Reducing the Rates of Cardiovascular

Disease and Diabetes in Greensboro, NC

Evaluation Plan for Racial and Ethnic Approached to Community Health (REACH)

Reducing CVD and Diabetes Rates

Table of Contents
Section 1: Conceptualization of Evaluation.........3
Section 2: Program Description.. 4
Section 3: Evaluation Plan...9
Section 4: Reporting Plan..12
Section 5: Detailed Budget14
Section 6: Detailed Timeline.15
References..16

Reducing CVD and Diabetes Rates

Section 1: Conceptualization of Evaluation

What purpose(s) will be served by the evaluation?
The purpose of this evaluation is to determine if the Racial and Ethnic Approaches to
Community Health (REACH) program is truly successful with helping to reduce racial and
ethnic disparities, related to cardiovascular disease (CVD) and diabetes, in a Greensboro
community.
What broad questions will be addressed by the evaluation?
1. Have community members learned how to identify the risk factors that may lead to CVD and
diabetes?
2. Are community members more aware of the resources that may improve/maintain their health?
3. Has REACH strengthened the capacity by which they address ethnic health disparities?
a. Has REACH implemented evidence and practice based strategies in the community?
4. Have CVD/Diabetes rates decreased among community members?
Who are the key stakeholders?
The Pilot test is being implemented by REACH, which is a program administered by the
Centers for Disease control and Prevention. Therefore, REACH's key stakeholders include the
CDC, the community members, program leaders within the community who are working as
health educators, and Greensboro policy makers.

6.

What assumptions are being made?

The health status of community members can be improved.
Appropriate programs can be developed that meet the needs of community members.
The majority of the community has access to the programs REACH offers.
Community members will be present at every program.
Program leaders aspire to improve community members knowledge & self-efficacy toward their
health.
Community members understand the importance of reducing CVD and diabetes risk factors.

What are the major contextual factors that need to be considered?

Reading & education level of participants
Age of participants
Resources needed
Transportation to and from programs
Funding
Level of personal importance of certain health issues
Access to minority communities

1.
2.
3.
4.
5.

Reducing CVD and Diabetes Rates

Section 2: Program Description

Program Purpose:
REACH is a national program that focuses on reducing racial and ethnic health
disparities. The program educates participants on how to modify negative risk factors and health
behaviors that lead to chronic illnesses; such as CVD and diabetes (CDC, 2015).
Program Goals and Objectives:
Outcome Objective: Identify barriers to health that are a result of race, education, income,
and other social factors.
Outcome Objective: Identify and develop effective strategies for overcoming ethnic
health disparities.
Program Goal: Increase positive health behaviors (smoking cessation, healthy
eating, physical activity) among African American residents in the south side
neighborhood of Greensboro, NC.
Program Goal: Decrease CVD and diabetes rates among African American residents
in the south side neighborhood of Greensboro, NC.
Target Audience:
African Americans diagnosed with or at risk of developing CVD or diabetes in
Greensboro, NC neighborhood.
Program Location:
This program will be pilot-tested in the urban south side neighborhood of Arlington Park
in Greensboro, NC; also referred to as ol' Asheboro, and the Asheboro Street neighborhood. The
population age of this neighborhood varies and the majority is of minority race/ethnicity. The
program activities will take place at Bennett College in Greensboro, NC from August of 2016 to
August of 2017.
Results of Previous Evaluation:
The REACH Risk Factor Survey is conducted annually and gathers health-related
information of communities about disease prevalence, fruit and vegetable consumption, physical
activity, preventative services usage, and immunization records. Recent evaluations found that
smoking prevalence has decreased among African Americans and Hispanics, and daily vegetable
and fruit consumption has tripled after the implementation of REACH (Liano, Tucker, Okoro,
Giles, Mokdad, & Harris, 2004).
Logic Model Description:
REACHs logic model is illustrated below. The chart reads from left to right and
identifies the inputs for the program, activities, outputs, and short-term and long-term goals.

Reducing CVD and Diabetes Rates

The REACH program aims to reduce CVD and diabetes among residents in the
neighborhood of Arlington Park, by targeting smoking cessation, healthy eating, and physical
activity. The program is composed of the following five elements: Finding eligible residents to
participate in the program, choosing health educators to conduct the program, offer education for
healthy eating and physical activity, and hosting CVD and diabetes support groups for
participants. REACHs program will last from August of 2016 to August 2017.
The first step of the REACH program is to identify and recruit qualifying participants of
the Arlington Park community. This is an urban neighborhood of primarily African American
individuals. To be eligible to participate in this program, the participants must be diagnosed with
CVD or diabetes, or at high risk of developing the diseases. African Americans are twice as
likely to suffer from diabetes compared to Whites and 13% of African Americans, aged 20 and
older, have been diagnosed with Type 1 or Type 2 diabetes (King, 2007). African Americans are
also more likely to be obese or overweight in comparison to other ethnic groups (King, 2007).
With obesity being a risk factor for CVD and diabetes, it is important to reach the African
American population sooner than later. By identifying the individuals at risk and obtaining health
pre-test results, REACH will be better able to modify and adjust the program according to the
needs of the clients.
The participants will be responsible for nominating 20 trusted and respected members of
the community to serve as health educators. By utilizing individuals who are well-known in the
community, we hope that the community members will trust the information they are receiving
in their educational classes and support groups. Health educators will be required to complete at
least 100 hours of health education sessions for diabetes and CVD, and are required to attend
monthly meetings to discuss progress of the program. We hope that by educating members living

Reducing CVD and Diabetes Rates

in the community, that these nominated health educators will continue to work together to
improve and maintain the health of the community once the REACH program is completed.
Participants in the program will have opportunities to attend educational classes directed
toward healthy eating habits and positive health behaviors such as smoking cessation and
physical activity. These free educational classes will be offered weekly by the health educators
with hopes of increasing the participants knowledge. Instructional classes for preparing healthier
food options and meals, such as including more fresh fruits and vegetables will also be offered.
There will also be programs offered that focus on increasing participants confidence to be more
physically active and the cessation of using tobacco products. Another major element of REACH
is linking residents and participants with healthcare providers. CVD and diabetes are conditions
that require constant attention and check-ups. REACH hopes that the educational classes offered
will encourage participants to take their health more serious, and take advantage of the resources
being offered.
Lastly, REACH plans to create and guide support groups for community members. The
purpose of these support groups is to offer participants a safe haven to express their emotions,
along with strengths and weaknesses they discover while in the program. In these groups,
participants will be able to ask their health educators any questions and concerns they may have
regarding the program and behavior change. Also, participants may have the opportunity to offer
and receive advice from other members on how to be more successful in the program. These
support group meetings allow participants to establish smaller support groups with other
members or neighbors. This is an advantage because the support of the groups will help to build
the self-efficacy and confidence needed to be successful in the REACH program.

Reducing CVD and Diabetes Rates

Logic Model:
Inputs
Community
Members

Activities

Trained
Health
Educators

Education for
Healthy
Eating

Outputs

Recruit
African
American
community
members in
Greensboro.
Identify
qualifying
participants.
Complete a
health pretest for
qualified
participants.

Nominate 20
candidates to
attend
trainings
about risk
factors for
diabetes and
CVD, and
serve as
health
educators.

Health
educators
host
educational
classes on
healthy
eating.
Health
educators
offer lessons
for healthy
eating.

Create a
registry of
potential
participants.
Identify 300
qualified
participants.
Assess
participants
health
knowledge
and behaviors.

Short-Term
Outcomes

Health

educators
complete 100
hours of
trainings.
All health
educators and
program

directors
attend monthly
meetings
throughout the
project to
discuss
progress.
Classes are
offered
biweekly.
45%
attendance in
meetings.

Long-Term
Outcomes

Increased

awareness for
REACH in
the
community.
Increased

readiness to
make health
changes.
Health
knowledge

about CVD
& diabetes
increased.

More
community
members take
advantage of
REACH.
Improve
attitudes
toward
positive
health
changes.
Post-test
results show
REACH is
effective and
successful.

Increased

health
educators
capacity of
CVD &
diabetes
education and
instruction.
Increase
teambuilding
between
health
educators in
the
community.

Health
educators
continue to
work together
to improve
the
communitys
health.

Participants
have new
attitudes
towards
healthier
food.
Participants
skill of
preparing
healthy meal
options
correctly
continues
after REACH
has ended.

Increase
participants
knowledge
for healthy
food options.
Increase
participants
skill for
health meal
preparation.

Reducing CVD and Diabetes Rates

Education to
Increase
Positive
Health
Behaviors

CVD &
Diabetes
Support
Groups

Provide

education to
participants
on tobaccouse cessation.
Educate

participants
on the
importance of
physical
activity.

Educate
participants
on the
importance of
routine visits
with
healthcare
providers.

Offered

weekly lessons
to participants
on tobacco-use
cessation.
Offer

biweekly
exercise
classes to
participants.
Assisted 50%
of participants
in finding
local

healthcare
providers.

Increase

participants
self-efficacy
of tobaccouse cessation.
Increase

participants
knowledge of
different
exercise
options for
improving
physical
activity.

Increase
participants
knowledge
for routine
doctor visits.

Participants
aspire to quit
using tobacco
products
completely.
Participants
continue
being
physically
active for the
recommended 30 minutes
a day.
Participants
schedule
routine
appointments
for health
checkups.

Encourage

participants
to express
their
strengths and
weaknesses
in the support
group.
Encourage
participants
to build
relationships
with others in
the support
groups.

Support

groups had
80%
attendance.
Participants

developed
smaller
support groups
with
neighbors.

Increase

participants
selfconfidence.
Participants
can recognize

the benefits
of being part
of a support
group.

Participants
self-efficacy
for CVD &
diabetes
constantly
improves.
Participants
continue to
encourage
and support
each other
outside of the
support
groups to
maintain new
health
behaviors.

Reducing CVD and Diabetes Rates

Section 3: Evaluation Plan

Specific Evaluation Questions:
The following questions are the broad questions that will be addressed by the evaluation:
1. Have community members learned how to identify the risk factors that may lead to CVD
and diabetes?
2. Are community members more aware of the resources that may improve/maintain their
health?
3. Has REACH strengthened the capacity by which they address ethnic health disparities?
a. Has REACH implemented evidence and practice based strategies in the community?
4. Have CVD/Diabetes rates decreased among community members?
Program Design:
This planned evaluation is a quasi-experimental design and consists of an experimental
group and a control group in natural environments. The control group will be used to establish a
baseline to compare the effects of the REACH program. All 300 participants will begin the
program by completing a pre-test for CVD and diabetes knowledge. In the experiment, 30
residents will act as a control group. This control group will meet with health educators at the
beginning of the program to receive a booklet of information for maintaining CVD and diabetes.
The participants in the control group will not take part in the other offered programs and
activities. Through the course of the year, these participants will meet weekly with the health
educators to discuss their progress. These weekly reports may determine if the programs (healthy
eating education, positive health behavior education, and support groups) offered to the other 270
residents through REACH are truly effective. The remaining 270 residents will be a part of the
experimental group and take part in all of REACHs educational programs and activities. A posttest will be administered immediately after the program has ended. Before the program begins,
an evaluator will conduct an observation of the neighborhood residents. The evaluator will
interview residents and observe the behaviors, knowledge, and attitudes about CVD and diabetes

Reducing CVD and Diabetes Rates

10

knowledge. Through these interviews and observations, evaluators will be able to identify the
initial knowledge level of a sample of the residents. This information can be used to build the
program efficiently.
Variables:
Skills learned to prevent or maintain CVD and diabetes
Adherence to REACHs programs
Shift in norms: Eating habits, exercising habits, smoking cessation
Level of confidence to maintain CVD and diabetes risk factors
Program appreciation
Instrumentation
Observations
For the control group, evaluators and their assistants will do observations while residents
meet weekly with their health educator to discuss progress in the program. Their knowledge and
self-efficacy will be measured after they receive their educational material at the beginning of the
program. Residents in the experimental group will be observed by evaluators weekly to measure
skill improvements, self-efficacy, relationships built during the program, and attitude.
Surveys
All 300 participants will be asked to complete a pre-test, a progress survey, and a posttest. Participants who choose to take part in the program will receive $10 vouchers for the local
farmers market. Residents chosen for the control group will also be offered a $10 gift card for
the nearest gas station after completing the progress survey to ensure they remain active with the
program. The pre-test survey will be mailed out in August of 2016. The progress survey will be
mailed out in January of 2017. The post-test survey will be mailed out in August of 2017.
Focus Groups
Focus groups will be held monthly with health educators and voluntary program
participants. Focus groups will give participants an opportunity to voice their opinions, concerns

Reducing CVD and Diabetes Rates

11

and critiques with the program. Health educators will also be able to ask participants any
questions they may have for the operation of the program.
Data Collection Plan:
Observations
The evaluator and their assistant will perform observations of the residents and their
results will be summarized and combined for each program.
Surveys
Surveys can be mailed back the office located at Bennett College or handed back to
health educators in the neighborhood who will then take them to the office at Bennett College
and where the results will be averaged by health educators.
Focus Groups
Health educators and their assistants will take notes while residents express their thoughts
and concerns during the focus groups. These notes will be shared during the monthly meeting
with the health educators and directors.

Reducing CVD and Diabetes Rates

Evaluation Crosswalk:

12

Reducing CVD and Diabetes Rates

13

Section 4: Reporting Plan

The data collected and results from the surveys, focus groups, and observations will be
studied and summarized into an organized manual in October of 2017. The manual may also be
found as a pdf on the City of Greensboros website and the CDC website. The results of the
program and suggested recommendations will then be presented to the evaluator, Greensboro
officials, and the nominated health educators of the community during the next city council
meeting. An even more condensed form of the program will be presented in a newsletter for
residents of the neighborhood. The pamphlet will contain the major facts and information needed
to maintain and prevent CVD and diabetes, and tips for how to continue maintaining the healthy
behaviors. The final report manual will also be shared with stakeholders.

Reducing CVD and Diabetes Rates

Section 5: Detailed Budget

14

15

Reducing CVD and Diabetes Rates

Section 6: Detailed Timeline

August 2016
September 2016-August 2017
January 2017
August 2017
October 2017

Recruit health educators, health educators trained, pre-test mailed to

participants
Program activities held weekly, observations of activities completed
Progress survey mailed to participants
Post-test surveys mailed to participants
Results of programs presented to evaluators, Greensboro officials,
and health educators

Project Timeline and Task List

Recruit
staff
Aug.
16
Sept.
16
Oct.
16
Nov.
16
Dec.
16
Jan.
17
Feb.
17
Mar.
17
Apr.
17
May
17
June
17
July
17
Aug.
17
Sept.
17
Oct.
17

Health
educator
training

Pretest
mailed

Programs
held
weekly

Observations

Progress
survey

Posttest

Results
Presented

16

Reducing CVD and Diabetes Rates

References
Centers for Disease Control and Prevention. (2015). Racial and ethnic approaches to
community health. Retrieved from https://www.cdc.gov/nccdphp/dch/programs/reach/
King, M. L. (2007). Community health interventions. Center for American Progress. Retrieved
From https://www.americanprogress.org/wp-content/uploads/issues/2007/02/pdf/
community_health.pdf
Liano, Y., Tucker, P., Okoro, C. A., Giles, W. H., Mokdad, A. H., & Harris, V. B. (2004).
REACH 2010 surveillance for health status in minority communities. Morbidity and
Mortality Weekly Report. Retrieved from http://www.cdc.gov/Mmwr/preview/mmwrhtml/
ss5306a1.htm