Hypertension and Type 2 Diabetes in Hispanic Adults, Capstone Project Example

Introduction

Throughout many population groups, patients are at a severe risk of chronic illness when they possess poor nutritional and exercise habits, both of which contribute to this risk in different ways. It is important to recognize the many disparities that exist in some populations due to differences in culture, language, education, knowledge, access to care, and other barriers that prevent them from achieving optimal health and wellbeing within their communities. It is important and necessary to develop a strategic approach that will be used to improve the understanding of different populations and their risk of chronic illnesses as attributed to poor nutrition and limited exercise. These efforts are instrumental in shaping outcomes for these individuals and their care and treatment plans. It is imperative to consider the different challenges associated with these elements and to determine how to improve the understanding of chronic illness within this population. The disparities that exist must be addressed in the development of an effective protocol to accommodate the needs of this population groups in different settings. The following discussion will address the issues related to an increased risk of hypertension and type 2 diabetes in the adult Hispanic population between the ages of 18-39. This discussion will demonstrate the impact of culture and language barriers, as well as other challenges that this population faces in their efforts to maintain positive health and wellbeing, and the issues that must be addressed to support this population and its exposure to chronic illness and limitations in obtaining adequate access to healthcare services.

Selected Target Population

The proposed population is Hispanic adults between the ages of 18-39. This population is relevant because they face critical challenges in their ability to reduce the risks associated with chronic illnesses such as hypertension and type 2 diabetes. According to statistics, “Hispanic adults are 1.7 times more likely than non-Hispanic white adults to have been diagnosed with diabetes by a physician” (The Office of Minority Health, 2013). Furthermore, according to the Centers for Disease Control, “certain Hispanic subpopulations (Mexican Americans, Puerto Rican Americans, Cuban Americans, and other Hispanic Americans) are characterized by low levels of hypertension awareness, treatment, and control. Because Hispanics are the fastest growing and youngest racial/ethnic population in the United States (6), targeted strategies to reduce morbidity and mortality rates among this population are essential” (2006). With respect to hypertension and diabetes, it is important to develop a strategy to better understand the impact of these conditions on the Hispanic population in order to demonstrate how effective planning might reduce the risks and improve health-related outcomes.

Preventative Health Strategic Planning

Developing and implementing a successful strategy in order to accommodate the health-related needs of Hispanic adults between the ages of 18-39 requires an assessment of current challenges within Hispanic communities. This includes an evaluation of specific criteria such as mental health referrals, access to basic preventative healthcare services, substance abuse concerns, childhood and adult obesity rates, and other factors that may pose an increased risk for adults aged 18-39 for type 2 diabetes and hypertension. The primary objectives of the strategic plan include an emphasis on 1) nutrition and 2) physical activity in determining the risks associated with type 2 diabetes and hypertension for a smaller community where approximately 60% of its residents are of Hispanic origin. Therefore, it is important to address this population and the risks of hypertension and type 2 diabetes using a specific intervention method that will be described in the following paragraphs.

A preventative health strategy requires an effective understanding of the specific population group in question, including their customs, habits, preferences, and attitudes towards healthcare and treatment in different settings. The primary objectives of this project are as follows: 1) To improve prevention efforts associated with diabetes and hypertension in the adult Hispanic population between the ages of 18-39; 2) To create opportunities for community outreach in order to educate individuals regarding the risks associated with these chronic conditions; and 3) To identify the barriers that exist and to conduct a risk assessment regarding the issues that this population faces with respect to diabetes and hypertension. It is expected that many adults in the chosen community are unfamiliar with their own risks associated with diabetes and hypertension and require additional insight regarding these concerns in order to prevent these conditions from taking place.

It is important to use a model for intervention that is likely to improve the ability to target the desired population and to address the problems that they face in a hands-on manner. For example, Healthypeople.gov offers a tool known as Map-It, whereby five basic steps are required to conduct an intervention for a given community: 1) mobilize; 2) access; 3) plan; 4) implement; and 5) track (2013). Each of these efforts represents an opportunity to consider the population group in question and how an organized intervention might meet their needs in an effective manner. This is accomplished through a creative approach that supports long-term success in a manner that is consistent with healthcare objectives and indicators for a given population. It is important to recognize the recommended strategies that are important in conducting this approach, known as a promising practice or intervention: “Promising practices and interventions are that those that have the potential to effectively address the issues of concern in your community. They are usually (though not always, as we’ll see) things that seem to have worked elsewhere, as judged by standards that make sense for your community and your issue” (The Community Tool Box, 2013). In this context, it is necessary to develop the appropriate intervention method from the very beginning to ensure that the resources are available and are appropriate to meet the needs of this population in an effective manner (The Community Tool Box, 2013). Therefore, it is important to recognize the different criteria for this population group that are necessary to conduct a successful intervention. At the same time, there is always a risk associated with this type of practice; therefore, this must be addressed as early as possible in order to determine how to best move forward with the appropriate strategy to target the population in the desired manner (The Community Tool Box, 2013).

Perhaps the most important component of the proposed intervention is the cultural identifiers and barriers that may exist and how these are best managed in the context of the intervention effort. It is important to address the Hispanic population in a manner that is consistent with their culture and their degree of readiness to take on a program of this nature (The Community Tool Box, 2013). This will ensure that the efforts made are not futile and will achieve the stated purpose. In this manner, it is expected that the intervention effort will explore the barriers to entry for the proposed population, including language, lack of knowledge, customs, attitudes, and preferences regarding healthcare and related outcomes. These efforts are likely to produce a more effective approach to the population and its specific needs with respect to diabetes and hypertension.

It is also important to consider the barriers that exist within this population group and how these barriers might impact planning efforts for the intervention itself. A study by Pabon-Nau et.al (2010) demonstrated that “Hispanics are a heterogeneous group and cannot be represented by one subset of this population…nationality might be a proxy for risk factors that accompany various migration experiences and the process of acculturation.” Therefore, it is important to note that this population group even more diverse within the context of its culture; therefore, additional studies must be conducted in order to reflect the dimensions of education that are required to conduct outreach for the smaller subsets of this larger population group. Furthermore, it is of critical importance to identify population-based needs that have not been met because this reflects a means of supporting the chosen Hispanic population more effectively. Many Hispanics are known to exhibit limited knowledge of type 2 diabetes and its risks, in spite of the prevalence of this condition within Hispanic communities (Cusi and Ocampo, 2011). Therefore, it is necessary to provide greater awareness of type 2 diabetes for this population group and to conduct the effort in such a way that it captures the spirit of this population and their specific attitudes and beliefs regarding type 2 diabetes (Cusi and Ocampo, 2011).

In order to effectively conduct the intervention effort, it is necessary to establish an approach that supports the implementation of community health workers into the community (Palmas et.al, 2012). In the past, these individuals have been effective in performing outreach within Hispanic populations because they represent these communities and the values that they bring (Palmas et.al, 2012). These efforts are indicative of a successful community-based outreach effort that captures not only the spirit of the Hispanic community, but also their customs and preferences regarding healthcare and treatment (Palmas et.al, 2012). These are key priorities in conducting the intervention because they represent a means of determining the types of efforts that the population might be responsive to versus those that they will not understand and implement to meet their needs (Palmas et.al, 2012). It is also important to consider the different aspects of care and treatment that are required to ensure that the chosen community recognizes the dangers of hypertension and type 2 diabetes and takes the steps that are necessary to reduce the risks associated with these chronic conditions (Palmas et.al, 2012).

From a health-based perspective, there are many risks for Hispanics associated with type 2 diabetes and hypertension. Therefore, it is necessary for adults to be provided with direct knowledge and information regarding these concerns in a manner that they will understand. As a result, language barriers must be addressed and evaluated as best as possible in order to achieve the desired outcomes. For example, the process of acculturation is essential for this target population group because they are likely to possess language barriers and other challenges that could prohibit their ability to understand the importance of the intervention and the impact of hypertension and type to diabetes on their daily lives (Barrera et.al, 2012).

It is important for intervention leaders to recognize that cultural barriers may exist and are likely to contribute to negative outcomes if these barriers are not broken and the intervention is modified according to group needs (Barrera et.al, 2012). It is expected that “Ideally, a culturally adapted intervention is equally appealing and effective for participants at all levels of acculturation” (Barrera et.al, 2012). These efforts will demonstrate that the intervention is appropriate for the population group and is also effective in addressing the original problems to begin with (Barrera et.al, 2012). These efforts must also support the creation of an intervention-based environment that will support the needs of the chosen population group at all levels, including those persons that might be most resistant to an intervention (Barrera et.al, 2012).  Therefore, these efforts must offer an approach that is appropriate for the population and their specific cultural needs and wants (Barrera et.al, 2012).

One of the key factors of the intervention-based effort must be the identification of ethnic-based disparities that exist within the chosen population group in an effort to produce effective outcomes and to determine how to best direct the intervention to minimize these disparities as best as possible. With chronic illness, these disparities are particularly relevant and must be addressed in the context of improving knowledge and prevention efforts to improve overall health and wellbeing (Tucker et.al, 2010). These efforts require these disparities to be evaluated and methods must be chosen to reduce their prevalence within the chosen Hispanic community (Tucker et.al, 2010). For chronic illnesses such as type 2 diabetes and hypertension, disparities are particularly relevant and must be addressed in a manner that enables the population to understand the serious nature of these conditions but to also recognize how they might be successful in their own prevention efforts in this manner (Tucker et.al, 2010). In this manner, self-reporting of behaviors is critical in determining if these individuals possess any patterns of risk factors associated with type 2 diabetes and hypertension, such as nutritional habits and physical activity (Tucker et.al, 2010). Upon review of these events, it is likely that intervention leaders will have the opportunity to develop the intervention to better accommodate the needs of this population group (Tucker et.al, 2010).

It is important to recognize the different alternatives that are available in order to promote an effective intervention with this population group. This is achieved through the recognition of other disparities and issues that might exist, such as the following: “Hispanics are less likely to receive preventive care than their White counterparts, and being diagnosed with diabetes or CVD often occurs later in the course of these conditions, leading to more complications…Part of this disparity may be explained by a lack of utilization of the health care system, with more than one-fourth of Latino adults not having a health care provider, and a similar proportion reporting not obtaining any health care information from medical personnel in the past year” (Diaz et.al, 2012, p. 5). Therefore, it becomes necessary to develop a strategy that will improve patient outcomes in the context of creating an environment that supports wellness and preventative visits to the doctor on a regular basis in order to address any possible risks as early as possible (Diaz et.al, 2012). These efforts will demonstrate the potential impact of the intervention on the chosen population in different ways by promoting their wellbeing with clinical assessments and evaluations of their psychosocial and health risks (Diaz et.al, 2012).

Finally, the creation of a successful intervention effort requires key personnel and community-based supporters who will provide their knowledge and expertise, in addition to funding for the proposed programmatic effort. It is imperative to consider the different options that are available in the community by identifying specific donors and collaborators who might be interested in the intervention effort. Local clinics will be targeted as possible contributors to provide education and testing for hypertension and type 2diabetes and will screen Hispanic adults in the designated age group to determine their risks. Therefore, an effort will be made within the community to target these potential collaborators and donors in an effort to achieve the desired objectives with the intervention-based effort in the desired format and with the appropriate approach to education and recognition of these chronic illnesses and their impact on the population in question.

Conclusion and Recommendations

The development of a successful program to target Hispanics between the ages of 18-39 who are at high risk for type 2 diabetes and hypertension is both challenging and rewarding in different ways. It is important to recognize the value of this intervention effort and its potential impact on the chosen community. However, there are a number of factors that must be considered that will demonstrate the effectiveness of the intervention for this group. It is imperative to develop a program that recognizes cultural identity and its importance to this population. Therefore, intervention leaders must conduct their research regarding adult Hispanics, including their customs, habits, attitudes regarding health, and preferences. This information will shed some light regarding the type of intervention effort that is required and the type of approach that should be considered in order to provide this group with an ideal framework for improving their health and wellbeing.

The proposed intervention must target Hispanic adults in a smaller community that are between the ages of 18-39 to determine their risk factors associated with type 2 diabetes and hypertension. It is important to provide this population with the tools and resources that are necessary to achieve the intervention-based objectives and to support the development of effective outcomes for this group. Screening tools and education that is specifically targeted for the Hispanic culture will ensure that this group will obtain specific knowledge and information that will enable them to make improved choices regarding their nutritional and exercise habits in order to reduce their risk of type 2 diabetes and hypertension.

Improved nutrition and physical activity must serve as a primary focus because it reflects a means of expanding the health and wellbeing of this population accordingly. It is believed that an effective intervention program that is targeted for this group will demonstrate a commitment to optimal health and wellbeing for Hispanic adults and also serve as a key facilitator in the development and implementation of similar programs for other population groups across different cultures, as the needs are very similar and require the same level of attention in other adult population groups.

References

Barrera, M., Toobert, D., Strycker, L., and Osuna, D. (2012). Brief report: effects of acculturation on a culturally adapted diabetes intervention for Latinas. Health Psychology, 31(1), 51-54.

Centers for Disease Control (2006). Hypertension-related mortality among Hispanic

subpopulations – United States, 1995-2002. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5507a3.htm

The Community Tool Box (2013). Criteria for choosing promising practices and community interventions. Retrieved from http://ctb.ku.edu/en/tablecontents/sub_section_main_1152.aspx

Cusi, K., and Ocampo, G.L. (2011). Unmet needs in Hispanic/Latino patients with Type 2 Diabetes Mellitus. The American Journal of Medicine, 124(Suppl 10), S2-S9.

Diaz, V.A., Mainous, A.G., Williamson, D., Johnson, S.P., and Knoll, M.E. (2012). Cardiovascular and diabetes risk perception in a Hispanic community sample. Ethnicity & Disease, 22, 5-11.

Healthypeople.gov (2013). Map-It: a guide to using healthy people 2020 in your community. Retrieved from http://healthypeople.gov/2020/implement/MapIt.aspx

The Office of Minority Health (2013). Diabetes and Hispanic Americans. Retrieved from

http://minorityhealth.hhs.gov/templates/content.aspx?ID=3324

Pabon-Nau, L.P., Cohen, A., Meigs, J.B., and Grant, R.W. (2010). Hypertension and diabetes prevalence among US Hispanics by country of origin: the National Health Interview Survey 2000-2005. Journal of General Internal Medicine, 25(8), 847-852.

Palmas, W., Teresi, J.A., Findley, S., Mejia, M., Batista, M., Kong, J., Silver, S., Luchsinger, J.A., and Carrasquillo, O. (2012). Protocol for the Northern Manhattan Diabetes Community Outreach Project. A randomized trial of a community health worker intervention to improve diabetes care in Hispanic adults. BMJ Open, 2(2), retrieved from http://bmjopen.bmj.com/content/2/2/e001051.full

Tucker, K.L., Mattei, J., Noel, S.E., Collado, B.M., Mendez, J., Nelson, J., Griffith, J., Ordovas, J.M., and Falcon, L.M. (2010). The Boston Puerto Rican Health Study, a longitudinal cohort study on health disparities in Puerto Rican adults: challenges and opportunities BMC Public Health, 10, 1-12.