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Health Assessment: The Town Of Randolph, MA

Community Health Assessment

This document contains a description of the town of Randolph, Massachusetts. A Community Health Assessment which embraces vital aspects of its physical, psychological and social Integrity was conducted. Also,  a community diagnosis of a dysfunction/function issue within the community as well as a comprehensive analysis out lining a plan of action for resolving these issues was undertaken..

Outline

Introduction

Community Health Assessment

  • Physical Integrity
  • Psychological Integrity
  • Social Integrity

Community Diagnosis

Care Plan

Conclusion

Community Health Assessment

The Town of Randolph, Massachusetts

Introduction

The purpose of this community health assessment is to offer the Board of Health in the town of Randolph suggestions for resolving pertinent community health issues, which have existed over a significant period of time. These issues have climbed to epidemic proportions grasping public health attention.

With this information, it is hoped that the board of health be able can channel its limited resources to areas most needed to significantly improve its residents’ health status.  More importantly, community health assessments are meant to identify strengths, health concerns and available resources within in our community to address health abnormalities (Center for Disease Control and Prevention, 2010).This assessment was achieved by conducting a windshield survey.

Community Health Assessment

Physical Integrity:-

  • Location and size

        Town of Randolph is situated in the city in Norfolk County, Massachusetts, United States. As of the 2010 census, the town population was 32,112. It is located at 42°09′24″N 71°2′56″W / 42.15667°N 71.04889°W / 42.15667; -71.04889 (42.173417, -71.049124); fifteen miles south of Boston, at the intersection of Routes 128 and 24. The location supports its economic and social history through its easterly boundaries within the state. Importantly, towards the North the town of Randolph shares boundaries with by Milton and Quincy; Braintree and Holbrook on the east, Canton on the west, and Avon and Stoughton on the south and southwest.

Precisely, Randolph can be found 15 miles south of Boston and 211 miles from New York City. According to the United States Census Bureau, the town has a total area of 10.5 square miles (27.2 km²), of which 10.1 square miles (26.1 km²) is land and 0.4 square mile (1.1 km²) (4.10%) is water. It is drained by the Cochato River and Blue Hill River, which flow into the Neponset River. (U.S. Census Bureau, 2010).

  • Topography

This embraces natural features that would impact architectural designs and safety of the environment. During the community health assessment authorities were concerned about to the degradation of land surfaces though construction of buildings in areas formally delegated for agricultural development. Major concerns were related to respecting properties in close proximity to each other with regards to disruption of the privacy of residents in the neighborhood. Hence adhering to zoning polices in erecting infrastructure according to specified.

There ought to be no blockage in street/pathways. Buildings ought to be accessible to streets, business places, hospitals, schools and accessible to transportation ( History Town of Randolph, 2010).

  • History, Industry and environmental factors

During King Philip’s war, most of the area of present day Randolph and Holbrook was parceled to settlers from Boston and Braintree. In 1793 Randolph was incorporated of the town of Braintree. According to the centennial address delivered by John V. Beal, the town was named after Peyton Randolph, first president of the Continental Congress. During this time local many industries emerged. Farmers started making shoes and bodueots to augment household incomes from subsistence farming. With half of a century these industry blossomed into being the main income for residents of this town ( History Town of Randolph, 2010).

Employees arrived from New England, Canada, Ireland and later Italy as well as Eastern Europe. The common goal was seeking improvement in their financial circumstances while adding value to the quality of life in the Randolph. By 1850, the town became one of the nation’s leading boot producers, shipping boots as far away as California and Australia. With the decline of the shoe industry at the beginning of the twentieth century bringing changes to the industrial climate Randolph then evolved into a suburban residential community. As manufacturing and service industries took precedence ( History Town of Randolph, 2010).

However, by 1950s, Randolph experienced significant growth in its Jewish population with Jews moving in from Boston’s Dorchester and Mattapan neighborhoods. This continued until the early 1990s, when the Jewish population shrank to about 6,000 but still remains a significant and prominent part of the town of Randolph. The environment attracted former residents of Dorchester, Mattapan and other Boston neighborhoods, as Blacks, Asian and Latino populations African-Americans, Cape Verdeans, Caribbean people, Chinese, Vietnamese and Puerto Ricans and many others. The twenty-first century Randolph is a very diverse industrialized community (History Town of Randolph, 2010)      ).

2010 U.S. Census Bureau (2006-2010 American Community Survey)

U.S. Census Bureau (2006-2010 American Community Survey)

The median household income reflects $64,607annually, which is slightly higher than that of Massachusetts. Number of renters in Randolph who pay 30% and more of their income in rent is relatively higher when compared to the state level. Whereas the amount of owner occupied houses in Randolph is higher than the state level (U.S. Census Bureau, 2010).

  • Government

Randolph was originally governed by a representative town meeting form of government. In a special election on April 7, 2009, the town adopted a new charter, which took effect January 2010. This charter created a council-manager system of governance. The current town manager is David C. Murphy, ( History Town of Randolph, 2012)

Psychological Integrity:-

  • Population

(US Census, 2010)

There were 11,313 households. 31.7% contain children under the age of 18; 53.0% have married couples living together; 13.4% consist of female householders with no husband present, and 29.4% were non-families. 23.6% of all households were single male or female; 10.5% of them were 65 years of age or older. The average household size was 2.71 and the average family size was 3.25. Population distribution can be described as 23.3% under the age of 18, 7.2% 18 to 24, 30.9% 25 to 44, 24.3% 45 to 64, and 14.3% 65 years of age and older. The median age was 38 years. For every 100 females there were 91.7 males. For every 100 females age 18 and over, there were 88.0 males (US census, 2012)

Area
Count
Area
Percent
MA State
Percent
Persons under 18 years of age *   7,215 23.3 23.6
Persons under 20 years of age   8,451 26.0 25.5
Persons age 65 years and over   4,041 12.4 13.3
White non-Hispanic persons   16,724 51.4 81.0
Black non-Hispanic persons   9,925 30.5 6.0
Hispanic persons   1,325 4.1 7.9
Asian persons   4,494 13.8 4.9
AFDC Medicaid Recipients   1,141 4.2 7.1
Multiple Assistance Unit Medicaid Recipients   101 1.0 1.2

Source: U.S Census Bureau, 2010 Census

  • Education

The town of Randolph has one high school servicing grades 9-12 (Randolph High School), one middle school for grades 6, 7, and 8 (Randolph Community Middle School), and four elementary schools with grades K-5. They are John F. Kennedy; Margaret L. Donovan; Martin E. Young and Elizabeth G. Lyons Elementary Schools. Pre- K education is provided through home schooling. Educational programs provide alternatives for students. For example, the Blue Hills Regional School District,  allow Randolph students entering the ninth grade have an opportunity of attending the Blue Hills Regional Technical School/ Blue Hills or the Norfolk County Agricultural School/Aggie, instead of Randolph High School. The school system is governed by a School Committee (Town of Randolph,  2012).

Randolph School District Profile, Selected Populations Report Accessed July 2012 (Massachusetts Department of Elementary and Secondary Education, school year 2011-2012)

  • Religion

There are a number of religious denominations found in the town of Randolph. These include Christianity, Judaism, Islam and other multi-ethnic religious groups. The large presence of whites and Jews in the population makes Judaism the dominant religious culture.

  • Socio-economic characteristics

An analysis of the town of Randolph’s socio economic characteristic reveal that due to the      variation in ethnic composition the population is relatively better socioeconomically than adjacent communities as well as others across the nation. Below are recent data pertaining to unemployment, below poverty line community levels and WIC participation among mothers and children requiring additional assistance with formula and family planning education. Further analysis of these data would be further discussed in the community diagnosis section of this document.

CHNA 20 Community Health Assessment, 2011  (Kids Count 2007

Massachusetts Labor and Workforce Development, 2011, Labor Market Information (Labor Force and Unemployment Data, most recent 13 months) Accessed July 2012

CHNA 20 Community Health Assessment, 2011 (U.S. Census Bureau, 2005-2009 American Community Survey)

(e)       Crime

Even though the crime rate in Randolph is relatively stabled there are still incidences of assault which ought to recognized and addressed as a public health issue. Below is a table showing incidences of assault occurring in the town of Randolph.

Social integrity :

  • Health care facilites

There are no hospitals in the town of  Randolph, but one long term care facility, Cedar Hill Health Care Center. Comparing the foregoing data retrieved with concerns of stakeholders in the town’s health care industry, it was discovered that while diversity has positive impacts there are some major socio-economic health challenges.

  • Health Indicators

Health indicators within a community reflect not only the present health status, but also predict future developments based on trends. After viewing the health indicator data below there is a significantly commendable low rate of HIV/AIDS infection among the other sexually transmitted diseases such as syphilis. However, gonorrhea and chlamydia have been reported to have a high incidence within the town of Randolph. Other concerns include congestive cardiac failure, hepatitis B and asthma, especially, among the childhood populations. Below are additional data pertaining to these conditions.

Area Count Area percent State percent
Per Capita Income $23,413 $25,952
Per Capita Income 1,245 4.1 9.3
Population below 200% of poverty level 4,967 16.2 21.7
Children less than 18 years of age living below 100% of poverty line 338 4.8 12.0
Unemployed persons age 16 and over   1,590     1,590 8.5

(US census, 2010)

Area Count Area Crude Rate State Crude Rate  
HIV Incidence N/A N/A 8.6
HIV/AIDS Prevalence   84 258.1 261.0
AIDS and HIV-related deaths   1 3.1 2.2
Tuberculosis   NA N/A 3.7
Pertussis 0 0.0 5.8
Hepatitis-B   7 21.5 11.3
Syphilis   NA N/A 9.4
Gonorrhea   20 61.4 37.9
Chlamydia   139 427.0 322.1
Area Count

 

Area Age-specific  Rate  State  Age-specific 

  Rate   

Chlamydia, ages 15-19   0 0.0 3.9
Gonorrhea, ages 15-19   NA N/A 76.6
Chlamydia, ages 15-19   35 1698.0 1310.9

( Center for Disease Control, 2012)

MassCHIP Health Status Indicators Report for Randolph (Massachusetts Department of Public Health, 2011)

(c) Health Literacy

When health literacy  is evaluated in Randolph Community it was found to be closely related to social literacy. Department of health and human services defined health literacy as ‘The degree to which individuals have a capacity for obtaining, processing, and understanding basic health information and services. This Community has the most foreign born residents in South Shore vicinity. As such, language is a great indicator as to how well heath information is received and interpreted. Over 40 different languages are spoken in the town of Randolph.  Apart from English, the three other major languages spoken are Vietnamese, Haitian Creole, and Spanish (Bach, 2012).

MassCHIP Health Status Indicators Report for Randolph (Massachusetts Department of Public Health, 2011)

MassCHIP Health Status Indicators Report for Randolph (Massachusetts Department of Public Health, 2011)

MassCHIP Health Status Indicators Report for Randolph (Massachusetts Department of Public Health, 2011)

Community Diagnosis

  • Community Genogram

  • Explanation of genogram relating data retrieved from assessment

The above community genogram offers a brief summary of the Town of Randolph and the community health diagnoses, which have been identified. This diagram does not depict a wellness diagnosis, but the town of Randolph certainly has one. In the epidemiology of social diseases now redefined sexually transmitted disease there is a wellness diagnosis in the category of HIV/AIDS and syphilis. Incidence is none existent on the area level. However, a prevalence existents at the rate of   84 area count; crude area rate258.1, and crude state rate 261.0.

Alternatively, chlamydia and gonorrhea rank high in both incidence and prevalence at a crude area rate of 61.4 (gonorrhea) and 427.0 (chlamydia), respectively. This community genogram also depicts a community health diagnosis related to incidences of cardiovascular daisies and asthma which are ther three health community diagnoses, which have been identified.

(c) Discussion on diagnosis

Marjorie Muecke (2004) contends that the concept ‘community health diagnosis’ initially plays the role of identifying sources of ambiguity that have impeded making the goals and values of community health nursing operational. As such, she suggests refinements of meaning in conceptualization of the community health diagnosis, which can focus more on the community as a primary level of analysis (Muecke, 2004). There is no doubt that while three major health conditions emerged as a triad of concerns in the town of Randolph, there are underlying influences, which predispose to these conditions that ought to be further explored before a more comprehensive community health diagnosis could become definite. Distinctly, social disease community diagnosis is linked to social integrity, while cardio vascular relates to physical and asthma psychological.

Development of cardio vascular disease emerges from a person’s life style. Associating factors are high serum cholesterol levels, age, gender, high blood pressure, diabetes mellitus; tobacco smoking, air pollution lack of exercise; excessive alcohol consumption and stress (Kelly, & Fuster, 2010).  A study conducted in Nigeria by Mbakwem, Aina, Amadi, Akinbode, and Mokwunyei (2013) cited life style impacts being a consequence as well sequel of the dysfunction. They have further advanced that health promotion measures should focus on preventing complications and improving quality of life (Mbakwem et.al, 2013).

The researchers realized that there was insufficient evidence based studies on quality of life in patients with cardio vascular disease in sub-Sahara Africa while many existed for the Caucasian section of the population. As such, they embarked upon a comparative analysis  applying two instruments for assessing the variable in heart disease patients. The quality of life index was measured in ‘stable HF patients attending the cardiology clinic of the Lagos University Teaching Hospital using a disease specific instrument, Kansas City Cardiomyopathy Questionnaire (KCCQ) and a generic one, the WHOQOL- BREF’ (Mbakwem et.al, 2013, abstract).

Quality of life and four other domains were assessed utilizing a sample of 190 patients’ health data as well as responses to administered Kansas City Cardio Vascular Questionnaires (KCCQ) and WHOQOL – BREF. Results were compared. It was discovered that over 25% of stable patients with heart disease had poor quality of life. Therefore, this is a very serious indicator for health promotion management regarding primary, secondary and tertiary levels of intervention (Mbakwem et.al, 2013).

Importantly, when these variables are applied to the Town of Randolph they reflect much more about than a community health diagnosis itself. Precisely, it is saying to community health promotion specialists that in this town, perhaps, dietary education may be necessary since rates of hypertension, diabetes mellitus; alcohol substance abused and tobacco smoking are associated with heart disease. To some degree air pollution can be linked to the prevalence also (Kelly, & Fuster, 2010).

Similarly, when asthma as a community diagnosis is considered there are many questions, which ought to be answered with regards to the causes of this abnormality. Experts have identified a combination of complex incomprehensive environmental factors causing this condition. More importantly, they have concluded that while genetic and psychological factors could predispose to asthma twenty-first century evidence based research shows where a change in environmental conditions inclusive of air pollution has been the emerging element in the high incidence of asthma within modern societies (Boulet, 2009). Again life the style variable surfaces as a social determinant.

Studies conducted by Wendy More (2010) and colleagues revealed five distinct clinical phenotypes of asthma. These were identified with applications of unsupervised hierarchical cluster analysis.  Clusters were obtained from subjects who met the American Thoracic Society definition of severe asthma. This supported clinical heterogeneity in asthma and the necessity for more relevant approaches towards classification of its severity. Insidiously, it means that health promotion specialists will have to review their approaches in management from primary, secondary and tertiary level perspectives (More et.al, 2010).

Consequently, supporting health promotion research conducted by Barbara Velsor-Friedrich, Lisa Militello, Rebecca Lieb, Israel Gross, Edna Romero and Maryse Richards (2011) regarding ‘Promoting Self-Care In African-American Teens With Asthma’ revealed that when the NHBU expert panel guidelines for the treatment of asthma was applied to a sample of high school teen only 56% of them were in control of the condition. Therefore, health promotion should be a combination of exploring contemporary evidence based findings and applying them to modernization of health promotion strategies (Velsor-Friedrich et.al, 2011).

Notably, while the control of HIV/AIDS can be applauded traditional sexually transmitted diseases are still prevalent. Both Chlamydia and gonorrhea are bacterial infections for which cures exist. Untreated gonorrhea in women can cause pelvic inflammatory disease infertility and in men urinary tract conditions including stricture (Workowski & Berman, 2006). This is the epidemiological significance of controlling gonorrhea and chlamydia within the town of Randolph.

Evidence based research reveals that while this may be the epidemiology of chlamydia in the town of Randolph many cases can still go undetected as newer strains of organisms causing the disease emerge. For example, research conducted by Margaretha Jurstrand, Hans Fredlund and Magnus Unemo confirmed in 2006 that the presence of ‘a new variant of Chlamydia trachomatis (nvCT) in Sweden. Due to a cryptic plasmid deletion, the nvCT was undetectable in several of the genetic diagnostic systems used internationally at that testing time. However, it was identified as being active since 2003 (Jurstrand et.al, 2013).

Consequently, while primary health promotion is focused on prevention, secondary must also keep close contact with changes in the epidemiology of organism affecting hosts through frequent diagnostic screening. Precisely undetected strains of an organism, especially, in sexually transmitted disease health promotion techniques impact its effectiveness. Ultimately, incidences and prevalence escalate. Public health then cannot address the abnormality professionally.

Hence, this is an obvious limitation to the epidemiological model approach towards health promotion intervention. In applying the SIR model which contains three components the disease will be limited to three considerations. First S (t) reflects those who have not been infected, but are susceptible. Secondly I (t) represent people who are already infected and have the capability of transmitting the disease. Thirdly, R (t) identifies those who have been infected recovered and are no longer capable of transmitting the organism (Daley & Gani, 2005).             How then would this epidemiological model account for people carrying diverse undetected strains? Therefore, primary health promotion must aim at continuous research within the science to embrace contemporary changes inclusive of organism mutation

Care Plan

Goal:-

To control incidences and prevalence of cardiovascular disease; asthma and sexually transmitted diseases (Gonorrhea and chlamydia)

Objectives:-

  • To sensitized community regarding emerging health concerns
  • To educate community through health promotion concerning life style changes
  • To engage stakeholders in the change process
  • To collaborate resources in embracing and sustaining changes.

Intervention

Objective Time-Frame Strategy Application Evaluation
To sensitized community regarding emerging health concerns 2-3 months 1.Speak with department of health officials

2. Obtain their support in the dissemination of data process,

3.Seek approval to commence sensitization process

1. Begin media wide dissemination of information regarding cardiac disease and sexually transmitted gonorrhea and chlamydia.

2. Considerations should be made in generalizing the project including other communities in turning attention away from Randolph and the perception of the health problem being specific to Randolph

Conduct a survey to evaluate response to the information whether the community is seeking answers or more information.
To educate community through health promotion concerning life style changes 2-3 years  Provide accessible health education and  available services for these condition 1.Design workshops

2.Design health promotion literature

2. Design educational programs

Have participants evaluate what they have leant by filling out questionnaires
To engage stakeholders in the change process 2-3 years Invite Stakeholders to join the process Relate progress of the intervention so far and gather responses for moving forward with funding for a wider outreach Asses their reaction and support by how many consent to joining the process
To collaborate resources in embracing and sustaining changes 2-3 years Obtain funding to expand health promotion venture Provide a more detailed sustained project that would control these conditions in the long term Conduct another community health assessment to identify new developments and strategies in addressing them.

Conclusion

Comparatively, the town of Randolph is remarkably unique. Its ethnic diversity is unmatched by any other community in the Commonwealth. Nonetheless, Randolph as any other community in the world has it peculiar health issues which can be resolved through education and careful intervention strategies. Cardiovascular conditions are prevalent worldwide. With just one health care facility and not clinics health promotion is necessary through clinical intervention. It is hoped that the proposed care plan bear fruit into resolving these issues in this otherwise affluent community.

References

Boulet, L. (2009). Influence of comorbid conditions on asthma. Eur Respir J 33 (4): 897–906.

Center for Disease Control and Prevention (2010) Retrieved on April 19th from  http://www.cdc.govCommonwealth of Massachusetts official website. http://www.mass.gov/portal/cities-towns/randolph.html

Daley, D., & Gani, J. (2005). Epidemic Modeling: An Introduction. NY: Cambridge University Press

Jurstrand, M. Fredlund, H., Unem, M. (2013). The new variant of Chlamydia trachomatis was present as early as 2003 in Örebro County, Sweden, but remained undetected until 2006. Sex Transm Infec.

Kelly, B., & Fuster, V. (2010). Promoting Cardiovascular Health in the Developing World: A  Critical Challenge to Achieve Global Health. Washington, D.C: National Academies Press.

Mbakwem, A. , Aina, F. , Amadi, C. , Akinbode, A. and Mokwunyei, J. (2013) Comparative analysis of the quality of life of heart failure patients in South Western Nigeria. World Journal of Cardiovascular Diseases, 3, 146-153

Moore, W. Meyers, D., Wenzel, S. (2010). Identification of Asthma Phenotypes Using Cluster Analysis in the Severe Asthma Research Program. American Journal of respiratory and   Critical Care, 181(4), 313-323

Muecke, M. (2004). Community Health Diagnosis in Nursing. Public Health Nursing, 1(1), 23-35

History Town of Randolph. (2010). Town of Randolph. Retrieved on April, 2013 from http://www.townofrandolph.com/Public_Documents/index

US Census Bureau (2010). Randolph Census Records. Retrieved on 19th April, 2013 from http://www.americantowns.com/ma/randolph/info

Velsor-Friedrich, B. Militello, L. Lieb, R.  Gross, I. Romero. E., & Richards, M. (2011). Promoting Self-Care In African-American Teens With Asthma. Asthma 56, A1909-A1909

Workowski, K., & Berman, S. (2006). Sexually transmitted diseases treatment guidelines, 2006 MMWR Recomm 55 (11), 1–94