The program aims to bring lifestyle change to the African American whose eating habit has subjected them to be prone to lifestyle diseases like Obesity, hypertension, cancer and other diseases related to eating an unhealthy diet. The vision of the program would be “to inspire a healthy eating lifestyle amongst the African American Community in America” and the mission would be “to enable African American Community to treasure healthy diet” The program will run with the slogan “Eat healthy live longer”. The program will be designed to guarantee a healthy community in the African American culture.
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According to Stephens (2005), lifestyle diseases like excess weight and obesity are substantial public health and clinical issue that occur majorly as a result of unhealthy eating and lack of physical exercise, but majorly on eating an unbalanced diet. Lemelle et al (2011), further states that deviations in fruit and vegetable intake amongst the African Americans, are associated to the environmental resources whereby access to grocery stores and vegetable market is limited and also the personal zeal to stick to healthy lifestyle faded making the community vulnerable.
The changes in the health behaviour of the African American society in Philadelphia play a major role in the increase of the lifestyle diseases like obesity and overweight condition as there lifestyle has subjected them to choose junk and processed meals which is equally risky(Dixon & Wilson, 1994). The earlier interventions for the change of the poor eating habits and prevention of lifestyle diseases as a result of it included a random trial of weight loss programs as well as interventions designed to improve dietary behaviour through an improved knowledge based on a recommendation for eating a balanced diet on every meal. Churches dominated by African American have also used motivation speakers to pass the information on good eating and recommendable diet.
Though started conducted by CDC shows the reduction in the death rate amongst African American by 25% for those aged seventeen years and above, the CDC discovered a trend of increase in chronic conditions like cancer and obesity which is associated to lifestyle change (Center for Disease Control., & Center for Chronic Disease Prevention and Health Promotion, 1994). The study also indicates that African American who are aged between 18-49 are twice more likely to perish from a cardiovascular disease as compared to the whites and also there is a 50% likelihood of African American aged between 35-64 to have the condition of high blood pressure in comparison to the whites (Vital, 2017). Gourdine (2011), observed that American heart association affirmed the evidence with the fact they provided stating that African Americans have a higher cardiovascular health issue as compared to other races they link to the unhealthy behaviours, cultural inclinations and attitudes and also lack of determination in changing their lifestyle.
The participants of the program will be of age between 18-75 African American race and they have to reside in the metropolitan area of Philadelphia. The recruitment process will be conducted through self-referrals from print media such as newspaper advert as well flyers that will be distributed in the community settings (Virgil, K. M., & IUPUI, 2013). The actual residence would be determined through zip code. The program will disqualify any candidate with the history of lifestyle diseases like cancer and cardiovascular. In addition to this, the participants with an eating disorder as well as those who participate in a weight loss program will be disqualified from the program.
The program will be community-based with a vital responsibility of tackling unhealthy eating behaviour by creating interventions that address the priorities of the African American community as well as resources together with the stakeholders. The program will use a consistent approach by taking the initial step of conducting a multilevel needs evaluation for the African American community in the residents that are located in Philadelphia, to find out about their views and concerns on the diseases associated to poor eating habit among the diseases like cardiovascular disease, obesity, cancer , hypertension and diabetes (Belgrave, 1998). In addition to this, we will go further and inquire about their knowledge on balanced diet and how they are supposed to balance the meals in regards to the quantity and also the prevention bit of it through altering their eating lifestyle. Secondly, the program would use an integrated approach to provide education based on the risks associated with chronic diseases would be vital in addressing the priorities which might have emerged at the launch of the pilot phase of the program.
In accordance to Kerr, Weitkunat & Moretti (2005) guideline, To motivate the residence and encourage them to take place in the program, the program will introduce motivational interview which will be educative in nature and strategic in ensuring the African American community in Philadelphia to get anxious and motivated in participating in the program.
The integrated approach that the program will use will be based on the ecological model of health that would put emphasis in multiple types of factors that work at both communities on an individual level (Corcoran, 2007). The program will look at the conceptualized integration in regards to the disease concentrations to enable us to prioritize the concerns that would emerge from the target population in the needs evaluation stage (Hughes et al, 2017). Furthermore, the health care providers will be ready to deliver counselling and advice to the affected members in the target population as a ensure of intervention to curbing the health behaviour changes the interventions that are unified in regards to the concentration of the lifestyle disease due to unhealthy eating habits.
According to Gourdine (2011), an integrated approach will play a key role in ensuring the success of the program as it would be effective in increasing dietary behavior in relation to disease-specific approach, this is due to the fact that the education that is assimilated in regards to diseases concentration may tackle the challenges pertaining literacy and also provide help to the individuals in connecting the risk factors for the lifestyle diseases like cancer and cardiovascular diseases (Burbank & Riebe, 2002).
Program challenges
Shortage of financial and material resource
Grembowski (2001), states that every program should anticipate financial constraints, like any other program we anticipate financial challenges mostly when it comes to acquiring resources for the program. The program will start with a fixed budget which is dangerous considering the economy has not fully recovered from the recession prices keeps on changing making it difficult to accurately budget and hence increase the chances of having a deficit in the budget.
To combat this challenge I will over budget and also set some money aside to deal with the deficit that might occur in the course of the running of the program.
Appropriate communication methods.
The target population ranges from 18 to 75 years of age. This poses a challenge as the target population is of different age group and therefore different messages will have to be designed in a way that is related to different age groups. In the process, the information may be distorted or interpreted in a different giving another meaning other than the desired one
Secondly, due to the stride made with the Technology multiple means through which information can be disseminated to a population. The availability of multiple communication channels may deter us from getting the single most appropriate communication method. To counter this, I will conduct an initial survey to understand the dynamics of the target population to get assess how the population receive information after which we can determine the most appropriate communication method to use (Corcoran, 2007).
Technological failures
This challenge is anticipated in the electronic and technological devices. Besides the devices malfunctioning during the process, some workers might not be well familiar with applications that will be deployed and due to minimal time, we might not be able to conduct sufficient training. According to Corcoran (2007), Some of the devices that will be used in the program would need software or firmware upgrade at some point which might be a challenge to the staff who are not technically oriented. The program would also involve different age group and the older generation of both the participant might find it hard to cope with the current technology.
To curb this we will ensure we have a backup of the manual process just in case technology brings an issue, we will also pair the staff and the participant on the age bracket and ensure they gain confidence in using the new devices and also in cases of upgrades needed in technological devices
Keeping the community motivated
The program success majorly relies on how cooperative the African American community in Philadelphia will be. The program will touch on their lifestyle in regards to eating habits, it’s not easy to accept an override of an individual eating habit and this may demoralize the participant making it hard to register them to the program. This might affect the recruitment process because if the community doesn’t feel motivated enough they will not want anything that deals with the program and therefore the program would be bound to fail.
Cultural and social challenges
The African American Social economic status cannot sustain a healthy lifestyle at the same time most of them do not receive social support, this is a challenge to the program as most of them will strain due to their socioeconomic status to keep up with the program and they are likely to slide back to their usual lifestyle. Some of the target population have a belief about a certain type of food due to the cultural issues, this plays a big role in encouraging the unhealthy diet which therefore makes them prone to lifestyle diseases.
Resources and sustainability
The program will focus on balance diet, for illustration purposes, it is expected that some of the resources that will be used in demonstration might be perishable therefore even with storage equipment that is available, it is not expected to last for long.
Human resource is another challenge, the program will need professional health care providers, in this case, the nutrition experts who will be key to identifying critical aspects of the participants as well as tracing their progress. Getting enough professional is a big challenge and the few that we will start with will definitely be overstretched.
This challenge will be countered by a partnership with other organization whose visions relate to ours and by this we will pull all the resources that the partnership has to curb the challenge.
Barriers to participation
This is the logistical challenge like long travel by which some of the staff members will have to make, and also the movement around the target area which is likely to make them fatigue and affect their judgment. To counter this, there will be policies that would ensure the rotation of the staff to give them enough rest to enhance their output.
Environmental challenges
This is challenges are usually unforeseen and are referred to as the acts of gods, it includes natural disasters like floods, hurricane, storm, lightening among others (Dziegielewski, 2013), One can never be ready enough for natural disaster, but just to be cautious about it we will be keeping tracks of the weather forecast and make the right decision before going to conduct the study.
Theoretical rationale
Health belief model
This program is relative to the health belief model. Health belief model was used by a scientist in predicting the behaviours regarding health. The model was initially developed in the 1950 and later on updated in the 1980s (Trepton-Adams, 1979). The theory behind the model is on the basis that an individual willingness to alter their behaviour in regards to health is primarily as a result of the following factors:
Perceived susceptibility
This factor is based on the fact that individuals only change their health behaviour when they believe they are at risks, for instance, an individual who thinks they are not at a risk of HIV during unprotected intercourse are the ones who are less likely to use protection (Trepton-Adams, 1979). This factor relates to the program in the sense that, as much as the African American community in Philadelphia feel that they are not at a risk of lifestyle diseases due to their eating habits will continue eating an unhealthy diet till the point where they will realize they are risking their lives.
Perceived Severity
This factor is based on the school of thought that an individual would change their behaviour based on the seriousness or the degree of the consequences of the individual behaviour. For example, when we consider young lovers, there is a higher probability that when they have the flu they will avoid kissing on the mouth, because of the consequences of spreading the flu, or for the case of Ebola where the couples would totally avoid each other because of the dire consequences of contracting the killer disease (Corcoran, 2007).
The link between this factor and the program is that. The majority of the target population in the Philadelphia are yet to figure the consequences of having an unhealthy lifestyle based on their eating habit (Trepton-Adams, 1979). Most of the African American in Philadelphia has embraced the poor diet without really considering the consequences and repercussion it has to their health. This might be due to lack of information or education in the areas of health and nutrition leading the majority of the African American society to dangerous lifestyle diseases.
Perceived benefit
According to Trepton-Adams (1979), this factor is based on the fact that it is cumbersome to make people change their behaviour unless they see themselves gaining something out of the change. For example, a smoker would only quit smoking when he is convinced that when he stops his life would improve tremendously. This would actually convince him because at the end of smoking he would eye for the improved life and he/she would be looking forward to it.
The program basically intends to use this factor and come up with workshops and roadshows as well as social media campaign to educate the African American community in Philadelphia on the cons of eating unhealthy. With this information, they would be linked to eating healthy with long life and a life free of diseases which is paramount and therefore they will embrace the program.
Perceived Barriers
One of the major reason why health behaviour change is proving to be hard is based on the fact that change is generally perceived in be hard. Health behaviour change does not entail physical change alone but also social and psychological (Trepton-Adams, 1979). One of the reasons why change is hard is because it requires resources such as time and money. This in itself is a big barrier as the majority of the African American are not well of as compared to other races, therefore, they may perceive the change as hard. Lifestyle change also does not come easy it’s like breaking a social norm which has existed for ages.
This health belief model is accurate, it acknowledges the fact that wanting to change a health behaviour of an individual depends on the individual will to change. Based on this it incorporates two elements one of them being cues which prompts towards an external push that makes one desire to change their eating habit
Transtheoretical model
This model also relates to the program. According to McDonald et al (2014), the model was developed in the 1970s by Diclemente and Prochaska. McDonald et al (2014) further indicate that the emphasis of the model is based individual’s decision making which can further be referred to as a model of deliberate change (Trepton, 1979). According to McDonald et al (2014), the Transtheoretical model functions on the assumption that individuals do not change behaviour hastily and decisively. Relatively, change in behaviour which is more of a habit occurs through a cyclical process which is usually continuous.
This model suggests that people move through six phases of change which are:
Precontemplation: according to (Trepton, 1979), this is the stage where there is no intention of taking action in a foreseeable future, the benefit of changing behaviour is usually underestimated and the cons are usually highlighted more than the pros.
- Contemplation: according to McDonald et al (2014), at this stage, the individual is weighing the options of changing the health behaviour. It is the point that marks realization where the individual starts realizing that their behaviour might somehow be problematic.
- Preparation: at this stage of the model, the action to be taken is known and there is a gradual move towards the action of behaviour change. In relation to the program, this is where participants make move and start eating fruits and vegetable as well as thrive to live a healthy lifestyle (Trepton, 1979).
- Action: this is a stage where the behaviour has been fully charged and there is a continuous effort towards sustaining the action. In relation to the program, this is a stage where the participant continuously eats healthy and they are keen on watching their diet as they ensure they eat a recommended balanced diet (Trepton, 1979).
- Maintenance: According to McDonald et al (2014), most of the programs stagnate at this stage, the change has been sustained and it’s at the optimum level, the individuals in this stage are determined to avoid relapse. Associating this with the program, this is a stage where the participant would have got rid of the poor eating habit in totality and they have a strong determination to continue following the program as they stay healthy and the chance of relapse is almost nil at this.
- Termination: According to Trepton (1979), this is the final stage and at this point, there is no chance the participants would go back to their previous behaviour. This stage is rarely achieved as majority stuck on the maintenance stage.
This model gives the procedure for how the program should be implemented the stages are important to follow as they are traceable and it will be easy to know the progress of the participants. The model also enhances the sustainability of the program which is core to the success of the program (McDonald et al, 2014).
Marketing
Concerning social marketing, the program will use the community sponsored program, like seminars and medical camps to appeal to the target population. This social programs will enhance interaction between the staff and community which is needed for the smooth running of the program (Burbank & Riebe, 2002). The interaction will also provide further insights into the target population to iron out any issues that might be assumed.
According to Kerr, Weitkunat, & Moretti (2005), for the program to be effective, the best marketing strategy should be employed. In this case, due to the technological era, I will put more focus on social media marketing. The program would be advertised on popular sites like Facebook, Twitter and Google, the social media advertisement would target mostly the youths and young adults (McDonald et al, 2014). Social media will enable the information to be disseminated at a faster rate as it would easily find people on WhatsApp due to the digital nature of it.
The door to door strategy which will be effective for the elderly and those that are not prone to accessing social media (Hughes et al, 2017). Roadshows will also be used where the target population is a bit dense and vast. We will also advertise the program in a popular local radio station by sponsoring a program on the radio that is popular to the target population. We will also use the local newspaper and popular magazines to inform the population about the program.
Evaluation and measurement
The basic outcome will be based on a balanced diet with the bias on fruit and vegetable intake, this is because the African American tend to avoid food rich in vitamins which is key to fighting diseases which they are prone to. There would be an evaluation of integrated risk education versus disease-specific education on changes in the percentage of the target population who achieved the threshold for each of these behaviours. The program will use health information trend survey items in the evaluation of fruit and vegetable. Participants will be precisely asked the number of cups of fruits and vegetable they take daily (don’t know 0,1=none, 3=more than four cups). The qualified participants that meet guidelines for the category of every variable would be the one that recorded at least taking 2-3 cups.
To make the program traceable we will eliminate the participants who engage in physical activity and still eat an unhealthy diet and those who have started engaging in a physical activity in a span of one month. This will be done to ensure the program focusses on eating habit and any other factor which might compromise the program has to be eliminated.
In this program, impact evaluation method would be the best as it would assess the effects that the program has had on the minority community as well as it will prove traceable information on changes in behaviour which is key to the program (Grembowski, 2001).
The program outcome would be evaluated in one month after implementation. There would be a follow up for the participant who would not have completed all the four sessions. The reason to do the evaluation in a month time is that of the interest of the program to determine if integrated risk education and disease-specific education had an impact in making an initial attempt to impact changes in chronic illness related lifestyle behaviours (Grembowski, 2001).
Resources
The following resources would be needed for the success of the program:
- Human resource: This entails the staff that is needed, the staff will perform the various function in ensuring the program runs efficiently. The program would require healthcare providers like nutritionist, nurses and specialist, physical Activity specialist among others. Majority of the staff will be required for marketing and data collection as well as for data analysis and finally for the administrative duties (Grembowski, 2001). The program will also need the subordinate staff to ensure regular cleaning of the offices and equipment and also prepare snacks for the other staff.
- Equipment: The program will require different equipment, from weighing machine, equipment for physical exercise, laptops, stationeries, data collection devices among other devices (Corcoran, 2007).
- Logistics: this category would involve the transport, there would be a vehicle needed to transport the staff and carry equipment from the office to different location (Grembowski, 2001).
- Partnership: partnership both in private and public sector. The partners would supplement the financial and human resource on activities of the program that is considered critical. The partnership would be core to ensuring the sustainability of the program because of the partners would work towards the same goal as the program and there would be an enabling environment, for instance, laws that support or protect the program can be easily enacted via a partnership with political class (Grembowski, 2001).
- Space: the program will need offices to run, the head office will be close to the target population and will host the administrative staff. The program would also require a storeroom where bulky things that are needed in the program can be kept after work hours (Grembowski, 2001).
Conclusion
In brief, the program highlights the health behaviour changes that have led to an increase in the lifestyle diseases like cancer, diabetes and obesity specifically as a result of the unhealthy eating habit of the African American. The proposal provides a program that focuses on encouraging the community to take a healthy balanced diet mostly fruits and vegetable to reduce the rate of chronic illness in African American Community in Philadelphia.
In conclusion, socio-economic status is a major drive towards getting the lifestyle diseases. Besides the healthy food being a little bit expensive than the junk, it is not easily accessible and therefore this obstacles has played a key role in ensuring the African American continue eating an unhealthy diet as healthy food, therefore, it increases their chances of getting the lifestyle diseases.
The program offers the best solution as it is interactive and also it provides enough information that everyone would associate with. The program is feasible considering most of the resources are locally available and many organization are ready to partner with the program to ensure its success. Many people are also ready to volunteer both as participant and as staff.
References
Belgrave, F. Z. (1998). Psychosocial aspects of chronic illness and disability among African Americans. Westport, Conn: Auburn House.
Burbank, P. M., & Riebe, D. (2002). Promoting exercise and behaviour change in older adults: Interventions with the transtheoretical model. New York, NY: Springer.
Center for Disease Control., & Center for Chronic Disease Prevention and Health Promotion (U.S.). (1994). Chronic disease in minority populations: African-Americans, American Indians and Alaska native, Asians and Pacific Islanders, Hispanic Americans. Atlanta, Ga.: Centers for Disease Control and Prevention.
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Dixon, B. M., & Wilson, J. (1994). Good health for African Americans: Introducing the 24-week Sankofa Program–for nutritional and lifestyle transformation. New York: Crown.
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Gourdine, M. A. (2011). Reclaiming our health: A guide to African American wellness. New Haven: Yale University Press.
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Kerr, J., Weitkunat, R., & Moretti, M. (2005). ABC of behaviour change: A guide to successful disease prevention and health promotion. Edinburgh: Elsevier Churchill Livingstone.
Lemelle, A. J., Reed, W. L., & Taylor, S. E. (2011). Handbook of African American health: Social and behavioural interventions. New York: Springer.
McDonald, J. A., Indiana University, Bloomington., & Indiana University, Bloomington, (2014). Application of Health Belief Model constructs as related to college students’ indoor and outdoor tanning. (Dissertation Abstracts International, 75-12.)
Virgil, K. M., & IUPUI ScholarWorks. (2013). Community-based exercise program attendance and exercise self-efficacy in African American women.
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Vital Signs. (2017, July 03). Retrieved from https://www.cdc.gov/vitalsigns/aahealth/index.html
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