Date of Degree


Document Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)




Jean Dowling Dols


The zip codes where patients live are stronger determinants of health outcomes than the frequency of visits with a primary care provider. Providers have a unique opportunity to extend health care beyond the clinic walls and engage in efforts to improve the communities where their patients grow, live, work, and age. In order to impact the health of patients, a culture of health needs to be developed. The Robert Wood Johnson Foundation culture of health action framework directed the build of a foundation of health as a shared value in a neighborhood with high morbidity and mortality rates in southwest San Antonio, Texas. This community quality improvement intervention was designed to equip participating community members with knowledge, skills, and supplies to be drivers for health as a shared value. Prior to implementation, community surveys assessed perceptions regarding health as a shared value. A one-time class offering opened discussion regarding the effects of stress on heart health. A 7-week class, Health to the Fourth Power, was developed to equip community stakeholders using healthful education, physical activity, community responsibility, and plant-based meal preparation. Post implementation survey results revealed moderate understanding of health interconnectedness. Health to the Fourth Power participants increased daily fruit and vegetable consumption, decreased body mass index, and decreased mean systolic blood pressures. It is imperative for medical providers to advocate for a culture of health in their patients’ communities.