Type 2 Diabetes Prevention by Lifestyle Modification Intervention
Type 2 diabetes is one of the fastest growing chronic diseases in the United States. In the last 5 years rates of diagnosed cases rose worldwide, 5% to 6.2%, or 328 million. In order to combat that growing rate, Nourish 927 in union with the Montgomery County Health Department are joining forces to show middle Tennessee and Fort Campbell, KY citizens that they are in control of many of the risk factors.
Goals and Objectives
Nourish 927 and The Montgomery County Health Department will be working together in a social media push to educate the people of Montgomery County and Fort Campbell about their risk factors for Type 2 diabetes and what they can do to reduce them. Some of the more easily controlled risk factors are obesity, high blood pressure, high cholesterol and an inactive lifestyle. They will also be offering easy ways for people to change their life choices in an effort to reduce their risks. Stage 1 of this program will include social media information sharing through local Facebook groups to provide info. Stage 2 asks those wanting to know more to reach out to Nourish 927 or the Montgomery County Health Department so that they have local help.
The quantitiave goals for this program are, by the end of the 8-week program, 65% of participants will interact with 50% of the posts as tabulated by comment, like and share counts. By January 2016, 25% will have contacted Nourish 927 or the Montgomery County Health Department to learn more about programs that are offered to help lower their risk of Type 2 diabetes. Of the 25% who contact Nourish 927 or the Montgomery County Health Department 50% of contactors will commit to a program and reduce their overall body weight by 5% in 6 months as determined by self-reported weight checks.
Sponsoring agency/Contact person
The Montgomery County Health Department, (931) 648-5747
Primary target audience
Everyone is at risk for diabetes in some form or another. Type 2 diabetes, formerly called adult-onset diabetes, is the most common type of diabetes. About 95 percent of people with diabetes have type 2. People can develop type 2 diabetes at any age, even during childhood. However, this type of diabetes develops most often in middle-aged and older people. Behavioral traits such as inactivity and those who watch more than 3 hours of TV per day are at an increased risk for Type 2 diabetes as well. As well as persons with sedentary occupations and lower income. People from minority populations are more frequently affected by type 2 diabetes. Minority groups constitute 25 percent of all adult patients with diabetes in the United States and represent the majority of children and adolescents with type 2 diabetes. African Americans, Hispanic/Latino Americans, American Indians, and some Asian Americans and Native Hawaiians and other Pacific Islanders are at particularly high risk for the development of type 2 diabetes. Diabetes prevalence rates among American Indians are 2 to 5 times those of whites. On average, African American adults are 1.7 times as likely and Mexican Americans and Puerto Ricans are twice as likely to have the disease as non-Hispanic whites of similar age. Psychographics such as low self-esteem and lack of positive outlook also seem to be linked to diabetes, via link to being overweight.
Primary target key strategies
The barriers that are standing between our audience and the desired action have multiple facets. First cultural practices and beliefs are highly regionalized and since are not selecting a specific nationality to target our communication towards, we may run into cultural barriers such as the eating habits of certain cultures. For example, Mexican-Americans traditionally eat a high in sodium, fat, and sugar based diet. Suggesting foods that will easily mix into any culture, lower saturated fat options, low sodium and more natural forms of sugar; will ideally blend well with any culture. Another barrier that stands between our audience and the desired action will be correcting the misinformation that is rampant on food packaging in grocery stores. Many people are highly susceptible to believing that because a package says it’s “all natural” that it is healthy. Educating our audience to see the benefits of reading ingredients lists will help them to be better informed about the choices they make. Another barrier to overcome will be the social aspect of eating and inactivity. The American social lifestyle is permeated by gatherings that center on food and sedentary activities. Offering ideas to have social gatherings that don’t involve sitting and watching TV or eating far too much food will help this barrier to be eliminated
Secondary target audience
The intended secondary audience is the family members and other household occupants of those living in the home with the primary audience member. This includes children, elderly parents and other varied residents.
Secondary target key strategies
The key strategies and barriers are similar to those of the primary audience. Because the secondary audience will not directly receive the intervention they do not need to be addressed directly. The primary audience’s lifestyle change will indirectly influence the members of their household.
For the primary target audience pretest I asked 2 men and 3 women to view the printed brochure and provide feedback to the six required questions. The first thing that caught most people’s eye, 4 out of 5 was the colorful and easy to read format. One person mentioned that the title “Are you at risk?” caught their eye interest immediately and made them want to read more. All of the pretest subjects agreed that the main message was being aware of the risks of diabetes and healthy choices one can take to lower their diabetes risk factors. While the objective of the brochure is supposed to be one clear message, I feel that it is unrealistic to encourage people to lower their risks without explaining what their risks are first. All pretest participants agreed that it raised their interest in the subject. One participant said “Yes, I even learned a simple trick for reading labels.” All 5 participants also agreed that the wording was appropriate for the target audience. No one had any recommendations improvements for the layout. But one of the participants did mention that the wording of one of the sentences, while correct was an awkward read. I will go back and improve that sentence immediately before posting. Another participant mentioned that adding in a section that explains what exactly Type 2 diabetes is would be helpful as well as more ways diet and exercise help prevent diabetes. While I appreciate that feedback because of the focus for this brochure I am going to leave that explination out due to readability issues and in the interest of brevity.
The theoretical foundation the Type 2 Diabetes Prevention by Lifestyle Modification Intervention will be based upon is the Stages of Change Model, or the Transtheoretical Model. It will be used through this project to chart progress of individual participants as they move through the stages; precontemplation, contemplation, preparation, action and maintenance. Precontemplation, contemplation and preparation will occur during the social media intervention. Action will be facilitated through the follow-up program with maintenance most successfully achieved through the optional upgrade to fitness, personal coaching and the daily nutritional supplement.
The program as a whole is designed to be completed in 8 months. 8 weeks of social media campaign intervention with a follow up 6-month program for participants who sign up.
Nourish 927 will be tasked with designing the social media intervention materials. The local health department will review for accuracy. The follow up program will be hosted at the Montgomery County Health Department with participation from Nourish 927. The optional upgrade, to fitness programs and nutritional supplements will be purchased through Nourish 927. All one-on-one coaching will be done by Danielle Porter at Nourish 927.
Danielle Porter with Nourish 927 and the Montgomery County Health Department.
Intervention Cost: $0
a. Facebook: $0
b. Nourish 927 time and graphic designs: $0 donated to the community
c. Montgomery County Health Department: $0, cost is already covered in the programs they already provide.
Total cost and justification for intervention and follow-up program are already covered in the salary of the health department employees. This is a service they currently provide; the intervention will just highlight these services. Nourish 927 is donating their time to the community in order to bring awareness to the issue. The participant covers optional upgrade to fitness program and nutritional supplement. Nourish 927’s costs are covered through any commission those sales generate.
Personel required, Danielle Porter from Nourish 927 and Dietiticans and Nutritionists from the Montgomery County Health department. Resources needed include a laptop and internet access.
Issues of concern/potential problems
The only issues of potential concern revolve around getting the media materials prepared in during the timeline. Due to time constraints of the Montgomery County Health Department and Nourish 927 and their other business responsibilities.
The outcome evaluation plan we are planning to implement, described above. Using surveys through a panel study best fits our organization’s mission because the changes in our audience may be difficult to measure accurately. In a panel study, information is collected at multiple times from the same members of the intended audience. When intended audience members are differentially exposed to the program, this design helps evaluators sort out the effects of different aspects of the program or different levels of exposure. The panel will allow us to have a variety of audience members, at all different levels of risk, exposing them to different intervention materials and testing to ensure that they are hitting the target market and are effective. Our priority is the increase general awareness of the risk factors associated with Type 2 diabetes. Even if the community does not sign up for the follow-up program if their awareness of the issue is increased we have made a positive impact.
Also, we will be incorporating the RE-AIM framework to your evaluation program. By applying this framework, we will evaluate how well the research translates into practice and are we demonstrating effectiveness and efficiency enough? This framework also helps to measure the translatability and public health impact of the initiative by examine all five of the dimensions of the acronym RE-AIM which include: Reach into target population, Effectiveness or efficiency, Adoption by target settings, institutions and staff, Implementation, and Maintenance of interventions. RE-AIM will help our initive evaluate a large population setting such as the Montgomery County Health Department, by choosing to follow this framework, it will also help to further evaluate the goals and reach the intended outcomes.