PHE 630 Final milestone 5

Milestone One Introduction to the Problem Epidemiological Assessment The “What”: Diabetes Mellitus is a disorder in which the body has prolonged long periods of high sugar levels ( Diabetes , 2023).Diabetes has caused thousands of people to lose their lives before the age of 60 it is beginning to be known as a silent epidemic in its own rights, and it continues to rise globally ( The Silent Epidemic That Is Killing Nearly 7 Million of Us Every Year , 2020). Rural communities, have less access to healthcare facilities, and resources, a very low number of healthcare professionals, are not insured, have no transportation, receive little to no education and awareness regarding diabetes, and have increased rates of people in their community who are overweight and less active physical ( Why Diabetes Is a Concern for Rural Communities - RHIhub Toolkit , 2020). This leads to diabetes causing other havoc and damage to their bodies resulting in shorter life spans. Pre-diabetes, Diabetes Type 1, Diabetes Type 2, and Gestational Diabetes need to be addressed in rural communities so that these people will have better outcomes in health. Person The “Who” Place The “Where” Time The “When” ● Society ● Poor areas ● Non-Urban Communities ● All Ethnic Groups ● Below the Federal Poverty level ● Those who are less educated ● Clinical Trials ● Hospitalizations ● Patterns The “Why” and “How”: Prediabetes can happen if someone has a parent, or sibling who has diabetes type 2, is obese, not being physically active, and gives birth to a baby 9 pounds or larger ( Prediabetes , n.d.).Diabetes Type 1 occurs when there is not enough insulin produced by the pancreas and incorrect insulin response from the cells ( Type 1 Diabetes - Symptoms and Causes , n.d.). Diabetes Type 2 happens when there is low production of insulin and incorrect insulin response from cells ( Type 2 Diabetes - Symptoms and Causes , 2023). Gestational diabetes is only seen during pregnancy, and it occurs when the cell by how cells of the woman's body do not use the sugar well ( Gestational Diabetes - Symptoms & Causes , n.d.).We know 2

Milestone Two Strategic Action Plan The proposed program’s vision is to narrow the complications caused by Diabetes Mellitus in rural areas. . The proposed program’s mission is to expand awareness, implement easier access to treatment and improve the quality of life. The proposed program’s objectives and strategies involve the following: Objective 1: Focus on rural counties with high prevalence of Diabetes Mellitus ○ Strategy 1.A: Assess the National Diabetes Statistics Report o Strategy 1.B: Assess the United States Surveillance System Objective 2: Increase the presence of public healthcare professionals in rural areas. o Strategy 2. A: Find public/private partnerships that will support rural health structures. o Strategy 2. B: Build onto the current rural healthcare professional workforce. Objective 3: Implement new ways of providing healthcare services in rural areas. o Strategy 3. A: Providing Telehealth services. o Strategy 3. B: Implementing Mobile units. 5

Milestone Four Dissemination Plan The target audience is those who live in rural communities who will benefit from this program. The communication of this program will reach them in various ways and the message objective is to help the overall community improve health. Social media platforms, local newspaper, radio station, and local news stations will have ongoing information to report to the community about the program. This will lead to various age groups receiving the information. Sometimes rural communities are very close-knit nit and therefore it is very important that the healthcare professionals remain vigilant and continue to receive advanced training and education as needed so that they can relate to those patients whom they will serve through this program. The plan for the dissemination of findings has been detailed in Appendix E. 8

Appendix A—Social, Epidemiological, Educational, and Ecological Assessments Description of Current Status Description of Desired Outcome Phase 1: Social Assessment ● Quality of Life (QoL) Quality of life of those who have prediabetes and diabetes type1, type 2, and gestational can who live in rural communities with limited resources can be poor. Will have all the resources that they need within adequate range of where they live. Phase 2: Epidemiological Assessment ● Indicators (mortality, morbidity, disability data) ● Other factors (genetic, behavioral, environmental) The people that live in these communities in rural America has less access to decent housing and other resources for daily living that will require them to have healthier lives Will have adequate housing and access to places that can provide reasonable materials to help improve their living conditions. Phase 3: Educational and Ecological Assessment ● Predisposing Factors ● Enabling Factors ● Reinforcing Factors The people living in these rural communities may lack the needed resources they need to sustain health and may lack adequate healthcare staffing to provide the education that is needed to maintain health Will have public health professionals that will serve rural communities in places such as local clinics and health departments to provide education and treatment 11

Objective 2: Increase the presence of public healthcare professionals in rural areas. Strategy 2.A: Finding public/private partnerships that will support rural health structure. Action Step(s) Person(s) responsible Date to be completed Resources required Barriers Collaborators Step 2.A.1: Town hall meeting Health Commissioner Spring of 2024 SITE/FACILITATOR COUNTY LEADERSHIP NOT INTERESTED STAKEHOLDERS COMMUNITY LEADERS Step 2.A.2: Set up meetings Health Director Summer of 2024 COORIDINATOR COUNTY LEADERSHIP NOT INTERESTED MAYOR Step 2.A.3: Attend meetings Researcher Summer of 2024 TRANSPORATION NOT ABLE TO ATTEND THE SPECIFIC DATE STAKEHOLDERS HOSPITAL ADMINSTATORS Step 2.A.4: Attend meetings Scientists Summer of 2024 TRANSPORATION NOT ABLE TO ATTEND THE SPECIFIC DATE STAKEHOLDERS ADMINISTRATORS OF HOSPITALS Step 2.A.5: Attend meetings and provide education Public health Educator Summer of 2024 EDUCATIONAL PACKETS NOT ABLE TO ATTEND THE SPECIFIC DATE DOCTORS NURSES STAKEHOLDERS Strategy 2.B: Building onto the current rural healthcare professional workforce. 14

Objective 3: Implement new ways of providing healthcare services in rural areas. Strategy 3.A: Providing Telehealth services. Action Step(s) Person(s) responsible Date to be completed Resources required Barriers Collaborators Step 3.A.1: Find a company who deals with telehealth services Health Director Winter of 2026 TELEHEALTH.HHS. GOV COST STAKEHOLDERS Step 3.A.2: Find a company with internet services/hardware/software Technicians/Engineer Spring of 2026 TELEHEALTH.HHS. GOV COST HEALTH DIRECTOR\HEALTH COMMISSIONER Step 3.A.3: Find an appropriate equipment Health Educator Summer of 2026 COLLEGES/UNIVER SITIES OF PUBLIC HEALTH COST STAKEHOLDERS HEALTH DIRECTOR/HEALTH COMMISSIONER Step 3.A.4: Reviewing the telehealth company Doctor/nurse Fall of 2026 TELEHEALTH.HHS. GOV COMMUNICATION IS NOT SPECIFIC TO THE NEED STAKEHOLDERS PUBLIC HEALTH PROFESSIONALS Step 3.A.5: Reviewing the telehealth company Nutritionists Fall of 2026 TELEHEALTH.HHS. GOV COMMUNICATION IS NOT SPECIFIC TO THE NEED STAKEHOLDERS PUBLIC HEALTH PROFESSIONALS Strategy 3.B: Implementing Mobile units. Action Step(s) Person(s) responsible Date to be completed Resources required Barriers Collaborators Step 3.B.1: Find the funding for a mobile unit Health Commissioner Winter of 2027 GRANTS FOR MOBILE HEALTHCARE CLINICS /CROWDFUNDING GOVERNMENTAL BARRIERS R/T TO POLICIES AND PROCEDURES HEALTH DIRECTOR HEALTH COMMISSIONER STAKEHOLDERS 17

Program Structure Inputs Activities Outputs Human Resources Activity Grouping 1 Products Time Attendance Training Performance management ● Workshops ● Conferences ● Surveys ● Classes taught. Sessions conducted. People who participated Financial Resources Activity Grouping 2 Services ● Grants ● Fundraiser events ● Crowdfunding Apply for grants. Find a platform. Set goals. ● ● Service hours provided. ● Counselling sessions provided. ● Seminars provided. ● Community Resources Activity Grouping 3 Infrastructure ● Food and Nutrition services ● Employment and training services ● Public facilities Community guides Stakeholders’ identification Volunteers Workforce Partnerships Policies Material Resources Activity Grouping 4 Other ● Paper handouts ● Computers ● Laptops ● Organization participation Community grant Languages in the community ● System processes ● Technologies ● Support 20

Program Function Outcomes ( Note: Please adjust cell merging to reflect the scaffolding of outcomes from short-term to intermediate too long-term. Add/delete rows as needed to meet project expectations.) Short-Term Outcomes (Predisposing Factors/Intrapersonal Level) Intermediary Outcomes (Reinforcing Factors/Interpersonal Level) Long-Term Outcomes (Enabling Factors/Community Level) Make people aware of the program Program to provide and improve parts educational aspects on Diabetes Mellitus Improved health in many rural communities in America ● Help to shift attitudes about the program ● Everyone can participate in the program ● Provide the benefits of the program Increased participation in receiving services and treatment of program ● Encourage positive attitudes about the program ● Provide services information Offering help and encouragement of acceptance of the program More federal government agencies' involvement in the program ● Look at other possible resources for the program ● Encourage engagement at local townhall meetings Providing open dialogue in whatever form is needed ● Encourage local government body participation ● Broadcast on local TV, and social media Impact 21

The Combating Diabetes Mellitus in Rural America program is personal to me. I live in a small rural community were the resources and lack of public health professionals is very low. Most rural communities do not have the necessary means to help their people with the health aliments that they suffer from. Diabetes Mellitus is a metabolic disorder in which can cause havoc to a person’s body if it is not take care of. This program will help to provide access to care, treatment, and preventative measures to those in need who live in rural communities across America. The goal of this program is to help alleviate the potentially devastating effects of Diabetes Mellitus starting from Prediabetes to Gestational Diabetes with the right tools of education, medication, diet, and exercise along with follow-up care with a primary healthcare professional. 22

Appendix D—Evaluation Plan Objective 1: Focus on rural counties with high prevalence of Diabetes Mellitus Strategy 1.A: Assess the National Diabetes Statistics Report * Evaluation Question Indicator(s) Data Source / Instrument Qualitative or Quantitative Data? Target Population Timeline Individual(s) Responsible P How do we access the information? Maps of service areas CDC WEBSITE qualitative Health director/Health commissioner Within 3 months Program leader O Does it require written or electronic authorization? Designee at CDC CDC WEBSITE qualitative Health director/Health commissioner As needed Program leader I Will this require constant password changes? Designee at CDC CDC WEBSITE qualitative Health director/Health commissioner As needed Program leader * The first column indicates the evaluation type: process (P), outcome (O), or impact (I). Strategy 1. B: Assess the United States Surveillance System 23

* Evaluation Question Indicator(s) Data Source / Instrument Qualitative or Quantitative Data? Target Population Timeline Individual(s) Responsible P How do we access the information? Maps of service areas CDC WEBSITE qualitative Health director/Health commissioner Within 3 months Program leader O Does it require written or electronic authorization? Designee at CDC CDC WEBSITE qualitative Health director/Health commissioner As needed Program leader I Will this require constant password changes? Designee at CDC CDC WEBSITE qualitative Health director/Health commissioner As needed Program leader * The first column indicates evaluation type: process (P), outcome (O), or impact (I). 24

Objective 2: Increase the presence of public healthcare professionals in rural areas. Strategy 2.A: Finding public/private partnerships that will support rural health structure. * Evaluation Question Indicator(s) Data Source / Instrument Qualitative or Quantitative Data? Target Population Timeline Individual(s) Responsible P Where are public and private partnerships located? Internet /organizations designee Surveys quantitative Stakeholder/healt h director/health commissioner Ongoing Program leader O When and where to arrange meetings? Organization designee Meeting guides in communities qualitative Stakeholder/healt h director/health commissioner As needed Program leader assistant I How will this positively help the potential partners? Organization designee Questionnaires quantitative Stakeholder/healt h director/health commissioner Ongoing Program leader * The first column indicates the evaluation type: process (P), outcome (O), or impact (I). Strategy 2.B: Building onto the current rural healthcare professional workforce. 25

* Evaluation Question Indicator(s) Data Source / Instrument Qualitative or Quantitative Data? Target Population Timeline Individual(s) Responsible P What is the current workforce? Maps of service areas Workforce database quantitative Stakeholder/healt h director/health commissioner Within 6 months Health Director/Health Commissioner O How can this improve conditions for the current workforce? Board of healthcare professionals Surveys qualitative Stakeholder/healt h director/health commissioner Ongoing Health Director/Health Commissioner I What benefits could be offered? Program leader Questionnaire quantitative Stakeholder/healt h director/health commissioner As needed Program leader * The first column indicates evaluation type: process (P), outcome (O), or impact (I). 26

Objective 3: Implement new ways of providing healthcare services in rural areas. Strategy 3.A: Providing Telehealth services. * Evaluation Question Indicator(s) Data Source / Instrument Qualitative or Quantitative Data? Target Population Timeline Individual(s) Responsible P Who is the local internet provider? Internet Websites qualitative Stakeholder/healt h director/health commissioner Within 3 months Program leader O What is the best service plan that they offer? Website of internet provider and designer Internet Provider quantitative Stakeholder/healt h director/health commissioner Within 3 months and ongoing Program leader I What program offers the best patient security program, Website internet provider designee Internet Provider qualitative Stakeholder/healt h director/health commissioner As needed Program leader * The first column indicates evaluation type: process (P), outcome (O), or impact (I). Strategy 3.B: Implementing Mobile units. 27

* Evaluation Question Indicator(s) Data Source / Instrument Qualitative or Quantitative Data? Target Population Timeline Individual(s) Responsible P What vehicles are best for this service? Website of medical company designee Mobile unit companies/websi te quantitative Stakeholder/healt h director/health commissioner/Ce rtified mechanics and technicians Within 3 months Health Director/Health Commissioner O What type of employees will be needed for this service? Board of healthcare providers Mobile unit companies/websi tes/federal and state government agencies quantitative Stakeholder/healt h director/health commissioner/Ce rtified mechanics and technicians Within 3 months and as needed, ongoing Health Director/Health Commissioner I Are there any special qualifications and certifications needed for this type of service? Board of healthcare professionals Federal and state agencies qualitative Stakeholder/healt h director/health commissioner/Ce rtified mechanics and technicians Within 3 months and as needed, ongoing Health Director/Health Commissioner * The first column indicates the evaluation type: process (P), outcome (O), or impact (I). 28

Appendix E—Dissemination Plan The Priority Population Health Professionals Target Audience Description The "recipient" (include level of education, health literacy level) The priority population includes those that live in rural communities in which many may have little education and may have little faith in healthcare professionals Healthcare professionals will have advanced training and education Communication Event Summary of communication need The communication event will reach those who live in rural communities in various ways Healthcare professionals will communicate how the target audience's needs and behavior are Message Objective What is the intent? This will show the program and show that it is being designed for rural communities to help with overall health This plan will show the needs of the communities and give insight to the healthcare professionals on how the people address and look at their own health needs Timing Duration, frequency, etc. There will be ongoing communication until the communities of the program feel as though the community is receiving the help it needs. The plan will continue until the program leader feels as though the healthcare professionals have all the information in place and the assistance has been provided to the target audience Vehicle List several types of media/communication strategies-formats appropriate for audience Social media platforms, local newspapers, flyers, and local news stations along with radio stations as well Online courses such as webinars and Zoom meetings as well as printed pamphlets and medical news journals Vehicle of Choice Medium (form) + Channel (route) Medium → internet/social media platform Channel → Facebook is more popular in rural communities Medium → Printable information Channel → Online /medical news media platforms 29

The Priority Population Health Professionals Explanation for Why You Chose Medium Over Other Options There will be various age groups which tend to gravitate to social media outlets Healthcare Professionals can use printed information and provided online education that will be easily accessed that has been in medical journals Description of Health Literacy Many who live in rural communities have sometimes less education than those who live in urban areas and do not always trust healthcare professionals Healthcare professionals will have the expectation of advanced training and so their advancement is there Sender(s) Author, distributor, coordinator, etc. Program leader CDC, Scientists, healthcare professionals, etc. Feedback Mechanism Currently available and needed avenues Available Mechanisms → It can be assessed by looking at the contact information on the website. Needed Avenues → Will have a feedback mechanism worked out for those who do not access the internet Available Mechanisms → Healthcare professionals will be able to talk with and educate the patients. Needed Avenues → Printed material will be available that is in simple language and different languages also 30

P.E.S.T.L.E. Analysis of External Influences The Priority Population Health Professionals Political Republicans/Democrats Medical and drug companies Economic Little to no work Little businesses Social Poor communication No communication between healthcare professionals and the target audience Technological Advancements in technology in rural communities Growth of Internet services and use everywhere Legal Community members could seek legal issues if viewed as not fair Federal/state and local regulations must be followed by all healthcare professionals Environmental Access to care should improve health which should lead to a better community overall Unintended circumstances could arise that may shift focus off of the program 31