Running head: BROWARD COUNTY

Broward County: Evidence- Based Community Interventions

Vivarian Moulton
University of South Florida
Community/ Public Health Nursing: Population Focused Nursing

BROWARD COUNTY

Broward County
Geographic Location
Broward County is located 252 miles south of Tampa Florida, formed from Dade and
Palm Beach counties in 1915. Broward is neighbors with Palm Beach, Miami- Dade, Collier
county, and Monroe county. Broward County is an urban area and is home to Fort Lauderdale,
Sunrise, Lauderhill, and Hollywood; cities all within its 1320 square mile borders. (Broward
County, 2015) From 2011 to 2013, the population in Broward county was 1 764 752 as
compared to Floridas population of 19 098 497. Three major public employers in Broward
County are the Broward County Government, North Broward Hospital District, and Memorial
Healthcare System (Broward County, 2015).
Population and Socioeconomic Factors
Florida Charts reports that in Broward county, children under 18 comprise 9.57 % (385
760) of the population, persons between the ages of 18-64 comprise 9.56% (1 112 913), and
persons 65 and older comprise 7.74% (266 076) of states population.
In 2011 to 2013, 7.81% (1 168 970) of the population of Broward county was white
compared to the 15.5% (489 867) of blacks within the county. In Broward County, 10.47% (463
017) of the population were Hispanics compared to the 8.87% (1 301 735) of Non- Hispanics. In
2006 to 2010, the poverty level of families below poverty level was 9.1% compared to Floridas
13.8% family poverty level. Twelve point nine percent of the population greater than 25 in 2006
to 2010 are without a high school diploma compared to the Floridas 14.7%. In 2006 to 2010,
14.8% of Broward Countys population over 5 does not speak English very well in comparison to
Floridas 11.8% (Florida Charts, 2015).

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This paper will focus on stroke incidences in Broward County as the rates of 33.3 are higher than
normal in Broward County compared to Floridas 31.3.
Analysis of Data
Strengths
There are many strengths of Broward County. According to Florida Charts, in 2004,
adults with hypertension who take measures to control their blood pressure was 96.7 compared
Floridas 96.4 (2015). In 2013, Browards rates of adults with any type of health care insurance
coverage was 78.7 compared to Floridas 77.1% (Florida Charts, 2015). In 2013, 75.5% of
Broward county residents had their cholesterol checked in the past two years compared to
Floridas 73.2% (Florida Charts, 2015). 82.4% of adults had their cholesterol checked in the past
five years in Broward County compared to Floridas 79.5%. In Broward County, 12.1% of adults
are current smokers versus Floridas16.8% (Florida Charts, 2015).
A majority of residents have insurance which makes it easier to find and keep a primary
care physician that will help to personalize a plan of care. This plan of care will enable the
residents to better manage their hypertension, have more regular cholesterols checks as
hyperlipidemia is a risk of stroke, and to be exposed to information regarding smoke cessation
(Harrisons Manual of Medicine, 2015).

Weaknesses
The Broward county system has aspects that can be improved upon. The weaknesses of
Broward County involve the 23.8% of adults who were unable to see a doctor in the last year due

BROWARD COUNTY

to financial concerns in 2013 compared to Floridas 20.8% (Florida Charts, 2015). Only 24.3%
of adults in Broward exercise vigorously in 2007 compared to Floridas average of 26.0%
(Florida Charts, 2015). Adults in Broward County who engage in heavy or binge drinking in
2013 was 19% compared to Floridas 17.6% (Florida Charts, 2015). Adults who have never been
told they had diabetes in 2013 was 10.7% compared to Floridas 11.2% in 2013 (Florida Charts,
2015).
Being physically active is a key component in controlling weight and Body Mass Index
and prevention of type 2 diabetes, which are risk factors for stroke when uncontrollable and
Broward County residents fall below the state average for physical activeness (Patel and Fisher,
2015). Broward County residents exceed the states average excessive drinking, using alcohol in
moderation is one of the key components in helping to manage the risk factors of stroke. Overall,
avoiding the physician because one cannot afford it ensures that these modifiable and
controllable factors will go unseen. Stroke levels in Broward County is 32.8%, Hillsborough
County is 31.5%, Miami Dade County is 28.1%, and Palm Beach County is 28.9% while
Floridas levels are 31.3% (Florida Charts, 2015).
Health Indicators
According to Doctors Patel and Fisher (2015) in the 5 Minute Clinical Consult, there are
controllable and unmodifiable dispositions for stroke. Modifiable factors include age, gender,
race, family history/ genetics, and a history of strokes or Transient Ischemic Attacks.
Nonpermanent and controllable factors include smoking, illicit drug use, hypertension, atrial
fibrillation, valvular heart disease, endocarditis, recent myocardial infarction, severe carotid
artery stenosis, hypercoagulable states and patent foramen ovale (Patel et al., 2015).

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Community Health Models

There are many factors that influence an individuals and to a larger extent the
communitys health. Ones circumstances and environment such as; lifestyles choices, the state
of the place, genetics, income, education level and relationships all impact ones health (Healthy
People 2020, 2015). In order for appropriate interventions to be developed it is imperative that
the various factors influencing health outcomes are surveyed.
The main factors that contribute to the high percentage of the population with stroke in
Broward County are individual behavior, the socioeconomic environment including ones
income and environment, and education. The cost of a doctors visit is a great concern for
residents of Broward regardless of the more readily available jobs and they tend to be less active
physically. Even though more of the population earned high school diplomas, less understand
English in Broward County.
Negative Nursing Diagnosis
The members of the population subgroup are African Americans. According to the
National Stroke Association, African Americans are the race most impacted by stroke and are
twice as likely as Caucasians to get and die from a stroke (Minorities and Strokes, 2014). The
stroke rates for African American community are related to the high rates of hypertension,
diabetes, smoking, obesity, and below poverty economic status as evidenced by the 29.4 % of the
African American population hospitalized by strokes with these factors such as the 12.2% who
smoke, the 16.1% who use alcohol, 10.3% who have been diagnosed with diabetes, and the
13.2% who are below poverty level.
Evidence Based Interventions

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Primary interventions are aimed at preventing diseases which have a direct impact on
health. In the primary prevention of stroke, the recipients would be the community of African
Americans. Strokes can be greatly reduced in the African American community by educating and
promoting awareness in its primary state. The National Institute of Health (2008) states that
education should be provided in the importance of regular physical activity for at least 30
minutes per day, limiting the consumption of alcohol, smoke cessation, reduction of salt intake
and eating a diet richer in fruit and vegetables. This education can be accomplished with the
distribution of simple yet concise flyers, posters, and pamphlets at healthcare places, government
buildings and educational institutions. Stakeholders would be the community members and
healthcare providers. This information can should be geared towards the demographic of those
prone to strokes. The role of the nurse in these instances should be to educate students at schools
if they display risk factors or personalizing plan of care for patients who visit their clinics,
physicians office and hospital.
Secondary prevention includes controlling the impact of the disease that is already
ongoing by slowing its progress. The recipient in this stage of intervention would be more
personalized, hence it would be the individual. Interventions at the secondary stage would
include proper monitoring of the comorbidities the patient may present with, ensuring the
accuracy of information provided by patients, and ensuring that there is an environment of trust
between the physician and patient. Stakeholders would be the community members and
healthcare providers. The nurse would further help with the screening process, following up with
the patient, treatment, and compliance.
Tertiary prevention helps to manage the long term effects of an illness. The nurse
provides supportive care and personalized plans of care. The recipients would be both the

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recipient and the community. Stakeholders would be the community members and healthcare
providers. Interventions at the tertiary level include rehabilitation programs, support groups,
monitoring of medication or treatment plan of the patient while tracking the progress.
Health Policy Proposal
According to the World Health Organization, health policy encompasses decisions, plans,
and the actions needs to achieve specific health care goals within a society (2015). According to
the World Health Organization, a detailed policy outlines a vision for the future which strongly
influences targets and points of reference in the short and long term (2015). Strong, specific
health policies, once implemented equally, will have a positive impact on the African American
community who are prone to experience strokes. Within Broward County, strokes affect a higher
rate of African Americans than Caucasian, Hispanics and non- Hispanics. Dyslipidemia,
uncontrolled hypertension, sedentary lifestyle, obesity, and diabetes are risk factors of stroke
which needs to be addressed by a health policy.
The health policy proposal includes knowledge of all possible symptoms, assessing all
patient knowledge about their risk factors and addressing those which are modifiable, education
about medications and the importance of continuing of all treatments even with improvement of
symptoms, and the necessity of a primary care physician. Both primary and secondary
interventions in this policy revolves around education and awareness with a goal of managing
modifiable risk factors of stroke and preventing complications. This health policy proposal
would affect stakeholders including the community members, healthcare providers, public
officials, legislators, and funding sources. Supporters of the proposed policy include community,
public officials, legislators, health care providers, and funding sources.

BROWARD COUNTY

A new change can be either be hindered by the opposition or implemented with an iron
fist by supporters. Supporters and opposition for this proposal include community members,
public officials, legislators, health care providers and funding sources. Community members will
hold each other accountable, public officials and legislators will promote the legislation and
implementation of this law, and based on the public perception these supporters will influence
funding or if they are opposers they will do none of the above. To put the health policy plan in
action, I would research what is currently the current interventions, completing evidence based
research in a smaller population, and presenting these findings to the review board so that I could
begin promoting and raising awareness of these new interventions.
The health policy proposal addresses the underlying cause of modifiable risk factors
associated with stroke in the African American minority population and gives them the
opportunity to be aware, to be educated and to make a lifesaving change in their lives. With the
knowledge that health literacy is of high importance, the literature would be comprehensible by
at least a fourth grader. This information would prevent further stroke related deaths and control
the risk factors that lead up to a stroke in Broward County first and then nationwide as the results
become clearer that such an intervention does directly impact stroke incidences.
Conclusion
From this paper, one can see that the rate of stroke in Broward County is higher than that
of the state and surrounding counties. Primary, secondary, and tertiary interventions have also
been evaluated in their impact on the community outcome. This paper also highlighted the
strengths and weaknesses of Broward County while providing a proposal in how to strengthen
the weaknesses. Personally, this project will help my current patients as a nursing student and my

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future patients as a registered nurse to be more engaged and encouraged to partake in healthier
choices that will positively affect their quality of life and lifespan.

References
Determinants of Health. (n.d.). Retrieved June 30, 2015, from
http://www.healthypeople.gov/2020/about/foundation-health-measures/Determinants-ofHealth
Florida Charts. (2015). Retrieved July 2, 2015, from
http://www.floridacharts.com/charts/QASpecial.aspx
Harrisons Manual of Medicine (2015). Stroke. Retrieved July 31, 2015, from
http://nursing.unboundmedicine.com/nursingcentral/view/Harrisons-Manual-ofMedicine/623090/all/Stroke?q=stroke&ti=0
McGoun, B. (2013). BROWARD HISTORY. Retrieved July 4, 2015, from

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http://www.broward.org/History/About/Pages/BCHistory.aspx
Minorities and Stroke. (2014, September 9). Retrieved July 31, 2015, from
http://www.stroke.org/understand-stroke/impact-stroke/minorities-and-stroke
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http://www.broward.org/econdev/Pages/Default.aspx
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World Health Organization. (2015). Retrieved June 30, 2015, from
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