eating candy
• Eat six small healthy meals a day
• Avoid eating late at night
• Walk for 30 minutes
• Watch less television Don’t eat heavy meals in the evening