MPH5999 | Planning and Evaluation in Public Health

For this selected organization, identify the individual who will mentor you through the capstone and field experience. Schedule a site visit and collect information about the organization and mentor. In this section:

 

a.Provide a detailed background of the organization. For example, include vision and mission statement, history, types of services offered, target population, role in the community, and so on.

 

b.Explain how the organization will help you to implement your project; be as specific as possible. You may also provide anticipated commitments from the organization.

 

c.Identify your mentor. Describe your mentor's educational background, professional experience, position, history with the organization, and so on.

 

d.Describe the role your mentor will play in helping you to design and implement the field experience project. Additional specifics to include are: mentoring session schedule, expectations of the mentoring relationship (from both mentor and mentee), orientation plan to become knowledgeable about the organization, and so on.

 

Describe how the public health field or a given population or community might be affected by the project. Objectively provide examples of how the professional activities of your project can benefit you in your role as a public health practitioner and bring about transformative social change in your community or in the profession. In this section, describe the following:

 

Provide the demographics of your targeted population and explanation of why you selected this specific population.

 

Describe in depth the geographical boundaries and jurisdictions: for example, school district, neighborhood, city, town, state, and so on.

e are lack of exercise, unhealthy meal planning, overweight, obesity etc.  As suggested by Moore et al. (2015), a meal rich in fat and lacking in fiber could increase the chances of type 2 diabetes. Obesity has been linked with the development of conditions such as insulin resistance, which contributes significantly to the development of type 2 diabetes. The reduction in the age of onset of diabetes has been linked with reducing the span of life. Additionally, type 2 diabetes has become a community based problem and needs immediate intervention policies. The early onset of type 2 diabetes has been associated with microvascular complications. Myocardial infarction is the most common microvascular complications which have been seen to arise in such cases. As mentioned by Mayer-Davis  et al. (2017), the early onset of type 2 diabetes has been seen to increase the risk of cardiovascular disease manifold times.  The early onset of type 2 diabetes has been linked to the development neuropathy which results in shrinkage of nerves and blood vessels (Gemmill, , Brown, Nandagopal, Rodriguez & Rother, 2011). This further reduces the flow of blood to the heart resulting in the development of cardiovascular conditions over the years. Additionally, the type 2 diabetes has been associated with the development of conditions such as proliferative retinopathy.  It has also been linked with the development of microalbuminuria. Microalbuminuria is a condition characterized by increase in the level of urine albumin where the kidney leaks small amount of albumin in the urine (Phelps et al., 2016).

Benefits gained by population and geographical area served

There has been considerable increase in the rate of contraction of type 2 diabetes in the youth   within the United States. During the year 2011-2012 around 5300 children and adults aged 10 to 19 years old were diagnosed with type 2 diabetes (niddk.nih.gov, 2018). It could further lead to a number of complications such as frequent hospitalizations owing to hyperglecemia crisis, shortness of breath or coma. It has been rated as the seventh most leading cause of death within the United States. The economic burden of the health issue has been huge where the average medical expenditure for people diagnosed with diabetes was $13,700 per year (Issel & Wells, 2017). Therefore, a community wide education campaign could be developed focusing upon some of the most US boroughs where the problem has been rampant. It could reduce the impact of diabetes upon the community as a whole.

Purpose of the project and expected outcomes

The implementation of the project could lead to spreading awareness within the population regarding following a proper diet and lifestyle. As mentioned by Gemmill  et al. (2011), following of a healthy diet could reduce the chances of developing insulin resistance. The insulin resistance has often been linked with protein and carbohydrate rich diet. Additionally, educating the community on active lifestyle and diet can reduce the chances of contraction of diabetes by eliminating factors such as hypercholesterolemia.

Part 2:

Background of the organization

For the current study, the US based organization American Diabetes Association (ADA) has been taken into consideration. It is a Government based organization which looks into care and management of people suffering from diabetes. Type 2 diabetes within young adults has been growing at the rate of an epidemic within the United States. In order to identify the underlying causes of the health issue within the population a project has been undertaken by the researcher in collaboration with the American diabetes association.

The vision, mission and history of the American diabetes association could be discussed over here. The vision is to create a – “life free of diabetes and all its burdens. The mission is to –“to prevent and cure diabetes and to improve the life of all people affected with diabetes” (professional.diabetes.org, 2018). The organization was founded in the 1940   and was non-profitable in nature. It originated in the Virginia state of USA and its main goal was to educate the general public upon diabetes care.

Implementation of the project with the help of the organization

The organization aims to continuously support research and development for diabetes care and improve the life of the larger community. I as a researcher worked as a part of the ADA diabetes care and management project. In this respect, the infrastructure and the required finances were funded by the ADA itself.  The patients who were to receive diabetes care and support from ADA were treated as participants of a randomized control trial. The various results and data were used by me for the identification of the main causes for the over presentation of the problem within the population.

Role of mentor to design and implement field experience project

I have been working under the mentorship of   Dr. Jeus who had been a post –doctoral fellow with ADA. He had been working as a senior researcher in the department of Endocrinology and had specialized in diabetes care for more than 10 years.  I had been involved as part of a regular research work where randomized control trials   had been conducted on patients who visited the ADA often with complains of diabetes. I had received sufficient amount of guidance from Dr. Jeus for which helped me in planning different stages of the research. One of the benefits of working under the mentorship of Dr.  Jeus was that he helped me out sufficiently with the stochiometric analysis. Additionally, the orientation program at the ADA provided me a good exposure to the variety of diabetes care and management projects handled over there. The practical in –house sessions ensured that I was exposed to many associated lines of care and health management.

Demographics of target population

For the current project the young adults were taken into consideration   living within the neighborhood areas of Virginia. This is because the problem has been on the rise within the specified age group. Some of the contributing factors which had been highlighted over here were lifestyle, genetics etc.

Part 3:

Implementation strategies

For the control and management of diabetes a number of educational and prevention programs could be implemented. One such program is the Diabetes Prevention Program which focused more upon dietary changes and increased physical activity. The aim behind the implementation of such programs is improved health and reduced healthcare costs.  The project aims at the implementation of the diabetes prevention program at the community wide level. However, for the implementation of the project a lot of field work will need to be conducted. Through the field experience project data will be collected upon the intensity of the problem, the target population affected the causative factors and the steps which could be taken to cope up with the problem.

For the purpose of collection of data a field survey will need to be undertaken where participants will be selected from young adults contracted with type 2 diabetes. A randomized control trial will be conducted with the participants. However, in order to conduct the RCT prior consent needs to be taken as per the Code of Ethics for health education. The participants should be informed much in advance regarding the survey. The information needs to be cascaded in a transparent manner. One of the additional features which needs to be taken into consideration over here are confidentiality concerns.  At no stage of the research process the privy and confidential details of the participants should be shared. This is in accordance with the Data protection act which prohibits the sharing of the exact name and details of the participants.  As per the ethics and confidentiality concerns, at no stage of the research process the individuals should be forced to provide in more information (Busse, Aboneh & Tefera, 2014).  Therefore, the participants should be made free to give or withhold as much information as they want to. At any stage of the research process the participants have sufficient rights to ask questions regarding the benefits and risks attached with the research process. Hence, it falls within the responsibilities of the researcher to inform the participants regarding the same.  Hence, the purpose of the study should be laid out in the consent forms.

Some of the barriers which have been identified while conducting the research study are having equitable access to the participants of the research study.  In this respect, being located at a distance from the organization often makes it difficult for the researcher to understand the exact health experiences of the participants. Additionally, the cross cultural faiths and beliefs often prevent the participants from sharing their health details (Hargreaves et al., 2016). Additionally, the lack of time and money also prevents the participants from sharing important health details.

In order to educate the participants regarding the purpose of the project an effective campaign could be built up through poster and graphical presentations. The pictorial presentations could be used to highlight to the participants of the randomized control trials the importance of diabetes prevention program. Additionally, a powerpoint presentation could be used to inform the stakeholders regarding the various components and elements of the RCTs, the exact time plan and the cost involved

Part 4:

The project aims at type 2 diabetes management within young adults residing within the United States. A number of project goals have been undertaken over here, which have been further discussed below.

Goal 1

Deliverable: Delay the appearance of late disease complications      Objective: to check for the development of  associated disease complications			Deadline:
Major Task	Due Date	Who?	Completed (ü)
1. provide the patient  with regular check up
2. conduct regular blood test of the patient to check  the conditions  such as neuropathy and retinopathy
3. to strict  control hyperglyceamic diet of the patient
4.
5.
Deliverable: decrease rate of mortality      Objective: to check  the progression  of other serious disorders such as cardiac or kidney disorder			Deadline:
Major Task	Due Date	Who?	Completed (ü)
1. to educate the patients regarding the importance of diet control
2. undertake physical activities to maintain a healthy heart
3.
4.
5.
Deliverable: enhance the quality of life  Objective: to provide  the patient  with  maximum health support which reduces the  burden associated with the disease			Deadline:
Major Task	Due Date	Who?	Completed (ü)
1. provision of free community health check up
2. educate the patient on  the various forms of maintenance of life
3. educate the patient  on the importance of  physical activities  which could reduce stress and trauma  within the patient
4.
5.
Deliverable: good control to glycemia to reduce the incidence of microvascualr complications      Objective: to prevent the occurrence of microvascualr complications  within the patient			Deadline:
Major Task	Due Date	Who?	Completed (ü)
1. to conduct regular height, weight and urine  check up within the patient
2. to reduce the uptake of starchy food or diet by the patient specially limit urea and starchy food uptake
3.
4.
5.

Goal 2

Deliverable: To provide  continued therapy      Objective: to help the patient prolong or meet with the therapeutic requirements			Deadline:
Major Task	Due Date	Who?	Completed (ü)
1. to provide health therapies at minimal cost
2. increase the access to  healthcare and support  by implementing  some of the modern technologies such as mobile medical vans
3.
4.
5.
Deliverable: Provide education programs in lieu of diabetes management      Objective: to  reduce the myths related  to diabetes management within the patient			Deadline:
Major Task	Due Date	Who?	Completed (ü)
1. to educate the patients on the various   complications related to diabetes which could  help them in whistle blowing the  relevant channels on time
2. the  patients  should be made to realize  the importance of   diet control and physical exercises through educational sessions
3.
4.
5.
Deliverable:  to provide physical  exercise  sessions to the patient      Objective: to make the patient stay healthy			Deadline:
Major Task	Due Date	Who?	Completed (ü)
1. the physical exercises could  reduce the chances of development of bad cholesterol
2. to keep the heart and the overall  health of the patient healthy
3.
4.
5.
Deliverable:      Objective:			Deadline:
Major Task	Due Date	Who?	Completed (ü)
1.
2.
3.
4.
5.

Mitigation Plan

For effective implementation of the project sufficient level of patient education is required by highlighting the complications attached with various aspects of diabetes management and care.

Documentation and Record Keeping Tools

For proper documentation and record keeping electronic health records could be used by the patient

Part 5:

Evaluation plan:   

To evaluate and measure the success of the project related to education about diabetes management and raising awareness regarding physical activity and diet, it is planned to use both interview method and observation to collect data. Observation skills will be used to collect quantitative data related to glucose control, complications in patients and duration of physical activity after the implementation of the project. Secondly, semi-structured interview method will be used to collect quantitative data from people who took part in awareness program. The main questions for the interview will include thoughts and perception about the awareness programs, changes in life after the program, changes in health outcome after the program and any limitations of the program. Interviewing skills will be used to maintain respect, manage language and cultural differences and extract as much information from patient as possible. Hence, collection of both quantitative and qualitative data can help to evaluate success of the project and find out any flaws in the content or implementation process. This form of evaluation is necessary to establish the effect of intervention and increase the likelihood of inclusion of the project in evidence based practice (Fineout-Overholt et al., 2011)

While collecting information from research participants, they will be assured regarding the privacy and confidentiality issues of their personal information. Their names and personal details will not be published or recorded and they will be informed that only data related to program outcome will be taken. The interview will be done in a room with video recording so that clients are not concerned about any ethical issues during the interview. Grossoehme (2014) suggest that confidentiality breaches is a common concern for researchers during qualitative research and protecting identities plays a role in minimizing conflict during the data collection process.

While working at the selected organization, I had observed that I faced difficulties in communicating with people with hearing disabilities and racial background while educating about the importance of physical activity in diabetes management. I faced this difficulty because of poor awareness regarding cultural values and attitudes of racial groups. I also faced issues in communicating with hearing disabilities as it required additional skill set. My feedback to the mentor is to provide health promotion staffs training regarding cultural competence to death with culturally diverse client during health promotion.

References

Busse, H., Aboneh, E. A., & Tefera, G. (2014). Learning from developing countries in strengthening health systems: an evaluation of personal and professional impact among global health volunteers at Addis Ababa University’s Tikur Anbessa Specialized Hospital (Ethiopia). Globalization and health, 10(1), 64.

Fineout-Overholt, E., Gallagher-Ford, L., Melnyk, B. M., & Stillwell, S. B. (2011). Evidence-based practice, step by step: evaluating and disseminating the impact of an evidence-based intervention: show and tell. AJN The American Journal of Nursing, 111(7), 56-59.

Gemmill, J. A. L., Brown, R. J., Nandagopal, R., Rodriguez, L. M., & Rother, K. I. (2011). Clinical trials in youth with type 2 diabetes. Pediatric Diabetes, 12(1), 50–57. https://doi.org/10.1111/j.1399-5448.2010.00657.x

Grau-Pérez, M., Kuo, C. C., Spratlen, M., Thayer, K. A., Mendez, M. A., Hamman, R. F., ... & Miller, F. W. (2017). The association of arsenic exposure and metabolism with type 1 and type 2 diabetes in youth: the SEARCH Case-Control study. Diabetes care, 40(1), 46-53.

Grossoehme, D. H. (2014). Overview of qualitative research. Journal of health care chaplaincy, 20(3), 109-122.

Hargreaves, J. R., Goodman, C., Davey, C., Willey, B. A., Avan, B. I., & Schellenberg, J. R. A. (2016). Measuring implementation strength: lessons from the evaluation of public health strategies in low-and middle-income settings. Health policy and planning, 31(7), 860-867.

Issel, L. M., & Wells, R. (2017). Health program planning and evaluation. Jones & Bartlett Learning.

Mayer-Davis, E. J., Lawrence, J. M., Dabelea, D., Divers, J., Isom, S., Dolan, L., ... & Pihoker, C. (2017). Incidence trends of type 1 and type 2 diabetes among youths, 2002–2012. New England Journal of Medicine, 376(15), 1419-1429.

Moore, G. F., Audrey, S., Barker, M., Bond, L., Bonell, C., Hardeman, W., ... & Baird, J. (2015). Process evaluation of complex interventions: Medical Research Council guidance. bmj, 350, h1258.

Nadeau, K. J., Anderson, B. J., Berg, E. G., Chiang, J. L., Chou, H., Copeland, K. C., ... & Sellers, E. (2016). Youth-onset type 2 diabetes consensus report: current status, challenges, and priorities. Diabetes Care, dc161066.

niddk.nih.gov (2018), niddk.nih.gov , Retrieved on 18 July 2018, from https://www.niddk.nih.gov/about-niddk/research-areas/diabetes/diabetes-prevention-program-dpp

Phelps, C., Madhavan, G., Rappuoli, R., Levin, S., Shortliffe, E., & Colwell, R. (2016). Strategic planning in population health and public health practice: a call to action for higher education. The Milbank Quarterly, 94(1), 109-125.

professional.diabetes.org (2018), professional.diabetes.org , Retrieved on 22 July 2018, from https://professional.diabetes.org/diabetes-primary

Vedung, E. (2017). Public policy and program evaluation. Abingdon: Routledge.

Wang, S. Y., Andrews, C. A., Herman, W. H., Gardner, T. W., & Stein, J. D. (2017). Incidence and risk factors for developing diabetic retinopathy among youths with type 1 or type 2 diabetes throughout the United States. Ophthalmology, 124(4), 424-430.