Capital Campaign
Highlights
In 2018 Ko‘olauloa Health Center partnered with Hawai‘i Medical Service Association for a two- year project period. The purpose of the project was to implement Ho‘opi‘i Ola Pono Lifestyle Enhancement Program. The intent of the program was to improve the health status of the QUEST and QUEST eligible community through kanaka (individual), pū ‘ulu a‘o (group), and moku (district) wide interventions.
The Lifestyle Enhancement Program (LEP) was comprised of two components-a diabetes prevention program (DPP) and diabetes self-management education (DSME). KHC adopted Centers for Disease Control and Prevention (CDC) T2 curriculum to use for the DPP. Early on modifications were made to shorten the length of time from 26 weeks to 16 weeks; include the dietitian into the DPP classes to provide nutritional education and food demonstrations; add emphasis to blood pressure monitoring and management in addition to HbA1c control, physical activity, and lifestyle changes. For the last two cohorts upon graduation, the contracted lifestyle coach remained in close contact with the participants through weekly phone calls and once-a- month group meetings.
KHC was able to facilitate DPP cohorts comprised of 73 unduplicated participants. All participants report increased lifestyle knowledge with 85% who have reported to have increased their consumption of healthier foods and increased physical activity. The cohorts yielded 483 pounds of combined weight loss, an average of 636 pounds per unduplicated participant. Over the course of each cohort, many participants were able to improve their HbA1c values, blood pressure, and decrease their BMI.
KHC implemented two six-week DSME programs for the community through this project. The agency is not DSME accredited; therefore, the six-week program was offered at no cost to the participants. KHC utilized the Stanford curriculum initially through the Hawaii Kidney Foundation’s partnership and later an adaption of the initial program tailored to the relevant needs of the community. The classes educated those with the diagnosis of diabetes what can be done through lifestyle modifications to better manage their condition. Participants were also invited to have a 1:1 appointment with the dietitian to go over food journals, modifications if needed, nutritional intake and physical activity goals.
There were examples of participants who have a diagnosis of diabetes whose providers encouraged them to attend both DSME and DPP, or group classes plus individual appointments. One participant Carla’s story stands out because she was diagnosed with Uncontrolled Diabetes and her HbA1c stayed in the double digits since 2017. She was initially referred for individual Nutrition Counseling with some success, and the Dietitian encouraged her to join the Lifestyle and Wellness Program for extra support. The group motivation really helped her to start exercising, eating healthy and meeting regularly with providers, especially her endocrinologist who helped by updating her medication regime. Additionally, she was referred to behavioral health for support with her stress, and depression. Over 7 months, she lost 18 pounds and her HbA1c dropped to 8.4 (from 12.1 in September 2019).
It seems that combination of individual counseling and group interventions really contributed to her success, and the Dietitian was essential piece of this team. Meeting individually allowed Carla to get her specific questions answered and furthermore individualize her plan for her health needs. With verbal permission from Carla this is what she said, “[Ke‘alohi] shared lots of recipes, and what we needed to know to get ourselves better [regarding Type 2 Diabetes.] The class helped me better myself, it all made sense, and motivated me. I needed to do this for me to get better and for my grand babies.”
An initial meeting was held in July 2019 with Hawaii Community Action Program (HCAP). Through that meeting we have worked with different programs in the community to help meet the needs of the people and audience. KHC was able to participate with Project Reach’s back to school bash and winter vine at Kahuku High & Intermediate School, ‘ohana resource night hosted by Hau‘ula Elementary, parent open house at Kahuku High & Intermediate and Kahuku Elementary, and exploring opportunities to collaborate with Ke Ola Mamo as well as the Institute for Human Services.
Through our annual Uniform Data System (UDS) report to Health Resources Service, Administration (HRSA), we have 19% of our adult population who have diabetes and 10% of our adult population who have hypertension. We track other chronic conditions as well but have notice that these two comorbidities affect our community as well as the scare resources in the community have a direct effect on the patients. We are continuing to collaborate with community stakeholders to find resources and interventions to addresses the needs of the patients and community.
A community health needs assessment (CHNA) was distributed through Survey Monkey in paper and online form.
A community health needs assessment (CHNA) was distributed through Survey Monkey in paper and online form; the responses are from 116 individuals. The results showed: 1) approximately 66% of the respondents have an annual household income of $75,000 or less (30% $0 to $24,999; 20% $25,000 to $49,999; and 16.4% $50,000 to $74,999); 2) patients reported being told they have the following: 9.8% diabetes, 14.3% prediabetes, 13.4% hypertension, and 18.75 obesity; 3) patients report needs that are important: 52.63% healthier food options, 49.12% recreation facilities, 50.88% nutritionist, and 54.39% wellness services (diabetes, nutrition, and exercise); 4) areas patients report agencies should focus on include: obesity, homelessness, illegal drug abuse, and diet & nutrition. KHC intends to send out another CHNA midyear of 2020 in hopes of getting a better response rate.
Overall the program had a positive impact on the community. There were some roadblocks and many areas that can still be modified, the intent and the initial pilots of the interventions demonstrated that they can be sustainable even if they must deviate from the way it was first thought of. We have learned that health education is necessary and though lifestyle coaches have passion and want to serve the community we may need to bring a health educator facilitate the programs (help from lifestyle coaches would be invited). We also learned that though the community and staff want dietary counseling in diabetes prevention programs, having a dietitian do more than a demonstration and answering medical nutritional therapy questions is not the best utilization of the position.
We have also learned that the community needs a SNAP/EBT eligible farmer’s market; however, the patrons are not going to come instantly even if offering double bucks. Majority of those who utilize farmer’s markets learned to do so and those who do not have to be trained to, it doesn’t happen in 6 months. A farmer’s market that takes SNAP/EBT should be available when those benefits renew, we had selected the weeks tohave the market, not knowing those are weeks that people are not paid or don’t have much of their benefit left. Also, the narrow vendors that were able to sell at the market was small and didn’t offer what people might be looking for.
We learned though the community of the need for dietary counseling via diabetes prevention programs.
