¡Bienvenidos!
For my capstone I focused my efforts to benefit Amigas en Salud. I founded Amigas en Salud in the spring of 2013 and have been working to improve and expand the program for the past two years. Amigas en Salud is a social cognitive and culturally tailored exercise and health awareness program for Latinas in Carrboro, Chapel Hill and Durham, North Carolina. To learn more about Amigas en Salud, why I chose this project, and what I’ve done over the past two years, keep reading!
Mission statement
Amigas en Salud aims to promote health literacy and independence by providing Latinas with the tools to understand and manage their overall wellbeing and chronic disease condition through exercise and health awareness.
My inspiration: A Statement of Need
The Latino community in North Carolina has a high need for healthcare due to the prevalence of obesity, diabetes mellitus type 2, and hypertension. 1 Morbidity and mortality increase when diagnosed with one or more of these conditions. In North Carolina, age-adjusted death rates were calculated from common chronic conditions in the Latino community, with 66.4% deaths from heart disease, 11.2% from Diabetes, 20.5% from stroke, and 8.7% from kidney disease.2
Obesity further increases the risk of a multitude of complications, such as type 2 diabetes mellitus, sleep apnea, osteoarthritis, stroke, gallbladder disease, hypertension, and a number of cancers.3 According to NHANES III, the age adjusted prevalence of obesity and overweight in Hispanic women in the United States older than 20 is 74.4%, significantly higher than white Americans.4 Diabetes and hypertension have been found to be associated with a number of macro-vascular complications.5 Someone with hypertension or diabetes has an increased risk of coronary artery disease, congestive heart failure, peripheral vascular disease, kidney disease, stroke, and heart attack. The high prevalence of these chronic conditions is due in part to multiple preventable factors common among Latinos, such as diets low in fruits and vegetables, high sedentary rates, and an elevated prevalence of smokers; and further highlights the need to address health among Latinas living in North Carolina.6
The high rates of life threatening diseases and risk factors make affordable health care a vital tool for management of chronic diseases; yet data show that a larger percentage of the Latino population remains uninsured when compared to the national average.1 Preventive care through wellness programs is an effective strategy to address disparities in disease prevalence and access to health care. Wellness programs have the potential to decrease health care costs to the State and patient by improving the physical health and health-related quality of life of the participants, resulting in less disability down the line.
Additionally, the need for effective, low cost chronic disease management and prevention programs in the Latino community will continue to grow as the population size increases. The Latino population currently accounts for approximately 8.9% of the total United States population. In Durham there are estimates that the overall growth will be 4,865 Latinos from 2013-2017 (see Appendix A).7,8 Furthermore, the percentage of Hispanic families living below the federal poverty level in North Carolina in 2008 was 24.8 (compared to 6.7 for whites), emphasizing the need for low cost interventions.2 The sudden expansion in the number of underserved Latino immigrants, the language barrier, and the lack of health insurance have made it difficult for Latino families to find information and resources that would help them take control of their health. In 2013, there were no comprehensive, culturally tailored programs for Latinas in the Chapel Hill, Carrboro and Durham area that attempted to address the overall well being of their participants. Upon a needs assessment of Latinas in these areas, there was an expressed need for such a program. Amigas en Salud was created to serve as an avenue to access the various resources in the community to meet this need.
Program and product development
Amigas en Salud of Chapel Hill was founded in May 2013 as one of the first Latina exercise and health awareness programs in the Carrboro and Chapel Hill area. The organization is based on assessment of community needs and consists of four main components: Zumba, free childcare, promotion of health literacy through bi-monthly tutorials, and access to resources in the community. Amigas en Salud then launched a Durham branch on October 11, 2014 using the same model. The Durham branch was founded in collaboration with Immaculate Conception Catholic Church in Durham and Duke Pediatric Mental Health Initiative. The wellness program is possible due to the network of outreach and education organizations in the Triangle that have offered their services to better the participants of Amigas en Salud.
In the Evidence Based Practice II course, I was given the opportunity to develop a PICO question that was tailored to benefit Amigas en Salud: What are the health benefits of a community based exercise and health education program for underserved Latinas? The information gathered from this research was compiled into a Critically Appraised Topic. This information will help the directors, participants, and future investors understand the importance of wellness programs similar to Amigas en Salud. In the Topics in Health Promotion and Wellness course, I had the opportunity to develop a program proposal for the expansion of Amigas en Salud to Durham. The proposal included a statement of need, background, and program description. This assisted in the development of the Durham branch. During this course, I also learned about evaluation methods. I was then able to put this information into practice when I held a focus group and performed a process evaluation of the program. From the information gained, Amigas en Salud has additional tools to better serve the community. Additional components that went into my capstone include an Amigas en Salud Feria de Salud (Health Fair) for Latinas on November 15, 2014, a financial analysis of the program with the assistance of Eddie Alcorn (MBA, MPH) and Mat Despard (MSW), and training of a student liaison to represent Amigas en Salud within UNC.
In order to summarize Amigas en Salud for all those involved with or interested in the program and for future sources of funding, I compiled a comprehensive Amigas en Salud document:
- Mission Statement
- Statement of Need
- Evidence-Based Framework
- Program Components, History, and Future
- Financial Analysis
- Evaluation Methods and Results
- Program Improvement
- Possibility of Expansion
The Impact
The personal stories of Amigas en Salud participants illustrate how the program addresses the needs of Latina community members. One participant had a heart attack at 33 years of age and another soon thereafter. She was on strict orders to maintain a certain weight and blood pressure, but didn’t have the resources to follow the physician’s guidelines. Amigas en Salud was able to provide her with courses on nutrition and healthy exercise, local organic vegetables from Farmer Foodshare, weekly Zumba classes, an exclusive discount at the YMCA, and a supportive community.
Acknowledgements
Amigas en Salud and this capstone would not be possible without the support from numerous individuals and organizations. I would like to give my gracias to Mitzy Gonzalez, Eddie Alcorn, Mat Despard, my committee members (Susan Clifford and Sadye Paez Errickson), my capstone advisor (Prue Plummer), all of the childcare volunteers, and the numerous presenters/organizations that enhanced our knowledge. Most importantly, me gustaría dar las gracias a las participantes de Amigas en Salud. Han enriquecido mi vida.
References
- Minority Health. Cent. Dis. Control Prev. 2011. Available at: http://www.cdc.gov/minorityhealth/populations/REMP/hispanic.html#10. Accessed September 11, 2014.
- North Carolina Minority Health Facts: Hispanics/Latinos. Off. Minor. Heal. Heal. Disparities State Cent. Heal. Stat. 2010:1-11. Available at: http://www.schs.state.nc.us/SCHS/pdf/Hispanic_FS_WEB_080210.pdf. Accessed August 23, 2014.
- Khaodhiar L, McCowen KC, Blackburn GL. Obesity and its comorbid conditions. Clin. Cornerstone 1999;2(3):17-31. Available at: http://www.ncbi.nlm.nih.gov/pubmed/10696282. Accessed November 27, 2014.
- Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA. 2012;307(5):491-497. doi:10.1001/jama.2012.39.
- Long AN, Dagogo-Jack S. Comorbidities of diabetes and hypertension: mechanisms and approach to target organ protection. J. Clin. Hypertens. (Greenwich). 2011;13(4):244-51. doi:10.1111/j.1751-7176.2011.00434.x.
- Kim S, Koniak-Griffin D, Flaskerud JH, Guarnero PA. The impact of lay health advisors on cardiovascular health promotion: using a community-based participatory approach. J. Cardiovasc. Nurs. 2004;19(3):192-9. Available at: http://www.ncbi.nlm.nih.gov/pubmed/15191262. Accessed September 16, 2014.
- American Community Survey. US Census Bur. 2014. Available at: http://www.census.gov/acs/www/. Accessed August 24, 2014.
- Data from Strategic Planning Demographics Population Profile Dashboard. UNC-CH Strategic Planning. 2013.
*For a full list of references used in my capstone, see hyperlinks.
7 Responses to “Amigas en Salud: from the beginning”
Heather Eustis
Sarah,
I’ve told you this many times, but I am so impressed with you and Amigas en Salud. I remember when you were first planning this program and were so excited about it. It is wonderful that your excitement and passion has stayed strong throughout. Your program has definitely made a positive impact on many Latinas. It is very shocking to me to read about the statistics you cited about the health concerns in the Latina community. It is sad to read that despite the Affordable Care Act, a large percentage of this population remain uninsured. Therefore, this really highlights the need for health and wellness programs like yours. I think it would be really interesting for you to collect outcome measures of your participants. As you know I have a strong interest in multiple sclerosis, therefore my capstone centered around this population. I have been particularly interested in the concept of self-efficacy (ie. Extent or strength of one’s belief in one’s own ability to complete tasks & reach goals). In various populations, persons with higher levels of self-efficacy demonstrate better disease management and increased physical activity. Therefore, I think it would be really interesting for you to utilize a self-efficacy outcome measures (such as the Exercise Self-Efficacy Scale) to really start capturing objective measures of your programs effectiveness. It would also be interesting to capture your participants’ level of self-efficacy to manage their health. As we have learned, populations with increased health illiteracy suffer the most in our healthcare system. Anyway, I really urge you to consider options like these because then you could write a paper and get it published to maybe help facilitate similar programs starting across the country! I think you are in an excellent position to explore these options (if you haven’t already done so). Bottom line, you rock!!!
Heather
Sarah van der Horst
Thank you, Amy for all your help with this project! Your connections to the exercise community at the UNC SRC were absolutely vital. To answer your questions:
1. I would say one of the most important things I’ve learned (among many!) is the power of connections. Without the connections I’ve made to powerful and caring people in the community, I would not have been able to start and sustain Amigas en Salud. Furthermore, I wouldn’t be able to help the participants get the resources they have needed (like YMCA memberships, domestic and sexual violence support, DM checks, consultations with MDs and med students, shoes, etc). I believe that these resources have served to empower the women.
2. I would definitely be open to sharing this information and supporting those interested in starting a similar program. As far as the best method for doing this, I would think that a workshop may be beneficial (or an informal session) where I could explain my experience and methods of starting Amigas en Salud and then discuss the possible barriers that they might face in trying to start a similar program in their program. A program like this varies a great degree depending on the resources in your area. The primary reason I was able to start Amigas was my connection to the University. If there isn’t a university in the area that someone is trying to start it we’d want to look at other possible systems of support (like the YMCA, religious groups, outreach organizations, schools, etc).
Thanks again!
Sarah
Sarah van der Horst
Thank you so much for the kind words, Prue! I couldn’t have done it without your guidance and encouragement. I recently had a meeting with the woman who is the lead at the Durham branch, and we have decided to continue to support the group and to train members to become Zumba instructors. We hope to foster a sense of leadership within the group and improve the likelihood of sustainability.
Again, thank you for everything!
Sarah
Prue Plummer
Sarah,
I’d like to echo the sentiments of Amy and Deidra — your passion and dedication to this endeavor is highly commendable and inspirational. I know you’ve put in a lot of work to this project, not just this semester, but for the last few years. It has been a pleasure to work with you and follow your progress. You have impacted positively the lives of many.
Congratulations, and keep up the amazing work!
Prue
Amy Gwynn
Sarah,
It’s been such a pleasure to see you so passionately pursue this topic, and integrate it into so many of our courses. It’s so great that Amigas is directly serving a clearly identified need in our community, and this capstone only helped further your (and many others) understanding of that need and how you can best serve it.
After reviewing Amigas in our health and wellness class, I’m so amazed to see what how comprehensive your plan is now. From your specific outlined charlas to financial analysis, potential areas of improvement, and areas for expansion remind me somewhat of the business plans we wrote. It’s clear you are making a big difference in the lives of these women and are considering not only physical health, but overall well-being in a way that is specific and culturally sensitive to this population. I’m so impressed you’ve been able to expand to Durham already!
Two questions for you:
1) What would you say is the most important thing you learned through your capstone work on Amigas?
2) Would you be open to sharing this information and experience with people attempting to start similar projects in other areas of the country/world? If so, what do you think the best way to do this would be? Attempting to publish some kind of cohort study perhaps?
Thanks!
Amy
Sarah van der Horst
Hi D!
Thank you so much for the feedback and encouragement! You were a crucial part in designing the project when you helped me out with those surveys! I have given a lot of thought to the pros and cons of a nonprofit status. And for now, I’ve decided not to seek the 501(c)3 title. I always invite anyone who is interested to turn the program into a nonprofit to do so, with the caveat that they would have to dedicate their time to ensuring that this goes smoothly indefinitely so that I am not left with the pieces once they move on (a hard offer to sell). From the research I have done, the work involved would become exponentially more stressful and thereby less enjoyable when coordinating an official non-profit. I also see this project as a way to help this underserved community both physically and financially, and so the draw of having donors to pay for resources isn’t as strong. The program overall isn’t that expensive, and I am fortunate to have SHAC agree to supporting us when additional funds are needed (I recently had a meeting, and they have agreed to continue the financial relationship with Amigas en Salud!).
Thanks again for reading my capstone!
Sarah
(I contacted your friend and am just waiting to hear back about a time that works for her! Thanks for the connection!)
Deidra Debnam
“Life’s most persistent and urgent question is, ‘What are you doing for others?’” – Martin Luther King, Jr.
Sarah,
I am SO PROUD of your dedication to making a difference in the Latina community. I remember the earlier stages of your vision and assisting you at the 2013 Feria de Salud at St. Thomas More where we surveyed Latinas about their interest in a free exercise and health awareness program. I love how you have incorporated the needs of your participants (e.g., childcare, transportation, financial constraints, language and literacy components, etc.) in the development of your program. It was obvious from the start, just by your utilization of surveys during the development phase, that you wanted to create the most valuable and effective program that you could – and the success of the program is proof of your hard work, the work of your colleagues and volunteers, and the community support you have attained.
The health literacy component of Amigas en Salud is phenomenal! It reminds me of a famous quote, “Give a man a fish and you feed him for a day; teach a man to fish and you feed him for a lifetime.” The charlas that you have implemented in Chapel Hill illustrate the comprehensive nature of your health education component. Although the Durham branch is fairly new, the charlas in Durham have also addressed important aspects of health including topics on physical, dental, mental health, and more. I’m so glad I was able to put you in touch with my friend who I think could be a great resource for a future charla to share her personal story (http://www.getintuneandjustbreathe.com/) and to educate participants on how to take active roles in their healthcare.
In the comprehensive Amigas en Salud document you mentioned that Amigas en Salud is not a nonprofit (p. 12). Have you considered applying for nonprofit status? This may help to address some of the financial barriers that the program has.
Once again Sarah, I’m very impressed with how you have transformed a vision into reality. I know your program will continue to make a positive impact in the community and will inspire others to serve. As with any large undertaking there are always challenges and obstacles to overcome. Even during the difficult times, continue to remember what inspired you to start Amigas en Salud and never forget the countless individuals your program has influenced for the better. I can’t wait to see how the program continues to grow!