Running head: PORTSMOUTH PUBLIC HEALTH DEPARTMENT 1

Community Health Project Paper: Part II

Dorcas Bentil, Savannah Boggs, Leah Crouch, Vignette Kaltsas, Christina Luchau

Abena Osei-Gyami, Alexis Taylor, Tajé Usher, Phoebe Wallen, and Lily Zheng

Old Dominion University, School of Nursing

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Community Health Project Paper: Part II

Old Dominion Nursing Students initially partnered with the community garden to

improve the health of the aggregate through encouraging healthy eating behaviors. This

semester, students worked with the local food pantry to provide outreach and education to the

aggregate on diabetes risk and management. The purpose of our efforts was to utilize the Health

Planning Model to improve aggregate health in Portsmouth, VA and to apply the nursing process

to the larger aggregate within a systems framework.

Planning

Identification of Health Problem

Nursing students of Old Dominion University partnered with Eastern Virginia Medical

School (EVMS) to help the members of the Portsmouth community. The most significant health

problems identified were uncontrolled diabetes and hypertension. 12.4% of the Portsmouth

population has diabetes compared to the entire state of Virginia which is only 9.3% (City-Data,

2018). Members of the community had ineffective health maintenance related to uncontrolled

diabetes and hypertension as evidenced by high blood pressure readings, high blood sugar and

verbalization of a knowledge deficit. Additional health problems included knowledge deficit,

imbalanced nutrition, and risk for injury. The identified outcome was to reduce the prevalence of

uncontrolled diabetes and hypertension and increase the knowledge of both disease processes

within 6 months. Interventions were focused on analyzing the prevalence of diabetes in the

Cradock community as well as educating about healthy eating and the importance of regular

checkups. ODU nursing students performed A1c and blood pressure checks to help meet this

goal.

Health Planning and Needs

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The priority nursing diagnosis addressed by the efforts applied this fall, under the

Portsmouth Public Health Department is deficient knowledge related to diabetes with a focus in

the Cradock community. Intervention is vital for this community due to 14% of the Portsmouth

population being diagnosed with diabetes in 2013 compared to the 9% of total Virginians with

diabetes (County Data Indicators, 2016; Virginia Department of Health, 2017). One objective is

to assess the Cradock community’s diabetes prevalence and increase the community’s awareness

of that prevalence by utilizing a door to door community health survey. Another objective is to

educate those who have diabetes about managing their nutrition, blood pressure, and blood sugar

levels through vegetable cards and hemoglobin A1c testing and blood pressure screenings at

pop-up food pantries. The final objective is to assess the environmental barriers in the Cradock

neighborhoods that prevent those community members from participating in physical activity

through the PhotoVoice project participation.

Intervention

Implementation

For the management of chronic illnesses such as high blood pressure and diabetes,

several primary and secondary interventions were provided for the Cradock community. The

main intervention provided was a series of blood pressure and HbA1c screenings during various

community events. All screening were provided within Afton Square, which is a central

gathering place in the neighborhood. Recruitment to the screening was accomplished through

face-to-face interactions at the event. These events included screenings, providing education, and

referral to primary care. The first event was at the neighborhood’s National Night Out, a

partnership event between the neighborhood and the Portsmouth Police Department. In

collaboration with EVMS Family Medicine, we provided screenings, health maintenance

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education, as well as an ‘Ask the Expert’ where a physician from Portsmouth Family Medicine

was available to answer health questions.

Subsequent interventions were provided at Food Pantry events in conjunction with the

Southeastern Virginia Food Bank. During these events, participants lined up early in the morning

to receive various perishable goods such as fruits, vegetables, bread, meat, and durable goods

such as diapers and formula. Our intervention at these events included distribution of vegetable

cards that correlated to the vegetables that were distributed as part of the food pantry. These

vegetable cards included information about vegetable taste, preparation, nutrients, and health

benefits written in non-medical terms. The cards also included a recipe for the chosen vegetable.

Interventions were geared toward nutrition, health promotion, and diabetes screening due

to the high levels of diabetes specifically identified in this neighborhood. Food insecurity is

estimated to be 19.6% in Portsmouth compared to 10.6% in Virginia overall (Greater Hampton

Roads, n.d.). These populations are more likely to attend Food Pantry events, which is why

screening provided at this event is most likely to capture this vulnerable population. In a meta-

analysis, investigators found that the overall rate of food insecurity is significantly higher in

individuals with diabetes at 9.3 % compared to individuals without diabetes at 6.8 % (Gucciardi,

Vahabi, Norris, Del Monte, & Farnum, 2014). The relationship between food insecurity and

diabetes theoretically occurs due to decreased access to healthy foods.

Alternative Interventions

In addition to the interventions discussed, alternatives interventions can be used to

address the aggregate deficient knowledge. Other interventions specifically geared towards our

aggregate would be aimed at preventing and reducing the community’s risk for developing

diabetes, helping community members monitor their diabetes, and providing resources for
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community members with diabetes to manage their diabetes. To assist community members in

preventing and reducing risks for developing diabetes, future nursing students working with this

aggregate can organize classes for adults about diabetes prevention and management to include

discussion about diet. Specifically, teaching about nutritious, low-fat, healthy eating such as a

DASH diet plan can reduce the risk for diabetes and help with control of blood sugar levels

(Campbell, 2017). Another applicable intervention would be to organize exercise groups

specifically aimed towards overweight adults and focusing on methods to lose 7% of body

weight to lower risk of diabetes (Wilding, 2014).

To help community members monitor their diabetes, setting up tents outside the local

food bank to check A1c levels, blood pressure, and provide teaching should be continued. In

addition, nursing students can set-up events at local schools or recreational centers, such as the

Senior Station or the local Lions Club, where nursing students can assess community members’

risk for diabetes; assessment would include having A1c level checked, getting weighed, and

provided with a BMI to determine obesity. These events can also be an opportunity for nursing

students to provide resources such as information where to get medical care or students can assist

with scheduling appointments and follow-ups with the local free clinic. In planning for assisting

community members to manage their diabetes, nursing students can help do outreach events that

focus on creation of self-care plans. Students can help community members recognize their

baseline ABC’s: A1c level, blood pressure, and cholesterol to use in monitoring their health risks

(U. S. Department of Health and Human Services, n.d.). Nursing students can also help

community members create a diabetic meal plan, a physical activity plan, routine blood glucose

checks, and with scheduling of yearly eye and foot exams.

Applied Research and Literature Review

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The use of current research in the guidance of care allows for the implementation of

evidence-based practice and effective interventions. Research relevant to the previously-stated

objectives and nursing diagnoses for Cradock include those focused on diabetes diagnosis and

management.

Nurses have unique perspectives on patient needs that must be considered when planning

diabetes interventions, and as a group of nursing students, we used our skills in applying the

nursing process to more comprehensively reach the Cradock community. One experimental

research study analyzed the effectiveness of a nursing team on the management of diabetes

within a specific community. 179 participants with type 2 diabetes either took part in nurse-led

interventions or standard interventions, and “glycosylated hemoglobin (HbA1c) level, body mass

index, waist circumference, visual acuity, ankle brachial index, kidney function index, urinary

protein level, and electrocardiogram” (Ni, Liu, Li, Diao, Dong, & Tao, 2017, p. 76) were

measured to determine the effectiveness of these procedures. The results were collected at 6, 12,

and 24 months after the initiation of the interventions, and they indicated that HbA1c level, ankle

brachial index, and waist circumference were significantly improved with the participants in the

nurse-led group while the other measures did not show significant change. The study concludes

that interventions that are both nurse-led and focused may be more effective in improving self-

management of diabetes than other standard interventions. (Ni et al., 2017, p. 76).

Food pantries such as the one that took place in Cradock can serve as a place to interact

with and reach those who are vulnerable to poor diabetes management. However, it may be

difficult to implement and evaluate interventions focused on increasing diabetes self-

management. Another study focused on determining the effectiveness of implementing diabetes

self-management education at food banks and providing these food banks with food appropriate
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for those with diabetes, ultimately with the goal of promoting diabetes self-management. Using a

randomized control trial, 423 participants were screened for baseline A1c levels before and after

implementation of the intervention. The results indicated that although there was evidence of

improvement in food security and stability and fruit and vegetable intake, there was no

significant data supporting the idea that the intervention improved diabetes management related

to controlled blood glucose levels (Seligman, Smith, Rosenmoss, Berger Marshall, & Waxman,

2018, p. 1229). It was speculated this may be related to insufficiently comprehensive education

or that the option to still choose foods at the food banks that were not considered diabetes

appropriate (e.g., high-carbohydrate or added sugars); the authors also admitted that the study

proved difficult to retain participants and facilitate appropriate follow-up (Seligman et al., 2018,

pp. 1230-1232). They suggested that although providing support for vulnerable populations with

chronic diseases such as diabetes may be improved by reaching into local communities, this

alone would likely be insufficient in achieving effective management of these diseases without

connecting these communities to health care access and more intensive and comprehensive self-

management initiatives (Seligman et al., 2018, p. 1233).

Nursing theory can be an invaluable tool to nurses when considering how to approach

patient care, and our group’s interventions focused largely on face-to-face personal interactions

with our aggregate. One study utilized Hildegard Peplau’s Theory of Interpersonal Relationships

as a way to determine if using the theory as a guide for planning interventions to promote

diabetes self-management. Using a quantitative, evaluative, pre-experimental design to guide the

research, 30 participants engaged in counseling over two weeks and were given educational

material on the topic of diabetes management. The study measured knowledge, attitude, practice,

average fasting blood glucose, and post prandial blood glucose as indicators of intervention
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effectiveness. The results found significant improvements in all levels of measurement.

Knowledge, attitude, and practice increased from 8.3 to 20.8, 24.6 to 36.5, and 24.8 to 50.5

respectively; average fasting blood glucose decreased from 125.4 to 115.8, and post prandial

blood glucose decreased from 171.4 to 144.3 (Fernandes & Naidu, 2017, p. 129). Due to the

positive results yielded from this study, the concept of using Peplau’s Theory of Interpersonal

Relationships as a way to develop and implement interventions effective in improving diabetes

self-management should be considered among other health care professionals seeking to

accomplish a similar goal.

Understanding the population that is to receive health interventions is vital in providing

effective care. We utilized our assessments from the previous semester to better plan and

implement our care, which focused on personal interactions due to the community’s small size

and easily-accessible interventions such as educational materials, A1c testing, and BP measuring

because of the prevalence of hypertension and diabetes in this community that appeared to be not

as financially privileged as surrounding communities. One study took this concept of

understanding the health care recipient in providing care and used it to search for differences

within a population that may affect the effectiveness of assistance in diabetes management. A

“solution-focused qualitative approach, supplemented with a quantitative scale” was used to

guide the study (Bhaloo, Juma, & Criscuolo-Higgins, 2018, p. 243). After analyzing the data

collected by semi-structured interviews by telephone with 25 participants, the results revealed

that strong support from family and friends, the physician’s style of communication and message

conveyed, and the fear of health declining due to uncontrolled diabetes were large factors that

contributed to diabetes self-management (Bhaloo et al., 2018, p. 243). Female participants were

determined to be more positively influenced by the presence of physician empathy, while males
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appeared to be positively influenced by “improved health literacy” (Bhaloo et al., 2018, p. 243).

Women were also deemed at a higher disadvantage when lacking a strong support system than

men (Bhaloo et al., 2018, p. 243). Understanding these differences and applying them to patient

and aggregate care may allow for more effective care, especially when seeking to improve

diabetes self-management among a population with uncontrolled diabetes.

Continuing with the concept of understanding diverse patients and aggregates, the last

study analyzes sociodemographic factors that may be related to participating in diabetes self-

management education (Adjei Boakye, Varble, Rojek, Peavler, Trainer, Osazuwa-Peters, &

Hinyard, 2018, p. 685). The researchers analyzed data collected from the Behavioral Risk Factor

Surveillance System of 84,179 participants with diabetes, specifically through a lens focused on

“age, sex, race/ethnicity, marital status, education, and annual household income” (Adjei Boakye

et al., 2018, p. 685). Using “weighted, multivariate logistic regression models” developed by the

researchers, they found that that African American males were more likely to engage in diabetes

self-management education (DSME) than other ethnicities (Adjei Boakye et al., 2018, p. 685).

Another finding indicated that men were less likely to participate in diabetes self-management

education (DSME) programs than women. Other significant indicators of hesitance toward

engaging in diabetes self-management education include Hispanic ethnicity, at most a high

school or less than high school education, a household income between $15,000 and $24,999

annually, and no health insurance (Adjei Boakye et al., 2018, p. 685). These results could assist

those interested in implementing such educational programs by understanding what

demographics may be more or less willing to participate in their intervention.

Barriers
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Throughout the implementation phase of our project, there were some barriers that we

had to address and try to overcome to make implementation successful. One major barrier that

we encountered was coordination and planning of events for the project. With a group as large as

ours, everyone has personal and academic commitments that conflicted with events scheduled by

the community partner. This made many people unavailable to participate in those events. A way

we can overcome this barrier when working on future projects is to ensure events are scheduled

and announced in advanced to ensure participants can be flexible when scheduling exogenous

activities. This can be a common barrier with any project that involves a lot of participants.

There were also multiple requests for documentation from our community partner. More

organizational efforts could have been made on both sides of the community partnership to

ensure everything was obtained and in place before the start of the project. Another barrier to

implementing the intervention of the door to door community survey is that we were unable to

start this until the very end of the semester because of the lengthy process of IRB approval.

There was nothing that could have facilitated the approval being processed faster; however, we

made sure to participate in the other interventions while that intervention was on hold.

The implementation of blood pressure screening and hemoglobin A1c testing were

performed at food pantries located in Cradock. For the food pantries, individuals line up early in

the morning to ensure a spot in line for food. A barrier to this is when asked to come and get

screening and testing done, they do not want to lose their spot in line and miss out on getting

their food. A way we tried to overcome this is to make sure they knew our station was set up at

the end of the receiving line and to encourage them stop by and get checked.

During those food pantries, we also surveyed the members of the community about

vegetable cards and which format of the vegetable cards was most appealing and easy to read. A
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barrier to this is that the community members did not understand the purpose of us showing them

the cards and were more interested in which recipe on the card they liked more. This skewed the

results of the survey. A way we can overcome this barrier is to make sure they understand the

purpose of the survey before giving an answer to which card they like better.

Safety was another barrier we had to address and overcome in this community project.

The area of Cradock can be considered unsafe, so this affected when we were able to go out and

survey the environment in the community. To ensure safety measures were being taken, we only

went out in the daytime, used the buddy system when walking around the Cradock

neighborhood, and made sure to notify local neighborhood watch and police that we were in the

area performing assessments.

Evaluation

Evaluation Plan

The plan for the project was to create interventions that addressed the issue of diabetes in

the Cradock community. As a group, we were able to participate in research with EVMS to

screen for the prevalence of diabetes in the Cradock community. The research will be used to

establish further interventions in the community. In order to gather research, we worked with

EVMS at the food pantry in Cradock to test community members’ A1c’s and blood pressures.

The research is being gathered by Dr. Mary Romero, who will be responsible for compiling and

analyzing the data. In order for individuals to participate, they will need to be living in the

Cradock neighborhood and will need to sign a form to be included in the research study.

Unfortunately, this research will take more time to complete than we had in the semester. Due to

time constraints, we are unable to evaluate the research.

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The second intervention implemented was vegetable cards. People at the food pantry

were asked to compare varying designs of the same vegetable cards and share their opinions

about their visual appeal and whether or not the wording was understandable. We kept track of

the responses and will use them to determine the most effective card. This will be the template

used to create cards in the future that can be distributed to educate the public on different

vegetables and their uses.

Limits of Evaluation

The biggest limitations of the evaluation process were time and the format of the

intervention. We spent much of the semester waiting for IRB approval to assist Dr. Romero with

the project and we did not get approved until December 3rd. We were able to assist throughout

the semester, but our help was limited since we were waiting to be cleared for the actual

community health assessment. The main part of the project that we evaluated was the vegetable

card production and surveying. To determine which card was best received by the community,

we used a quantitative evaluation method. We made three separate cards, displayed them at the

Afton Park food pantry, and provided the community members with a survey to ascertain which

style they found the most helpful. A survey was the best way to evaluate the community’s

reactions to the vegetable card due to its cost and time effective nature (Hollin, Young, Hanson,

Bridges, & Peay, 2016). Since the cards are being made for the community, it is very important

to make sure that they have a design that they will like and catered to their needs. Making their

preferences a priority enhances the health promoting effect that the cards will have on the

community (Hollin et al., 2016). Other than making the vegetable cards, our role in this study

was to gather and provide the community information to Dr. Romero and her job was going to be
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evaluating it. Since we did not get to do much of the door to door surveys and since Dr. Romero

is responsible for collecting and analyzing the data, we did not really have much else to evaluate.

Recommendations and Implications

Through the use of photovoice canvassing to identify barriers to physical activity in the

Cradock community, we began to build a foundation of knowledge of the possible issues

contributing to the communities uncontrolled diabetes and hypertension and were able to sow the

seed for change by submitting our findings for the review of policymakers in Portsmouth who

have the power and finances to fix the barriers. Unfortunately, we have yet to see the results of

this intervention due to the long-length of the review process by policymakers and the even

longer process of city implementation of necessary interventions. Depending on the effectiveness

of the intervention, regular photovoice canvassing may be performed in the future to bring

awareness to new barriers or to catch those that may have been overlooked previously. The A1c

and blood pressure screenings further affirmed the identified issues of uncontrolled diabetes and

hypertension by revealing a large number of individuals with high hemoglobin A1c and high

blood pressure, though these findings are limited to the number of community members that

actually participated in the health screenings. The education provided and recommendations

made by EVMS staff and the student nurses would be a good area of follow-up for future student

groups. Through the use of a survey it would be possible to assess the number of individuals

who participated in the screenings during the time of our intervention to see how many of them

followed through on seeking a consultation or treatment from the free clinic or from their

primary care doctor, how many ignored the health issue, and how many did not seek professional

treatment but implemented lifestyle changes such as health eating promoted by our group’s

vegetables cards. Also, this survey could further assess the reason that professional care may not
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have been sought out. Additionally, the next set of student nurses will be able to follow-up on the

vegetable cards’ effectiveness by reassessing the communities knowledge of the vegetables

promoted at the food pantry and the number of people who actually used the information from

the cards to improve their eating habits.

Due to the limited time we are allotted in a semester, we were unable to follow the

nursing process completely through to truly evaluate our success, and we were unable able to

implement all of the planned interventions. This allows future students the opportunity to pick up

where we left off and participate in follow-up evaluation and assessments of the concerning

health issues in the Cradock community. For future students working with the same aggregate, in

order to promote better organization, there needs to be a standardized list of required documents

necessary for participation in research with EVMS that must be completed prior to the start of

the semester so as to alleviate stress on both the community partners and students participating.

Additionally, it may be advantageous for them to have a set list of events planned at the start of

the semester so that everyone in the group may plan accordingly with their various schedules.

Though the students may still be expected to participate in events that were not planned at the

beginning of the semester, for these supplemental events, not every student nurse will be

expected to attend if they have a scheduling conflict that cannot be avoided. It may be a positive

idea to set up quarterly meetings or phone conferences throughout the semester to talk with the

community partners to assess the progress being made toward mutual goals, which should be set

at the beginning of the semester, and to discuss any necessary changes to the way that these goals

are being reached.

Through the interventions provided and the current research reviewed, the essential role

that nurses and student nurses play in the interventions to improve patient self-management of
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diabetes in a community, specifically the Cradock community, is seen. The hesitant reaction of

the community to the screenings and vegetable cards implicates a need for continued presence at

the food bank to gradually allow the community to become comfortable with EVMS and ODU

students and increase their understanding and awareness of the health issues of diabetes and

hypertension. Also, EVMS will be able to use the identification of the barrier of the community’s

lack of understanding of the purpose of the vegetable cards to modify the way that they present

the cards in the future in order to make their purpose more clear, hopefully allowing the

vegetable cards to remain a useful resource. The identification of these health risks through the

health screenings provided will allow the community the opportunity to choose health; whereas,

before they were unaware and subsequently unconcerned about their eating habits and level of

physical activity. Additionally, with the barriers to physical activity identified there needs to be

something done about the safety hazards in order to promote physical activity in the community

which will improve the overall health of the people living within in it. Possible city interventions

may include, redoing sidewalks or putting in new sidewalks to make safe walkways and

increased police presence in the community to promote feelings of security. There needs to be

further evaluation of the effectiveness of interventions already provided and continued education

and assessment in order to truly tackle the concerning rates of uncontrolled diabetes and

hypertension in Cradock.

Conclusion

In conclusion, we gathered that conducting a community assessment on an aggregate is

challenging especially coming from outside of the community. People are generally not open to

the idea of others knowing what is going on with their personal lives but are also inclined to open

up especially to healthcare professionals if they realized by doing so will bring change and help
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to them. This experience emphasized how social determinants of health contributed to health and

healthcare disparities. From our assessment we gathered that diabetes prevalence is high in the

Cradock community and saw the need for education. Education regarding healthy eating habits

was implemented through vegetable cards, diabetes management through hemoglobin A1c

testing and blood pressure checks and barriers to a healthy lifestyle through photovoice. From

our partnership with EVMS, we got first hand experience of the challenges of conducting

research studies and getting IRB approval for the study. Starting this community health project

was also very challenging considering the Portsmouth Public Health Department group was a

new group with no prior connections with community partners to aid in our project and we are

glad that we’ve established rapport with our aggregate and a relationship with community

partners to make it easier for the next group to pick up from where we left off. In all we are glad

our interventions were received well. We also hope that the next group of nursing students

working with this aggregate will use the suggested recommendations to reduce barriers to the

interventions and follow up with Dr. Romero on the EVMS diabetes research study to develop

and implement alternate interventions to improve the health of our aggregate.

PORTSMOUTH PUBLIC HEALTH DEPARTMENT 17

References

Adjei Boakye, E., Varble, A., Rojek, R., Peavler, O., Trainer, A. K., Osazuwa-Peters, N., &

Hinyard, L. (2018). Sociodemographic factors associated with engagement in diabetes

self-management education among people with diabetes in the United States. Public

Health Reports, 133(6), 685–691. doi: 10.1177/0033354918794935

Bhaloo, T., Juma, M., & Criscuolo-Higgins, C. (2018). A solution-focused approach to

understanding patient motivation in diabetes self-management: Gender differences and

implications for primary care. Chronic Illness, 14(4), 243–255. doi:

10.1177/1742395317736372

Campbell, A. P. (2017). DASH eating plan: An eating pattern for diabetes management.

Diabetes Spectrum, 30(2): 76-78. doi: 10.2337/ds16-0084

Centers for Disease Control and Prevention. (2018). Diabetes report card 2017. Atlanta: US

Department of Health and Human Services. Retrieved from

https://www.cdc.gov/diabetes/pdfs/library/diabetesreportcard2017-508.pdf

City-Data. (2018). Portsmouth, Virginia. Retrieved from http://www.city-

data.com/city/Portsmouth-Virginia.html

County Data Indicators. (2016, May 16). Retrieved from

https://www.cdc.gov/diabetes/data/countydata/countydataindicators.html

Fernandes, S., & Naidu, S. (2017). Promoting participation in self care management among

patients with diabetes mellitus: An application of Peplau’s Theory of Interpersonal

Relationships. International Journal of Nursing Education, 9(4), 129–134. doi:

10.5958/0974-9357.2017.00109.X
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Greater Hampton Roads. (n.d.). Food insecurity rate. Retrieved from

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Gucciardi, E., Vahabi, M., Norris, N., Del Monte, J. P., & Farnum, C. (2014). The Intersection

between Food Insecurity and Diabetes: A Review. Current Nutrition Reports, 3(4), 324-

332.

Hollin, I. L., Young, C. N., Hanson, C., Bridges, J. F., & Peay, H., (2016). Developing a

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Ni, Y. X., Liu, S. Z., Li, J. P., Diao, Y. S., Dong, T., & Tao, L. (2017). Effects of nurse-led team

management on type 2 diabetes patients in the community. Journal of Nursing, 64(2),

76–87. doi: 10.6224/JN.000028

Seligman, H. K., Smith, M., Rosenmoss, S., Berger Marshall, M., & Waxman, E. (2018).

Comprehensive diabetes self-management support from food banks: A randomized

controlled trial. American Journal of Public Health, 108(9), 1227–1234. doi:

10.2105/AJPH.2018.304528

U. S. Department of Health and Human Services. (n.d.). Managing diabetes. Retrieved from

https://www.niddk.nih.gov/health-information/diabetes/overview/managing-diabetes

Virginia Department of Health. (2017). Diabetes burden in virginia. Retrieved from:

http://www.vdh.virginia.gov/content/uploads/sites/25/2016/05/Diabetes-in-Virginia-

2017_final_7_17.pdf

Wilding, J. (2014). The importance of weight management in type 2 diabetes mellitus.

International Journal of Clinical Practice, 68(6), 682-91. doi: 10.1111/ijcp.12384

Honor Code
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“I pledge to support the Honor System of Old Dominion University. I will refrain from any form

of academic dishonesty or deception, such as cheating or plagiarism. I am aware that as a

member of the academic community it is responsibility to turn in all suspected violators of the

Honor Code. I will report to a hearing if summoned.”

Signature: Dorcas Bentil, Savannah Boggs, Leah Crouch, Vignette Kaltsas, Christina Luchau

Abena Osei-Gyami, Alexis Taylor, Tajé Usher, Phoebe Wallen, and Lily Zheng

Date: 12/10/18