Running head: CENSUS TRACT 22.

01 1

Census Tract 22.01: Community-As-Partner Report

Jackson Copper, Taylor Hibbetts, Tanya Garcia, and Richard Douglas

University of Arizona

Census Tract 22.01: Community-As-Partner Report

CENSUS TRACT 22.01 2

We are a group of four University of Arizona College of Nursing, students that are

completing a community as a partner project in Tucson, Arizona, census tract (CT) 22.01. To

assess the community’s strengths and stressors, we observed the community by driving around

and conducting key informant interviews. As a result, we decided on an exercise intervention

based on this community’s needs, presented it to the community, and provided Pima County with

our census tract findings.

Community Assessment

Community Core

Our CT has a population of 3,515 while Pima County has a population of 1,003,338

people. Our CT consists of 53.6% whites, compared to 80.7 percent of Pima County. Our CT

also is 74.7% Hispanic or Latino, compared to 36.1% Hispanic or Latino. Another contrast in the

data was that our CT had higher instances of Spanish speakers than average when compared to

Pima County. In our CT, 66.3 percent spoke Spanish, and 27.9% were fluent in Spanish and

spoke minimal English; while Pima had 23.6% and 6.8% respectively (Pima County Health

Department Public Health Nursing Community Profile CT 2201, 2018).

Physical Environment

We found that our CT has significantly less new homes than average for Pima County.

Our CT had 1.7% of its homes built after the year 2000, while Pima County had 21.1% of its

homes built after 2000. Most of our CT’s houses, 65.2%, were built between 1960-1979 while

the average for Pima County is 29% (Pima County Health Department Public Health Nursing

Community Profile CT 2201, 2018).

Health and Social Services

CENSUS TRACT 22.01 3

Our CT contained a plethora of health and social services. Nearby hospitals were Banner

University Medical Center South and Southern Arizona VA Health Care System. For long term

care and senior centers, our CT had El Pueblo Senior Center and the Arizona Veteran Home

nearby. In addition to Concentra Urgent Care, multiple pharmacies, and dispose-a-med sites,

there were a wide range of medical offices, dental offices, and integrative care modalities to

choose from as well as mental health services, La Frontera, and social services such as SAAF

Housing Department (Pima County Health Department Public Health Nursing Community

Profile CT 2201, 2018).

Economy

Despite the local businesses, the median household income is well below the Pima

County average, 42% of the CT lives in poverty as opposed to 19.1% of Pima County (Pima

County Health Department Public Health Nursing Community Profile CT 2201, 2018).

Transportation & Safety

The CT included safety departments such as the Pima County Sheriff’s Office, the

Tucson Police Department Santa Cruz Station, as well as the Tucson Fire Department Station

#10. There were also many transportation systems such as bus stops and sidewalks throughout

the neighborhood (Pima County Health Department Public Health Nursing Community Profile

CT 2201, 2018).

Politics and Government

Our CT fell inside the city limits of Tucson and is under Tucson City Council Ward 5,

Pima County District 2, Arizona State Legislative District 2, and US Congressional District 3

(Pima County Health Department Public Health Nursing Community Profile CT 2201, 2018).

Communication
CENSUS TRACT 22.01 4

The Arizona Daily Star was located within our CT as well as a payphone, many

billboards, and free computers and wifi in the library (Pima County Health Department Public

Health Nursing Community Profile CT 2201, 2018).

Education

Our CT had a higher percentage of people with less than an 9th grade education (19%)

compared to 4.9% in Pima County . It also had lower high school graduates 61.9% and

bachelor’s degrees 11% when compared to Pima County 87.7% and 30.8% respectively. Our CT

contained a local childcare, elementary, middle school, high school, and library nearby (Pima

County Health Department Public Health Nursing Community Profile CT 2201, 2018).

Recreation

There was limited recreational opportunity in our CT. Some resources included Jet Multi-

Sport Training, Viva Performing Arts Center, and Bravo Park (Pima County Health Department

Public Health Nursing Community Profile CT 2201, 2018).

Community Nursing Diagnosis

Strengths and Stressors

Our CT’s biggest strengths included its family oriented community, many health services

available, and the police presence. Many key informants commented on how family oriented the

community was including a public health nurse, “I believe that it is a community interested in

family and helping each other through tough times.” The evidence of many health services were

observed during our windshield survey. We observed many different health services including

medical offices, dental offices, integrative care services, and mental health services. The last

strength identified, police presence, was identified in key informant interviews. A journalist at
CENSUS TRACT 22.01 5

The Arizona Daily Star stated, “I think this area is really safe. There are always police patrolling

with the police station being right there.”

The three most critical stressors our group found in the community were chronic health

issues such as diabetes and cancer, low income or insufficient income, and substance

abuse/mental health issues. Many key informants stated diabetes was a critical stressor. A public

health nurse at Theresa Lee Public Health Center stated, “Poor nutrition again related to many of

the factors cited above thus increased risk for heart disease and diabetes, etc.” When asked about

the major health issues in the community, the Fire Captain said that there were a lot of

respiratory issues and people dealing with diabetes. Many key informants also mentioned low

income as a critical stressor. “Other concerns include poverty and no access to care,” said the

librarian at El Pueblo Library. A health provider at Alma Medical Inc. stated, “There is also a

big portion of unemployed or uninsured adults. This makes it very hard for our facility to care for

them. Many will come for a few visits but stop because they can’t afford it anymore.” Mental

health issues and substance abuse was also mentioned on different occasions. “Drugs and gangs

are at the top of the problem list. Addicts, prisoners, and people with mental/behavioral disorders

visit the library often to use the phone, the computers, or the wifi,” said the librarian at El Pueblo

LIbrary. A Public Information Officer Deputy of Pima County Sheriff’s Department stated, “I

see two major issues in this community, opiates and mental health. Opiates are the main cause of

drug overdoses and crime. With regards to mental health, a large majority of the calls that the

local police respond to have to do with people who have mental health issues.”

Four significant concerns identified by the community - substance abuse, improper use of

emergency services, diabetes, and mental health - were placed into a Priorities of Care Table for

analysis. This table can be found in Appendix A, and serves as a planning tool that ranks each
CENSUS TRACT 22.01 6

problem in terms of severity, public interest, and the students’ ability to intervene. Of the four,

diabetes scored as the highest priority.

Nursing Diagnosis

While an individual can develop diabetes at any point in their lifespan, the elderly are

considered to be especially at risk, and potentially limited in their ability to care for themselves

once they have the disease. For this reason, our team chose to focus on the elder population

within CT 22.01, and developed the following nursing diagnosis: At risk for complications of

diabetes among elderly population in and around CT 22.01 related to inadequate diet, poor

exercise, and lack of knowledge about the importance of exercise; as evidenced by key

informants reporting a high number of diabetic individuals in the community.

Community Nursing Program Plan

Good Goal

A healthy diet and adequate exercise are two critical factors that can help prevent or

reduce the negative impact of diabetes. The elderly population have the potential to struggle

with mobility issues, and may not beware of the long-term consequences of a sedentary lifestyle.

In response to this our team developed the goal to increase the knowledge of the elder population

about how exercise can help prevent diabetes and reduce the negative consequences of diabetes.

Evidence-Based Article

Our group came across an article titled: The effects of tai chi on peripheral

somatosensation, balance, and fitness in Hispanic older adults with type 2 diabetes: a pilot and

feasibility study.
CENSUS TRACT 22.01 7

Purpose. Our group intended to hold a gentle exercise session to reduce the negative

impacts of diabetes and promote overall health. The article focused on specific symptoms of

diabetes, but shared our main purpose.

Sample. The population within CT 22.01 is predominantly hispanic, and we focused on

older adults specifically. However, we planned to include all older adults in the activity, not

only those who already have diabetes. The intervention in the article targeted elderly hispanic

individuals with diabetes, but not those without.

Setting. In the article, participants were recruited in person from education classes in the

community and from a waitlist for a university wellness program. Our group planned to perform

an intervention at the local senior center that catered to our CT. All settings were areas that cater

to improving senior health, although unlike in the article our group had no concrete indication of

whether our attendees had engaged in these health promoting activities.

Strength of Evidence. The article’s level of evidence rating is L3. The evidence is

taken from a controlled trial with a reference group, but the groups are not randomized.

Healthy People 2020

The most relevant overarching goal is the first, to “attain high-quality, longer lives free of

preventable disease, disability, injury, and premature death”. (Office of Disease Prevention and

Health Promotion [ODPHP], 2018) Our education session will outline how exercise can both

prevent diabetes and minimize the negative consequences in those already effected, which can

lead to serious injury and death.

Healthy People 2020 has a specific topic for diabetes. Its goal is to “reduce the disease

burden of diabetes mellitus (DM) and improve the quality of life for all persons who have, or are

at risk for, DM.” (ODPHP, 2018) This goal is perfectly in line with our intentions.
CENSUS TRACT 22.01 8

The most relevant objective number is D-16.1: “Increase the proportion of persons at

high risk for diabetes with prediabetes who report increasing their levels of physical activity.”

(ODPHP, 2018) This objective does not encompass those who are not yet at risk, who we also

planned to educate, but it addresses exercise as a tool for prevention.

Legislation

In 2015, the Medicare Diabetes Prevention Act was passed, which provided Medicare

coverage for the National Diabetes Prevention Program (DPP). The National DPP introduces

evidence-based community programs that will help prevent the onset of type 2 diabetes in at-risk

individuals (American Diabetes Association [ADA], 2015). These programs focus on lifestyle

changes, including better nutrition, exercise, and weight loss. Individuals can significantly

reduce their risk of developing diabetes if they commit to these changes, and the results are even

more profound in the senior population (ADA, 2015). The Medicare Diabetes Prevention Act is

a health policy that increases the reach and the impact of the National DPP.

Intervention

For our proposed intervention, we used health teaching from the intervention wheel and

targeted the elder population at El Rio Senior Center. On September 21, 2018, we gave an

educational presentation on the benefits of physical activity and reducing the consequences of

diabetes. The goal of this health education project was to address managing and preventing

diabetes among this population in the community. The nursing students will demonstrate small

and easy exercise routines that will help increase the physical activity in the elder population.

The rationale for exercise intervention was to educate this population the importance of regular

physical activity for effectively preventing diabetes or manage it if they already have it.
CENSUS TRACT 22.01 9

Our group formulated three SMART objectives that reflect the impact of the health

education project. By September 21, 2018, about 25% of senior citizens who attended will reflect

at least three ways they could exercise as demonstrated by the students. By September 21, 2018,

25% of senior citizens will volunteer at least one way that exercise helps to prevent diabetes. By

September 21, 2018, 25% of senior citizens will state how exercise can manage or prevent

diabetes.

Plan for Implementation. The goal of this educational project was to increase exercise

among senior citizens in order to prevent or manage diabetes. Our program activities for this goal

included:

● Arranging with El Pueblo Senior Center a time and place to do an education

session on how increasing exercise can prevent or manage diabetes

● Preparing education materials such as a poster board to help the audience

visualize the information

● Demonstrating simple exercises that seniors can do at home or at their

convenience

● By September 21, 2018, the student nurses will give a presentation to the senior

community about how exercise can reduce the risk or help improve diabetes

Plan for Evaluation. Before and immediately following the health education project on

September 21, 2018, the student nurses will administer a verbal 2 question survey to participants

attending the education session. The survey will address both SMART objectives. The complete

evaluation tool can be found in Appendix B.

Collaboration. Our community partners included Theresa Lee Public Health Department

as well as two experienced public health nurses working at this location. These two nurses
CENSUS TRACT 22.01 10

mentored us and provided us information about the census tract and their experience in the

community. We also collaborated with the coordinator of El Pueblo Senior Center, where we

presented our health education project.

Level of Prevention. Our intervention can function at all levels of prevention. The

project which addresses exercise may be a primary prevention that aims for the elderly in the

stage of susceptibility. It is a general health promotion intervention that can be applied to healthy

older adults to prevent diabetes from developing (Anderson & McFarlane, 2015). The

presentation may also be a secondary prevention where diabetes may be developing in the early

stages and can be detected and treated (Anderson & McFarlane, 2015). Diabetes in the early

stage of onset may be reversed with exercise. There are several in this population that are already

affected by the consequences of diabetes, therefore the purpose of exercise as a tertiary

prevention is to limit further disability and rehabilitate the affected people to their full abilities

(Anderson & McFarlane, 2015).

Resources. One of the best sources that was available for this health education project

was the El Pueblo Senior Center. This center was a great meeting area for many of the seniors

that live in this area. It was great to see because not only were we able to reach individuals in our

census tract, we were able to talk to other seniors that lived in other areas in the community.

Since the education project revolved around exercise, the largest constraint to our community

was the fact that the residents can not go outside and exercise all the time. The cause of this is

because of the extreme heat that the community deals with living in Southern Arizona, and that

there is the potential for gang violence at night. So, the aim of the project was to teach the

community ways to exercise inside of their own homes with minimal equipment. Another

constraint to the community was that they were not able to come and view the health education
CENSUS TRACT 22.01 11

project because they may not have had adequate transportation to the Senior Center. This limits

their ability to get out of their house and learn about different ways to improve their health.

Implementation of Community Nursing Intervention

The health education project worked extremely well. We decided to present to the elderly

at the El Rio Senior Center and talk to them about exercise and diabetes prevention and

management. The community demonstrated interest because the seniors were very interactive

with us and were open to share information about exercise in their personal lives. The seniors

participated when we demonstrated the exercises and were engaged when the topics about

exercise and diabetes were presented to them. In all, 21 seniors were present during the

presentation, 18 were females. Our presentation included a board, which is able to be seen in

Appendix C, that listed different benefits to exercise and pictures of the exercises that we were

teaching. The board was very easy to read and helped our group present our topic.

Evaluation of Community Nursing Intervention

By a show of raised hands, we decided to evaluate the effectiveness of this intervention

with a two question survey that reflected our SMART objectives: “Does anybody here know how

exercise can benefit those with diabetes?” and “Who knows three exercises that can help prevent

diabetes?” This was a poor way to evaluate the presentation because the elders were not as prone

to raise their hands. Before the presentation, only a couple of the seniors raised their hands for

either of the questions. After presenting, there were still only a couple people who raised their

hands but almost all of the seniors were nodding their heads and were extremely eager to

participate in the exercises. We concluded that many of the seniors learned something valuable

and useful.

Conclusion
CENSUS TRACT 22.01 12

At the end of this experience, the most important thing that our group learned was how

receptive the elderly population was to learning. The entire group at the Senior Center were very

active in participating in the exercises and sharing their thoughts. If we were to repeat this

education project again, we would definitely change the evaluation method. We all believed that

the instructional section and exercise demonstration went very well but it was difficult to judge

who learned what because the seniors were not very open to raising their hands when asked to.

We thought that a short written survey would be more helpful to compare results. Despite the

poor evaluation, we believed that we did reach both of our SMART objectives because over 50%

of the seniors were actively participating and engaging during the presentation. Through our

observations, we believed that we made a positive impact on these people’s lives and hopefully

they will continue to use these exercises throughout their lives to maintain a healthy lifestyle.
CENSUS TRACT 22.01 13

References

American Diabetes Association. (2015). Preventing diabetes in seniors. Retrieved from

http://www.diabetes.org/advocacy/advocacy-priorities/prevention/preventing-diabetes-

in.html.

Anderson, E. T., & McFarlane, J. (2015). Community as partner: Theory and practice in nursing

(7thed.). Philadelphia, PA: Wolters & Kluwer.

Cavegn, E. I., & Riskowski, J. L. (2015). The effects of tai chi on peripheral somatosensation,

balance, and fitness in Hispanic older adults with type 2 diabetes: A pilot and feasibility

study. Evidence-Based Complementary and Alternative Medicine. doi:

http://dx.doi.org.ezproxy2.library.arizona.edu/10.1155/2015/767213.

El Pueblo Senior Center. (2018). Retrieved from

https://www.tucsonaz.gov/parks/ElPuebloCenter.

Office of Disease Prevention and Health Promotion. (2018). Diabetes. In Healthy People 2020.

Retrieved from https://www.healthypeople.gov.

 CENSUS TRACT 22.01 14

Appendix A

Priorities of Care Table

Community health Identified Communi Nursin Availabil Severit Applicable Ideas for nursing Total

concern or problem, in Pima ty g ity of y of HP2020 intervention score

(stressor, risk factor, County’s expressio student resources outcom Determina (Use Minnesota

need, determinant) Health n of s’ relevant e(s) nt of Wheel)

Needs interest in ability for without Health ** The interventions

Assessmen addressin to addressin effort category listed below are just

t1 g address g to examples. Students

problem2 proble problem address can use any of the

m proble interventions from

m the wheel.

Substance Abuse 2 4 1 1 2 10

Physical Advocacy**:

Environ Write a letter to

a legislative

representative

supporting

community

groups proposal

to address

Stressor 1
 CENSUS TRACT 22.01 15

Improper use of 1 4 2 1 1 9

emergency service Social Community

Environ Organizing**:

Invite all

stakeholders to

a meeting to

discuss

approach to

Stressor 2

Diabetes 2 4 2 2 2 12

Health Policy

Services Development

and

Enforcement**:

Draft a policy

for agency

addressing
 CENSUS TRACT 22.01 16

Stressor 3

Mental health 2 4 1 1 1 9

Biology Health

and Teaching**:

Genetics Teach a class at

the library

addressing

Stressor 4

Note.1Score 1 point if consistent with report findings as a concern in Pima County. Score 2 points if 1 of Pima

County’s 4 priority areas: Anxiety and Depression; Substance abuse; Injuries and accidents; Diabetes. From “Pima

County Health Needs Assessment Snapshot”. 2Community Expression of Interest (second column) is double

weighted to emphasize its importance. Key: 0 = low, 1 = moderate, 2 = high. Adapted from “Community Health

Diagnosis in Nursing” by M. A. Muecke, 1984, Public Health Nursing, 1, p. 31; and “Community Assessment and

Evaluation” by G.F. Shuster, 2010, in M. Stanhope and J. Lancaster (Eds.) Foundations of Nursing in the

Community, Community-Oriented Practice, 3rded., p. 232. St. Louis: Mosby/Elsevier/Evolve.

CENSUS TRACT 22.01 17

Appendix B

Evaluation Tool

Survey

By a show of hands:

1. Who can share at least one way that exercise can help with diabetes?

2. Who can share some exercises that can help prevent diabetes?

Appendix C
CENSUS TRACT 22.01 18

Visual Aid