The City of Independence Health Department (IHD) is located in Independence, Missouri, a suburb of Kansas City, Missouri. IHD currently offers services to the 117,270 residents of Independence, MO, the fourth most populated city in the state.In 2011, IHD launched the Building a Healthier Independence (BHI) initiative which aims to increase access to healthy foods, increase opportunities for physical activity and decrease the use of tobacco products among residents of Independence. The BHI initiative fosters collaboration among various City departments and community organizations and businesses to improve the health of city residents. The BHI initiative allowed for the creation of the “Get Healthy Independence” app, which serves as a health resource tool, indicating places to be active and acquire healthy foods.
The creation of the mobile health app was preceded by a community health assessment performed in 2011, which shed light on perceived health problems in Independence with Overweight/Obesity identified as a top priority. This led health department staff to adopt the issue as a main priority. The community health assessment also demonstrated that approximately 70 percent of Independence residents were overweight or obese and that 58 percent of residents did not utilize the abundance of parks and trails the city had to offer. It was determined that IHD would provide a convenient and easy to use resource that citizens of Independence could utilize to identify places in Independence to be active.
A mobile app was created titled Get Healthy Independence which provides all available park and trail locations in Independence, including capabilities that each park location has to offer. Other capabilities were also added to the app including farmers’ market locations, walking groups and the locations of all community gardens available for public use.
The goal of the Get Healthy Independence app is to create a local mobile health app to provide healthy eating and active living resources to Independence residents. With the rise in overweight and obese Independence residents, the creation of an app to link residents to places to be active and receive healthy foods was recognized. Objectives of the Get Healthy Independence app include:
Provide locations for Independence residents to be physically active
Advertise current events that promote healthy eating and active living in the community
Provide locations for Independence residents to have access to healthy foods
The Get Healthy Independence app began in late 2012 as a partnership between three city departments comprised of the Parks and Recreation Department, IHD, and the Technology Services Department under the BHI campaign. Because the campaign’s main focus is on healthy eating, active living, and smoking cessation, the app was created to showcase where and when Independence residents could make healthy choices regarding diet and exercise. The Technology Services Department received the appropriate training and equipment to create an interactive mobile app. The mobile app contents were agreed upon by the City of Independence Parks and Recreation Department and IHD. The app was created for both iPhone and Android devices to increase the number of Independence residents with the ability to download the free app. Upon the completion of the app, an advertising campaign was assembled and remains as an ongoing activity to inform people of the free mobile health app available to them.
The creation of the Get Healthy Independence App has allowed hundreds of residents the opportunity to locate and go to areas in Independence where residents can be more physically active and find healthy foods. The intended and actual impact of the app was to create greater utilization of city parks and trails, participation in healthy community events, greater participation at local farmers’ markets and utilization of public community garden space. All objectives of the creation of the Get Healthy Independence app were met as a finished product was developed to link residents of Independence to places to be active and to have greater access to healthy food options. The inter-department collaboration among the City of Independence Technology Services, Parks and Recreation Department, and IHD allowed for the idea and creation of the Get Healthy Independence app to become a reality and a free available resource to all residents of Independence.The practice of creating a free, mobile app for the community incorporates the use of technology resources, health resources and education to encourage residents to become more physically active and consume healthier food options. Incorporating mobile health among public health practice will allow for greater exposure of healthy resources to members of the population IHD serves.
The City of Independence Health Department (IHD) is located in Independence, MO, a suburb of Kansas City, MO. The free Get Healthy Independence app serves any resident who has access to a smartphone reaching approximately 50 percent of the population. Independence has a population of 117,270 residents of Independence, MO and is the fourth most populated city in the state.The BHI initiative aims to increase access to healthy foods, increase opportunities for physical activity and decrease the use of tobacco products among residents of Independence. BHI has been successful in creating innovative change in the community including 19 community gardens, the expansion of farmers’ markets, a complete streets and smoke-free parks policy and an extensive marketing and media campaign highlighting healthy lifestyle behaviors. The creation of the Get Healthy Independence app provides an innovative resource to community members to assist them in locating places to be active and find healthy foods.
A community survey for Independence residents was performed in 2011, which shed light on perceived health problems in Independence with Overweight/Obesity identified as a top priority. This led IHD staff to adopt the issue as a main priority. The community health assessment also demonstrated that approximately 70 percent of Independence residents were overweight or obese and that 58 percent of residents did not utilize the abundance of parks and trails the city had to offer. It was determined that IHD would provide a convenient and easy to use resource that citizens of Independence could utilize to identify places in Independence to be active. A mobile app was created titled “Get Healthy Independence” which provided all available park and trail locations and what capabilities each park location had to offer. Other capabilities were also added to the app such as farmers’ market locations, walking groups and the locations of community gardens available for public use.
According to the 2011 Community Health Assessment, 70 percent of Independence residents are overweight or obese. The Get Healthy Independence app was created to provide a free resource to residents of independence to find opportunities to be healthy. The app was created in response to the percentage of overweight and obese Independence residents and is intended to be utilized by all Independence residents wanting to find greater opportunities to participate in healthy activities within their community.
App downloads can be tracked to determine the number of individuals utilizing the free and available mobile map.
With about 50% of the adult population owning smart phones, roughly 50,000 people could be potentially reached in Independence. While at the moment less than 5% of the target population has downloaded the Get Healthy Independence app, it continues to reach people on a daily basis, continually increasing the number of people exposed. The Centers for Disease Control and Prevention’s (CDC) health and fitness app offers a comparison. The CDC’s app has only been downloaded around 10,000 times with a target population of 50 percent of the US population. The Get Healthy Independence app has achieved a larger portion of the target population than the CDC app.
IHD has offered a number of programs and educational resources to residents of Independence to increase opportunities for active living and healthy eating. Several community events have been organized focusing on physical activity, and a complete streets policy was passed to encourage incorporation of all modes of transportation, including walking and cycling, among planning and construction projects. Several food demos at various farmers’ markets have been done to demonstrate ways to incorporate fruit and vegetables into meals and snacks. The activities listed are a few of many initiatives IHD has employed to decrease overweight and obesity in Independence.
The creation and availability of a mobile health
app, available to members of the community was initiated and created because almost 50 percent of all adults are smartphone owners and are more frequently utilizing their mobile devices to get health information. The creation of the app incorporates technology and public health practice to deliver a reliable, efficient and easy to use tool to locate places to be active and have greater access to healthy foods.The Get Healthy Independence app utilizes an existing tool in a creative way and is an innovative practice. Recently, mHealth has begun to be utilized as an appropriate tool for public health practice. The Get Healthy Independence app focuses on health promotion, as the app provides resources for healthy living to residents of Independence. IHD staff routinely monitor the app for outdated information and work quickly to make the necessary changes. Continual updates allow for users of the app to have relevant and up to date information. Few local health departments and municipal governments have developed innovative tools such as the Get Healthy Independence mobile health app. Not only is the collaborative effort of the app’s creation innovative, but the capabilities and functions of the app to promote public health exhibit innovation.
The current practice is not evidence based; however, the app provides a useful resource for the community that encourages an active and healthy lifestyle.
The creation of the Get Healthy Independence app does address CDC winnable battles including nutrition, physical activity and obesity. The app provides resources entailing where to be physically active and get healthy foods.
Nutrition, Physical Activity, and Obesity
The Get Healthy Independence app was designed to provide locations for Independence residents to be physically active, advertise current events that promote healthy eating and active living in the community, and provide locations for Independence residents to have access to healthy foods. Since much of the public health infrastructure (parks, trails, farmers’ markets, and community gardens) already existed, the Get Healthy Independence app provides the much need resource to access the healthy activities. The City of Independence Health Department (IHD) sought a broad coalition under the Building a Healthier Independence (BHI) campaign in order to achieve these goals. The BHI campaign has a multitude of other population-based health goals for Independence and was the perfect tool to recruit collaborators for the development of an app.Work on the app began in November of 2012 with the meeting of the City of Independence Department of Parks and Recreation, Department of Technology Services and IHD. The app was released in the following months, but has continued to evolve. In the fast paced world of mobile technology, constantly adding and improving features is a must, but IHD also needed to ensure that the features will be used and bene¬fit public health. IHD staff continually works with the Department of Technology Services to add features and to improve the overall usability of the app. Currently there are five main features in Get Healthy Independence: parks, community gardens, farmer’s markets, trails, and walking programs. All five now have the option to view by map or switch to a list view.
Selecting parks will allow the user to choose from a multitude of park amenities including Athletic Fields, Basketball Courts, Fishing Lakes, Trails, Playgrounds, Shelters, Spraygrounds, and Tennis courts. This gives the user the ability to select exactly which features they want in a park. ‘View All Parks’ will bring up a map of all the parks in Independence. Touching the place marker on the map will display a list of park amenities and an option for directions will appear. Park information is updated continuously by the Independence Parks and Recreation Department. This tool allows individuals to fi¬nd the perfect place to become physically active.
While Independence has over a dozen community gardens, only four are currently available for public use. The community gardens function is managed by IHD and can be shown in both list and map view. The location is given along with the phone number directly to our community gardens coordinator. By promoting the community gardens by map, users can find locations close to home or work. The gardens are an inexpensive activity for residents looking for nutritious food.
Independence now has three farmers’ markets to serve fresh produce to residents. Information about locations, times, and dates are provided. This is updated by IHD staff continually throughout the year. The function is an acknowledgement that farmer’s markets are often inconvenient for shoppers and provides users an easy way to stay up-to-date on where and when to buy fresh fruits and vegetables.
Trails also appear as a feature under parks; however, if residents want options to find different types of trails, this is a great tool. The options are ‘Nature’, ‘Linear (under 1 mile)’, ‘Linear (over 1 mile)’, and ‘Loop Trail’. Similar to the other functions the map, list, and directions are all included and trails are kept up to date by the Parks Department. Runners and walkers can find the exact trail and location to suit their needs.Walking programs was recently added to assist IHD’s efforts in The Mile Starts Here program. The program gathers anyone willing to join and walks one mile every Wednesday morning from May through October. There are various locations around Independence that the program switches between every week, such as downtown, an athletic complex and a nature trail. The times, dates, and locations are provided by map and list view, along with a link to a map of the actual walking trails.
Partners for the creation of Get Healthy Independence were drawn from relationships that already existed from the BHI campaign. The City of Independence Technology Services and Parks and Recreation were involved from the beginning of the app’s inception. Technology Services provided 227 staff hours to develop the apps capability and functions. IHD assisted Technology Services with funding for training, phones, an apple computer, and other technical equipment.
The Parks and Recreation department lent its detailed data about all the amenities, locations, and functions of all the parks in Independence. Without involvement from Parks and Recreation the app would not have been able to provide locations to be physically active and an essential function of the app would have been in jeopardy.
Larger scale promotion of the app has recently begun. Two seven foot free-standing banners are traveling to various locations within the City, such as City Hall, the Health Department, Mid Continent Public Libraries, and other high traffic areas. Informational fliers will also be used at IHD functions, as well as social media promotion through Twitter, Facebook, Pinterest, and IHD’s website. 339 Facebook likes and 201 Twitter and Pinterest followers combine for a total of 540 social media followers. The flyers and banners both contain QR codes, or quick response codes, so that residents have the ability to quickly download the app without having to search the App Store or Google Play.
Filming for an intermission advertisement has taken place. The 30 second video will appear at all 33 Missouri Mavericks home games over the 2013-2014 season to promote the app with the use of the mascot and two players. The Missouri Mavericks are a local professional hockey team, which draws over 5,000 people to the average home game.
Future promotion will use other techniques employed by mHealth and may target schools, community events, and even doctors to prescribe the app for patients who need inexpensive options for nutrition and exercise.Now, IHD has plans in place to ensure the functioning of the app. Chronic disease staff within IHD are tasked with promoting the app and continually look for potential improvements. Moving forward, costs should be limited to staff time among the departments, as most of the software and equipment will function for years to come.
Much of the initial funds to set up the app were provided by a Social Innovation Fund grant through the Missouri Foundation for Health. In 2011 IHD used a portion of those funds to provide Technology Services with the resources to create an iPhone and Android mobile application. In November of 2012 $2000 were spent on apple computers and $500 on an iPhone for the iPhone app. A Nexus 10 tablet was also purchased in the same month for android app development. Training for Technology Services staff was about $200 and 227 hours of Technology Services staff time went into app creation.
The goal of the Get Healthy Independence app was to create a local mobile health app to provide healthy eating and active living resources to Independence residents. With the rise in overweight and obese Independence residents, the creation of an app to link residents to places to be active and receive healthy foods was recognized. Objectives of the Get Healthy Independence app included: provide locations for Independence residents to be physically active, advertise current events that promote healthy eating and active living in the community, and provide locations for Independence residents to have access to healthy foods. Independence Health Department (IHD) is currently engaged with community members and organizations to implement a community health improvement plan (CHIP). With the implementation of the CHIP process, a healthy eating and active living workgroup was created to reduce the percentage of overweight and obese residents in Independence. The Get Healthy Independence app was reviewed and recommendations for improvement were given by members of the healthy eating and active living workgroup utilizing a focus group format. Focus group recommendations were reviewed and submitted to the Technology Services Department for implementation. A proxy measure IHD will be using to evaluate the entire Building a Healthier Independence (BHI) campaign is our Community Health Assessment. In 2011 IHD conducted an extensive community survey which included information to calculate Body Mass Index and questions about park and trail usage.In November of 2013 Independence Health Department will be completing the 2013 Community Health Assessment. Many of the same questions from the 2011 Community Health Assessment will be asked again to gauge how well BHI and other department activities have been working over the past two years. In the last Community Health Assessment, 8,048 households received a survey, 1,677 households completed surveys and 319 surveys were returned due to address change or incorrect addresses, giving the survey a 21.7% response rate.
If IHD sees Body Mass Index decrease along with an increase in park and trail usage IHD will be able to label our app and BHI campaign a success. The comparison is very much an approximate measure for all Building a Healthier Independence activities, rather than a direct measure for the app. While over 450 people have downloaded the app, how many use it to find parks, trails, farmers’ markets, community gardens, and walking programs remains unknown.
The functions of Get Healthy Independence directly meet our objectives as the parks and trails functions provide locations for Independence residents to be physically active. The farmers’ markets and Community Gardens functions provide locations for Independence residents to have access to healthy foods. Finally the walking programs and farmers’ markets functions advertise current events that promote healthy eating and active living in the community.
With about 50% of the adult population own smart phones, roughly 50,000 people could be potentially reached in Independence. While at the moment less than 5% of the target population has downloaded the Get Healthy Independence app, it continues to reach people on a daily basis, continually increasing the number of people exposed. The Centers for Disease Control and Prevention’s (CDC) health and fitness app offers a comparison. The CDC’s app has only been downloaded around 10,000 times with a target population of 50 percent of the US population. The Get Healthy Independence app has achieved a larger portion of the target population than the CDC app.
As evaluation moves forward so will the assessment of the app’s features. Results from the Community Health Assessment, such as Body Mass Index and satisfaction with access to healthy foods, will help guide focus for each feature. Findings may also bring about the need for additional features or uses and the additional features will require cyclical evaluation.Technical evaluation of the app regarding performance and usability has also been evaluated. The app loads quickly with an average start up time of 6 seconds on Android and 11 seconds on iOS. Once the app is open features respond in 1 second on both Android and iOS. The app’s text is roughly equivalent to 12 point font for ease of viewing. The features are listed in a simple, clear format to ensure anyone who uses the app can find exactly what they need.
Independence has been fortunate enough to have several intergovernmental partners to spread the responsibility of maintaining a functioning app. The City’s Technology Services Department is instrumental in making large functionality changes, while the Parks and Recreation and Independence Health Department (IHD) are responsible for updating information related to parks locations, farmers’ markets, and community events. All three departments have worked closely together to ensure the app remains up to date with the most valuable and time-sensitive information. The creation of the app has demonstrated the capability and capacity that the City of Independence possesses to create and maintain innovative approaches to increasing the public’s health.To our knowledge, there has been no other health department engaged in using technology to give the community local options for healthy recreation and healthy food options to prevent chronic disease.
No cost and benefit analysis was conducted but with the purchase of the proper technical equipment to craft and devise the Get Healthy app, other apps are on the verge of creation to serve in different capacities to members of the public to improve and monitor their health.
The app requires relatively little stakeholder commitment as responsibility is spread across several City departments. Technology Services is responsible for keeping the app glitch-free and functioning on all supported devices. IHD updates the Farmers’ Market, Community Gardens, and Walking Programs functions. The Parks and Recreation Department continually updates park amenities, locations, and trails on their website, which is automated to update the app at the same time.
Even though stakeholder commitment is not required to be high, IHD Chronic Disease staff work to ensure the app is functioning to its highest potential. The app will continue to be maintained and updated to ensure the most relevant and up-to-date information is available to members of the community.