OverviewDevelop a 35-page report that explains how an organization serves the health care concerns and needs of a population. The report should identify gaps in the health care service, explain strategies to bridge the gaps, and describe potential barriers to those strategies.Note: The assessments in this course build upon each other. You are strongly encouraged to complete them in sequence.SHOW LESSBy successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:Competency 1: Explain the principles and concepts of disease prevention and health promotion for diverse and vulnerable populations.Identify barriers to implementing evidence-based strategies to bridge gaps in the health care service provided by an organization to a vulnerable or diverse population.Competency 2: Develop evidence-based health promotion and disease prevention initiatives for diverse and vulnerable populations.Describe the primary health concern for a vulnerable or diverse population.Identify gaps in the health care service provided by an organization to a vulnerable or diverse population.Explain evidence-based strategies to bridge gaps in the health care service provided by an organization to a vulnerable or diverse population.Competency 3: Apply basic epidemiological concepts, data analysis methods, tools, and databases to determine the effectiveness of health promotion and disease prevention initiatives for diverse and vulnerable populations.Explain how a health care organization serves the primary health care concerns of a vulnerable or diverse population.Competency 5: Communicate in a manner that is scholarly, professional, and consistent with expectations for members of the health care professions.Write content clearly and logically, with correct use of grammar, punctuation, and mechanics.Correctly format paper, citations, and references using APA style.ContextPérez and Luquis (2014) stated, “Integrating cultural proficiency practices into the individual practices of health educators and public health organizational policies is a call to action” (p. 50). It is important for those in health care to be aware of the methods used to identify and evaluate the specific health care needs of individuals, communities, and populations, and to understand the meaning of health literacy as it pertains to the needs of a multicultural population or group.SHOW LESSWith a growing diverse population, the incorporation of cultural and linguistic competence should be included into the planning, implementation, and evaluation of health education and promotion programs. “In this process, it is essential to employ theoretical models that describe and explain culture and related concepts (Pérez & Luquis, 2014, p. 165). Cultural constructs need to be applied to all health education, promotion, and prevention interventions targeting diverse communities (Pérez & Luquis, 2014).ReferencePérez, M. A., & Luquis, R. R. (2014). Cultural competence in health education and health promotion (2nd ed.). San Francisco, CA: Jossey-Bass.Suggested ResourcesThe following optional resources are provided to support you in completing the assessment or to provide a helpful context. For additional resources, refer to the Research Resources and Supplemental Resources in the left navigation menu of your courseroom.ASSESSMENT MODELS IN PUBLIC HEALTHAssessment models are an integral part of public health program design and evaluation, but you might ask “exactly what are these models and how do I use them?”If you were a personal trainer and you had a new client, you could just list a variety of exercises and the number of repetitions to do. You could write up a meal plan with recommended breakfasts, lunches, and dinners and have an entire plan to present your client at the first meeting.It’s possible that such a strategy might meet your clients needs, but it’s unlikely.No, instead, you would meet with your client and talk about past history, likes and dislikes, concerns, and constraints. Only after determining what your clients goals are, can you begin to design an exercise and diet regimen that will be appropriate for this particular client.In the same way, while it would be possible to pick a health concern and apply whatever services and program components your agency has employed in the past, such a strategy does not have much chance of success.Instead, you would want to meet with community stakeholders, gather and analyze information, determine the context of the issue, and then create an intervention that is designed specifically to bring about the changes the community wants and needs.There are good reasons for using some kind of model or theoretical framework for any intervention.Most models provide a framework for critical analysis of the context for the situation you’re addressing. They don’t guarantee that your analysis will be complete or accurate, but they certainly help improve your odds!Models allow you to detail the intervention and this detail allows you to have measurable objectives. Measurable objectives allow you to identify your program’s accomplishments and failures, and in that way establish accountability.A good model will present a clear picture of what activities will be undertaken and what results you expect to see for the community and the people who make up that community.Let’s look at two specific models to see how they work.The first is the PRECEDE PROCEED model. PRECEDE focuses on the planning of a program and PROCEED on the assessment of its success. For this presentation, we will only look at PRECEDE – the planning.PRECEDE stands for Predisposing, Reinforcing, and Enabling Constructs in Educational/Environmental Diagnosis and Evaluation. As its name implies, it represents the process that precedes, or leads up to, an intervention.PRECEDE was developed for use in public health and makes some assumptions about how to prevent illness and promote health. These include:Health promotion has to include those affected by the issue or condition in question.Health is influenced by community attitudes and the community environment (physical, social, political, and economic).Health is only one of many factors that make life better or worse for individuals and the community as a whole.Health derives from many other factors economic, social, political, ecological, and physical that all contribute to quality of life for individuals and communities.PRECEDE has four phases:Phase 1: Identifying the ultimate desired result.Phase 2: Identifying and setting priorities among health or community issues and the behaviors, attitudes, and environmental factors that are either in the way of or necessary for attaining the desired result.Phase 3: Identifying the predisposing, enabling, and reinforcing factors that can affect the factors given priority in Phase 2.Phase 4: Identifying the administrative and policy factors that influence what can actually be done.Another model you should consider is PEN-3.The PEN-3 Model was developed to ensure that culture was not only a part of assisting public health planning, but was actually central in the planning, implementation and evaluation of health interventions.The PEN-3 is a conceptual model for d of health education programs. It consists of three aspects of health that each contain three factors that must be analyzed and considered in order to reach a culture-centered intervention strategy.The three aspects of health in a PEN-3 model are:Health education.Educational diagnosis of health behavior.Cultural appropriateness of health behavior.The first aspect of the pen-3 model is health education.This aspect helps define the target audience not so much in terms of just focusing on the person exhibiting the health behavior to be changed, but more in terms of an educational effort that encompasses the person and his or her social network. The factors within the health education aspect are:Person.Extended family.Neighborhood.The integration of individual, family, and community is one of the distinguishing characteristics of the PEN-3 model.The educational diagnosis aspect looks at the factors that influence actions. Pen-3 identifies these as:Perceptions: Knowledge, attitudes and beliefs that may influence whether or not a person will adopt a desired healthy behavior.Enablers are those things that enable or make possible the behavior availability of resources, accessibility, affordability, and so forth.Nurturers are those things that a person receives from the social networks that reinforce the desired healthy behavior.The cultural appropriateness of a health behavior aspect looks at the perceptions, enablers, and nurturers and determines whether or not they lead the population being analyzed to engage in healthy behaviors (positive), have a neutral relationship with health behaviors, but should still be incorporated into the intervention strategy (exotic) or which interfere with the target engaging in healthy behaviors or which encourage harmful behaviors.PRECEDE and PEN-3 are just two of the many models available for program design and assessment. Different models have different strengths and applications but the common denominator is that models help ensure that your program design addresses clearly defined goals instead of randomly chosen approaches to health intervention.REFERENCESL. Green and M. Kreuter. (2005). Health Promoting Planning: An Educational and Ecological Approach (4th Ed.). Mountain View, CA: Mayfield Publishers.Scarinci, I. C., Silveira, A. F., dos Santos, D. F., & Beech, B. M. (2007). Sociocultural factors associated with cigarette smoking among women in Brazilian worksites: a qualitative study. HEALTH PROMOTION INTERNATIONAL. 22 (2), 146-154.Internet ResourcesAccess the following resource by clicking the link provided. Please note that URLs change frequently. Permissions for the following link has either been granted or deemed appropriate for educational use at the time of course publication.U.S. Department of Health and Human Services, Office of Minority Health. (n.d.). The National CLAS Standards. Retrieved from http://minorityhealth.hhs.gov/omh/browse.aspx?lvl=…Assessment InstructionsPreparationNow that your team has a better understanding of the population served by the organization, you need to evaluate how able the organization is to serve the specific health care needs of the population identified in the Windshield Survey assessment.Use the Internet and the Capella library to locate at least three academic or professional resources to use in this assessment.Follow the same formatting instructions that you used in the Windshield Survey assessment. Your assessment should be done as a report for your team, using APA formatting for in-text citations and references.RequirementsIn your organizational evaluation, complete the following:Describe the primary health concern for a vulnerable or diverse population.Explain how the organization currently serves this health care concern. Be sure you include information on how the organization communicates to the population.Identify gaps in the health care service provided to the population.Explain evidence-based strategies to bridge the gaps in health care service provided to the population.Identify any possible barriers to implementing your strategies.Additional RequirementsInclude a title page and reference page. The completed assessment should be 35 pages in length, not including the title page and reference page.Reference at least three current scholarly or professional resources.Use current APA format for citations and references.Use Times New Roman font, 12 point.Double space.Organizational Evaluation Scoring GuideCRITERIANON-PERFORMANCEBASICPROFICIENTDISTINGUISHEDDescribe the primary health concern for a vulnerable or diverse population.Does not describe the primary health concern for a vulnerable or diverse population.Identifies the primary health concern for a vulnerable or diverse population.Describes the primary health concern for a vulnerable or diverse population.Describes the primary health concern for a vulnerable or diverse population, and includes information on frequency and causes.Explain how a health care organization serves the primary health care concerns of a vulnerable or diverse population.Does not explain how a health care organization serves the primary health care concerns of a vulnerable or diverse population.Explains how a health care organization serves a vulnerable or diverse population, but does not address specific health care concerns.Explains how a health care organization serves the primary health care concerns of a vulnerable or diverse population.Explains how a health care organization serves the primary health care concerns of a vulnerable or diverse population, and identifies specific initiatives and methods used to communicate the initiatives to the target population.Identify gaps in the health care service provided by an organization to a vulnerable or diverse population.Does not identify gaps in the health care service provided by an organization to a vulnerable or diverse population.Identifies gaps in the health care service provided by an organization, but does not show how the gaps relate to a vulnerable or diverse population.Identifies gaps in the health care service provided by an organization to a vulnerable or diverse population.Identifies gaps in the health care service provided by an organization to a vulnerable or diverse population, and explains the causes for the gaps.Explain evidence-based strategies to bridge gaps in the health care service provided by an organization to a vulnerable or diverse population.Does not explain evidence-based strategies to bridge gaps in the health care service provided by an organization to a vulnerable or diverse population.Identifies evidence-based strategies to bridge gaps in the health care service provided by an organization to a vulnerable or diverse population.Explains evidence-based strategies to bridge gaps in the health care service provided by an organization to a vulnerable or diverse population.Recommends evidence-based strategies to bridge gaps in the health care service provided by an organization to a vulnerable or diverse population.Identify barriers to implementing evidence-based strategies to bridge gaps in the health care service provided by an organization to a vulnerable or diverse population.Does not identify barriers to implementing evidence-based strategies to bridge gaps in the health care service provided by an organization to a vulnerable or diverse population.Identifies barriers to implementing evidence-based strategies to bridge gaps in the health care service provided by an organization, but does not show how the barriers are connected to a vulnerable or diverse population.Identifies barriers to implementing evidence-based strategies to bridge gaps in the health care service provided by an organization to a vulnerable or diverse population.Identifies barriers to implementing evidence-based strategies to bridge gaps in the health care service provided by an organization to a vulnerable or diverse population, and considers the consequences of failing to overcome the barriers.Write content clearly and logically, with correct use of grammar, punctuation, and mechanics.Does not write content clearly and logically, with correct use of grammar, punctuation, and mechanics.Writes content clearly and logically, but grammar, punctuation, and mechanics have frequent errors.Writes content clearly and logically, with correct use of grammar, punctuation, and mechanics.Writes clearly and logically, with correct use of spelling, grammar, punctuation, and mechanics; and uses relevant evidence to support a central idea.Correctly format citations and references using APA style.Does not correctly format citations and references using APA style.Inconsistently formats citations and references using APA style.Correctly formats citations and references using APA style. Citations contain few errors.Correctly formats citations and references using APA style. Citations are free from all errors.
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Running head: ORGANIZATIONAL EVALUATION
Health Promotion and Disease Prevention in Vulnerable and Diverse Populations
Copyright © 2017 Capella University. Copy and distribution of this document is prohibited.
East Harlem, an upper Manhattan neighborhood, is home to many immigrant
communities including one of the largest Latino communities in New York City with an overall
population of nearly 120,000. This neighborhood has the largest population of Latinos and
African-Americans with low incomes in New York City. Because of their low socioeconomic
status and low quality of living, the residents of this neighborhood face several health concerns.
Diabetes is a major health concern in the United States, but the residents of East Harlem are
disproportionately affected by it (Fox, Mann, Ramos, Kleinman, & Horowitz, 2012; National
Alliance for Hispanic Health [NAHH], n.d). East Harlem has the highest diabetes mortality rate
(13%) and the highest incidence of obesity (33%) in New York City (New York City Department
of Health and Mental Hygiene [NYCDOHMH], 2015). This disparity exists as Hispanics lack
access to proper nutrition.
The Frequency and Causes of Diabetes among the Vulnerable Population
The high rate of diabetes among the residents of East Harlem can be better understood by
analyzing the factors behind it. There are a number of factors that contribute to higher rates of
diabetes among certain racial or ethnic groups. Lack of access to health care because of language
and financial barriers directly impact the rates of diabetes mortality. According to the Agency for
Healthcare Research and Quality (AHCRQ), the diabetes patients among Hispanics are more
likely than whites to get readmitted to hospitals within a span of six months since the beginning
of the treatment (NAHH, 2010).
A primary reason for the increased occurrence of diabetes among the Hispanic residents
of East Harlem is the lack of resources to cope with their external environment, stress-related
problems, and poor nutrition. A lack of exercise also contributes to the onset of diabetes among
Hispanics. The external environment also plays a large role in the onset of diabetes by creating
unequal opportunities for people from different backgrounds to participate in recreational
physical activities. A poor understanding of the disease contributes to higher instances of
diabetes among Hispanics. Finally, because of a combination of genetic, lifestyle, and
environmental factors, Hispanics are more likely to have a family history of diabetes (NAHH,
Initiatives Implemented to Fight Diabetes in East Harlem
The Center for Chronic Illnesses (CCI) is one of the hospitals in East Harlem that deals
with all major illnesses including diabetes. The CCI can help the vulnerable diabetic population
in East Harlem by implementing appropriate strategies:
? Administrating insulin and glucose injections and prescribing oral medication to control
elevated blood pressure levels;
? Providing practical lifestyle management tips to the Hispanic population in East Harlem by
emphasizing relevant exercise methods and healthy dietary plans;
? Prescribing pills, such as INVOKANA (canagliflozin), to be used once a day, along with
dietary regulations and exercise, to lower blood glucose in adults with type 2 diabetes.
? Using an initiative called the Chronic Care Model. This initiative aims to optimize six
important elements of the health care system in the CCI: organization of health care, decision
support, self-management support, clinical information systems, delivery system design, and
community resources and policies;
? Ensuring the optimization of the health care system by improving the use of existing resources,
creating new resources, and promoting a new policy of interaction between empowered patients
and proactive health teams (Baptista et al., 2016). This sort of interaction encourages the patients
Comment [A1]: Very good!
to cope with and manage diabetes independently, which helps them avoid frequent and
preventable hospitalizations; and
? Implementing a major project founded under the Chronic Care Model called Project Dulce.
This project uses a team-based approach where nurse care managers oversee care and peer
educators provide culturally appropriate, group-based diabetes self-management education
(DSME) to patients.
? Health care organizations can communicate these initiatives to the residents of East Harlem
through care coordination. This involves sharing information among all of the participants
concerned with a patient’s care and organizing patient care activities, to achieve safer and more
effective care. This means that the patient’s preferences and needs are known ahead of time and
communicated to the right people at the right time, and that this information is used to provide
appropriate, safe, and effective care to the patient (Agency for Healthcare Research and Quality
[AHRQ], 2014). treatment of the disease.
Gaps in Health Care for the Treatment of Diabetes
As discussed earlier, a majority of the residents in East Harlem are at a high risk for
diabetes because of a combination of genetic and economic factors. But, many of them are
uninsured and hence medical treatments automatically become more expensive and inaccessible
to them owing to their low socioeconomic status. This neglect can lead to higher rates of
hospitalizations and increased chances of chronic disease and disability (Alliance to Reduce
Disparities in Diabetes [ARDD], n.d.). Some of the gaps in health care organizations for the
treatment of diabetes are as follows:
? A limited capacity to address both the prevention and the treatment of the disease when an
organization works alone to tackle diabetes. In addition, health care organizations may lack staff
Comment [A2]: Nice!
member who can speak Spanish. This causes problems in communication between the physicians
and patients (ARDD, n.d.); and
? Ensuring the implementation of healthy eating among individuals. One of the barriers to
implementing these recommendations could be that Hispanics face societal pressure to eat foods
that are high in fats and do not have access to affordable healthy food. To address these gaps in
medical care for diabetic Hispanics, health care organizations should implement interventions
that have a strong clinical and scientific foundation (Hu, Amirehsani, Wallace, & Letvak, 2013).
Implementation of Evidence-Based Strategies to Reduce Gaps in Medical Care for
Comment [A3]: Need to be clearer
in this area on the causes of the gaps.
Diabetics in East Harlem
One way to address the gaps in health care provided to diabetic Hispanics in East Harlem
is to increase health literacy among the Hispanic residents of this area. Health literacy refers to
the extent to which people have the capability to process, obtain, and understand basic health
information and services needed to make health-related decisions. In February 2016, Carranza
(2016) attempted to carry out a study to see how knowledgeable the Hispanic populations are
about diabetes. Patients were given immediate feedback on their responses to improve their
understanding of diabetes. The results of this study showed that 81.3% of the patients were
unable to accurately read a nutrition label.
To address the gaps in nutritional education or healthy eating it would also be beneficial
for the patients if the CCI could conduct monthly nutritional classes that teach the basic
principles of how to interpret nutritional labels, with a focus on the ideal amount of consumable
carbohydrates. Patients presented with this information will be able to better manage their
diabetes and avoid the negative consequences of an extremely high blood sugar level (Carranza,
2016). Health care organizations should also take collaborative action with other health and
Comment [A4]: I am not sure that it
is a quick solution to increase the
health literacy. I would change this!
community development centers from other neighborhoods in the city. Other community
development centers can also teach the health care organizations to communicate information
about resources to patients in their native language (Philis-Tsimikas & Gallo, 2014).
Barriers to Implementing Evidence-Based Strategies in the Care of Diabetes
While strategies that educate patients about diabetes and assist them to manage their
condition can help bridge gaps in the diabetes health care service, there are further barriers to the
implementation of these strategies. One of the biggest barriers to the prevention and treatment of
diabetes is the lack of general practitioners (GPs) and clinicians in health care centers. Some GPs
are reluctant to collaborate with diabetes educators and dieticians as they feel it diminishes the
value of their role. Because of this attitude, they are effectively depriving their patients of holistic
treatment (Mc Hugh, OMullane, Perry, & Bradley, 2013).
Health care providers play an important role in helping diabetic patients overcome the
barriers to self-management of their condition. If patients are aware enough to cope with the
illness on their own, they do not have to spend money on frequent hospitalizations. Health care
providers should actively engage with the patients to ensure the patients compliance with the
treatment plan. Cultural competency and language training to overcome communication gaps
will build trust and encourage patients to open up to the health care workers. Additionally,
encouraging family members to attend diabetes education programs provides them the
opportunity to learn more about the disease. However, there are some social and financial
barriers to the effective treatment of diabetes. Further research needs to be done about the
barriers to self-management of diabetes and the effective interventions to overcome these
barriers (Hu et al., 2013).
Comment [A5]: This part is very
Agency for Healthcare Research and Quality. (2014). Care Coordination. Retrieved from
Alliance to Reduce Disparities in Diabetes. (n.d.). Disparities in diabetes: Prevention and care.
Retrieved from https://merck.com/corporateresponsibility/docs/access/DisparitiesFACTSHEET.pdf
Baptisa, D. R., Wiens, A., Pontarolo, R., Regis, L., Reis, W. C., & Correr, C. J. (2016). The
chronic care model for type 2 diabetes: a systematic review. Diabetology & Metabolic
Syndrome, 8(1). https://doi.org/10.1186/s13098-015-0119-z Carranza, E. (2016). Health
literacy in the Hispanic population (Doctoral dissertation). Retrieved from
Carranza, E. (2016). Health literacy in the Hispanic population (Doctoral dissertation).
Retrieved from http://nmfonline.org/wp-content/uploads/2016/02/Carranza-ElizabethPaper.pdf Mc Hugh, S., OMullane, M., Perry, I. J., & Bradley, C. (2013). Barriers to,
and facilitators in, introducing integrated diabetes care in Ireland: a qualitative study of
views in general practice. BMJ Open, 3(8), e003217. doi:10.1136/bmjopen-2013-003217
Fox, M., Mann, D. M., Ramos, M. A., Kleinman, L. C., & Horowitz, C. R. (2012). Barriers to
physical activity in East Harlem, New York. Journal of Obesity, 2012, 18.
Hu, J., Amirehsani, K., Wallace, D. C., & Letvak, S. (2013). Perceptions of barriers in
managing diabetes. The Diabetes Educator, 39(4), 494503.
Mc Hugh, S., OMullane, M., Perry, I. J., & Bradley, C. (2013). Barriers to, and facilitators in,
introducing integrated diabetes care in Ireland: a qualitative study of views in general
practice. BMJ Open, 3(8), e003217. doi:10.1136/bmjopen-2013-003217
National Alliance for Hispanic Health. (2010). The state of diabetes among Hispanics. Retrieved
New York City Department of Health and Mental Hygiene (2015). Manhattan community
district 11: East Harlem. Retrieved from
Philis-Tsimikas, A., & Gallo, L. C. (2014). Implementing community-based diabetes programs:
The Scripps Whittier Diabetes Institute experience. Current Diabetes Reports, 14(2).
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