PHE 630 Final Project Template (3)

Public Health Grant Proposal For Combating Diabetes Mellitus in Rural America Prepared by Felissa M. Riley

Table of Contents Introduction to the Problem Epidemiological Assessment Health Equity Assessment Significance Strategic Action Plan Evaluation Plan Dissemination Plan References Appendix A—Social, Epidemiological, Educational, and Ecological Assessments Appendix B—Action Steps for the Program Appendix C—Program Logic Model Appendix D—Evaluation Plan Appendix E—Dissemination Plan 1

the how and why of Diabetes but there is not enough help in the rural communities to help tame this disease before it causes damage to many people's bodies that cannot be undone. Health Equity Assessment Structural Determinants Societal Structures and Social Relations Social Stratification Policy Contexts ● Health Maintenance ● Foodscape ● Group Context ● Minority Populations ● Low-income adults ● Physical Environment ● Worksite lifestyle programs ● Global treatment ● Treatment Targets Intermediary Determinants Material Circumstances Behaviors and Biological Factors Psychosocial Factors ● Dwelling ● Economic Stability ● Environmental exposures ● Genetic factors ● Environmental factors ● Lifestyle factors ● Emotional factors ● Behavioral factors ● Social factors Differentials 3

Differential Exposure Differential Vulnerability Differential Consequences Increase of general compartmentalization that leads to unjustness on exposure to health damaging conditions such as Diabetes Mellitus due to the socioeconomic status of a person based on their income, education, and occupation, which leads to the risk of development at a lower status. Differential exposure leads to unjust vulnerability based on social group identity because socially disadvantaged people may have higher rates of disease because of the great exposure to risk factors, and differential vulnerability leads to exposure to the same risk factors that can result in different levels of disease risk in different social groups. Differential vulnerability leads to unjust consequences when certain groups face an increased risk of developing diabetes due to factors such as socioeconomic disparities, limited access to healthcare, and exposure to environmental hazards. Summary of Health Equity Considerations It is very clear that Diabetes Mellitus, no matter what type, is a very concerning issue that needs to be addressed. It does not affect just one ethnic group, it affects many in our society, especially those who live in rural communities. The health equity considerations must be addressed with Diabetes so that we can help prevent serious complications. According to the CDC, many rural communities do not have programs regarding Diabetes management in America and this is something that needs to be addressed. Every rural community needs programs that can be easily accessed by community people to help them have better lives right from the start. Please refer to Appendix A for an assessment of social, epidemiological, and educational/ecological dimensions of the problem. Significance This program will help those who live in rural communities in America have access to important treatment, care, and preventative measures to help them live longer and healthier lives. This proposed program implementation will help to attract stakeholders, researchers, doctors, nurses, and other healthcare professionals who are passionate about helping those in need where the resources are limited. This proposed program will give a way to ask hospitals, private and public healthcare providers, and federal governmental agencies for health for their expertise in helping with the treatment, prevention, and care in regard to Diabetes Mellitus. 4

Milestone Three Evaluation Plan The proposed program’s plan for process, outcome, and impact evaluations has been detailed in Appendix D. [Insert a written summary of one or two paragraphs explaining main ideas. It is critical that your data collection methods involve both qualitative and quantitative data. Ensure that you have balanced your data collection planning accordingly]. 6

Milestone Four Dissemination Plan [Insert a brief introduction to the dissemination of findings. In addition, describe what communication strategies/formats/media you considered for the two audiences and your reasoning for choosing one medium over the others to communicate your finding for each of the two audiences.] The plan for the dissemination of findings has been detailed in Appendix E. 7

Type 2 diabetes - Symptoms and causes . (2023, March 14). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/symptoms- causes/syc-20351193 Diabetes Self-Management Education and Support in Rural America | CSELS | Rural Health . (2023, September 5). CDC. https://www.cdc.gov/ruralhealth/diabetes/index.html The silent epidemic that is killing nearly 7 million of us every year . (2020, December 14). The World Economic Forum. https://www.weforum.org/agenda/2020/12/diabetes-silent-epidemic-world-health/ Why Diabetes is a Concern for Rural Communities - RHIhub Toolkit . (2020, September 23). Rural Health Information Hub. https://www.ruralhealthinfo.org/toolkits/diabetes/1/rural-concerns 9

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 10

Objective 2: [Insert S.M.A.R.T. Objective 2.] Strategy 2.A: [Insert Strategy 2.A.] Action Step(s) Person(s) responsible Date to be completed Resources required Barriers Collaborators Step 2.A.1: [Insert first step.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] Step 2.A.2: [Insert second step.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] Step 2.A.3: [Insert third step.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] Step 2.A.4: [Insert fourth step.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] Step 2.A.5: [Insert fifth step.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] Strategy 2.B: [Insert Strategy 1.B.] Action Step(s) Person(s) responsible Date to be completed Resources required Barriers Collaborators Step 2.B.1: [Insert first step.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] Step 2.B.2: [Insert second step.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] Step 2.B.3: [Insert third step.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] Step 2.B.4: [Insert fourth step.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] Step 2.B.5: [Insert fifth step.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] 12

Objective 3 [Insert S.M.A.R.T. Objective 3.] Strategy 3.A: [Insert Strategy 3.A.] Action Step(s) Person(s) responsible Date to be completed Resources required Barriers Collaborators Step 3.A.1: [Insert first step.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] Step 3.A.2: [Insert second step.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] Step 3.A.3: [Insert third step.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] Step 3.A.4: [Insert fourth step.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] Step 3.A.5: [Insert fifth step.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] Strategy 3.B: [Insert Strategy 3.B.] Action Step(s) Person(s) responsible Date to be completed Resources required Barriers Collaborators Step 3.B.1: [Insert first step.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] Step 3.B.2: [Insert second step.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] Step 3.B.3: [Insert third step.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] Step 3.B.4: [Insert fourth step.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] Step 3.B.5: [Insert fifth step.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] 13

Program Structure Inputs Activities Outputs Human Resources Activity Grouping 1 Products ● [Insert text.] ● [Insert text.] ● [Insert text.] ● [Insert text.] ● [Insert text.] ● [Insert text.] ● [Insert text.] ● [Insert text.] ● [Insert text.] ● [Insert text.] Financial Resources Activity Grouping 2 Services ● [Insert text.] ● [Insert text.] ● [Insert text.] ● [Insert text.] ● [Insert text.] ● [Insert text.] ● [Insert text.] ● [Insert text.] ● [Insert text.] ● [Insert text.] Community Resources Activity Grouping 3 Infrastructure ● [Insert text.] ● [Insert text.] ● [Insert text.] ● [Insert text.] ● [Insert text.] ● [Insert text.] ● [Insert text.] ● [Insert text.] ● [Insert text.] ● [Insert text.] Material Resources Activity Grouping 4 Other ● [Insert text.] ● [Insert text.] ● [Insert text.] ● [Insert text.] ● [Insert text.] ● [Insert text.] ● [Insert text.] ● [Insert text.] ● [Insert text.] ● [Insert text.] 15

Program Function Outcomes ( Note: Please adjust cell merging to reflect the scaffolding of outcomes from short-term to intermediate to 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) ● [Insert text.] ● [Insert text.] [Insert text.] ● [Insert text.] ● [Insert text.] ● [Insert text.] ● [Insert text.] ● [Insert text.] ● [Insert text.] ● [Insert text.] [Insert text.] ● [Insert text.] ● [Insert text.] ● [Insert text.] ● [Insert text.] ● [Insert text.] Impact ( Note: Impact should focus on the single goal/purpose of the program, but phrased in terms of achieving health equity.) [Insert text.] 16

Objective 2: [Insert S.M.A.R.T. Objective 2–from Appendix B.] Strategy 2.A: [Insert strategy.] * Evaluation Question Indicator(s) Data Source / Instrument Qualitative or Quantitative Data? Target Population Timeline Individual(s) Responsible P [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] O [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] I [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] * The first column indicates evaluation type: process (P), outcome (O), or impact (I). Strategy 2.B: [Insert strategy.] * Evaluation Question Indicator(s) Data Source / Instrument Qualitative or Quantitative Data? Target Population Timeline Individual(s) Responsible P [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] O [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] I [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] * The first column indicates evaluation type: process (P), outcome (O), or impact (I). 18

Objective 3: [Insert S.M.A.R.T. Objective 3–from Appendix B.] Strategy 3.A: [Insert strategy.] * Evaluation Question Indicator(s) Data Source / Instrument Qualitative or Quantitative Data? Target Population Timeline Individual(s) Responsible P [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] O [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] I [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] * The first column indicates evaluation type: process (P), outcome (O), or impact (I). Strategy 3.B: [Insert strategy.] * Evaluation Question Indicator(s) Data Source / Instrument Qualitative or Quantitative Data? Target Population Timeline Individual(s) Responsible P [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] O [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] I [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] [Insert text.] * The first column indicates evaluation type: process (P), outcome (O), or impact (I). 19