Graduation Year


Document Type




Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department

Public Health

Major Professor

Janice Zgibor, RPh, Ph.D.

Co-Major Professor

Ronee E. Wilson, Ph.D, MPH

Committee Member

Deborah Austin, Ph.D

Committee Member

Wei Wang, Ph.D.


behavior change, Geospatial Analysis, health disparities, implementation


Background: The incidence and prevalence of chronic disease (CD) has increased in recent decades due to the advent of CD management and life-extending technologies. To address this burden on the population and healthcare system, evidence-based CD prevention programs have been developed to reduce the incidence and therefore the prevalence of these diseases. Despite the development and dissemination of effective interventions, African-Americans and Hispanics have disproportionately higher prevalence of CD and associated risk factors and disproportionately lower participation in CD prevention programs. Overweight/obesity and CDs may have intergenerational effects, with overweight adults being more likely to have overweight children who are in turn more likely to become overweight adults with CDs. These dissertative projects sought to disrupt this intergenerational cycle of CD by exploring how to engage people of minority background in CD prevention programs, to determine the acceptability and feasibility of a CD prevention program adapted to social media, the preferred method of health education for women of childbearing age, and to identify areas in Florida that would benefit from a CD prevention program such as this.

Methods: Four focus groups of residents of disadvantaged and medically underserved areas and nine key informant interviews with local business owners were conducted using a standardized questionnaire to asses health beliefs, barriers to healthy behaviors, and preferred methods of health communication among the target population. These data were thematically analyzed in Atlas.ti version 8.0. Results of this analysis informed the adaptation of an existing CD prevention program, the national Diabetes Prevention Program (nDPP), to a social media platform, Facebook, to address the needs of the community. The first four weeks of the nDPP were adapted to Facebook using Powtoon and Canva software, were assessed for fidelity by a certified nDPP Lifestyle Coach, and underwent an iterative editing process in collaboration with a community partner, REACHUP, Inc., to ensure cultural appropriateness. Height, weight, and waist circumference were measured pre- and post-intervention via a standardized protocol. Perceived stress, social support, depressive symptoms, and health-related quality of life were also assessed pre- and post-intervention. The final dissertative project utilized the Centers for Disease Control and Prevention and Robert Wood Johnson Foundation’s 500 Cities Data in conjunction with USDHHS locations of existing federally qualified health centers (FQHCs) to identify urban census tracts in Florida with high prevalence of CD and associated risk factors and inadequate access to FQHCs.

Results: Overall, residents and business owners in medically underserved areas of west central Florida identified distrust of medical professionals and pharmaceuticals as a barrier to receiving health care. Lack of transportation and safe recreational areas, were barriers to participating in health behaviors, though participants were concerned about how to prevent and manage diabetes, heart disease, and cancer. The preferred identified method of health communication for women of childbearing was social media, with Facebook being the most used social medium. The nDPP was chosen for adaptation to Facebook because it addressed most of the concerns of the target community. This Facebook-based adaptation of the nDPP, called HealthyLIFE, had no statistically significant results, though there were encouraging reductions in depressive symptom, perceived stress, and health-related quality of life. Tampa, St. Petersburg, Lakeland, and Jacksonville were the urban areas of Florida with the greatest prevalence of CD and associated risk factors, with areas with low insurance, low physical activity, poor physical health, high levels of poverty, high concentration of people of minority background, and high prevalence of stroke and diabetes were statistically significantly more likely to be within 0.5 miles of an FQHC.

Discussion: The results of this dissertation demonstrate the need for qualitative research to inform interventions to disrupt the etiology of chronic disease at the population level, particularly for people of minority background and low socioeconomic status who may experience greater barriers to participating in healthy behaviors and accessing preventive healthcare services. Integrating this type of data into the design and implementation of chronic disease prevention programs and targeting these programs to geographic areas with high prevalence of CD and associated risk factors can increase uptake by populations with historically low participation in these programs. With FQHCs serving less than 25% of urban census tracts with high prevalence of chronic disease and associated risk factors, there is a need for cost-efficient, effective, scalable, and accessible chronic disease prevention programs like HealthyLIFE to improve population health and reduce health disparities between racial and socioeconomic groups.

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Epidemiology Commons