Introduction.

Diabetes is increasing at an alarming rate in the United States. According to the

Centers for Disease Control National Diabetes Statistics Report for 2020 cases of diabetes

have risen to an estimated 34.2 million. Below is a summary of the latest diabetes statistics

included in the CDC’s report. Diabetes is a chronic disease that affects the pancreas’ ability

to produce the hormone, insulin. Insulin helps regulate the glucose level in the blood. The

recommended blood glucose range is anywhere between 70-110 mg/dl. With diabetes the

pancreas either does not produce enough insulin to go throughout the body, the body rejects

the insulin that is produced, or does not produce any insulin at all. Between 2000 and 2013,

there were 223,924 diabetes-related hospitalizations in Georgia. More than 1 in 10 Georgia

adults has diabetes, or more than a million people. Several hundred thousand more

Georgians have pre-diabetes, a condition that can be prevented from becoming full diabetes

through weight loss, increased physical activity, and better nutrition.

Fortunately, timely and sustained lifestyle intervention and pharmacological treatment

can intervene in new incidences and the prevalence of Diabetes. A health promotion proposal

that promotes certain lifestyles such as eating a healthy diet, physical activity, body weight

control, and stress management can help to address the prevalence of Diabetes. Diabetes

prevention program is relevant since it addresses these underlying factors. Besides, the

program raises the concept of agency in preventing Diabetes to decrease morbidity, mortality

and health care expenditure.

Based on this premise, it would be a perfect opportunity to implement a health

promotion program related to Diabetes. This program will be targeted to individuals who

have been diagnosed with Diabetes and prevent complications related to this disease and

address issues related to treatment non-compliance. The Diabetes prevention, promotion

program will complement the Georgia Diabetes Prevention and Control Program, which
are funded by the Illinois state government. Although the existing health promotion programs

and the proposed project aim to prevent the occurrence of Diabetes, the proposed program

focuses on a single underserved community. Also, the Diabetes Health Promotion Program

will improve the people’s environment as well as the economy. Besides, the proposed

program will complement the Georgia State Health Improvement Plan that addresses a broad

range of health conditions, including cardiovascular disease across the state.

Community description.

The Georgia health promotion program will target people living in poor

neighbourhoods, including African Americans in the greater Georgia region who are at high

risk of developing Georgia. These underprivileged areas in Georgia have been selected

because they have limited community health organizations that provide residents with social

services, health education programs, and health awareness events. The community I intend to

focus on is African Americans effected with diabetes in Georgia. Compared with non-

Hispanic whites, diabetes rates are about 60% higher in African Americans (GDCH, n.d.). In

Georgia, diabetes is ranked seven for cause of death (CDC, 2021). Therefore, it is imperative

that all individuals in the local healthcare community be involved. Any patient interaction is

an opportunity to inform, educate and motivate an individual to be active in their health

management. Other target audiences for this program could include underserved populations

in the community and policy-makers that could assist in removing any potential barriers

patients encounter in their Diabetes management.

South Fulton, Georgia will be the location of focus for this health promotion program.

South Fulton is a city in Fulton County, Georgia, United States, in the Atlanta metropolitan

area. Diabetes is one of the most common chronic diseases in Georgia. Diabetes was the

seventh leading cause of death in Georgia in 2010. In 2012, approximately 734,800 Georgia

adults and that accounted to 9.9% of the Georgia adult population reported that they had been
diagnosed with diabetes. Having an impact in the neighbourhoods with the highest

prevalence of Diabetes would reduce complications related to this disease saving millions in

health care costs.

The activities of the proposed program will take place in different strategic locations.

The locations of the health promotion program will include a mall area with a whole

food/farmers market, fresh food restaurants with healthy food selections on the menu,

recreational activities, bike riding pavements and a gym. The sites where project activities

will take place include hospitals and community healthcare centers. Specifically, locations

and hospitals in South Fulton, Georgia. It is well known that Non-Hispanic African

Americans (AA) or Blacks experience the highest prevalence of Diabetes. Furthermore,

Georgia is a relatively segregated city and most African American Georgiaans live in South

Fulton. Community-based campaigns are interventions that consist of many community

sectors such as highly visible, broad-based, multi-component strategies. Evidently, the

diabetes disease prevention program integrates multi-component strategies that have been

recommended by the Health People 2020 for addressing the problem of diabetes in the

community.

Needs Assessment.

The information provided above was gathered using US Census Bureau data and the

Georgia Department of Public Health Surveillance. It is apparent that the priority population

is African Americans in South Georgia who have been diagnosed with Diabetes. This

demographic would benefit the most the program. According to 2019 US Census Bureau

estimates, Georgia's Black or African American population was 31.9%. Additionally, the

target age group will be adults older than thirty. This group encompasses the majority of

Diabetes incidence and prevalence.

 Overall, complications related to Diabetes is “especially severe in blacks,” and

Diabetes management is also worse. African Americans have a higher prevalence of

comorbidities, higher baseline blood pressure levels and higher levels of inactivity.

Reviewing the assets and capacities of this demographic further supports the need for this

demographic. Regarding income, African Americans have the lowest median household

income at approximately $30,000 per year.

Socio-ecological Factors.

xxxxxxxxxx explained that human behavior could shape and be shaped by an

individual’s family, organizations, social networks, and “the society in which they live.”

Individuals do not always have control of their environment and the society in which they

live. The socio-ecological factors for this demographic are clear. Based on events that

happened in American history, there have been many influences that have shaped the

behaviors of African Americans today.

At one point there were clear systems in place to withhold this demographic from

climbing the socioeconomic ladder. It is reasonable to assume that the implications of these

events are long-lasting. The current political climate and administration have sparked some

resurgence of sediment that many minorities have expressed about their life experience as a

minority. African Americans are not well represented in healthcare, and there is a mistrust of

the healthcare system. The Tuskegee Experiment and a prime example of reasons why

African Americans may not trust the healthcare system. Furthermore, studies have shown that

when African Americans get health information from an African American doctor; they are

more likely to trust this information and follow it.

Spirituality is an important multidimensional cultural resource and coping strategy

used by many African Americans for managing chronic diseases such as diabetes. Spirituality

has been defined in numerous ways, including a belief in a power operating in the universe
that is greater than oneself, a sense of interconnectedness with all living creatures, an

awareness of the purpose and meaning of life, and the development of personal, absolute

values. An important cultural resource for African Americans that might affect self-

management of diabetes is spirituality. Spirituality is embedded in the rich cultural heritage

of African Americans and plays a central role in their lives. Thus, spirituality has profound

implications for health care. Researchers have also found that spirituality is important in

coping with diabetes. xxxxxxxxx noted that African American women mentioned asking God

for help in controlling diabetes, and when faced with difficult problems, they would “turn it

over to the Lord”. xxxxxxxxxxxx found that God played a central role in governing the lives

of older African American men and women with diabetes. xxxxxxxxx concluded that sources

of support for African American men and women with diabetes were a strong belief in God,

along with prayer, meditation, and support from church members.

The majority of people with diabetes in South Carolina live in rural areas and receive

diabetes care from physicians in small group practices, and they rarely receive

comprehensive diabetes self-care management education. Moreover, as rural residents, they

often face additional problems of multiple illnesses, travel distance from health care, limited

financial resources, the complexity of medication regimens for diabetes self-care

management, a lack of knowledge, and the stigma or shame of having the disease. Because

diabetes is one of the most challenging chronic diseases to manage, researchers have

developed an increased interest in self-management behaviors among African Americans, yet

most studies do not include African Americans, especially rural African Americans.

Stakeholders.

The stakeholders involved are essential. They could potentially remove barriers or

have the connections to do so. Poor management of hypertension contributes to many

complications that cost billions of dollars. The Public health department, healthcare
providers, dietitians or nutritionists, local gym owners or trainers, a funding agency

associated with diabetes, and nurses or doctors but specifically a psychiatrist would be vital

stakeholders. It would not be surprising that many of these stakeholders have hypertension or

suffer from related complications. I believe they would have a vested interested in promoting

the health, prevention, and better management of hypertension. Therefore, the stakeholders

necessary for this program must be community leaders, local healthcare professionals, and it

would be helpful for these individuals to be minorities.

My proposed strategies include an accountability partner that is also on the same

journey to decrease likelihood of getting diabetes or someone who is currently living with

diabetes. Program stakeholders would include dietitians or nutritionists, local gym owners or

trainers, a funding agency associated with diabetes, and nurses or doctors but specifically a

psychiatrist. A psychiatrist is a medical doctor who specialized in mental health, including

substance use disorders. Psychiatrists are qualified to assess both mental and physical aspects

of psychological problems. I am intentional on a psychiatrist because I want participants to

obtain a more in depth understanding to why things are done in a particular manner. Nurses

and doctors are always helpful in providing knowledge and evidence on medical conditions.

Dietitians or nutritionist will be used to teach participants how to control portion size and

make small yet major adjustments to their cooking styles. Local gym owners and trainers can

provide support and motivation to get active. They could even provide a discounted rate for

those participating in the program because gyms can be expensive and intimidating to some

people. A diabetes foundation associated funding agency will assist with any budget needed

on the local level all the way to national.

The Public health department as a stakeholder will organize and run health education

courses, and health promotion, awareness seminars, and events in the area. The education

courses and health promotion awareness events will encourage the community to adopt
healthy eating behaviors and avoid unhealthy behaviors such as smoking and excessive

alcohol drinking. Besides, the public health department will enhance the provisions of social

resources in the community, such as Diabetes screening services and care for those who have

been diagnosed with the disease. For the Federal Government, it is committed to providing

the required support to the various states and local government in the realization of a quality

health care for all Americans. Thus, the government will work closely with centers for

cardiovascular prevention as well as other relevant state agencies in financing the activities of

the proposed program.

Vision, Mission, Goals, and Objectives.

The vision for this health promotion program is that it will reduce Diabetes-related

complications such as Diabetes and chronic kidney disease. Furthermore, the individuals that

are affected by Diabetes will be better educated about their condition and be able to advocate

for themselves and the management of their hypertension. The program could have long-

lasting effects that could be replicated in other demographics who struggle with Diabetes.

This program is aimed to educate, increase self-efficacy, and improve outcomes of

African Americans who have high blood pressure. Improving outcomes involves better

management of this chronic disease and preventing complications, which is the goal of this

program. The first objective for the program is to have those individuals with uncontrolled

blood pressure to be controlled within one year and maintain control of their blood pressure

for the follow year. The second objective is to reduce the complications related to

uncontrolled hypertension by twenty percent.

Theoretical framework.

The PRECEDE-PROCEED model is a comprehensive structure for assessing

health needs for designing, implementing, and evaluating health promotion and other

public health programs to meet those needs. The PRECEDE-PROCEED model would be
beneficial in determining the needs of the diabetic community. The PRECEDE component

involves assessing social, epidemiological, behavioral, environmental, educational, and

ecological factors that informed the development of an intervention with underlying social

cognitive theory assumptions. The PROCEED component consists of pilot-testing and

evaluating the implementation of the strategy, its impact on mediators and outcomes of the

population under study (Binkley & Johnson, 2013). These reasons take a deeper look into

what the root of the problem is and makes multiple attempts from various angles to assist

with improving the issue at hand. Additionally, for long-term changes to be pervasive self-

efficacy must be involved. Selfefficacy allows individuals to have the confidence to

overcome perceived barriers. This health promotion program hopes to impact lifestyle

behaviors, and the PRECEDE-PROCEED model has qualities that would best serve this

purpose.

Intervention Strategy.

The intervention strategy that could serve to complete the program objectives is the

health education strategy. xxxxxxxxx state that there is no dividing line between health

communication and health education. This is appealing because this combination will be

instrumental in addressing those in the target population. This strategy is usually associated

with a certain type of setting such as classes or workshops. For this program, the setting will

be at hospitals and community health centers. For this strategy to be successful it is important

that the health promotion program accounts for how the target population learns. A

community health fair is a great setting for this intervention to come into fruition. The health

fair would be a great setting for education, distributing resources, and discussion.

Activities.

The two activities that are suitable for this program are seminars and community

awareness events. Educational seminars for the public health personnel will be held in
Georgia and its neighborhoods. The seminars will act as capacity building initiatives for the

health professionals from the target regions. The primary goals of the educational seminars

will be to enhance participant’s knowledge about Diabetes and empower them with expertise

essential for development and implementation of local public health initiatives. Educative

seminars will also target the gym owners who are important partners for this program. The

gym owners will be informed about the available opportunities to expand their businesses

while improving the health of the residents. The last group that group that will be involved in

the seminars is the government agencies (The Public health department for the local

government and federal agency at the national level). The state and local government

agencies should be informed on how to improve public health through partnership with the

local community. The three partners, including the business owners, public health

professionals, and government agencies will be required to attend all seminars to increase the

chances of success. Even though the seminars will educate the partners about their specific

role, they will also be educated on the importance of corporation to increase the program’s

success. As previously mentioned, studies show that when African Americans receive health

information and care from African Americans their outcomes are better and they are more

likely to adhere to treatment. Attempts will be made to gather information from prospective

patients to follow up with them via email or text message. This will also be a conduit for

passing on more health information, encouragement, and resources to increase self-efficacy.

When conducting community awareness events, the most vulnerable members of the

society will be targeted at each locality. Several activities will be conducted during awareness

events. Primarily, the participants will be voluntarily screened for Diabetes and then advised

accordingly. Those diagnosed with Diabetes will be referred for treatment at public health

centers. Furthermore, there will be lifestyle counseling for all the participants, which focus on

dietary intake, smoking cessation, and physical activity. During the community awareness
events, the participants will be trained on how to develop a healthy eating plan and the foods

they should avoid. The second piece of information will be physical activity. A combination

of activities can be used, including walking, aerobics, running and jogging. The last piece of

information will be tobacco cessation. The participants who are experiencing the problem of

addiction will be referred to cessation lines that offer continued support.

These activities are both related to the selected theoretical framework. In the first

stage, educative seminars for the partners focus on the identification of their needs and the

development of modules to address these specific needs. On this note, health professionals in

Georgia require more skills and expertise to address the issue of health diseases. Once the

public and health professionals are trained through the educative seminars, they will offer

high-quality medical services aimed to reduce the prevalence and prevent Diabetes. Other

partners will also help to address the problem of Diabetes through their contribution.

Specifically, the business owners and state and local government agencies will create a

healthy physical environment that will drive the program’s success. Additionally, the

community awareness events are closely related to intervention mapping since the events are

based on the identified needs of the target community. The objectives of the community

awareness events can also be changed based on the outcomes to address the needs of the

community comprehensively. Moreover, the intervention mapping will keep the target

community and partners engaged throughout the program development and implementation.

Inputs Activities Outputs Short-Term Intermediat Long-Term

Outcomes e Outcome Outcome

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