Diabetes Mellites type 2 is a systemic metabolic disease and one of the fastest growing epidemics. It is estimated that more than 400 million people have been diagnosed worldwide. In the USA alone, more than 37 million or 11.3% of the population have the disease 1,2 (CDC). Obesity found to be the most common causes of type 2 diabetes and other chronic debilitating conditions. The increase prevalence of obesity in children and adolescents in many parts of the world has led to increasing prevalence of type 2 diabetes mellitus in these age groups. Morales et al demonstrated that even modest weight reduction may reduce the risk of type 2 diabetes by 58%, Cancer by 11%, and CVD mortality by 41%.7
Numerous research articles highlight that type 2 Diabetes is potentially preventable disease through lifestyle modifications (e.g., weight loss, eating healthy and increased physical activity).
The aim of my project to explore an effective preventive intervention strategy for type 2 diabetes among Latino communities especially Latino youth in State of Kansas, by utilizing physical activity, and lifestyle change interventions. Implantation of these Interventions have been showed to reduce the risk of prediabetes and T2DM in these high-risk population.
The incidence and prevalence of clinically diagnosed type 2 diabetes has continued risen in minority. 3 Latino youths compare to other ethnic groups and are disproportionally affected by prediabetes and type 2 diabetes (T2DM). Studies have shown that without any change, 50% of Latino children and adolescents will develop T2DM 4,5. This is mostly due to sociocultural factors, such as lower income low education and inadequate healthcare access, as well as a genetic susceptibility to the disease. 6
For example, Aguayo et al found that “Latinos with the annual income lower than $20,000 had higher prevalence of diabetes 16.9% for men and 18.5% for women compare to those with income higher than $75,000, 12.8% and 8.3% respectively”.4 The study concluded that multidisciplinary and comprehensive approaches required to highlight the importance of cultural, social, and biological factors to further evaluate the susceptibility of these population to the disease 6. Another study find that education was another key determinant of health in the development of T2D in these population. They found that “15% of adults with less than a high school diploma had diabetes compared with 7% of adults with a bachelor’s degree or higher.8
Compelling scientific evidence indicates that lifestyle changessuch as physical activity, weight loss, will lower the incidence of T2DM by 58% compared to control group. Ann Intern Med. 2004; 140:951-957.
Albright et al states that structured lifestyle intervention is most effective to combat T2DM and obesity. This initiative will address physical activity and nutrition. In addition, multiple other studies are in favor of this method because it is cost-effective. Dunkley et al in their meta-analysis and systematic review summarized the effectiveness of type 2diabetes prevention programs, through lifestyle changes. they concluded that pragmatic prevention programs can be improved by maximizing standard adherence (2014).
A recent review article by Crus et al concluded that culturally appropriate programs that focus on building healthy communities appear to be an effective intervention to reduce type 2 diabetes in Latino youth.4
Another article by Page-Reeves J et al reveal that Self-management Education approach in conjunction with the culturally appropriate intervention has been showed to be more effective in glycemic control and self-management behaviors such as diet, physical activity, and diabetes-related knowledge.9
Furthermore, Coffman et al found that any intervention that improve the health literacy skill and interpretation of health-related information can significantly improve health outcome10.
Community Mobilization to Promote Health Behavior Change
Among many health behavior theories, I chose community mobilization theory. First of all, it is practical and easy to apply, and secondly it can be applicable to individuals or a group around specific community. It is often associated with community organization, raising awareness, building coalition, and action. Since it is focus on community-based strategies and health outcome, it will also enhance community participation, capacity building, and development.
Additionally, community mobilization models can also improve health behaviors among disadvantaged populations through culturally appropriate consultation and participation. 11
Community mobilization has four main phases: Planning, raising awareness, building a coalition, and taking action.
For my project, the plan is to offer culturally appropriate educational materials to the community through focus group discussion, interview, raising awareness by showing data and discussed their susceptibilities and serious health consequences of T2DM and obesity. Building coalition with the community through the family, church members, and other stakeholder in charge.
Especially in Latino community, since the family and loyalty are very important for them. For this reason, the engagement of the family members more important than the needs of individual. This loyalty may benefit the individual as the family may provide the support needed for disease self-management11.
My intention to offer a culturally appropriate self-management education program to improve health literacy among individuals in community and raise their awareness of serious consequences of T2DM and Obesity 12.
PRECEDE-PROCEED for Program Planning
I chose this model for planning because it has been shown to be productive and practical approach to address health issue. It can analyze various determinants of health that cause specific health issue in the community. “It comprises the process of planning, implementing, and evaluating of the health issue.” 15
This model has 8 phases.
1. Social Assessment: understand and analyze the community, including social status of the community, culture, languages, food habitus, and ask question why Diabetes and obesity need to be prevented.
2. Epidemiological including behavioral and environmental assessment: By building a logic model, further analysis the health-related issues that cause diabetes and obesity in Latino community. Behavioral causes such as poor nutrition behavior, socioeconomic status, environmental cause such as unavailability of safe recreational park for walking in the community.
3. Educational assessment: Analyze and assess the medical knowledge of the community regarding of the diabetes and obesity, and further evaluate the etiology and understand and describe the barriers. Provide them with practical and easy to follow instructions.
4. Administrative and policy assessment: In this point of the model, I will evaluate the food services in the community such as grocery stores, conventional stores, fast food, school food departments and create focus group to talk about diabetes prevention program.
1. Implementation: After understanding causal relations then develop the necessary training, educational material and resources require to implement the program.
2. Process evaluation: Evaluate level of interest of the community and their participation to the program.
3. Impact evaluation: Evaluate the program how the intervention makes them aware of the health consequences of diabetes and obesity.
4. Outcome evaluation: evaluate how the program affect diabetes rate, community and parents’ awareness regarding of the disease and it is serious long-term consequences.13,14
The intend of my program is to develop culturally appropriate intervention to engage and educate resource poor community especially Latino regarding the negative health consequences of Diabetes and obesity.
There is plenty evidence that support the positive impact of the community engagement interventions on a variety of health-related issue. They are based primarily in the theory of community mobilization, focus on planning, implementation, and evaluation that is found in PRECED- PROCEED models.13-15
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