Community Assessment: The American Public Health Association (APHA)

Posted: January 5th, 2023

Community Assessment: The American Public Health Association (APHA)

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Community Assessment: The American Public Health Association (APHA)

The American Public Health Association (APHA) is determined to pinpoint the needs of the immediate public health community in order to integrate nutrition and healthy living as core components of diabetes prevention and control (American Public Health Association, n.d.). The assessment describes the initiating stage in planning and policy design and implementation. Essentially, a community health assessment is the gathering, analysis, and application of data to mobilize and educate communities, garner resources, plan actions, and develop priorities to enhance public health (Green & Kreuter, 2004). Many private and governmental organizations have undertaken community health evaluations across a wide assortment of public health challenges. The APHA has identified a chronic disease, diabetes, as its principal focus point since it exerts significant pressure on patients, their families, the economy, and the health care delivery system in entirety.

Strategic Prevention Framework (SPF)

The strategic prevention framework, or SPF, describes a data-inclined operating system that assists inferential and statistical methods to design evidence-based diabetes prevention and control programs (Park, 2017). Ordinarily, prevention planners are anticipated to establish solutions to pressing issues facing their communities. However, experience and research have demonstrated that prevention has to commence with comprehension of the complex behavioural tendencies within their complicated environmental settings; it is only then that communities can develop and execute effective plans and programs to address diabetes as a chronic issue in society.

To enhance understanding, the APHA has to develop a strategic prevention framework. The framework is inclusive of two guiding principles and five sequential steps aimed at offering a comprehensive approach to the comprehension and addressing of diabetes prevention and control, as well as the behavioural tendencies that cause the problem (American Public Health Association, n.d.). APHA’s SPF is directed by two pertinent principles that should be integrated into every stage of the context. The first relates to cultural proficiency, which describes the capability of an association or individual to realize and interact effectually with personalities who are categorized by different lifestyles, principles, traditions, and philosophies based on their social connections and idiosyncratic heritage (DSHS Division of Alcohol and Substance Abuse, 2020). Another cross-cutting rule is that of sustainability. Here, the procedure of building an operative and adaptive scheme that accomplishes and upholds the desired long-term purposes is perceived as essential.

APHA’s SPF will include five stages, as is outlined in the subsequent sections.

Needs Assessment

It involves the identification of local prevention needs grounded on data, which includes demographics and the precise problem (Butuner, 2019). The aim of this phase is to comprehend the local prevention and control needs based on a meticulous review of data collected from varying sources. The data assists planners to pinpoint and prioritize diabetes effects on individuals and families in the community; illuminate the impact the challenges have on the community; identify the particular factors that lead to the identified problems; evaluate readiness, and define the resources needed to address the factors. Eventually, a thorough and all-encompassing assessment process assists to guarantee that diabetes prevention and control efforts are suitable and on track.

To undertake a comprehensive evaluation of prevention needs, professionals collect data on various aspects. First, the prevention planners need data regarding chronic disease, diabetes, including its prevalence, and how it affects individuals, the economy, and communities. The second item for data collection is concerned with the risk and safeguarding factors that contribute to diabetes in the community, especially those of high priority within the community. Lastly, prevention professionals at APHA seek data concerned with the community’s aptitude for prevention, including available resources and readiness. Across the United States, crude 2018 data by the Centers for Disease Control (CDC) indicated that over 100 million Americans are suffering from diabetes (see appendix 1, Centers for Disease Control, 2020). As of 2015, approximately 9.4 per cent or 30.3 million residents were living with the condition. Another estimated 84.1 million people had prediabetes, which is a condition that, if left untreated, typically contributes to diabetes type II in five years. The indication is that the risk factor for contracting the chronic condition is high among Americans. While a report by CDC (2017) indicates that the rate of fresh diabetes diagnoses is steady, the disease consistently presents a progressing public health care problem that requires urgent solutions. In 2015, diabetes was cited as the seventh dominant cause of mortality in the country. The CDC 2017 report also included county-level data, which was the first time it was doing so, with the data indicating that some specific regions in the country have had to bear a weightier diabetes encumbrance than others.

Diabetes refers to a severe chronic condition that can typically be managed through diet, physical activity, and the proper utilization of insulin and related medications intended to control levels of blood sugar (American Public Health Association, 2017). Individuals suffering from diabetes are at an elevated risk of severe health complications, for instance, premature death, loss of vision, cardiac diseases, kidney failure, stroke, and amputation of legs, feet, or toes.

By gender demographics, among the Alaska Native/American Indian group, men were less likely to contract diabetes, standing at 14.9 per cent, against the women’s 15.3 per cent prevalence rate (CDC, 2017). In Asian communities, women’s prevalence rate was 7.3 per cent against 9.0 per cent for men (see appendix 2). For Black, non-Hispanic, women stood at 13.2 per cent, while men stood at 12.2 per cent. The figure was 8.1 per cent for men and 6.8 per cent for women among white, non-Hispanics.

Also, diabetes prevalence in America differs across regions and socio-economic categories based on education. Among American adults who had not proceeded past high school education, approximately 12.6 per cent were suffering from diabetes (CDC, 2017). Among those possessing high school qualification, 9.5 per cent had the condition, while among those with a tertiary qualification, only 7.2 per cent had the disease. The trend demonstrates that, the higher the level of education, the lower the prevalence rate of diabetes among the population. The Appalachian and southern regions of the country possessed the highest incidences of new and diagnosed cases of diabetes. Therefore, many partners have identified the need to prevent and control the condition before it escalates and gets out of hand. For example, the CDC introduced the National Diabetes Prevention Program to reduce the impact of type 2 diabetes and prediabetes. Similarly, APHA collaborates with other stakeholders to enhance the treatment and management of the condition. APHA has partnered with Opus Science and Endocrine Society to assess the association between physicians and pharmacists and find solutions for improving diabetic patients’ care (Richard, 2012).

Capacity

 Its aim is to foster local readiness and resources to handle prevention and control needs. Here, the pertinent question is, “What does APHA possess to work with to address the issue?” APHA is an assets-based community with the capacity for research and project implementation. Its resources act as a positive reinforcement for attaining the vision of facilitating the healthiest generation it possibly can (Wahowiak, 2017). APHA possesses adequate resources for advocacy, which can simultaneously serve as generators of revenue, which in turn counter the challenge of restricted obtainment of revenue to increase the target operations. Besides, APHA has the application of various social media platforms in hand. The community can utilize the avenues presented by platforms such as Twitter, Facebook, and Instagram, among others, to create awareness about the risk factors of diabetes, ways of preventing the disease, and how to obtain treatment and therapeutic management for diabetic patients. APHA can also utilize the platforms to provide constant information and statistics regarding diabetes to ensure the public derives news continuously and are aware of the severity of the condition. In addition, communities can utilize other forms of resources to advance the program, including, people (volunteers and staff), specialized skills and knowledge (such as research expertise), concrete supplies of technology, money, and equipment, and existing efforts (policies) to address the issue.

Planning for Program Selection and Development

The process involves creating a plan of action by establishing what works to handle prevention needs and the manner of undertaking it. It involves what the planners need to do and what they ought to avoid (Butuner, 2019; Green & Kreuter, 2004). Strategic planning elevates the efficacy of prevention efforts through guaranteeing that prevention planners pick and execute the most feasible strategies and programs for their communities. Effective planning processes are characterized by the involvement of stakeholders, replacement of hunches and guesswork with data-based decisions, and the creation of all-inclusive, evidence-grounded prevention plans that address their priority diabetes prevention issues.

Consequently, APHA needs to prioritize the protective and risk factors linked to diabetes administration and containment (Leung, Lee, & O’Bryen, 2008). Here, APHA has identified diabetes as a risk area that needs urgent solutions in terms of treatment and prevention. To achieve these objectives, the community has to select appropriate practices and programs. APHA will apply a community nutrition education (CNE) approach to mitigate the issue. The program involves creating awareness among the public members and stakeholders about healthy eating and diets as a way of preventing and mitigating diabetes.

Program selection ought to be based on a solid foundation influenced by data evidence. The data could be from government registries, databases, peer-reviewed sources, individual assessment reports, and systematic reviews (SAMHSA, 2019). The rationale for selecting a nutritional approach towards preventing diabetes is driven by the report published by the National Health and Nutrition Examination Survey (NHANES), which indicated that a sedentary lifestyle, alongside consumption of unhealthy foods, were the leading causes of diabetes and obesity in America (Centers for Disease Control, 2020). Therefore, it is only logical to address one of the principal underlying causes of the condition using a viable, planned approach.

Also, APHA will combine practices and programs to guarantee a comprehensive approach. There will be a blend of on-site awareness programs and online advocacy that will run together. The blended approach will be based on a logic map that includes the inputs and expected outcomes from the selected practices and programs (see logic map in appendices). The logic model ought to be shared with the stakeholders prior to program execution. Besides, the selected practices and programs have to be appropriate for and be responsive to, the diverse cultural groups that are found in the focus population (SAMHSA, 2019). The United States has a diverse cultural fabric, implying that the selected program will be able to cater to their different backgrounds, cultural preferences, and general lifestyles. The step will be achieved through assessment, where prevention professionals will map out the cultural backdrop to mark out different population groups, including critical leaders in each of the groups.

Implementation

Implementation involves the delivery of evidence-based practices and programs as desired (Green & Kreuter, 2004). In other words, it details how the APHA can put its plan into action. APHA’s prevention planners will seek to deliver the nutrition-based program and awareness drives as intended. Successful implementation will depend on the supports provided by the prevention planners. For example, APHA will rely heavily on its past prevention successes to convince the public to accept its programs and practices. Its past successes in research and disease prevention will be a positive reinforcement.

Secondly, successful enactment will involve managerial and leadership sustenance. Deterrence practices and strategies tend to take varying forms and are executed in diverse situations (American Public Health Association, n.d.). Yet, to achieve the desired level of effectiveness, they all require robust administration and leadership from crucial stakeholders. Thirdly, it is imperative for APHA to select the best possible candidate in program delivery. The prospective prevention planners have to consider facets such as professional experiences and testimonials, pragmatic skills, talent, and ability to fit with the designated (focus) population. Fourth, APHA must ensure that any collaboration with a stakeholder or other players follows a distinct, well-laid-out action plan. The action plan has to include all tasks to be effected, clear deadlines, and people responsible. Also, the evaluation plan will be predominantly outcome-based because the prevention planners will be interested in comparing the levels of diabetes prevalence before and following the execution of selected practices and programs. The outcomes, besides the prevalence figures, will also include the number of respondents who have transformed their diets and lifestyles after participating in the practice and program.

In the preparation of practice and program implementation, it is critical to balance fidelity and adaptation (SAMHSA, 2019). Fidelity describes the extent to which practice or program is executed as desired. On its part, adaptation outlines to what extent, including which ways, practice or program is transformed to satisfy local conditions. Evidence-based practices and programs are described as such since they dependably lead to positive outcomes. As outlined by SAMHSA (2019), the greater the significance of fidelity to the initial program design, the higher the likelihood that the program will produce positive outcomes. For this reason, it is significant for APHA to tailor the program to better mirror the beliefs, attitudes, values, and experiences of the focus population. However, even while customizing the NCE program, it is critical to note that such adaptations could compromise the effectiveness of the program.

Therefore, remaining steadfast to the initial design of the evidence-based practice or program, while handling the distinct characteristics and needs of the focus population, will require a balance between adaptation and fidelity (SAMHSA, 2019). APHA will have to retain its core fundamentals, which are those constituents responsible for contributing to positive upshots, making them obligatory and essential. In other words, adapting with care is essential for APHA if the community is to achieve its objectives of preventing diabetes among the focus population. Besides, APHA will have to consider building capacity prior to altering or introducing its NCE program. Instead of altering the existent programs to fit the prevailing conditions, it is important that the community’s prevention officials consider approaches of developing resources or fostering local readiness to ensure the practices and programs are delivered as intended.

Evaluation Plan

It describes the exploration of the processes and results of practices and programs. It is the stage where APHA planners will determine whether the plan is succeeding or not (DSHS Division of Alcohol and Substance Abuse, 2020). Essentially, the assessment focuses on improving deterrence practices through the methodical gathering and valuation of information regarding prevention actions to decrease the vagueness, facilitate decision-making, and boost effectiveness. The evaluation stage will assist APHA to accomplish various things. First, it will be the stage where the community systematically records and outlines prevention activities. The step will enable future referral for prevention specialists who desire to compare the present state and the previous states. Secondly, evaluation assists the team in meeting the varied needs of stakeholders, including financiers. Each stakeholder requires pertinent information to guide their actions in implementing and monitoring developments of the prevention plan.

In addition, evaluation is important for building and fostering support and credibility for effectual prevention programming among the focus group. A positive evaluation outcome will generate greater confidence and trust among the public and stakeholders alike. Besides, and most importantly, the evaluation stage will help APHA to demonstrate the impact of the NCE program on diabetes prevention and mitigation. It will answer the pertinent query of how the community can decrease the prevalence of the condition, while simultaneously creating awareness among the public members regarding the benefits of consuming healthy diets. Finally, the evaluation step is vital in the SPF because it identifies the components of an all-inclusive prevention plan that are operating optimally and those that are below par. Identification of such elements will enable the prevention professionals to determine which areas to reinforce, which ones to alter, and which ones to eliminate altogether.

Essentially, process evaluation answers the query regarding whether AHPA accomplished what it had set out to do, whereas outcome evaluation gauges the express implications of practice or program after implementation. Therefore, a proper evaluation plan needs to consider the principles of feasibility, utility, accuracy, and propriety (SAMHSA, 2019). Selection of an appropriate evaluation plan is a meticulous process. The plan ought to be selected after clarifying its purpose, developing questions that have to be resolved, selecting the appropriate design, and selecting the suitable technique. APHA’s evaluation plan will be based on quantitative methods. This form of evaluation utilizes instruments such s checklists and surveys to generate data that is expressed typically through numbers. Such data permits planners to arrive at general conclusions regarding a population or an issue founded on solutions to queries such as “How often?” “How many” or “How much?” on the other hand, qualitative evaluation utilizes focus groups to produce data, which is typically expressed using words. Such data lets planners examine a population or issue in detail.

References

American Public Health Association. (2017). Addressing obesity and health disparities through federal nutrition and agricultural policy.

American Public Health Association. (n.d.). Conduct research to build an evidence-base of effective community health assessment practice. Retrieved from APHA: https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2014/07/07/13/06/conduct-research-to-build-an-evidence-base-of-effective-community-health-assessment-practice

Butuner, H. (2019). Systematic strategic planning: A comprehensive framework for implementation, control, and evaluation. Auerbach Publishers, Incorporated.

CDC. (2017). https://www.cdc.gov/media/releases/2017/p0718-diabetes-report.html. Centers for Disease Control.

Centers for Disease Control. (2020). National diabetes statistics report 2020: Estimates of diabetes and its burden in the United States. Centers for Disease Control.

DSHS Division of Alcohol and Substance Abuse. (2020). Quick overview of community coalitions and the strategic prevention framework. DSHS Division of Alcohol and Substance Abuse.

Green, L., & Kreuter, M. (2004). Health promotion planning: An educational and ecological approach (4th Ed.). ISBN-10: 0072556838, ISBN-13: 978-0072556834.

Leung, P., Lee, C.-S., & O’Bryen, P. J. (2008). Species and system selection for sustainable aquaculture. John Wiley & Sons.

Park, J. J. (2017). The strategic prevention framework: Effectiveness of substance abuse prevention system. Walden University.

Richard, C. (2012). Working together to fight diabetes: APhA, Endocrine Society, Opus Science collaborate to improve patient care. , 62. Pharmacy Today, 18(4), 62.

SAMHSA. (2019). A Guide to SAMHSA’s Strategic prevention framework. SAMHSA.

Wahowiak, L. (2017). APHA Annual Meeting engages participants in ensuring health for all: Nearly 12,000 health professionals attend APHA’s 2016 Annual Meeting and Expo. APHA.

Appendices

Appendix 1

Figure 1: CDC statistics showing the number of diabetic cases in the United States in 2018

 Source:  Centers for Disease Control (2020)

Appendix 2

Figure 2: Percentage of diabetes prevalence by demographics

Source: CDC (2017)

Appendix 4: APHP’s NCE Logical Model