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L127 Task 1

Nikkea Ferrin

Western Governors University

November 5th, 2020

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Section A1: Sentinel Town PDF

Please see attached file name “NF Sentinel Town Photo Journal”

Section B: Community Health Nursing Diagnosis Statement

Increased risk of limited access to healthcare among all residents of Sentinel Town

related to transportation issues and limited clinic availability as evidenced by poor road

conditions, no public transportation services, clinic closing at 5 p.m. and not open on weekends,

lack of pharmacy, and lack of emergency services.

Section B1: Health Disparity

A health disparity is defined as the differences in health outcomes that are closely linked

with social, economic and environmental disadvantages within a population (U.S. Department of

Health & Human Services, 2011). One major health disparity for the residents of Sentinel Town

is unreliable transportation. Most of the roads in town are dirt roads that often become

impassable during times of heavy rain or snow. There is also no public transportation system

available for residents that are unable or cannot afford to drive a car. Additionally, there are

limited sidewalks throughout the town and the ones that are present are in severe disrepair. These

poor transportation options significantly limit Sentinel Town’s access to healthcare. According to

Healthy People 2020 (2014a), studies have shown that a lack of reliable transportation can lead

patients to delay or skip medication, miss scheduled appointments, and postpone seeking medical

treatment.

Section B1a: Primary Community and Prevention Resources

Limited access to healthcare is a concern for the residents of Sentinel Town. However,

the town does have some community and primary resources available. The primary community

resources include the general store, service station, church, and the volunteer Emergency
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Medical Technicians (EMTs). The general store and service station carry a wide range of over

the counter medication and first aid supplies. This provides the residents with the supplies

needed to treat minor medical issues on their own. The church in town also has volunteers from

Home Grown Health Services to provide medical care on the first Friday and Saturday of the

month. Finally, multiple residents of Sentinel Town serve as volunteer EMTs for the town and

can provide ambulance transport into the city for emergency care. The primary prevention

resources in Sentinel Town include the local clinic and prescription mail service. The clinic is

open on weekdays from 9 a.m. to 5 p.m. The physician and nurse who work there will

occasionally make house calls to residents who are unable to make it into the clinic. The clinic

can also help residents set up prescription mail services in order to receive their medications

(SentinelU, 2017).

Section B1b: Contributing Factors and Underlying Causes

The contributing factors to the limited access to healthcare services in Sentinel Town

include limited clinic hours, no pharmacy, no emergency services, poor road conditions, no

public transportation and limited health insurance coverage. The primary underlying cause is

lack of financial resources to improve the town’s infrastructure and fund more healthcare jobs.

This is a rural, small town with mostly low-income residents. There is no governing body for the

town and all requests for funds must be made by the sheriff at the county or state level

(SentinelU, 2017).

Section B2: Evidence-Based Practice

According to the U.S. Health Resources & Services Administration (2019), the evidence

shows that in order to improve access to healthcare there needs to be an increase in the capacity

of healthcare services and infrastructure, improvement in the quality and effectiveness of

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healthcare systems, and better connections between the at risk patient population to primary and

preventive care services. By following these evidence based recommendations, access to

healthcare in Sentinel Town could be improved by increasing the capacity and hours of the

clinic, building new health care services such as a pharmacy or telehealth services, and

distributing information to the residents about the health care services available and helping them

get connected to those services.

Section B2a: Identification of Data

Sentinel Town has a population of 609 residents. The median household income is

$27,024. The number of residents living in poverty is 12%. The percentage of residents without

health insurance is not provided, however the clinic nurse, Dulce Lopez states that “many of our

citizens don’t have proper health insurance.” (SentinelU, 2017).

In 2018, Snohomish county in Washington state had a population of 822,083 residents.

The median household income was $82,751. The percentage of residents living in poverty was

7.5%. The percentage of residents without health insurance was 7.2%. (U.S. Census Bureau,

2019).

In 2019, the United States had a population of 328,239,523. The median household

income was $68,703. The national poverty level was 10.5%. The percentage of citizens without

health insurance was 8%. (U.S. Census Bureau, 2020).

According to Healthy People 2020 (2014b), there are multiple disparities that contribute

to decreased healthcare access including lack of health insurance, language barriers, disabilities,

inability to take time off from work to attend appointments, geographic and transportation-

related barriers, and a shortage of primary care providers and clinic hours. The above data

supports that lack of access to healthcare services is a true problem for the residents of Sentinel
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Town due to having a significantly lower income, higher poverty rate, and estimated lower

health insurance rate as compared to Snohomish county and national levels.

Section C1: Social Media Campaign Objective

Within one year there will be a 5% increase in the number of Sentinel Town residents

who receive primary and preventive care services.

Section C2: Social Marketing Interventions

The first social marketing intervention will be to create an SMS texting campaign to help

distribute knowledge about the healthcare resources available to the residents of Sentinel Town.

It was reported by the clinic nurse that many of the residents do not know what healthcare

resources are available or how to access them. The texting campaign would be a quick and easily

accessible way to help inform the residents of these resources.

The second social marketing intervention would be to design and print posters that

promote the texting campaign. These posters should be placed in areas of high foot traffic in

town such as the health clinic, general store, gas station, school and church. In order to receive

the information from the texting campaign, the residents need to opt-in to the campaign by

texting a keyword to a specific phone number on their cell phones. The posters would include the

phone number, keyword, and instructions on what to do in order to opt-in to the texting

campaign.

Section C3: Description of Social Media Platform

The SMS texting campaign format would be the best social media platform for

communicating with the residents of Sentinel Town because it is easy to use, requires minimal

user effort, and does not require consistent internet access. This platform only requires the

resident to sign up once through their cell phone and then they receive periodic text messages
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with important and relevant healthcare information. Some examples of information to be

distributed through these messages include how to sign up for health insurance, how to utilize

Telehealth services, available clinic hours, and reminders on when to get preventive health care

services such as the seasonal flu vaccine.

Section C3a: Benefits of Social Media Platform

Social media can be used to personalize health messages to target audiences, increase

timely distribution and impact of health information, facilitate interactive communication, and

empower people to make safer and healthier decisions (U.S. Centers for Disease Control and

Prevention [CDC], 2011, p. 1). The benefits of utilizing the SMS texting social medial platform

include easy access, free content, portable format, and the ability to reach many residents

quickly. For a social media campaign to be successful at supporting preventative healthcare,

there must be sufficient engagement with the campaign by the target audience. The residents of

Sentinel Town are more likely to engage with the SMS campaign format because it requires

minimal user effort to sign up. The resident only needs to sign up by texting a keyword to a

specific phone number. Then they will receive periodic messages with health information that is

targeted to the residents of Sentinel Town. The content provided through the SMS campaign is

also free and delivered in a mobile format. This makes it more likely for the residents to

participate as there is no cost to them and is convenient to use and share with other residents.

This social media format also makes the health information provided accessible to most of the

Sentinel Town residents. According to the Pew Research Center (2019), 95% of American adults

in rural areas own a cell phone. This suggests that even though Sentinel Town does not have

reliable internet access, the residents could still access the provided healthcare information

through text messages sent to their cell phones.

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Section C4: Benefit to Target Population

The target population of the SMS texting campaign includes all residents of Sentinel

Town who own mobile phones. The residents will benefit from this campaign because they will

receive healthcare information that is specific to their community. This information will include

resources on how to sign up for health insurance, how to access remote Telehealth services,

clinic hours, and information on why preventive care such as annual check ups and vaccinations

are important. Access to this information will help increase the target population’s access to

healthcare.

Section D: Best Practices for Social Media

According to the CDC (2011), the three key principles that make social media effective

as a health communication tool are personalization, presentation, and participation (p. 7).

Personalization ensures that the content included in the campaign will be tailored to the needs of

the target population. Presentation means that the content should be relevant to the target

population and presented in an accessible format. Finally, participation means that the campaign

partners and the public should be able to engage with the campaign in meaningful ways (CDC,

2011, p. 7).

Section E1: Stakeholder Roles and Responsibilities

There are multiple stakeholders in Sentinel Town who have specific roles that are critical

to the implementation of the social media campaign. Jack Carter is the Sheriff of Sentinel Town

and will be responsible for requesting funding from the county and state levels in order to fund

the campaign. The clinic staff and volunteer EMTs and firefighters will help promote the

campaign by word of mouth and posting promotional flyers in their work environment.

Volunteer residents will be responsible for printing and posting the promotional flyers
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throughout Sentinel Town and promoting through word of mouth. Finally, all residents in

Sentinel Town who have a cell phone will be the users of the social media platform.

Section E2: Potential Public and Private Partnerships

The private partnerships for the campaign will include the SMS texting company and a

Telehealth company. The SMS company will be responsible for tracking the number of residents

who participate in the campaign, managing users, and sending out the campaign content. A

Telehealth company may be interested in partnering with the social media campaign in order to

promote itself to the residents and could provide a commission to help fund the campaign.

The public partnerships will include the clinic physician and nurse, Sheriff, firefighters,

EMTs and resident volunteers. Elliot Evans is the clinic physician and would be responsible for

providing the healthcare information and resources that will create the content of the campaign.

The clinic nurse will be responsible for tracking the number of residents who come in for

preventative health services. The sheriff will be responsible for seeking state and county funding

to support the campaign. The firefighters and EMTs would be responsible for promoting the

campaign. Finally, other volunteer residents would be responsible for printing and posting the

promotional flyers throughout Sentinel Town. All public partners will form the social media

campaign committee.

Section E3: Implementation Timeline

The implementation timeline will be three months long. During the first month, the clinic

physician will provide the health information and resources content to the campaign committee.

The committee will research SMS texting companies and gather data on cost. They will also

research Telehealth companies that would fit the needs of Sentinel Town. Finally, the Sheriff

will request funding from the county and state.

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During the second month, the committee will choose an SMS and Telehealth company to

partner with. The committee will also design the promotional flyers for the campaign.

During the third month, the SMS company will launch the campaign. The committee will

poster the flyers throughout Sentinel Town and start promoting the campaign.

The campaign will run for one year and then the clinic nurse, Telehealth, and SMS

texting companies will provide statistical data that will be used to evaluate the effectiveness of

the social media campaign.

Section E4: How to Evaluate Effectiveness

The SMS texting campaign will be evaluated after a period of one year from the

implementation date. According to the CDC (2016), there are three types of indicators that can

be assessed to determine if a program is implementing their campaign as expected and achieving

their outcomes. These indicators include input, process, and outcome indicators. There are

primarily two indicators that need to be assessed in order to determine the effectiveness of the

campaign. The first is a process indicator and assesses how many residents signed up to receive

the messages from the campaign. This data can be obtained through the SMS texting company

and should include the resident’s age, race, and gender if available. An analysis of this

information will help determine the effectiveness of the campaign promotion. The residential

demographic data would show which subset of residents were not previously attracted to the

campaign and the campaign could then create promotional material tailored to those groups in

the future. The second question to evaluate the effectiveness of the campaign is an outcome

indicator and assesses if the primary objective was achieved. The primary objective of this

campaign is to increase the number of Sentinel Town residents who receive primary and

preventive care services by 5% within one year. This data will be obtained from the clinic staff
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and the Telehealth company. Evaluation of this data assesses the effectiveness of the content sent

to residents through the campaign. The campaign would use this data to see what kind of content

is most effective in achieving the objective and which content was ineffective. This information

would then be used to shape the future content of the campaign to be more influential to the

Sentinel Town residents.

Section E5: Cost of Implementing the Campaign

The largest direct cost of this SMS texting campaign will be the charges from the SMS

company that sends content to the residents. There are various factors that determine this cost

including the length of the campaign, number of residents participating, and how often messages

are sent out to residents (CDC, 2011, p. 24). The second direct cost will be the printing of posters

promoting the campaign. This cost varies depending on the paper style, size, number, and colors

used. The indirect costs of the campaign will include renting space for the campaign committee

to meet and travel costs for the sheriff while requesting funds from the county and state

leadership. This campaign also relies heavily on volunteer hours from the residents of Sentinel

Town for promotional and implementation support.

Section F: Reflection on Social Media Marketing

Social media is a valuable resource for the community health nurse because they can

distribute important health information to large numbers of the community quickly and easily.

An example of this could be a social media campaign utilizing a community Facebook page to

increase the number of influenza vaccines received in the community. Promotional material on

the page can be targeted on the specific populations within the community that fall behind in

vaccination rates.
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Section F1: Reflection on Future Nursing Practice

As a labor and delivery nurse, I can see how the use of social media could improve my

practice. One way to utilize social media within my field is to create an SMS texting campaign

that sends information to pregnant women throughout their pregnancy. This information could

include fetal development stages and how to stay healthy throughout the pregnancy. This would

be an easy way to distribute information directly to the specific population it applies to in a quick

and easily accessed format. I believe that the use of social media could be extremely beneficial in

my nursing practice.
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References

Healthy People 2020. (2014a). Access to Health Services. Retrieved October, 2020, from

https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/

interventions-resources/access-to-health

Healthy People 2020. (2014b). Access to Primary Care. Retrieved October, 2020, from

https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/

interventions-resources/access-to-primary

Pew Research Center. (2019). Demographics of Mobile Device Ownership and Adoption in the

United States. Retrieved October, 2020, from https://www.pewresearch.org/internet/fact-

sheet/mobile/

SentinelU. (2017). Sentinel Town®- Rural Community Simulation [Computer software].

Retrieved October, 2020, from https://sentinelu.com/sentinel-town/

U.S. Census Bureau. (2018). Quick Facts Snohomish County, WA. Retrieved from

https://www.census.gov/quickfacts/fact/table/snohomishcountywashington/

INC110218#INC110218

U.S. Census Bureau. (2020). Income, Poverty and Health Insurance Coverage in the United

States: 2019. Retrieved October, 2020, from https://www.census.gov/newsroom/press-

releases/2020/income-poverty.html

U.S Centers for Disease Control and Prevention, Office of the Associate Director for

Communication. (2011). The Health Communicator's Social Media Toolkit. Retrieved

October, 2020, from

https://www.cdc.gov/socialmedia/tools/guidelines/pdf/socialmediatoolkit_bm.pdf
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U.S. Centers for Disease Control and Prevention, Program Performance and Evaluation Office.

(2016). CDC Approach to Evaluation. Retrieved October, 2020, from

https://www.cdc.gov/eval/indicators/index.htm

U.S. Department of Health & Human Services. (2011). HHS Action Plan to Reduce Racial and

Ethnic Health Disparities: A Nation Free of Disparities in Health and Health Care.

Retrieved October, 2020 from

https://www.minorityhealth.hhs.gov/assets/pdf/hhs/HHS_Plan_complete.pdf

U.S. Health Resources & Services Administration. (2019). Vision: Healthy Communities, Healthy

People 2019-2022 Strategic Plan. Retrieved from

https://www.hrsa.gov/sites/default/files/hrsa/about/strategic-plan/HRSA-strategic-plan-

2019-2022.pdf