Participants also experienced weight loss. Four participants asked that their weight not be recorded and were not included in the results. The remaining participants (n = 41) lost a total of 286 lb in the 12-month period. The average weight loss was 6.35 lb per person (Figure 4). Weight loss ranged from 0.4 to 30 lb (2 participants), whereas 6 participants had no weight change. Eight participants gained weight, ranging from 1.2 to 21 lb. Considering the average age of participants was 60, the weight loss is a significant achievement. Body mass index (BMI) calculations were consistent with the recorded weight loss. Average BMI decreased from 31 to 30 over the 12-month period.
A statistically significant difference between mean preintervention and postintervention scores supports improvement in overall weight loss (p = .005), BMI (p = .001), and lowering of systolic (p = .007) and diastolic blood pressure (p = .039). Cohen's d was calculated based on the average Standard Deviation (SD) from two means. For Cohen's d 0.2 = small effect, 0.5 = medium effect, and 0.8 = large effect. The effect size for this intervention was in the medium to large effect range, with the exception of heart rate. Paired sample t tests and Cohen's d for weight, systolic and diastolic blood pressure, BMI, and heart rate pre and post means are reported as supplemental digital content (SDC) at http://links.lww.com/NCF-JCN/A62.
This study is limited by the small sample size. Limiting the research to 45 participants meant that the ability to accurately see the full effect on all participants may have been diminished. Another limitation was the use of anonymous records, which eliminated any qualitative information that might have been gained. Personal interviews on the effectiveness of the AFP could offer additional valuable information. Further research is needed to understand the health needs of food-insecure individuals and build effective interventions and health promotion programs.
Another limitation discovered during the study was monitoring blood glucose of AFP clients. While reviewing participants' records, it became evident that people with elevated glucose readings quit getting checked. One participant was asked why he stopped getting his sugar checked. He stated, “I got tired of the lectures.” That response warranted a look at our education process. Nurses can use negative messages when teaching patients, saying things such as, “You're going to go blind” or “We'll have to amputate your feet if you don't get this under control.” Nurses can do a good job teaching at the cognitive and psychomotor levels but do very little teaching at the affect level. Change takes place most often at the affect level because that is where values are made and strengthened. The good news is this gentleman was worked with individually and his blood sugar lowered from a 250 average to around 140. Further research needs to be done on using principles from the Pender's Health Promotion Model and conducting effective patient education.
Any nurse, but especially community health and faith community nurses, can identify individuals and households experiencing or at risk for food insecurity using the two-question Hunger Vital Sign™ tool (Children's HealthWatch, 2018). Here are two statements that persons might be asked to rate in order to assess for food insecurity:
- “Within the past 12 months, we worried whether our food would run out before we got money to buy more.”
- “Within the past 12 months, the food we bought just didn't last, and we didn't have money to get more.”
Those whose reply to one or both questions is “sometimes true” or “often true” can be considered food insecure and referred to federal resources—Supplemental Nutrition Assistance Program and the Special Supplemental Assistance Program for Women, Infants and Children, and state opportunities such as the Child and Adult Care Food Program. Provide details about local food banks, pantries, and backpack programs, such as any requirements, open hours, and locations. Make connections for transportation if needed.
Nurses can collaborate with food distribution outlets to provide nutrition education and health promotion interventions. Posters, food samples, recipes, and basic written information about a healthful diet can be offered. By regularly staffing an information table at the food bank to answer health questions, take blood pressures, measure weight, and provide referrals to community health services, the faith community nurse can build relationships with community residents. Through educational partnerships, food distribution sites can become clinical opportunities for nursing students and other healthcare learners.
Food insecurity is a daily experience for many households; these households have the added burden of increased risk for obesity, hypertension, cardiac disease, and diabetes. Together, those in churches, community organizations, and nurses have considerable potential to positively alter the food supply, while also providing health screening and promotion. Once residents understand their health risks and engage in the process of change, interventions, such as those implemented by the AFP, can empower community residents to improve their health outcomes. The success of such a program is more than the good interventions implemented. The effectiveness of the interventions is closely tied to the atmosphere of trust and compassionate care demonstrated by the nurses while providing care. The importance of Pender's Health Promotion Model cannot be overlooked. Helping people to believe in different health options is critical in developing successful interventions.
Nurses and other volunteers who want to become involved in improving food security and health habits can contact a community outreach program or a local food bank to investigate possibilities for involvement. Health promotion takes time to be effective. The AFP, now into the third year, has had measurable success on the individuals who have participated. The base of volunteers and donations from the community continue to increase. Both local businesses and volunteers are looking for opportunities where their time and products make a tangible difference.
As Christian nurses work in community services for the needy and develop relationships, spiritual needs may be revealed and addressed. The humble service of Christ-followers authentically demonstrates the mercy of God, speaking silently and convincingly to those in need. In this way, Isaiah 58:10 is made real: “If you pour yourself out for the hungry and satisfy the desire of the afflicted, then shall your light rise in the darkness and your gloom be as the noonday” (ESV).
Sidebar 1. What Is Food Insecurity?
Food insecurity is defined by the United States Department of Agriculture (USDA) as the limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable foods in socially acceptable ways (USDA, 2018). The USDA considers a household to be food insecure when inhabitants are at times unable to acquire adequate food for one or more household members because of insufficient money and other resources for food.
An estimated 11.8% of households in the United States were food insecure at least some time during 2017 (Coleman-Jensen, 2018). Homes with children are more likely to confront food insecurity. In 2016, 13 million children under 18 (18%) lived in food-insecure households; of those, 1% were in households with very low food security.
In 2016, households dealing with food insecurity were almost twice as common among children in households headed by non-Hispanic Black or Hispanic parents than in those headed by non-Hispanic White parents. Also, children living in homes headed by single women were three times more likely than homes with married couples to be food insecure (Child Trends, n.d.).
Another group that is more vulnerable to food insecurity is seniors. Gundersen and Ziliak (2017) reported that food-insecure seniors are worse off in health outcomes compared with food-secure seniors. For example, they are 65% more likely to have diabetes and 19% more likely to have hypertension. Seniors with uncertain food supply are 2.3 times more likely to be depressed, 66% more likely to have experienced a heart attack, and 91% more likely to have asthma.
Although living in poverty is often a characteristic of families who are food insecure, it is not the defining factor. National surveys, such as Current Population Survey Food Security Supplement (CPS-FSS) and the Survey of Income and Program Participation (SIPP) have demonstrated that nearly half of families who are food insecure have incomes above the official poverty line. Various national surveys also document that close to half of all families reporting food insecurity have incomes above the official poverty line (Wight, Kaushal, Waldfogel, & Garfinkel, 2014). The same surveys, according to Gundersen, Kreider, and Pepper (2011), have found that people who are not considered food secure may be able to achieve a stable food supply because they are forfeiting other needs, such as prescription medications.
Situations other than income can result in food insecurity, such as loss of a job, divorce, or caring for a sick family member. Families may move in and out of periods where their food supply is stable and then unstable.—Karen Schmidt, Contributing Editor, JCN
Child Trends. (n.d.). Key facts about food insecurity. Retrieved from https://www.childtrends.org/indicators/food-insecurity
Coleman-Jensen, A. (2018, November 5). United States Department of Agriculture, Economic Research Service. Food pantries provide emergency food to more than one-quarter of food-insecure households.
Retrieved from https://www.ers.usda.gov/amber-waves/2018/november/food-pantries-provide-emergency-food-to-more-than-one-quarter-of-food-insecure-households/
Gundersen, C., Kreider, B., & Pepper, J. (2011). The economics of food insecurity in the United States. Applied Economic Perspectives and Policy, 33(3), 281-303. doi:10.1093/aepp/ppr022
Gundersen, C., & Ziliak, J. P. (2017). The Health Consequences of Senior Hunger in the United States: Evidence from the 1999-2014 NHANES. A report prepared for Feeding America and the National Foundation to End Senior Hunger. Retrieved from http://nfesh.org/wp-content/uploads/health-consequences-of-senior-hunger-in-the-united-states-1999-2014.pdf
United States Department of Agriculture, Economic Research Service. (2018). Measurement. Retrieved from https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/measurement.aspx
Wight, V., Kaushal, N., Waldfogel, J., & Garfinkel, I. (2014). Understanding the link between poverty and food insecurity among children: Does the definition of poverty matter? Journal of Children & Poverty, 20(1), 1-20. doi:10.1080/10796126.2014.891973
Sidebar 2. Stories of Transformation
The Walking Club has been one of the best offerings we have started as part of the Action Family Program. The club has made it possible for those who attend to develop a greater sense of community. The walkers have built, and continue to build, relationships with one another.
Gaining New Purpose
The impact of the Walking Club on the Action Family community is evident in changes among participants. One morning last year, Jenny* came out to walk with the group for the first time. Someone had mentioned the walking program, and she realized this was a change she needed.
For many years, Jenny had been a caregiver for an elderly man, but he had passed away recently. Caring for this man had given purpose to her life for many years; with his death, she felt heartbroken and alone.
Having lost her sense of purpose, Jenny had become increasingly depressed. She rarely left her house and had given up socializing. She was unhappy, lonely, and unhealthy. That first day at the Walking Club, walking with the other members was an epiphany for Jenny, as the members welcomed her. She cried as she was leaving—happy tears, she said, explaining that this group and this activity were what she had been missing. As she became a regular walker, other participants embraced, accepted, and loved her.
In time, as Jenny walked faithfully with the group, we witnessed her attitude and her perspective on life turning from negative to positive. Jenny said she knew that God had brought her to the Dream Center, the sponsor organization of the AFP. Soon she was making friends and had invited a new acquaintance to join the Walking Club. Through Jenny's involvement with walking, and then in the AFP education programs, she started attending church, and a transformation became evident. Jenny tells us how she loves Jesus and gives him glory for bringing her to the Dream Center. She's happy again, is working on her health issues, making friends, and enjoying life: She feels she once again has purpose.
Notable Health Improvements
Other individuals have expressed similar narratives of transformation. One man who has been part of the Walking Club for more than a year has diabetes. He was pleased to see his hemoglobin A1C (HbA1C) drop from a high of 11 to a much healthier 7, due to his participation that has resulted in weight loss. Others have experienced similar results in their HbA1C levels and reductions in weight.
One lady who started walking with the group had been a heavy smoker. Because of the encouragement from participants who attend the Walking Club and other education classes, she decided to quit smoking. Support from her new friends at the AFP has helped her accomplish this feat. When she announced at one of the classes that she had not smoked in 2 weeks, the room erupted in applause. Her accomplishment was a touching moment for all of us.
Transformation Through Compassion
Sometimes, change and acceptance are slow in coming. An elderly man, Joe*, and his wife, Evie*, have come for several years to the community center to receive food. Many times, Joe has behaved rudely and hatefully. His attitude was one of entitlement, and he never had anything positive to say. Three years ago, when the AFP started, we changed the way we conduct our food outreach. Any time change happens, people's reactions are unpredictable; how would Joe and Evie perceive a new routine at the community center?
The implementation of the AFP included the addition of a weekly health check for participants. Compassionate nursing students measure vital signs, check weight, and assess other health markers. Joe and Evie, who had been coming to the center for many years, started receiving regular health checks. Every Saturday they sit one-on-one with a caring nursing student, who not only checks their vitals, but, for those brief 5 minutes or so, talks with them, listens, and simply touches them with the love of Christ.
This change in their weekly visit has clearly impacted this couple. Joe no longer arrives at the center as a grumpy old man, but as a person realizing he has needs. He has commented on numerous occasions that it's not just the food he and Evie need or want; they love coming to the center because this community feels like family to them. They love the changes that have been made and have become appreciative of what the AFP is doing to promote healthy living in their spirits, minds, and bodies. Joe has stated that they love being part of something—their involvement is not about receiving the food, but coming to be with family.
In addition to their active, positive participation in the AFP, Joe and Evie have begun attending the weekly Saturday worship service for those who come to the food outreach. Though they had not attended in the past, as a result of the contact and relationships with the volunteers, nurses, students, and staff, who simply love people with the love of Christ, this couple is now attending services and hearing the gospel.
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community health; faith community; food bank; food insecurity; health education; health promotion; nursing; Pender's Health Promotion Model
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