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RISK AWARENESS AND PREVENTION DEVELOPMENT 1

Risk Awareness and Prevention Development for Type 2 Diabetes



in the College Age Population








Kimberly M. Deans
Chuqiu Wu

Central Michigan University
HSC 419














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Introduction

Health Problem

Diabetes Mellitus affects an estimated 23.6 million people in the United States and is the
seventh leading cause of death (Healthy People 2020).

It is a condition that comes in three types
type 1, type 2 and gestational diabetes. Type 1 is an autoimmune disease that accounts for 5%
of all diagnosed cases of diabetes (SOPHE, 2012). Type 2 occurs when the body does not
regulate insulin properly. Prediabetes is a condition that leads to type 2 diabetes. Gestational
diabetes is a condition that develops during pregnancy. It is a temporary condition that occurs in
18% of all pregnancies (SOPHE, 2012).

It sometimes develops into type 2 diabetes. If
prediabetes and gestational diabetes are managed, type 2 diabetes can be prevented. It is
estimated that seven million people in the United States have diabetes and are currently
undiagnosed and another 79 million aged 20 years and older have prediabetes (SOPHE, 2012).


It is the goal of Healthy People 2020 to reduce the annual number of new cases of diagnosed
diabetes in the population from 8 out of 1000 people to 7.2 out of 1000 people. It is also a goal of
Healthy People 2020 to increase the proportion of persons with diagnosed diabetes who receive
formal diabetes education from the current 56.8 percent of diagnosed to 62.5 percent.

It is
necessary to develop preventive strategies to avoid onset of type 2 diabetes and to make diabetes
education more accessible to those who currently have the condition. As stated by Shin et al
(2012), early intervention in the prediabetic stage is a valuable approach to reduce diabetes
development and related complications (p.79).
The major risk factors for type 2 diabetes include being over 40 years old, overweight,
sedentary lifestyles, family history of diabetes, have had diabetes during pregnancy, high blood
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pressure, are African American, Hispanic American or Native American (SOPHE, 2012).
Diabetes cost the United States over $116 billion in direct medical cost in 2007 alone (SOPHE,
2012).

Symptoms of type 2 diabetes include the following: weakness, fatigue, dry itchy
skin/numbness, tingling of hands and feet, frequent infections, blurred eyesight, slow healing
cuts and scars, frequent urination, increased hunger and increased thirst (SOPHE, 2012).

The
affects of these symptoms lowers life expectancy by 15 years, increases risk of heart disease, and
is the leading cause of kidney failure, lower limb amputations, and adult-onset blindness
(Healthy People 2020).

Narrow the Health Problem
As noted by Reyes-Velazques (2008), It is particularly important to target college
students because it has been found that 70% of individuals in this population tend to gain weight
during their first year of school (p.161). In 2010 (CDC, 2012), the new incident rate of type 2
diabetes in the age group of 18-79 was (out of 1,000) 15.6 for those with less than a high school
diploma, 8.4 for those with a high school diploma and 7.0 with more than a high school diploma.
In 1990 (CDC, 2012), the rates were 4.1, 3.6 and 3.2. The rate of new incidents of type 2
diabetes has increased in all educational levels.

College educated adults are not immune to
developing diabetes therefore greater awareness of risk factors and prevention development
would be beneficial to the college age population. In a study by Strong, et al. (2008) it was
reported that previous work has demonstrated that college students are particularly vulnerable to
weight gain, preventing weight gain in this population may have important implications for long-
term weight management (p.1708). It has been reported that in data collected by the National
College of Health Assessment and the College Health Risk Behavior Survey, indicate that
physical activity and dietary patterns of many college students do not meet the recommendations
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of health professionals, and 29.9% of students are overweight or obese based on self-reported
height and weight values (Racette, et al p. 39). For these reasons, a type 2 diabetes risk
awareness and prevention development program is very important for the college population.
Proposed Solution
Our solution for type 2 diabetes prevention development and risk awareness is comprised
of three strategies. Using the Theory of Diffusion of Innovations our strategy at the community
level is to develop a Facebook group dedicated to healthy lifestyles and type 2 diabetes
education, including the importance of seeing their primary care provider on a regular basis. The
Theory of Planned Behavior and Health Belief Model to facilitate change at the individual level
is our strategy through support groups and role models utilizing MyFitnessPal.
Benefits of the Program
Benefits of our solution include technology which is popular in the target age group, a
personal plan to lower a persons risks and a social program for support. As stated by Hales,
researchers have found gender differences in first year weight gain. In men, increased alcohol
consumption and peer pressure to drink accounts for the extra pounds. In women, the strongest
correlation of weight gain is workload, which may lead to more stress related eating, greater
snacking, or less exercise (p. 161). The social and role model strategies will be very beneficial
to the success of the program. In this age group, peers are very influential.
Why the Program will be Successful
The program will be successful because it engages at both the community and individual
level. It is low cost to participants and it is low cost to administer. It will be located on campus
where the college age population spends time. Facebook and MyFitnesspal are available for use
on both computers and smart phones allowing for easy access to the information.
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Needs Assessment Survey Review
Our needs assessment was a 16 question survey to determine the level of knowledge of
diabetes risk factors (see Appendix A). We gathered demographic information based on age,
gender, and housing location. The majority of respondents were in the 18-24 age group (80%),
female (73%), and lived in off campus non-student housing (73%). The majority of our
respondents were from the Health Professions College and therefore their knowledge of health
issues may be greater than the general population. Of the diabetes awareness questions, all of the
respondents answered 4 out of 5 correctly. Only 40% knew that a diagnosis of diabetes was a
permanent condition. Obesity was listed by 60% as the main risk factor of diabetes. As there are
other risk factors and diabetes is a condition that cannot be cured, diabetes awareness education
is needed. Of those surveyed, 60% said they would attend a lecture on diabetes prevention. The
assessment of current prevention practice showed that only 53% of respondents regularly
exercised. The majority of respondents said they were eating three meals a day (80%); but they
also stated that they did over eat (20%). Development of prevention strategies is necessary to
increase exercise levels and improve diet habits. The survey also showed that 53% only
somewhat agreed diabetes could be prevented, 42% did not believe family history was a risk
factor and 30% said they only went to the doctor when they were sick. Education is necessary to
ensure screenings for diabetes are taking place in those with risk factors who may not have
symptoms. Type 2 diabetes can be prevented if prediabetes is managed properly.
Goals and Objectives
In order to deliver our risk awareness and prevention development message thoroughly,
we are using three different communication channels. Our first goal utilizes Social Media. Our
second goal utilizes interpersonal communication. Our third goal utilizes intrapersonal
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communication and tailoring of the information from the MyFitnessPal program. The following
are the program goals:
Goal 1: Risk Awareness Increase risk awareness of type 2 diabetes in college age
population
Program Objectives:
Process /Administrative: Establish Facebook group page dedicated to daily postings on
healthy lifestyle and type 2 diabetes education to begin at start of fall semester, 2014.
Impact/Learning: Increase awareness of type 2 diabetes risk factors, symptoms and
prevention in 25% of student population within seven months.
Impact/Behavioral: 30% of students will improve decision-making skills and choose
healthier lifestyle options after seven months of awareness education.
Goal 2: Creation of healthy lifestyles support group to promote physical activity and
nutrition and share ideas on incorporating it into their daily lives.
Program Objectives:
Process/Administrative: Set up meeting location and facilitator for bi-monthly meetings
October April.
Impact/Learning: By the end of the meetings, participates will have increased their daily
activity level by 25% and at least 20% will be able to demonstrate how to prepare a healthy
meal.
Impact/Behavioral: After attending the support groups, half of those participating will be
able to fit more physical activity and better nutrition into the daily lives.
Goal 3: Prevention Development reduce the incidence of prediabetes and type 2
diabetes among the college population.
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Program Objectives:
Process/Administrative: Set-up MyFitnessPal training and user groups to encourage
active monitoring of diet and physical activity by November 1, 2014.
Impact/Learning: 20% of support group students will be able to self-monitor food intake
to evaluate nutrient and calorie usage from physical activity after training provided by November
30, 2014.
Impact/Behavioral: 20% of support group students will be more physically active and eat
a healthy diet by the end of seven months.
Pre-Program/Administrative Strategies

The pre-program and administrative strategies for our program are the following:

1) Gaining support/adoption by stakeholders. The identified stakeholders for our program
include University Health Services, Central Michigan University Leadership, Student
Activity Center, Campus Dining Services, Student Government/Register Student
Organizations, and Information Technology, and grantor.
2) Addressing organizational policy. The policy that would need to be addressed includes
the following: informed consent to participate in support group waiver of liability or
release of liability, social marketing/media procedures of CMU, Emergency Care Plan,
ethical Issues, HIIPPA/Confidentiality of personal health information, establish
registration/tracking procedures of participants, procedures for recording keeping,
procedures manual, program participants with disabilities review, software use licensing
or permissions, and training of facilitators.
3) Marketing Strategies. The core benefit of our program is to protect individual health.
Our product is health education. Participation in the program is low cost. The place of our
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program is on campus. The promotion of our program will take the following forms: 1)
Group Facebook page create page CMU Healthy Lifestyle Forum and send
invitations/introduce the program during orientation sections to all incoming freshmen,
all students during registration; 2)advertising on main web page linking to University
Health Services, facebook link found there;3) set up booth on Mainstage in the fall, give
out relevant information/free gifts; 4)design posters to distribute to all student housing; 5)
ad in CM Life; and 6) public service announcements via CMU Student Announcements
and Orgsync site.

Personnel Requirements

The personnel requirement for the program is comprised of one health education, support
staff and consultants. The positions and duties are outlined as follows:

Health Educator:
1 month = 1FTE per week, 11 months .25FTE per week (10 hours per week)
*Research, select, and presentation of program nutritional, physical activity and social
components, pre test, post tests, tracking of progress
*Research and select location of lecture and support group
*Prepares materials to be distributed at Mainstage. Prepares display. Arranges staff or
volunteers.
*Presents and facilitates at kick-off lecture
*Creates poster and arranges distribution system to reach all on and off campus student housing
*Creates topics of discussion, prepares materials, and facilitates bi-monthly support group
*Maintains daily topics on Facebook page and monitors page, responds to members input, post
messages regarding lecture and support group
*Creates instruction materials for MyFitnessPal using existing help texts, acts as resource for
support group members
*Evaluates program

Office Support Staff:
1 month =.5 FTE per week (20 hours per week), 11 months .05FTE per week (2 hours per week)
*Assists health educator with administrative functions include word processing, copying,
distributing, confirming room reservations, coordination of volunteers.


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IT Support Staff:
*Set up Facebook page and links from other websites, security to university specs; troubleshoot
any tech issues with Facebook

Consultants:
Nutritionist: to review or create nutrition/diet recommendations/guest speaker at meeting
Physical Education Specialist: to review or create exercise program/guest speaker meeting


Budget

During the fall, 2012 semester, Central Michigan University had 18,686 students
enrolled. One of the objectives of our program is to increase awareness in 25% of the student
population or 4,671 students through the Facebook page. Of those students, we have included
4% or 200 students estimated to participate in our on-campus bi-monthly support group. Our
budget also includes distributing poster to all on-campus and off-campus student housing. CMU
has 22 on campus multi-floor dormitories and many off-campus housing complexes. We
budgeted for 300 posters to distribute amongst the buildings. Possible funding sources for our
program include grants from the Prevention and Public Health Fund, the American Diabetes
Association, or the State of Michigan Department of Community Health. Our budget is
comprised of total income of $33,000.00; total direct cost of $23,450.00; and total indirect cost
of $9,380.00 (see Appendix B).
Program Planning
Planning for our program begins in May, 2014. The program would kick-off in August
upon the return of students and start of fall semester, 2014. The program will run for seven
months. During the month of April, 2015, the impact evaluation would take place (see Appendix
C). There would be follow-up surveys at three, nine and 12 months from the end of the
program..

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Intervention Strategies

The educational interventions strategies for our program include social media, lecture,
support groups, and posters. In order to deliver our risk awareness and prevention development
message thoroughly, we are using four different communication channels. As stated in our goal
and objective section, we are utilizing social media (Facebook), interpersonal communication
(lecture), and intrapersonal communication (Support Groups and MyFitnessPal) . The program
also uses organizational and community channels in the form of posters.
Facebook page/community: Healthy Lifestyle Forum
Administrator will post facts on risk awareness and prevention of pre-diabetes and type 2
diabetes three times a day. It will provide links to other healthy lifestyle sites and to activities
that promote healthy lifestyles to prevent or manage type 2 diabetes.
It will serve as a community forum where members can post information, activities, or
share their experiences regarding type 2 diabetes to promote healthy lifestyles.
The format used is social networking at the macro level as it is open to all. It will utilize
the Theory of Diffusion of Innovation to increase awareness, to educate about the risks factors of
diabetes and to promote prevention development. The Theory of Diffusion of Innovation, as
explained by U.S. Department of Health and Human Services (HHS) is a community level theory
that explains how new ideas, products, and social practices spread within an organization,
community, or society, or from one society to another (p. 27). It is based on adopting a new
habit is easier if people can incorporate the new behavior with minimal disruption to their daily
pattern. Our objective is to get the word out that it is not difficult to incorporate healthy lifestyle
behaviors into your daily routine and that there are many people who support healthy lifestyles.
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Kickoff Lecture and Support Groups

The lecture will lay out the purpose and structure of the support groups. We will have a
health educator/facilitator lead the lecture and have a speaker that is either a nutritionist or
physical activity specialist. The lecture will introduce the importance of tracking your daily
intake of nutrition, physical activity and the equation necessary to the weight process. It will
walk through accessing MyfitnessPal, how we will utilize the program to track calories, and form
the support groups from the number of participants. The support groups would meet on-campus
bi-monthly to discuss their ups and downs with tracking their diet and activity. There will be an
optional weigh in and BMI measurement at their first attendance. The facilitator will lead each
meeting and create a conversation starter for each meeting. Participating in a weekly exercise
activity will be part of the meeting as well as sharing a new recipe idea. As incentive to
participation, each participant will receive a $10 gift card and a manual of reference materials, a
step counter, and if they participate in the weight and BMI tracking, a chance to win one of 2
$100 prizes for the most improved. Weight, physical activity and calorie consumption will be
tracked through MyFitnessPal. At the end of the program, information collected will be
analyzed. The two participants that had a combination of the most physical activity calories, the
closest calorie to recommended consumption, and improved BMI will be the contest winners. If
there is a tie or more than two contenders, the winners will be drawn from a hat of all eligible
participants.
The format would be a formal lecture at the micro or individual/group level. It will utilize
the Health Belief Model to motivate individuals to adopt a healthy behaviors by giving members
tools (MyFitnessPal and the consultants) and a buddy to work with. The Health Belief Model
is defined by the HHS as the beliefs about the effectiveness of taking action to reduce risk or
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seriousness(p.14). Factors that contribute to the success of a program based on the Health Belief
Model are a subjects readiness for change and confidence in ones ability to change(p. 14). To
create a successful environment, a facilitator needs to explain how, where and when to take
action and what the potential positive results will be, offer reassurance, incentives, and
assistance, provide training and guidance in performing action and demonstrate desired
behaviors(p. 14). The new behavior must be adopted by the individual. It cannot be forced. It
will also utilize the Social Cognitive Theory. The Social Cognitive Theory is defined by the HHS
as the dynamic, ongoing process in which personal factors, environmental factors, and human
behavior exert influence upon each other (p.20). The main strategy from this theory for our
support group is to promote mastery learning through skills training, model positive outcomes
of healthful behavior, and offer credible role models who perform the targeted behavior (p.20).
The Social Cognitive Theory has been very successful for dietary change (HHS, p.27).
Posters

The posters will serve as marketing for the Facebook page, kick-off lecture and support
group as well as a tool for risk awareness and prevention development for type 2 diabetes.
The format would be a poster campaign utilizing photos depicting choices between
healthy and unhealthy behaviors, an invitation to attend the lecture, and a link to the Facebook
site. It will utilize the Theory of Planned Behavior. According to HHS, this theory is about a
persons perception of what control they may have over the behavior (p.17). When a person
looks at one of our posters, the theory explains, the person will consider the following regarding
the behavior change: behavioral intention, attitude, subjective norm, and perceived behavioral
control (p.17). Our goal is to motivate a person to choose to be healthier by providing
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information that they are capable of making the change and that others are making the change
by participating in the Facebook and/or lecture/support group.
Evaluation
The evaluation for our program will be an internal evaluation compiled by the health
educator. The evaluation results would be presented to our stakeholders. The entire evaluation
would be presented to our organization and our funding source. We would present various
sections to the participants and others interested in implementing a similar program. The overall
design of our evaluation would include the following tools: 1) Pre-program participation survey,
post-program participation survey, and follow-up surveys at three, nine and 12 months post-
participation. 2) Administrative data would include staff timesheets, room reservations,
Facebook monitoring tools, and MyFitnessPal printouts.
The evaluation will be conducted to measure the various elements associated with the
process, impact and outcome evaluations. (A detailed list of the elements involved in the process,
impact and outcome evaluation, the tool we will use to measure, and the objective/goal to be
measured is found in Appendix D). In our process evaluation, are evaluation objectives are to
measure how closely the program implementation followed protocols, how successful it was in
recruiting and reaching members of the priority population, and how many people participated.
In our impact evaluation, our evaluation objectives are to measure how many participants gained
knowledge from the Facebook page, gained skills to utilized MyFitnessPal, and the affect the
journal and support group had on their nutrition and physical activity habits. In our outcome
evaluation, we are looking to measure the benefit of our program in lowering the risk of pre-
diabetes and type 2 diabetes in the college age population.

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Conclusion
Type 2 diabetes is a preventable disease. Prediabetes can be reversed with intervention.
Healthy People 2020 established goals to increase diabetes education and to reduce the annual
number of new cases of diagnosed diabetes. Our program works with those guidelines to
increase risk awareness and prevention development in the college age population to give young
adults the education and skills needed to avoid the onset of diabetes. It is through the various
communication channels and intervention strategies that our target audience will receive type 2
diabetes prevention education.















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References



Center for Disease Control. (2012, February 14). Age-Adjusted Incidence of Diagnosed Diabetes
per 1,000 population Aged 18-79 years, by Education, United States, 1980-2010 retrieved
from www.cdc.gov/diabetes/statistics/incidence/fig7.htm

Hales, D. (2012). Invitation to Health. Belmont, CA. Wadworth Cenage Learning.

Healthy People 2020/ U. S. Department of Health and Human Services. (2013, April 10).
Diabetes Healthy People 2020 retrieved from
www.healthpeople.gov/2020/topicsobjectives2020/overview.

Racette, Susan B., Deusinger, Susan S., Strube, Michael J., Highstein, Gabrielle R., &
Deusinger, Robert H. (2008). Changes in Weight and Health Behaviors from Freshman
through Senior Year of College. Journal of Nutrition Education Behavior, volume 40,
pages 39-42.

Reyes-Velazquez, Wanda , & Hoffman, Eric W. (2011) . Toward Reducing the Diabetes
Pandemic: College Students Perspectives of Type 2 Diabetes. Diabetes Spectrum,
volume 24, page 161-168.

Shin, JA, Lee, JH, Kim, HS, Choi, YH, Cho, JH, & Yoon, KH. (2012). Prevention of Diabetes:
A Strategic Approach for Individual Patients. Diabetes Metab Res Rev, volume 28 pages
79-84.

Society for Professional Health Educators (SOPHE). (2012, November). Spotlighting Diabetes
Prevention: Empowering Communities to Take Control retrieved from www.sophe.org

Strong, Kathryn A., Parkes, Serena L., Anderson, Eileen, Winett, Richard, & Davy, Brenda M.
(2008). Weight Gain Prevention: Identifying Theory-Based Targets for Health Behavior
Change in Young Adults. Journal of the American Dietetic Association, volume 108,
pages 1708-1715.

U.S. Department of Health and Human Services, (Spring, 2005). Theory at a Glance, A Guide for
Health Promotion Practice .







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Appendix A
Needs Assessment Survey
Diabetes Awareness in College Age Population
Please circle or write in your answers!

What is your age? Under 18 18 to 24 25 to 34 35 or older

What is your gender? Female Male

In which type of housing do you currently live?
On-Campus Housing Off-Campus student housing Off-Campus non-student housing

Diabetes is a condition that only affects people over 65. True False

Diet is an important factor in Diabetes management. True False

Alcohol consumption affects blood sugar levels. True False

Undiagnosed or untreated diabetes may cause sexual and/or pregnancy complications.
True False

Once you get diabetes, it never goes away. True False

Do you regularly exercise? Circle the one below that describes your average exercise status
per day.
No exercise at all Half hour per day One hour per day More than one hour per day

Do you eat at least three meals a day?
Yes No

How well do you eat?
Over eat (above 2000 kcal per day) Moderate Keeping a special diet: ____________

Family history is a risk factor of Diabetes.
Yes No

Are you willing to attend a Diabetes prevention lecture?
Yes No

How often do you have a physical exam?
One per year Only go when I am sick

Diabetes is a health condition I can prevent. Agree Somewhat Agree
Disagree
List risk factors of Diabetes: _______________________________________
Thank you for your participation!
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