Coronary Heart Disease Case Study Sample

I. Overview and Rationale
A. OVERVIEW OF THE PROBLEM Coronary Artery Disease or Coronary Heart Disease (CAD/ CHD) is the primary cause which leads to the majority of all problems of the heart (AHA). More than 600,000 Americans suffer from Coronary Heart Disease (CHD) ("Coronary heart disease" 2012). In order for an individual to be diagnosed with CAD there has to be a significant amount of plaque buildup which in time, if not treated could lead to atherosclerosis, the narrowing of arteries. (CDC, AHA). This disease has been established as the leading cause of death in the United States (AHA). One in every five deaths has been associated with CAD in the United States. According to the American Heart Association, 84 percent of the
individuals who died from the disease were 65 or older. Coronary artery disease remains the leading cause of death in the United States and world-wide (Hilscher, Bartley, & Zarski 2005).
The epidemiological climax in the United States occurred in the 1960s killing approximately one-third of all Americans (Jones & Greene, 2013). Data collected indicated that since the peak of CAD, rates has fallen 60 percent in the United States as well as other industrialized countries (Jones & Greene, 2013). Scientist observed a decline in the prevalence of the disease in the 1970s, but quickly noticed a rise in rates in the 1980s (Jones & Greene, 2013). Adults have been the population that CAD/CHD has affected the most (CDC). A 2009 review reported that in addition to it affecting all races, more than half have been men (AHA). The death rate is greater among white men than any other race (AHA). The majority of risk factors that are indirectly correlated with CAD have been deemed modifiable (AHA). These are mostly behavioral health and lifestyle issues (Coronary Heart Disease, Consumer Health Complete 2012). The major modifiable risk factors that can be changed are physical inactivity and a dietary shift (Coronary Heart Disease, Consumer Health Complete 2012). CAD directly affects the physical state of a being as well as the psyche. The observational studies suggest that the mental health of an individual directly affects the course of the disease. Psychological stress can add to the overall problem of CAD by eliciting cardiac responses, as psychological stress is a risk factor for the disease. (Rozanski, Blumenthal, Davidson, & Kubzansky 2005). Having to deal with the insurance system and paying for medical expenses may lead to financial stress. In 2004, the overall estimated direct and indirect cost of CHD in the United States was $133.2 billion (Hilscher, 2005). When an individual becomes aware that CHD has progressed to a point where it demands attention, as a result of myocardial infarction, angina pectoris, or the need for coronary artery bypass graft surgery, he or she needs to make immediate lifestyle changes in order to help ensure his or her future health. The schedule of treatment may require changes in diet and lifestyle, Cardiac Rehab and exercise, or changes to work-related patterns (Hilscher, 2005). The United States health care has not always been equal as far as access quality, individuals have not always had the opportunity to have primary and preventative care. There has been evidence that shows individuals in lower socioeconomic statuses tend to be at a higher risk for such diseases as CAD. In this study conducted, data was collected from US Nationwide
Inpatient Sample that showed higher prevalence rate of CAD in patients who had an income less than $50,000 a year than those who made more proving that economic status does have an impact on people with getting CAD (Bashinskaya, Nahed, Walcott, Coumans, Onuma, & Biondi-Zoccai). Families are often faced with the possibility of the CHD patients in their lives being disabled or dying as a result of the disease. CHD threatens family homeostasis, and the psychosocial effects of the illness ripples through the family unit, as family members attempt to adjust to their new situation. The need to restructure family roles and responsibilities as CHD progresses presents a variety of new challenges (Hilscher, 2005). Studies have shown that more common health conditions can lead to coronary artery disease (CAD). One of the biggest contributors of CAD is congenital heart disease, with patients having many of the same problems leading up to CAD with more adults having the congenital disease than children (Yalonetsky, Horlick, Osten, Benson, Oechslin, & Silversides). Often times when adults develop CAD they have also developed related conditions such as hypertension. The main age group that develops CAD are in their 40’s and are likely to have genetic tendency for the disease from the beginning (Hossein, Hesameddin, Ugurlucan, & Bina,).
B. PROBLEM STATEMENT One in four deaths are related to heart disease in Georgia, often due to lifestyle choices (Division for Heart 2013). In Fulton County alone, encompassing the city of Atlanta, Georgia, there were 1,850 cardiovascular related deaths alone in 2003. Also in 2003 $3.3 billion was spent in hospitalization bills with patients being admitted with CAD related complications. Out of all the counties in Georgia, Fulton County had the highest number of CVD related deaths out of all other counties by over 500 deaths. The overwhelming statistics of the severity of Georgia residents’ health is demonstrated in figure 1, where contributing risk factors that can lead to CAD are shown to be much higher in Georgia. (Gregory, Wu, & Kanny, 2005).
Figure 1

(Gregory, Wu, & Kanny 2005). There are currently a few programs in place that are doing everything possible to prevent coronary artery disease and other heart related diseases. There are several Georgia hospitals that support major groups like the American Heart Association. One event that AHA holds is the Start! Heart Walk and Go Red for Women which are meant to help raise awareness, educate the public, and reduce the risk of heart diseases in women by 25 percent. (Dunkin 2009).
C: SOLUTIONS TO THE PROBLEM AND DESIRED OUTCOME
The program that will be implemented is called P.U.M.P.; Preventing Unnecessary Myocardial Problems. The purpose of P.U.M.P. is to decrease coronary artery disease in the community. The program will include primary prevention activities that will increase the perceived gravity of the problem as well as providing prevention methods that will be aimed at creating a sense of urgency in taking action against coronary artery disease. Most deaths from coronary artery disease occur after age sixty five and are preventable (AHA). It is crucial to start making lifestyle changes early to prevent deaths from coronary artery disease in the future. For this reason, P.U.M.P will target adults in the community. This program will be beneficial in decreasing the cost of health care among the community as well as quality of life. The health belief model will be a valuable tool to the P.U.M.P program. According to the health belief model, the realization of cause and effect can help better prepare individuals for a certain outcome. In this case it would help Atlanta residents understand the serious problem CAD presents and help promote actions to prevent CAD. P.U.M.P will educate the community on the causes and consequences of coronary Artery Disease and the benefits of making healthy changes now through a family-friendly health fair that will have different booths to educate participants on the risk factors involved. P.U.M.P will also increase an awareness of individuals’ susceptibility to heart disease through screening assessments. The combination of primary prevention methods utilized during the program will increase the likelihood of the participants recognizing the issue and making a change in their health choices. The success of P.U.M.P will result in a happier and healthier community with a longer lifespan and decreased mortality rates from cardiovascular disease.

II. Program Mission, Goal, and Objectives
MISSION STATEMENT: To decrease cardiovascular disease.
GOAL: To decrease cardiovascular disease in the Atlanta community.
PROCESS OBJECTIVES • Prior to the program, P.U.M.P volunteers will recruit three different organizations for sponsorship.
Outcome (what) recruit different organizations
Priority population (who) P.U.M.P volunteers
Conditions (when) prior to the program
Criterion (how much) three
• Prior to the P.U.M.P health fair the staff will distribute flyers to 60% of the community residents.
Outcome (what) distribute flyers
Priority population (who) health fair staff
Conditions (when) Prior to P.U.M.P
Criterion (how much) 60 percent
IMPACT- LEARNING OBJECTIVES

AWARENESS • After attending the health fair, 100 percent of participants will be able to identify all of their personal risk factors for heart disease. Outcome (what) identify personal risk factors
Priority population (who) participants
Conditions (when) after attending the health fair
Criterion (how much) 100 percent
• After attending the health fair, 100 percent of the participants will be able to describe three lifestyle changes that are necessary to prevent heart disease. Outcome (what) be able to describe three lifestyle changes
Priority population (who) participants
Conditions (when) after attending the health fair
Criterion (how much) 100 perfect
KNOWLEDGE
• After reading the fliers all participants will be able to identify three risk factors for heart disease.
Outcome (what) identify three risk factors
Priority population (who) participants
Conditions (when) after reading fliers
Criterion (how much) all participants
• When asked, all participants of P.U.M.P will be able to describe three ways to decrease their personal risk factors for heart disease.
Outcome (what) able to describe three ways to decrease risk factors
Priority population (who) participants
Conditions (when) when asked
Criterion (how much) all ATTITUDE
During the health fair, 60 percent of the participants will justify their reason for eating a balanced diet.
Outcome (what) justify their reason for balanced diet
Priority population (who) participants
Conditions (when) during the health fair
Criterion (how much) 60 percent
• After attending each booth at the health fair, 75 percent of participants will exemplify a positive attitude on making necessary lifestyle changes.
Outcome (what) exemplify a positive attitude on making lifestyle changes
Priority population (who) participants
Conditions (when) after attending each booth
Criterion (how much) 75 percent
SKILLS DEVELOPMENT
• After attending the health fair all participants will apply the food pyramid guidelines to their diet.
Outcome (what) apply the food pyramid guidelines to their diet
Priority population (who) participants
Conditions (when) during the health fair
Criterion (how much) all
• After attending the health fair 75 percent of participants will be able to calculate their age predicted target heart rate.
Outcome (what) will be able to calculate their age predicted target heart rate
Priority population (who) participants
Conditions (when) after attending the health fair
Criterion (how much) 75%
ACTION/BEHAVIORAL
OBJECTIVES
• After attending P.U.M.P, 50 percent of participants will decrease their regular consumption of processed foods by 90 percent.
Outcome (what) decrease consumption of processed food by 90%
Priority population (who) participants
Conditions (when) after attending P.U.M.P
Criterion (how much) 50 percent
After attending P.U.M.P, 75 percent of participants will exercise for at least 150 minutes per week. Outcome (what) exercise
Priority population (who) 75 percent of participants
Conditions (when) after attending P.U.M.P
Criterion (how much) 150 hours each week
ENVIRONMENTAL OBJECTIVES
After attending P.U.M.P all participants will have access to the information provided at the program at their local health department.
Outcome (what) will have access
Priority population (who) participants
Conditions (when) after attending P.U.M.P
Criterion (how much) all
During P.U.M.P all participants will be provided with transportation to the program activities.
Outcome (what) transportation
Priority population (who) communities
Conditions (when) during P.U.M.P
Criterion (how much) all participants
OUTCOME OBJECTIVES
• Six months after the P.U.M.P program, half of the Atlanta residents will decrease their risk factors for heart disease by 10 percent.
Outcome (what) death rate will decline
Priority population (who) Atlanta residents
Conditions (when) 2025
Criterion (how much) 10 percent
By the year 2025, heart disease deaths will decrease by 50 percent in the Atlanta community. Outcome (what) decrease risk factors
Priority population (who) Atlanta community
Conditions (when) six months after P.U.M.P
Criterion (how much) 50 percent
III. Behavioral Change Theory Used in Developing Intervention Activities The Health Belief Model is the most used theory in health behavior application.
The HBM was created in the 1950s to discover why people chose to use or not use health care. It has been utilized for a variety of problems associated with health behavior. The HBM believes that an individual’s dealing with health related issue is dependent on three classes of factors. The three factors include the existence of motivation about a health concern to make health issues relevant, the belief that one is susceptible (vulnerable) to a serious health problem or to an illness/condition (perceived threat), and that following a particular health recommendation would be beneficial in reducing the perceived threat, and at a subjectively acceptable
cost. The health belief model consists of six constructs that all play a part in how an individual responds to a health concern. Cues to action is one construct in the health belief model. It plants a seed in the individual’s mind. It activates readiness in an individual through awareness and reminders. P.U.M.P’s cues to action will consist of flyers that will provide the reader with a list of risk factors and statistics on coronary artery disease as well as a Facebook page that will provide information on CAD. Perceived susceptibility is another construct of the health belief model that predicts that individuals who think that they are vulnerable to a certain disease will take the necessary actions to avoid their risk of developing the disease. P.U.M.P will achieved perceived susceptibility of its participants through screenings. The screenings will inform participants of their own current risk factors. This will make participants believe that they are susceptible to heart disease. Perceived severity is the seriousness of the disease and the consequences of not taking action. P.U.M.P will have a seminar on the consequences of cardiovascular disease that will make participants aware of their own perceived severity. The likelihood of action consists of the perceived benefits of the program’s actions. Participants will learn that they can prevent Coronary artery disease and live a longer and healthier life by participating in the P.U.M.P program. Barriers that may hinder the participants’ motivation to engage in using the skills provided by the program may include lack of time to commit to the changes, financial costs in changing their lifestyle and overall lack of motivation to make the changes necessary to prevent CAD in their lives. P.U.M.P will reduce barriers by providing incentives and a program that is free and accessible to all community members.

IV. Proposed Intervention Activities
Environmental Change Strategies
Environmental change strategy is most useful in providing opportunities, support, and cues to help people develop healthier behaviors. The environmental change strategy also helps remove barriers within the environment. A major environmental barrier that causes people to make unhealthy choices is the cost of healthier food options. During the health fair a nutritionist will provide participants with a simple recipe book in order to help participants learn how to prepare healthy recipes. Information will be provided that will educate participants on how to shop for nutritious food while on a budget. By removing the environmental barrier that causes the priority population to believe that healthy food is expensive; participants will be able to benefit from nutritious foods on a budget and will avoid unhealthy choices that lead to health problems such as coronary artery disease. Another barrier that may prevent community residents from participating in the health fair is transportation. For this reason, P.U.M.P will provide shuttle rides to all residents. The shuttles will provide transportation to and from the health fair.
Other Strategies: Behavior Modification Activities Behavior modification activities help people in the priority population experience a change in behavior. P.U.M.P. will implement behavior modification strategies through health screenings of risk factors that are correlated with heart disease such as blood pressure, cholesterol and glucose. The information provided to the participants during the health screenings will result in an increased sense of awareness and will help those in the priority population to begin the behavior modification process. The nutritionists that will be at the P.U.M.P health fair will provide information on and nutrition and will inform participants of the benefits of keeping a food log to keeping track of their intake of saturated fats. This helps participants recognize the dietary changes they need to make in order to reduce their chances for CAD.
Health Policy/ Enforcement Strategies Health Policies need to be implemented for the overall wellbeing of the Atlanta population that makes the community healthier. Through this implementation, the community will understand the severity of this problem, taking action to prevent the overall problem that CAD presents. Residents will then be able to understand the benefits of being healthy through what the policy implementation achieves. There are certain barriers that the program presents for the residents including the issues of time, work stress, or lack of motivation to participate in the program. In order for residents to receive foods stamps or any other government aid, community members must attend the education meetings. This also applies for individuals needing to keep their insurance rates down by attending the meetings. Residents must attend a monthly informational session educating them on the benefits of healthy cooking, teaching them what to buy at the grocery store, and making them aware of what unhealthy foods can do to their overall health over a period of time. The way that the program will be implemented is similar to the voting process. Separated by county zoning, each zone will go to a specified area with multiple health classes provided over a month’s period, with dates and times provided well ahead of time in order for residents to make proper arrangements to attend. It will have electronic sign in and mandatory signature requirement. Residents must present a photo ID at the sign in. This will be a regulated policy as it will have a huge impact as to whether some will receive benefits or not. Residents will be required to attend one session each month. Residents will have to pass a series of tests to insure that they are acquiring the knowledge provided, but in the beginning attendance is the main concern. This policy will go into place by the spring of 2015.
Health Related Community Strategies
Health related community strategies are aimed at improving the health of the priority population by reducing the barriers that might be preventing them from obtaining the services that are needed to implement behavior change. Examples of these services include tests, services, treatments and care. P.U.M.P will be implementing a community wide health fair. The purpose of the health fair is to create an increased sense of awareness for coronary heart disease among the community by providing health risk assessments and screening for risk factors by certified health professionals, as previously mentioned. The components of the health fair will include a variety of different booths that will each provide information and assessments for a single risk factor for cardiovascular disease. There will be different booths that focus on blood pressure, smoking, exercise, body fat composition, BMI and waist circumference, cholesterol and dyslipidemia. There will also be a booth that educates participants on the unmodifiable health risks that are associated with cardiovascular disease such as age and heredity and a booth that focuses of the consequences of developing CAD. The goal of the health fair is to make each participant aware of risk factors for CAD. This will increase susceptibility awareness among the participants. The education that is provided on the consequences of CAD will increase perceived seriousness and lead to behavior change that will prevent CAD. P.U.M.P will be using incentives to increase participation. Each participant will receive a red paper heart that will be punched at each booth after they receive the assessment and information that each booth requires. The participants will be eligible for a P.U.M.P t-shirt after the required number of holes are obtained. The audience at the P.U.M.P health fair will include the Atlanta community. It will take place on Saturday February the 11th at Centennial Park in Atlanta during heart awareness month.
Community Mobilization Community mobilization creates a sense of togetherness among community members by addressing their shared concerns. P.U.M.P will utilize health advocacy by using social media. A face book page will be created to target the Atlanta community. The purpose of the site is to reach a large number of the Atlanta community residents and raise awareness of coronary artery disease. It will also keep the Atlanta community informed of upcoming events. The Facebook page will launch on December the 11th, two months prior to the health fair. Facebook users will be able to join the Facebook page at any time and will be encouraged to share the social media site with their friends. The social media site will promote the upcoming health fair by posting one fact about cardiovascular disease each day leading up to the health fair. The facts shared on the Facebook page will serve as cues to action that will make its members consider behavior change that will prevent CAD. Members will also be more likely to attend the health fair because of these motivating updates. The site will post information about the health fair regularly to keep members informed and excited about the upcoming activities.
Health Communication Strategy: P.U.M.P. will use flyers as their health communication strategy. The flyers will provide information on the risk factors for cardiovascular disease. They will provide educational information that will make members of the priority population question their own need to make a change. The increase in awareness that the flyers will provide will increase the likelihood of Atlanta residents’ participation in the P.U.M.P health fair. The flyers will be distributed on Saturday, February 22nd from 12-4 pm.
Health Education Strategies:
Many of the health education strategies and the health communication strategies could be classified identically because of the way they were designed. It is important for health promotion programs to follow what is recommended for each strategy. Participants in P.U.M.P. will be provided with a cardiovascular disease seminar by cardiologist, Dr. John Doe on February 23rd. In his seminar, Dr. Doe will incorporate all five of the adult learning principles. His educational content will commonly be drawn from audiovisual materials, printed educational material, and in-class discussions to stimulate learning in the class population. Dr. Doe will discuss and dissect all modifying factors in his preferred health promotion model, The Health Belief Model, and demonstrate how it relates to cardiovascular disease. His purpose is to educate the population on how the health of the heart is essential for optimal health and wellness. Key characteristics that Dr. Doe incorporates into his curriculum are learning strategies that appeal to all of the individual’s senses.
V. Proposed Strategies for Resources Identification and Allocation
A. Personnel The different types of personnel needed to carry out the program will consist of internal and external personnel. The internal personnel will include individuals from within the organization to supply the needed labor. The external personnel involve individuals from outside of the organization to conduct part of the program.
The P.U.M.P program will include different sources of internal personnel. The first source will consist of 10 staff members within the program and people within the priority population to supply the needed labor. The second source will include 3 employees of the local health department. The employees of the health department will handle planning, implementation, and evaluation of the program. The employees will use peer education in order to educate the volunteers with specific knowledge and skills on how to carry out different parts of the program.
The external personnel of the P.U.M.P program will include representatives from The American Heart Association, cardiologist, nurses and various vendors. Representatives from the American Heart Association will inform people attending P.U.M.P of the different risk factors associated with Coronary Artery Disease and the lifestyle changes that can be made in order to avoid the risk factors. The Cardiologist will provide education on Coronary Artery Disease. Personal Trainers will have training sessions available to educate participants on the benefits of exercise. Nutritionists will provide information on a balanced heart healthy diet.
B. Curriculum and education
The P.U.M.P. program is meant to educate community members on ways to prevent CAD. This will be done by teaching people how to properly exercise, healthy eating habits, and education on the subject of CAD that P.U.M.P. aims to lower CAD prevalence. In the exercise curriculum portion, the personal trainers will demonstrate and teach participants proper form for exercising, different exercises to perform, what activities work what parts of the body, and what exercise routines are best for certain body types. In the healthy eating portion of the curriculum, participants will be taught the benefits of the food pyramid and how to properly apply it to their own everyday eating habits as well as teaching them a few new recipes to prepare. Lastly there will be a curriculum on CAD education, teaching participants all about the disease, how to prevent it and how to deal with the disease if one does get it.
C. Space Allocation
The PUMP health fair is going to be a community wide event. It will take place at Centennial Park in Atlanta. This location is large enough to accommodate everyone in the Atlanta community and is easily accessible by the buses that will be providing transportation to the community residents. Following the P.U.M.P. health fair there will be mandatory classes that community members will have to attend at their respective voting precincts, which will be provided by the county.
D. Equipment and Supplies Equipment for the program will be donated by volunteers for the groups. Computers and printers will be needed in order to obtain instructional material such as papers, brochures, flyers, and study guides. Tents will be provided for vendors in order to set up areas to promote their business. Other equipment needed to check participants health status include blood pressure cuffs, measuring tape, skinfold calipers, scales, and a blood glucose meter and will be provided by the American Heart Association. Nutritionists will be on site to provide information on how to make healthy choices. They will also give presentations on the importance of the food pyramid. Local health food stores will donate healthy snacks for the health fair participants. There will also be educational sessions for strength and exercise with basic equipment such as free weights, yoga mats, and stretch bands. The personal trainers will demonstrate a wide variety of exercises and discuss the importance of strength training as well as cardiovascular exercise. The equipment will be provided by the personal trainers who are working with P.U.M.P. A cardiologist will be providing a complimentary seminar on cardiovascular disease the day after the health fair when all participants are aware of their own personal risk factors for cardiovascular disease.
E. Budget
Revenue and support Amount
Contribution from sponsors: $7,500
Gifts: $500
Grants: $3,300
Participant fee: $0.00 Vendor Fee: (will pay for their advertisement at our health fair) $100
Sales of Curriculum: Vendors will have their material for sale at different prices
Total income $11,400
Expenditures Amount
Personnel, Salary, and Consultants: Health coach $1,200
10 internal staff members $1,400
Instructional material: paper, brochures, flyers, study guides $750
Incentives: 10, $50 gift cards, $300 for free t-shirts $800
Equipment: renting tents for vendors $400
Travel: gas for shuttle at health fair, renting the shuttle for health fair $650
Advertising: P.U.M.P. staff is volunteering their time to advertise with brochures and via web marketing
Total $5,200
Indirect Cost Amount
Renting park for health fair: $5,000
Park Insurance: $1,200
Total indirect cost: $6,200
Total expenditures: $10,000
Balance: $0
Budget Summary
The P.U.M.P budget plan will gain most of its income from various sponsors such as, the American Heart Association, which will generously donate a total of 7,500 dollars. The P.U.M.P program will receive grants at a total of 3,300 dollars. We understand that people can’t contribute to the program on a consistent basis; however various individuals have given us small amount of gifts that totaled around 500 dollars into our revenue and support income. There will be no participation fee due to the fact that the particular vendors will advertise their own product at the health fair. There is no cost for the sales of curriculum because the vendors that will appear at the health fair will have their own material for sale at a wide range of prices. The total income for the P.U.M.P program is calculated to be at 11,300 dollars. The P.U.M.P Program will spend 1,200 dollars on a Health Coach from a local wellness center in the Kennesaw community. The cardiologist will be present on his own terms and conditions educating people about the heart and other important educational information about their cardiorespiratory system. The next expense will be on instructional material like paper would cost 250 dollars and other supplies that will be used at a cost of 500 dollars. Another expense will be the incentives of the P.U.M.P program will be given out to the participants that are 10-50 dollar gift cards and t-shirts of the P.U.M.P logo that will also be given out to the participants would cost 300 dollars to be made. The P.U.M.P program will also provide transportation during the health fair by renting a shuttle for 500 dollars that will bring participants from the community and other places to come to the event and cost for the gas needed for transportation will be 150 dollars. The advertising of the P.U.M.P program such as doing brochures and web marketing will be provided by the P.U.M.P Staff own their own time that and total expenditures will come out to a total of 5,200 dollars. The P.U.M.P program will also have indirect expenses from renting out a park for the health fair at 5,000 dollars and park insurance at 1,200 dollars. The total indirect expense will come to a total of 6,200 dollars. That will also be calculated to P.U.M.P program’s total expenditure at 10,000 dollars.

VI. Proposed Strategies for Marketing the Program
A. Benefits of the program
The main goal of P.U.M.P is to lower the risk factors for heart disease among the Atlanta community members through an intervention using educational material such as pamphlets that will serve as cues to action to make participants think about their own need to make a change. P.U.M.P will also provide more in-depth learning and hands-on experiences such as BMI assessments and educating participants on the importance of determining their own target heart rate. These educational activities will make community members aware of their own personal risk factors for heart disease, the participants will understand the severity of CAD and start taking action by making the necessary lifestyle changes to prevent CAD. Lowering the risk factors for heart disease among the community will also provide an array of other benefits to the priority population such as lower blood pressure, a healthy weight, lower cholesterol and ultimately, a longer and healthier life.
B. The cost of the program
There will be no monetary cost for community members to attend the P.U.M.P program. Transportation will be provided for community residents to make the health fair more accessible. The only cost investment of attending the program for all participants will be their time. In order for the participants to reap the benefits of P.U.M.P, they must make time to attend the program so they can learn about the lifestyle modifications that need to be made. There will also be emotional costs and costs psychological for participants who are attending the health fair. The emotional costs include the participants’ individual attitudes and feelings towards committing to a healthier lifestyle. Psychological costs include giving up unhealthy behaviors such as smoking. The benefits of living a healthier and longer life by reducing the possibility of developing CAD far exceed the costs.
C. The place
The P.U.M.P flyers will be distributed on cars that are located in areas of the target population such as grocery stores, libraries, shopping centers and apartment complexes that are in the Atlanta community. Flyers will be distributed two weeks prior to the health fair on Saturday February 8th. The P.U.M.P health fair will be held outdoors at Centennial Park in Atlanta Ga. It will take place on Saturday February 22th from 12-4 pm. The event will be held in February to coincide heart health awareness month. P.U.M.P’s goal is to make the health fair accessible and convenient for all Atlanta community members. It will be held on a Saturday so that most participants will be off of work and able to attend. On February 23rd Dr. Doe, a respected cardiologist, will provide his free seminar on heart disease to participants of the health fair in his office building in Atlanta at 2 pm.
D. The promotional tools
P.U.M.P will use two different intervention strategies for the promotion of the P.U.M.P health fair. Health communication strategies will involve the P.U.M.P volunteers distributing flyers to the cars and doors of the community members two weeks prior to the event on Saturday February the 8th. This will serve as the program’s advertising--disclose the time and date of the upcoming health fair--as well as an informational tool educating the community about risk factors for heart disease. The information provided in the pamphlets will also serve as cues to action to make community members consider their own need for a change in their behavior. Ideally, the pamphlet will also increase the likelihood of participation in the program. P.U.M.P. will share information with the community by creating a Facebook page two months before the scheduled event on December the 1st. This will serve as community advocacy, which will keep community members involved, creating support for P.U.M.P and other community members who share the same beliefs. One fact about cardiovascular disease will be posted on the P.U.M.P. Facebook page each day leading up to the event. The Facebook page will also post about the different activities that will be available at the event to keep the community updated and involved. Community members will be encouraged to share the event with their friends to increase participation. This advertising tool will help community members stay connected while also keeping them engaged. Another tool that will be used is personal selling as the program team members will have to go to the individual hospitals and businesses for donations.
VII. Proposed Implementation of the Program (Chapter 12)
Stages of implementation
Phase 1: Adoption of the program
The first stage of implementation is adoption of the program. This occurs through the marketing of the P.U.M.P program. The flyers that are distributed to the community list risk factors for cardiovascular disease as well as consequences. A Facebook page is opened to the community and lists facts about cardiovascular disease. These marketing strategies serve as cues to action. The information that is provided makes the community members think about their own need to make a change. This increases the likelihood of community members adopting the program.
Phase 2: Identifying and prioritizing the tasks to be completed
Several small tasks need to be identified in order for the P.U.M.P program to be implemented. The correct number of flyers must be created for the priority population. Volunteers and sponsors must be recruited. Space for the program must be reserved. Every task is important to the success of the program and must not be overlooked. P.U.M.P will use a task development time line to help identify each task that needs to be completed as well as the time frame that it needs to be completed in. This will provide a visual aid to represent the sequence of events involved in the P.U.M.P program and will ensure that the program runs smoothly. It will also allow for P.U.M.P volunteers to monitor the progress of the program in case changes need to be made.

Phase 3: Establishing a system of management In the PUMP program there are going to be multiple groups of management including those who will be in charge of coordinating venues, those who will be in charge of the financial aspect, those in charge of advertisement, those in charge of getting professionals to speak at the event, and those who will need to organize the volunteers. The ones in charge of coordinating venues will need to make phone calls to park coordinators making sure that the dates and times of the venues will be available. Also under this group, the 10 members must contact local vendors who can either donate or rent out resources such as laptops, sound equipment, power point equipment, food, beverages, tables, chairs, and exercise demonstration equipment. The group members will need to know professional phone communication skills, and have knowledge of specific questions on how to ask local vendors to help. These group members will consist of both volunteers and paid workers. The volunteers will be chosen from among Kennesaw State University students who need volunteer hours. The opportunity will be an advertised position on campus. The others will be paid minimum wage based on a clock-in, clock-out system that will be monitored and implemented by the financial group. The financial group will be made up of contracted professional budget managers. There will be five budget managers who will be in charge of keeping up with paid workers hours and keeping their hours in with the salary budget, working with advertisement to ensure that its paid for and kept in budget, working with the venue group to maintain budget and make sure venues and resources are paid for, and making sure all donations are kept organized and allocated properly. The budget managers will meet with leaders from each group to ensure everyone is staying on track on a bi weekly basis. Each budgeter will get paid based on their set salaries made by the company they were contracted through. The advertisement group will contain the largest number of people, mainly consisting of volunteers. This group will work very similarly to a campaign group as they will be promoting the P.U.M.P program. The group will consist of two paid workers who will be in charge of delegating and keeping on a budget. The remaining workers will be volunteers who should be able to work with social media such as Facebook to advertise as well as have technological resources like Photoshop and creative experience with computers in order to make the proper flyers and pamphlets. This group is also responsible for distributing flyers. The final group will consist of five people, two of whom will be paid minimum wage while the other two will be non-salary interns. These people will also need to have the professional phone skills as well as having an in depth knowledge on the program so that they can not only convince professionals that this program is worth investing their time into but that the professionals they contact are the ones for that job. They will need to have good judgment that these individuals will be in the program’s best interest. Lastly there will be a technology team of five paid employees who will operate all technology the day of the event as well as ensuring all equipment needed is acquired by the group coordinating with the vendors. All volunteers from all groups will have compensation for their time such as available food while at work. They will also have the event as a good resume builder with plenty of recommendations from the group leaders for future jobs if their performances are up to par. There will be one large group meeting for all volunteers and paid workers alike at least 6 months before the event is to take place. This event will educate everyone on the purpose of the program and give everyone a since of unity behind the program. After a large group assembly, everyone will break off into their respective groups to learn what their jobs will entail before they will be expected to perform their duties.
Phase 4: Putting the plans into action
The P.U.M.P program will be targeting a large population so it is crucial that the program runs smoothly. To ensure that it is a success, P.U.M.P will use a piloting process to put their plans into action. This will allow P.U.M.P to test the program and work out any problems that may occur before it is implemented to the larger priority population. P.U.M.P will still be targeting the priority population by having the piloting process take place at the local health department. P.U.M.P will use the same flyers that will be used on the larger program to create Cues to action to make community members question their own health. The flyers will state that space is limited and there will be a cap to the number of participants who can attend the event.
Phase 5: Ending or Sustaining a Program
PUMP’s mission is to lower the rates of Coronary Artery Disease in the Atlanta area in order to make a healthier community. It is going to take several years for the program to take effect as it is going to involve working with local government after the health fair to ensure that community members are getting healthier. This program can be paired with other government programs such as food stamp regulations to make sure that people are buying what is best for their health. Decreased CAD rates will be evidence that the community has worked to achieve a healthier population. It is through these implementations that the community will be entrusted to make better lifestyle choices with the knowledge they have gained through the educational seminars. Community wide surveys will be distributed throughout the duration of the program to ensure that community members are getting the most out of the programs benefits.
Concerns Associated with Implementation
Safety and medical concerns:
The main goal of the health promotion program is to improve the health of the participants. To comply to the standards of safety and medical concerns participants will need to have their medical history documented. Program planners need to educate participants about the program they are joining in order to ensure the safety of the participants. The participants should only agree to participate in the program after they are in full understanding of what the program involves. All participants will be required to sign an informed consent form to verify their understanding of what the program’s goals are. Planners will explain the benefits of the program and will also inform participants of alternative programs. Participants will be informed that they are able to discontinue participation at any time.
Ethical Concerns: The program planners will go by the Code of Ethics for the Health Education Profession in order to make proper ethical decisions. This means the program planners will have integrity; planners will be honest, loyal, and accountable. Unethical practice will damage professional reputation and integrity. Program planners will face many ethical issues that revolve around three fundamental principles, which include Respect for Persons, Beneficence, and Justice. Respect for persons acknowledges the freedom of individuals, and requires people with diminished autonomy is provided special protection. Beneficence requires planners to be protective of the participants by maximizing anticipated benefits and minimizing harms. Justice requires that every participant shall be treated fairly. There are many ethical issues that can be dealt with and planners need to be prepared to handle these three components. Legal Concerns The legality of the program is one of the top priorities of P.U.M.P. leaders. Therefore, P.U.M.P. will proactively ensure that all aspects of the program abide by the above described code of ethics in order to protect participants, volunteers, and salaried workers. Participants are required to sign a consent form as a program planner instructs the participants on what to expect from the program. The consent form will release P.U.M.P. representatives from an liability experienced from harm or negligence throughout participants’ program experiences.
Program Registration and Fee collection P.U.M.P. will open registration for the public two months prior to the program launch. If participants do not have internet access they will be able to register on site at the health fair. Participants are not required to pay a registration fee.
Procedures of Record Keeping P.U.M.P. staff is required to keep all records of participants for the future evaluation phases that investors will be taking part in. Health Risk Assessments are a part of the program registration. Therefore, if an individual has risk factors for the types of activities the program will be partaking in, they will need to be cleared by their physician (if available).
Participant Manual Participants will be provided a participant manual in order to receive program information, educational materials and program procedures and guidelines. The manual can help participants organize information they receive and will be able to keep it all in one place. A manual can also work as a reference for the participants in order to answer questions the participant may have. Also participants who frequently use the manual and become familiar with it will be more prone to refer to it outside of the program.
Reporting and Documenting
All documentation such as waivers and consent forms will be readily accessible to all workers. All results of the program will be provided to the public so that residents can witness the impact of the program. This will encourage more participation from the residents who are considering getting more involved. Surveys will also help with the overall participant satisfaction of the program by helping the program make improvements.
Program Participants with Disabilities: The locations for the events will be catered and programmed by the planners to those who are at high risk of CAD and/or have received treatment for a previous incident dealing with coronary artery disease. The program planners will ensure that the guardians of the participants will provide the best medical resources for their loved ones to continue to participate in the program. This will include wheel chair accessibility, pet friendly environment for seeing eye dogs, sign language aid and a safe environment for the visually impaired.
Training For Facilitators:
On the first day, P.U.M.P. staff and volunteers will go through professional phone communication training and be briefed on methods for recruiting local vendors. On the second day volunteers and P.U.M.P staff will be instructed on how to inform the participants and caregivers on the issues of CAD and why the P.U.M.P program is the best fit for their condition.

Dealing with the Problems:
The program planners will meet with all non-paid volunteers, professional volunteers, and P.U.M.P staff if any issues need to be addressed. If there is an issue at the event that is out of the program planners’ control then the next stage will be to call upon local law enforces who will be at the fair already for crowd control.
VIII. Proposed Evaluation Plan
A. Evaluation Purposes and Issues to be Considered
Purpose of evaluation
The main purposes of evaluation are to improve the quality and effectiveness of the program. Formative evaluation takes place early on, before the program is implemented. P.U.M.P. will be using this type of evaluation by pilot testing the P.U.M.P. program. It allows the program planners to work out any problems that may arise and to use the information that is gained through evaluation to improve the program. An impact evaluation will also help P.U.M.P planners to determine if they are on target with their desired outcome changes such as knowledge, attitude, skills, environment or behavior. Evaluating the program helps the planners gain valuable information that will allow knowledgeable decisions to be made regarding the program. Evaluation can also be important to stakeholders. It can provide evidence that the program is worth its cost and also determine if funding for the program will continue.
Practical Problems or Barriers in Evaluation
Evaluation is a crucial step in the P.U.M.P program. Without evaluation, it is impossible to support that the program is effective. There are several barriers that may cause conflict to the evaluation process. Building evaluation into the program too late is one barrier that may arise. Evaluation should be set into place before the program begins. The outcome of the evaluation will help the program planners determine if the objectives were met. When evaluations are set into place early in the program it ensures that any problems with the program can be improved. It also makes data that is related to the outcome of the program less difficult to collect which results in a more successful program. Another problem that the P.U.M.P. program could potentially face is insufficient funding. The success or failure of this program is widely dependent on donations and without financial support, P.U.M.P. may lack the resources needed to pay personnel to conduct a sufficient evaluation.
Ethical Considerations
It is important that participants in the program give their consent before participating in the evaluation process. This ensures that all participants are informed of the purpose and risks of any evaluations that may take place during P.U.M.P. This promotes confidence among the participants by ensuring that their health and wellbeing will not be jeopardized by participating in any evaluation. It also assures participants that their rights and privacy will be protected. These ethical considerations help to secure participants trust in the program by informing them of the purpose of evaluation, which is to improve the P.U.M.P. program to better meet the needs of the community.
Who Will Conduct the Evaluation
The evaluation of the P.U.M.P program will be done by an evaluation consultant. This is referred to as external evaluation. The evaluation consultant is someone who is not connected with the program, but can provide an objective and unbiased review of the program. The consultant brings in a fresh perspective by having knowledge of program evaluation and depth of technical expertise. The consultant will explain material clearly in order to report any flaws within the program. The consultant will explain the benefits and risks of the evaluation. Also, the program staff will receive information on how to conduct an evaluation in order for future evaluations to be conducted within the program.
Rationale justifying the selection of the evaluator
The P.U.M.P program chose to use an external source as their evaluator for many reasons. Although it will be more expensive to use an external source for evaluation, P.U.M.P feels like the expertise and knowledge that will be provided by an outside source will be valuable to the program. Another benefit to using an outside source is that the evaluator will not be connected to the program in any way and will provide a more objective and unbiased review of the program as well as providing more breadth and technical expertise regarding the evaluation.
B. Evaluation Design
C. P.U.M.P. will embark on a non-experimental evaluation design. The program will integrate both qualitative and quantitative methods that will be distributed equally throughout the evaluation process. The program has selected model 4 to infuse qualitative (description of the goals achieved from individual outcomes) and quantitative methods (how many people will comeback and use the program?) to be certain that the program would have excellent reviews and could be looked at from two perspectives simultaneously.
D. The qualitative method that the program will utilize is the participant-observer study. P.U.M.P. chose this method so the evaluator could get a feel for what the participant might think, say, or how he/she participates in the program. Some drawbacks to this approach might include the evaluator becoming sidetracked while participating in various activities throughout the program. A positive outlook towards this method is that the evaluator would see an increase of usage of the program from the success it has given participants after their first trial The non-experimental design will not be used well with the experimental or time series design approach. Non- experimental design approach would only allow the program to be evaluated over a period of the P.U.M.P program itself will take considerable amount of time to be implemented. The only drawback that can could potentially come from this design is the lack of knowing whether or not participants were motivated to apply these lifestyle modification changes as a long -term lifestyle change from the educational tools about the risk factors and symptoms of CAD.
E. The quantitative approach of the Participant observer studies would be used in the P.U.M.P program by observing and analyzing the behavioral change of participants as they apply all the educational tools that they will or have received from the health fair and other health promotional events that will enhance the awareness on coronary artery disease.
F. P.U.M.P will not face any challenges with internal and external validity. With internal validity participants could have a lifestyle change within the participant’s daily life that will increase their usage of the P.U.M.P. program. Participants will not show pretest-to-posttest differences because the non experimental approach allows P.U.M.P staff and vendors to see how well participant may take it upon themselves to learn more about coronary artery disease outside of the program in order to avoid risk factors. Mortality is another threat to internal validity being that participants may drop out of the program between the pretest and posttest, which may affect the overall outcome of the program to decrease the risk of coronary artery disease. External validity is another validity that should not be considered. Many factors will not hinder the external validity and are known as reactive effects and this causes individuals to react in a certain way. Social desirability can occur due to participants wanting to impress the evaluator by saying certain risk factors have been avoided regardless of the participant’s actual behavior. Expectancy effect can cause participants to act in a certain way when attitudes are projected onto the participant. For instance a participant who smokes will be told a number of times that smoking is a major risk factor of CAD the participant may behave in a self-defeating manner. The Hawthorne effect refers to a behavior change of the special status of those being tested. Participants will show an increased ability to apply vital lifestyle changes to avoid certain risk factors and symptoms. This program will only be valid and reliable to participants as they witness more of the benefits of the program due to the evaluation process.

C. Matrix of Objectives, Program Outcomes, Intervention Activities, Evaluation Measures and Type of Evaluation

Proposed Program Objectives
Program Outcomes
Intervention Activities
Evaluation Measures
Type of Evaluation
Process/Administrative Objectives

1- Prior to the program, P.U.M.P
Volunteers will recruit three different organizations for sponsorship. Recruit different organizations NA Will provide that the program has appropriate materials Process
2- Prior to the P.U.M.P health fair, the staff will distribute flyers to 60% of the community residents. Distribute flyers NA Distribution of pamphlets Process
Learning – Awareness Objectives

1- After attending the health fair, 100% of participants will be able to identify all of their personal risk factors for heart disease. Identify personal risk factors Health education Survey Analysis Impact
2- After attending the health fair, 100% of the participants will be able to describe three lifestyle changes that are necessary in preventing heart disease. Able to describe three lifestyle changes Health education Survey Analysis Impact
Learning – Knowledge Objectives

1- After reading the flyers, all participants will be able to identify three risk factors for heart disease. Identify three risk factors Health Education Increased awareness and knowledge provided by flyers Impact
2- When asked, all participants will be able to describe three ways to decrease their personal risk factors for heart disease. Able to describe three ways to reduce risk factors Health Education Increased awareness and knowledge provided by program education Impact
Learning – Attitude Objectives

1-During the health fair 60% of the participants will justify their reason for eating a balanced diet. Justify the reason for a balanced diet
Health Education Behavior is modified by increased knowledge leading to changes in attitude Impact
3- After attending the health fair, 75% of the participants will exemplify a positive attitude on making necessary lifestyle
Changes.
Exemplify a positive attitude on making lifestyle changes
Health Education A new behavior and attitude is adopted Impact
Learning – Skill Development Objectives

1- After attending the health fair all participants will apply the food pyramid guidelines to their diet. Apply the food pyramid guidelines to diet
Community Organization and Community Building Healthy eating habits will be made as a positive health change
Impact
2-After attending the health fair 75% of participants will be able to calculate their age predicted max heart rate. Will be able to calculate target their age predicted max heart rate
Community Organization and Community Building Increased knowledge is exhibited in the skills gained through the program Impact
Action/Behavioral Objectives

1-After attending P.U.M.P, 50% of participants will decrease their regular consumption of processed foods by 90% Decrease consumption of processed food by 90%
Community Advocacy Measures of health risks are decreased Outcome
2- After attending P.U.M.P, 75% of participants will exercise for at least 150 minutes per week. exercise
Community Advocacy Measurable change in QOL due to increased exercise Outcome
Environmental Objectives

1- After attending P.U.M.P all participants will have access to the information provided at the program at the local health department. Will have access to information
Health-Related Community Service Adequacy of resources are given to participants and distributed Process
2-During P.U.M.P shuttle rides to the community will provide all participants with transportation transportation
Health-Related Community Service Transportation Services provided to the community removing potential barriers Impact
Outcome/Program Objectives

1-six months after the P.U.M.P program, half of the Atlanta community will decrease their risk factors by 10% Death rate will decline Health policy/ enforcement- evaluation Measurable risk factors decreased along with QOL increase Outcome
2-By the year 2025 heart disease deaths will decrease by 50% in the Atlanta community Decrease risk factors Health policy enforcement- evaluation Measures in the morbidity and mortality rates decrease
Outcome

D. Proposed Data Presentation
When presenting data to the population, P.U.M.P. will be sure to incorporate all sections and recommended guidelines that are included in a successful evaluation report. The program will be sure to include the abstract to describe the overview of the program, the introduction to pose the purpose of program which includes the primary goals as well as the objectives. The report will also contain methods and procedures P.U.M.P. utilizes (priority populations, instruments used, and how data was collected and analyzed) as well as the results from the program’s data collection. At the end of the report, the program will describe the interpretation of the results as well as the conclusions about the program’s effectiveness. It is also imperative that P.U.M.P. discusses the limitations of the program as well as recommendations. In addition to the inclusion of what is needed in the program’s evaluation report, P.U.M.P. will also include tables and figures to clearly express numerical data that will be self-explanatory for an uneducated individual about the subject matter.
P.U.M.P. desires to actively seek evaluators who not only evaluate the program to fulfill the obligations of the stakeholders, but also evaluators who press decision makers to constantly make improvements to the program. Key characteristics to increase utilization that P.U.M.P. will adopt is to involve stakeholders in the planning process, provide high quality research, incorporate a sense of clarity in written reports as well as charts that will be presented, and to focus the evaluation on conditions that decision makers can change.
IX. Summary Coronary artery disease is an unnecessary problem in the state of Georgia as it is an avoidable disease through a healthy and active lifestyle. CAD is a potentially life threatening disease that causes plaque buildup in the arteries and over time can eventually lead to atherosclerosis, which is the narrowing of the arteries. It can be caused by hereditary disposition but it can also develop over time due to lack of exercise, poor diet, smoking, and diabetes. The goal of P.U.M.P. is decrease cardiovascular disease in the Atlanta community. The target population that P.U.M.P. chose is adults living in Atlanta as the city was shown to have a higher prevalence rate of CAD and is the centerfold of the state. The program is targeting adults specifically because adults are the most at risk for developing preventable habits that can lead to CAD later on in life. An adult can also fully grasp and understand the risks of getting CAD, which will hopefully lead the community as a whole to change as is the goal of the program. In order to better advertise and explain the purpose of the program to the public, there will be distribution of flyers, education provided at the health fair to be held at Centennial Park in down town Atlanta, and a Facebook campaign that will launch by December 11th. The health fair will provide screenings to determine which participants are at a higher risk of CAD, as well as providing everyone with recipe books in order to promote healthy eating, and effective exercise regimens that will help lower the participants’ risk of getting CAD. Buses will be available to transport community members to the fair to promote more attendance for those who may have difficulties with transportation. Once the fair has been completed, six months after the P.U.M.P program, half of the Atlanta residents will decrease their risk factors for heart disease by 10 percent. In order to further insure that this outcome happens, there will be a state requirement that Atlanta residents must attend monthly meetings that educate on an overall healthier lifestyle. Progress must also be evident that participants are in fact applying their knowledge to their personal lives. If residents do not comply and attend the meetings, their health insurance rates will go and individuals on such government handouts such as food stamps will no longer be able to receive them until they have begun to go to the educational meetings. Outside evaluators will be present to mark the overall success of the program and intervene when changes need to be made. At the end of the program, the mission is to decrease cardiovascular disease. Atlanta’s transformation will just be one small stepping stone to a healthier city, a healthier state, and a healthier country as whole.

X. References
Works Cited
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Hossein Ahmadi, S., Hesameddin Abbasi, S., Ugurlucan, M., & Bina, P. (2013). Positive Family History as the Single Traditional Risk Factor for Developing Extensive Very Premature Coronary Artery Disease: A Case Report. Journal Of Tehran University Heart Center, 8(1), 54-57.
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Rozanski, A., Blumenthal, J. A., Davidson, K. W., Saab, P. G., & Kubzansky, L. (2005). The Epidemiology, Pathophysiology, And Management Of Psychosocial Risk Factors In Cardiac Practice. Journal of the American College of Cardiology, 45(5), 637-651.
Shah, I., Faheem, M., Shahzeb, & Rafiullah. (2013). FREQUENCY OF CORONARY ARTERY ANOMALIES IN ADULT CARDIOLOGY PRACTICE; AN ANGIOGRAPHIC STUDY. JPMI: Journal Of Postgraduate Medical Institute, 27(2), 136-142.
Yalonetsky, S., Horlick, E., Osten, M., Benson, L., Oechslin, E., & Silversides, C. (n.d). Clinical characteristics of coronary artery disease in adults with congenital heart defects. International Journal Of Cardiology, 164(2), 217-220.
XI. Appendices