- What preventive measures are necessary for COVID-19 prevention?
- What to do when infected with COVID-19?
- How do you stay connected during lockdown to reduce stress and depression?
- What are the different ways to stay active and healthy during the pandemic?
- What do you understand or know about COVID-19?[fig 2,3]
We used the following methods to solve the public health concerns in our target community:
- Digital learning: We organized weekly Zoom meetings wherein we educate participants on preventive methods to protect themselves from getting infected (such as the proper use of masks, regular handwashing, clean environment, and eating healthy), when to seek medical help, and symptoms and understanding of the COVID-19.
- Exercise routines and other activity projects were organized virtually.
- Access to healthcare services was made easy by helping participants contact their primary care doctors via Telehealth, home delivery of prescription medication, and health services for their pets.
- The essential needs of all participants were met, such as preparing meals for the seniors and their pets’ supplies.
- Ensuring they know the place and time for receiving their COVID-19 vaccines with free transportation to and from the vaccination centers.
- Forming a COVID-19 vaccination and post-intervention Survey [fig-4]
- Drafting a request to the government to increase technology access and implement digital literacy programs among the elderly population by ensuring that those on Medicare are offered a smartphone designed specifically for the elderly users.
Our health promotion program aims to ensure that seniors living in the low-income area of north Miami-Dade, county Florida, receive the required help and stay healthy through uncertain times.
Typically, in public health, health communication is either verbal, written, or both. When creating a health communication strategy, it is imperative that a good understanding of the audience, their culture and way of life, education level, ethnic group, and socioeconomic status are all considered. Language also played a vital role in communication.
Some of the effective communication strategies used during the project activities include:
- Utilizing research-based resources that are proven to be effective in creating health promotion plans.
- Studying the culture, language, and religion of the audience.
- Studying the standard means of news dissemination for the aging population, including the local radio station and TV station .
The study aimed to prevent the spread of COVID-19 infection among the elderly population living in North Miami-Dade, the county in Florida, and most of the audience are retirees. In this community, about 40% speak Spanish; not all of them are college graduates, and all are Christians. Hence, our weekly health program communication with them includes English and Spanish languages. We also send them flyers to read about staying safe during the pandemic, text messages on best practices to help them stay active, and reminder messages for their scheduled health check-ups with their primary care doctors.
In summary, a good understanding of the target audience is a prerequisite to a good health-communication strategy. Our participants have all received their COVID-19 vaccines with our weekly health communication strategies and efforts to convince them of the safety of the COVID-19 vaccines.
The two primary methods used for evaluating the efficacy and stability of the health promotion implementation that was performed were:
- Qualitative Evaluation: With this, we replicated prior methods proven to be effective, such as interviews, focus groups, and observation . We emailed (interview) questionnaires to all participants in the form of pre-and post-COVID-19 knowledge assessment and vaccination surveys to assess the impact and understanding of the pandemic in the community and gauge how favorable the community might be towards receiving the vaccine. The focus group came together every Monday morning, during which we discussed several ways to stay active and healthy through the pandemic. The participants were also able to raise their concerns, ask questions, and receive feedback on the surveys they had participated. Lastly, the observational method was conducted during the weekly zoom meetings virtually [fig 4-5].
- Quantitative Evaluation: This method examined the data analysis and collection. It was used in assessing the impact, outcomes, and generalizability of the health promotion program implemented in the target community. We collected data such as ethnicity, age of participants (55+), level of education, occupation or retired, health records, income, and gender [fig 1]. With these data, we assembled graphs depicting the structure and overview of the target community [fig 1]. This method assists in designing appropriate health programs fitting individual community interests.
The public health model suitable for this target population is the Transtheoretical Model (the Stages of Change). We aim to ensure our target population eats healthy meals during the pandemic and avoids consuming processed foods. This theory assumes that people do not change their behaviors quickly and decisively . Instead, a change in habitual behavior occurs continuously through a cyclical process:
- Precontemplation- This is when people do not intend to change their behavior. During this stage, we continue to educate them on health risks associated with unhealthy or unbalanced nutrition and how such behavior might impact their immune system while fighting COVID-19.
- Contemplation- This is when people begin intending to make changes. We will reinforce this behavioral stage by providing them with nutritious food items and cooked meals.
- Preparation or Determination- This is when they are ready to start healthy eating practices. We will ensure they have access to the required meals.
- Action- This happens with recently changed behavior and slow adaptation to the new healthy eating plan. We continue to encourage them and take surveys so that we can make changes as necessary.
- Maintenance- This stage occurs when people can sustain their new behavior change for at least six months. We will continue to evaluate the success of the new health plan, send surveys to them to inquire about any struggle, complaint, or challenges they might have, and address them quickly.
- Termination- This is when the participants fully adapt to the new behavior and do not return to old habits. Here, we will continue to send them new healthy varieties of food recipes to continue building on their progress.
Contact tracing is a method used to evaluate those at risk of contracting the virus after meeting a person who recently tested positive for the virus.
Research shows that considering the estimates for COVID-19 transmission, under effective contact tracing, less than one in six cases yields any subsequent untraced infections. It also showed that changes to the definition of close contact do tend to reduce this burden, but with increased risk of untraced cases. This further explained that tracing using a contact method requiring over four hours of exposure is ineffective in controlling the spread of COVID-19 .
The ideology of the contact tracing strategy is to provide detailed survey information on social encounters from thousands of participants coupled to predictive models of control and contact tracing to investigate the possible efficacy of the method and the distribution of secondary cases that may go unnoticed or untraced.
Community partnership with non-Governmental organizations
Health is a complex concept, and its promotion requires a considerable amount of support from other organizations and professionals in other sub-fields of the health care sector to effectively improve all aspects of health promotion, including social, economic, cultural, and environmental determinants of health .
When selecting the partners for health promotion, we considered organizations with similar vision, mutual interest, respect, perspective as our organization and are willing to share ideas.
The community health and empowerment network, have partnerships with AARP, Clear Health Alliance, Simply Healthcare, and Pet smart charities. Our partners share a similar mission and vision as us by helping provide free COVID-19 tests, food supplies, pet foods, and masks to the target population in North Miami.
Partnering with the above-mentioned organizations enabled us to provide joint professional health education, joint conferences, and essential needs to the community. Partnering with another organization provides individual and community benefits, especially for the low-income and communities of color, by building on the civil rights movement and advancing social justice.
The AARP partnership helped ensure that all seniors in the target community (North Miami) have healthcare coverage, access to specialists, access to primary health providers (providing free transportation to and from appointments).
The PETSMART partnership made available free pet foods to pet owners who could not afford these due to the pandemic economic restraints.
The Clear Health Alliance and Simply healthcare provided free mobile clinics to the target community three times a week, including free health screenings and COVID testing. Medical advice was offered, and specialists’ referrals were given to participants who needed it.
Working with the team
Teamwork is critical in every organization, including public health. We worked with several health clinics, state government agencies, and a few other organizations that primarily offered financial aid to our project. However, we also needed the support of Veterinarians and their clinics since our project provided pet foods and other pet supplies for needy or low-income families.
We did not collaborate with veterinarian’s clinics at the start of our project, which was a significant need for low-income families. The Veterinary clinic COVID-19 protocols must be followed when working with them. Few clinics were open solely for critical care cases, while the less urgent services were canceled. Hence, we sought the support of a few Veterinary clinics in the area which later showed interest in offering veterinary telemedicine work for the pets. However, such methods posed difficulty for first-time patients .
The Veterinary clinic eventually offered free healthcare services to our pets in the form of Curbside Veterinary services. During this, the pet owner would wait in their car after notifying the clinic of his arrival. The staff would pick the pets from the car and examine them inside the mobile clinic. After examination, the staff discusses the findings over a video call with the pet owner.
The challenges encountered with such pets’ health care services were that not every resident owned a vehicle, making it a significant challenge. Additionally, with the COVID-19 restrictions, many pets who might need dental care and other less urgent care were not able to receive such services, which are usually the most common cause of hospital visits for pets.
We worked diligently on finding the best practice that could benefit our participants while caring for their pets.
- According to the U.S Census Bureau, the overall population of older adults over the age of 65 in our target community of North Miami-Dade County increased from 14.5% in 2012-17% in 2019 (2,716,940 population) .
- A total number of 162,583 deaths from COVID-19 among adults 85 years and older has been reported in the U.S since the pandemic started. Among ages 75-84 years, 146,310 deaths, 115,381 deaths among ages 65-74, and 78883 deaths among ages 50-64 have been reported .
- The total number of deaths from COVID-19 among those in nursing homes or long-term care facilities is 105,097.
- An estimate of 95% of Americans who died of COVID-19 was over the age of 50 , and eight out of ten deaths have been among adults aged 65 and older.