California Health Improvement Program
Community Health Assessment
Introduction:
A Community Health Improvement Plan is a systematic, long-term, effort to improve the health and address a community's health problems. It is one avenue of public health in order to address a certain problem. Its steps or parts, include: Organize, Prioritize, Plan, and Implement and Evaluate.
A Community Health Assessment is the foundation of community health improvement. A Community Health Assessment is what identifies potential negative health outcomes in given population. Using it you can realize the health profile of said population and the potential resources for an interventions, use it to focus on an issue that would both satisfy stakeholders and help the community.
Demographics:
As of 2014, California’s population is 38,802,500 people. 50.3% of the people are female and the white alone population represents 73.2% of the state. The next most prevalent population is the Hispanic/Latino’s which represent 38.6% of Californians. Asians, African Americans, and Other Pacific Islanders make up the rest of the population. The majority of the people are between the ages of 18 and 65, making up 63.5% of the population. Those under the age of 18 years represent the next highest demographic being 23.6% of the population. 81.2% of Californians have at least a high school diploma and 30.7% have gone on to get their bachelor’s degree. In California, the median household income between the years of 2009 and 2013 was $61,094 which is almost $8,000 more than the U.S as a whole. The percentage of Hispanic-owned firms in 2007 was 16.5%.8
The six health problems that were chosen to be assessed for our population were as follows; Chronic Obstructive Pulmonary Disease, Diabetes, Intentional Injury; Homicide, HIV & AIDS, Breast Cancer, and heart disease. The decision to assess these specific health problems was largely made off the cause-specific mortality rate. From that data heart disease was an obvious choice, being the number one cause of death in California.1 Diabetes, cancer, and lung disease are also in the top five cause of death.1 This was the primary criteria in our decision of what health problems to assess with the exception of homicide. Intentional injury, i.e., homicide was disproportionate among minorities, hispanic populations specific, and thus was chosen as our final health problem.
COPD
Chronic Obstructive Pulmonary Disease, COPD, is the name of a group of diseases that causes trouble breathing by restricting airflow. COPD is the fourth actually leading cause of death in California.2 Symptoms include chronic phlegm production, chronic cough, and wheezing. Tobacco use, i.e smoking, is the most common cause for COPD, air pollutants being the second, and asthma being one of the largest risk factors.5
In 2012 by using both U.S. Census and Health Behavioral Risk Surveillance System the prevalence of both COPD and Asthma can be estimated. California has a total population of 38,041,430 people.2,3 Pediatric asthma, asthma among persons under age 18, was estimated at 810,547 total cases.2 Adult asthma, cases among persons 18 and older, for the same year was 2,537,041 cases. Lastly, COPD was estimated at 1,331,210 total cases in 2012.2,3 Table 1
The CDC’s MMWR also reveals that in 2005 a total of 12,608 deaths occurred with COPD being the underlying cause of death. Of that 5,944 were men and 6,664 were women.6 The report also reveals that over the past 10 years the death rate both nationally and for California has remained generally unchanged.5,6 Table one illustrates the national statistics considering said trend.4,5
COPD has been proven to be associated with increased mortality. People, 65 years of age and older, living with stage 1 or 2 of COPD lose, at most, only few years of life expectancy when compared with persons having no lung disease. This loss is in addition to any years of life lost due to smoking.4 Current smokers, however, with stage 3 or 4 COPD lose, on average, about six years of life expectancy, not counting the additional 4 that can be lost from smoking.4
According to both the CDC and California’s Department of Public Health several disparities exists. First is gender. In California 3.9 percent of male adults have COPD, while 5.3 percent of adult women have COPD.4 Next is age. Generally speaking persons 65 years of age and older are about twice as likely.4 About 10 percent of person 65 and older have COPD while about 5% persons 18 to 65 have COPD. Employment is also a disparity. Those who are employed have 2.7 percent of COPD, unemployed persons with COPD is at 4.6 percent, retirees are holding at 9 percent, and of persons who are “unable to work” 15.4 percent have COPD.4,5 However it has been agreed upon by healthcare professionals, including the CDC, that COPD is generally undiagnosed and therefore these numbers could actually be larger.4,5
HIV/AIDS
Over 1.2 million people are living with HIV infection in the United States.6 HIV destroys CD4+ cells, a type of T cell that is crucial to the immune system that ward off many diseases and infections. Once the immune system is compromised, other diseases are able to infect the body. When a person with HIV progresses to having AIDS, the body becomes more susceptible to opportunistic infections. Not all cases of HIV will advance to AIDS.7
In the United States, Hispanics/ Latinos are disproportionately affected by HIV. Back in 2010, Hispanics accounted for only 16% of the population but 20% of those living with HIV were Hispanic.7 In California, there is a total of 169,734 cases of HIV/AIDS. Hispanics make up 38.4% of the population and 33.4% are infected with HIV/AIDS as of December 31, 2013.8,9 The prevalence of HIV/AIDS among the Hispanic population in California has been rising for the past number of years. In 1996, the number of Hispanics/Latinos living with HIV/AIDS was 7,890. In 2006, the number increased to 17,951 and as of December 31, 2013 the total HIV/AIDS cases among Hispanics in California was 59,484.8,9
HIV/AIDS is most prevalent in those ages 30-39 and 87.4% of cases in California were among men. The largest risk exposure of HIV/AIDS is among men who have sex with men. 66.7% of cases take part in this risk exposure. Injection drug users are also at high risk for contracting HIV.9
Studies have shown that there is a higher prevalence of HIV with low socioeconomic status.10 A high concentration of HIV/AIDS cases are in Southern California and the Bay Area.9 In 2012, the highest poverty rate in California was in Los Angeles.12 Los Angeles is also shown to have the highest number of HIV/AIDS cases and 48.3% of its population is Hispanic.13 Living in poverty can increase the risk of HIV because access to healthcare is limited, people can’t afford the medication that can lower HIV levels in the blood, and HIV testing isn’t done.11
Homicide
Homicide has long been a problem in the state of California. In 2013 there were 1,745 reported cases of homicide crimes throughout the state; a rate of 4.6 homicide crimes per 100,000 people.1 This represents the lowest rate in the past decade, yet is still higher than the national average of 4.5 homicide crimes per 100,000 people.2 California, being the most populous state in the United States, therefore this translates into one of the highest numbers of homicides in the nation. Among these, a disproportionate amount are among the Hispanic population. Historically, Hispanics have been the second largest ethnic group in the state. The proportion of Hispanic victims of homicide crimes has been higher than the total percentage of Hispanics amid the population (see graph). Over the past decade Hispanics make up about 36% of the total population of California, but account for ~43% of the homicide victims, the largest proportion of any race or ethnic group.1
Among the Hispanic population, the majority of victims have been male, men accounting for 84.2% of all Hispanic homicide victims. A ratio of about 17:3 of men and women victims respectively.. Furthermore, the majority of victims among the Hispanic population range between 18-29 years of age.1 With the majority of the burden on the younger population, years of potential life lost are a more appropriate measure of mortality. All homicide deaths among Hispanics in California have led to 31,559 years of potential life lost, using 75 years of ages as the reference. As previously stated, areas with higher populations of Hispanics also tend to have higher rates of homicide (see map3 below). These disparities demonstrate the severity of homicide as a health priority amongst Hispanics in California.
Gang violence and poverty are the major risk factors for homicide amongst Hispanics in California. Hispanic organized crime has been active in the past decade.4 Age, gender, and ethnic disparities can all be explained by gang violence. The economic impact of homicide extends further than medical bills. Evidence shows that increased rates of foreclosure often precede increases in gang violence.5 Poverty, therefore, is another upstream risk factor for homicide.
Breast Cancer
Cancer is the second leading cause of death in the United States.1 Breast cancer is the most common cancer among American women.2 A woman living in the United States has a 12.3% lifetime risk of being diagnosed with breast cancer.3
In California, cancer accounts for 24% of all deaths.4 Breast Cancer is the number one most commonly diagnosed cancer among women in California and the second leading cause of female cancer deaths.5 More than 4,000 Californians died due to breast cancer in 2010.6 For all races of women in California, there is a breast cancer incidence rate of 118.8 and a mortality rate of 21.8.7
There are many risk factors for breast cancer. Some cannot be controlled, such as having a family history of breast cancer, high breast density, high bone mineral density, high endogenous hormone levels, and early menstruation. Many risk factors are due to lifestyle such as postmenopausal hormone use, oral contraceptive use, lack of physical activity, obesity, smoking, and drinking alcohol.8
Breast cancer incidence is the highest among high income populations, particularly caucasian women. However, mortality rates are highest among African American women. A report released by the CDC in 2012 showed that black women have a 41% higher death rate from breast cancer and stated, “Black women experience inequities in breast cancer screening, follow-up, and treatment after diagnosis, leading to greater mortality.” 9
Cancer treatment is often long and expensive, and presents many financial burdens. In the United States in 2010, it was estimated that $124.6 billion would be spent on cancer, with $16.5 billion of that used for breast cancer.10 Studies have found that lifetime costs per patient of those with breast cancer range from $20,000 to $100,000.11
Heart Disease
Heart Disease is the leading cause of death in the United States. The American Heart Association reports that over 81 million adults in the United States have at least one type of cardiovascular disease.1 The mortality rate for heart disease in the United States is 193.3 deaths per 100,000 population (CDC faststats).2
In California, 58,034 deaths were due to heart disease in 2010, out of 233,143 total deaths.3 Diseases of the heart account for about 25% of all deaths in California. In 2010 there were 1,876,680 cases of heart disease, with 8,429,796 cases projected in 2030.4
Risk factors for heart disease include age, a family history of heart disease, diabetes, obesity, poor diet, physical inactivity, smoking, and excessive alcohol use.5 A number of racial minorities have higher rates of these risk factors, causing significant disparities. The American Heart Association reports that cardiovascular age-adjusted mortality rates for African Americans are 33% higher than those of the overall United States population.6 Racial minority populations often have less access to health insurance and health care, which can increase their risk of developing and dying from cardiovascular diseases.
The expense of heart disease in the United States is tremendous. In 2011, $215.6 billion was spent on heart disease alone, not including stroke or other cardiovascular diseases.7 The direct costs involved were hospital stays, emergency room visits, visits to doctors’ offices, and home care. Indirect costs included loss of productivity and mortality. The combined indirect and direct costs for all cardiovascular diseases was $320.1 billion for the United States in 2011.8
In 2012 there were approximately 2.3 million diagnosed cases of diabetes in California. This amounts to over 8% of the state population,1 not including undiagnosed cases, making it one of the most common diseases in the state.2 Prevalence is much higher amongst Hispanics than any other racial or ethnic group in the state; around 10.5% of Hispanics have been diagnosed with diabetes, nearly 2% higher than African Americans and 3% higher than American Indians and Alaskan Natives, the ethnic groups with the next highest prevalence.1 This represents one of the most prominent health disparities facing Hispanics in California. Diabetes, although not frequently listed as the underlying cause of death, has been considered to play a role in the death of 35-40% of all diabetes patients. Diabetes increases risk of CVD, heart attack, kidney disease and stroke, as well as non fatal disabilities such as blindness, amputations, and nerve damage.3 Death rates of diabetes amongst Hispanics in California have been relatively stable.4 Some reports have shown a recent decline in mortality,1 but that is likely due to a large increase in the Hispanic population within the state.5
Hispanics face several disparities that increase their likelihood of having diabetes. Of all ethnic/racial groups Hispanics had lower educational status and the highest rate of being uninsured.6 Together these decrease the probability of Hispanics seeking diagnosis or treatment for diabetes thus increasing its severity. Education is one of the most prominent risk factors for type II diabetes. Those who receive health education specific to diabetes are also less likely to develop type II diabetes.8 Differences in socioeconomic status are correlated with diabetes. Counties with lower socioeconomic status and high unemployment have increased risk for diabetes.9 As these trends increase over time, the prevalence of diabetes also increases driving up total costs. Over the next quarter century costs of diabetes are expected to double at a minimum.10 In 2010 estimates put total direct and indirect healthcare costs of diabetes in California at $24 billion.11 This accounts for 1.3% of the entire economy of California.12 Without drastic changes to the treatment options available for the public, the economic burden placed upon the people will create an economic disaster. As the problem increases, the morbidity and mortality of diabetes will also increase.
Work Plan
Introduction:
This work plan and related evaluation and budget sections will focus on the management and control of diabetes among the Hispanic population in California. Over 8% of the population in California suffers from diabetes28 and it is disproportionately high among the Hispanic population, with about 10.5% being positively diagnosed28. While diabetes is not commonly recorded as the cause of death, it leads to diseases such as cardiovascular disease, heart attack, kidney disease and stroke which are often main causes of death30.
Logic Model:
Goals and Objectives
Goal Statement;
Reduce diabetes in California among hispanics.
Outcome Objective;
By December 31, 2025 reduce diabetes prevalence to 7.5%, 10.5% being base. Among hispanics.
Impact Objective;
By December 31, 2020 Increase percent of adults who engage the recommended amount of physical activity to 67%, 47% being base.
Process Objective;
By December 31, 2018 have 9 new recreational centers built.
Process Objective;
By December 31, 2015 implement a diabetes media campaign with at least 5 different mediums.
Process Objective,
By December 31, 2018 offer 3000 free gym health classes with of goal of having a total of 90,000 attendees.
Impact Objective;
By December 31, 2020 increase the average number of fruits and vegetables an adult consumes to 8 serving per day, 5.7 being base
Process Objective;
By December 31, 2018 offer 3000 free cooking classes with of goal of having a total of 90,000 attendees
Process Objective:
By December 31, 2018 collaborate with 300 supermarkets to improve their healthy food access to customers.
Process Objective;
By December 31, 2018 have 4 sustainable media campaigns targeted to increase health diet awareness.
Interventions:
(Process objective 1.1)
Nine new recreational facilities will be built across the six chosen counties. While there are many gyms and fitness centers in Southern California, there are areas where residents would need to travel many miles to get to one. Our plan is to place the recreation centers in such areas to allow access to fitness equipment to those who may not have a gym near by. The facilities will be located in primarily Hispanic neighborhoods and will include a wide variety of activities and classes to appeal to different age groups. These facilities will include weight and cardio machines, a pool, and rooms for fitness classes. If the location sites permit, outdoor basketball courts and soccer fields will also be included. Our aim is to provide a convenient, safe location for people to engage in physical activity, and to show people that exercise can be a fun, social, and rewarding experience.
Orange, Riverside, San Diego, and Imperial counties will each receive one new facility and Los Angeles and San Bernadino counties will each receive two facilities. We will start by designing and building one recreation facility in Los Angeles County to use as a pilot test. Along with our partners, we will work with city planners to secure a location for the facility. Next we will work with an architect to design the structure. Once the land is secured, and the design approved, construction will begin. While it is being built, gym equipment and decor for the interior will be purchased.
Once these steps are completed and the recreation center is ready to be used, we will be able to assess the costs and time it took to build it and can plan for the remaining eight facilities.
(Process objective 1.2)
By December 31, 2015 we will implement a five part media campaign to raise awareness for diabetes and support our diabetes program. In order to increase engagement in physical activity we plan on raising awareness of both the problem and a solution to the public. An increase in awareness as well as capacity to solve the problem will empower the public and elicit a change in behavior.
Television advertisements are one of the five mediums we will be using. We will be advertising commercials on the four major networks: ABC, CBS, Fox, and NBC. These advertisements will include information about the importance of diabetes as well as the importance of having a balanced diet and exercise. The purpose of these advertisements is to reach a large amount of the population in a short period of time and to encourage people to enroll in our instructional classes. Television advertisements have been used before to improve health outcomes and reduce smoking.49,50 By altering the message to inform the population about diabetes as well as guiding towards a simple solution these television advertisements will support our program and meet the needs of Hispanics at risk and with diabetes.
We will also be advertising our program on Spanish radio networks to reach our target audience. We will advertise on four FM radio stations and one AM radio station: 94.3 KBUA, 97.9 KLAX, 103.1 KDLE, 107.5 KLVE, and 930 KHJ. With similar messages as those being aired on television, we will focus specifically on Hispanics rather than a broad message to all. These radio messages will also focus more on our instructional programs and encourage people to attend. With messages in Spanish we expect to reach a larger proportion of Hispanics than through any other means of our media campaign.
Billboards and fliers will be distributed throughout the surrounding area. Billboards will contain facts about diabetes as well as a link to our instructional website. Fliers will have more detailed information about diabetes, instructions on how to enroll in our classes, as well as sources of other information including our website. Fliers will be handed out at local markets, centers of commerce, and centers of entertainment that attract large numbers of Hispanics and will be provided in both English and Spanish. Few studies have been done to show the effect of billboards and fliers in health behavior change, but exposure through the various forms of media as well as increased access to programs to prevent and reduce the effects of diabetes we believe they will be effective.
Lastly a website will be created for support in varying parts of our program. Available in both English and Spanish, it will provide necessary information about diabetes, simple ways of how to reduce risks, and how to get involved in our instructional classes. The website will be maintained throughout the course of our program. Website such as heart.org, breastcancer.org, and alz.org have been effective at relaying information about their respective diseases. Many information based websites exist for diabetes, but the main difference with ours is that it will be tailored to Hispanics in Southern California and have information regarding our program developed specifically for them.
Through these forms of advertising we hope to inform the population about the disease as well as encourage them to enroll in our program. With messages in Spanish we expect to reach a larger proportion of Hispanics than through any other means of our media campaign.
(Process objective 1.3)
By December 31, 2018 we will offer 3000 free gym health classes with the goal of having a total of 90,000 attendees. We will have accommodations for 30 people per class. To encourage more people to come, we will offer a variety of classes including Zumba, yoga, strength training classes, and hip hop classes. All of these classes will be free for anyone who brings in a flyer they were given about the class. To reach our goal of 3000 classes with 90,000 people attending we will offer these classes twice a week in 20 different counties across Southern California for three years.
On the Center for Disease Control and Prevention they discuss how to best prevent diabetes. The first thing they say is this, “The Diabetes Prevention Program (DPP), a major federally funded study of 3,234 people at high risk for diabetes, showed that people can delay and possibly prevent the disease by losing a small amount of weight (5 to 7 percent of total body weight) through 30 minutes of physical activity 5 days a week” 47. Offering these gym classes twice a week can get people comfortable with physical exercise and can give them options as well as different workout ideas to do on their own. They will also be able to experience exercise in a fun and inviting way.
Studies have been done to prove that exercise can greatly help reduce, delay or prevent diabetes. One study was done where non-diabetic patients with a risk of disease were either given Metformin (a medication to treat type 2 diabetes) or lifestyle changes which included at least 150 minutes of physical activity per week. The study’s conclusions went as followed, “Lifestyle changes and treatment with metformin both reduced the incidence of diabetes in persons at high risk. The lifestyle intervention was more effective than metformin” 48.
California’s population is 38.5% Hispanic8 and diabetes is disproportionately high among Hispanics 28. Offering these free gym classes in Southern California where this percentage of those greatly affected by diabetes is a logical reason to implement this intervention.
(Process objective 2.1)
By December 31, 2018 offer 3000 free cooking classes with of goal of having a total of 90,000 attendees. As part of our goal to reduce diabetes prevalence, we want to help people make better food choices. Many people may go out to eat on a regular basis, instead of cooking in their homes. Studies show that those who regularly prepare their own meals consume less fat. A study from the Journal of the American Dietetic Association reported, “Young adults who reported frequent food preparation reported less frequent fast-food use and were more likely to meet dietary objectives for fat (P < 0.001), calcium (P < 0.001), fruit (P < 0.001), vegetable (P < 0.001), and whole-grain (P = 0.003) consumption.” 51 By providing cooking classes to the public, we aim to demonstrate the cooking can be simple and delicious.
There have been successful interventions that have shown that cooking classes can lead to healthier diets. A 2007 study from Public Health Nutrition on the impact of a community-based food skills intervention states, “This exploratory trial shows that a food skills intervention is likely to have a small but positive effect on food choice and confidence in food preparation.” 52
First we will meet with nutritionists to come up with curriculum for the courses. The meals prepared will be Mexican and American dishes, focusing on using fresh fruits and vegetables, simple techniques, and affordable ingredients. In each county, cooking classes will be held for one hour, once a week for four weeks. The course will then repeat the same four lessons the following weeks. Classes will be free and everyone is welcome. We will find instructors in each county and locations such as schools or churches to hold the events.
(Process objective 2.2)
By December 31, 2018 we, the project team, will collaborate with 300 supermarkets to improve their healthy food to increase access to customers. Access to healthy foods is a problem among minorities. The project team, will go to local grocery stores and supermarkets to fix this issue. The project team will go to various supermarkets among the five counties in our target geographic area. The geographical area includes Los Angeles, Orange, San Bernardino, Riverside, San Diego, and Imperial counties. Our plan is two fold. First is to help groceries to find affordable producers so that they can more easily stock healthy food items, or if the already have it stocked, increase their profit margin; thus incentivising them to sell more. The other avenue is where the food is located. Convincing stores to give better positioning should increase the amount of fruits and vegetables purchased. This will be done over the course of three years.
Several agencies, including both the Center for Disease Control and the American Nutrition Association, have done extensive research into food deserts. Food deserts are areas that do not have access to health foods, including fruits, vegetables, and whole grains. 53,54 Studies have shown that food deserts are a factor in both obesity and thus diabetes. 53,54 Studies have also shown that decreasing these deserts by increasing access of healthy foods is effective at increase healthy food intake. 53,54
This is our plan, by the sheer factor of increase accessibility of health foods to our communities, our target population will increase their healthy food intakes.
(Process objective 2.3)
Much like our media campaign to increase awareness about diabetes and our instructional physical education classes, we will have a second campaign later on to discuss our cooking classes. The purpose of this media campaign will be to address the issues of diabetes in relation to diet. Much like our first campaign we will use various forms of media (except fliers) to contact our target population. Television commercials, radio advertisements, instructional billboards, and our instructional website will all provide the necessary information to enroll in our cooking classes to be offered at that time. The process and implementation will follow the same pattern as our first media campaign to increase physical activity.
Implementation:
Management:
The program directors will be us, the staff of the Latino Diabetes Association, and we will be directly in charge of overseeing the program and working with partners. We will report to the County Health Departments of each of the six counties. The executive director of the program will be Brett Griswold, Associate Director of the Los Angeles Chapter of the American Diabetes Association.
Timeline:
P. O. | Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | Oct | Nov | Dec | => |
1.1 | X | X | X | X | X | X | X | X | X | X | X | X | X |
1.2 | X | X | X | X | X | X | X | X | X | X | X | X | |
1.3 | X | X | X | X | X | X | X | X | X | X | X | X | X |
2.1 | X | X | X | X | X | X | X | X | X | X | X | X | X |
2.2 | X | X | X | X | X | X | X | X | X | X | X | X | X |
2.3 | X | X | X | X | X | X | X | X | X | X | X | X | X |
All of our activities/objectives, save the blitz physical activity media campaign, are planned to go beyond a year. Most are planned for at least 3 years time frame. This three year period is the bulk of our intervention.
Partnerships:
We will also partner with the American Diabetes Association, American Heart Association, and the American Cancer Society. Staff and recruiting power from these organizations will be one of the greatest assets their partnerships will offer.
In order to accommodate the increased number of classes we will partner with 24 Hour Fitness and local community centers to hold the fitness and cooking classes respectively.
Marketing:
The areas we are focusing all our interventions are in 6 counties across Southern California: Orange County, Los Angeles County, San Bernardino County, San Diego County, Imperial County and Riverside County. We will ask for volunteers to pass out fliers spread the word about the free cooking classes and gym classes offered in neighboring areas. Billboards will be placed throughout the counties next to busy roads so they are in prime areas to be seen. We also plan on creating both T.V. and radio commercials that will be played on popular stations so they can reach out to the maximum number of people as possible. By placing our interventions in common areas where many people can see them and are impacted my them, we can ensure we are reaching a large portion of our target audience.
Evaluation Plan
Formative Evaluation:
Introduction:
Our goal of reducing diabetes among Hispanics in California is greatly impacted by formative evaluations. It is important to ensure the quality our all our programs is good and the participation is high. Without the participation of our targeted audience, our programs would be ineffective and have no impact. Within formative evaluations, program design and delivery are improved. Formative evaluations begin with interventions and will usually continue on to the implementation phase, ending when the intervention is concluded. This allows for quality improvements to be made before the program terminates. Throughout the intervention, updates received through formative evaluations will be shared with stakeholders through periodical emails and annual meetings with representatives from the American Heart Association, American Diabetes Association, and chosen fitness centers.
Process Objective 1.1:
By December 31, 2018 have 9 new recreational centers built across the six chosen counties.
Evaluation: Between January 31, 2017 and March 31, 2017, we will have our team evaluate the condition and success of the recreational centers built. They will report on the quality of the equipment, the status of how busy the rec centers are as well the friendliness of the crew working at the centers. They will also interview multiple people, asking about their experience going to the recreational center and whether they feel like their health has improved because of it.
Process Objective 1.2:
By December 31, 2015 implement a diabetes media campaign with at least 5 different mediums.
Evaluation: On December 1, 2015 we will have an expert panel preview the advertisements before they are published. Experts in advertising, media, and personal fitness will be invited to screen all five mediums prior to their implementation a month later. Criticism will be used to improve quality.
Process Objective 1.3:
By January 4th, 2016 our team will begin to offer free gym health classes, with of goal of having a total of 90,000 attendees, in order to help increase accessibility, and knowledge, to services that help increase physical activity among our target population.
Evaluation:
By April 1st, 2016 our team will begin to evaluate this activity. The team will begin to conduct informal intercept interviews with participants to access; their personal satisfaction with class, their response to it, and if, in their opinion, it is helping them be more physically active. The project team will also do an internal audit to see exactly how many classes were actually offered, how many attendants, and exactly whether the funds associated with this activity was spent the way it was meant to.
Process Objective 2.1:
By December 31, 2018 offer 3,000 free cooking classes with a total of 90,000 attendees.
Evaluation: Between January 1 and March 20, 2017, five focus groups will be conducted in each of the counties to assess the success of the cooking classes so far and how they can be improved. Interviews will also be conducted during the same time period to determine how the classes are going from the perspective of the instructors. Changes will then be made according to the feedback received in order to make the cooking classes more accessible, helpful and enjoyable.
Process Objective 2.2:
By December 31, 2018 collaborate with 300 supermarkets to improve their healthy food access to customers.
Evaluation: On June 1, 2016 we will collect sale data from the 300 supermarkets we partnered with to determine whether or not sale of healthy foods increased, decreased, or remained the same during the program. By analyzing the outcome, people buying more healthy food, we will confirm whether improved access to healthy foods does increase consumer consumption of these products. In order to evaluate if the change was due to our intervention or confounding factors, we will use a control group of 50 supermarkets and measure their change in sales of the same food items over the same period of time.
Process Objective 2.3:
By December 31, 2018 have 4 sustainable media campaigns targeted to increase health diet awareness.
Evaluation: On December 1, 2018 we will have an expert panel preview the advertisements before they are published. Experts in advertising, media, and cooking will be invited to screen all four mediums prior to their implementation a month later. Criticism will be used to improve quality.
Summative Evaluation:
Introduction:
Summative Evaluations are critical to the success of any program. They are used to tell where you programs has potential weakness, or strengths, whether or not a program is “cost effective”, and how effective the intervention was overall in achieving their goals and objectives. They are typically done throughout a program to insure the program's success. Stakeholders will regularly meet to address weaknesses and to make appropriate changes to the interventions. During these meetings descriptive statistics will be disseminated to all attendees so that all stakeholders will know exactly where the programs are at. At this time any stakeholder will be able to give out recommendations for improvement based off the collected data.
Outcome Objective:
By December 31, 2025 the intervention will reduce diabetes prevalence to 7.5%, 10.5% being base. Among hispanics.
Evaluation:
The outcome objective for the intervention will be evaluated at the beginning of every year. The stakeholders will review relevant vital statistics in relation to the objective. This will most be taking from disease surveillance systems for example the CDC Morbidity and Mortality report.
Impact Objective 1:
By December 31, 2020 Increase percent of adults who engage the recommended amount of physical activity to 67%, 47% being base.
Evaluation: At the beginning of each year from 2017 to 2021, online surveys will be conducted in California counties that we have chosen to focus on. People will be able to answer how much physical activity they perform.
Impact Objective 2:
By December 31, 2020 increase the average number of fruits and vegetables an adult consumes to 8 servings per day. (base 5.7)
From January to March 2021, 1,000 phone surveys will be conducted across the six counties to assess fruit and vegetable consumption. Participants will be randomly selected and asked to share about how many servings of fruits and vegetables they eat in a day. This information will allow us to see if our impact objective has been met.
Budget
I. Personnel Costs
- Salaries and Wages $316,000.00
- Fringe Benefits $98,160.00
- Consultants/Contracts $310,000.00
- First year consultants $20,000.00
Subtotal $744,160.00
II. Non-Personnel Costs
- Program Material $1,020,000.00
- Office/work Space $7,200.00
- Office Supplies $4000.00
- Mail/Postage $1,800.00
- Out-of-State Travel $0
- In-state Travel $175,000.00
- Telephone $6,400.00
Subtotal $1,214,400.00
Total $1,958,560.00
Justification
Personnel costs include salaries for the four project managers. Each one of the project managers will be over a specific aspect of the program, including the media campaign, building recreation centers, supermarket outreach, and both types of classes: fitness and cooking. Each project manager will receive $42,000 a year for compensation, plus benefits. Two supermarket liaisons will also be hired to help with the workload of collaborating with supermarkets across Southern California. These liaisons will be full-time salaried employees given $32,000 a year, plus benefits. Lastly, the program will pay two dietitians to teach the cooking classes who will be paid an hourly rate at $40 dollars an hour but will not exceed an average of 15 hours of work per week. Their travel will also be compensated for. The dietitians will not receive benefits due to their part-time status. Total benefits will cost 36% for the salaried employees and 10% for the hourly employees to pay for taxes and training.
Consultant and contract costs will include the contracting fees for building the recreation centers, contracting personal trainers, and the social media firm. We estimate that contracting fees for building the recreation centers will be about 25% of the total cost of building, or $250,000 per recreation center. As we will be paying half the total building costs, we will pay $125,000 per recreation center, or $250,000 each year for constructing two recreation centers per year. Contracting personal trainers will be done with existing fitness centers. We will pay for their time, but will not hire them as employees. We estimate paying each trainer $50 per hour, and each week there will be 24 hours of classes. This totals to $60,000 each year. For the media campaign we will contract a Media Specialist to create the advertisements. We estimate this to cost about $10,000. We will have two media campaigns, totaling $20,000. As these events occur once and not yearly, these will be one time fees we pay at the beginning of the project.
Non-personnel costs include program materials, office space, office supplies, mail and postage, in-state travel, and telephones. Program materials will include the construction costs of building each recreation center. We estimate each center to cost $1,000,000. As we will be paying half the total costs, we will pay $500,000 per recreation center. Each year we will construct two recreation centers, leaving our total construction costs at $1,000,000 per year. We further estimate needing no more than $20,000 for computers, printers, fax machines and any unexpected material costs. We will require office space for six employees (four managers and two supermarket liaisons) totaling $7,200 each year. We estimate office supplies at $4,000 per year. This will provide basic office supplies such as pens and paper. Most of the work will be done electronically, keeping this cost relatively low. Mailing costs are estimated at $300 dollars per person per year. With 6 full-time employees (four managers and two liaisons) this gives us an estimated $1,800 per year.
Telephone costs for eight employees (four managers, two dieticians, and two supermarket liaisons) we estimate to be $6,400. For in-state travel we estimate that the entire program team will not exceed 1,000 miles per day. If so, that is all that will be compensated for. We will pay $0.50 per mile giving a cost of $500 per day. Taking away from holidays and other breaks, we estimate $175,000 per year for in-state travel. This will include some compensation for food and necessary lodging. Since this intervention will focus entirely on Southern California and we have no partners outside of the project area, we do not expect to require any out-of-state travel costs.
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