HL 367 Major Project: Fall 2013

Katie Tourville & Hyacinthi Mwangu

Mission: To increase minority communities awareness of the link between obesity and diabetes through education. DV: awareness of the link between obesity and diabetes IV: education Target Population: minority communities Agency: Chicago Department of Public Health Agency Mission: to make Chicago a safer and healthier place by working with community partners to promote health, prevent disease, reduce environmental hazards and ensure access to health care for all Chicagoans. Our Job in Agency: Community Health Educatorto be well informed regarding all matters affecting the health of the citizens of Chicago. It shall formulate policies and otherwise advise the mayor of the city and the commissioner of health on

Assess General Need

There may be lack of familiarity with recommended food items, which may

be costly, difficult for families to obtain, and require special preparation (4,80). Finally, many youth who are obese nd it difficult to engage in strenuous physical activity (American Diabetes Association, 1999). Diabetes and obesity are related, and insulin resistance causes weight gain and the diseases associated with obesity (P. Attia, 2013). Behavior modification is necessary to tackle obesity and type 2 diabetes and it requires individual awareness of the existing problem ( J. DeVilleAlmond, AA Tahrani, J. Grant, M. Gray, GN. Thomas, S. Taheri, 2011). There are environmental disparities for those with diabetes (C. Horowitz, 2004). Preventing obesity for all children may be a way to reduce socioeconomic and ethnic health disparities (S. Kumanyika & S. Grier, 2006). There are issues of death, impaired quality of life, and direct costs of health care related with obesity and weight gain (A. Mokdad, B. Bowman, E. Ford, F. Vinicor, J. Marks, J. Koplan, 2001).

Assess General Need

Different ethnic groups living in US have high prevalence to develop obesity

and type 2 diabetes compare to those who are living in their country of origin (A. Nicola & C. Manisha, 2013). There is a need to increase awareness of the link between diabetes and obesity not only in minority but in all communities (Diabetic Care Services, 2013). Mexican Americans are at increased risk for obesity and diabetes (FisherHoch. S, Rentfro. A, Wilson. G, Salinas. J, Reininger.B, Restrepo. B, Mc Cornmik. J, and Perez, A, 2010). African-American, Hispanic, and Native American children are at great risk of being diagnosed with impaired glucose tolerance and type 2 diabetes (Goran. M, Ball. G and Cruz. M, 2003). There are increasing number of children with obesity and type 2 diabetes in ethnic groups (Lipton. R, Drum. M, Burnet. D, Rich. B, Cooper. A, Baumann. E, and Hagopian, 2005). Ethnic groups ,which are minorities, are at high risk of developing obesity and diabetes (Oldroyd. J, Banerjee. M, and Heald. A, 2005). Many parents are not aware of their children being obese because they are eating unhealthy meals, long hours of watching TV, and lack of exercises put those children on high risk of developing type 2 diabetes (S. Nevins and J. Hoffman, 2012).

Theoretical Definition of DV
Having knowledge of the link between obesity, an excessive

amount of body fat which increases your risk of illness, and diabetes, a group of diseases that affects how your body uses blood glucose (Mayo Clinic, 2013). This knowledge includes: 1) knowing what obesity is; 2) knowing what diabetes is and its forms; 3) knowing of the increased risk of diabetes with obesity; 4) knowing the mechanism for the link between having both obesity and diabetes; and 5) knowing what to do to prevent diabesity (Diabetic Care Services, 2013) (P. Hogan, 2013).
http://www.thefreedictionary.com/awareness http://www.mayoclinic.com/health/obesity/DS00314 http://www.mayoclinic.com/health/diabetes/DS01121

http://www.diabeticcareservices.com/diabetes-

Model of DV Reflecting Theoretical Definition

Awareness of the link between obesity & diabetes -having knowledge of the relationship between being obese (an excessive amount of body fat which increases your risk of illness) and diabetes (a group of diseases that affects how your body uses glucose). This involves knowing what obesity is, what diabetes is and its forms are, what the relationship between the two is, what the mechanism is, and ways to prevent diabesity, a combination of obesity and diabetes. (Mayo Clinic, 2013) (Free Dictionary, 2013) (Diabetic Care Services, 2013)

Knowing what obesity is

Knowing the mechanism for the relationship between obesity and diabetes

1. Knowing what
diabetes and its forms are

Knowing the relationship between obesity and diabetes

Knowing how to prevent diabesity (diabetes and obesity)

Dependent Variable Test

1) What is obesity? Explain. (10 points) 2) What is diabetes? Explain. (10 points) 3) Is there an increased risk of diabetes if you are obese? Explain why/why not there is an increased risk. (5 points) 4) What to do to prevent obesity and diabetes? (15 points) Total: ___/40

Score Measurement 10-20/40: poor understanding of the link between obesity and diabetes 21-30/40: moderate understanding of the link between obesity and diabetes 31-35/40: good understanding of the link between obesity and diabetes 36-40/40: excellent understanding of the link between obesity and diabetes
Answer Key 1) Obesity is: having too much body fat which causes one to have a higher health risk 2) Diabetes is: a group of diseases that affect how your body uses sugar in the blood 3) Yes, there is an increased risk of diabetes if you are obese. This is because: if you are overweight, this causes more stress on your body. It can affect your ability to maintain the right amount of sugar in the blood, therefore increasing your risk of diabetes. 4) To prevent obesity and diabetes, exercising 30 minutes a day and eating properly are very important. It would be helpful to eat a high fiber, low carbohydrate diet.

Dependent Variable Test

Test Validity: Our test will measure the awareness of the link

between diabetes and obesity per our theoretical definition listed above. Our test consists of four questions, which are testing the individuals awareness, or knowledge of, each aspect which includes obesity, diabetes, the increased risk of diabetes if you are obese, and how to prevent obesity and diabetes (diabesity). Our theoretical definition includes all of these aspects; therefore our test has content validity, and actually measures our DV per the theoretical definition of the DV. Test Reliability: We could measure our test in two different areas of minority communities in Chicago. It would take place in a different church in each of these locations, on a Tuesday and Thursday of the same week. The test results should be the same in both areas of Chicago. This would demonstrate that we have test-retest reliability (test consistency), as the

Assess Specific Need

Pre-Test Results on Diabetes Awareness Test: Program Group: 10/40 Control Group 10/40

Identify Measurable Objectives

Participants will score from 1/10 to at least a 9/10 on

question 1 (what is obesity?) by the end of the 8 week program. Participants will score from 1/10 to at least a 9/10 on question 2 (what is diabetes?) by the end of the 8 week program. Participants will score from 1/5 to at least a 4/5 on question 3 (is there an increased risk of diabetes if you are obese? Explain why/why not there is an increased risk) by the end of the 8 week program. Participants will score from 2/15 to at least 14/15 on question 4 (what to do to prevent obesity and diabetes?) by the end of the 8 week program. This will total for 36/40=excellent understanding of the

Plan an Evidence-Based Program

We will use the Outreach Model and Model for Healthy

Living. Author: Community Tool Box; Church Health Center Year: 2013; 2010 Links: http://ctb.ku.edu/en/table-ofcontents/implement/access-barriersopportunities/outreach-to-increase-access/main http://chreader.org/contentPage.aspx?resource_id=621 When executing our program, based off of the Model for Health Living (The Church Health Center, 2010), we will focus on the 7 factors of the model: faith, movement, medical, work, emotional, nutrition, and friends and family.

 This image is the Model for Healthy Living from the

Church Health Center (The Church Health Center, 2010).

Plan an Evidence-Based Program

Model Program-The Church Health Center: Model for Healthy Living (Church Health Center, 2010) Introduction: Week 1 Living healthy lives doesn't just mean that you see the doctor regularly. Rather, healthy living means that all aspects of your life are in balance. Your faith, work, nutrition, movement, family and friends, emotions and medical health all contribute to a life filled with more joy, more love and more connection with God. The Model for Healthy Living visually illustrates how these seven key dimensions of our body-and-spirit experience overlap at the core of our lives. Our Program Model: Diabesity Awareness Program Introduction: Meet Tuesday and Thursday for 1 hour each, for a total of 2 hours per week. On Tuesday, collect pre-test data on knowledge of obesity and diabetes. Confirm that the participants have access to the church; arrange different methods of transportation if necessary. On Thursday, show them the pre-test results and motivate them to want to learn about the material (nutrition, movement, and medical health) throughout our outreach program. Focusing on a relationship with themselves: the link between their body and their health Meet Tuesday and Thursday for 1 hour each, for a total of 2 hours per week. In the church setting, we will establish a link between their body and health, and the importance of how these two relate. Educate on the topic of obesity. What is obesity? How do you become obese? How does obesity affect your body? We will focus on these aspects of the topic, and use these questions to enhance their understanding. On Tuesday, we will separate them into small groups so they feel comfortable sharing their knowledge or lack of knowledge. The small groups will be more effective in their understanding in the long run. On Thursday, we will review and meet as an entire group to discuss these three questions and obesity more in depth. We will show an informational video on obesity as well, so they have a visual of what it is. Medical: Partnering with your healthcare provider to manage your medical care. You are the expert in your own health care. Your doctor is your partner. Yes, doctors have education, training, and experience you dont have, but you know yourself better than any doctor ever will. When it comes to your medical care, you bring something important to the conversation. You can build a partnership with your health care provider that lets you participate in managing your medical care. Week 3 Medical Aspects of Diabetes Meet Tuesday and Thursday for 1 hour each, for a total of 2 hours per week. As diabetes is an important factor of medical care, we will explore this topic in detail. Since they may not have healthcare providers, we will help aid their knowledge of diabetes. Educate on the topic of diabetes. What is diabetes? How do you get diabetes? How does diabetes affect your body? On Tuesday, we will separate into the same small groups as Week 2 and discuss these three questions. On Thursday, we will review and meet as an entire group to discuss these questions more in depth. We will bring in 10 different foods, all varying in sugar content. We will ask them to rank the foods from least amount of sugar to most amount of sugar. Then explain how sugar (such as high fructose corn syrup) is a large contributor to diabetes.

Faith Life: Building a relationship with God, your neighbors, and yourself. We have moved a universe away from seeing faith as an important part of health, and its time to bring the two back together. This affirms that we are body-and-spirit beings created and loved by God. Even if you dont consider yourself religious, you can explore a richer faith life and enjoy the benefits this experience will bring to your overall wellness.

Week 2

Emotional: Managing stress and understanding your feelings to better care for yourself. Its pretty easy to turn to unhealthy habits in response to stress in our lives. For many people, that habitwhether food, mindless television, excessive spending, alcohol, or something elsemakes us momentarily feel better even though we know its bad in the long term. Through understanding your feelings and emotional needs, you can make changes to take better care of yourself and manage stress in healthier ways.

Week 4

Emotional: Managing your weight to address diabetes issues. Meet Tuesday and Thursday for 1 hour each, for a total of 2 hours per week. We will help them understand the connection between obesity and diabetes in relation to their stress, emotions, and feelings. Educate on the how obesity and diabetes are related. Does the increase of one factor influence the other? Is it dangerous to your health to be both obese and diabetic? On Tuesday, we will separate into the same small groups and discuss these questions above, exploring the relationship between obesity and diabetes. On Thursday, we will review and meet as an entire group to make sure they understand the relationship between obesity and diabetes. We will show the movie Weight of the Nation. This displays how fast food affects our health and how it can put you at risk for diabetes, due to obesity. The Role of Family/Friends and environment in diabetes. Meet Tuesday and Thursday for 1 hour each, for a total of 2 hours per week. Educate on how to prevent obesity and diabetes, in regards to the power of a support system of family and friends. What can we do to prevent them from occurring? What lifestyle changes can we make? What are ways we can make these lifestyle changes have longevity and be consistent? On Tuesday, we will separate into the same small groups and discuss these questions above, and see what ideas the group members have in order to prevent diabetes and obesity from occurring. On Thursday, we will review and meet as an entire group to hear what ideas were discussed on Tuesday. We will explore as a group how to make these ideas into permanent lifestyle changes. Also, we will focus on commitment to yourself and internal and/or external motivators (such as family and friends).

Friends & Family: Giving and receiving support through relationships. God, Jesus, and Holy Spirit were the very first relationship. Even God exists in community. Coping with life is sometimes hard, but friends and family make it easier. You can both give and receive support through the relationships in your life.

Week 5

Nutrition: Making smart food choices and developing healthy eating habits. Good nutrition builds strong bodies that can lead to being whole people better connected to God. What you eat matters. Whatever your eating habits are now, you can increase your understanding of how food affects your overall well-being, learn to make smart food choices, and develop healthy eating habits.

Week 6

Making smart food choices in preventing/managing diabetes. Meet Tuesday and Thursday for 1 hour each, for a total of 2 hours per week. Educate on one of the main ways to prevent obesity and diabetes, which is nutrition . What is nutrition? How does it pertain to what I eat every day? On Tuesday, we will separate into the same small groups and discuss the importance of nutrition and the food we consume. We will ask them to log their meals from the previous day, then share with the group what that consists of. We will explore alternatives of some of the more unhealthy foods they are eating.

On Thursday, we will review and meet as an entire group to address as a group the important factors of nutrition. We will play This or That? where we have two different foods in which they decide what the healthier alternative is. After the alternative is known, we will explain why that alternative is beneficial and an option they should consider.

Movement: Discovering ways to enjoy physical activity. We were created to move. When you consider the way the parts of the body are hinged together and rotate and reach in every direction, its easy to see that God means for us to move. Its part of how we celebrate our body-and-spirit connection to God. No matter what your physical activity level is now, you can discover ways to enjoy movement.

Week 7

Movement: making healthy physical activity choices for preventing/managing your diabetes. Meet Tuesday and Thursday for 1 hour each, for a total of 2 hours per week. Educate on one of the other main ways to prevent obesity and diabetes, which is exercise, or movement. What is exercise? What are different ways we can exercise? Why is exercise beneficial to our health? What safety/health concerns do we need to be aware of before we exercise?

On Tuesday, we will separate into the same small groups and discuss the questions above; making sure each member understands exercise and its benefits, but also the safety concerns that accompany it.
On Thursday, we will review and meet as an entire group to make sure everyone understands the importance of exercise and safety while exercising. Then we will talk about different ways to exercise and the benefits of exercising with others, such as friends or family. We will teach a few simple stretching techniques as well for their warm-up and cool-down to exercising.

Work: Appreciating your skills, talents, and gifts. We were made to work, and the value of work is intrinsic. You can appreciate the skills, talents, and gifts you bring to your work situation, whatever it is. You can find meaning for your life through your job or volunteer commitments.

Week 8

Wrap Up: Review of previous weeks... Meet Tuesday and Thursday for 1 hour each, for a total of 2 hours per week. On Tuesday, we will review as an entire group the topics we have covered over the last 7 weeks. As we are reviewing, we will help them appreciate the learning they have accomplished, and the work they have put in to do so. The topics will include: what is obesity, what is diabetes, how are obesity and diabetes related, and how can we prevent obesity and diabetes? We can play jeopardy as a fun game to keep everyone engaged in the material. On Thursday, we will conduct post-test and collect results.

Implement the Program Model

We will use the Outreach Model (Community Tool

Box, 2013), and the Model for Healthy Living (The Church Health Center, 2010). Outreach is reaching out, but the type and degree of outreach depends on an efforts purpose, goals and target population. We are reaching out to minority communities in Chicago, our target population. The program will last for eight weeks to ensure they have awareness of the link between obesity and diabetes. They must have transportation to the church; rides can be coordinated to get to the church, or we could work with a local taxi company to provide reduced fare rides. We will have helpers to read the information or write

Implement the Program Model (continued)

We can educate in smaller groups so there is more

interaction. Our personal approach will be empowering our target population, showing that we care for them by increasing their knowledge and awareness. To implement effective outreach: we will meet people where they are, be respectful, listen to the communities, build trust and relationships, get the word out in a nonstigmatizing manner. Service and information will be offered in a variety of locations and at non-traditional times, especially after work hours. Written information will be friendly and easy to understand, information will be in the primary language of those who will use the service, and we will make sure to follow-up. Repeating information is very important to make it the most effective possible. This program will start as soon as our grant request is

Behavior Change Model (SCT light)

Our tp knows what to do?

We will ask our tp if they know that they should be aware of the link between obesity and diabetes. We will explain our program and how it will increase their awareness of this link.
Our tp knows how to do it?

We will explain the structure of our program, meeting for 8 weeks, twice a week on Tuesday and Thursday for an hour each. It will take place at a church in Chicago.
Our tp wants to do it (is motivated)?

We will give them incentive to want to learn and have an increased awareness. We can apply the information to their family and friends that may suffer diabetes or obesity, and cause them to want to help these individuals live longer and happier lives.
Our tp believes it can do it (is self-efficacious)?

We will empower them to want to learn and increase their awareness. We will use positive reinforcement to motivate them.
Our tp has a supportive environment?

The members of the church, priests, family and friends, employees of the health

Evaluation Design
PreTest On Diabesity Awareness Test Program Group Results: 10/40

Intervention

Post-Test On Diabesity Awareness Test Program Group Results:36/40

-Outreach Model
(Community Tool Box, 2013) -Model for Healthy Living (Church Health Center, 2010)

Pre-Test On Diabesity Awareness Test Control Group Results: 10/40

Post-Test On Diabesity Awareness Test Control Group Results: 10/40

What are the threats?

The threats to internal validity that may accompany

our evaluation design since they are not randomized are selection of our program and control groups. Since they are picked to be in the group, they could decide to not participate or alter their results. It is voluntary to participate in our program model.

Evaluate Mission Fit in Program

Our mission fit question is: Did we increase the

awareness of the link between diabetes and obesity in minority communities? Yes, we increased the awareness of the link between diabetes and obesity in minority communities. Our evidence that we met our mission is that the scores in the program group increased, as they were supposed to. The program group went from receiving a 10/40 on the pre-test, to receiving a 36/40 on the post-test. And the control group did not change, so our program made the difference.

Marketing and Communication

We would market through posters/flyers posted around the

city with visuals to make those aware in the churches of our education program. Our social marketing campaign can be executed through the radio, television newscasts, or the newspapers. We could display posters and pass out flyers with images that convey our education program; we would give this to the priest as well to hand out. The goal of our marketing will be to increase awareness of the link between obesity and diabetes. Because were dealing with a minority and low-income population, computers wont be accessible. Therefore, Facebook and other social media wouldnt be as effective for communicating throughout our program. We would communicate with local radio stations and newspapers. We could have a local television channel through the church we are working at in Chicago, aid in

Grant Information
The granting agency is the United States Department of Health

and Human Services. The mission of this agency is The mission of the Department of Health and Human Services is to help provide the building blocks that Americans need to live healthy, successful lives. We fulfill that mission every day by providing millions of children, families, and seniors with access to high-quality health care, by helping people find jobs and parents find affordable child care, by keeping the food on Americans shelves safe and infectious diseases at bay, and by pushing the boundaries of how we diagnose and treat disease, (US Department of Health and Human Services, 2013). The grants purpose is to test practical, sustainable, and cost efficient adaptations of efficacious strategies or approaches to prevent and treat diabetes and/or obesity. Our mission is to increase awareness of the link between obesity and diabetes. Therefore it is compatible with our mission, as the grant is aiming to prevent and treat diabetes and/or obesity. This is the link to the granting agency: http://www.hhs.gov. This is the link to the explanation of the grant:

Webliography
American Diabetes Association. (1999). Emerging Epidemic of Type 2 Diabetes in Youth. Retrieved September 24, 2013, from http://care.diabetesjournals.org/content/22/2/345.short Abate. N, and Chandalia, M. (2003, January). The impact of ethnicity on type 2 diabetes. Journal of Diabetes and its Complications. Volume 17. Issue 1. Retrieved September 28th, 2013, from http://www.sciencedirect.com/science/article/pii/S1056872702001903 Attia, P. (2013). Is the obesity crisis hiding a bigger problem? [video file]. Retrieved from http://www.ted.com/talks/peter_attia_what_if_we_re_wrong_about_diabetes.html (Church Health Center, 2010). Model for Healthy Living. Retrieved November 19, 2013 from, http://chreader.org/contentPage.aspx?resource_id=621. Community Tool Box, (2013). Section 6. Using Outreach to Increase Access. Retrieved October 10, 2013, from http://ctb.ku.edu/en/table-of-contents/implement/access-barriers-opportunities/outreach-to-increase-access/main Dandona, P., Aljada, A., & and Bandyopadhyay, A. (2004). Trends in Immunology - Inflammation: The Link Between Insulin Resistance, Obesity and Diabetes. Retrieved September 24, 2013. DeVille-Almond J., Tahrani AA, Grant J., Gray M., Thomas GN., Taheri S. (2011). Awareness of Obesity and Diabetes: a Survey... [Am J Mens Health. 2011] - PubMed - NCBI. Retrieved September 24, 2013, from http://www.ncbi.nlm.nih.gov/pubmed/20413385. Diabetic Care Services, (2013). A Codependent Relationship: Diabetes and Obesity. Retrieved October, 20 th, 2013, from http://www.diabeticcareservices.com/diabetes-education/diabetes-and-obesity

Webliography (continued)
Fitzgibbon. M, S.M, Dyer. A, VanHom. L and Christoffel. K. (2002, February). A Community-Based Obesity Prevention Program for Minority Children: Rationale and Study Design for Hip-Hop to Health Jr. Prevention Medicine. Volume 37. Issue 2. Retrieved from http://www.sciencedirect.com/science/article/pii/S0091743501909776

Fisher-Hoch. S, R. A, Wilson. G, S. J, Reininger. B, R. B, Mc Cornmik. J, and Perez, A. (2010, May, 7th). Socioeconomic Status and Prevalence of Obesity and Diabetes in a Mexican American Community, Cameron County, Texas, 2004-2007. Preventing Chronic Diseases. Public Health Research, Practice and Polices. Retrieved September 28th, 2013, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2879985/
Goran. M, Ball. G and Cruz. M, (2003, April). Obesity and Risk of Type 2 Diabetes and Cardiovascular Disease in Children and Adolescents. The journal of clinical endocrinology and Metabolism. Retrieved September 28th, 2013, from http://jcem.endojournals.org/content/88/4/1417.full Horowitz, C. (2004). American Public Health Association - Barriers to Buying Healthy Foods for People With Diabetes: Evidence of Environmental Disparities. Retrieved September 24, 2013, from http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.94.9.1549 Kumanyika, S., & Grier, S. (2006). Project MUSE - Targeting Interventions for Ethnic Minority and LowIncome Populations. Retrieved September 24, 2013, from http://muse.jhu.edu/journals/foc/summary/v016/16.1kumanyika.html Lipton. R, D. M, Burnet. D, R. B, Cooper. A, B. E, and Hagopian. W. (2005, May 1st). Obesity at the Onset of Diabetes in an Ethnically Diverse Population of Children: What Does It Mean for Epidemiologists and Clinicians? Journal of the American Academy of Pediatrics. Retrieved September,

Webliography (continued)
Mokdad, A., Bowman, B., Ford, E.,Vinicor, F., Marks, J., Koplan, J. (2001). JAMA Network | JAMA | The Continuing Epidemics of Obesity and Diabetes in the United States. Retrieved September 24, 2013, from http://jama.jamanetwork.com/article.aspx?articleid=194179. Oldroyd. J, Banerjee. M, and Heald. A, (2005, September, 18th). Diabetes and ethnic minorities. Postgraduate Medical Journal. Volume 81, Issue 958 . Retrieved September, 28th, 2013, from http://pmj.bmj.com/content/81/958/486.full.html#ref-list-1

Ornish, D. (2013). The killer American diet that's sweeping the planet [video file]. Retrieved from http://www.ted.com/talks/dean_ornish_on_the_world_s_killer_diet.html
Nevins. S, and Hoffman .J, (2012, May 10th). The Weight of the Nation: Children in Crisis. Top Documentary Films. Retrieved fromhttp://topdocumentaryfilms.com/weight-nationchildren-crisis/ Rushing Josh. (2012, October, 9th). Fast Food, Fat Profits: Obesity in America. Top Documentary Film. Retrieved from http://topdocumentaryfilms.com/fast-food-fat-profitsobesity-america/ Shimabukuro, M. (1998). Fatty Acid-induced Cell Apoptosis: A Link Between Obesity andDiabetes. Retrieved September 24, 2013, from http://www.pnas.org/content/95/5/2498.short

Reflection
I believe that this project has helped me develop the necessary skills intellectually, both in my personal growth and my professional growth in my field of community health education. Working with a partner on this project has made me to discover my work ethic and improve the areas I was falling short. In my opinion, you gain knowledge through learning from mistakes you made. Also, putting more time on reading materials and finding evidence from literature reviews. During the beginning of this course, the informations and terminology were so difficult to understand for me. This course was very difficult, my intellectual was challenged, and critical thinking skills were put to the test. I was able to develop my critical thinking skills and professional intelligence after overcome the challenges. Also, my leadership skills and communication skills have also improved over the period of taking this course. Now I have a strong understanding of the material. I will use this knowledge to develop a program if I work on an agency. I will use method of evaluation within that agency to help it reach its overall goal, or mission. Also, I am able to assist someone or organization in doing research and finding evidence-based information that is valid and reliable. Overall, I strongly believe that writing this paper and completing this project has made me a more knowledgeable individual. At the beginning of this project myself and my partner started off as strangers and as the work went on we gained confidence, trusted in each other, and learned how to work as a team to accomplish our program planning

Reflection (continued)
From my perspective, I feel as though this project has helped my professional growth develop relative to the program planning/evaluation process. When the course began, I had a brief overview of what this process involved, based off the knowledge from other classes, but not a clear path of where it would go. It was difficult at first to decide on a mission with my partner. We had the idea of what we wanted; it was just the wording of our mission that was difficult. This involved evaluating who we wanted our target population to be, and how exactly we wanted to explain a relationship between obesity and diabetes. Once this was clarified and confirmed, we were able to begin researching. I have a very good understanding of how the program planning/evaluation process works and feel like I could apply this to any situation or problem. I can assess a general need to have a warrant for proceeding. I am able to now to distinguish between what the dependent and independent variables are, and what the target population is. From this, I can assess the general need, identify measurable objectives, find an evidence-based program, implement it, and then evaluate. I feel confident that I could be thrown into a

Reflection (continued)
My independent/self-directed learning has improved through this project. Each time Cinti and I met, we were able to discuss the topic more and more in depth. Aside from meeting, we had our own individual tasks and goals we had to accomplish for the project each week. When we had to find the literature and review it, this really pushed my independent learning. It took it to a different level, as I had to not only read a piece and analyze it, but evaluate it through the program planning and evaluation process. I had to identify new parts, like the measurable objectives in the piece. This process really helped to have a grasp and good understanding of the piece. Also, my critical thinking, as far as determining what research is valid and finding/using valid materials has improved. When we had to ask the questions of each piece, I was able to sort through the false material and see what the true research of the piece was. In addition, my collaborative learning increased through this project. Working with Cinti provided me with another way of thinking and understanding the material. We were able to problem solve, sort out information, and decide what would work best. Through this, we were able to understand how each of us learned and processed information. We were able to work together to achieve common goals. Diabetes and obesity are both topics we share a passion for, so it worked out well in researching them. I was able to look at them from more of a medical