In Los Angeles County, around 10% of the residents are diabetic. It is estimated that the number of pre-diabetic residents in the County of Los Angeles is far greater than the number of residents with diabetes. If no action is taken, then the pre-diabetic people are at risk of becoming diabetic in the near future. The Centers for Disease Control and Prevention (2015a) has launched a one-year program dubbed; Diabetes Prevention Program (DPP). The program is intended to be adopted by lifestyle coaches and related institutions in all counties to ensure that more people are not diagnosed with diabetes. This report aims to review the curriculum for the Diabetes Prevention Program that is offered by the Centers for Disease Control and Prevention in preventing diabetes. Several sections of the curriculum will be reviewed, such as its background, the target audience in Los Angeles County, the materials available in the program, the theories behind the program, as well as the health educators.
According to the Centers for Disease Control and Prevention (2015b), the DPP curriculum is a National based program that is aimed at assisting both diabetes and pre-diabetics in taking care of their health. It is a 12-month program with two phases, each with six months, says the Centers for Disease Control and Prevention (2015b). The first phase involves weekly sessions where the victim engages with the program instructor for physical exercises, advice on eating habits, skills on how to solve problems, as well as how to cope with society. This is driven by the fact that many diabetic people are said to be poor in choosing the right diet, taking regular and healthy exercises, and coping with society (Centers for Disease Control and Prevention, 2015b). In addition to having a close relationship with the instructor, the diabetic or pre-diabetic person gets the chance to interact with a small group of people who are recovering from the same situation. It motivates the person to make even more efforts as the results are promising (Aroda et al., 2015).
The second phase of the program involves monthly sessions, where the person under the program visits the instructor once every month (Centers for Disease Control and Prevention, 2015a). In this phase, it is assumed that the diabetic or pre-diabetic person under the program adopted the recommendations that were given during the first phase. These recommendations include healthy eating habits, regular and healthy exercises, and skills on how to cope with others and solve problems (Delahanty et al., 2013). Therefore, the main aim of the second phase is to assess the progress of the person under study.
According to Hamman et al. (2015), the DPP program has been proven to reduce the risk of people developing type 2 diabetes by 58%. It implies that the program is effective and worth adopting as a county. The program has been absorbed by more than 625 organizations throughout the United States of America as a result of its proven remarkable results (Hamman et al., 2015). These organizations offer the program in their counties, where pre-diabetics and people with high risks of developing type 2 diabetes are advised to go through the program.
Target Audience in Los Angeles County
The Centers for Disease Control and Prevention has studied the community in Los Angeles and the Service Planning Area (SPA 6) to a point that it has come up with an LA community profiling (Gilbert, Sawyer, & McNeil, 2014). In this profile, communities in Los Angeles have been grouped according to the prevalence of diabetes and the associated conditions, such as obesity and smoking. For example, the number of residents in LA becoming obese has increased over the years; both adults and students are becoming obese now more than several years ago (Gilbert et al., 2014). According to the Centers for Disease Control and Prevention (2015a), about 24.3% of adults are obese in Los Angeles. The number of students said to be obese in the county is more than 20%. It means that these people are at a higher risk of being diagnosed with type 2 diabetes if no action is taken (Gilbert et al., 2014). It has been said that the rate of obesity differs between communities. One community in LA and SPA 6 is rated 4% in terms of the number of children that are obese, while another is rated 37 (Gilbert et al., 2014).
According to Hoskin et al. (2014), the age groups that are at higher risks of being diagnosed with type 2 diabetes are 42 year-olds and above. In addition, individuals with family members that are diabetic are classified as having higher risks of becoming diabetic, which means that the curriculum identifies the target audience for this program (Hoskin et al., 2014). In the curriculum, the Hispanics living in Los Angeles have been identified as a special audience regarding diabetes due to their high risk of developing diabetes (Jaacks et al., 2014). In addition, the program has singled out residents with low income in the Service Planning Area (SPA 6) as having lower risks of obesity and diabetes (Gilbert et al., 2014). This area includes communities in Athens, Compton, Florence, Lynwood, Crenshaw, Hyde Park, and Watts. In other words, the identified groups in Los Angeles and SPA 6 that need to be taken through the DPP program are those aged 42 and above, pre-diabetics, diabetics, as well as high-income earners.
Theories Governing the Diabetes Prevention Program
According to Boston University (2015), there are several theories that drive the DPP curriculum. They include the diffusion of innovation theory, transtheoretical model, health belief model, the theory of reasoned action, as well as social learning theory (Boston University, 2015). The diffusion of innovation involves the passing of ideas from one person to another. It could involve the passing of new ideas to a group of people who are willing to utilize the information for the advancement of their health. The modes of communication employed in this theory include word of mouth, the Internet, newspapers, telephone, as well as posters on the streets (Boston University, 2015). People with a strong influence are normally used to pass on the information to the community. In the DPP, the diffusion of innovation theory is used to pass information that entails effective methods of exercising, good and healthy eating diets, and how to cope with stress and other problems in life (Rockette-Wagner et al., 2015). The diffusion of innovation theory has been proven to be effective in educating communities about diabetes and how to handle it (Boston University, 2015).
The transtheoretical model states that change of behavior occurs in phases (Rockette-Wagner et al., 2015). The change in habit is not dependent on the various factors that are based on theory; instead, it varies from one person to another. The main stages of behavioral changes are 5; thus, the model is also known as ‘stages of change’ (Rockette-Wagner et al., 2015). The first stage is known as pre-contemplation. In this stage, the victim is not aware of the dangers involving his choice of behavior. For example, an individual could be consuming certain types of food that he presumes are healthy. Contrary to the truth, those foods are extremely high in calories, with little or no amounts of other essential elements, such as vitamins and minerals. Therefore, people in this stage do not intend to change their behavior. The second stage is known as contemplation. According to Rockette-Wagner et al. (2015), persons in this stage recognize the need to change their behavior, but they do not make commitments to change. For example, a person may realize that if he does not start doing physical exercises, he might add more weight and become obese. However, the person does not develop an exercise regime (Rockette-Wagner et al., 2015). In the third stage of the transtheoretical model, the victim prepares to make changes in his behavior and goes on to prepare a plan that he intends to adopt soon (Rockette-Wagner et al., 2015). It could be an overweight person who visits a lifestyle coach, and together they develop an exercising schedule. In the fourth stage of the model, the victim takes action based on his preparation to change his behavior. For example, an overweight person starts to exercise, according to his planned exercise schedule. The fifth stage is known as maintenance, where the victim decides to uphold his newly acquired behavior (Rockette-Wagner et al., 2015). One can argue that the transtheoretical model is the theory that is being employed in the DPP Curriculum. The curriculum encourages the prevention of diabetes through a change of behavior (Centers for Disease Control and Prevention, 2015a).
According to the University of Pittsburgh (2012), the health belief model involves a change in belief about an individual’s health. Some people believe that they will be diagnosed with a certain disease probably due to their family health history (University of Pittsburgh, 2012). Others believe that adopting certain behaviors, such as exercising, will not have a positive influence on their health. The use of this model in the prevention of diabetes assists in helping pre-diabetic, as well as those at high risk of getting type 2 diabetes to believe that they can overcome the condition through proper diet, exercise, and the right mindset (University of Pittsburgh, 2012).
The theory of reasoned action involves the victim having intentions to change his behavior (University of Pittsburgh, 2012). These intentions are normally influenced by attitudes towards the intended behavior and the norms of the behavior, says Boston University (2015). For example, an individual may have the attitude that taking exercises could result in blisters or muscle pulls; thus, the exercises are not worth taking (Boston University, 2015). However, going through the stories of other reformed people who had the same attitude and are now reformed will help the individual to develop a positive attitude towards physical exercises.
Materials used in the DPP
Materials used in the DPP curriculum are structured in a manner that the facilitator and the person undergoing the program are able to follow smoothly (U.S. Department of Health and Human Services, 2013). There is a comprehensive guide that is to be followed by both parties involved in each of the sections that is to be covered. In the guide, there is a section where all are informed on how to prepare for the next class. All the required items are listed so that no one will miss any of the activities that are programmed to take place. In fact, there is a checklist for each section, which makes sure that each party gathers all the necessary materials and equipment useful in that topic. The U.S. Department of Health and Human Services (2013) adds that there is a follow-up section where the facilitator makes follow-ups on the progress of the person under the program. The follow-up ensures that there is positive progress. The facilitator is supposed to make brief comments before and after each session.
The Centers for Disease Control and Prevention (2015b) has put up measures that ensure only qualified personnel conduct training as lifestyle coaches and health educators. These educators must have received prior training on how to successfully deliver the curriculum on diabetes prevention. Those qualified as health educators under the DPP program are able to develop good relationships with the participants (Diabetes Advocacy Alliance, 2014). In addition, they are able to organize the materials provided under the curriculum so as to produce the expected results. According to the U.S Department of Health and Human Services, qualified health educators are able to monitor the behavior of the participants and report whether progress for each participant is positive or not. They can then make adjustments as necessary so that all the participants achieve good results through the adoption of good behaviors (Diabetes Advocacy Alliance, 2014).
The curriculum is suitable for use in Los Angeles County. The results that are associated with it are impressive. Every health institution in the county should adopt the program. The health centers in SPA 6, such as the Martin Luther King Jr. Center for Public Health and Ruth Temple Health Center should also be supplied with the curriculum. A minimum of 3 health educators should be trained on how to deliver the program to the participants that will be recruited in their institutions. Education institutions in the county, as well as the SPA 6, should also be encouraged to adopt and implement the curriculum. It would require the institutions to identify some individuals who can deliver the program to the participants effectively.
The number of people becoming diabetic will keep on increasing if no action is taken to address the issue. However, the Diabetes Prevention Program that was developed by the CDC has been of great use in the prevention of diabetes. The information that is in the curriculum is effective for the residents of Los Angeles County. Several theories, such as diffusion of innovation, the transtheoretical theory, the health belief model, as well as the theory of reasoned action have anchored the development of this curriculum. The materials used to deliver the Diabetes Prevention Program are tailored to ensure that pre-diabetics do not end up becoming diabetic. Individuals that are recruited to act as health educators in the curriculum are equipped well to handle the participants. Therefore, the curriculum is fit for adoption by the County Los Angeles.
Aroda, V. R., Christophi, C.A., Edelstein, S. L., Zhang, P., Herman, W. H., Barret-Conner, L. M.,.. Ratner, R. E. (2015). The effect of lifestyle intervention and metformin on preventing or delaying diabetes among women with and without gestational diabetes: The Diabetes Prevention Program Outcomes Study 10-Year Follow-Up. Journal of Clinical Endocrinology & Metabolism, 100(4), 1643-1653.
Boston University. (2015). Behavioral change models. Web.
Centers for Disease Control and Prevention. (2015a). National Diabetes Prevention Program. Web.
Centers for Disease Control and Prevention. (2015b). Standards and Operating Procedures. Web.
Delahanty, L. M., Pan, Q., Jablonski, K. A., Aroda, V. R., Watson, K. E., Bray, G. A.,… Franks, P. W. (2013). Effects of weight loss, weight cycling, and weight loss maintenance on diabetes incidence and change in cardiometabolic traits in the diabetes prevention program. Diabetes Care, 37(10), 2738-2745.
Diabetes Advocacy Alliance. (2014). Healthy People 2020 Spotlight on Health Webinar: National Diabetes Prevention Program Q&A. Web.
Gilbert, G. G., Sawyer, R. G., & McNeill, E. B. (2014). Health education: Creating strategies for school & community health (4th edn.). Burlington, MA: Jones and Barlett.
Hamman, R. F., Horton, E., Barrett-Connor, E., Bray, G. A., Christophi, C. A., Crandall, J. Venditti, E. (2015). Factors affecting the decline in the incidence of diabetes in the Diabetes Prevention Program Outcome Study (DPPOS). Diabetes, 64(3), 989-998.
Hoskin, M. A., Bray, G. A., Hattaway, K., Khare-Ranade, P. A., Pomeroy, J., Semler, L. N.,… Wylie-Rosset, J. (2014). Prevention of diabetes through lifestyle intervention: lessons learned from the diabetes prevention program and outcomes study and its translation to practice. Current Nutrition Report, 3(4), 364-378.
Jaacks, L. M., Ma, Y., Davis, N., Delahanty, L. M., Mayer-Davis, E. J., Franks, P. W.,… Wylie-Rosett, J. (2014). Long-term changes in dietary and food intake behavior in the Diabetes Prevention Program: An outcomes study. Diabetic Medicine, 31(12), 1631-1642.
Rockette-Wagner, B., Edelstein, S., Venditti, E. M., Reddy, D., Bray, G. A., Carrion-Petersen, M. L.,… Kriska, A. M. (2015). The impact of lifestyle intervention on sedentary time in individuals at high risk of diabetes. Diabetologia. 58(6), 1198-1202. doi: 10.1007/s00125-015-3565-0.
U.S. Department of Health and Human Services. (2013). Diabetes Prevention Program- DPP. Web.
The University of Pittsburgh. (2012). National Diabetes Prevention Program. Pittsburgh, PA: University of Pittsburgh Press.