Comprehensive Examination: Concentration Question for Health Behavior & Community Health Version

Question 1 (65% of grade): Please Answer Every Question!!!! This essay is very important for my last exam before graduating. Please do your best!

Diabetes was the seventh leading cause of death in 2013 in the United States.  Almost one in 10 Americans (9.3%) or 29 million are estimated to have diabetes with an additional 86 million at the pre-diabetes stage.  The prevalence of diabetes has almost quadrupled since 1980 and is expected to rise to approximately one in three by the year 2050.  Consequences of diabetes can be serious:  Heart disease, stroke, kidney damage, blindness, limb amputations and gum disease.  Disparities in rates occur by race/ethnicity and geographic region of the country.  Furthermore, only about half of those with diabetes have ever attended a diabetes self-management class, short of the HP2020 target of 62.5% (CDC, 2015).

In the state of Mississippi, mortality from diabetes is considerably higher than nationally (32.8 vs. 23.9 per 100,000 persons) and the rate for African-Americans is almost three times that for Whites (60.4 vs. 22.3 per 100,000 persons).  This has prompted the state department of health to create an action plan for the state (Mississippi State Department of Health, 2016).  Its largest city, Jackson, with almost four out of five residents as African-American (US Census Bureau, 2016) has decided to follow the health department’s lead and attempt to address the high prevalence and mortality of diabetes among its residents.  Local public health officials, health providers and other community leaders in the city of Jackson, MS have formed a planning group and approached the local community health center (Jackson-Hinds Comprehensive Health Care) to try to address this health issue.

 (Please note that parts of this scenario are fictitious.)

Using what you have learned in this program and given the above scenario, do the following:

1.   Research and present a community health assessment for the city of Jackson (you can use its county – Hinds – as comparison). This assessment should include:
   1.   Brief introduction describing the city geographically and built environment-wise [1 paragraph]
   2. Demographic profile: Select at least 6 demographic variables and present the data for Jackson and Hinds county in at least 1 table and provide written description of data patterns.  [1-3 paragraphs]
   3. Health (epidemiologic) profile: This should include: i) description of health problem, risk factors for the problem and its potential health consequences; ii) national data for:  prevalence/incidence, trends over time and any health disparities. [2-4 paragraphs]
   4. Local health comparisons: Select at least 4 health variables to compare Jackson with Hinds County or Hinds County with Mississippi – depending on data availability.  Present data in at least 1 table and provide a written description of data patterns.  Examples of health variables might be:  prevalence of risk factors (e.g., unhealthy diet, physical inactivity, stress), prevalence of health conditions (e.g., obesity, stroke, kidney damage, amputations, gum disease, CVD), consequences of health problem (e.g., ED use or hospitalization or mortality for diabetes) [1-3 paragraphs]
2. Describe who your stakeholders might be and what contribution you might expect each stakeholder group to make. [1-2 paragraphs]
3.  Develop and describe in detail an intervention that you would propose to address this public health issue. [3-8 pages] This program description must include:
   1. Describe the key elements of the health program that you are proposing to address your health problem. Be sure to identify the type of program that you are proposing (e.g., health education, behavior change intervention, etc.).  Discuss whether this is an evidence-based program and why you selected it.  Be sure to include length of the intervention and frequency and the role of key personnel.
   2. Describe who your target population for your intervention will be, how you would recruit them, and about how many individuals you might expect to participate.
   3. Use a behavior change model to guide your intervention or a portion of your intervention.
      1. Describe the main constructs of the model, short literature review describing how this model has been used to address this or a similar problem in the past, pros/cons of using this model, and explain why you think that this model is appropriate for this intervention.
      2. Describe how you will incorporate the model into your intervention.
   4. Develop 1 goal, 2 process and 2 outcome objectives for your intervention. All objectives must be SMART.  Outcome objectives may focus on short-term, medium-term or long-term outcomes but each objective should focus on a different outcome.
   5. Describe your social marketing strategy (e.g., 4 P’s) to assure that the target population knows about your intervention and is likely to be utilized.

4. Develop and describe an evaluation of the program that you have proposed. [2-5 pages]

1. 1. Describe your process evaluation:
      1. How will you address your 2 process objectives?
      2. How will you collect data to address your process objectives?
      3. Describe how you will assure the fidelity of the intervention.
   2. Describe your outcome evaluation
      1. What design are you proposing and why did you select it?
      2. Who would you include as a subject in the evaluation?
      3. If you will be using a comparison group, where would they come from and how would they be recruited?
      4. How will you collect data to address your outcome objectives?
      5. Describe the measures that you will use to measure your outcomes.
      6. Describe how you would examine if there is a dose (degree of intervention exposure) – response (change in outcome variable) relationship between your intervention and the effect on program participants? Be sure to specify how you would measure both the dose and the response.
   3. Explain how the results from this outcome evaluation will help you and your stakeholders advocate for your health program.

Please note that: 

• Paragraph and page guidelines have been provided to give you an idea of length. But if you are a little under or over that is okay as long as you have addressed all the aspects of what has been requested.
• All tables must be free-standing (not embedded in text and self-explanatory). Tables must follow proper form for table formatting.  They should be sequenced as follows in your document:  text, references, tables.  You may submit your tables as a separate file if you prefer.