Date of Award


Scholarly Projects

Projects: SPU Access Only

Degree Name

Doctor of Nursing Practice (DNP)



Faculty Chair

Julie Pusztai

Faculty Reader

Bomin Shim

Executive Summary

Executive Summary

Background: Globally, those in poverty are more likely to die from a chronic disease compared to the wealthy due to limited access to health services, higher levels of risk behavior, and psychosocial stress (WHO, 2019). Chronic disease and low socioeconomic status are often interwoven in a vicious circle and there is a strong affiliation between low education and poor health outcomes (Van der Heide et al., 2013). It has been speculated that this may be due to the individual’s reluctance to seek medical care due to lack of knowledge or distrust of the medical community (Lewis, Abrams, & Seervai, 2017). Failing to address health education and/or barriers leaves individuals struggling to cope with a potentially preventable lifelong disease. Therefore, a gap exists when it comes to addressing the environmental and socioeconomic barriers related to disease prevention.

Purpose: The purpose of the project was to design and implement a chronic disease prevention class which aimed to increase an individual’s potential for behavior change and identify personal barriers among an underserved community.

Methods: The project’s setting was through a faith-based organization that serves an underprivileged community. The MAP-IT framework and Transtheoretical Model (TTM) was used to guide the implementation of this project. However, due to the COVID-19 pandemic, the class had to be modified to take place online to accommodate the quarantine orders. A volunteer sampling approach was used via the organization’s website and social media pages and provided a link to the recorded class. Data was gathered via Survey Monkey at the beginning and end of the video and used a mixed-method approach. The hope was after watching the video, participants would have identified a health goal with a plan and move at least one stage up on the TTM to show an increased potential for behavior modification.

Results/outcomes: Four participants completed the pre-survey however only one of those participants completed the post-survey. Although there was only one complete data set, it did prove to be a successful outcome since the individual’s behavior moved up one stage on the TTM. Interestingly, all four responses identified their personal barrier to low self-efficacy. The low response rate was thought to be related to the online format, since prior in-person classes with the organization have been successful.

Sustainability: Undergraduate nursing students through a partnering university are planned to be taking over the class for the continuation and growth of this project. A set of clear instructions regarding the format and a script of the class were electronically provided to the university’s liaison. Additionally, a link to the class video and printable pamphlets for enhanced educational material were provided. There is a potential for future project opportunities in the community from the data gathered on participant barriers.

Limitations/Implications for Practice: This project was limited in that individuals had to problem solve their health goal independently. Participants may have become discouraged or uninterested from the non-interactive nature of the class. Face-to-face education is preferred over an online platform because of the personal aspect and better sense of community when done in-person (Kemp & Grieve, 2014). Virtual learning may prove challenging in low-income communities due to the potential lack of internet and webcam access. This project demonstrated that more research is needed on health educational strategies in underserved communities, especially when in-person education is not possible or limited.


Kemp, N., & Grieve, R. (2014). Face-to-face or face-to-screen? Undergraduates' opinions and test performance in classroom vs. online learning. Frontiers in Psychology, 5: 1278. doi: 10.3389/fpsyg.2014.01278

Lewis, C., Abrams, M.K., & Seervai, S. (2017). Listening to low-income patients: Obstacles to the care we need, when we need it. To The Point. Retrieved from

Van der Heide, I., Wang, J., Droomers, M., Spreeuwenberg, P., Rademakers, J., & Uiters, E. (2013). The relationship between health, education, and health literacy: Results from the Dutch adult literacy and life skills survey. Journal of Health Communication, 18(sup1), 172–184. doi: 10.1080/10810730.2013.825668

World Health Organization (WHO). (2019). Chronic Diseases and Health Promotion. Retrieved from