HL 367 Major Project: Fall 2013

HL 367 Major Project: Fall 2013 Katie Tourville & HyacinthiMwangu

Mission: To increase minority communities’awareness of the link between obesity and diabetes through education. DV: awareness of the link between obesity and diabetes IV: education Target Population: minority communities Agency: Chicago Department of Public Health Agency Mission: “to make Chicago a safer and healthier place by working with community partners to promote health, prevent disease, reduce environmental hazards and ensure access to health care for all Chicagoans. Our Job in Agency: Community Health Educator—”to be well informed regarding all matters affecting the health of the citizens of Chicago. It shall formulate policies and otherwise advise the mayor of the city and the commissioner of health on all health issues.”

Assess General Need • “There may be lack of familiarity with recommended food items, which may be costly, difficult for families to obtain, and require special preparation (4,80). Finally, many youth who are obese ﬁnd it difficult to engage in strenuous physical activity” (American Diabetes Association, 1999). • Diabetes and obesity are related, and insulin resistance causes weight gain and the diseases associated with obesity (P. Attia, 2013). • Behavior modification is necessary to tackle obesity and type 2 diabetes and it requires individual awareness of the existing problem ( J. DeVille-Almond, AA Tahrani, J. Grant, M. Gray, GN. Thomas, S. Taheri, 2011). • There are environmental disparities for those with diabetes (C. Horowitz, 2004). • “Preventing obesity for all children may be a way to reduce socioeconomic and ethnic health disparities” (S. Kumanyika & S. Grier, 2006). • There are issues of death, impaired quality of life, and direct costs of health care related with obesity and weight gain (A. Mokdad, B. Bowman, E. Ford, F. Vinicor, J. Marks, J. Koplan, 2001).

Assess General Need • Different ethnic groups living in US have high prevalence to develop obesity and type 2 diabetes compare to those who are living in their country of origin (A. Nicola & C. Manisha, 2013). • There is a need to increase awareness of the link between diabetes and obesity not only in minority but in all communities (Diabetic Care Services, 2013). • Mexican Americans are at increased risk for obesity and diabetes (Fisher-Hoch. S, Rentfro. A, Wilson. G, Salinas. J, Reininger.B, Restrepo. B, McCornmik. J, and Perez, A, 2010). • African-American, Hispanic, and Native American children are at great risk of being diagnosed with impaired glucose tolerance and type 2 diabetes (Goran. M, Ball. G and Cruz. M, 2003). • There are increasing number of children with obesity and type 2 diabetes in ethnic groups (Lipton. R, Drum. M, Burnet. D, Rich. B, Cooper. A, Baumann. E, and Hagopian, 2005). • Ethnic groups ,which are minorities, are at high risk of developing obesity and diabetes (Oldroyd. J, Banerjee. M, and Heald. A, 2005). • Many parents are not aware of their children being obese because they are eating unhealthy meals, long hours of watching TV, and lack of exercises put those children on high risk of developing type 2 diabetes (S. Nevins and J. Hoffman, 2012). • Minorities have been more affected by obesity and put them on high risk of developing type 2 diabetes (J. Rushing, 2012).

Theoretical Definition of DV • Having knowledge of the link between obesity, an excessive amount of body fat which increases your risk of illness, and diabetes, a group of diseases that affects how your body uses blood glucose (Mayo Clinic, 2013). This knowledge includes: 1) knowing what obesity is; 2) knowing what diabetes is and its forms; 3) knowing of the increased risk of diabetes with obesity; 4) knowing the mechanism for the link between having both obesity and diabetes; and 5) knowing what to do to prevent diabesity (Diabetic Care Services, 2013) (P. Hogan, 2013). • http://www.thefreedictionary.com/awareness • http://www.mayoclinic.com/health/obesity/DS00314 • http://www.mayoclinic.com/health/diabetes/DS01121 • http://www.diabeticcareservices.com/diabetes-education/diabetes-and-obesity

Model of DV –Reflecting Theoretical Definition

Dependent Variable Test 1) What is obesity? Explain. (10 points) 2) What is diabetes? Explain. (10 points) 3) Is there an increased risk of diabetes if you are obese? Explain why/why not there is an increased risk. (5 points) 4) What to do to prevent obesity and diabetes? (15 points) Total: ___/40 Score Measurement 10-20/40: poor understanding of the link between obesity and diabetes 21-30/40: moderate understanding of the link between obesity and diabetes 31-35/40: good understanding of the link between obesity and diabetes 36-40/40: excellent understanding of the link between obesity and diabetes Answer Key 1) Obesity is: having too much body fat which causes one to have a higher health risk 2) Diabetes is: a group of diseases that affect how your body uses sugar in the blood 3) Yes, there is an increased risk of diabetes if you are obese. This is because: if you are overweight, this causes more stress on your body. It can affect your ability to maintain the right amount of sugar in the blood, therefore increasing your risk of diabetes. 4) To prevent obesity and diabetes, exercising 30 minutes a day and eating properly are very important. It would be helpful to eat a high fiber, low carbohydrate diet.

Dependent Variable Test • Test Validity: Our test will measure the awareness of the link between diabetes and obesity per our theoretical definition listed above. Our test consists of four questions, which are testing the individual’s awareness, or knowledge of, each aspect which includes obesity, diabetes, the increased risk of diabetes if you are obese, and how to prevent obesity and diabetes (diabesity). Our theoretical definition includes all of these aspects; therefore our test has content validity, and actually measures our DV per the theoretical definition of the DV. • Test Reliability: We could measure our test in two different areas of minority communities in Chicago. It would take place in a different church in each of these locations, on a Tuesday and Thursday of the same week. The test results should be the same in both areas of Chicago. This would demonstrate that we have test-retest reliability (test consistency), as the results will be the same on Tuesday and Thursday.

Assess Specific Need • Pre-Test Results on Diabetes Awareness Test: • Program Group: 10/40 • Control Group 10/40

Identify Measurable Objectives • Participants will score from 1/10 to at least a 9/10 on question 1 (what is obesity?) by the end of the 8 week program. • Participants will score from 1/10 to at least a 9/10 on question 2 (what is diabetes?) by the end of the 8 week program. • Participants will score from 1/5 to at least a 4/5 on question 3 (is there an increased risk of diabetes if you are obese? Explain why/why not there is an increased risk) by the end of the 8 week program. • Participants will score from 2/15 to at least 14/15 on question 4 (what to do to prevent obesity and diabetes?) by the end of the 8 week program. • This will total for 36/40=excellent understanding of the link between obesity and diabetes

Plan an Evidence-Based Program • We will use the Outreach Model and Model for Healthy Living. • Author: Community Tool Box; Church Health Center • Year: 2013; 2010 • Links: http://ctb.ku.edu/en/table-of-contents/implement/access-barriers-opportunities/outreach-to-increase-access/main http://chreader.org/contentPage.aspx?resource_id=621 • When executing our program, based off of the Model for Health Living (The Church Health Center, 2010), we will focus on the 7 factors of the model: faith, movement, medical, work, emotional, nutrition, and friends and family. • We have created a program that is based on what diabetes and obesity are, how they are related, and what to do to prevent them.

This image is the Model for Healthy Living from the Church Health Center (The Church Health Center, 2010).

Plan an Evidence-Based Program

Implement the Program Model • We will use the Outreach Model (Community Tool Box, 2013), and the Model for Healthy Living (The Church Health Center, 2010). Outreach is reaching out, but the type and degree of outreach depends on an effort’s purpose, goals and target population. We are reaching out to minority communities in Chicago, our target population. • The program will last for eight weeks to ensure they have awareness of the link between obesity and diabetes. • They must have transportation to the church; rides can be coordinated to get to the church, or we could work with a local taxi company to provide reduced fare rides. • We will have helpers to read the information or write the answers for them on their tests.

Implement the Program Model (continued) • We can educate in smaller groups so there is more interaction. • Our personal approach will be empowering our target population, showing that we care for them by increasing their knowledge and awareness. • To implement effective outreach: we will meet people where they are, be respectful, listen to the communities, build trust and relationships, get the word out in a non-stigmatizing manner. • Service and information will be offered in a variety of locations and at non-traditional times, especially after work hours. Written information will be friendly and easy to understand, information will be in the primary language of those who will use the service, and we will make sure to follow-up. • Repeating information is very important to make it the most effective possible. • This program will start as soon as our grant request is approved. • (Community Tool Box, 2013) (Church Health Center, 2010)

Behavior Change Model (SCT light) • Our tp knows what to do? We will ask our tp if they know that they should be aware of the link between obesity and diabetes. We will explain our program and how it will increase their awareness of this link. • Our tp knows how to do it? We will explain the structure of our program, meeting for 8 weeks, twice a week on Tuesday and Thursday for an hour each. It will take place at a church in Chicago. • Our tp wants to do it (is motivated)? We will give them incentive to want to learn and have an increased awareness. We can apply the information to their family and friends that may suffer diabetes or obesity, and cause them to want to help these individuals’ live longer and happier lives. • Our tp believes it can do it (is self-efficacious)? We will empower them to want to learn and increase their awareness. We will use positive reinforcement to motivate them. • Our tp has a supportive environment? The members of the church, priests, family and friends, employees of the health department, and us as community health workers will all provide a supportive environment. We will explain they have enough support succeed through the program, and get through any barriers of the environment.

Evaluation Design Intervention -Outreach Model (Community Tool Box, 2013) -Model for Healthy Living (Church Health Center, 2010) Pre–Test On Diabesity Awareness Test Program Group Results: 10/40 Post-Test On Diabesity Awareness Test Program Group Results:36/40 Post-Test On Diabesity Awareness Test Control Group Results: 10/40 Pre-Test On Diabesity Awareness Test Control Group Results: 10/40

What are the threats? • The threats to internal validity that may accompany our evaluation design since they are not randomized are selection of our program and control groups. Since they are picked to be in the group, they could decide to not participate or alter their results. It is voluntary to participate in our program model.

Evaluate Mission Fit in Program • Our mission fit question is: Did we increase the awareness of the link between diabetes and obesity in minority communities? • Yes, we increased the awareness of the link between diabetes and obesity in minority communities. • Our evidence that we met our mission is that the scores in the program group increased, as they were supposed to. The program group went from receiving a 10/40 on the pre-test, to receiving a 36/40 on the post-test. And the control group did not change, so our program made the difference.

Marketing and Communication • We would market through posters/flyers posted around the city with visuals tomake those aware in the churches of our education program. Our social marketing campaign can be executed through the radio, television newscasts, or the newspapers. We could display posters and pass out flyers with images that convey our education program; we would give this to the priest as well to hand out. The goal of our marketing will be to increase awareness of the link between obesity and diabetes. • Because we’re dealing with a minority and low-income population, computers won’t be accessible. Therefore, Facebook and other social media wouldn’t be as effective for communicating throughout our program. • We would communicate with local radio stations and newspapers. We could have a local television channel through the church we are working at in Chicago, aid in communicating with the members in our group.

Grant Information • The granting agency is the United States Department of Health and Human Services. The mission of this agency is ” The mission of the Department of Health and Human Services is to help provide the building blocks that Americans need to live healthy, successful lives. We fulfill that mission every day by providing millions of children, families, and seniors with access to high-quality health care, by helping people find jobs and parents find affordable child care, by keeping the food on Americans’ shelves safe and infectious diseases at bay, and by pushing the boundaries of how we diagnose and treat disease,” (US Department of Health and Human Services, 2013). • The grant’s purpose is “to test practical, sustainable, and cost efficient adaptations of efficacious strategies or approaches to prevent and treat diabetes and/or obesity.” Our mission is to increase awareness of the link between obesity and diabetes. Therefore it is compatible with our mission, as the grant is aiming to prevent and treat diabetes and/or obesity. • This is the link to the granting agency: http://www.hhs.gov. • This is the link to the explanation of the grant: http://grants.nih.gov/grants/guide/pa-files/PA-13-352.html. • There is not an amount of money specified for the grant.

Webliography American Diabetes Association. (1999). “Emerging Epidemic of Type 2 Diabetes in Youth.” Retrieved September 24, 2013, from http://care.diabetesjournals.org/content/22/2/345.short Abate. N, and Chandalia, M. (2003, January). The impact of ethnicity on type 2 diabetes. Journal of Diabetes and its Complications. Volume 17. Issue 1. Retrieved September 28th, 2013, from http://www.sciencedirect.com/science/article/pii/S1056872702001903 Attia, P. (2013). Is the obesity crisis hiding a bigger problem? [video file]. Retrieved from http://www.ted.com/talks/peter_attia_what_if_we_re_wrong_about_diabetes.html (Church Health Center, 2010). “Model for Healthy Living.” Retrieved November 19, 2013 from, http://chreader.org/contentPage.aspx?resource_id=621. Community Tool Box, (2013). “Section 6. Using Outreach to Increase Access.” Retrieved October 10, 2013, from http://ctb.ku.edu/en/table-of-contents/implement/access-barriers-opportunities/outreach-to-increase-access/main Dandona, P., Aljada, A., & and Bandyopadhyay, A. (2004). “Trends in Immunology - Inflammation: The Link Between Insulin Resistance, Obesity and Diabetes.” Retrieved September 24, 2013. DeVille-Almond J., Tahrani AA, Grant J., Gray M., Thomas GN., Taheri S. (2011). “Awareness of Obesity and Diabetes: a Survey... [Am J Mens Health. 2011] - PubMed - NCBI.” Retrieved September 24, 2013, from http://www.ncbi.nlm.nih.gov/pubmed/20413385. Diabetic Care Services, (2013). A Codependent Relationship: Diabetes and Obesity. Retrieved October, 20th, 2013, from http://www.diabeticcareservices.com/diabetes-education/diabetes-and-obesity

Webliography (continued) Fisher-Hoch. S, R. A, Wilson. G, S. J, Reininger. B, R. B, McCornmik. J, and Perez, A. (2010, May, 7th). Socioeconomic Status and Prevalence of Obesity and Diabetes in a Mexican American Community, Cameron County, Texas, 2004-2007. Preventing Chronic Diseases. Public Health Research, Practice and Polices. Retrieved September 28th, 2013, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2879985/ Fitzgibbon. M, S.M, Dyer. A, VanHom. L and Christoffel. K. (2002, February). A Community-Based Obesity Prevention Program for Minority Children: Rationale and Study Design for Hip-Hop to Health Jr. Prevention Medicine. Volume 37. Issue 2. Retrieved from http://www.sciencedirect.com/science/article/pii/S0091743501909776 Goran. M, Ball. G and Cruz. M, (2003, April). Obesity and Risk of Type 2 Diabetes and Cardiovascular Disease in Children and Adolescents. The journal of clinical endocrinology and Metabolism. Retrieved September 28th, 2013, from http://jcem.endojournals.org/content/88/4/1417.full Horowitz, C. (2004). “American Public Health Association - Barriers to Buying Healthy Foods for People With Diabetes: Evidence of Environmental Disparities.” Retrieved September 24, 2013, from http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.94.9.1549 Kumanyika, S., & Grier, S. (2006). “Project MUSE - Targeting Interventions for Ethnic Minority and Low-Income Populations.” Retrieved September 24, 2013, from http://muse.jhu.edu/journals/foc/summary/v016/16.1kumanyika.html Lipton. R, D. M, Burnet. D, R. B, Cooper. A, B. E, and Hagopian. W. (2005, May 1st). Obesity at the Onset of Diabetes in an Ethnically Diverse Population of Children: What Does It Mean for Epidemiologists and Clinicians? Journal of the American Academy of Pediatrics. Retrieved September, 28th, 2013, from http://pediatrics.aappublications.org/content/115/5/e553.full#content-block

Webliography (continued) Mokdad, A., Bowman, B., Ford, E.,Vinicor, F., Marks, J., Koplan, J. (2001). “JAMA Network | JAMA | The Continuing Epidemics of Obesity and Diabetes in the United States.” Retrieved September 24, 2013, from http://jama.jamanetwork.com/article.aspx?articleid=194179. Oldroyd. J, Banerjee. M, and Heald. A, (2005, September, 18th). Diabetes and ethnic minorities. Postgraduate Medical Journal. Volume 81, Issue 958 . Retrieved September, 28th, 2013, from http://pmj.bmj.com/content/81/958/486.full.html#ref-list-1 Ornish, D. (2013). The killer American diet that's sweeping the planet [video file]. Retrieved from http://www.ted.com/talks/dean_ornish_on_the_world_s_killer_diet.html Nevins, S., and Hoffman, J.(2012, May 10th). The Weight of the Nation: Children in Crisis. Top Documentary Films. Retrieved from http://topdocumentaryfilms.com/weight-nation-children-crisis/ Rushing Josh. (2012, October, 9th). Fast Food, Fat Profits: Obesity in America. Top Documentary Film. Retrieved from http://topdocumentaryfilms.com/fast-food-fat-profits-obesity-america/ Shimabukuro, M. (1998). “Fatty Acid-induced β Cell Apoptosis: A Link Between Obesity and Diabetes.” Retrieved September 24, 2013, from http://www.pnas.org/content/95/5/2498.short

Reflection I believe that this project has helped me develop the necessary skills intellectually, both in my personal growth and my professional growth in my field of community health education. Working with a partner on this project has made me to discover my work ethic and improve the areas I was falling short. In my opinion, you gain knowledge through learning from mistakes you made. Also, putting more time on reading materials and finding evidence from literature reviews. During the beginning of this course, the information’s and terminology were so difficult to understand for me. This course was very difficult, my intellectual was challenged, and critical thinking skills were put to the test. I was able to develop my critical thinking skills and professional intelligence after overcome the challenges. Also, my leadership skills and communication skills have also improved over the period of taking this course. Now I have a strong understanding of the material. I will use this knowledge to develop a program if I work on an agency. I will use method of evaluation within that agency to help it reach its overall goal, or mission. Also, I am able to assist someone or organization in doing research and finding evidence-based information that is valid and reliable. Overall, I strongly believe that writing this paper and completing this project has made me a more knowledgeable individual. At the beginning of this project myself and my partner started off as strangers and as the work went on we gained confidence, trusted in each other, and learned how to work as a team to accomplish our program planning and evaluation goal. I will be able to use this project on my resume when I apply for jobs in community health education field. This will show that I have experience in creating a program and that I have one implemented within the university, not just one paper.

Reflection (continued) From my perspective, I feel as though this project has helped my professional growth develop relative to the program planning/evaluation process. When the course began, I had a brief overview of what this process involved, based off the knowledge from other classes, but not a clear path of where it would go. It was difficult at first to decide on a mission with my partner. We had the idea of what we wanted; it was just the wording of our mission that was difficult. This involved evaluating who we wanted our target population to be, and how exactly we wanted to explain a relationship between obesity and diabetes. Once this was clarified and confirmed, we were able to begin researching. I have a very good understanding of how the program planning/evaluation process works and feel like I could apply this to any situation or problem. I can assess a general need to have a warrant for proceeding. I am able to now to distinguish between what the dependent and independent variables are, and what the target population is. From this, I can assess the general need, identify measurable objectives, find an evidence-based program, implement it, and then evaluate. I feel confident that I could be thrown into a situation to come up with a model and program/evaluation plan and complete it successfully. The process is easy to understand and explain to others. This is what helps make it work and be successful.

Reflection (continued) My independent/self-directed learning has improved through this project. Each time Cinti and I met, we were able to discuss the topic more and more in depth. Aside from meeting, we had our own individual tasks and goals we had to accomplish for the project each week. When we had to find the literature and review it, this really pushed my independent learning. It took it to a different level, as I had to not only read a piece and analyze it, but evaluate it through the program planning and evaluation process. I had to identify new parts, like the measurable objectives in the piece. This process really helped to have a grasp and good understanding of the piece. Also, my critical thinking, as far as determining what research is valid and finding/using valid materials has improved. When we had to ask the questions of each piece, I was able to sort through the false material and see what the true research of the piece was. In addition, my collaborative learning increased through this project. Working with Cinti provided me with another way of thinking and understanding the material. We were able to problem solve, sort out information, and decide what would work best. Through this, we were able to understand how each of us learned and processed information. We were able to work together to achieve common goals. Diabetes and obesity are both topics we share a passion for, so it worked out well in researching them. I was able to look at them from more of a medical standpoint, and Cinti was able to view them from a community health educator standpoint. I believe this helped our project have more different ways and ideas to view the concept of our mission.

HL 367 Major Project: Fall 2013