Evidence-Based Practice Proposal Final Paper Research Proposal

Evidence-Based Project: Targeting Middle-Aged African Americans Victims of Diabetes as a Result of Poor Housing Health Risks for Care Access
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Abstract
Problem Statement: Many people across the United States are struggling with basic issues such as housing. This enhances their vulnerability to condition such as diabetes. Among the African Americans, poor housing has been attributed to increased cases of diabetes. The project aims at understanding how many people acquired the condition due to factors related to housing. The project further aims at finding how their burden can be eased through the use of evidence-based approaches.
Solution Description: there are many health disparities in many regions of the world. The minority groups, such as the African Americans are experiencing a high prevalence of diabetes. The solution proposed is advocating for positive changes within the population based on the known risk factors. The main solutions include losing weight, routine physical exercise, and the right choice of diet. There are numerous studies affirming that using these interventions will reduce cases related to diabetes. The impact of these interventions is reducing the disparities in the prevalence of diabetes.
Application of Change Model: Thee implementation will rely on Roger’s theory, which involves four stages: awareness of the product, innovation, or idea, decision to adopt or reject, initial use, and continued use. All these stages will ensure that the project is successful and all changes required are attained. The change model ensures that the process of the evidence-based project follows standardized models to achieve the intended results.
Evaluation Plan: The project intends to evaluate how the prevalence of diabetes among middle-aged African American women can be prevented, managed, and reduced. As such, the project will be focused on reducing the diabetes burden experienced by this section of the population. The evidence-based project intends to provide interventions against housing-based diabetes risks and assist the diabetic as a result of housing among the target group.
Implementation Plan: During the implementation stage of an evidence-based project, the success depends on the reliability and validity of research backing the project. Reliability and validity are essential during the evaluation of the research quality. They are used to reveal how well a method, test, or research approach measures a phenomenon. Reliability describes a measure's consistency and how well it can be applied realistically.
Evidence-Based Project: Targeting Middle-Aged African Americans Victims of Diabetes
Problem Statement
Even in a developed nation like the United States, millions of people are still struggling to access basic human needs such as housing. As of 2016, there were 135 million homes in the United States, of which 30 million have wanted health and safety hazards (Ross, Parsons, & Vallas, 2016). The hazards include inadequate heating, gas leaks, damaged plumbing, and exposure to lead paint. Such homes are disproportionately located in areas of concentrated disadvantage affecting low-income earners and minority groups. Burton (2007) found that poor housing conditions increase the risk of developing diabetes among middle-aged Black Americans. According to Berkowitz et al. (2018), unstable housing is prevalent, associated with an increased risk of diabetes-related in-patient and emergency department use.
Moreover, findings suggest that the increased prevalence of diabetes among homeless communities is associated with conditions linked with the state of being homeless (Lim et al., 2019). Such conditions include an increased burden of mental illness and dependence on psychotropic medication. People living in low-income areas have the most obstacles in accessing health care. These are the underserved communities, a condition linked to poverty and inequality. Such populations are unable to meet stipulated universal healthcare requirements. Thus, people who suffer diabetes because of exposure to poor housing conditions are more likely to have their lives destroyed in the long run, given the health and financial burden that the condition brings. This project aims to use evidence in targeting these persons and assisting them directly or indirectly in managing the condition so that they can remain active in other areas of life and fend for their families.
The table below lists some of the interested parties.
Party

Possible Role

American Diabetes Association

Data, statistics, and research material
Funding

National Institute of Diabetes and Digestive and Kidney Diseases

Insight
Data, statistics, and research

Hospitals and Clinics

Treat identified victims
Provide data on diabetes cases

Community Health Workers

Identification and tracking of victims
Evaluation of case-by-progress
First-hand reports

Diabetes Online Community (Hilliard, Sparling, Hitchcock, Oser, & Hood, 2015)

Source of information

Community-based Diabetes Collaborations

Source of information
Sensitization of this program

The question to be addressed therefore is: In African American Middle-Aged Persons with Diabetes, how many acquired the condition from housing-related issues, and in what ways can their health burden be eased with an expected outcome of reducing diabetes-related emergencies, and to what extent will the program impact diabetes issue in the United States within ten years? Expected outcomes include diabetes aware communities, conversations on home remedies to prevent diabetes, and reduced clinical visits.
The project's success will depend on the reliability of research, data, and expert opinions of different scholars. To this end, a comprehensive electronic search was conducted in several online databases, including National Center for Biotechnology Information (NCBI), People Living with And Inspired by Diabetes (PLAID), BMJ Open Diabetes Research & Care, PubMed, Cochrane Database of Systematic Reviews, and CINAHL. The search criteria included English-only peer-reviewed literary material published between 2000 and 2020. Of the 48 publications that were shortlisted, ten articles were found relevant for this program based on the following keywords (See Appendix 1 for list of sources):
The connection between diabetes & housing
Diabetes in Middle-Aged African Americans
Diabetes among underserved
Prevalence of diabetes
Housing health risks
Solution Description
Globally, there exist health disparities, diabetes complications, and co-morbidities (Spanakis & Golden, 2014). Studies indicate that minority groups based on race and ethnicity experience a higher prevalence of diabetes than non-minority communities. Several factors contribute to these findings, including clinical & biological, social, and health system factors (Golden, 2012). In the United States, black adults are twice as likely as white adults to suffer from type 2 diabetes (NIH, 2018) (Tracey, 2000).
Proposed Solution
Therefore, the project seeks to push for positive changes among this population based on known risk factors such as losing weight, routine physical exercises, and the right choice of diet. Studies suggest that making these positive changes will be vital in reducing existing health disparities for developing diabetes (NIH, 2018). Besides, it is essential to reduce diabetes-related clinical visits (Fenton et al., 2006) and prevent new diabetes (Shi, 2016) target group.
The solution will include diabetes-related civic education that will reach the target group through technological means. The education will be tailored based on the living conditions, available resources, and the overall needs of the target groups ( Philis-Tsimikas & Gallo, 2015). Further, the solution seeks to educate the target community on the importance and benefits of telehealth and telemedicine technologies in the management of diabetes (Pradeepa, Rajalakshmi, & Mohan, 2019). Through the program, the target community will be educated on the non-costly and straightforward measures through which diabetes can be prevented and managed.
Organization Culture
The choice of the target group was motivated by several factors. Studies have suggested that diabetes prevalence among middle-aged African Americans is high and that some of the causative risks are related to the environment in which these communities exist. Given their high vulnerability, they also face inequality in access to much-needed health care (Baciu, Negussie, & Geller, 2017). Therefore, it is essential to target and directly help this group ease the disease's burden through prevention and management. The target group is also ideal in passing down the education to subsequent generations in the long-term.
Expected Outcomes
Expected outcomes include a reduction in the diabetes-related clinic and hospital emergency visits and a decrease in the prevalence of diabetes among the target group in 10 years. Further, through the project, it is expected that the penetration of diabetes-related civic education within the target group will stimulate positive change on known risk factors. The program will operate on the basis that prevention is less costly than management (and treatment), and therefore, expectations include behavioral changes towards diabetes prevention.
Method to Achieve Outcomes
The project's success will depend on collaboration among multiple entities, including government institutions, private organizations, professionals, and local businesses, community-based movements, and community members. It will include the decimation of information, pooling of resources, and assistance in managing individual cases. The evaluation will be done based on objectives against outcomes.
Outcome Impact
One of the expected outcomes is to reduce the existing disparity in diabetes prevalence. With the black communities showing the highest prevalence rate, yet with difficulties in accessing care, it is expected that the program will help reduce diabetes cases among African Americans. The result is to reduce the overall burden of diabetes currently weighing on taxpayers and the government.
Application of Change Model
Previous papers have established that middle-aged African American women show a high prevalence and severe outcomes on diabetes-related issues. Based on the research papers used in the project, diabetes and its subsequent outcomes are closely related to housing conditions. The weaker the housing conditions, the higher the diabetes risks in such housing. Middle-Aged African American women are disproportionately experiencing these conditions, and therefore, a targeted intervention, as proposed by this paper, promises positive outcomes. However, this will require intentional and deliberate changes that will be best achieved through Roger's Diffusion of innovation (DOI) Theory.
Developed in 1962 by E.M Rogers, DOI tries to explain how an idea or product gains acceptance, gets momentum and spreads through a specific social system or population (Sahin, 2006). The result of such a process is to change the behavior of a population. For instance, the project intends to educate and help the target population overcome the diabetes burden. Roger's theory involves four stages: awareness of the product, innovation, or idea, decision to adopt or reject, initial use, and continued use. The implementation of the evidence-based project will rely on the stages of this theory to understand that the efficiency and reliability of the project depend on the number of people who will subscribe.
Optimum outcomes will only be realized and actualized if the project will attract all the people who could benefit from the project, including government institutions and private organizations. Further, the project is expected to face the same challenges that act as influencers to the adoption of an idea or innovation. These factors include relative advantage, compatibility, complexity, triability, and observability (Dearing, 2010). Integrating these factors into the project's implementation plan would provide a reliable basis for evaluating the project.
The first stage is awareness. Given this, the project presents a new dimension to the public health system. It will invoke channels of communication, such as the media, to reach out to the target population. People will first know that such a project exists, and then they will understand how they can get more information and learn further about the project. The awareness stage also involves principles of knowledge. These include the functioning principles that give the project a relative advantage and make it compatible with the reality in communities.
After becoming aware of the project, the target population might develop different attitudes towards the project. Given the current political climate and the prevalence of conspiracy theories, especially on social media, the project is expected to face opposition and support in equal measure. Here, the degree of uncertainty about the functionality of the project and the subsequent social enforcement will impact an individual's beliefs and opinions. The success of the project past this stage will depend on the availability of reliable, evidence-based information with minimum uncertainties that will spur observable outcomes. The project's efficiency will also rely on practical and cost-effective innovations on measures to prevent and manage diabetes housing risks.
The third stage is the first use, where community members experience the benefits of the project after the first use. The stage is critical because the initial users will act as ambassadors who will determine whether their friends, colleagues, and relatives want to be involved in the project. The factor of triability will play an essential role in this stage as it will determine if the project will be accepted. Negative feedback from initial users will stop more individuals from seeking the services of the project. On the other hand, positive feedback may cause the necessary peer-influence to attract more families with middle-aged African American women.
The last stage involves continued use. Positive feedback from the initial beneficiaries of the project will open doors for more community members. In this stage, the project will cater to individuals looking for information to support their decision to align with this project. The stage will also involve reinforcing new ideas by eliminating uncertainties and providing observable and experienced outcomes.
Evaluation Plan for Evidence-Based Project
The project intends to evaluate how the prevalence of diabetes among middle-aged African American women can be prevented, managed, and reduced. As such, the project will be focused on reducing the diabetes burden experienced by this section of the population. The evidence-based project intends to provide interventions against housing-based diabetes risks and assist the diabetic as a result of housing among the target group.
The Rationale for the Methods Used in Collecting the Outcome Data
The mixed method approach will be used to collect the data. The methodology consists of the systematic integration of both qualitative and quantitative data in an investigation. The mixed method helps in understanding the research problem by obtaining and analyzing both qualitative and quantitative research in a single study (Wisdom & Creswell, 2013). As such, qualitative data on diabetes issues on both in-patient and outpatient diabetes-related visits will be obtained from hospitals and health centers. Moreover, quantitative data will be collected through questionnaires and interviews through which beneficiaries will describe the experience of being involved in the project. Open-ended questionnaires will provide avenues for the inclusion of mental and emotional benefits of the program.
Data from hospitals and clinics will be essential in mapping trends, predictions, and projections. A reduction in the number of clinical/hospital visits by people from the target population will imply a positive outcome observed over at least three years. On the other hand, if the data suggests that the number of visits is constant, the program's implications do not significantly impact the fight against diabetes (Pantaleon, 2019). An unfavorable outcome would imply the program is not working
How the Outcomes will be Measured and Evaluated Based on the Evidence
SPSS will be used in measuring and evaluating the outcome data. The analysis of variance, also known as ANOVA in SPSS, will be used to examine the differences between the independent and dependent variables. Therefore, the project's viability will be determined by outcomes from both data and statistics and non-quantifiable data, as mentioned earlier. The ANOVA test's validity is facilitated by assuming that a common variance exists in all populations. The observations are sampled independently and randomly in each sample, and each sample is derived from a normally distributed population. Wisdom & Creswell (2013) explain that the ANOVA will assist in testing the reliability of the data by using Cronbach's alpha, an essential measure in assessing the survey design. ANOVA is applicable in the current analysis because it will help make a reliable and confident decision by supporting the Evidence by comparing the...