Planning and Evaluation in Public Health

This article discusses the rise of type 2 diabetes in young adults in the US and its management. It covers the significance of the problem, benefits gained by the population, and implementation strategies. The article also talks about the American Diabetes Association and the role of mentor in designing and implementing the field experience project. The project aims to delay the appearance of late disease complications, decrease the rate of mortality, enhance the quality of life, and good control to glycemia to reduce the incidence of microvascular complications.

Running head: PLANNING AND EVALUATION IN PUBLIC HEALTH
Planning and Evaluation in Public Health
Name of the student
University name
Author’s note

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PLANNING AND EVALUATION IN PUBLIC HEALTH
Part 1:
Description of public health problem
The current study focuses upon the aspect of type 2 diabetes management in young
adults within the United States. The problem has been on the rise within the current decade
where more number of youths has been affected with type 2 diabetes. The causative factors
behind the same are genetics as well as environmental factors. By the year 2002, 3700 youths
were newly diagnosed with type 2 diabetes. The rate of type 2 diabetes was as high as 49.4
per 100000 among the 15-19 years old minority population (Issel & Wells, 2017). It was
found that the problem was more predominant in females than in males. With so many youths
affected with type 2 diabetes, the quality of life is severely impaired. Additionally, diabetes
has been associated with a number of health complications such as heart and kidney disorder,
obesity, leg amputations, retinopathy, glaucoma etc (Mayer-Davis et al., 2017).
The figures are alarming as 193,000 Americans under the age of 20 years have been
diagnosed with diabetes (Grau-Pérez et al., 2017). In the year 2015, 84.1 million Americans
aged 18 years and older were diagnosed with pre-diabetes. It was found that out of 30.2
million adults aged 18 years or older, 7.2 million were not aware of having diabetes
(Hargreaves et al., 2016). The occurrence rates were higher in the Asians and Non-Hispanic
blacks. These could be attributed to the lifestyle or diet followed by the target population
group.
Type 2 diabetes is caused due to a number of factors such as genetics and lifestyle.
The combination of these two factors can result in the development of insulin resistance
within an individual. As mentioned by Vedung (2017), it has been related with socio-
economic status and education level of an individual. The rates have been seen to be higher

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with high school drop outs whereas with active lifestyle and proper diet the progress of the
diseases could be controlled. Hence, social awareness serves important criteria over here and
could be propagated through community based education programs.
Significance of the problem
The lifestyle adopted by an individual often contributes to a huge amount in the
development of a particular disorder. Some of these 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).

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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.

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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.

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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.

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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

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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.

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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
()
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
()
1. to educate the patients regarding the importance of diet
control

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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
()
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
()
1. to conduct regular height, weight and urine check up within
the patient

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2. to reduce the uptake of starchy food or diet by the patient
specially limit urea and starchy food uptake
3.
4.
5.

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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
()
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
()
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

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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
()
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
()
1.
2.
3.
4.

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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

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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.

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