PUBH 746 Program Planning and evaluation in Public Health

Introduction

According to the recent report, Alabama has the4^th highest percentage of patients suffering from diabetes². Alabama Department of Public Health is concerned about this fact and regarding this matter ADPH is planning to start a program, which concerns about the control and prevention against diabetes¹. Controlling of diabetes includes routine based checking of foot and blood. It has been found that a few numbers of patients are following this routine checkup. This awareness program will help to make patients to lead a healthy life and increased number of patients coming for foot and blood checkup will reduce the percentage of diabetes affected people in Alabama. Wilcox County has been chosen to start this program as the county has no diabetes prevention and control program and the demography in this county has made it preferable area to launch this type of program.

 It has been found that African Americans have the high chance to be affected by type 2 diabetes as they are prone to obesity and for poor glycaemic control¹⁵. The mentioned program is to focus about the diabetes rate in Wilcox County. There are several reasons for choosing Wilcox County for this pilot program such as- it has higher diabetes rate in Alabama, the county is dominated by African American people who are prone to diabetes and most importantly Wilcox has no diabetes prevention program.

Need of the program

Alabama has been highlighted for the higher diabetes rate. It has been found that most of the people in Alabama are not going for foot and blood checkup. The main aim of this program is to increase percentage of adult patients of Wilcox County, Alabama for foot and blood checkup from 60% to 95%.This percentage increase will help to reduce the diabetes percentage in Alabama.

The data regarding the diabetes rate of Alabama shows a certain growth of percentage of the number of people suffering from diabetes from year 1994 to 2013^1.The percentage was 3.5 in 1994.In the year 2013 the percentage has reached to 12.6 ^{2 .}It can be seen that the percentage growth is more rapid in case of Alabama County if it is compared with the data from the other county.Wilcox County in Alabama is dominated by African-American people.

72% of total population of Wilcox County belongs to African American race. It has been found out that African –American people are prone to diabetes. According to the research it can be assumed that this increasing number of diabetic patients at Wilcox will further increase as most of the people are habituated in consuming foods with high calorie and lack of physical activities. Most of the people from this community are suffered from type 2 diabetes. It has been found that type 2 diabetes is preventable and can be controlled through regular foot and blood checkups. There is a lack of awareness about the prevention and control of diabetes among the adults of Wilcox. Presently percentage of patients going for foot and blood checkups is 60%, the desired target for 2018 is 95%.

Stakeholders and their roles:

Stakeholder	Roles
Patients of Camden Hospital,Wilcox	Participants of survey
Wilcox County Health Department	Planning Committee
Alabama Department of Public Health	Planning Committee
Corporate Communications  Medical Center	Planning Committee
Wilcox Health Foundation	Financial Commitment
Doctor’s Direct Health Coaches	Planning Committee
Division Director	Planning Committee Consultant
Human Resource Director	Planning Committee
Employees at Wilcox Health Centre	Planning Committee Data Collection

The efforts to prevent and control the diabetes:

Presently Wilcox County Health Department has no diabetes prevention programs. However, some hospitals and clinics have some program related to diabetes management. One of those programs is initiated by Cahaba Centre for Mental Health. The Diabetes Management program initiated by this health centre provides treatment, management and prevention of diabetes. This health centre organizes monthly diabetes support campaign.

The main problem is that spreading the awareness about foot and blood checkups among the diabetic patients at Wilcox, and increase the number of percentage of patients going for checkups. In order to do this a centralized program is needed to implement.

The proposed program is evidence driven program which has been proposed to run for 2 years. The program is supposed to be designed by Alabama Department of Public Health. The program can be considered successful if the percentage of patients going for foot and blood checkup is increased.

Choosing of model:

In order to plan a health program the selection of model is important. The effectiveness of the model depends on the three factors- fluidity, flexibility and functionality .Fluidity refers to the logical and step by step approach of the program for achieving the goal. Flexibility refers to the adaptability of the health program and functionality refers to the effectiveness of the program¹⁰.Considering these three factors it can be said for developing the pilot program for diabetes prevention for the Wilcox County can be done through Precede-Proceed Model. The main advantage of using Precede-Proceed model is that it tells what exactly is to be implemented in the program.

SMART Objectives (Goals and objective):

Program Goal: To increase the percentage of foot and blood checkup for adult diabetic patients(from 60% to 95%)
SMART Objective 1: Within first 6 months the percentage of foot and blood checkup will increase 10%
Key Component	Objective
Specific	More patients will come for foot and blood checkups
Measurable	Increase of 10% will be achieved in the number of patients for foot and blood checkup
Achievable	The target is achievable within 6 month
Realistic	The target is realistic as there is sufficient funding granted for the program.
Time-bound	June 1,2018 to November 1,2018
Program Goal: To identify other factors of diabetes
SMART Objective 2: Adult patients from Wilcox County Hospital will participate in the survey .
Key Component	Objective
Specific	The patients who are adult and suffering from diabetics will participate in the survey
Measurable	Surveying 150 patients can be done easily as there are sufficient volunteers
Achievable	The entire survey and the evaluation of the data of the survey can be done within 6 months
Realistic	The task is realistic as there are sufficient numbers of volunteers to conduct the survey properly.
Time-bound	November 2,2018 to April 2,2019
Program Goals: To identify the patients who are not going for the checkups and the reason of this behavior.
Key Component	Objective
Specific	The patients who are not taking foot and blood checkup regularly will be asked about the reason of their approach.
Measurable	A selected area of Wilcox will be chosen from where the residents who are diabetic will be interviewed.
Achievable	The task is achievable as 6 month time period is granted for this program.
Realistic	The task is realistic as the interview will be done on the persons from selected area of Wilcox.
Time-bound	April 3,2019 –July 3,2019
Program Goals: Addressing the events those are preventing patients to go for foot and blood checkup and modification of the program
SMART Objective: Awareness camp regarding foot and blood checkup will be organized.
Key Component	Objective
Specific	Setting up awareness camps that will address the key factors of diabetes and the importance of foot and blood checkups
Measurable	Total 6 camps will be organized in different parts of the Wilcox.
Achievable	In order to implement this successfully sufficient fund and man power resource is available.
Realistic	Setting up one awareness camp per month is realistic idea
Time-bound	July 4,2019 to Dec 4,2019

Precede-Proceed Model for initiating the program:

PRCEDE (Predisposing, Reinforcing, and Enabling Constructs in Education/environmental Diagnosis and Evaluation )

Predisposing factors: These are the mental factors of the individuals those determine the different behavioral approach towards daily checkups.60% of people are going for foot and blood checkups but rest of the people are not interested in checkups. The reason of this behavioral difference is needed to be evaluated.

Reinforcing factors: These factors are the awareness of the society towards the importance of foot and health checkups in order to prevent and control diabetes. Diabetic Foot Ulcers affect 15-25% of patients. Society needs to be aware about that proper daily foot and blood checkup can reduce the chance of diabetes.

Enabling factors in education/environmental assessment: These are the internal and external factors those are responsible for the individuals for not going or taking the checkups. There can be external factors such as long distance between patient’s residence and checkup clinics.

. Evaluation: The impact evaluation of the model is determined by the objective function of participating data. It has been observed that at the adults above the age 20 are suffering from diabetes⁹.

The outcome evaluation is determined by the effectiveness of the model. Precede-proceed model helps to identify the key objective of the program. The right identification of the objective helps the plan to run accordingly¹³.

Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development (PROCEED) 

According to the US census bureau Wilcox county is dominated by African-American population⁴.African Americans have 1.6 times higher risk to get affected by diabetes than white American. It has been found that African Americans have the high chance to be affected by type 2 diabetes as they are prone to obesity and for poor glycaemic control.

According to the county health rankings and roadmaps the highest percentage of diabetes prevalence is in Greene which is 23%⁵.Next is Wilcox which has 21%.Thses information supports the necessity of developing the health program plan in Wilcox County.

In order to make improvement of the thinking approach of the patients some motivational factors are needed to be present in front of them¹¹.Patients who are coming for the foot and blood checkup are needed to be encouraged by appreciating their doings¹¹.This will motivate others to come for the checkups. The health program regarding the control and prevention of diabetes is launching for the first time for Wilcox County. The county health department has no individual division for diabetes and awareness about foot and blood checkup.

Sustainability of the plan:

The program is based on the Precede-Proceed model. The program is about the effectiveness of the self-care and foot and blood checkup in diabetic prevention. The program will include the face to face interview of the residents of Wilcox about the ways of maintain the life style and self-caring sessions along with 1 hour fitness training, where they will be taught the daily exercise in order to prevent diabetics.

Evaluation Plan:

The above plan will be successful if the percentage of the number of patients taking the checkup grows from 61% to 95% which is an estimated target for 2018¹².The successful implementation of the program will increase the percentage of patients going for daily foot and blood checkups. Currently Alabama has the 4^th highest diabetes rate. In Alabama, Wilcox County has the diabetes rate of 21% which is the second highest in Alabama. The successful implementation of the program will reduce this percentage, which will gradually help to reduce the diabetes percentage of Alabama.

Methodology:

The approach to implement the plan will be a step by step method where success of the previous step will determine the next step. Here for evaluation of the plan secondary data can be used as basic information. The improved situation can be measured by primary data which can be collected by interview and surveys. In this case mixed approach of data collection can be followed. The participants of the surveys can include the students from the schools and the patients from the local hospitals. It has been found that obesity is a major factor for diabetes and 39% of children in Alabama are either overweight or obese. The primary data collected from survey will help to understand the current diabetic patient scenario in Alabama. Another survey can be conducted after a certain period to evaluate the effectiveness of the program. Comparison between two data sets can be indicated the success of the program.

Indicators that determine the evaluation of the program are-

1. The rate of patients going for blood and foot checkups.
2. The diabetes affected percentage in Wilcox County.
3. The diabetes percentage of Alabama.

Resource distribution of the plan

Program	Budget
Increase percentage of foot and blood checkup	5000
Conduction of survey	5000
Identify the reason of not going for checkups	5000
Organizing awareness camp	5000
Modification and evaluation of the programa	5000

Conclusion

Wilcox County has second highest diabetes rate and it has no current diabetes control program. Foot and blood check up can prevent and control diabetes.Wilcox County has no program regarding diabetes control. The program regarding the diabetes control can reduce the percentage of diabetes affected people. The proper planning and choosing of model can help to implement the program successfully. The success of the program depends on the strategic plan of the model as well as the participation and response of the people.This program can motivate the people of Wilcox to lead a healthy life by maintaining certain activities. This will eventually help to reduce the higher percentage of diabetes affected people in Wilcox.

References

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