Running head: COUMMINTY CHANGE PROJECT
Planned Community Change Group Project
Holley West, Mary Bierlein, Jessica Stewart, Michelle Klochack, and Alyson Swinehart
Ferris State University
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Abstract
Kent County, Michigan has been identified to have a high rate of chlamydia infection amongst
women between the ages of 20-24. This paper includes an analysis specified to the community
needs in Kent County based on high chlamydia rates which examines strengths of the community
and identifies possible barriers leading to increased rate. The paper also includes a problem
statement which clearly acknowledges the population of females ages 20-24 years old as a high
risk population in Kent County related to several causative factors. Numerous direct and indirect
consequential measures are identified that would demonstrate success of the intervention
implemented.
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Planned Community Change Group Project
Since the beginning of civilization public health nursing has existed with records
indicating early populations burying waste products away from water supplies to control
communicable diseases (Harkness & DeMarco, 2012). Since then, professional public health
nursing has been driven by the health needs of the community and the population it serves. In
the twentieth century, public health nursing played a dominant role in the spread and treatment of
diphtheria, smallpox, measles as well as countless other communicable diseases. As we step
further into the twenty-first century, public health nursing is acknowledging modern day
challenges such as bioterrorism, teen pregnancy, chronic diseases, HIV/AIDS, and prevention
and treatment of sexually transmitted diseases (STD) such as chlamydia (Harkness & DeMarco,
2012).
“Chlamydial infection is the most common STI in the United States and, since 1994, has
comprised the largest proportion of all STDs reported to the CDC” (Harkness & DeMarco, 2012,
p. 253). Many women infected with chlamydia go undiagnosed due to the lack of significant
symptoms the infection presents. Often symptoms are mild, and can include abnormal vaginal
discharge or burning with urination (Access Kent, 2009). A chlamydia infection can result in
urethritis, cervicitis and pelvic inflammatory disease which may cause of infertility in woman
among childbearing age. The infection can also spread to newborns through the delivery process
resulting in a neonatal eye infection or pneumonia if the mother is infected (Harkness &
DeMarco, p. 253). The most specific test used to diagnose chlamydia is by obtaining a culture;
however, urine tests are also now available in ordered to diagnose this infection (Harkness &
DeMarco, p. 253). Chlamydia is caused by a bacterium and treatment is fairly easy and involves
administration of an antibiotic. Several antibiotics can be prescribed to treat this infection. The
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most common antibiotics used are azithromycin, doxycycline, and erythromycin. After taking the
appropriate antibiotic, the infection resolves in one to two weeks (Harkness & DeMarco, p. 253).
Analysis
In 2010, Kent County was the third leading county to have the most confirmed reported
cases of chlamydia in Michigan with only Wayne and Oakland Counties ranking higher
(Department of Community Health, 2011b). Chlamydia greatly exceeds any other sexually
transmitted disease (STD) reported in Kent County. Furthermore, Kent County Health
Department reported 2,217 cases of confirmed chlamydia infections in females during 2010
resulting in a rate of 726 per 100,000 (Department of Community Health, 2011a). The most
recent data reported from the Centers for Disease Control and Prevention states that the national
average rate of chlamydia for women is 592.2 per 100,000 (CDC, 2011b). The number of
women affected was at a rate of 2:1 in 2010 (Access Kent, 2011). In the same year the number of
African Americans diagnosed with chlamydia in Kent County was at a rate of almost 9:1 (Access
Kent, 2011).
The two associated zip codes of Kent County that have the highest chlamydia and
poverty rates of the county are 49507 and 49503, which are located within the city of Grand
Rapids (Access Kent, 2011). Kent County has several colleges including: Ferris State University,
Aquinas College, Michigan State University, Cornerstone University, Kuyper College, Calvin
College, Grand Rapids Community College, Aquinas College Child Development Central,
Kendall College of Art and Design (FSU), and Compass Film Academy. This accounts for the
large amount of people living in the small geographical area of Grand Rapids.
One noted factor contributing to the high rates of chlamydia are teens and adults not
practicing safe sex. Chlamydia is spread during anal, oral or vaginal sexual contact with an
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infected person (Harkness & DeMarco, 2012, p. 253). An additional factor influencing rates
would include women unaware they have a chlamydia infection. An additional factor influencing
rates would include women unaware they have a chlamydia infection due to the lack of
pronounced symptoms. Many women are either asymptomatic or have very mild symptoms.
Other symptoms that may occur are abnormal vaginal discharge or a burning feeling with
urination that may be attributed to other medical issues (Access Kent, 2009). A combination of
un-safe sex practices and lack of symptoms in order to be diagnosed with chlamydia could lead
in unintentionally spreading the disease to others.
Michigan and the United States show an increase percentage of chlamydia (CDC, 2011b).
This increase could be associated with the population’s increased adherence to screening
programs, diagnostic tests being are more sensitive, accurate case reporting from physicians and
labs, and modernized better information systems providing clear, accurate statistical information.
The asset-based assessment model could be associated with this effort, which is a model that’s
attention is directed to community strengths and resources as a primary approach to community
assessment. Using collaboration with community members shifts the focus from dependency on
experts to empowerment of all, working together toward a goal (Harness & DeMarco, 2012).
With application of this model a true and precise evaluation of community change can be
observed.
Kent County’s community possesses the resources and strengths necessary to take action
and change the statistics. This county has rates of chlamydia well above the national and state
average and the application of the following interventions and resources would make a
difference. The Kent County Health Department offers testing, provides assistance in contacting
partners and provides treatment and counseling services (Access Kent, 2011). They also have a
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“Reducing the Risk” incentive which is a “16-session research-based curriculum designed to
reduce the rate of teenage pregnancy and exposure to sexually transmitted diseases” (Access
Kent, 2011, para. 6). This information is targeted toward children ages 14-18 and focuses on
increasing the use of contraception and condoms as well as reducing or delaying the frequency of
intercourse (Access Kent, 2011, para. 6). MTV Network, Kaiser Family Foundation and Planned
Parenthood have promoted a national campaign “Get Yourself Tested” (GYT) (CDC, 2011a).
The Patient Protection and Affordable Care Act of 2010 expands insurance access for young
adults and eliminates chlamydia screening copayments. The National Chlamydia Coalition is
training medical professionals, endorsing screening, developing tools to facilitate office-based
screening, disseminating information through lectures, articles and webinars, and promoting
quality measures to improve adolescent care. They also address racial/ethnic disparities using a
mini grant to develop community level prevention approaches (CDC, 2011a).
The Fuller Clinic is the main Public Health Clinic and is located in the 49503 zip code.
There are satellite clinic locations, which are clinics that are associated with hospitals spread
throughout the county. These clinics include Kentwood Clinic, North County Clinic, Sheldon
Clinic Sheldon Complex, and the Wyoming Clinic. Additional places for diagnosis and treatment
include: Mary Free Bed, Spectrum Health-Butterworth, St. Mary's Health Care-general
information, Grand Rapids Women's Health, Heartland Health Care Center, Helen DeVos
Children's Hospital, and Pine Rest Christian Mental Health.
Although information is available to the community through several resources, testing
and treatment appears to be a barrier in the community. The task of locating and identifying
services available and fees related to these services is difficult. There is a large need for an easy
“one stop shopping” ad for ease of access to available community resources and teaching within
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Kent County. Advertisements placed in common places, teaching at local public places, and
outreach programs would increase awareness. Local schools, newspapers, governmental offices,
and medical practices would be additional resources for increasing awareness and the
collaborative efforts in the community. Due to this drastic increase above the national average
rate and identified community barriers, it necessitates involvement from the community health
nurse in the form of a community change project.
Problem Statement
By means of thorough analysis of Kent County statistics, it is evident chlamydia infection
rates are far exceeding the national average in the population of 20-24 year old females. Possible
causative factors that can be measured and changed to decrease the incidence of chlamydia
include increasing community awareness of chlamydia infections. This would include increasing
the knowledge of 20-24 year old female of the signs and symptoms of chlamydia, transmission
of the disease, implications of Chlamydia, and places in the community to get tested and receive
treatment. Another factor that would decrease the rates of Chlamydia would be to increase the
knowledge of the target population on safe sex practices.
Through use of a community intervention to decrease the rates of chlamydia in 20-24
year old females, one would see both direct and indirection measures changed indicating success.
One such direct measure that would be evident is a decrease in chlamydia rates. Local agencies
and medical facilities would see an increase in the number of women seeking testing and
treatment. The community Health Departments would notice an increase in the number of
condoms passed out to the target population. Local health care providers would observe lower
incidences of urethritis, cervicities and pelvic inflammatory disease which are caused by
chlamydia (Harkness & DeMarco, 2012). Furthermore maternity departments in local hospitals
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and birthing centers would detect a reduction in the rate of associated neonatal eye infections and
pneumonia which can be transferred to the newborn through the delivery process if the mother is
infected (Harkness & DeMarco, 2012).
Indirect measures could also be evident if the intervention implemented into the
community was successful. One such indirect measure would be women of childbearing age
would have a decrease in fertility difficulty. A major cause of infertility in young women of
childbearing age is the presence of pelvic inflammatory disease (Harkness & DeMarco, 2012).
As previously mentioned, pelvic inflammatory disease is caused by chlamydia. If intervention
were successful in the community, infertility rates associated with chlamydia would decrease
among women ages 20-24. Another indirect measure that could be seen would be decreased rates
of other STDs. With females ages 20-24 participating in safe sex practices with using a condom,
other STDs could also be avoided. As well as the community could see a decrease in the rates of
un-planned pregnancies.
The following problem statement will assure appropriate community health action in the
form of a research based intervention to implement into the community to successfully decrease
rate of chlamydia:
Risk of chlamydial infection among young women ages 20-24 in Kent County, Michigan
related to unprotected sexual contact with an infected person, sexual contact with multiple
partners, sequential sexual partnerships of limited duration, cervix of teenage girls and young
women not fully mature leaving them more susceptible to infection if sexually active, and
multiple obstacles to accessing health care among young adults.
Conclusion
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In conclusion, public health nursing has always responded to the priority health needs of
the community by serving individuals, families and the community as a whole. It was identified
through an analysis that Kent County has a rate of chlamydia infection that is well above both
the National and State average (Department of Community Health, 2011a). The population most
affected by the infection is 20-24 year old females (Access Kent, 2011). Strengths of the
community, existing agencies and possible barriers were all identified to form a problem
statement specific to the community. Acknowledgement of causative factors that can be
decreased and both indirect and direct measures that would signify success of the intervention
were also recognized. With this analysis and problem statement, a research based intervention
can be formed and can be implemented into the community to bring about change.
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References
Access Kent. (2011). Health education programs. Retrieved from
http://www.accesskent.com/Health/HealthDepartment/Health_Promotion/Health_Educati
on.htm#Com.
Access Kent. (2009). Kent county health department 2009 communicable disease summary.
Retrieved from
http://www.accesskent.com/Health/HealthDepartment/CD_Epid/pdfs/2009/2009_CD_Su
mmary.pdf.
Centers for Disease Control and Prevention. (2011a). CDC grand rounds: chlamydia prevention:
challenges and strategies for reducing disease burden and sequelae. Retrieved from
www.cdc.gov/mmwr/preview/mmwrhtml/mm6012a2htm?s_cid=mm6012a2_w.
Centers for Disease Control and Prevention (2011b). Sexually transmitted diseases. Retrieved
from http://www.cdc.gov/std/Chlamydia2009/stateA.htm.
Department of Community Health (2011a). Number of chlamydia cases and rates per 100,000
population. Retrieved from
http://www.mdch.state.mi.us/pha/osr/CHI/STD_H/ZYT2AL25.ASP.
Department of Community Health (2011b). Ten counties with leading chlamydia cases.
Retrieved from http://www.mdch.state.mi.us/pha/osr/CHI/STD_H/SD10CC1A.ASP.
Harkness, G.A., & DeMarco, R.F. (2012). Community and public health nursing practice:
evidence for practice. Philadelphia: Wolters Kluwer/Lippincott, Williams & Wilkins.
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