Epidemiology Paper Part Three: Implementation and Evaluation - Asian Americans with type 2 diabetes 1. Identify a public health theory you will use to support the implementation of your prevention and health promotion activities. Provide evidence that supports the use of this theory within the program you designed.

Efficient initiatives in the areas of health promotion, chronic illness management, and public health decrease disease risks and facilitate the maintenance and improvement of public health and chronic ailment management. They have the potential to improve individual, familial, community and organizational self-sufficiency and wellness. Typically, this sort of success necessitates behavioral modification at several levels including individual, community, and organizational (US Department of Health and Human Services, 2014). But every initiative doesn’t enjoy equal success. Initiatives with the greatest likelihood of achieving required results are founded on an explicit grasp of health behavior targets, and their environmental context of occurrence. Providers employ strategic planning theories for developing and managing such initiatives, constantly using meaningful assessment for bringing about improvements. Health behavioral theory may be a crucial factor throughout the process of initiative planning.

The interactive, multilevel ecological perspective has been recommended in relation to diabetes mellitus type 2 health improvement and prevention strategy implementation within the Asian-American population. According to this strategy, health promotion today entails more than mere societal education on healthy practices. Rather, it incorporates attempts at modifying organizational behavior, in addition to communities’ social and physical environments. Further, it deals with development and advocacy of health promotion policies (e.g., economic incentives). Such initiatives which aim at addressing health issues across the aforementioned spectrum operate on different levels and adopt various strategies (US Department of Health and Human Services, 2014).

The ecological standpoint stresses the inter-reliance and interaction between factors across and within each health-issue level. It focuses on individual interface with their respective sociocultural and physical environments. The following two main ecological perspective principles assist with the identification of health promotion intervention points: 1) Several levels of influence impact, and, in turn, are impacted by, behavior; 2) Individuals’ social setting influences, and, in turn, is influenced by, individual behavior (reciprocal causation). For explaining the first principle, McLeroy et al. (1988) cited the following 5 levels of influence with regard to health-related conditions and behaviors: (1) Individual or intrapersonal factors; (2) Organizational or institutional factors; (3) interpersonal factors; (4) public policy factors; and (5) community factors.

To practically address the level of the community necessitates considering public policy and organizational factors, besides societal norms and networks.

Intrapersonal factors

The most fundamental level is that of the individual; hence, planners need to effectively account for and guide individual behavior. Several healthcare providers dedicate the major part of their time at the workplace to face-to-face patient education or counseling. Further, individuals typically form the main target audience of health educational matter. As individual behavior constitutes the basic group behavior unit, individual-level behavioral modification models frequently integrate broader-level group, community, institutional and national behavioral models (Trickett, 2009). As individuals form groups, manage institutions, engage in policy-making and implementation, and vote for and appoint their political and institutional leaders, accomplishing institutional and policy modification necessitates influencing individuals. Besides exploring behavior, such individual-level models emphasize intrapersonal factors (that occur or exist within a person’s mind or self), which include beliefs, attitudes, knowledge, skills, motivation, prior experience, self-concept, and developmental history.

Interpersonal factors

Interpersonal-level health behavioral models maintain the assumption that people exist within their respective social environments, and are shaped by them. A person’s social environment comprises of family members, friends, colleagues, healthcare providers, etc. People’s behavior and feelings are shaped by the views, beliefs, conduct, guidance, and assistance of these persons...

Besides impacting behavior, those surrounding an individual influence their health as well. Several interpersonal-level theories exist, with the SCT (Social Cognitive Theory) (Trickett, 2009; US Department of Health and Human Services, 2014) being one among the most widely adopted and soundest health behavioral theories. It examines reciprocal individual and environmental interactions, and psychosocial factors governing health behavior.
Organizational/community factors

Group and community focused programs form the core of disease prevention- and control- linked public health strategies. Community-level theories examine the functioning and transformation of social systems, as well as how institutions and community members may be mobilized. They provide approaches which are effective in diverse settings including healthcare organizations, worksites, governmental organizations, schools, and community groups. These models embody the ecological perspective, effectively tackling individual, group, community and organizational problems. Communities are typically understood in terms of their geography; however, it is possible to define them based on other criteria as well (e.g., based on collective identity (such as Asian-Americans) or based on common interests (such as the scientific community)) (US Department of Health and Human Services, 2014). The planning of community-level initiatives necessitates familiarizing oneself with the distinctive traits of that community. This proves especially true when tackling health issues within culturally or ethnically diverse communities.

2. Design evidenced-based prevention and health promotion activities that can be implemented to decrease the health risk among your previously identified population.

The Community Guide or Guide to Community Preventive Services represents an evidence-based repository on what proves effective when it comes to public health. It presents various strategies for reducing diabetes mellitus type 2 (T2D) risks among the Asian-American community (Task Force on Community Preventive Services, 2005). This data may be utilized for selecting and designing an initiative corresponding to the ecological perspective and addressing the specific factors linked to T2D in the Asian-American population.

· Put combined physical activity and diet promotion initiatives into action for T2D prevention within the high-risk population. The initiatives may encompass coaching, counseling, or both combined.

· Come up with case management initiatives for coordinating and providing healthcare to all diabetics.

· Engage health workers from the community in prevention initiatives for better weight-related results and glycemic control within the high-risk community.

· Come up with intensive lifestyle programs for T2D-diagnosed persons for supporting diet change, better glycemic control, weight management, and consistent physical activity.

· Come up with team-based initiatives for facilitating T2D management and improvement in lipid, blood glucose, and blood pressure levels.

A combination of physical activity and diet promotion initiatives facilitate the reduction of new-onset T2D. Moreover, they improve cardiovascular and diabetes risk factors, such as obesity, elevated blood pressure, and elevated blood sugar. They aim at T2D prevention within the high-risk population. Lastly, they actively motivate individuals to engage in more physical activity and adopt a healthy dietary regime.

Team-based patient care represents an institutional, systems-level intervention assigning a multidisciplinary professional team for facilitating T2D self-management by patients. Individual teams comprise of patients, primary care practitioner (not a doctor, in all cases), and at least one other health professional. This team assists the patient with getting the right medical exams done, using medication for risk factor management, treatment adherence, and making healthy lifestyle and behavioral choices.

Interventions that engage health workers from the community for preventing diabetes improve weight-related results and blood glucose control among the high T2D-risk group. Community workers form the frontline workers in the public health arena functioning as the bridge between health systems and underserved populations. Initiatives can include lifestyle modification and diabetes prevention related education and counseling for high-risk individuals.

Rigorous lifestyle interventions aid T2D-diagnosed individuals in achieving improved glycemic control, in addition to decreasing…