Introduction
Diabetes mellitus is currently a significant issue on a global scale, as it is becoming more prevalent and affecting more people. The World Health Organization lists type II diabetes as one of the illnesses with a global impact on public health. An intervention can be successfully implemented to address the health risks and maximize well-being because the condition is directly correlated with a person’s dietary and lifestyle choices.
However, the fact that the disease depends on such elements also correlates with factors such as one’s socio-economic status. West Virginia was selected for the health intervention as the state was shown to have the national record for the most cases of diabetes in the adult population. Moreover, the selected age demographic of 45-64 years adults correlates with the overall risk of disease occurrence, which is higher in this particular life stage.
The intervention is based on the evidence-based individual-level framework, the health belief model. Furthermore, health interventions, including informational campaigns, physical activity implementations, and nutritional assistance, must be adequately evaluated in terms of the success of the practical application of the theory mentioned above. A significant part of the intervention is devoted to evaluation, which will help to determine the project’s level of success. The process will be evaluated based on how many people attend group meetings, call the hotline, and participate in the program. This will be discovered through observation or monthly statistics measurements.
Background
West Virginia has the highest rates of diabetes in the country. Namely, statistics highlight that more than 230,000 people in the state, which constitute approximately 16% of the population, have been diagnosed with type 2 diabetes (American Diabetes Association, 2021). Additionally, the state has a higher death rate correlating with the condition – 41,3, followed by Mississippi – 41 and Arkansas – 33,8 (CDC, 2022).
The statistics regarding the health complications linked to the condition illustrate the severity of the current situation in the state. Namely, current literature highlights that more than 5,500 amputations were performed between 2011 and 2016 in West Virginia due to diabetes complications (Minc et al., 2020). Based on the statistics mentioned above, it is inevitable that West Virginia is a state where an intervention addressing the condition is needed.
It is also vital to mention the risks associated with the expected rates that researchers predict to be higher than they are currently. Namely, almost 35% of the adult population in West Virginia has prediabetes (American Diabetes Association, 2021). The statistic was established by determining that the blood glucose level, while not reaching the market-associated level with the condition, is higher than average. It is also important to mention the expenses correlating with diabetes, as 2017 the state had $1,7 billion in expenses linked to the disease (American Diabetes Association, 2021). The statistical data illustrate the severity of the condition and its impact on an economic level.
As mentioned, adults are most at risk of developing type 2 diabetes. There are several contexts for the phenomenon. Initially, geographical location is a factor that increases the likelihood of adverse health outcomes.
West Virginia is one of the most rural states in the country, which highlights potential negative aspects such as the lack of healthy nutritional choices, challenges in accessing medical assistance, and several socio-economic elements (Shawley-Brzoska & Misra, 2018). The socio-economic factor, in particular, is to be addressed as diabetes is often linked to economic challenges. Namely, researchers have determined that one of the circumstances facilitating high rates of people with high blood glucose levels is that more than 17% of West Virginians live below the poverty line (Shawley-Brzoska & Misra, 2018). This aligns with inadequate nutrition, resources, and lower-quality medical care.
The problem that has been highlighted previously is measured through different tools. One of the most evident ones is determining the number of patients diagnosed with diabetes by their medical provider. On the other hand, researchers have measured the blood glucose level to determine whether the condition can worsen on a state level (American Diabetes Association, 2021). If the results highlight a number higher than average yet lower than one associated with type 2 diabetes, the condition is classified as prediabetes.
Risk factors also include determining the family history, measuring adherence to physical exercise initiatives, and questioning nutritional choices and dietary efforts. For example, results highlighting that most demographics do not prioritize healthy food, doctor check-ups, and physical activity correlate with potential increases in the state rate for adults with diabetes.
Diabetes can be treated and prevented, so prevention measures are crucial. These include eating a balanced diet, exercising regularly, avoiding being overweight, and routinely checking blood glucose levels. Suppose the patient adheres to the doctor’s health plan regarding nutritional and physical changes. In that case, the condition can be addressed, and the patient will be in remission (Misra, Farjo, & McGinnis, 2021). As a result, a blood level below the diabetes mark can be achieved, which puts the patient outside the statistical dimension of the disease.
Risk Factors: Improper Nutrition and a Lack of Physical Activity in Adults in West Virginia
Several risk factors correlate with the high rate of type 2 diabetes in West Virginia. Namely, researchers highlight that one of the determinants is body mass which frequently puts individuals with type 2 diabetes in the overweight or obese category (Galicia-Garcia et al., 2020). Statistics highlight that 39,1% of West Virginians have a Body Mass Index (BMI) higher than 30, which is only 0,7% lower than in Mississippi, the state with the highest obesity rates in the country (America’s Health Rankings, 2021). Weight, on the other hand, is related to one’s nutritional choices as well as physical activity.
Research conducted in West Virginia has administered a questionnaire that has helped determine that 80% of individuals at risk for diabetes did not work out, while almost 40% had an inadequate diet (Misra, Farjo, & McGinnis, 2021). It can be stated that the risk factors linked to high rates of obesity are high body mass, which is facilitated by a lack of physical activity and poor nutritional adherence. However, such a phenomenon can also be affected by a lack of knowledge on the subjects, health illiteracy, the lack of resources, the inability to purchase healthy food, and low socioeconomic status.
Theory
The high rate of obesity among adults in West Virginia can be exemplified through the individual-level theory of the Health Belief Model. The selection of an individual-level framework has been facilitated by the desire to be inclusive regarding the perception of success and barriers of each person. Recognizing that experiences differ based on one’s background, family, community, and history is essential. The Health Belief Model (HBM) identifies the factors that the individual perceives concerning their condition.
Namely, six perceived concepts are highlighted in the framework: susceptibility, severity, benefits, barriers, cues to action, and self-efficacy (US Department of Health and Human Services, 2005). For example, a person is to believe they have a high chance of developing diabetes to proceed to minimize risks. The sensitivity of people in society to this issue grows as a result of increased attention to diabetes in the family, regular doctor examinations of patients with risk factors for the disease, and increased social awareness of this illness (McCoy & Theeke, 2019). This is addressed through helpful information on the development of type 2 diabetes, potential threats, and demographics that are vulnerable to developing the disease.
Moreover, the individual has to be aware and believe that the condition correlates with the severity of health outcomes and negative consequences concerning their well-being. Those with family members experiencing diabetes are more likely to understand the severity of the condition as they are familiar with its negative consequences and threats. However, the concept can be addressed through an informational campaign and does not require personal experience with the phenomenon.
The patient is to perceive the benefits of putting effort into their health. Namely, they are to be reassured that the strategies they adhere to combat the issue are effective and result in long-term benefits (US Department of Health and Human Services, 2005). This can also be facilitated by sharing helpful information, conversations with individuals who managed to overcome negative consequences, and providing statistical data on remissions concerning type 2 diabetes.
Furthermore, perceived barriers are another concept highlighted as the perception of the input that is to be generated to achieve positive results. Thus, if the perception is that efforts for managing diabetes are too high for the outcome, change is unlikely to occur. As a result, public health plan implementation is to facilitate reassurance and assistance. Cues to action, on the other hand, relate to the practical implementation of behavior alteration. The individual is to be ready to adhere to the plan of action, and the public health initiative is to provide the tools and information necessary to make the most significant change possible.
Last but not least, self-efficacy is another concept within the HBM framework. Namely, the element illustrates one’s individual belief that they can adhere to the health plan and facilitate success in the progress of their condition (US Department of Health and Human Services, 2005). The initiative can effectively address the confidence with the help of the organization and individuals operating the project.
For example, participants can be provided with guidance on maintaining positivity and beneficial health results linked to their nutrition and activity levels. Moreover, goal-setting is another element that motivates people to continue their health journey despite potential external disturbances. Verbal motivation is also a potentially effective action that aligns with the theory.
Intervention
The goal of the intervention is to assist people aged 45 to 64 in coping with and managing type 2 diabetes. The objective will be accomplished in many ways, including a support hotline, group sessions, and an awareness information campaign. For the intervention to be successfully implemented on a state level, it is essential to select an organization that directly correlates with efforts to combat type 2 diabetes complications.
This is why the American Diabetes Association, an organization that already has an office in Virginia/WV, will assist in facilitating community health. The American Diabetes Association is a significant resource provider working on a federal level (American Diabetes Association, 2022). The fact that the entity already operates in West Virginia highlights the experience of working with the communities selected for assistance.
The role of the American Diabetes Association in this particular initiative is to allocate resources to address the community’s health concerns and provide one-on-one assistance with physical and nutritional needs. They will also allocate experts such as nutritionists and fitness specialists for group meetings, establish a hotline for diabetes assistance, print and share pamphlets, and share information through online platforms to create interest in the intervention. Collaboration with this particular entity can majorly impact the success of the initiative.
On the one hand, the American Diabetes Association is experienced and knowledgeable in creating informational campaigns. On the other hand, the entity is aware of the community differences between demographics. As a result, a patient-centered approach can be achieved by considering local characteristics and potential perceived barriers that can hinder success on an individual and community level.
As mentioned, the aim is to assist adults between 45 and 64 in managing their type 2 diabetes status. The implementation is intended to work specifically with West Virginia residents due to the condition’s seriousness in this particular state. Based on current statistics, more than 230,000 people in West Virginia have diabetes, most of whom are in the age demographic for which the intervention is intended (American Diabetes Association, 2021). The initiative will likely be able to assist this many individuals at an early stage. Nonetheless, the goal is to create favorable circumstances in which at least 8,000 West Virginian adults receive the necessary resources aligning with the intervention.
The number, while not addressing the severity of the high number of people with diabetes, is mentioned as it is inevitable that helping 8,000 people will result in experience gain and expertise in the field. As a result, the intervention can become more significant in the future, and the positive result will be maximized further.
Several recruitment channels can be applied to establish the group participating in the intervention. Researchers mention that print and online marketing campaigns successfully generate interest in diabetes assistance programs (Mensa-Wilmot, Bowen, Thummalapally, Murphy, & Rutledge, 2018). Thus, the participants will find out about the initiative through printed pamphlets and online campaigns.
The printed pamphlets will contain information on diabetes, the intervention itself, how to access the resources, and further details. A similar approach will be implemented regarding online advertising. The pamphlets will be placed in places where individuals with diabetes address their condition, namely, doctors’ offices and pharmacies. Moreover, the campaign will be advertised online through designated diabetes groups on social media and websites with data on available resources for West Virginians with the abovementioned condition.
Multiple tasks are planned to be implemented to address the health issue of high rates of type 2 diabetes among adults aged 45-64 in West Virginia. The first task is to conduct an informational campaign concerning the organization’s aim and diabetes as a condition, its symptoms, outcomes, and ways to minimize negative consequences. The information will be shared through printed pamphlets and social media on the website of the American Diabetes Association.
Data on diabetes, such as how the condition manifests, steps to implement to manage it, and doctors’ recommendations, will be included. This is included to address perceived severity and benefits based on the Health Belief Model. The informational campaign will also be included in the group sessions, another task to be employed within the intervention.
Group sessions are meetings where participants can either learn more about their condition or about committing to a healthier lifestyle while receiving community support. The nature of the session will take two different approaches. Once a week, a meeting will be held on nutrition, during which a certified dietician will talk about foods to avoid or substitute with healthier options and provide participants with nutritional plans.
This particular task is to consider the demographic’s cultural and socio-economic conditions. As mentioned, more than 17% of West Virginians live in poverty (Shawley-Brzoska & Misra, 2018). Moreover, to combat potential limitations such as a lack of knowledge of healthy dietary options or resistance towards significant changes, the dietician will establish meal plans that individuals can adhere to.
As a result, nutritional changes will be easier to establish due to the cost-effectiveness, cultural considerations, and implementation of widely available ingredients. On the other hand, the second weekly group session will approach the physical activity component of diabetes management. The participants will be able to learn about safe and effective exercise based on their preferences and health conditions, as well as participate in fitness events such as long group walks, jogging, and other types of sports. While it is a group intervention, the task aligns with the individual-level theory of the Health Benefit Model. The sessions imply that each person will receive a customized plan, be able to ask questions, and be reassured that they are on the right path by the expert speaker based on the concept of the perceived barriers.
Last but not least, it is vital to establish a hotline to assist individuals with diabetes with their day-to-day questions on nutrition and potential complications. The hotline implies the presence of a certified expert who can provide the participant with comprehensive solutions and support. Researchers highlight that psychosocial factors affect the effectiveness of diabetes interventions (McCoy & Theeke, 2019). It is challenging due to the food culture in West Virginia and the family and friend gatherings in which food that correlates with adverse outcomes for people with diabetes is shared. Having a support system through the phone can alleviate the feeling of isolation when adhering to a healthier lifestyle.
Moreover, it adheres to the concept of cues to action and self-efficacy as the participant receives needed information and verbal reinforcement. All the tasks will be implemented over the two-year intervention without minimizing the informational and practical assistance. Thus, over the next two years, the initiative will be advertised, two weekly group meetings will be held, and the hotline will operate to support adults with the conditions mentioned above.
Evaluation Process
It is crucial to evaluate the change to determine whether the implementation was successful. Regarding the process, the attendance of group meetings, hotline calls, and participation in the program will be assessed based on the number of participants. Thus, if attendance is consistently high after several months of establishment, and the hotline is relatively popular among adults with diabetes, the process will be successful. This will be determined through observation or statistics measured each month.
Evaluation Outcome
The size of the change in initially observed characteristics is expected to be low during the first week and months, but consistently grow as the initiative becomes more well-known among community members. Regarding outcomes, it was initially established that the goal is to assist 8,000 people during the two years in which the program will operate. The initiative will be deemed beneficial enough if the rate is achieved or exceeded.
The rate of assisted individuals will be measured through an online survey, as such tools are commonly applied in diabetes assistance initiatives (Mensa-Wilmot, Bowen, Thummalapally, Murphy, & Rutledge, 2018). The survey will include several options for answers to the question, “Has the American Diabetes Association Virginia/West Virginia Office assisted you in diabetes management?” (Table 1). The potential answers include “yes, significantly,” “yes, moderately,” and “no.” The first two answers will be considered positive when measuring the impact. As mentioned previously, the established standard was 8,000 individuals, which is to be assessed through the online survey.
Evaluation Impact
Regarding the community impact, the initiative is designed to bring awareness to the positive impact of having a healthy lifestyle on the symptoms of type 2 diabetes. Current literature highlights that almost 40% of West Virginians with diabetes rate their diet as unhealthy and their exercise level as low (Misra, Farjo, & McGinnis, 2021). The goal is to reach a statistic of 50% concerning healthy nutrition and 30% concerning active lifestyles. The outcomes will be measured through a questionnaire distributed during the weekly meetings and through the hotline. Questions such as “Would you rate your eating habits as healthy?” and “Do you exercise regularly (at least twice a week)?” will be included (Table 2).
Conclusion
Since type 2 diabetes is widespread among West Virginians, it is essential to employ a theory-based intervention to minimize potential health and economic aspects correlating with the severity of the condition. The individual-level theory, namely, the Health Belief Model, can successfully address the socioeconomic, cultural, and demographic characteristics of the selected group of individuals who will be assisted. The initiative, including establishing weekly meetings, a hotline, and an informational campaign, can ameliorate the current situation by informing and assisting the public with challenges. Nutrition and physical activity are addressed through an evidence-based framework encompassing data sharing, moral support, and a patient-centered approach that considers the individual traits of the participants. As a result, the community will be healthier, the mortality rate will decrease, and the overall understanding of the condition and ways to manage it will be maximized.
References
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