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K.A.L.A.S. pagKaing Angkop Laban sa Alta Presyon Pineda, Mary Lynn Ramos, Ramil Ponelas, Maria Lech Raagas, Quennie Rentillo, Tiffanny Presentors: Reloj, Jernelyn & Quicho,Tanya Joy Introduction to the Community • Baranggay 733 is located in District V, Zone 80 of San Andres Bukid in Manila. • land area of 2,500 square meters bordered by an estero on A. Linao St. on the north, Tripa de Galleria on the east, Estrada Street on the south, and Singalong Street on the west. • population size to be approximately 1,657 • average of 4.5 members per family • the sex ratio between males to females is 1:1. Most are single. Introduction to the Community • Baranggay 733 is not an entirely depressed baranggay • Majority of the residents (32.6%) are high school graduates while 24.6% are college graduates. • The leading cause of mortality in the area is the same as the national leading cause of mortality, which is heart disease • The leading cause of morbidity is bronchitis Introduction to the Community • The baranggay has good access to health care and facilities with a baranggay health worker assigned to the baranggay. • The Jose Fabella Health Center, which is located in Barangay 724, provides free health services. • Government tertiary hospitals nearest the Barangay are the Philippine General Hospital and Ospital ng Maynila Medical Center. Project Proposal Review of Related Literature • Hypertension remains to be one of the most prevalent diseases in the Philippines. • Heart disease, the primary cause of mortality in the country may come from hypertension. • Diet and nutrition plays a great role in the prevention of hypertension and heart disease. Review of Related Literature • Dr. Price found that deaths from heart disease were inversely proportional to the vitamin content in the butter. (Journal of the American Dental Society, 1930) • Vitamin D helps prevent high blood pressure and protects against spasms. As vitamin D is needed for calcium absorption, it contributes to a healthy nervous system and helps prevent arrythmias. Review of Related Literature • "The reason why South Asians get heart disease at an earlier age is because they have a higher proportion of people with bad cholesterol and less good cholesterol," (Dr. Salim Yusuf of McMaster University in Hamilton, Ont.) Review of Related Literature • Eating habits that develop early can be difficult to change. Therefore, a preventive diet is recommended for all healthy children over the age of two years. The Work Plan DECISION MATRIX IDENTIFICATION OF THE PROBLEMS FORMULATING CRITERIAS TO DETERMINE THE PROBLEM’S MAGNITUDE RANKING BASED ON THE CRITERIAS ADDRESSING THE MAIN PROBLEM The Decision Matrix Criteria Magnitude of the Problem 30% Rank Wtd Rank Feasibility and Sustainability 30% Rank Wtd Rank Concern of the Community 20% Rank Wtd Rank Impact to the Community 20% Rank Wtd Rank Total Rank Weight Heart Diseases Diarrhea Tuberculosis Hypertension 4.00 1.20 3.28 0.98 3.86 0.77 4.00 0.8 3.75 5 3.57 3.42 1.71 1.07 1.03 0.51 3.14 3.57 1.57 0.94 1.07 0.47 2.43 1.86 2.43 0.49 0.37 0.49 3.57 3.42 1.71 0.71 0.68 0.34 3.21 3.15 1.81 4 3 1 Diabetes 2.14 0.64 3.14 0.94 4.28 0.86 2.14 0.43 2.87 2 PROBLEM TREE Uncontrolled Hypertension Prevalence of Hypertension Smoking Unhealthy Lifestyle Lack of efforts in prevention Delay in recognition Lack of hypertensive medication Comorbid diseases Increased Age Genetics Poverty Lack of knowledge PROBLEM TREE Kidney Disease More Poverty Stroke Low Birth Weight babies Fetal Death Heart Disease Increased Expense For medication PROBLEM TREE PAST 10 YEARS: PRIMARY HEALTH CONCERN = COMMUNICABLE DISEASES As the years goes by… SHIFT to LIFESTYLE DISEASES… Advent of VACCINES & ANTIBIOTICS: ► CONTROLLED INFECTIOUS DISEASES 2006 (DOH): HYPERTENSION is 2ND most common cause of MORTALITY and the 5TH most common cause of MORBIDITY. BRGY. 733 ZONE 80: It is the 1ST cause of MORBIDITY. ↑ age & genetic predisposition = HYPERTENSION NOTE: Not only those with genetic predisposition will develop hypertension. ALL are at risk. Lack of knowledge = unhealthy lifestyle delay in recognition of the disease POVERTY: has a role in the prevalence of hypertension Lack of finances= UNABLE to BUY MEDS Array of complications STEMS from hypertension… Hypertension per se = leading cause of morbidity and mortality ► HEART DISEASE Kidney & Stroke …these DRAINS THE FAMILY’S RESOURCES due to costly medical care SOLUTION TREE Reduced Prevalence of Hypertension Cessation of Smoking Healthy Lifestyle Prompt Recognition Lack of hypertensive medication Comorbid diseases Increased Age Increased Prevention Genetics Poverty Increased knowledge SOLUTION TREE Reduced incidence of Kidney Disease Focus of family resources on Nutrition, education etc Reduced Incidence of Stroke Healthy infants Reduced Incidence of Heart Disease Reduced Expense For medication SOLUTION TREE ↑ knowledge of the residents regarding hypertension = BEHAVIORAL CHANGES They now will be practicing: HEALTHY LIFESTYLE VIGILANT ON OWN’S BLOOD PRESSURE Early Recognition + Health Seeking Behavior = control of hypertension ▼ prevalence of hypertension ▼ complications: ► stroke ► kidney disease ► LBW in infants ► heart disease ║ ▼ Better Quality of Life Health Plan General Objective • To increase the knowledge of 15 % of residents aged 15-45 years old in Brgy 733 Singalong Manila regarding Hypertension prevention through proper nutrition by 40% from the baseline from May 2007 to July 2007. Specific Objectives Objective 1 Specific Objective Strategy Content Persons Responsible Resources/ Materials Time Allotted Budget Indicators To conduct information dissemination in the barangay regarding project activities Brgy Tour, Poster Placement Putting Pineda, up Mary Lynn posters and giving out flyers containin g activity schedule Posters, Flyers One half 300 day pesos Posters and flyers were put up and given out Objective 2 Specific Objective To determin the baseline knowledge of participants regarding hypertension a. Definition b. Risk factors which focused on right nutrition c. Recognition d. Monitoring e. Prevention Strate gy Content Multiple choice questions regarding hypertension, its definition causes, recognition, monitoring and prevention Persons Responsible Ponelas, Maria Lech Resources/ Materials Time Allotted Budget Indicator Pretest Questionnaires, Pencils 30 minutes before each lecure 200 pesos Pre-test Scores Objective 3 Specific Objective To conducthealth education lecture regarding hypertension w/ the ff content a. Definition b. Risk factors which focused on right nutrition c. Recognition d. Monitoring e. Prevention Strateg y Lecture Content Lecture content will include latest statistics regarding hypertensio n, definition, causes, recognition, monitoring and prevention Persons Responsible Quicho, Tanya Resources/ Materials Visual Aids, Lecture content, flyers Time Allotted 1 hour every 2 weeks Budget 500 pesos Indicators 1 lecture Given and 15% of residents aged 15-45 years old in attendance Objective 4 Specific Objective To determine the knowledge of participants regarding hypertension after lectures re: the ff a. Definition b. Risk factors w/c focused on right nutrition c. Recognition d.Monitoring e.Prevention Strat egy Posttest Content Persons Responsibl e Pineda, Mary Lynn Resources/ Materials Questionnaires, Pencils Time Allotted 30 minutes after lecture Budget Indicators Multiple choice questions regarding hypertnsion, its definition, causes, recognition, monitoring and prevention 100 pesos Post test scores Objective 5 Specific Objective To conduct a food bingo that will feature healthy and nutritious foods Strate gy Food bingo Content Persons Responsible Raagas, Quennie Resources/ Materials Bingo cards, props, prizes Time Allotted 1 hour Budget Indicators This is an interactive activity that will feature foods that are both healthy and nutritious 800 pesos 30% of attendees should be in target age group and 75% of answered questions presented at the course of the bingo Objective 6 Specific Objective To form a booklet containing recipes of nutritious foods which will be left in the community Strategy Content Persons Responsible All members Resources/ Materials Reference material, bond paper Time Allotted 4 days Budget Indicators Cookbook Disseminati on Gathering of nutritious foods recipes 500 pesos Number of booklet given should be at least 30 cookbooks Objective 7 Specific Objective Strategy Content Persons Responsible Resources/ Materials Time Allotted Budget Indicators To monitor blood pressure of residents aged 1545 years old BP monitoring BP monitoring Ramos, Ramil Stethoscope, BP apparatus 3 days in a week none 15% of residents aged 1545 who went to have their blood pressure taken had more or equal to three blood pressure readings Objective 8 Specific Objective Strategy Content Persons Responsible Resources/ Materials Time Allotted N/A Budget Indicators To strengthen existing core group members for hypertensio n through recruitment of new members who will be duly trained in blood pressure reading by 100% Meeting with residents N/A Rentillo, Tiffany N/A none 3 new members should be acquired Objective 9 Specific Objective Strategy Content Persons Responsible Resources/ Materials Time Allotted Once a week Budget Indicators To train new core group members in blood pressure monitoring Lecture, demonstration on BP reading Lecture on the basics of BP reading and demonstration Reloj, Jernelyn Visual Aids, BP apparatus, Stethoscope 500 pesos 3 successful return demo of BP reading and pre and post test scores Objective 10 Specific Objective To conduct a role playing activity tackling the effect of proper nutrition on hypertensi on Strategy Content Persons Responsible All Members Resources/ Materials Props, One day script, lights Time Allotted Budget Indicators Role Playing A play written and acted by the group will be done 1000 pesos 75% correct answers of questions asked of viewers in aftershow question and answer Rationale • A community health intervention on hypertension was done in Baranggay 733 by previous medical clerks who rotated in the baranggay. • They targeted women 15-49 years old. • One of their objectives was to do risk assessment on their subjects and it was found out that the second most common risk factor is: OBESITY • This was the main inspiration of the group in targeting diet as the area in the resident’s lifestyle to intervene on. • The main thrust of the group is to increase the knowledge on hypertension. • A special age group from the population, 15-45 years old, is targeted. As such the general objective are as follows: To increase the knowledge of 15% of residents aged 15-45 years old in Brgy 732 Singalong, Manila regarding Hypertension prevention through proper nutrition by 40% from the baseline from May 2007 to July 2007. First specific objective: • To conduct information dissemination in the baranggay regarding project activities. This will ensure that the residents are well aware of a project ongoing in their community. Second specific objective: • To determine the baseline knowledge of participants regarding hypertension. Test scores will be used as the baseline data for the participants’ knowledge. Third specific objective: • To conduct health education lecture regarding hypertension w/ the ff. content a.Definition b.Causes c.Recognition d.Monitoring e.Prevention This will be the medium for increasing participants knowledge. Fourth specific objective: • To determine the knowledge of participants on hypertension after lectures. The scores will then be compared to baseline and analyzed to determine the increase in knowledge Fifth specific objective: • To conduct a food bingo that will feature healthy and nutritious foods beneficial in prevention of hypertension. • This will be done in an effort to inculcate a healthy lifestyle among participants & for them to identify what kinds of foods are healthy to prevent hypertension. Sixth specific objective: • To form a booklet of recipes that will be left with the community. • This booklet will serve as a tool that will help the community in eating healthy. Seventh specific objective: • To monitor blood pressure of women aged 15-45 years old. With this, participants will be more aware and will be able to recognize if they need treatment. Eighth specific objective: • To form a core group of residents with at least 5 members who will conduct BP monitoring. This was done to ensure sustained BP monitoring once the group has disengaged. Ninth specific objective: • To train a group of residents regarding BP reading. • Again this will ensure sustainability of monitoring. Tenth specific objective: • To conduct a role playing that will show behaviors that favor prevention of hypertension through proper nutrition. This was done to strengthen the behaviors taught regarding proper nutrition and hypertension. Project Implementation Objective 1 To conduct information dissemination in the baranggay regarding project activities Objective 1: INFORMATION DISSEMINATION • the group decided to conduct a parade done last June 2, 2007. • The group prepared materials like a huge banner, posters, and flyers. • These materials contained the name of the project, the activities in store for the baranggay people, and some informative clips which points out the importance of monitoring blood pressure. • The group also recorded a jingle entitled “Boom Kalas!” in the tune of Boom, Tarat tarat which was continuously played in the baranggay hall and was heard all over the vicinity while the group was conducting the parade. The Banner Posters RESULTS • Some residents in the community approached the group and asked what KALAS is all about. • Some of the residents of the community already went to the baranggay hall for blood pressure monitoring • Some asked us what the project was all about and asked when we will conduct our activities so that they can attend and participate in our activities. Problems Encountered • Number of flyers distributed was not enough for the whole community Solutions • Through the parade, the group was able to personally invite the residents of the community to participate in our project • Posters were placed to different parts of the baranggay so that everybody can actually read it and be informed that there is an on-going project in their community. Solutions • Since the barangay have sound system, activities will be announced and the jingle will be played every time the group is in the baranggay to inform them that there is free BP check-up or we have scheduled activity for that day in the baranggay hall. Objective 2 To determine the baseline knowledge of participants regarding hypertension a.definition, b.risk factors with focus on right nutrition, c.recognition, d.monitoring, e.prevention Objective 2: • 20-item yes/ no questions THE PRETEST 1. Upang makatipid, mas mainam na kumain ng junk foods/chichiria sa paaralan at sa trabaho bilang snacks. A. Tama B. Mali 5. Limitahan ang pagkain ng itlog sa limang beses sa isang lingo (kasama ang balut ) upang bumaba ang BP. A.Tama B.Mali 10. Mainam na magpakulo, mag-ihaw o maglaga na lamang ng pagkain KAYSA magprito upang maiwasan ang pagtaas ng BP. A.Tama B.Mali 12.Upang makatipid HUWAG ITAPON ang mantikang lumalabas sa karne, gamitin ito ulit sa pagpriprito. A.Tama B.Mali 13. Mas makabubuting gumamit ng COCONUT oil sa pagpriprito kaysa CORN oil. A.Tama B.Mali 16. Mas mainam ang SINAING na kanin kaysa sa SINANGAG na kanin. A. Tama B. Mali 17. Tanggalin ang balat ng manok bago lutuin. Hiwain at tanggalin ang taba sa mga karne. A.Tama B.Mali • Set A questions (#1,5,10,12,13,16,17) are about attitudes on food selection and meal preparation techniques Objective 2: THE PRETEST 3. Ang paninigarilyo ay nakakabawas ng timbang at nagpapababa ng blood pressure. A.Tama B. Mali 4. Ang regular na pag inom ng alak (1-3 beses sa isang lingo) ay nakalilinis ng katawan at nagpapalabas ng maduming dugo at nagpapababa ng BP. A.Tama B.Mali 11. Ang pagiging obese (sobrang katabaan) ay HINDI nagdudulot ng mataas na blood pressure. A.Tama B.Mali 19. Ang kawalan ng aktibidad at sobrang timbang ay nagdudulot ng altapresyon. A. Tama B. Mali • Set B questions (#3,4,11,19) are about risk factors and lifestyle which predisposes to hypertension Objective 2: THE PRETEST 2. Ang pag inom ng isang basong gatas (skim milk) na mayroon lamang 80 calories at 0 fat, na nakakataas ng presyon ng dugo. A.Tama B. Mali 8. Ang mga pagkaing mayaman sa fiber (oatmeal, gulay,prutas) ay tumutulong upang maging mababa at normal ang BP. A.Tama B.Mali 15. Ang blood pressure na 90/60 ay nangangahulugang LOW BLOOD/MABABANG BP. A. Tama B.Mali 18. Ang sakit sa bato at atake sa puso ay mga komplikasyon ng altapresyon. A. Tama B. Mali • Set C questions (#2,8,15,18) are about hypertension its definition, recognition and prevention. Objective 2: THE PRETEST 6. Ang sodium o asin sa mga prosesong pagkain tulad ng mga de-lata, instant sopas,at iba pang snack items ay nakakaapekto sa pagtaas ng presyon ng dugo. A. Tama B. Mali 7. Ang dyeta na mababa taba at kolesterol ay nakakatulong magpababa ng presyon ng dugo. A. Tama B. Mali 9. Nagdudulot ng high blood pressure ang pagkaing mataas sa taba at kolesterol gaya ng chicharon, balat ng lechon, cream, gata, pagkaing prito, at taba ng karne . A.Tama B.Mali 14. Ugaliing kumain ng tocino, sausage, hamon, tuyo, tinapa, asin, toyo bagoong, patis, vetsin, at mga pagkaing de-lata. A. Tama B. Mali 20. Mas mainam kainin ang taba ng ISDA kaysa sa taba ng baboy at baka. A.Tama B.Mali • Set D questions (#6,7,9,14,20) are about eating habits and awareness on proper nutrition to prevent hypertension. THE BASELINE KNOWLEDGE • 56.5 % of the residents are still unaware on limiting their egg consumption to 3 eggs /week • 50% are still unknowledgeable on the recommended type of cooking oil to use in preventing hypertension • 41% of the respondents had poor knowledge on the risk factors of hypertension such as obesity and smoking THE BASELINE KNOWLEDGE • 74% of the respondents failed to classify 90/60 as normal blood pressure • 39% of respondents answered wrongly on the effect of salty and fatty foods in the elevation of blood pressure Pre-Test Objective 3 To conduct health education lecture regarding hypertension with the following content a.definition, b.risk factors with focus on right nutrition, c.recognition, d.monitoring, e.prevention Objective 3: THE HEALTH EDUCATION LECTURE • June 7, 2006, Thursday • aimed to increase the awareness of the residents on the prevention of hypertension by promoting healthy lifestyle, proper food preparation and nutritional education Objective 3:THE LECTURE TOPICS I.Definition of Hypertension a. Stages of hypertension (JNC7) II.Risk factors with focus on right nutrition a.Dietary Approaches to stop hypertension b.Proper food selection and preparation c. Nutritional education III.Recognition a. Awareness on the signs and symptoms !V.Monitoring a.BP monitoring technique V.Prevention a.Lifestyle modification RESULTS • residents aged 15-45 years old • Lecture lasted for 1 hour • There were a total of 46 attendees. • This number of participants was below the targeted number, which is 15% of residents 15-45 years old that is around 120 participants. Table 3: List of the number of participants and their respective ages Age of the Attendees 15-25 26-35 36-45 TOTAL Quantity 12 15 19 46 Problems Encountered • Invitation of participants Solutions • Repeated announcement • Served refreshments • Good site design Objective 4 To determine the knowledge of participants regarding hypertension after lecture regarding the following a. definition, b.Risk factors with focus on right nutrition, c.recognition, d.monitoring, e.prevention Objective 4:THE POST-TEST • Gave post-test examination RESULTS Scores 20 19 18 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1 0 Total Mode Mean Pretest 0 0 7 2 7 8 4 1 10 1 1 2 2 1 0 0 0 0 0 0 0 46 12 13.08 Posttest 8 15 19 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 46 18 18.45 • Table 3: Summary of Scores of the Pre-test and Post-test of Male and Female Residents aged 15-45 years old who attended the health education lecture regarding hypertension prevention in the Brgy 733 Barangay Hall RESULTS PRETEST • Highest: 18/20 • Lowest: 7/20 • 52% of the participants got scores of 15 and above, while 48% got scores less than 15. • Mean score: 13.08 POST TEST • Highest:19/20 • Lowest: 14/20 • 99% got scores of 15 and above, while only 1% got a score below 15 • Mean score: 18.45 RESULTS • 40% target increase = (Mean Pre-test x 0.40) + Mean Pre-test = (13.08 x 0.40) + 13.08 = 18.312 • Percent Increase = (Mean Post-test-Mean Pre-test) x 100% Mean Pre-test = (18.45-13.08.)x 100% 13.08 = 41.05 RESULTS • The percent increase of the mean scores is 41.05%, almost 1.05% higher than the target increase of 40% set by the group. • This shows that the health education lecture increased the knowledge of the participants by 40%. Test for Significance • Hypothesis Testing H0= There is no significant difference between the pre and post test scores HA= There is a significant difference between the pre and post test scores Df=0.10 Critical Region= t< -1.684 and t> 1.684 Computed t= -12.69 • Conclusion: There is a significant difference between the pre and post test scores Problems Encountered • The reason for the low scores of the participants in the pre-test may be attributed to the following: a.) In the questionnaires, though the keywords were highlighted, the lengthy construction of the questions may have led to confusion and faulty analysis of the participants thereby resulting to low pretest scores (ex: #5, 6, 9) b.) The non familiarity of the terms used in the question (ex: skim milk #2, coconut oil and corn oil in #13) c.) Presence of external factors that may have distracted the participants during the lecture such as the hot weather and the noise in the neighborhood d.) Presence of internal factors such as the personal concerns of the participants such as their willingness to listen and learn Objective 5 To conduct a food bingo that will feature healthy and nutritious foods One of the most colorful highlights of the program implementation Held last June 09, 2007 at around one o’clock in the afternoon Agenda: Familiarize the community about the food that may help prevent and control hypertension. Target: 30% of the participants fall under the population target of the project SURPRISE! …a FLOCK of lively barangay residents flood the barangay hall to register that sun-scorching afternoon… Table 3. Distribution of the number of participants in each age bracket in Brgy. 733, Zone 80, San Andres Bukid, Manila. RESULT: 95 participants responded 32 % from 31-45 age bracket 24 % from 15-21 age bracket Exceeding of the group’s projected initial target of 30% OUTCOME: successful in covering the target population to contrive the agenda AGE 14 y/o and below 15-25 y/o Number of Participants 4 23 26-30 y/o 31-45 y/o 16 31 21 n=95 46 y/o and above Figure 1. Frequency distribution of participants as to age criteria in Brgy. 733, Zone 80, San Andres Bukid, Manila 21; 22% 4; 4% 23; 24% 14 y/o and below 15-25 y/o 26-30 y/o 31-45 y/o 46 y/o and above Majority of the participants: 15-45 years old Adult group dominated the participation of the event followed by the early adolescence group and young adult. 31; 33% 16; 17% Figure 2. Frequency distribution of participants as to gender in Brgy. 733, Zone 80, San Andres Bukid, Manila. 28 male participants 28; 29% male female 67; 71% 67 female participants Slight predominance of the female population since majority of the male were out for work during the activity. Each participant = 1 bingo card; valid for fifteen games Card content: various nutritious foods, fruits and vegetables which were arranged randomly just like in the usual bingo cards Randomly cut pictures of 75 foods were pasted to occupy the empty boxes until it’s filled up with a spare box at the center Prizes: blouses, shorts, shades, umbrellas, thermos and… the grand prize, 5-kilo white rice Strategy: For the community to readily identify and associate essential foods and acquaint themselves on the beneficial claims with regards to hypertension in particular. …MECHANICS… For each food item drawn, nutritional information of it was given and varied throughout the 15 games. Each game has specific pattern the players followed. The first to chart the specified pattern in each game was declared the winner. A prize was given to the winner after he/she was able to answer the question given to claim the prize. After every game, the participants were also asked some questions regarding the lecture of the group about hypertension, its causes, risk factors, signs and symptoms, proper diet to avoid and control hypertension and information given by the game master every time a food was drawn. Prizes were also given to those who can answer the questions correctly. RESULTS: Majority of the winners: female imminent from 31-45 age group Second in line: adolescence and young adult (15-25 years) group Some of them were later identified as frequent visitors of the barangay hall Table 4. Distribution of the age and gender of the proclaimed winners of the nutribingo Brgy. 733, Zone 80, San Andres Bukid, Manila. AGE 15-25 y/o 26-30 y/o 1 1 GENDER Male Female No. of winners 9 2 10 3 31-45 y/o 46 y/o and above 1 2 11 3 12 5 n=30 OUTCOME: Campaign was more on the association that people will remember the vital nutrients they will benefit if they will eat the food so that they will prevent and avoid hypertension. Healthy diet and lifestyle was also promoted. The said activity lasted an hour and a half of excitement and spectacular extravaganza. Problems Encountered Main problem: CROWD management Well-attended activity: Participants had lots of DEMANDS and some COMPLAINTS regarding the proceedings The group recognized that this was natural and was able to pacify the participants in a friendly way. For most part of the game the crowd well-behaved not until the game approach to its conclusion; a man claiming he was the first who completed the bingo card. To respond to such stir, the coordinator of the activity manage to appease him and settle the commotion promptly and orderly as she explained the whole thing to him in a more chronological approach of what had happened before the winner of the grand prize was proclaimed. Objective 6 To form a booklet containing recipes of nutritious foods which will be left in the community Objective 6: THE COOKBOOK • As part of the effort to reinforce the learning of the residents regarding eating healthy foods to avoid hypertension, the group decided to compile different recipes and give it out to the residents in form of a booklet. Objective 6: THE COOKBOOK • Each group member was tasked to find recipes. • The recipes that were chosen were those w/ low fat and salt recipes as well as affordable. • A total of 10 recipes are included in the cookbook. • Booklets were given to the community during the disengagement day. Results • The group was able to come up with 10 healthy recipes, properly typed and compiled and we distributed them to the baranggay. • We were able to create 30 cookbooks & we distributed them to the community. • All of the cookbooks were given out. The people were very eager to participate. Problems Encountered • It was not easy for some of us to come up with a healthy recipe. • In addition, it was also a challenge for the group to think of a recipe that is not only simple, affordable but also tasteful and would appeal to the target residents aged 15-45 years. Objective 7 To monitor blood pressure of residents aged 15-45 years old Objective 7: BP MONITORING • To accomplish this objective the group first worked on establishing a schedule of the BP monitoring 3x a week at the baranggay hall. • Necessary measures were taken to inform the community of the said schedule through: Announcements in the brgy. Posters Flyers Jingle Objective 7: BP MONITORING • BP monitoring proper • 9:00am-12:00nn Mon-Weds we took BP readings of people who came in voluntarily in the brgy. hall • Daily record of BP monitoring. Objective 7: BP MONITORING • The patients who came in were both from the 15-45 age group both male and female as well as those who are not covered in the target age group. Results To be able to interpret the blood pressure readings of the participants, we used JNC7 Classification of hypertension as our guide. Classification Normal Pre-hypertension Stage 1 HPN Stage 2 HPN Systolic BP <120 120-139 140-159 ≥160 Diastolic BP <80 80-89 90-99 ≥100 Table 6. Frequency of BP monitoring participants per age bracket Total number of participants: Participants aged 15-45 years old: The total number of participants who came in for BP monitoring was 82 out of this, only 59 participants are included in the target population. The rest came from participants older than 45 years of age. 82 59 There were no participants younger than 15 years of age. Participants above 15-45 years old: 23 The mean number of patients who come in for blood pressure monitoring per day is 7 patients per day. Figure 3. Gender distribution of participants in blood pressure monitoring M ale F em ale 39% 61% Figure 4. Gender distribution of participants in blood pressure monitoring aged 15-45 years Ma le Fe m a le 49% 51% In the overall participant gender distribution, 61% of attendees are female while 39% are male. In the 15-45 year old age group, 51% of the participants are female while 49% are male. On both charts it can be seen that more female than males go to the baranggay hall during blood pressure monitoring sessions. Table 7. Frequency of participants aged 15-45 years old who visited the baranggay hall for blood pressure monitoring more than once Number of Visits 2 3 4 5 >5 Number of Participants 9 6 5 2 0 • There were a total of 22 participants who visited more than once to have their blood pressure taken. • There were no resident who went back a 5th time to have their blood pressure taken. Table 7. Frequency of participants aged 15-45 years old who visited the baranggay hall for blood pressure monitoring more than once Number of Visits 2 3 4 5 >5 Number of Participants 9 6 5 2 0 • The objective of the blood pressure monitoring for this project is have at least 15% of those who went to have their blood pressure taken to come back a third time to have their blood pressure taken. • Based on this table, it shows that there were a total of 13 residents, or 22.0% of the target age group, went back and had their blood pressure taken 3 or more times. Figure 5. Frequency distribution of the blood pressure classification of participants in the blood pressure monitoring aged 15-45 years old 40 35 30 F req uen cy 37 25 20 15 10 5 0 1 si ve on ge ge 2 • A total of 16 participants or 27% of the participants in the target age group were classified as prehypertension. 16 3 3 P re • There were 3 participants whose blood pressure fell under the stage 1 hypertension and 3 participants under stage 2 hypertension. en ns i ta te S ot or m N hy p er JNC 7 Cla ssifica tio n S ta Problems Encountered • There are a lot of instances that a handful of participants in the BP monitoring were above the age group of 15-45 years old. schedule of BP monitoring w/c was during school days & most students can’t go to the brgy hall to have their BP checked. Mothers were busy w/ their household chores Fathers go to work. Objective 8 To strengthen existing core group members for hypertension through recruitment of new members who will be duly trained in blood pressure reading by 100% Objective 8:CORE GROUP RECRUITMENT There were a total of 3 members of the existing core group. Therefore the group wanted to recruit 3 more core group members to increase the core group into 100%. RESULTS • A meeting was held among the residents of the community regarding the importance of having knowledge and training in BP monitoring. • With this approach, the recruitment of new members will further provide the availability of individuals trained to monitor the BP of the residents of the barangay. Problems Encountered • Due to different schedules and working hours of the residents, candidates for the new members of the core group focused mainly to the local volunteers • The group especially identified those participants whose presence is almost always seen in the baranggay hall during project activities Objective 9 To train new core group members in blood pressure monitoring Objective 9: CORE GROUP TRAINING • Volunteers from the residents of the community were given a lecture and training session about proper BP measurement. • The methods on how to properly measure the BP included the steps in proper BP measurement based on Bates’ Guide to Physical Examination and History Taking, 8th edition and The Cleveland Clinic Disease Management project as references Objective 9: CORE GROUP TRAINING • To be considered as a duly trained core group member, they should successfully be able to measure blood pressure. • After the lecture, training and demonstration about the proper BP measurement was conducted, volunteers were evaluated accordingly. • First is to perform the step by step process of measuring blood pressure and then the accuracy of their measurement assessed through repeat measurement conducted by the medical clerks. Objective 9: CORE GROUP TRAINING • Use of blood pressure assessment tool consisting of steps needed for blood pressure measurement. • A scoring system was assigned for each step. • A maximum score is 25 points and passing score is 19 points • blood pressure should be verified by one of the group members. Blood Pressure Measurement Tool Steps Done Step 1. The patient should be allowed 3 to 5 minutes of rest before measurement. Step 2. The patient should be seated, feet flat on the ground, and arm supported and rested on a table on heart’s level Step 3. The patient arm is bared without rolling sleeve of clothing. Step 4. The cuff is placed on the patient’s bare upper arm, with the lower edge of the cuff 2.5 cm above the antecubital fossa. The midline of the bladder of the cuff should lie over the path of the artery. Step 5. The cuff is rapidly inflated to 70 mm Hg and then steadily inflated by 10mm Hg increments while the examiner simultaneously palpates the patient’s brachial or radial artery pulsation. At the point at which the pulse is no longer palpable, the cuff is deflated. Note the pressures at which the pulse is obliterated on insufflation and reappears on desufflation. This determines how high to inflate the cuff on subsequent readings. Step 6. Wait 15 to 30 seconds, then place the bell head of the stethoscope over the brachial artery. Inflate the cuff to a pressure 30 mm Hg above the pressure noted in step 5. Step 7. Allow the cuff to slowly deflate at a rate of 2 mm Hg per second while listening for repetitive sounds Step 8. Record the pressure at which the first of at least two repetitive sounds is heard. This is the systolic pressure (phase 1 sounds). Adjust the valve such that the cuff deflates at a rate of 2 mm Hg per beat. Step 9. Record the pressure at which the last regular sound is heard. This is the diastolic pressure (phase 5 sounds). Not Done RESULTS • There were a total of 4 participants in core group training sessions. • This group of people were given the lecture and training session in 2 different sessions. • There were 2 participants in each session. • To evaluate the learning of the participants, a pre and post test examination was given to them. The score results for each individual as shown below Participant/ Age EA/ 47 MG/ 44 BD/29 JG/21 Mean Post Test Score 20 20 18 15 18.25 Pre test score 10 17 12 12 12.75 %increa se 100% 17.64% 33.33% 20% 43.1% RESULTS • The pre and post test scores of the participants showed that the group was able to increase their knowledge by 43.1%. • This is consistent with the goal of the group to increase knowledge by 40%. Test of Significance Hypothesis Testing H0= There is no significant difference between the pre and post test results of the core group participants HA= There is a significant difference between the pre and post test results of the core group participants Df=0.10 Critical region: t < -2.132 and t > 2.132 Computed t= -2.70 Conclusion: There is a significant difference between the pre and post test results of the core group participants RESULTS • The participants were allowed to measure the blood pressure for five tries. • A total of 3 out of 4 of the participants satisfactorily measured blood pressure after five tries. Top Three most common mistakes in return demonstration 6 5 4 3 2 1 0 W rong D ias tolic pres s ure W rong S y s tolic pres s ure D eflation of c uff too quic k ly Problems Encountered • blood pressure measurement is highly skill based • about teaching medical terms and the methods of taking BP measurements in layman’s term. Objective 10 To conduct a role playing activity tackling the effect of proper nutrition on hypertension Objective 10: ROLE PLAYING • This aims to effectively deliver the importance of proper diet and nutrition in the prevention of hypertension • The plot is about a rock star with unhealthy life style and improper diet and nutrition • Inspired by the life of Ely Buendia • To assess if the concept of the play is inculcated in the minds of the viewers, questions would be asked after the play RESULTS • • • • • • Held on June 30, 2007 at 10 am More than 20 residents attended the activity 16 attendees are from the target population The play lasted for 15 minutes 15 questions were asked after the play All 15 questions were asked correctly on first attempt • All the audience participated in the QandA portion • The viewers also asked questions and clarifications regarding hypertension and heart disease Role Playing Problems Encountered • Lack of participation from the other barangay residents especially those living in streets aside from Dagonoy (i.e., Zapanta and Estrada) • Overlap in the schedule of community duty with the nursing students from other school Conclusion • The main thrust of the group was to increase the knowledge of 15% of residents aged 15-45 years old by 40% • All goals of the specific objectives were met except for the attendance goal for the lecture. Recommendations On Management • The group recommends to those who will conduct a study in the baranggay to have their activities done, if possible, during weekends. This may increase the turnout of the participants in the project activities. On Strategy • small group set up rather than a one-time lecture approach • couple fun activities with the activities which are historically known to be less attended On Health Intervention Projects • behavior measurement be done with regards to diet • other lifestyle modification project References • • • • • • • • • • • Bates’ Guide to Physical Examination and History Taking, 8th edition Harrison’s Principles of Internal Medicine 16th ed. Journal Watch Pediatrics and Adolescent Medicine June 13, 2007 Journal Watch Cardiology January 2, 2007 Journal Watch Neurology August 29, 2006 The Cleveland Clinic Disease Management Website The Mayo Clinic Website (www.mayoclinic.com) The DOH Philippines Website (www.doh.gov.ph) The City of Manila Website (www.cityofmanila.com.ph) www.dashdiet.org BP ay Bantayan nang Pagbubuntis ay Maalagaan, A Health Promotion On Hypertension and Screening of Hypertension Among Women Age 15 To 49 Years Old in Barangay 733 Zone 80 District V, Manila Thank You for Listening! Sama sama tayong labanan ang Alta Presyon! Sama sama tayong kumalas!
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