Intervening to Prevent Diabetes

Introduction
Following a review of the health of Riverside County, it was found that the mainly African American population was suffering from high rates of diabetes. The Community Action Partnerships for Health Organization (CAPHO) was contacted to see if it would be will to work with the heath care community to address the problem of diabetes in the county. CAPHO agreed and set about developing a plan with objectives, sub-objectives and action items. The goal was to reduce the rate of diabetes among the population through prevention.
Background of the Organization
CAPHO “had been providing services to low-income African American women for ten years” (Harris, 2010, p. 183) so it was willing to address this health issue in the county, which the organization itself had noticed becoming an issue in recent years. The Organization developed the Healthy Soon Project to help focus on the issue of diabetes. The Project aimed at addressing the main two factors for the rising prevalence of diabetes—namely, obesity and lack of exercise. CAPHO saw that it also had to address the environment in which these people lived, as the sidewalks were not good for walking, the parks were not safe, and the convenience stores did not sell much fresh or healthy food. Thus, Organization defined its two main objectives in this manner:
· Program Health Objective: Increase the percentage of African American women who participate in the intervention who are at a healthy weight to 60 percent by 2012.
· Program Environmental Objective: Increase to 40 percent the number of stores and other venues that sell affordable produce in low - income neighborhoods by 2015 (Harris, 2010, p. 184).
Brief Description of the Purpose of the Evaluation
The purpose of the evaluation was to determine the areas in which the organization could achieve an impact. They stated the expected outcome and the intervention approaches that they would use to achieve their goals. The evaluation’s purpose was to determine the extent to which the outcomes were achieved and the extent to which the interventions were successful. To that end, a series of questions needed to be answered, including the initiative activities that were to be used, the frequency with which the activities were to be conducted, and the intended outcomes. The following questions were helpful in determining the extent to which the project would be successful:
1. What human, financial, and material resources were provided and used?
The Healthy Soon Project used a budget of $150,000 good for one year. The human resources consisted of one supervisor and three support staff—however, the team also reached out to other researchers in the fields to obtain ideas about how to implement a successful evidence-based intervention for the best results. By reaching out in this to obtain information on EBP (evidence-based practices), the team was conforming to the recommendations of numerous scholars who have called for more EBP in the health care industry (Leach, 2006; Rubin, 2011). As for material resources, the project focused on providing gym facilities for the population, obtaining diabetes screening supplies, having a dietician on contract, and bringing in local farmers to help provide fresh foods at the farmer’s market to make up for the lack of selection at the local convenience stores and foodmarts.
2. What educational activities were carried out?
Educational activities that were carried out for the population at risk of developing diabetes included nutrition education, education on tailoring a diet that was low in fat and calories and high in fiber, and education on how to keep a food/exercise journal to help monitor how one was eating and whether one was getting in enough exercise throughout the week.
There was also a need to educate policy makers so that legislation could be enacted “to reduce advertising for alcohol in convenience stores” (Harris, 2010, p. 189). This had to be followed up with educating members of a coalition to support legislation that promoted the distribution of and greater access to healthy foods for communities and underserved populations. Education of store owners was also needed with respect to handling produce. Overall, the whole population of the county needed education on what the risk factors were for diabetes.
3. Were all the components of the plan implemented?
All of the components of the plan were implemented, just not at the same time or at least not all within the first month when the audit/evaluation was conducted. The main components had been implemented within the first month of the project. These included:
· Physical activity in the gym—the gym was open 8 hours a day, was equipped and staffed, and participants were registered, with baselines measured and journals begun.
· Nutrition—a dietician had been hired and was committed to providing 20 hours per week with one hour sessions; 50 participants had been registered with baselines measured and journals begun.
· Walking with peers—partners had teamed up and journals had begun.
Those components were in place in the first month of the project. The other components, though not fully in place, had gotten underway and they included:
· A legal and regulatory framework—for reviewing laws, forming a coalition, holding meetings with legislators and providing a monthly newsletter.
· Farmers’ markets—farmers still needed to be contacted for establishing a site and schedule for market hours.
· Convenience store initiative—monthly meetings needed to be scheduled with minutes taken, trainer identified, and training scheduled.
· CAPHO/farmers/store owners partnership—this still needed to be scheduled by the end of the first month.
4. What is the level of implementation of the women’s nutrition and exercise initiatives?
Only 15% were exercising for 30 minutes per week and 36% of the intervention group “said it was okay for people to get diabetes” (Harris, 2010, p. 202).
5. What activities have taken place to develop the farmers ’ market?
The farmers’ market had not yet been implemented after one month, but “meetings had begun among the constituencies, and a coordinator had been named, ensuring that the remaining components were being developed” (Harris, 2010, p. 203).
6. What activities have taken place to support the policy to reduce advertisements for alcohol?
So far not much action had been taken on this component; however, some efforts had been put forward: “Work toward developing the alcohol-advertising legislation had started with a review of existing laws and the development of the legal and regulatory framework. An advocacy coalition had formed that brought together a group of ten advocates” (Harris, 2010, p. 200).
7. What is the knowledge of diabetes risk factors among women who participate in the initiative?
The knowledge of diabetes risk factors among women who participated in the initiative was very low: one-hour lectures were developed to inform them of the risk factors and educational material was printed off for their taking—but baseline measures indicated that more than 1 in 3 women believed diabetes was not a threat to their health or at least was not an issue to be worried about.
Conclusion
As Nutbeam (2000) and Schilinger et al. (2002) show, health literacy is crucial in the prevention of diseases like diabetes among communities. Health education is one of the biggest components in changing people’s lifestyle because it empowers them to take ownership of their own health and start making changes. However, Harris (2010) shows that the environment is also an important factor to consider as it will make a difference on the number of resources that are available and the extent to which a community will be able to act on the information it receives from health care providers. For example, if a community has no access to fresh foods, fruits and vegetables, educating them about the need for such could be problematic, especially if the community does not know how to take steps to resolve the lack of access to healthy foods on their own. Thus, this case study shows how important it is to approach issues like this holistically.
References
Harris, M. J. (2010). Evaluating Public and Community Health Programs, John Wiley &
Sons, Incorporated ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/touromain-ebooks/detail.action?docID=484874
Leach, M. J. (2006). Evidence?based practice: A framework for clinical practice and
research design. International Journal of Nursing Practice, 12(5), 248-251.
Nutbeam, D. (2000). Health literacy as a public health goal: a challenge for contemporary
health education and communication strategies into the 21st century. Health promotion international, 15(3), 259-267.
Rubin, A. (2011). Teaching EBP in social work: Retrospective and prospective. Journal
of Social Work, 11(1), 64-79.
Schillinger, D., Grumbach, K., Piette, J., Wang, F., Osmond, D., Daher, C., ... &
Bindman, A. B. (2002). Association of health literacy with diabetes outcomes. Jama, 288(4), 475-482.