Health Promotion Assignment on Prevent T2 Diabetes program

Question

Task: Background
Globally, more than 425 million people are living with diabetes, accounting for 8.8% of the world population and estimated to project to 629 million (9.9%) by 2045 (International Diabetes Federation, 2017). Type 2 diabetes is responsible for 90% of all diabetes population. Without treatment and disease management, diabetes can cause serious complications such as cardiovascular disease, blindness, kidney failure, amputations and premature death. Approximately, AUD1,088 billion annually has spent on the healthcare costs of diabetes (NCD Risk Factor Collaboration, 2016) which means diabetes corresponds to one in every eight dollars of healthcare costs (International Diabetes Federation, 2017). The WHO has recommended four simple and effective strategies to prevent type 2 diabetes and its complications, including 1) achieve and maintain a healthy body weight; 2) be physically active; 3) eat a healthy diet, low sugar and saturated fat intake; and 4) avoid tobacco use (World Health Organisation, 2017).

The National Diabetes Prevention Program: a community-based health promotion
The Diabetes Prevention Program (DPP) trial was a large-scale Randomised Control Trial conducted in the USA between 1996-1999 to examine the effectiveness of a lifestyle change intervention in preventing type 2 diabetes. The outcomes of the DPP trial revealed that a physical activity and healthy diet intervention effectively reduced diabetes incidence by 58% regardless of gender and ethnicity (Diabetes Prevention Program Research Group, 2002). The 3-year follow up study also found the diabetes risk was reduced by 16% for every kilogram of weight loss (Hamman et al., 2006). The research evidence derived from the DPP trial has positively influenced the Centers for Disease Control and Prevention (CDC) to translate research into reality at community level within public and private sectors. The CDC developed the evidence-based diabetes prevention program entitled ‘The USA National Diabetes Prevention Program’ (National DPP) also known as ‘Prevent T2’ implemented in 2012. The CDC formed a cooperative agreement with State Health Departments to launch the Prevent T2 program. The Prevent T2 is a year-long lifestyle change program providing physical activity and healthy eating sessions through individual goal setting plans. A digital format of the program is also offered as an optional mode.

Instructions for Health Promotion Assignment
Review ‘The USA National Diabetes Prevention Program’ (National DPP) also known as ‘Prevent T2’. Then use the assessment template to develop a report drawn from your critical analysis and applying theory into practice.

1. Critically explain the target group of the Prevent T2 program in the following topics based on the evidence. Use credible evidence to support you point of view.
• Explain the target population of the Prevent T2 program in the context of community health. • Explain the importance and significance of this prevention among the target population.

2. Use the following topics to critically analyse the appropriateness of the Prevent T2 program. Support your point of view with the evidence derived from the program and creditable evidence.
• Describe aims and level of prevention.
• Explain which health promotion strategies (see the list below) had been applied to the Prevent T2 program. (It is not necessary for the program to apply all strategies to the program, please explain only relevant strategies)

1. Involves population as a whole (Equitable)
2. toward action on determinants of health (Holistic)
3. Combines diverse approaches (Inter-sectorial)
4. Aim at public participation (Participation)
5. Health professional have enabling role (Empowerment)

• Health promotion activities/interventions that had been incorporated into the Prevent T2 program such as lifestyle change program, health education session, screening test etc.

3. Use the following topics to critically analyse the Prevent T2 program based on the concepts of community capacity building and empowerment.

• Critically explain community capacity building and empowerment strategies (Laverack’s ladder) that had been applied to the Prevent T2 program such as community participation, community engagement and community capacity.
• Critically explain the main communication channels used in the Prevent T2 program.

Answer

Target Population:
Overview of the target population and community of program explored in the health promotion assignment:
Based on the Centres for Disease Control and Prevention and National Diabetes Prevention Program report, 71% of people over 60 years old are affected by Type 2 diabetes due to heavy body weight, unusual physical activities, unhealthy diet, and tobacco consumption (Cdc.gov. 2021). It indicates that people over 60 years of old age and adults who are living with the prediabetes symptom and adults who are living with high risks of type2 diabetes are the main target population and community of the Prevent T2 Diabetes program (Cdc.gov. 2021).

Significance and importance of diabetes prevention program among the identified target population:
According to the report of the Centres for Disease Control and Prevention and the National Diabetes Prevention Program, more than 425 million people are affected by diabetes, and they are living with diabetes (Goldberg et al., 2017). Type 2 diabetes is mainly responsible for 90% of the total population living with diabetes. The main significance of the Prevent T2 Diabetes program is to provide the lesson regarding long-lifestyle change program, the lesson of physical activity and sessions for healthy eating through setting goal plans for maintaining a healthy diet individually.

The Prevent T2 Diabetes program is one of the important initiative National Diabetes Prevention Program to address the burden of type2 diabetes and prediabetes issues in the United States (Cdc.gov. 2021). The Prevent T2 Diabetes program is very much important to individually screen people for checking diabetes and take the appropriate strategies and steps to prevent severe complications from diabetes (Holliday et al., 2019). The report defines that without any disease management and any treatment, diabetes can cause severe issues and complications such as blindness, cardiovascular disease, amputations, kidney failure and premature death (Aroda et al., 2017).

However, it is important to get screened and maintain a healthy diet chart, maintain healthy body weight, do regular exercise for being physically active, intake low sugar food and saturated fat food and avoid the consumption of tobacco. It is significant and important to prevent the health issues for Type2 diabetes because the report of the Diabetes Prevention Program trial explores that healthy diet and physical activity effectively reduced the diabetes incidence among old age people by 58% regardless of ethnicity and gender (Cdc.gov. 2021). After three years of follow up study of diabetes affected people, the report found that the trail of the Diabetes Prevention Program reduced the risk of diabetes by 18% for every kilogram of human body weight loss (Apolzan et al., 2019).

Conceptual framework of Community based health promotion:
Aims and Level of the Prevention:
The Prevent T2 Diabetes program's main aim is to control the risks of Diabetes by providing appropriate sessions of healthy eating and physical activity by setting the individual goal plan. The Prevent T2 Diabetes program aims to provide the digital format of the program to the people (Ritchieet al., 2019). The Prevent T2 Diabetes program's goal is to engage the people in affordable and cost-effective high-quality lifestyle change programs to reduce the risk of prediabetes and type2 Diabetes and improve the overall health of the people.

The Prevent T2 Diabetes program is considered as the year-long life cycle change program and evidenced-based prevention program for curing Diabetes (Ritchie et al., 2018). The level of prevention of Prevent T2 Diabetes program is providing the ultimate level of prevention to reduce the risk of Diabetes (Cdc.gov. 2021). It aims to maintain a certain standard to achieve positive outcomes by facilitating healthy services by a trained lifestyle coach and reviewing the data every six months.

Health promotion strategies to Prevent T2 Program:
The Prevent T2 Program main health promotion strategy is public participation. The National Diabetes Prevention Program of the United States aims to make the path easier for the people and encourage people with prediabetes to involve and participate in the affordable, cost-effective, appropriate and highest quality lifestyle change program (Cdc.gov. 2021). It would help them to reduce the risk of a severe complication of type2 diabetes. It would also help people to improve their overall health condition (Ariel-Donges et al., 2020). It is also considered as an evidence-based prevention program that indicates the Prevent T2 Program also applied the holistic health promotion strategy to take quick action based on the determinants of health (Mensa-Wilmot et al., 2018). A holistic health promotion strategy helps in taking the quick appropriate, and necessary action based on the complication of prediabetes and Type2 Diabetes disease.

Health Promotion activities and interventions incorporated in the Prevent T2 Program:
The Prevent T2 Program maintains the appropriate conceptual framework to deliver a high-quality prevention program.

At first, the Prevent T2 Program organised the “screening test” for people with prediabetes syndrome to determine the appropriate lifestyle change program for the person. It helped to determine the risk of development percentage of type2 diabetes (Holliday et al., 2019).

After that, the Prevent T2 Program organised a life cycle change program recognised by the CDC to provide evidence-based solution and to build healthy new habits among the people. The program provides the facility of the lifestyle coach to train the people about new skills, motivate and encourage the people to meet health goals (Ely et al., 2017)). It indicates that the program provides health education session for individual people to prevent the risks of Type2 diabetes (Cdc.gov. 2021). Through this health education session, the lifestyle coach recommended effective rules and strategies to prevent the complications and development of Type2 Diabetes (Aroda et al., 2017). It includes information regarding a healthy diet chart, the way to achieve healthy body weight and its maintenance, schedule of exercises for being physically active and caution for avoiding the use of tobacco products.

Concepts of community empowerment:
Critical explanation of Community capacity building and empowerment strategies:
The Prevent T2 Program maintains the appropriate framework for preventing the increasing rate of Type2 Diabetes in the United States. It develops partnerships with private and public sectors that include national, and community organisations, local and state health departments, federal agencies, community education programs by universities, private and public ensures, etc (Cdc.gov. 2021). It engages the community of employers and insurers by offering them a lifestyle change program of the Prevent T2 Program as a covered benefit. The Prevent T2 Program increased the engagement of the community by offering them the online tools to connect with the Medicaid managed care organisations, Medicaid Agencies of the state and to provide commercial healthy health plans for the employers to reduce the risk of developing Type2 Diabetes (Apolzan et al., 2019). It increases the participation of the community in the Prevent T2 Program by offering affordable, cost-effective and highest quality lifestyle change program for individual people based on their health complications. These entire strategies helped the National DPP program of the US to enhance the capacity of the community by improving their health condition (Ritchie et al., 2017).The Prevent T2 Program uses Lavarack's ladder strategy as the empowerment strategy for building the community's capacity. This strategy indicates that in health program-related services, community-based communication plays an important role to empower the community to participate in the health care program. It provides a link between the social aspects and controlling capacity to control the individual people in the community. The Prevent T2 Program used Lavarack's ladder strategy with the help of their potential leaders to increase the interaction among the community. It helped them to increase the engagement of the community in the health care program.

Critical explanation of Communication channels and critical analyse of appropriate communication strategies used in the Prevent T2 Program:
The Prevent T2 Program used several communication channels to effectively communicate with their target audience and encourage them to be positively involved in the Prevent T2 Program (Cdc.gov. 2021). It includes posters, postcards, advertisement in a newspaper, articles in Newspapers, news releases, web banners, and developing web content to post a blog about the program, live announcements by the radio public services, and develop the social media content for Facebook, Twitter etc (Ritchie et al., 2018). The main communicative strategies of the Prevent T2 Program are:

1. To engage the people by attracting them with the creative concept,
2. Giving regular feedback through Facebook, Twitter and other social media platform,
3. Inspire them to read the articles about the preventive policies of Type2 diabetes and its importance etc.

It helped them to increase the participants of the community in the Type2 diabetes prevention program.It analysed that the above-defined communication strategies are appropriate for increasing the engagement and participation of the people in the Prevent T2 program. ?

References:
Apolzan, J. W., Venditti, E. M., Edelstein, S. L., Knowler, W. C., Dabelea, D., Boyko, E. J., ... &Gadde, K. M. (2019). Long-term weight loss with metformin or lifestyle intervention in the diabetes prevention program outcomes study. Annals of internal medicine, 170(10), 682-690.https://www.acpjournals.org/doi/abs/10.7326/m18-1605

Ariel-Donges, A. H., Gordon, E. L., Dixon, B. N., Eastman, A. J., Bauman, V., Ross, K. M., &Perri, M. G. (2020). Rural/urban disparities in access to the National Diabetes Prevention Program. Translational behavioural medicine, 10(6), 1554-1558.https://academic.oup.com/tbm/article-abstract/10/6/1554/5522034

Aroda, V. R., Knowler, W. C., Crandall, J. P., Perreault, L., Edelstein, S. L., Jeffries, S. L., ... & Nathan, D. M. (2017). Metformin for diabetes prevention: insights gained from the diabetes prevention program/diabetes prevention program outcomes study. Diabetologia, 60(9), 1601-1611.https://link.springer.com/article/10.1007/s00125-017-4361-9

Cdc.gov. (2021).CDC - About the Program - National Diabetes Prevention Program - Diabetes DDT.Retrieved 18 March 2021, from https://www.cdc.gov/diabetes/prevention/about.htm.

Cdc.gov. (2021).Lifestyle Change Program Details | National Diabetes Prevention Program | Diabetes | CDC.Retrieved 18 March 2021, from https://www.cdc.gov/diabetes/prevention/lcp-details.html.

Cdc.gov. (2021).Retrieved 18 March 2021, from https://www.cdc.gov/diabetes/prevention/pdf/t2/resources/How_to_Use_the_PreventT2_Consumer_Materials.pdf. Cdc.gov. (2021).What's New | CDC. Retrieved 18 March 2021, from https://www.cdc.gov/diabetes/prevention/whats-new.htm.

Ely, E. K., Gruss, S. M., Luman, E. T., Gregg, E. W., Ali, M. K., Nhim, K., ... & Albright, A. L. (2017). A national effort to prevent type 2 diabetes: participant-level evaluation of CDC’s National Diabetes Prevention Program. Diabetes care, 40(10), 1331-1341.https://care.diabetesjournals.org/content/40/10/1331.short

Goldberg, R. B., Aroda, V. R., Bluemke, D. A., Barrett-Connor, E., Budoff, M., Crandall, J. P., ...&Temprosa, M. (2017). Effect of long-term metformin and lifestyle in the diabetes prevention program and its outcome study on coronary artery calcium. Circulation, 136(1), 52-64.https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.116.025483

Holliday, C. S., Williams, J., Salcedo, V., &Kandula, N. R. (2019). Peer-Reviewed: Clinical Identification and Referral of Adults WithPrediabetes to a Diabetes Prevention Program. Preventing chronic disease, 16.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6741942/

Mensa-Wilmot, Y., Bowen, S. A., Thummalapally, S., Murphy, M. D., & Rutledge, G. E. (2018).Marketing and Communication Strategies to Increase Enrollment in National Diabetes Prevention Program—Implications for Evaluation of Technical Assistance.

Ritchie, N. D., Christoe-Frazier, L., McFann, K. K., Havranek, E. P., & Pereira, R. I. (2018). Effect of the National Diabetes Prevention Program on weight loss for English-and Spanish-speaking Latinos. American Journal of Health Promotion, 32(3), 812-815.https://journals.sagepub.com/doi/abs/10.1177/0890117117698623

Ritchie, N. D., Kaufmann, P. G., Gritz, R. M., Sauder, K. A., &Holtrop, J. S. (2019). Presessions to the National Diabetes Prevention Program may be a promising strategy to improve attendance and weight loss outcomes. American Journal of Health Promotion, 33(2), 289-292.https://journals.sagepub.com/doi/abs/10.1177/0890117118786195

Ritchie, N. D., Sauder, K. A., &Fabbri, S. (2017). Reach and effectiveness of the National Diabetes Prevention Program for young women. American journal of preventive medicine, 53(5), 714-718.https://www.sciencedirect.com/science/article/abs/pii/S0749379717303239

Ritchie, N. D., Sauder, K. A., Phimphasone-Brady, P., &Amura, C. R. (2018).Rethinking the National Diabetes Prevention Program for low-income whites. Diabetes Care, 41(4), e56-e57.https://care.diabetesjournals.org/content/41/4/e56.abstract