Introduction
Founded by William Aiken in 1835, the historic town of Aiken is located on the eastern border of South Carolina (Aiken County Historical Society, 2014). The city of Aiken is encapsulated by three large highways/roads. These infrastructural borders include Anderson Pond Road, Highway 1, and I-20. Silver Bluff Road and Whiskey Rd are the primary roads that facilitate traffic throughout Aiken. The small towns that border the city of Aiken are Warrenville, Graniteville, New Ellenton, Couchton, Williston and more. Although starting off as a small railroad town in the early 1800’s, Aiken has evolved into an urban city that has since been ranked number one by Southern Living, lifestyle and tourism magazine, as the best small town in the south in 2018 (Leusse, 2022). Aiken functions primarily for production and consumption as there are many small businesses that provide production and many stores that enable consumption for the community. The purpose of this paper was to thoroughly assess the City of Aiken and to formulate and implement a plan to resolve the issue of obesity.
Assessment of Community
Aiken is an eclectic small town that has a population of 31,895 people (U.S. Census Bureau, 2021). There is an abundance of life on the streets with scenic walkways and bike paths to accommodate those on foot. Downtown, during the weekends, many people congregate to socialize and enjoy refreshments at locally owned restaurants and bars. The most popular of these congregation areas, The Alley, welcomes its visitors with a large cast iron banner showcasing its name. Open space in downtown is limited, as each side of the road is occupied with clusters of tightly grouped buildings and store fronts. The urban downtown hub is well maintained with appealing flowers, water fountains and green grass to bring nature into a predominantly architectural area. Most of the downtown homes have historically traditional characteristics with white column pillars and older structural styles. There are some buildings, such as the Holley Hotel, that are vacant and show signs of decay with chains draped around the entrances, fragmented windows and deteriorating wood. Although historic, this abandonment in some parts of the downtown area is unappealing and uninviting.
As one travels from the downtown area, there is a shift in socioeconomic and health traits. The racial composition of the population consists of 61.5% Caucasian, 33.3% Black/African American, 2.3% Hispanic, 1.8% Asian, and the other 1.1% is multiracial (U.S. Census Bureau, 2021). Unlike the downtown area that is predominantly Caucasian, the true composition of the city is represented in the area between downtown and Anderson Pond Rd. Poverty and low health statuses are very prevalent in these areas. According to the U.S. Census Bureau (2021), 12.5% of people in Aiken are impoverished. This can be seen in areas of trailer parks, government funded housing, and veterans that are unemployed. The population of veterans in Aiken is 2714 people, which is approximately 11.7% of the total population of Aiken (U.S. Census Bureau, 2021). The veteran population, along with many others of this community, display signs of patriotism through political and nationalistic merchandise. For example, many wear hats that displayed United States of America or the Veteran Affairs logo.
Politics in the city of Aiken have shown themselves to be in favor of conservative ideations. There are various forms of local and national political advertisement in the community, such as bumper stickers of Donald J. Trump and yard signs stating, “Say No to Pascalis Project.” Information regarding this is made readily available to the community through newspaper stations at gas stations and billboard advertisements. Local officials campaign using these resources in efforts to reach the entirety of the community and accommodate those who may not have access to internet services.
Community health services are abundantly available in Aiken and are spread thoroughly through the city. These services include urgent care centers, pharmacies, and dental offices. These facilities are active as the parking lots are mostly occupied by people. The same was observed at the local gym of Planet Fitness, which shows that groups of the community value their health, while others are trying to improve their health. Adult obesity is 37% in Aiken so it could be improved upon. Another indication that this is a community value is that primary care physicians see 3196 patients per year which is a 6.93% increase from last year (County Health Rankings and Roadmaps, 2022). Covid-19 still has its grasp on the community as businesses and services, such as Julie Ziegler Dentistry, are trying to control the spread of covid by closing the waiting room and requesting for patients to call in prior to entry.
Religious opportunities are plentiful as there are many churches in the community. The churches of Aiken represented denominations of Baptist, Methodist, Pentecostal, Episcopal, and non-denominational. The variety of denominations allows the community to practice their specific beliefs. A sign displayed in front of Millbrook Baptist Church was asking for canned goods to help the community and provide the impoverished with food. This shows how the church contributes to the health and wellbeing of the community in ways other than religion.
Analysis of Data
The religious availability of Aiken is a strong suit for the community. The churches provide the community with a place to share their common beliefs and values with one another and help to unite the community together. Healthcare availability is a strength of Aiken as well. There are opportunities for the community to seek primary care, urgent care, or health maintenance services, such as dentist offices. Connecting the community members to services that prevent barriers that limit them from receiving healthcare allows them the opportunities to receive the help they desire. Safety is held to a high standard in Aiken, as there are many officers that are on patrol. The higher quantity of officers out for patrol allows for quicker responses to emergencies, which gives the community a sense of security in their safety.
Weaknesses of the community are more prevalent. Poverty stricken areas are examples that the median household income is lower in Aiken. According to the Census Bureau (2021), the median household income of Aiken is $56,202. This is lower than the national average of $67,521, but higher than surrounding areas, such as Augusta, which is $53,269 and North Augusta, which is $51,084 (U.S. Census Bureau, 2021). A primary weakness relates to the health and morbidity of the Aiken community. According to Schmitt (2017), the highest obesity rates throughout the United States is in the Midwest and the South. With this being said, Aiken is already at risk for obesity. Aiken has an overabundance of fast-food restaurants on Whiskey Road that encourage people to eat ultra-processed food (UPF). According to Beslay (2020), UPF is associated with significant increases in weight. Kathy Kitchens, NP (personal communication, September 26th, 2022) explained that roughly 90% of her patients in Aiken are obese. The nutritional quality of an individual’s diet is one of the most major modifiable risk factors for weight management (Beslay, 2020). The town does not offer many affordable restaurants that are nutritious and that produce quality food. Kathy Kitchens, NP (personal communication, September 26th, 2022) stated that “Education is key to tackling obesity with the primary focus being on diet.” The issue of obesity must be approached from a multifactorial perspective to help address the issue. However, with the help of Aiken’s abundance in healthcare services, the community can unite in efforts to address this issue collectively.
Plan for Intervention
Introducing a long-term program that educates about obesity, connects community members with local resources and encourages routine follow-ups would prove to be beneficial for the Aiken community. The initiation of a long-term program would offer the Aiken community an opportunity to take control of their weight and regain their footing towards a healthier, happier life. The program would need to offer in-person and digital modes of application that would focus on the education and maintenance of weight management. According to Kathy Kitchens, NP (personal communication, September 26th, 2022), education and lack of resources are the biggest barriers for overweight individuals to incorporate a balanced diet into their routine. Regarding Kathy Kitchen’s observation, the program would need to also connect participating patients with one of the many health related resources located in Aiken.
An example of a program that offers beneficial change to a community relating to obesity is the mobile app Zanadio. Zanadio, which was approved by the German Federal Institute for Drugs and Medical Devices, has been introduced on the national scale in Germany to help provide a digital and multimodal treatment plan for patients diagnosed with obesity (Forkmann, 2022). The goal of Zanadio is to provide education and support to patients in order to beneficially change their lifestyle choices to treat obesity (Forkmann,2022). The program incorporates nutritional, behavioral, physical and psychological support to their patients as part of their six-to-12-month long treatment plan. The mobile app allows patients to communicate with physicians and psychotherapists. Forkmann (2022) found that the patients using Zanadio expressed that weight loss was important. Many of them stated they had a long history of weight loss attempts. The success of Zanadio was judged by a clinical trial in which they reached a weight loss of at least five percent in all patients. Forkmann (2022) found that 3-5% of weight loss still positively affects obesity-related comorbidities and improved physical and psychosocial comorbidities.
The program that would be implemented in Aiken would be named ChangeU. ChangeU would be like Zanadio but with alterations to better fit the community and would use the strength of the community to its advantage. The new program would focus on Aiken’s greatest strength which is availability and abundance of health care. These health care facilities would partner with ChangeU to promote the use of the program as a treatment option for obesity. They would do this through referrals to the classes or with a QR code located at the facility to encourage the patients to download the mobile app. The mobile app would eliminate any barriers, such as conflicting work hours and lack of time due to taking care of the children, that may inhibit individuals from attending the in-person classes. The incorporation of in-person classes differs from zanadio but would better help the implementation of the program in Aiken due to higher amounts of older individuals who are not as technology oriented in comparison to their younger counterparts.
The design and implementation of Zanadio was clinically proven to be effective so ChangeU would incorporate similar techniques. ChangeU would focus on three main cornerstones of implementation. The first being knowledge transfer. Educating these patients would be done through classes or through educational videos on the mobile app. The patient would be regularly assessed of their newly obtained knowledge through end-of-lesson quizzes and examinations to ensure comprehension of the material. The next cornerstone would be transition. The patients will transition from their old nutritional and physical habits into the program’s expected habits. The transition will be promoted by the app as it will offer exercise programs and nutritional tracking to enable the patient to see daily progression. The last cornerstone consists of motivation and support techniques to aid the patient through their transition to a healthier, happier life. ChangeU would partner with the abundance of local therapists, dieticians, psychologists, and sports therapists to provide patients with the resources necessary to permanently transform their weight and health. The app will also send out frequent motivational notifications to encourage patients in their journey. Like Zanadio, recommended treatment duration would be six-to-12 months so that proper education and implementation can be of concrete understanding for the patient.
The goal for ChangeU would be for patients to lose at least 3-5% of body weight after six months to one year after the initial assessment. This goal is very attainable if the participating individual adheres to the treatment options provided and applies the provided cornerstones of implementation into their situation.
Evaluation
To adequately evaluate ChangeU, the program will have questionnaires or surveys at the end of each evaluation method that allows the patient the opportunity to give their opinion and to introduce recommendations for improvement. This will allow developers and designers to tailor the information to enhance the overall experience for the community. ChangeU will measure outcomes to determine if the goal is being met by obtaining statistical data from the mobile app users. The app will allow users the option to share statistical information regarding their progress with ChangeU upon creation of an account. The statistical data that would be shared includes updates on body weight, nutritional tendencies, and physical activity throughout the course of the program. The users that choose to share this information will provide ChangeU with the information needed to evaluate effectiveness of knowledge transfer, transition, and supportive techniques to ensure patients are receiving effective treatment.
References
Aiken County Historical Society (2014). Aiken county historical society: Aiken, SC. https://www.aikencountyhistory.org/about/
Beslay, M., Srour, B., Méjean, C., Allès, B., Fiolet, T., Debras, C., Chazelas, E., Deschasaux, M., Wendeu-Foyet, M. G., Hercberg, S., Galan, P., Monteiro, C. A., Deschamps, V., Calixto Andrade, G., Kesse-Guyot, E., Julia, C., & Touvier, M. (2020). Ultra-processed food intake in association with BMI change and risk of overweight and obesity: A prospective analysis of the French NutriNet-Santé cohort. PLoS Medicine, 17(8), 1–19. https://doi.org/10.1371/journal.pmed.1003256
County Health Rankings & Roadmaps. (2022). County health rankings. https://www.countyhealthrankings.org/app/south-carolina/2022/rankings/aiken/county/outcomes/overall/snapshotcarolina/2022/rankings/aiken/county/outcomes/overall/snapshot
Forkmann, K., Roth, L., & Mehl, N. (2022). Introducing zanadio —a digitalized, multimodal program to treat obesity. Nutrients, 14(15), 3172. https://doi.org/10.3390/nu14153172
Luesse, V. F. (2022). Aiken, South Carolina: A horse-country town rich in tradition. Southern Living. https://www.southernliving.com/souths-best/aiken-sc
Pew Research Center. (2022, June 13). Religious landscape study. Pew Research Center’s Religion & Public Life Project. https://www.pewresearch.org/religion/religious-landscape-study/state/south-carolina/
Schmitt, C. L., Curry, L. E., Homsi, G., Williams, P. A., Glasgow, L. M., Van Hersh, D., Willett, J., & Rogers, T. (2017). Public and opinion leader willingness to fund obesity-focused policies in Kansas. Policy, Politics & Nursing practice, 18(3), 125–134. https://doi.org/10.1177/1527154417749492
U.S. Census Bureau. (2021). U.S. Census Bureau quick facts: Aiken City, South Carolina. US Department of Commerce. https://www.census.gov/quickfacts/aikencitysouthcarolina
