Community Health Fairs: Time for a redesign?

¹Community Health Center, Inc., New Britain, CT, USA

²University of Pennsylvania School of Medicine, Philadelphia, PA, USA

³Yale University School of Medicine, New Haven, CT, USA

*Corresponding Author:

Douglas P Olson, MD
Community Health Center
Inc. 85 Lafayette Street
New Britain, CT 06051, USA
Tel: 860.224.3642 x 5102
Fax: 860.224.2760
E-mail: OlsonD@chc1.com

Received date: January 03, 2012; Accepted date: February 13, 2012; Published date: February 15, 2012

Citation: Olson DP, Fields BG, Huot SJ, Windish DM (2012) Community Health Fairs: Time for a redesign? J Community Med Health Edu 2:123. doi:10.4172/jcmhe.1000123

Copyright: © 2012 Olson DP, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

Purpose: Community health fairs are an important part of public health yet little data exist that provide information as to why people attend.

Methods: This cross sectional study surveyed attendees at a health fair conducted in an urban, underserved community to determine attendees’ reasons for attending the event. The responses were coupled with results of screening tests.

Results: 228 attendees were surveyed, and nearly half (47%) of participants stated they came to the health fair for information or education; only 18% came for a diagnostic test or an examination. There were 71 attendees with a blood pressure greater than 140/90 mmHg, and 18 (25%) did not have a known diagnosis of hypertension. There were no new diagnoses of diabetes or HIV.

Conclusions: Nearly half of the people who attended this community health fair came for education and health information, and a minority came for a screening test or exam.

Introduction

Health fairs are a common public health promotion activity, and often serve as important venues to connect underserved populations with the healthcare system. We sought to assess the reasons that individuals attend a health fair and analyze results of common screening tests performed at this event, in order to better inform future fair organizers about their participants’ needs.

Methods

This cross-sectional study using a validated, modified survey instrument [1] was conducted at the Yale Primary Care Internal Medicine health fair held in September 2010 in Waterbury, CT. All adult participants of the fair that spoke English or Spanish were eligible to participate in the study. Attendees were offered screening for obesity, hypertension, diabetes, proteinuria and HIV antibody status. Health promotion stations included literature and instruction about age-appropriate cancer screening, gait and balance for the elderly, nutrition, foot care, and substance abuse. As participants exited the health fair, a convenience sample was asked by study staff to participate anonymously in a verbally administered one-on-one survey to collect demographic data and basic information about their medical history. These data were matched with the individual’s health screening results. The study was approved by the Yale University IRB.

Results

228 (63%) attendees participated in the survey; 176 (75%) were female; the average age was 54 years [range 21 to 84]; 164 (72%) spoke English; 30% had less than a high school education, while 6% had a college education or greater. 73% had a primary care provider and 80% had insurance, which included Medicaid (Table 1).

Table 1: Attendee Characteristics.

Nearly half (47%) of participants stated they came to the health fair for information or education; only 18% came for a diagnostic test or an examination. All participants surveyed were screened for obesity and hypertension, 134 (59%) were screened for diabetes, 98 (42%) were screened for proteinuria and 122 (53%) were screened for HIV seropositivity.

Twenty six percent of study participants were overweight (BMI >25-29.9), 30% were obese (BMI>30-34.9) and 23% were morbidly obese (BMI>35). Thirty one percent of blood pressure readings met a diagnosis for essential hypertension (>140/90 mmHg) and75% of these patients had a known diagnosis of hypertension. Of the 6 patients (4%) screened who had a random glucose of > 200 mg/dL, all had a known diagnosis of diabetes. 8 patients (8%) screened had proteinuria. No patients had a positive HIV result (Table 2).

Table 2: Screening Results.

80% (182 people) of participants rated their health as “good”, “very good”, or “excellent”. Overall, 66 study participants (29%) had visited the emergency department (ED) for care at least once in the past year (range of ED visits was 1 to 18) and 31 of these (47%) had been admitted to the hospital in the past year. Of those who visited the emergency room, 55 (83%) had a primary care physician.

Discussion

The community served by this health fair was demographically heterogeneous, consistent with many populations served by other health fairs across the country for the past 20 years [2]. Our population had an increased number of Spanish speakers (30%) compared to the national population (16.3%) but not that of Waterbury, CT (31.2%) and had a lower educational level with 30% having less than a college degree compared to approximately 20% of people both nationally and in Waterbury, CT [3]. The health fair attendees were representative of many attendees at other health fairs [2] who are often economically disadvantaged, ethnically diverse and lack advanced formal education.

There are two important findings of this study that make it unique. First is that despite nearly 4 out of 5 attendees having both a primary care physician and some form of health insurance, 40% had visited the emergency department for care in the past year. A high percentage of these people - 83% - were admitted to the hospital, which compares to the national emergency department admission rate of 13%. Because 4 out of 5 respondents stated that their health was “good” or better, there may be a disconnect between patient understanding of their health and actual health status, though our study was not designed to evaluate this. Nonetheless, this may suggest an enhanced role for specific education about health status and warning signs of decompensation by primary care providers as a tool to help decrease ED visits.

Second, because the great majority of people attending the health fair had regular primary care providers, this survey demonstrates that most attendees might benefit more from additional health information and education as opposed to commonly available diagnostic or therapeutic interventions. This is important, because it informs rational health fair design to invest more resources in patient education and disease management and in specific screening/therapeutic interventions not readily available (e.g., dental screening, hearing and vision assessment, etc.).

This study is limited in that it surveys only a single site health fair and does not include patient follow-up. Yet, it provides data that can help inform the planning of future health fairs.

Many people came for education and information, and the great majority already had a primary care physician and access to healthcare. Routine chemistry screening tests were once done routinely at health fairs and were shown not to be neither helpful nor cost effective [4], and with this in mind, it might be time to look more critically at what services are offered at health fairs, to which individuals, and why. Health fairs can attract a heterogeneous population, as evidenced in our study. Educational efforts aimed at enhancing patient awareness and improving chronic disease management should be considered for future health fairs, as they are cost-effective and engage patients more fully in managing their health.

Acknowledgements

Drs. Olson and Windish had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

References

1. Dillon DL, Sternas K (1997) Designing a successful health fair to promote individual, family and community health. Journal of Community Health Nursing14: 1-14.
2. Heath JM, Lucic KS, Hollifield D, Kues JR (1991) The health beliefs of health fair participants. J Community Health 16: 197-203.
3. United States Census Bureau. 2000 Census Data. Accessed 11 December 2011.
4. Alpert JP, Greiner A, Hall S (2004) Health fair screening: the clinical utility of the comprehensive metabolic profile. Family Medicine 36: 514-519.