Program Planning for Target Population

¶ … health issues facing the differed populations of the United States today, and these health concerns differ between males and females, income levels, and races. As such, it is important, prior to discussing any particular health concern, to first establish the target age cohort for which information is to be presented. Once this cohort is established, creating programs targeted to a specific population becomes a much simpler task.

This paper discusses the top five leading causes of death for African-American women age 25 to 44 in the United States in the year 2001. Additionally, this paper will focus on one particular cause of death for this population, and will outline an existing prevention program, aimed at this target age cohort. Finally, this paper will present data from studies on this prevention effort, to determine if the effort is succeeding.

As stated, the age cohort to be analyzed in this paper is that of African-American women in the United States age 25 to 44. According to the National Vital Statistics System, the leading cause of death in 2001 within this population was Human Immunodeficiency Virus Disease, commonly known as HIV. The HIV virus leads to a mortality rate of 17.3 per 100,000 individuals in this population. HIV deaths were followed in that year by death from malignant neoplasms, with a 15.0 rate, accidents or unintentional injury, with a 14.7 rate, heart disease, equaling a rate of 13.5, and homicide, with a rate of 12.1 (CDC, 2004).

Clearly, HIV infection led to a high number of deaths within this age cohort in 2001. In an effort to reduce the number of deaths and infection rates, many federal, state, and local agencies implemented prevention strategies, aimed specifically at those most at risk for HIV infection. Programs such as the Holistic Health Recovery Program, the Healthy Relationships Program, and the Black Women's Heath Project were developed to combat HIV infection in African-American men and women in low income areas (O'Leary, 2005).

One of the most successful prevention programs, however, is that of the Real AIDS Prevention Project, or RAPP. RAPP is a program designed to reduce the risk and prevalence of HIV infections among women in high risk areas, through the increased use of condoms. Based on the HIV Prevention in Women and Infants Demonstrations Project (WDP), this community mobilization program is centered on the behavioral change model of disease prevention. This transtheoretical model centers on the concept that behavioral modification involves a series of stages, and that in order to evoke a change, the individual must be ready to change. Additionally, the project involves the idea that effective behavioral modification strategies rely on social learning and "diffusion of innovation" (Liebman, et al., 1999).

'Diffusion of innovation" can be thought of as a way to communicate new ideas over time across a specific social system. According to Everett Rogers, author of Diffusion of Innovations (1962), four elements are necessary in the diffusion of innovation process, and these four elements are the core concepts of the RAPP program. First, an idea or practice must be present. Secondly, communication channels must be opened for the passage of the idea. Third, the concepts of the idea must be presented slowly over a longer period of time, in order for each stage of behavioral change to occur. Finally, a social system must be present that encourages adaptation of the new idea (Rogers, 1962).

The RAPP program is centered on these ideas. Funded by the Center for Disease Control (CDC), the original five-year project of WDP, lasting from 1993 to 1998, grew into the RAPP program, which is now available nationwide through informational packages available from the CDC. The program uses peer volunteers in areas of high risk of HIV, including those of African-American females in the 25 to 35 age group. These peer volunteers solicit assistance from local community organizations and businesses to target specific individuals for intervention. Additionally, the peer volunteers sponsor small group outreach activities, such as safer-sex parties and informational meetings (Liebman, et al., 1999).

Following identification of at-risk individuals in the target age cohort, the peer volunteers interview the client one-on-one to determine the client's stage of "readiness to change." Using printed materials about role models in the community who have elected to use safer sex decision making skills, the clients are exposed to behaviors which help avoid the risk of HIV infection, and are given information on how to alter their own behaviors in safer ways. These role model stories and safer-sex discussions focus on increasing the females confidence in their right to demand condom use from their partner, identifying advantages and disadvantages to condom use, and the building of support groups within the cohort population to assist in changing behaviors (Liebman, et al., 1999).

Additionally, peer volunteers perform street outreach sessions, where those volunteers walk through their neighborhoods, and distribute the printed role model stories and behavioral modification techniques. Participating businesses in the area offer free condoms as part of the social network group, and display the information, so it is available for all at-risk individuals in the area. Newsletters or brochures containing information about the HIV virus, and condom use are also used in the project (Liebman, et al., 1999).

According to research by Lauby, Smith, and Stark in 2000, these behavioral intervention programs appear to work in the target population. Their study, involving the original WDP program, included survey data of 3,722 African-American females, with a mean age of 25. At the beginning of the project, in 1993, 68% of the women surveyed did not intend to use condoms with their primary partners. Additionally, 13% of those surveyed did not use a condom with their primary partners for one month or longer. Thirty percent of the population used condoms with partners other than their primary partner (Lauby, et al., 2000).

Following the study, additional survey data was collected. The researchers noted a 112% increase in the willingness of the participants to discuss condom use with their partners. Additionally, the demand for partners to use condoms had risen 13%. There was also a nine percent decrease in those never using condoms (Lauby, et al., 2000).