Running head: EVALUATING COMMUNITY HEALTH EDUCATION

Community Environmental Assessment:

Rainier Vista

Jessie Almli, Breonna Brown, Maxine Cole, Jackie Cullinane, Bethany Ewing, Madison Hiday,
Chloe Kellogg, Yi Lian Klimecki, Amy Lee, Nicole Mckenzie, & Melanie Medina
Seattle University College of Nursing

Abstract
Purpose: The goal of our project is to strengthen the Horn of Africa Services (HOAS) HEAL
(Healthy Eating, Active Living) program through evaluation, collection of survey data to assess
program efficacy, and research into East African cultural factors that impact health outcomes.
Background/Significance: The East African community in Seattle is approx. 39,000. The
majority of the African speaking population is concentrated in South Seattle. In King County,
33% of African Americans have hypertension. This is higher than the King County average of
25%. South Seattle has higher rates of hypertension than North Seattle. Some of the most
common diseases in South Seattle include heart disease, stroke, and diabetes. Our research
suggests that East African dietary and cultural norms may contribute to a higher risk for
developing these diseases.
Methods: The HEAL program aims to improve the health knowledge of children and parents. In
order to improve the HEAL program, we created and distributed surveys to assess the efficacy of
the program. The surveys are age-adjusted assessments of retained knowledge of children and
parent participants. We also evaluated program curriculum and determined areas of
improvement. Lastly, we conducted research on the East African cultural factors that influence
diet and exercise.
Results:
Goal #1- surveys results yielded topics that should be emphasized in the next HEAL Program
(n=15); results were sent to HOAS
Goal #2- provided comments on current curriculum, based on survey results; comments were
sent to HOAS
Goal #3- E. African cultural information was compiled and sent to HOAS for future use
Conclusion: Although these are preliminary surveys, they offer insight into how the future
HEAL program could be improved. Ultimately, data obtained from these surveys can be used to
secure future HOAS grants that will serve to improve the health of the East African community

Running head: EVALUATING COMMUNITY HEALTH EDUCATION

in Seattle. Limitations of the survey include the fact that there was no baseline assessment of
knowledge before subjects participated in the program. Also, some of the participants did not
leave contact information; thus, no data was collected on these individuals.
References
Graham, E. (1996, September 1). Clinical Topics. Retrieved February 14, 2015, from
https://ethnomed.org/clincal
https://ethnomed.org/clincal
HOAS. (Date not listed). East Africans in Seattle. Retrieved March 4, 2015, from
http://www.hoas.org/east-african-community-in-seattle/
King County. (2015). King County Community Health Indicators. Retrieved March 4, 2015,
from http://www.kingcounty.gov/healthservices/health/data/indicators.aspx
McGuigan, C. (n.d.). Feature. Retrieved February 14, 2015, from
https://ethnomed.orghttps://ethnomed.org
Owens, C. (n.d.). Clinical Topics. Retrieved February 14, 2015, from
https://ethnomed.org/clinicalhttps://ethnomed.org/clincial
https://ethnomed.org/clincial
Oniango, R.K., Mutuku, J.M., & Malaba, S.J. (2003). Contemporary African food habits and
their nutritional and health implications. Asia Pacific Journal Clinical Nutrition, 2003,
12(3): 231-236.
Conducted Research
After reviewing the HEAL curriculum we designed and administered two surveys (3/5/2015) to
assess retained information from participants who had been enrolled in the HEAL program in
Spring 2014.

Survey Questions for Children

(Correct answers are highlighted)
Please read each question carefully, and answer as best as you can.
What is the healthiest drink?
A. Water
B. Soda
C. Juice
What food is the best for your body to grow up strong?
A. Pizza and juice.

Running head: EVALUATING COMMUNITY HEALTH EDUCATION

B. Salad and meat.
C. Peanut butter and jelly sandwich.
D. Burger and french fries.
Yes or no: Eating healthy food will make you healthier when you grow up.
Yes or no: Eating candy and cake will make you healthier when you grow up.
Yes or no: Running, biking, or swimming each day is good for your health.
What do you do more every day?
A. Watch TV
B. Play outside with friends
Which food should you eat the most?
A. Vegetables.
B. Pizza
C. Macaroni and cheese
D. Candy
E.
Who can you ask when you have a question about healthy food?
A. Your doctor
B. Your teacher
C. Your mom or dad
D. All of them
Yes or no: You can still be healthy if you eat as much candy as you want and not play outside.
Tell us ways you stay healthy at home:
A. I eat a lot of fruits and vegetables
B. I play outside everyday
C. I watch TV a lot
D. I eat a lot of candy
Yes or no: I feel safe playing outside around my house.
Yes or no: I have fruits and vegetables in my house every day

Childrens Results:
Ques
t-ion
1

Students Scores/Answers (n=10)

C

Running head: EVALUATING COMMUNITY HEALTH EDUCATION

2
3
4
5
6
7
8

I
C
C
C
Play
C
Parents

I
C
C
C
TV
C
Doctor

I
I
I
C
C
Doctor

C
C
C
C
Play
C
Doctor

C
C
C
I
TV
C
Doctor

I
C
C
TV
I
Doctor

C
C
C
C
Play
C
Parents

I
TV
I
Parents

9
10

C
Eat
produce

C
Watch
TV

I
Eat
produc
e

C
Play

C
Eat
produc
e

C
TV

C
Eat
produc
e

Eat
produc
e

C
C
C
C
C
Parent
s
Eat
produc
e

11

Not safe Not safe

Yes
safe
Yes
produc
e
7/7

Yes
safe
Yes
produc
e
1/7

Yes
safe
Yes
Yes
produc produce
e
6/7
4/7

12

Not
Yes
Yes
Yes
safe
Safe
safe
safe
Yes
Yes
Yes
Yes
Yes
Yes
produce produce produc produc produc produc
e
e
e
e
6/7
6/7
3/7
7/7
6/7
3/7
C= correct I=Incorrect - = no answers or all options selected
Quantitative:
Mean: 5.4/7 or 70%
Median: 6/7 or 85.7%
Mode: 6/7 or 85.7%
5/8 or 62.5% students claim to play more than they watch TV
3/8 or 37.5% students claim to watch TV more than they play

5/10 or 50% of students claim that they could ask their doctor for healthy food information
4/10 or 40% of students claim that they could ask their parents for healthy food information
1/10 or 10% of students claim that they could ask their teachers for healthy food information
4/10 or 40.0% claim to not feel safe playing outside around their home
6/10 or 60.0% claim to safe playing outside around their home
ALL students claim to have fresh produce in their homes
Concerns and recommendations if survey were to by used again:
1) The question, Tell us ways you stay healthy? is a select all that apply, but that is not
specified in the directions.

I
C
I
C
TV
C
Teacher
C
Eat
produce,
watch
TV
Not safe

Running head: EVALUATING COMMUNITY HEALTH EDUCATION

2) Also, the students may not be reading the questions carefully, because many answered C. I
watch TV a lot to stay healthy at home, however they may have just read the options (offering
information about their lifestyle habits, not knowledge about health eating and living.)
3) The answer key for Who can you ask when you have a question about healthy food?,
suggests D. All of them (doctor, parents, and teachers), however this question only offers
qualitative data.
4) Perhaps have a preceptor read the questions aloud while students follow along and answer.
This may decrease students misunderstanding question, such as whether a question is testing
knowledge, survey preferences/habits, or asking for multiple answers.
5) We recommend using a similar survey for pretests and posts for future HEAL curriculum

Survey Questions for High School Students

Please read each question carefully, and answer as best as you can.
What are examples of foods with protein? Select all that apply.
A. Chicken
B. Apple
C. Steak
D. Chocolate bar
What is the healthiest drink option?
A. Water
B. Soda
C. Juice
What is an example of a carbohydrate? (Choose all that apply)
A. Bread
B. Celery
C. Spaghetti
D. Bagel
E. Walnuts
What is the healthiest meal?
E. Pizza and juice.
F. Salad and lean meat.
G. Peanut butter and jelly sandwich.
H. Burger and french fries.
True or False: Nutrition is important for body growth and development.
Why is it important to receive good nutrition?

Running head: EVALUATING COMMUNITY HEALTH EDUCATION

A.
B.
C.
D.

Energy
Growth and Development
Keep a healthy weight
All of the above

What do you consider good ways to receive good nutrition? (Choose all that apply)
A. Eating pizza and drinking soda for dinner.
B. Including vegetables, grains, proteins, and dairy in your meals.
C. Eating fruits and carrots for snacks.
D. Eating chips for snacks.
E. Skipping breakfast and only eating lunch and dinner
Select all the reasons why you want to develop healthy eating habits:
A. I dont need to develop healthy eating habits.
B. To be able to focus better in school and sports.
C. To prevent diseases, such as heart disease, diabetes, and high blood pressure in the
future.
D. To grow tall and strong
True or False: Running, biking, or swimming for 30 minutes each day lowers your chance of
getting heart disease and diabetes?
How does eating well and exercising daily make you healthy in the future (Choose all that apply)
A. Decreases risk of stroke, high blood pressure, and heart disease
B. Weight gain
C. Improves sleep
D. Decreases risk of arthritis
E. Decreases chances of living longer
F. Decreases risk of developing type 2 diabetes
How many days and hours of exercise per week is needed to promote long term health benefits?
A. 1 day a week for 30 min
B. 6 days a week for 30 min
C. 2 days a week for 20 min
D. 1 day a week for 1 hr
How many days do you exercise per week?
C. 1 day or less
D. 2-3 days
E. 3-4 days
F. 4 days or more

Running head: EVALUATING COMMUNITY HEALTH EDUCATION

How many food categories are there, and what are they?
A. 3 categories dairy, vegetables, and protein.
B. 4 categories bread, vegetables, and fat.
C. 3 categories fruits, protein, vegetables, and fat.
D. 5 categories fruits, vegetables, grains, protein, and dairy.
Which category of food should you eat least of?
F. Vegetables.
G. Dairy.
H. Grains.
I. Protein.
Which two food categories should have the same amounts on your plate? **Maybe dont grade
hard question
A. Fruits and vegetables.
B. Protein and dairy.
C. Grains and vegetables.
D. Fruits and grains.
Where can you find more about food categories and appropriate daily nutrition?
E. Your doctor.
F. Your teacher
G. www.myplate.org
H. All of the above.
True or false: You can eat as much junk food as you want and do 10 minutes of exercise per day
and be healthy.
How do you calculate how many calories you need per day?
A. Using a persons body type.
B. Using a persons activity level.
C. Using both a persons body type and activity level.
D. It doesnt matter how many calories you get per day
True or false: It is important to balance your activity level with your calorie level.
Select all ways that you stay healthy and balance your energy level well at home:
A. I try to eat a lot of fruits and vegetables.
B. I exercise at least thirty minutes a day at least three times a week.
C. I dont focus on what I eat; I only eat what tastes good and dont care about the health
risks.
D. If I eat something with more calories every once in awhile, I make sure to exercise so
I balance it out

Running head: EVALUATING COMMUNITY HEALTH EDUCATION

Which of the following can get in the way of healthy eating?
A. High number of fast food restaurants and convenience stores, and a lack of grocery
stores.
B. Farmers markets open every Sunday
C. A grocery store that serves fresh fruits and vegetables
D. Being educated on nutrition during school
Which of the following can get in the way of physical activity?
A. Having physical education classes (PE) in schools.
B. Parks, playgrounds, and recreation centers easily accessible in the community.
C. A community lacking sidewalks, safe streets, and parks.
D. Having bike lanes
True or false: I feel safe playing outside in my community.
True or false: I have fruits and vegetables in my house every day.

High School Students Results

Survey#2 n=5
Questions:
Nutrition
(Protein)
Nutrition
(Drink)
Nutrition
(Carbohydrates)
Nutrition
(Healthiest)
Nutrition
(Growth)
Nutrition
(Importance)
Nutrition
(Receiving)
Nutrition
(Eating habits)
Exercise

Students:
1

Running head: EVALUATING COMMUNITY HEALTH EDUCATION

(Risk)
Exercise/Nutritio
n
(Benefits)
Exercise
(How much)*
Nutrition
(Food categories)
Nutrition
(Unhealthy)
Nutrition
(Food categories)
Nutrition
(Food categories)
Exercise/Nutritio
n
(Risks)
Nutrition
(Calories)
Exercise
(Importance)
Exercise/Nutritio
n
Healthy habits
Nutrition
(Barriers)
Exercise
(Barriers)
Feel safe*
Produce*

4+ days

4+days

2-3 days

2-3 days

3-4 days

yes
yes
9/21
42.9%

yes
yes
10/21
47.6%

yes
yes
9/21
42.9%

yes
yes
12/21
57.1%

no
yes
15/21
71.4%

* = qualitative data
Quantitative:
Mean: 52.3%
Median: 47.6
Mode: 42.9%
Qualitative:
Students claim to exercise at least 2 days a week
4 out of five students report feeling safe to play outside their home

Running head: EVALUATING COMMUNITY HEALTH EDUCATION

All students report having fresh produce in their homes
Review:
All students knew what food options were the healthiest. All students had trouble knowing the
number of food group serving a day what food for carbohydrates. One person reported feeling
unsafe playing outside. All students reported getting at least 2 to 3 days of exercise a week, when
we would hope they students would answer 4+ days.
ALL students claim to have fresh produce in their homes
Survey Concerns:

My greatest concern about both surveys was the incorporation of

'select all that apply' questions and all of the above options. I would
recommend that 'select all that apply' questions be revised into single
answer questions, because often students selected all correct answers,
just not every correct answer. The 'select all that apply' format lowers
students results, making it appear that they know less about healthy
eating and living. Looking at the second survey comprehensively,
rather than just the average, shows that the five student participants
have at least a basic understand of healthy eating and active living.

Also questions that read select all way that you., should be revised
to ways to to collect objective quantitative data.

We hope that this information helps inform future HEAL curriculum. These surveys may serve as
a starting point for future pretest/posttest. Thank you again for your partnership with Seattle
University nursing students. We admire your organization and wish HOAS and all of Rainier
Vista all the best.