1. Beyond the Volcanoes: A Community Partnership for Health in Rural Nicaragua Carly Crave, BSN Student Christina Lundy, BSN Student Claire Simonpietri, BSN Student Amy Cory, PhD, RN, CPNP Valparaiso University College of Nursing

2. Acknowledgements Funding for this research project was obtained by internal grants through the Office of Institutional Advancement at Valparaiso University We are grateful to the individual donors who share the vision for projects that are beneficial to the health of the community members, sustainable over time, and educationally enlightening to the students at Valparaiso University

3. Background Health inequities exist in Nicaragua  Gender  Ethnicity  Socioeconomic status  Geography

4. Purpose To promote health equity in a rural Nicaraguan community through social transformation using community-based participatory action research (CBPAR) Cory, A. (2007)

5. Theoretical Framework Ecological approach to CBPAR  Ecological model of human development Bronfenbrenner (1979, 1989)  School health theory Marx & Wooley (1998)  Primary health care theory McElmurry & Keeney (1999) Cory, A. (2007)

6. SCHOOL/ WORK COMMUNITY FAMILY Age Gender Ethnicity Culture Values Beliefs SES Health Education Physical Activity Nutrition Services Education Counseling, Psychological, and Social Services Equitability Availability Accessibility Affordability Acceptability Appropriateness Sustainability Health Services Healthy School/Work Environment Health Promotion for Staff Family and Community Involvement Ecological Approach to CBPAR Cory, A. (2007) Health

7. Ethical Considerations Institutional review board approval obtained from Valparaiso University

8. CBPAR Six phases  Cyclic and iterative Partnership Assessment Planning Implementation (action plan) Evaluation Dissemination Adapted from Cristancho, S. (2007)

9. CBPAR Research Methods  Mixed methods Quantitative  Structured survey  Systematic observation Qualitative  Interviews  Focus groups Cristancho, S. (2007)

10. Partnership Phase

11. Community Health Assessment Results Key informants (n = 13)  Primary health concerns (n = 39 responses) Gastrointestinal illnesses 28% Respiratory illnesses 25% Urinary tract infections 13% Skin infections 13% Hypertension 5% Pregnancy 5% Domestic violence 5% Diabetes 3% Arthritis 3%

12. Conclusions Two primary health concerns were identified by the key informants  Gastrointestinal ailments  Respiratory illness

13. Assessment Phase

14. Community Health Assessment Results Community members (n = 77)  Primary health concerns (n = 186 responses) Respiratory illnesses 35% Gastrointestinal illnesses 16% Urinary tract infections 13% Fever 9% Arthritis 7% Hypertension 6% Headaches 4% Diabetes 4% Skin infections 3% Anemia 1% Pregnancy 1% Dental problems 1%

15. Conclusions One major health concern was identified by the community members  Respiratory illness

16. Planning Phase

17. Results Community Readiness Survey  Community members (n=32) Community knowledge  The causes of indoor air pollution  Two stone stoves for cooking  The effects of indoor air pollution on health  Causes respiratory disease Community resources to remediate indoor air pollution  Human capital  Leaders with knowledge on building improved cookstoves Community readiness to change  Ready to improve respiratory health through improved stoves

18. Locally Elected Stove Committee, Valpo Research Team, and Local Interpreters Printed with permission.

19. Conclusions Community members verbalized their readiness to improve their respiratory health through improved cookstoves

20. Implementation Phase

21. Results Indoor Air Pollution Baseline Survey  Community members (n=36) Baseline data were obtained on stove recipients  Household demographics  Types and uses of household fuel  Gathering fuel  Fuel drying  Women’s and children’s health and wellbeing  Eyes  Cough  Chest illness  Short of breath  Headache  Kitchen type  Stove type  Smoke extraction method (if present)

22. Improved Cookstove

23. Evaluation Phase

24. Results Indoor Air Pollution Evaluation Survey  Community members (n=36) Follow up data were obtained on stove recipients  Age  18 – 86, µ = 30.69  Gender  Males 11.1%  Females 88.9%  Occupation  Homemaker 88.8%  Farmer 5.6%  Teacher 5.6%

25. Results Indoor Air Pollution Evaluation Survey  Follow up data were obtained on stove recipients  Types of household fuels used  Wood 100%  LPG 13% (secondary fuel)  Electric 2.7% (secondary fuel)  Gathering fuel  Gather 94.4%  Buy 5.6%  Amount of fuel  Very scarce 2.8%  Rather scarce 2.8%  Just enough 27.8%  Plentiful 66.6%  Green fuel  Never 33.4%  Usual 2.7%  Occasional 63.9%

26. Results Indoor Air Pollution Evaluation Survey  Follow up data were obtained on stove recipients Women’s and children’s health and wellbeing improved  Eyes 94.6%  Cough 83.8%  Chest illness 91.9%  Short of breath 89.2%  Headache 83.8%

27. Conclusions Follow up data  The respondents reported: Fewer health problems related to eyes, cough, chest illness, shortness of breath, and headaches Satisfaction with their improved stoves Understanding stove maintenance Future improvements should include a decrease in the size of the opening for the wood on their stoves

28. Questions?