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Diabetic Evidence-based Community Interventions for Type II Diabetics

Capstone Project
Emma Jagasia
University of South Florida College of Nursing
Community Health


Diabetic Evidence-based Community Intervention

Hillsborough County is only one out of the sixty-seven counties in the state of Florida.
Hillsborough is roughly 1,020.21 square miles large with and average of 1,204.9 people per
square mile. That is equal to almost 1,316,298 million people living in the county (County
Health Profile, 2013). Although the population is predominately white (53.7%), there are a large
percentage of both African Americans (15.6%) and Hispanics or Latinos (24.9%), with a small
percentage Asians (3.4%), and two or more races(01.9%). In data collected in 2012,
Hillsborough residents lived mainly in rural areas (96%) (Country Health Profile, 2013). The
urban living accounts for the most people but only half of the landmass of the county.
Hillsborough is approximately 42.4% agricultural land or rural area (Rodney, 2007). With such a
high population, employment is a large factor in the economic setting. The three largest
employers in Hillsborough are the University of South Florida, WellCare, and Tampa General
Hospital (Major Employers, 2015). There are also twelve major healthcare settings in the area:
All Childrens Hospital, Brandon Regional Hospital, Moffitt Cancer Center, VA Hospital,
Memorial Hospital, South Florida Baptist Hospital, St. Josephs Hospital (Womens, and
Childrens), Shriners Hospital for Children, South Bay Hospital, Tampa General Hospital, Town
and Country Hospital, and Florida Hospital. The ambulatory Surgery center and Kindred are
health settings were patients are either admitted and discharge or taken care of for prolonged
periods of time (Hillsborough County Hospitals, 2015).
In Hillsborough County, one can experience both extremes of socioeconomic status. In
the Bay Shore, Davis Island areas, there are many multi-million dollar waterfront homes. Less
than ten miles away in the downtown Tampa area, there are a multitude of old, rundown homes
that are low income housing. There are 14.2 percent of Hillsborough county residents that are


currently living below the poverty level. This is high compared to the 13.8 percent average of the
state of Florida. 10.7 percent of families in this county live below the poverty level as well as
19.9 percent of people under the age of eighteen, which is higher than the state averages (9.9%,
19.5%). The median household income in the county, as of 2013, was 49,536, two thousand
dollars higher than the state median. In terms of education, 10.2 percent of the twenty-five years
and older population do not have a high school diploma (County Health Profile, 2013). However,
86.8 percent of people twenty-five years or older have a high school diploma or higher (United
States Census Bureau, 2014). In the county and the state of Florida, English is the predominate
language, with Spanish being the second most commonly spoken. There percentage of the
population greater than five years old that does not speak or understand adequate English is 10.2
percent. This is a high number, but it is lower than the state average (11.8%). This can pose a
problem when it comes to not only education, but also jobs and healthcare. With the high number
of Hillsborough county citizens at or below the poverty line, the access to adequate healthcare
and educational resources is a situation in desperate need of attention. This paper will analyze
and interpret the strengths and weaknesses of the Hillsborough County Healthcare model as well
as discuss interventions to better help the help of the community.
Analyze, interpret, and prioritize data
According to the County Health Profile, Hillsborough County has a variety of strengths
and weaknesses. The strengths include instances relating to crime and suicide rates. When
compared to the state of Florida, the county has lower rates of all types of crime and domestic
violence, which includes larceny, burglary, aggravated assault, motor vehicle theft, robbery,
forcible sex offenses, and murder. The total domestic violence offense in the Hillsborough area
over a 3-year period (per 100,000 people) was 566.8 compared to 572.0 in the entire state


(County Health Profile, 2013). The largest difference in occurrence was with larceny charges
(1,695.1 in Hillsborough and 2,332.1 in Florida). When looking for future homes, jobs, or areas
to start businesses, these values are important determining factors. The suicide rates in the county
are also lower than the state average. In 2013, there were 12.7 incidences of suicide per 100,000
people. Floridas suicide rate as of 2013 was 13.8 per 100,000 people (County Health Profile,
2013). This difference may be attributed to the ample resources for coping and mental health that
the county provides. When it comes to healthcare related issues, Hillsborough County is only
lower than the state average on AIDS cases (15.6 compared to 16.1 cases per 100,000 people)
(County Health Profile, 2013). Due to the high prevalence of AIDS and HIV in the state of
Florida, many resources have been developed and marketed to help reduce the spread of HIV and
help manage those who already have an infection. In Hillsborough County there are currently
fourteen HIV testing, counseling, and referral sites (HIV Counseling). This resource helps
Hillsborough maintain a slightly lower average of AIDS cases.
Although Hillsborough County has positive strengths relating to crime and health, there
are still a lot of areas that have a need for improvement. The rates of many chronic diseases in
the county are significantly higher than the average in the state of Florida. In the healthcare
setting, Hillsborough County has a high rate of heart disease and diabetes. The number of
teenage pregnancies, age 15-19, is also higher in the county than in the state. The number of
births to mothers between the ages of fifteen and nineteen was 30.9 incidences per 100,000
people while the state number 26.7 (County Health Profile, 2013). This number can be related to
the number of people under the age of 19 living in poverty. Heart disease and diabetes are two
common causes of death in the United States. From 2010-2013 the state of Florida had 153.9
heart related deaths per 100,000 people and 19.6 diabetes related deaths. The numbers were even


higher in Hillsborough County. Heart disease related deaths accounted for 170.4 people (for
every 100,000), with a higher prevalence in African Americans than White Americans. Deaths
due to diabetes or complications from poor diabetic management account for 22.7 deaths (per
100,000 people) (County Health Profile, 2013). Both heart disease and diabetes, require intensive
education and resources to help maintain and manage overall health and quality of life. These
high death rates can be attributed to poverty, access to healthcare, stigma behind chronic disease,
and health literacy. When it comes to healthcare, education and access to resources are vital
elements in improving death rates and quality of life.
Diabetes management and screening will be the priority health issue discussed in this
paper. In the United States 9.3% of Americans are currently living with diabetes. In 2012, 86
million citizens over the age of twenty were diagnosed with pre-diabetes. To put this in
perspective, diabetes is the 7th leading cause of death (Statistics About Diabetes, 2014). The
complications caused by diabetes can be controlled and or maintain through a consistent
medication regime and healthy lifestyle changes. Hillsborough County currently has a high
incidence of deaths related to diabetes (22.7) (County Health Profile, 2013). Therefore, it is
essential to look into the available resources in the community and create ways to better fit the
need for proper diabetic education and management.
Comprehend, discuss, and apply community health models
Determinants of Health are defined as the range of personal, social, economic, and
environmental factors that influence health status (Determinants of Health, 2015). Healthy
People 2020 include policymaking, social factors, health services, individual behavior, and
biology and genetics as determinants of health categories.


Many factors contribute to the development and progress of Diabetes. Type 1 diabetes is
determined based on human biology and genetics. There are not lifestyle behaviors or social
factors that lead to type one diabetes. However, type 2 diabetes can be related to social factors,
health services, individual behavior, and biology and genetics. Social factors dealing with type 2
diabetes include poverty, access to healthy educational information, availability of healthy choice
foods, neighborhood safety, social or cultural norms and traditions, and physical barriers. If a
person does not have the means or access to obtain healthy options foods, or if a neighborhood is
not safe to walk around, then making lifestyle choices that benefit overall health might be
difficult if not impossible. The current healthcare situation also makes it difficult to receive
medical treatment or be an active participant in supportive and preventative care. The difficulty
can be caused by lack of access, lack of funds, and language barriers. Complications can also be
due to unhealthy lifestyle choices. This decision can be caused by insufficient education or
insufficient means to obtaining healthy food options. The people of Hillsborough County are at
risk for developing life threatening diabetic complications due to social factors, unhealthy
lifestyle choices, and inadequate access to healthcare as evidence by the increasing high number
of deaths due to diabetes or diabetic complications.
Evidence Based Diabetes Interventions
With all community/population-based interventions, there are three levels: primary,
secondary, and tertiary. For prevention of diabetes in Hillsborough County, the main goal is to
maintain low blood glucose levels and normal blood pressure levels in order to slow the develop
of diabetic complications. The primary level of intervention for this case would be identifying at
risk populations and promoting a lifestyle intervention. The at risk population would be those
with a high Body Mass Index (BMI), high blood pressure levels, and high fasting blood glucose


levels. The intervention program would include a low caloric, low fat diet with 150 minutes of
moderate intensity exercise per week (Diabetes Prevention Program Research Group, 2002). This
prevention would be done on an individual basis. The stakeholders involved in the project would
be community members along with healthcare providers. Community health nurses would hold a
large role in providing education and support to those at risk patients.
The secondary level of prevention is aimed towards those patients with a new case of
diabetes. The stakeholders of this project would be community nurses. The goal of this
information is to provide symptom management so the disease process does not progress. In a
journal from the American Diabetes Association (2006), medical nutrition therapy, or MNT, was
used as a secondary intervention to individuals with diabetes. MNT was carried out through
community health nurses and registered dietitians. These healthcare workers were involved in
screening and educational teaching. Screening is an important part of this process. Outcomes are
best with early detection and treatment. This intervention is geared to community members and
healthcare providers as well as public officials. Type one diabetes is found at a young age and
type two diabetes has become more prevalent in younger populations. Public officials must keep
up with current nutritional guidelines and suggestions in order to maintain health school
The tertiary level of prevention is aimed at prevention of disability and life altering
complications of individuals in the community. The stakeholders are primary care physicians and
community health nurses. The In one study done by Cabrini Medical Center (1997), a diabetes
management team composed of a nurse educator and an endocrinologist was used to treat
patients in the hospital. This team proved to help decrease hospital stays, control blood glucose
levels, and decrease the rate of readmissions (Koproski & Pretto & Poretsky, 1997). This


intervention allows the team to monitor compliance while in the hospital and prevent further
negative impacts on health. The therapy is aim at healthcare professionals, and the community
health nurse has the role of monitoring for compliance outside of the hospital setting.
Development of Diabetes Health Policy Proposal
Hillsborough County should promote a lifestyle intervention to all citizens who are
considered at risk for developing type two diabetes. This would be a primary intervention geared
towards individuals in the community who have a high BMI, high blood pressure, or high fasting
glucose levels. The goals of this policy are decrease the amount of new incidences of type two
diabetes and to decrease the total number of deaths related to the diabetes process. The proposal
will affect community members, healthcare providers, and can be a solid health promotion
platform for public officials. Supports of the project will be health-funding sources such as
American Diabetic Association, Center for Disease Control, and World Health Organization.
Companies such as McDonalds and other fast food companies as well as Soda Corporations
would not benefit from this change. Implementing health eating and a well balanced diet would
cause a decrease in profit for corporations such as these. To get the policy put into action, there
will need to be ample support from healthcare professionals. After support, school systems
should be targeted first and then policy makers second. By implementing a lifestyle change
system to all patients at risk for developing diabetes, all populations are being analyzed and
people are being saved from a life full of strict medication regimens and an altered quality of life.

Hillsborough County is a large county with many strengths and weaknesses. With a large
population of rich, middle class, and poor, healthcare is an important topic to discuss. Diabetic


care for instance is currently increasing in the county, the state, and the nation. By implementing
a program aimed at those most at risk, the county is providing citizens with an intervention that
would help maintain health and increase the quality of life. Happy healthy people lead to a
prospering county, and that is what Hillsborough County aims towards.



County Health Profile. (2013). Retrieved June 29, 2015, from

Determinants of Health. (2015). Retrieved June 29, 2015, from

Diabetes Prevention Program Research Group. (2002). REDUCTION IN THE INCIDENCE OF

New England Journal of Medicine, 346(6), 393403. doi:10.1056/NEJMoa012512

Hillsborough County Hospitals. (2015). Retrieved June 29, 2015, from

HIV Counseling, Testing, and Referral Sites. (n.d.). Retrieved June 29, 2015, from

Koproski J, Pretto Z, Poretsky L. Effects of an intervention by a diabetes team in hospitalized

patients with diabetes. Diabetes Care 20: 15531555, 1997.



Major Employers. (n.d.). Retrieved June 29, 2015, from

Rodney, C. (2007). Issues the Rural-Urban Fringe: Hillsborough County Agriculture Stewardship
Program. Retrieved June 28, 2015.

Statistics About Diabetes. (2014, June 10). Retrieved June 29, 2015, from

United States Census Bureau. (2014). Retrieved June 29, 2015, from