Lauren Jones and Rebecca Oakes

November 7th, 2016

HEA 625-01

Section 1: Conceptualization of Evaluation

What purpose(s) will be served by the evaluation?
The purpose of this evaluation is to determine if the Racial and Ethnic Approaches to
Community Health (REACH) program is truly successful with helping to reduce racial and
ethnic disparities, related to cardiovascular disease (CVD) and diabetes, in a Greensboro
community.

What broad questions will be addressed by the evaluation?

1. Have community members learned how to identify the risk factors that may lead to CVD and
diabetes?
2. Are community members more aware of the resources that may improve/maintain their
health?
3. Has REACH strengthened the capacity by which they address ethnic health disparities?
a. Has REACH implemented evidence and practice based strategies in the community?
4. Have CVD/Diabetes rates decreased among community members?

Who are the key stakeholders?

The Pilot test is being implemented by REACH, which is a program administered by the
Centers for Disease control and Prevention. Therefore, REACH's key stakeholders include the
CDC, the community members, program leaders within the community who are working as
health educators, and Greensboro policy makers.

What assumptions are being made?

1. The health status of community members can be improved.
2. Appropriate programs can be developed that meet the needs of community members.
3. The majority of the community has access to the programs REACH offers.
4. Community members will be present at every program.
5. Program leaders aspire to improve community members knowledge & self-efficacy
toward their health.
6. Community members understand the importance of reducing CVD and diabetes risk
factors.

What are the major contextual factors that need to be considered?

Reading & education level of participants
Age of participants
Funding and resources needed
Transportation to and from programs
Level of personal importance of certain health issues
Access to minority communities
Section 2: Program Description
Program Purpose:
REACH is a national program that focuses on reducing racial and ethnic health
disparities. The program educates participants on how to modify negative risk factors and health
behaviors that lead to chronic illnesses; such as CVD and diabetes (CDC, 2015).

Program Goals and Objectives:

Outcome Objective: Identify barriers to health that are a result of race, education, income,
and other social factors.
Outcome Objective: Identify and develop effective strategies for overcoming ethnic
health disparities.
Program Goal: Increase positive health behaviors (smoking cessation, healthy
eating, physical activity) among African American residents in the south side
neighborhood of Greensboro, NC.
Program Goal: Decrease CVD and diabetes rates among African American residents
in the south side neighborhood of Greensboro, NC.

Target Audience:
African Americans diagnosed with or at risk of developing CVD or diabetes in
Greensboro, NC neighborhood.

Program Location:
This program will be pilot-tested in the urban south side neighborhood of Arlington Park
in Greensboro, NC; also referred to as ol' Asheboro, and the Asheboro Street neighborhood. The
population age of this neighborhood varies and the majority is of minority race/ethnicity. The
program activities will take place at Bennett College in Greensboro, NC from August of 2016 to
August of 2017.

Results of Previous Evaluation:

The REACH Risk Factor Survey is conducted annually and gathers health-related
information of communities about disease prevalence, fruit and vegetable consumption, physical
activity, preventative services usage, and immunization records. Recent evaluations found that
smoking prevalence has decreased among African Americans and Hispanics, and daily vegetable
and fruit consumption has tripled after the implementation of REACH (Liano, Tucker, Okoro,
Giles, Mokdad, & Harris, 2004).

Logic Model Description:

REACHs logic model is illustrated below. The chart reads from left to right and
identifies the inputs for the program, activities, outputs, and short-term and long-term goals.
The REACH program aims to reduce CVD and diabetes among residents in the

neighborhood of Arlington Park, by targeting smoking cessation, healthy eating, and physical
activity. The program is composed of the following five elements: Finding eligible residents to

participate in the program, choosing health educators to conduct the program, offer education for

healthy eating and physical activity, and hosting CVD and diabetes support groups for

participants. REACHs program will last from August of 2016 to August 2017.

The first step of the REACH program is to identify and recruit qualifying participants of

the Arlington Park community. This is an urban neighborhood of primarily African American

individuals. To be eligible to participate in this program, the participants must be diagnosed with

CVD or diabetes, or at high risk of developing the diseases. African Americans are twice as

likely to suffer from diabetes compared to Whites and 13% of African Americans, aged 20 and

older, have been diagnosed with Type 1 or Type 2 diabetes (King, 2007). African Americans are

also more likely to be obese or overweight in comparison to other ethnic groups (King, 2007).

With obesity being a risk factor for CVD and diabetes, it is important to reach the African

American population sooner than later. By identifying the individuals at risk and obtaining health

pre-test results, REACH will be better able to modify and adjust the program according to the

needs of the clients.

The participants will be responsible for nominating 20 trusted and respected members of

the community to serve as health educators. By utilizing individuals who are well-known in the

community, we hope that the community members will trust the information they are receiving

in their educational classes and support groups. Health educators will be required to complete at

least 200 hours of health education sessions for diabetes and CVD, and are required to attend

monthly meetings to discuss progress of the program. We hope that by educating members living

in the community, that these nominated health educators will continue to work together to

improve and maintain the health of the community once the REACH program is completed.
 Participants in the program will have opportunities to attend educational classes directed

toward healthy eating habits and positive health behaviors such as smoking cessation and

physical activity. These free educational classes will be offered weekly by the health educators

with hopes of increasing the participants knowledge. Instructional classes for preparing healthier

food options and meals, such as including more fresh fruits and vegetables will also be offered.

There will also be programs offered that focus on increasing participants confidence to be more

physically active and the cessation of using tobacco products. Another major element of REACH

is linking residents and participants with healthcare providers. CVD and diabetes are conditions

that require constant attention and check-ups. REACH hopes that the educational classes offered

will encourage participants to take their health more serious, and take advantage of the resources

being offered.

Lastly, REACH plans to create and guide support groups for community members. The

purpose of these support groups is to offer participants a safe haven to express their emotions,

along with strengths and weaknesses they discover while in the program. In these groups,

participants will be able to ask their health educators any questions and concerns they may have

regarding the program and behavior change. Also, participants may have the opportunity to offer

and receive advice from other members on how to be more successful in the program. These

support group meetings allow participants to establish smaller support groups with other

members or neighbors. This is an advantage because the support of the groups will help to build

the self-efficacy and confidence needed to be successful in the REACH program.

Logic Model:

Inputs Activities Outputs Short-Term Long-Term

Outcomes Outcomes
Community Recruit Create a Increased More
Members African registry of awareness for community
American potential REACH in the members take
community participants. community. advantage of
members in Identify 300 Increased REACH.
Greensboro. qualified readiness to Improve
Identify participants. make health attitudes toward
qualifying Assess changes. positive health
participants. participants Health changes.
Complete a health knowledge Post-test results
health pre-test knowledge and about CVD & show REACH is
for qualified behaviors. diabetes effective and
participants. increased. successful.
Trained Nominate 20 Health Increased Health
Health candidates to educators health educators
Educators attend trainings complete 200 educators continue to work
about risk hours of capacity of together to
factors for trainings. CVD & improve the
diabetes and All health diabetes communitys
CVD, and serve educators and education and health.
as health program instruction.
educators. directors attend Increase team-
monthly building
meetings between health
throughout the educators in the
project to community.
discuss
progress.
Education Health Classes are Increase Participants
for Healthy educators host offered participants have new
Eating educational biweekly. knowledge for attitudes towards
classes on 45% healthy food healthier food.
healthy eating. attendance in options. Participants
Health classes. Increase skill of preparing
educators offer participants healthy meal
lessons for skill for health options correctly
healthy eating. meal continues after
preparation. REACH has
ended.
Education Provide Offered Increase Participants
to Increase education to weekly lessons participants aspire to quit
Positive participants on to participants self-efficacy of using tobacco
Health tobacco-use on tobacco-use tobacco-use products
Behaviors cessation. cessation. cessation. completely.
Educate Offer bi Increase Participants
participants on weekly exercise participants continue being
 the importance classes to knowledge of physically active
of physical participants. different for the
activity. Assisted 50% exercise options recommended 30
Educate of participants for improving minutes a day.
participants on in finding local physical Participants
the importance healthcare activity. schedule routine
of routine visits providers. Increase appointments for
with healthcare participants health checkups.
providers. knowledge for
routine doctor
visits.
CVD & Encourage Support Increase Participants
Diabetes participants to groups had 80% participants self-efficacy for
Support express their attendance. self-confidence. CVD & diabetes
Groups strengths and Participants Participants constantly
weaknesses in developed can recognize improves.
the support smaller support the benefits of Participants
group. groups with being part of a continue to
Encourage neighbors. support group. encourage and
participants to support each
build other outside of
relationships the support
with others in groups to
the support maintain new
groups. health behaviors.
Section 3: Evaluation Plan
Specific Evaluation Questions:

The following questions have are the broad questions that will be addressed by the evaluation:
1. Have community members learned how to identify the risk factors that may lead to CVD
and diabetes?
2. Are community members more aware of the resources that may improve/maintain their
health?
3. Has REACH strengthened the capacity by which they address ethnic health disparities?
a. Has REACH implemented evidence and practice based strategies in the community?
4. Have CVD/Diabetes rates decreased among community members?

Program Design:

This planned evaluation is a quasi-experimental design and consists of an experimental

group and a control group. The control group will be used to establish a baseline to compare the

effects of the REACH program. All 300 participants will begin the program by completing a pre-

test for basic CVD and diabetes knowledge. Using a convenience sample, 30 residents will be

chosen to act as a control group. This control group will meet with health educators at the

beginning of the program to receive a booklet of information for maintaining CVD and diabetes.

The participants of the control group will not take part in the other offered programs and

activities until after the evaluation has been completed. However, through the course of the year,

these participants will meet weekly with the health educators to discuss their progress. These

weekly reports may determine if the programs offered by REACH to the other 270 residents are

truly effective. The remaining 270 residents will be a part of the experimental group and take

part in all of REACHs educational programs and activities. A post-test will be administered

immediately after the program has ended. Before the program begins, an evaluator will conduct

an observation of the neighborhood residents in public areas of the neighborhood. The evaluator

will interview residents and observe the behaviors, knowledge, and attitudes toward CVD and
diabetes knowledge. Through these interviews and observations, evaluators will be able to

identify the initial knowledge level of a fraction of the residents. This information can be used to

make modifications to the program.

Variables:

Skills learned to prevent or maintain CVD and diabetes

Adherence to REACHs programs
Shift in norms: Eating habits, exercising habits, smoking cessation
Level of confidence to maintain CVD and diabetes risk factors
Was the program appreciated?

Instrumentation

Observations

For the control group, evaluators and their assistants will do observations while residents

meet weekly with their health educator to discuss progress while in the program. Observers will

be trained on interobserver reliability to ensure the observations are measured consistently. The

control groups knowledge and self-efficacy will be measured after they receive their educational

material at the beginning of the program. Participants in the experimental group will be observed

by evaluators to measure skill improvements, self-efficacy, relationships built during the

program, and confidence levels.

Mailed Paper Surveys

All 300 participants will be asked to complete a pre-test, a progress survey, and post-test.

Participants who choose to take part in the program will receive $10 vouchers for the local

farmers market. Residents chosen for the control group will also be offered a $10 gift card for the

nearest gas station to ensure they remain active with the program. The pre-test survey will be

mailed out in August of 2016. The progress survey will be mailed out in January of 2017. The

post-test survey will be mailed out in August of 2017.

Focus Groups

Focus groups will be held monthly with health educators and voluntary program

participants. Focus groups will give participants an opportunity to voice their opinions, concerns

and critiques with the program. Health educators will also be able to ask participants any

questions they may have for the operation of the program.

Data Collection Plan:

Observations

The evaluator and their assistant will perform observations of the residents and their

results will be combined for each program.

Mailed Paper Surveys

Surveys can be mailed back the office located at Bennett College or be handed to health

educators in the neighborhood.

Focus Groups

Health educators and their assistants will take notes while residents express their thoughts

and concerns during the focus groups. These notes will be shared during the monthly meeting of

the all the health educators and directors.

Observation Observation Observation Survey: Survey: Focus

of healthy of positive of support Control Experimental group
eating health group groups groups about meetings
classes behaviors meetings about CVD CVD &
classes & diabetes diabetes
knowledge knowledge

Have community
members learned
 how to identify the X X X
risk factors that may
lead to CVD and
diabetes?

Did classes
properly educate X X X
participants on how
to practice healthy
living?

Were
participants educated X X X X X
about the risk factors
that lead to CVD and
diabetes?

Are community
members more
aware of the X
resources that may
improve or maintain
their health?

Were
participants X X X
instructed on how to
quit using tobacco
products?

Were
participants X X X
instructed on how to
quit using tobacco
products?

Were
participants X X X
instructed on healthy
eating options?

Are
participants more X X X
knowledgeable on
the importance of
routine doctor visits?

Has REACH
strengthened the X X X X X
capacity by which
they address ethnic
health disparities?

Has
REACH
 implemented X X
evidence and
practice based
strategies in the
community?

Have CVD and X X

diabetes rates
decreased among
community
members?
Section 4: Reporting Plan

The data collected and results from the surveys, focus groups, and observations will be

studied and summarized into an organized manual in October of 2017. The manual may also be

found as a pdf on the City of Greensboros website and the CDC website. The results of the

program and suggested recommendations will then be presented to the evaluator, Greensboro

officials, and the nominated health educators of the community during the next city council

meeting. An even more condensed form of the program will be presented in a newsletter for

residents of the neighborhood. The pamphlet will contain the major facts and information needed

to maintain and prevent CVD and diabetes, and tips for how to continue maintaining the healthy

behaviors. The final report manual will also be shared with stakeholders.
Section 5: Detailed Budget
Section 6: Detailed Timeline

August 2016: Pre-test mailed out to participants

August 2016: Health Educators are trained

August 2016-August 2017: Focus groups held monthly

January 2017: Progress survey mailed to participants

August 2017: Post-test survey mailed to participants

 References

Centers for Disease Control and Prevention. (2015). Racial and ethnic approaches to

community health. Retrieved from https://www.cdc.gov/nccdphp/dch/programs/reach/

King, M. L. (2007). Community health interventions. Center for American Progress. Retrieved

From https://www.americanprogress.org/wp-content/uploads/issues/2007/02/pdf/

community_health.pdf

Liano, Y., Tucker, P., Okoro, C. A., Giles, W. H., Mokdad, A. H., & Harris, V. B. (2004).

REACH 2010 surveillance for health status in minority communities. Morbidity and

Mortality Weekly Report. Retrieved from http://www.cdc.gov/Mmwr/preview/mmwrhtml/

ss5306a1.htm