The Florida Department of Health in Orange County (FDOH-Orange) is one of 67 Public Health Departments under the governance of the integrated Florida Department of Health (DOH). DOH-Orange is responsible for protecting, promoting and improving the health of the county's 1.2 million residents and over 75 million annual visitors. Included in the Department's geographical purview is Orlando, the county's seat, residence to some of our nation's most sought-after theme parks and tourist attractions, and a over 175 incorporated municipalities and towns along. As Florida's fifth most-populated county, Orange County boasts a tapestry of racial and ethnic communities, generous distributions of varying age ranges, and economic strata that call Orange County home. FDOH-Orange welcomes opportunities to reach and impact all of these diverse communities to improve health status and health outcomes.
In May 2019, the FDOH-Orange County Office of Community Health (FL DOH-Orange) joined comprehensive efforts statewide to address chronic conditions that critically impact community health and well-being. While billions of dollars are spent annually in Florida to address heart disease risks, heart disease remains the leading cause of death. In 2018, Florida Charts confirmed hypertensive heart disease deaths in Orange County as exceeding state rates. While only marginally increased from 2017 counts, 2018 hypertensive heart disease deaths showed the highest levels since 2015 and nearly 37% increase since then. Particularly, current data indicates rates of cardiovascular disease and stroke among Black and African American populations in Orange County exceeded rates in White populations.
In collaboration with the Centers for Disease Control and Prevention and the Million Hearts® in County Health Departments program, FDOH-Orange piloted the Step Into Your Best Life program (SIYBL). Illustrating Million Hearts® 2022 strategies, SIYBL was purposed to use an 8-week period to prevent cardiovascular disease incidence by:
- Reducing inactivity by at least 20% among Black and African American populations ages 35-64,
- Enhancing access to places for physical activity, and
- Fostering a peer support group to reduce social isolation and loneliness in priority populations.
SIYBL's 8-week curriculum focused on educating participants on individual and community-level CVD risks, improving health literacy, and providing instruction on Chicago-style Steppin' as a method for increasing regular physical activity in target populations. Objectives, therefore were programmatic and participant-based. By the culmination of Step into Your Best Life, the following objectives were to be accomplished:
- Create/Enhance access at least two places for physical activity in Orange County,
- Disseminate preliminary findings and cardiovascular disease prevention education to Orange County communities-at-large,
- Collaborate with stakeholders to mobilize communities throughout Orange County on CVD risk factors and preventive measures,
- Facilitate environments conducive to peer support for dance lesson participants,
- Implementation of two screenings of documentary High Blood Pressure: A State of Emergency in the African American Community with panel discussion following,
- At least 80% of participants would attend at least 6 dance lessons,
- At least 80% of participants would receive blood pressure screenings from credentialed professionals and educational guidance,
- At least 80% of participants would identify dance as a viable physical activity,
- At least 80% of participants would indicate intentions to continue physical activity in subsequent weeks,
- At least 60% of participants would report increased duration and frequency of physical activity in the previous week, and
- At least 20% of participants would report at least 5% reduction in systolic blood pressure.
Step into Your Best Life collaborated with Hebni Nutrition and launched during a World Record-breaking attempt for the world's largest line dance. This opportunity offered unparalleled access to participants and seamless integration into the event purpose. Three locations throughout Orange County served as venues for dance lessons. Three, two-hour, dance lessons weekly offered SIYBL opportunities to accomplish its primary objectives. Two screenings of the High Blood Pressure documentary featuring post-screening panels from well-known Orange County residents (including form CBS Morning anchor Mark McEwen) recovering from strokes provided opportunities to discuss preventive measures. Finally, a culminating event entitled Summer Breeze provided a shared experience for participants to initiate sustained lifestyle changes learned, and display dance skills acquired during SIYBL.
Gratefully, all objectives of SIYBL were accomplished. Outcomes showed that as many as 60% of participants attended lessons at all three locations weekly. Such retention and participation has been unmatched previously. Further, more than 55% of participants reported increased frequency and duration of weekly physical activity due to participation in SIYBL. More than 70% of participants indicated intentions to continue physical activity in consecutive weeks, and 90% recognized dance as a viable physical activity after participating in the 8-week program. Two community screenings of the High Blood Pressure were implemented during Minority Health Month and National Hypertension Month, and garnered noteworthy support from various communities. The culminating event, Summer Breeze 2019, brought more than 200 participants from all venues to celebrate completion of the program and to pledge sustained commitment to health promoting activities and expanded self-management of chronic conditions.
Factors for Success
Step into Your Best Life was designed to meet unique needs of targeted populations. Imaging, training contexts, no cost, and direct interactions with professionals reflected the inclusiveness needed for Black and African American populations to recognize the program's targets and respond accordingly. Engagement from notable community stakeholders recovering from strokes offered direct connections with target populations and allowed educational material dispersion. Participation in existing community events and marketing on social media increased awareness and resulted in high levels of retention and participant increase over the duration of the program.
Public Health Impact
Among various cultures, dance has historically been considered creative art and identity support. FDOH-Orange's reframe of dance as a health-promoting physical activity through SIYBL removed barriers priority populations currently face in sustaining prescribed levels of weekly physical activity, increased social interaction, and reduced loneliness. SIYBL's use of dance offered various levels and complexities to heighten endorphins, increase heart rates, increase lung capacity, and improve motor skills for participants were tangible to target populations and enjoyable. Additional activities focused on target population needs and increased awareness of preventive and self-management methods to reduce CVD incidence and mortality in Black and African American populations.