IHP 410 Module 4 Final Project Milestone Two example

Milestone Two: Health Promotion, Prevention and Diabetes Management Strategies for Arab American Adults at a Community Health Center

[Student Name]

Southern New Hampshire University

IHP 410: Population Health and Cultural Competence

Module Four Final Project Milestone Two

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Milestone Two: Health Promotion, Prevention and Diabetes Management Strategies for Arab American Adults at a Community Health Center

Critique of Current Programs

Milestone One showed that Arabic-speaking adults with type 2 diabetes at the composite health center are less likely to have an A1c test, more likely to have an A1c above 9 percent, less likely to complete an eye exam or attend diabetes education, and more likely to visit the emergency department for glucose problems than English-speaking patients. The center's current programs explain part of the gap. Diabetes education is offered only in English, only on weekday afternoons, and in a format that assumes patients can read written handouts. Eye exams require a referral to an outside optometrist. Nobody contacts patients who drift out of care, and nothing is offered to the many patients who fast during Ramadan. The programs are clinically sound but designed for a patient who speaks English, works standard hours and does not fast.

Health Promotion: Arabic-Language Self-Management Education

Diabetes self-management education and support is the foundation of diabetes care. A systematic review of 118 interventions found that education reduced A1c by an average of 0.74 percentage points, compared with 0.17 in control groups, with the largest reductions when group and individual sessions were combined and when patients received 10 or more hours of contact (Chrvala et al., 2016). The center should train one of its Arabic-speaking medical assistants as a diabetes educator under the supervision of the certified educator and offer a series of group classes in Arabic, combined with individual visits. Classes should be held in the evening and on Sunday afternoons, offered in separate sessions for women and men when requested, and use pictures, food models and cooking demonstrations with familiar dishes, adapting portions rather than forbidding traditional foods.

Prevention of Complications: Pre-Ramadan Education and On-Site Retinal Screening

Two strategies target preventable complications. First, the center should hold a pre-Ramadan program each year, starting six to eight weeks before the month. It would combine an individual risk assessment and medication review, following international guidance on diabetes and Ramadan (Hassanein et al., 2022), with a group class on meal planning, glucose monitoring and when to break the fast. A structured Ramadan education program in the United Kingdom reduced hypoglycemic events during Ramadan from nine to five among attendees, while events rose from nine to 36 among nonattendees, and prevented weight gain (Bravis et al., 2010). Second, the center should purchase a retinal camera for on-site screening during primary care visits, with images read remotely, removing the extra appointment that many patients never make.

Disease Management: Community Health Worker Outreach

Patients without an A1c in the past year are invisible to clinic-based programs. The center should hire an Arabic-speaking community health worker from the community to contact these patients by phone and in person, help them schedule visits at convenient times, arrange transportation, and connect them with pharmacy refills and social services. The community health worker would also present at mosques and cultural associations, where trust is already established, and bring back patients' concerns to the care team.

Summary of Strategies

The table links each strategy to its level and the baseline measures it should improve.

Table 1

Proposed Strategies and Their Targets

How the Strategies Fit Together

The strategies reinforce one another. The community health worker brings patients back into care, where on-site screening and an A1c test happen at the same visit. Education builds the skills patients need to manage diabetes day to day, and the pre-Ramadan program applies those skills to the month that carries the highest risk. Cultural competence is not a separate component but the design principle of each: language, timing, gender preferences and religious practice are built in. This follows the framework in which cultural competence operates at organizational, structural and clinical levels rather than depending on individual clinicians (Betancourt et al., 2003).

Risks and How to Address Them

Each strategy carries a risk of falling short. Classes may be poorly attended if patients do not know about them or cannot arrange childcare; the center can promote them through Arabic-language radio and social media, offer a supervised children's corner and ask early participants to invite relatives. The community health worker position may turn over, taking relationships with it; pairing the worker with a clinical supervisor and documenting community contacts reduces that loss. Some patients may be uneasy about a camera image of their eye; a short explanation in Arabic by a trusted staff member usually resolves this. Pre-Ramadan visits may crowd the schedule in the weeks before the month; blocking dedicated sessions in advance prevents them from displacing other care. Finally, clinicians may see the program as extra work, so the medical director should present the Milestone One data at a staff meeting and report progress each quarter.

Resources

The strategies require one community health worker position, part-time educator time for the trained medical assistant, a retinal camera and reading service, and evening staffing for classes. Some costs may be offset by Medicaid managed care plans, which have an interest in fewer emergency visits and better quality scores, and by billing for education and retinal screening where allowed.

Conclusion

The center's current diabetes programs are clinically appropriate but designed around assumptions that do not fit its largest patient group. Arabic-language education, pre-Ramadan preparation, on-site retinal screening and community health worker outreach address the specific gaps found in Milestone One, rest on published evidence and build cultural competence into the system. The next milestone will address how the center engages patients and communicates with them.

References

Betancourt, J. R., Green, A. R., Carrillo, J. E., & Ananeh-Firempong, O. (2003). Defining cultural competence: A practical framework for addressing racial/ethnic disparities in health and health care. Public Health Reports, 118(4), 293-302. https://doi.org/10.1016/S0033-3549(04)50253-4

Bravis, V., Hui, E., Salih, S., Mehar, S., Hassanein, M., & Devendra, D. (2010). Ramadan Education and Awareness in Diabetes (READ) programme for Muslims with type 2 diabetes who fast during Ramadan. Diabetic Medicine, 27(3), 327-331. https://doi.org/10.1111/j.1464-5491.2010.02948.x

Chrvala, C. A., Sherr, D., & Lipman, R. D. (2016). Diabetes self-management education for adults with type 2 diabetes mellitus: A systematic review of the effect on glycemic control. Patient Education and Counseling, 99(6), 926-943. https://doi.org/10.1016/j.pec.2015.11.003

Hassanein, M., Afandi, B., Yakoob Ahmedani, M., Mohammad Alamoudi, R., Alawadi, F., Bajaj, H. S., Basit, A., Bennakhi, A., El Sayed, A. A., Hamdy, O., Hanif, W., Jabbar, A., Kleinebreil, L., Lessan, N., Shaltout, I., Mohamad Wan Bebakar, W., Abdelgadir, E., Abdo, S., Al Ozairi, E., . . . Binte Zainudin, S. (2022). Diabetes and Ramadan: Practical guidelines 2021. Diabetes Research and Clinical Practice, 185, Article 109185. https://doi.org/10.1016/j.diabres.2021.109185