Assignment Prompt & Instructions
– ## HealthPromotionProposal2.docx
– ## HealthPromotionProposal2.docx
**## HealthPromotionProposal2.docx**
Health Promotion Proposal, Part 2
**Exercise Instructions**
**Health Promotion Proposal, Part 2**
**This is a continuation of the health promotion program proposal, part one**, which you submitted previously.
Please approach this assignment as an opportunity to integrate instructor feedback from part I and expand on ideas adhering to the components of the MAP-IT strategy. Include necessary levels of detail you feel appropriate to assure stakeholder buy-in.
**Directions**
You have already completed the steps 1-4.
**Do not resubmit part 1.** Make sure you incorporate any suggested revisions or improvements into your submission according to your instructor’s comments.
**To assist in maintaining harmony between Part I and 2 here you have a reminder of the previous paper outline:**
· 1. Describe the health problem. Using data and statistics support your claim that the issue you selected is a problem. What specifically will you address in your proposed health promotion program? Be sure your proposed outcome is realistic and measurable.
· 2. Describe the vulnerable population and setting. What are the risk factors that make this a vulnerable population? Use evidence to support the risk factors you have identified.
· 3. Provide a review of literature from scholarly journals on evidence-based interventions that address the problem. After completing a library search related to effective interventions for your chosen health promotion activity, you will write a review that evaluates the strengths and weaknesses of all the sources you have found. You might consult research texts for information on how to write a review of the literature found in your search.
· 4. Select an appropriate health promotion/disease prevention theoretical framework or conceptual model that would best serve as the framework guiding the proposal. Provide a rationale for your selection which includes a discussion of the concepts of the selected model
**For this assignment develop criteria 5-8 as detailed below:**
**You will submit just this section 5-8 as an essay. Please do not resubmit Part 1.**
Use a presentation page. Start the body of content with topic 5.
· 5. Propose a health promotion program using an evidence-based intervention found in your literature search to address the problem in the selected population/setting. Include a thorough discussion of the specifics of this intervention which includes resources necessary, those involved, and feasibility for a nurse in an advanced role.
· Be certain to include a timeline. (3 to 4 paragraphs- you may use bullets if appropriate).
· 6. Thoroughly describe the intended outcomes. Describe the outcomes in detail concurrent with the SMART goal approach.
**The SMART goal statement should be no more than one sentence** (1 paragraph).
· 7. Provide a detailed plan for the evaluation of each outcome. (2-3 paragraphs).
· 8. Thoroughly describe possible barriers/challenges to implementing the proposed project as well as strategies to address these barriers/challenges. (2+ paragraphs).
· Finish the paper with a conclusion paragraph (2 paragraphs) without typing the word "conclusion" before the paragraph.
**Paper Requirements**
This assignment is to be submitted as an essay- with an introduction, questions developed at the graduate level, and a conclusion to summarize and synthesize key points. Remember, your Proposal must be a scholarly paper demonstrating graduate school-level writing and critical analysis of existing nursing knowledge about health promotion.
APA must be strictly followed.
Your final assignment should be minimally 5 pages (excluding title page and references).
Finish the essay with your reference page.
**Please review the Grading Rubric for this Assignment.**
s
**## HealthPromotionProposal2.docx**
2
**Health Promotion Proposal: Type 2 Diabetes Mellitus in Vulnerable Populations**
Antonio Estremera
Florida National University
Health Promotion & Role Development in Adv. Nursing Practice
Dr. Nora Hernandez-Pupo
May 31, 2025
**Health Promotion Proposal: Type 2 Diabetes Mellitus in Vulnerable Populations**
Type 2 Diabetes Mellitus (T2DM) is a progressive, chronic metabolic condition typified by insulin resistance and impaired glucose regulation. T2DM is a public health priority because its rapidly growing prevalence and associated devastating complications like cardiovascular disease, nephropathy, neuropathy, and retinopathy impose colossal burdens on healthcare systems and societies. T2DM is estimated to affect 537 million adults in 2021 and is expected to rise to 783 million in 2045 (Yameny, 2024). This increase is due to urbanization, physical inactivity, unhealthy diets, and aging. Low- and middle-income countries account for almost 75% of the diabetes burden, which is glaring evidence of disparities in resources and infrastructure (Sun et al., 2022). The human cost, expressed as mortality and morbidity, and the financial cost, point distinctly to the imperative for effective health promotion interventions to avert and manage T2DM. The proposal, therefore, is based on implementing a health promotion program for the community targeting vulnerable groups to enhance lifestyle behavior, disease care, and the consequent reduction in T2DM occurrences and complications. The program outcome will be gauged using glycemic control (the HbA1c levels) and self-reported adherence to recommended lifestyle as the outcome measures and indicators for success within six months.
**Definition of Vulnerable Population**
This program focuses on low-income, urban minority adults, with a specific focus on African American and Hispanic individuals, who have disproportionately high levels of T2DM and complications. In the US, 37.3 million individuals have diabetes, with type 2 diabetes accounting for 90–95% of the total (Chen et al., 2025). Racial and ethnic minorities carry a disproportionate burden; for instance, American Indian and Alaska Native adults are 2.5 times more likely than their White counterparts to have diabetes, and Hispanic adults report similar rates (CDC, 2024). Such disparities stem from multifaceted social determinants of health like poverty, unhealthy food access, housing instability, and health care access inadequacies (Khavjou et al., 2024). Cultural factors, language use, and health illiteracies further enhance vulnerability, leading to delays in diagnosis, poor disease management, and increased complication rates (CDC, 2024)
These risk factors have been well documented in epidemiological studies. For instance, several ways have been suggested as to how food insecurity can cause higher diabetes risk and related problems. Consumers experiencing food insecurity might buy affordable, energy-packed foods, which can increase their risk of obesity and diabetes. The anxiety that comes with insufficient food may also harm metabolism, possibly leading to weight increase and insulin problems (Maudrie et al., 2022)
**.** These vulnerabilities necessitate culturally tailored health promotion interventions that address individual behaviors and structural barriers to care.
**Review of Evidence-Based Interventions for Type 2 Diabetes Management**
The randomized controlled trial by Ory et al. (2025) evaluated three diabetes self-management education and support (DSMES) interventions among adults with Type 2 Diabetes Mellitus (T2DM) in Texas, covering rural and urban populations. The study compared an asynchronous virtual education program with personalized counseling (vMMWD), a technology-based self-guided support tool (TBES), and a combination. Results showed all three interventions significantly reduced hemoglobin A1c (HbA1c) at 3 and 6 months, with sustained improvements. The combined intervention did not outperform individual modalities, suggesting that each alone effectively improves glycemic control. Similar benefits were observed in rural and urban participants, highlighting broad accessibility. Strengths include the rigorous randomized design, large sample size with high retention (~90%), and inclusion of underserved rural populations. The long follow-up supports the interventions’ lasting effects. Limitations include the inability to track specific engagement metrics within the TBES tool and the lack of differential analysis by race or socioeconomic status, suggesting that tailored strategies may be necessary for diverse groups.
Gerber et al. (2023) investigated a mobile health (mHealth) intervention combining clinical pharmacists and health coaches to improve glycemic control in African American and Latinx adults with T2DM, disproportionately affected by diabetes. The randomized clinical trial included 221 participants from a Chicago urban medical center. The intervention provided remote pharmacist telehealth support and health coaching through home visits, calls, and text messages. After 12 months, HbA1c decreased by 0.79 percentage points, a reduction sustained through 24 months and greater than reductions reported in prior similar trials (0.42–0.45 points). The success was attributed to addressing barriers like transportation and telehealth access, with health coaches facilitating virtual visits and reinforcing medication adherence and lifestyle changes. Strengths include focusing on underrepresented minorities, providing long follow-ups, and integrating social determinants of health. Limitations involve challenges integrating health coaches into healthcare teams, patient technology use variability, and limited economic impact and scalability data.
**Evaluation of Literature on Diabetes Self-Management Interventions**
Both studies provide compelling evidence supporting the efficacy of technology-enhanced self-management interventions for improving glycemic control among adults with T2DM. Ory et al.’s (2025) research advances the understanding that virtual asynchronous education, personalized counseling, or self-guided digital tools can achieve clinically meaningful reductions in A1c across diverse geographic settings, including underserved rural populations. These findings show that these options can work well in many settings and suit patients' preferences. The study also uses a well-designed RCT and tracks lasting results, increasing its findings' reliability outside the study. However, since tracking how patients interact online is challenging, it’s harder to interpret how different doses affect them. Additional studies might look at detailed patient usage and implement interventions flexible to changing patient habits.
Gerber et al. (2023) add to these results by demonstrating that integrating clinical pharmacists and health coaches with mHealth tools can effectively close racial and ethnic minority disparities in glycemic control, including among African Americans and Latinx individuals. The strength of this trial is its culturally appropriate strategy that targets structural barriers, including access to transportation and digital competency, through tailored support and telehealth facilitation. The longer follow-up to 24 months is also beneficial in demonstrating the durability of the effects, a factor of great importance in the chronic disease situation. However, the study identifies limitations in integrating health coaches as part of the conventional healthcare team, which could impact the implementation fidelity and the overall sustainability. Economic evaluations and scalability studies are still critical next steps toward the broader implementation, particularly in resource-scarce settings.
Collectively, the studies reinforce the potential of technology-facilitated, patient-centered diabetes self-care programs but identify significant areas for improvement. Future research must focus on maximizing engagement tracking, tailoring interventions to patient sociodemographic and clinical factors, and solving the implementation barriers in healthcare systems. Additionally, incorporating the social determinants of health, as included in Gerber et al.’s intervention, is vital for reducing disparities and achieving equitable outcomes. Both interventions show that varied T2DM groups need adaptive, accessible, and culturally relevant diabetic care.
**Theoretical/Conceptual Framework**
The Health Belief Model (HBM) is a proper theoretical model to inform this health promotion proposal for Type 2 Diabetes Mellitus (T2DM) among vulnerable groups. HBM studies factors such as how likely someone is to get a disease, how severe they think it would be, the benefits of taking action, what stops them from acting, and cues that motivate them to make healthy choices (Alyafei & Easton-Carr, 2024). Considering the difficulties caused by limited understanding of health information, cultural diversity, and financial restrictions, these constructs matter a lot for understanding lower-income, minority adults’ actions and understanding regarding diabetes.
As a result of the HBM, the program can customize programs that focus on raising diabetes awareness, praising lifestyle changes, and working to reduce difficulties such as access to healthy meals and cultural resources. Community health workers sending reminders and checking on progress, along with opportunities for education and peer support, result in participants feeling encouraged to continue caring about their health. The holistic approach of this model is consistent with the evidence for culturally appropriate diabetes interventions and provides a sound basis for enhancing health outcomes among the target vulnerable groups.
**References**
Alyafei, A., & Easton-Carr, R. (2024, May 19).
_The Health Belief Model of Behavior Change_. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK606120/
Centers for Disease Control and Prevention. (2024).
_National Diabetes statistics report_. Diabetes. https://www.cdc.gov/diabetes/php/data-research/index.html
Chen, X., Zhang, L., & Chen, W. (2025). Global, regional, and national burdens of type 1 and type 2 diabetes mellitus in adolescents from 1990 to 2021, with forecasts to 2030: a systematic analysis of the global burden of disease study 2021.
_BMC medicine_,
_23_(1), 48.
[https://doi.org/10.1186/s12916-025-03890-w](https://doi.org/10.1186/s12916-025-03890-w)
Gerber, B. S., Biggers, A., Tilton, J. J., Smith, D. E., Lane, R., Mihăilescu, D., Lee, J.-A., & Sharp, L. K. (2023). Mobile health intervention in patients with type 2 diabetes.
_JAMA Network Open_,
_6_(9), e2333629–e2333629. https://doi.org/10.1001/jamanetworkopen.2023.33629
Khavjou, O. A., Sun, M., D’Angelo, S. R., Neuwahl, S. J., Hoerger, T. J., Cho, P., … & Zhang, P. (2024). Economic costs attributed to diagnosed diabetes in each US State and the District of Columbia: 2021.
_Diabetes Care_, dc240832.
[https://doi.org/10.2337/dc24-0832](https://doi.org/10.2337/dc24-0832)
Maudrie, T. L., Aulandez, K. M. W., O’Keefe, V. M., Whitfield, F. R., Walls, M. L., & Hautala, D. S. (2022). Food stress and diabetes-related psychosocial outcomes in american indian communities: A mixed methods approach.
_Journal of Nutrition Education and Behavior_,
_54_(12). https://doi.org/10.1016/j.jneb.2022.06.004
Ory, M. G., Han, G., Nsobundu, C., Carpenter, K., Towne, S. D., & Smith, M. L. (2025). Comparative effectiveness of diabetes self-management education and support intervention strategies among adults with type 2 diabetes in Texas.
_Frontiers in Public Health_,
_13_.
[https://doi.org/10.3389/fpubh.2025.1543298](https://doi.org/10.3389/fpubh.2025.1543298)
Sun, P., Wen, H., Liu, X., Ma, Y., Jang, J., & Yu, C. (2022). Time trends in type 2 diabetes mellitus incidence across the BRICS from 1990 to 2019: an age-period-cohort analysis.
_BMC Public Health_,
_22_, 1-14.
[https://doi.org/10.1186/s12889-021-12485-y](https://doi.org/10.1186/s12889-021-12485-y)
Yameny, A. A. (2024). Diabetes mellitus overview 2024.
_Journal of Bioscience and Applied Research_,
_10_(3), 641-645.
[https://doi.org/10.21608/jbaar.2024.382794](https://doi.org/10.21608/jbaar.2024.382794)
**## HealthPromotionProposal2.docx**
2
**Health Promotion Proposal: Type 2 Diabetes Mellitus in Vulnerable Populations**
Antonio Estremera
Florida National University
Health Promotion & Role Development in Adv. Nursing Practice
Dr. Nora Hernandez-Pupo
May 31, 2025
**Health Promotion Proposal: Type 2 Diabetes Mellitus in Vulnerable Populations**
Type 2 Diabetes Mellitus (T2DM) is a progressive, chronic metabolic condition typified by insulin resistance and impaired glucose regulation. T2DM is a public health priority because its rapidly growing prevalence and associated devastating complications like cardiovascular disease, nephropathy, neuropathy, and retinopathy impose colossal burdens on healthcare systems and societies. T2DM is estimated to affect 537 million adults in 2021 and is expected to rise to 783 million in 2045 (Yameny, 2024). This increase is due to urbanization, physical inactivity, unhealthy diets, and aging. Low- and middle-income countries account for almost 75% of the diabetes burden, which is glaring evidence of disparities in resources and infrastructure (Sun et al., 2022). The human cost, expressed as mortality and morbidity, and the financial cost, point distinctly to the imperative for effective health promotion interventions to avert and manage T2DM. The proposal, therefore, is based on implementing a health promotion program for the community targeting vulnerable groups to enhance lifestyle behavior, disease care, and the consequent reduction in T2DM occurrences and complications. The program outcome will be gauged using glycemic control (the HbA1c levels) and self-reported adherence to recommended lifestyle as the outcome measures and indicators for success within six months.
**Definition of Vulnerable Population**
This program focuses on low-income, urban minority adults, with a specific focus on African American and Hispanic individuals, who have disproportionately high levels of T2DM and complications. In the US, 37.3 million individuals have diabetes, with type 2 diabetes accounting for 90–95% of the total (Chen et al., 2025). Racial and ethnic minorities carry a disproportionate burden; for instance, American Indian and Alaska Native adults are 2.5 times more likely than their White counterparts to have diabetes, and Hispanic adults report similar rates (CDC, 2024). Such disparities stem from multifaceted social determinants of health like poverty, unhealthy food access, housing instability, and health care access inadequacies (Khavjou et al., 2024). Cultural factors, language use, and health illiteracies further enhance vulnerability, leading to delays in diagnosis, poor disease management, and increased complication rates (CDC, 2024)
These risk factors have been well documented in epidemiological studies. For instance, several ways have been suggested as to how food insecurity can cause higher diabetes risk and related problems. Consumers experiencing food insecurity might buy affordable, energy-packed foods, which can increase their risk of obesity and diabetes. The anxiety that comes with insufficient food may also harm metabolism, possibly leading to weight increase and insulin problems (Maudrie et al., 2022)
**.** These vulnerabilities necessitate culturally tailored health promotion interventions that address individual behaviors and structural barriers to care.
**Review of Evidence-Based Interventions for Type 2 Diabetes Management**
The randomized controlled trial by Ory et al. (2025) evaluated three diabetes self-management education and support (DSMES) interventions among adults with Type 2 Diabetes Mellitus (T2DM) in Texas, covering rural and urban populations. The study compared an asynchronous virtual education program with personalized counseling (vMMWD), a technology-based self-guided support tool (TBES), and a combination. Results showed all three interventions significantly reduced hemoglobin A1c (HbA1c) at 3 and 6 months, with sustained improvements. The combined intervention did not outperform individual modalities, suggesting that each alone effectively improves glycemic control. Similar benefits were observed in rural and urban participants, highlighting broad accessibility. Strengths include the rigorous randomized design, large sample size with high retention (~90%), and inclusion of underserved rural populations. The long follow-up supports the interventions’ lasting effects. Limitations include the inability to track specific engagement metrics within the TBES tool and the lack of differential analysis by race or socioeconomic status, suggesting that tailored strategies may be necessary for diverse groups.
Gerber et al. (2023) investigated a mobile health (mHealth) intervention combining clinical pharmacists and health coaches to improve glycemic control in African American and Latinx adults with T2DM, disproportionately affected by diabetes. The randomized clinical trial included 221 participants from a Chicago urban medical center. The intervention provided remote pharmacist telehealth support and health coaching through home visits, calls, and text messages. After 12 months, HbA1c decreased by 0.79 percentage points, a reduction sustained through 24 months and greater than reductions reported in prior similar trials (0.42–0.45 points). The success was attributed to addressing barriers like transportation and telehealth access, with health coaches facilitating virtual visits and reinforcing medication adherence and lifestyle changes. Strengths include focusing on underrepresented minorities, providing long follow-ups, and integrating social determinants of health. Limitations involve challenges integrating health coaches into healthcare teams, patient technology use variability, and limited economic impact and scalability data.
**Evaluation of Literature on Diabetes Self-Management Interventions**
Both studies provide compelling evidence supporting the efficacy of technology-enhanced self-management interventions for improving glycemic control among adults with T2DM. Ory et al.’s (2025) research advances the understanding that virtual asynchronous education, personalized counseling, or self-guided digital tools can achieve clinically meaningful reductions in A1c across diverse geographic settings, including underserved rural populations. These findings show that these options can work well in many settings and suit patients' preferences. The study also uses a well-designed RCT and tracks lasting results, increasing its findings' reliability outside the study. However, since tracking how patients interact online is challenging, it’s harder to interpret how different doses affect them. Additional studies might look at detailed patient usage and implement interventions flexible to changing patient habits.
Gerber et al. (2023) add to these results by demonstrating that integrating clinical pharmacists and health coaches with mHealth tools can effectively close racial and ethnic minority disparities in glycemic control, including among African Americans and Latinx individuals. The strength of this trial is its culturally appropriate strategy that targets structural barriers, including access to transportation and digital competency, through tailored support and telehealth facilitation. The longer follow-up to 24 months is also beneficial in demonstrating the durability of the effects, a factor of great importance in the chronic disease situation. However, the study identifies limitations in integrating health coaches as part of the conventional healthcare team, which could impact the implementation fidelity and the overall sustainability. Economic evaluations and scalability studies are still critical next steps toward the broader implementation, particularly in resource-scarce settings.
Collectively, the studies reinforce the potential of technology-facilitated, patient-centered diabetes self-care programs but identify significant areas for improvement. Future research must focus on maximizing engagement tracking, tailoring interventions to patient sociodemographic and clinical factors, and solving the implementation barriers in healthcare systems. Additionally, incorporating the social determinants of health, as included in Gerber et al.’s intervention, is vital for reducing disparities and achieving equitable outcomes. Both interventions show that varied T2DM groups need adaptive, accessible, and culturally relevant diabetic care.
**Theoretical/Conceptual Framework**
The Health Belief Model (HBM) is a proper theoretical model to inform this health promotion proposal for Type 2 Diabetes Mellitus (T2DM) among vulnerable groups. HBM studies factors such as how likely someone is to get a disease, how severe they think it would be, the benefits of taking action, what stops them from acting, and cues that motivate them to make healthy choices (Alyafei & Easton-Carr, 2024). Considering the difficulties caused by limited understanding of health information, cultural diversity, and financial restrictions, these constructs matter a lot for understanding lower-income, minority adults’ actions and understanding regarding diabetes.
As a result of the HBM, the program can customize programs that focus on raising diabetes awareness, praising lifestyle changes, and working to reduce difficulties such as access to healthy meals and cultural resources. Community health workers sending reminders and checking on progress, along with opportunities for education and peer support, result in participants feeling encouraged to continue caring about their health. The holistic approach of this model is consistent with the evidence for culturally appropriate diabetes interventions and provides a sound basis for enhancing health outcomes among the target vulnerable groups.
**References**
Alyafei, A., & Easton-Carr, R. (2024, May 19).
_The Health Belief Model of Behavior Change_. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK606120/
Centers for Disease Control and Prevention. (2024).
_National Diabetes statistics report_. Diabetes. https://www.cdc.gov/diabetes/php/data-research/index.html
Chen, X., Zhang, L., & Chen, W. (2025). Global, regional, and national burdens of type 1 and type 2 diabetes mellitus in adolescents from 1990 to 2021, with forecasts to 2030: a systematic analysis of the global burden of disease study 2021.
_BMC medicine_,
_23_(1), 48.
[https://doi.org/10.1186/s12916-025-03890-w](https://doi.org/10.1186/s12916-025-03890-w)
Gerber, B. S., Biggers, A., Tilton, J. J., Smith, D. E., Lane, R., Mihăilescu, D., Lee, J.-A., & Sharp, L. K. (2023). Mobile health intervention in patients with type 2 diabetes.
_JAMA Network Open_,
_6_(9), e2333629–e2333629. https://doi.org/10.1001/jamanetworkopen.2023.33629
Khavjou, O. A., Sun, M., D’Angelo, S. R., Neuwahl, S. J., Hoerger, T. J., Cho, P., … & Zhang, P. (2024). Economic costs attributed to diagnosed diabetes in each US State and the District of Columbia: 2021.
_Diabetes Care_, dc240832.
[https://doi.org/10.2337/dc24-0832](https://doi.org/10.2337/dc24-0832)
Maudrie, T. L., Aulandez, K. M. W., O’Keefe, V. M., Whitfield, F. R., Walls, M. L., & Hautala, D. S. (2022). Food stress and diabetes-related psychosocial outcomes in american indian communities: A mixed methods approach.
_Journal of Nutrition Education and Behavior_,
_54_(12). https://doi.org/10.1016/j.jneb.2022.06.004
Ory, M. G., Han, G., Nsobundu, C., Carpenter, K., Towne, S. D., & Smith, M. L. (2025). Comparative effectiveness of diabetes self-management education and support intervention strategies among adults with type 2 diabetes in Texas.
_Frontiers in Public Health_,
_13_.
[https://doi.org/10.3389/fpubh.2025.1543298](https://doi.org/10.3389/fpubh.2025.1543298)
Sun, P., Wen, H., Liu, X., Ma, Y., Jang, J., & Yu, C. (2022). Time trends in type 2 diabetes mellitus incidence across the BRICS from 1990 to 2019: an age-period-cohort analysis.
_BMC Public Health_,
_22_, 1-14.
[https://doi.org/10.1186/s12889-021-12485-y](https://doi.org/10.1186/s12889-021-12485-y)
Yameny, A. A. (2024). Diabetes mellitus overview 2024.
_Journal of Bioscience and Applied Research_,
_10_(3), 641-645.
[https://doi.org/10.21608/jbaar.2024.382794](https://doi.org/10.21608/jbaar.2024.382794)
**## HealthPromotionProposal2.docx**
Health Promotion Proposal, Part 2
**Exercise Instructions**
**Health Promotion Proposal, Part 2**
**This is a continuation of the health promotion program proposal, part one**, which you submitted previously.
Please approach this assignment as an opportunity to integrate instructor feedback from part I and expand on ideas adhering to the components of the MAP-IT strategy. Include necessary levels of detail you feel appropriate to assure stakeholder buy-in.
**Directions**
You have already completed the steps 1-4.
**Do not resubmit part 1.** Make sure you incorporate any suggested revisions or improvements into your submission according to your instructor’s comments.
**To assist in maintaining harmony between Part I and 2 here you have a reminder of the previous paper outline:**
· 1. Describe the health problem. Using data and statistics support your claim that the issue you selected is a problem. What specifically will you address in your proposed health promotion program? Be sure your proposed outcome is realistic and measurable.
· 2. Describe the vulnerable population and setting. What are the risk factors that make this a vulnerable population? Use evidence to support the risk factors you have identified.
· 3. Provide a review of literature from scholarly journals on evidence-based interventions that address the problem. After completing a library search related to effective interventions for your chosen health promotion activity, you will write a review that evaluates the strengths and weaknesses of all the sources you have found. You might consult research texts for information on how to write a review of the literature found in your search.
· 4. Select an appropriate health promotion/disease prevention theoretical framework or conceptual model that would best serve as the framework guiding the proposal. Provide a rationale for your selection which includes a discussion of the concepts of the selected model
**For this assignment develop criteria 5-8 as detailed below:**
**You will submit just this section 5-8 as an essay. Please do not resubmit Part 1.**
Use a presentation page. Start the body of content with topic 5.
· 5. Propose a health promotion program using an evidence-based intervention found in your literature search to address the problem in the selected population/setting. Include a thorough discussion of the specifics of this intervention which includes resources necessary, those involved, and feasibility for a nurse in an advanced role.
· Be certain to include a timeline. (3 to 4 paragraphs- you may use bullets if appropriate).
· 6. Thoroughly describe the intended outcomes. Describe the outcomes in detail concurrent with the SMART goal approach.
**The SMART goal statement should be no more than one sentence** (1 paragraph).
· 7. Provide a detailed plan for the evaluation of each outcome. (2-3 paragraphs).
· 8. Thoroughly describe possible barriers/challenges to implementing the proposed project as well as strategies to address these barriers/challenges. (2+ paragraphs).
· Finish the paper with a conclusion paragraph (2 paragraphs) without typing the word "conclusion" before the paragraph.
**Paper Requirements**
This assignment is to be submitted as an essay- with an introduction, questions developed at the graduate level, and a conclusion to summarize and synthesize key points. Remember, your Proposal must be a scholarly paper demonstrating graduate school-level writing and critical analysis of existing nursing knowledge about health promotion.
APA must be strictly followed.
Your final assignment should be minimally 5 pages (excluding title page and references).
Finish the essay with your reference page.
**Please review the Grading Rubric for this Assignment.**
s
**## HealthPromotionProposal2.docx**
2
**Health Promotion Proposal: Type 2 Diabetes Mellitus in Vulnerable Populations**
Antonio Estremera
Florida National University
Health Promotion & Role Development in Adv. Nursing Practice
Dr. Nora Hernandez-Pupo
May 31, 2025
**Health Promotion Proposal: Type 2 Diabetes Mellitus in Vulnerable Populations**
Type 2 Diabetes Mellitus (T2DM) is a progressive, chronic metabolic condition typified by insulin resistance and impaired glucose regulation. T2DM is a public health priority because its rapidly growing prevalence and associated devastating complications like cardiovascular disease, nephropathy, neuropathy, and retinopathy impose colossal burdens on healthcare systems and societies. T2DM is estimated to affect 537 million adults in 2021 and is expected to rise to 783 million in 2045 (Yameny, 2024). This increase is due to urbanization, physical inactivity, unhealthy diets, and aging. Low- and middle-income countries account for almost 75% of the diabetes burden, which is glaring evidence of disparities in resources and infrastructure (Sun et al., 2022). The human cost, expressed as mortality and morbidity, and the financial cost, point distinctly to the imperative for effective health promotion interventions to avert and manage T2DM. The proposal, therefore, is based on implementing a health promotion program for the community targeting vulnerable groups to enhance lifestyle behavior, disease care, and the consequent reduction in T2DM occurrences and complications. The program outcome will be gauged using glycemic control (the HbA1c levels) and self-reported adherence to recommended lifestyle as the outcome measures and indicators for success within six months.
**Definition of Vulnerable Population**
This program focuses on low-income, urban minority adults, with a specific focus on African American and Hispanic individuals, who have disproportionately high levels of T2DM and complications. In the US, 37.3 million individuals have diabetes, with type 2 diabetes accounting for 90–95% of the total (Chen et al., 2025). Racial and ethnic minorities carry a disproportionate burden; for instance, American Indian and Alaska Native adults are 2.5 times more likely than their White counterparts to have diabetes, and Hispanic adults report similar rates (CDC, 2024). Such disparities stem from multifaceted social determinants of health like poverty, unhealthy food access, housing instability, and health care access inadequacies (Khavjou et al., 2024). Cultural factors, language use, and health illiteracies further enhance vulnerability, leading to delays in diagnosis, poor disease management, and increased complication rates (CDC, 2024)
These risk factors have been well documented in epidemiological studies. For instance, several ways have been suggested as to how food insecurity can cause higher diabetes risk and related problems. Consumers experiencing food insecurity might buy affordable, energy-packed foods, which can increase their risk of obesity and diabetes. The anxiety that comes with insufficient food may also harm metabolism, possibly leading to weight increase and insulin problems (Maudrie et al., 2022)
**.** These vulnerabilities necessitate culturally tailored health promotion interventions that address individual behaviors and structural barriers to care.
**Review of Evidence-Based Interventions for Type 2 Diabetes Management**
The randomized controlled trial by Ory et al. (2025) evaluated three diabetes self-management education and support (DSMES) interventions among adults with Type 2 Diabetes Mellitus (T2DM) in Texas, covering rural and urban populations. The study compared an asynchronous virtual education program with personalized counseling (vMMWD), a technology-based self-guided support tool (TBES), and a combination. Results showed all three interventions significantly reduced hemoglobin A1c (HbA1c) at 3 and 6 months, with sustained improvements. The combined intervention did not outperform individual modalities, suggesting that each alone effectively improves glycemic control. Similar benefits were observed in rural and urban participants, highlighting broad accessibility. Strengths include the rigorous randomized design, large sample size with high retention (~90%), and inclusion of underserved rural populations. The long follow-up supports the interventions’ lasting effects. Limitations include the inability to track specific engagement metrics within the TBES tool and the lack of differential analysis by race or socioeconomic status, suggesting that tailored strategies may be necessary for diverse groups.
Gerber et al. (2023) investigated a mobile health (mHealth) intervention combining clinical pharmacists and health coaches to improve glycemic control in African American and Latinx adults with T2DM, disproportionately affected by diabetes. The randomized clinical trial included 221 participants from a Chicago urban medical center. The intervention provided remote pharmacist telehealth support and health coaching through home visits, calls, and text messages. After 12 months, HbA1c decreased by 0.79 percentage points, a reduction sustained through 24 months and greater than reductions reported in prior similar trials (0.42–0.45 points). The success was attributed to addressing barriers like transportation and telehealth access, with health coaches facilitating virtual visits and reinforcing medication adherence and lifestyle changes. Strengths include focusing on underrepresented minorities, providing long follow-ups, and integrating social determinants of health. Limitations involve challenges integrating health coaches into healthcare teams, patient technology use variability, and limited economic impact and scalability data.
**Evaluation of Literature on Diabetes Self-Management Interventions**
Both studies provide compelling evidence supporting the efficacy of technology-enhanced self-management interventions for improving glycemic control among adults with T2DM. Ory et al.’s (2025) research advances the understanding that virtual asynchronous education, personalized counseling, or self-guided digital tools can achieve clinically meaningful reductions in A1c across diverse geographic settings, including underserved rural populations. These findings show that these options can work well in many settings and suit patients' preferences. The study also uses a well-designed RCT and tracks lasting results, increasing its findings' reliability outside the study. However, since tracking how patients interact online is challenging, it’s harder to interpret how different doses affect them. Additional studies might look at detailed patient usage and implement interventions flexible to changing patient habits.
Gerber et al. (2023) add to these results by demonstrating that integrating clinical pharmacists and health coaches with mHealth tools can effectively close racial and ethnic minority disparities in glycemic control, including among African Americans and Latinx individuals. The strength of this trial is its culturally appropriate strategy that targets structural barriers, including access to transportation and digital competency, through tailored support and telehealth facilitation. The longer follow-up to 24 months is also beneficial in demonstrating the durability of the effects, a factor of great importance in the chronic disease situation. However, the study identifies limitations in integrating health coaches as part of the conventional healthcare team, which could impact the implementation fidelity and the overall sustainability. Economic evaluations and scalability studies are still critical next steps toward the broader implementation, particularly in resource-scarce settings.
Collectively, the studies reinforce the potential of technology-facilitated, patient-centered diabetes self-care programs but identify significant areas for improvement. Future research must focus on maximizing engagement tracking, tailoring interventions to patient sociodemographic and clinical factors, and solving the implementation barriers in healthcare systems. Additionally, incorporating the social determinants of health, as included in Gerber et al.’s intervention, is vital for reducing disparities and achieving equitable outcomes. Both interventions show that varied T2DM groups need adaptive, accessible, and culturally relevant diabetic care.
**Theoretical/Conceptual Framework**
The Health Belief Model (HBM) is a proper theoretical model to inform this health promotion proposal for Type 2 Diabetes Mellitus (T2DM) among vulnerable groups. HBM studies factors such as how likely someone is to get a disease, how severe they think it would be, the benefits of taking action, what stops them from acting, and cues that motivate them to make healthy choices (Alyafei & Easton-Carr, 2024). Considering the difficulties caused by limited understanding of health information, cultural diversity, and financial restrictions, these constructs matter a lot for understanding lower-income, minority adults’ actions and understanding regarding diabetes.
As a result of the HBM, the program can customize programs that focus on raising diabetes awareness, praising lifestyle changes, and working to reduce difficulties such as access to healthy meals and cultural resources. Community health workers sending reminders and checking on progress, along with opportunities for education and peer support, result in participants feeling encouraged to continue caring about their health. The holistic approach of this model is consistent with the evidence for culturally appropriate diabetes interventions and provides a sound basis for enhancing health outcomes among the target vulnerable groups.
**References**
Alyafei, A., & Easton-Carr, R. (2024, May 19).
_The Health Belief Model of Behavior Change_. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK606120/
Centers for Disease Control and Prevention. (2024).
_National Diabetes statistics report_. Diabetes. https://www.cdc.gov/diabetes/php/data-research/index.html
Chen, X., Zhang, L., & Chen, W. (2025). Global, regional, and national burdens of type 1 and type 2 diabetes mellitus in adolescents from 1990 to 2021, with forecasts to 2030: a systematic analysis of the global burden of disease study 2021.
_BMC medicine_,
_23_(1), 48.
[https://doi.org/10.1186/s12916-025-03890-w](https://doi.org/10.1186/s12916-025-03890-w)
Gerber, B. S., Biggers, A., Tilton, J. J., Smith, D. E., Lane, R., Mihăilescu, D., Lee, J.-A., & Sharp, L. K. (2023). Mobile health intervention in patients with type 2 diabetes.
_JAMA Network Open_,
_6_(9), e2333629–e2333629. https://doi.org/10.1001/jamanetworkopen.2023.33629
Khavjou, O. A., Sun, M., D’Angelo, S. R., Neuwahl, S. J., Hoerger, T. J., Cho, P., … & Zhang, P. (2024). Economic costs attributed to diagnosed diabetes in each US State and the District of Columbia: 2021.
_Diabetes Care_, dc240832.
[https://doi.org/10.2337/dc24-0832](https://doi.org/10.2337/dc24-0832)
Maudrie, T. L., Aulandez, K. M. W., O’Keefe, V. M., Whitfield, F. R., Walls, M. L., & Hautala, D. S. (2022). Food stress and diabetes-related psychosocial outcomes in american indian communities: A mixed methods approach.
_Journal of Nutrition Education and Behavior_,
_54_(12). https://doi.org/10.1016/j.jneb.2022.06.004
Ory, M. G., Han, G., Nsobundu, C., Carpenter, K., Towne, S. D., & Smith, M. L. (2025). Comparative effectiveness of diabetes self-management education and support intervention strategies among adults with type 2 diabetes in Texas.
_Frontiers in Public Health_,
_13_.
[https://doi.org/10.3389/fpubh.2025.1543298](https://doi.org/10.3389/fpubh.2025.1543298)
Sun, P., Wen, H., Liu, X., Ma, Y., Jang, J., & Yu, C. (2022). Time trends in type 2 diabetes mellitus incidence across the BRICS from 1990 to 2019: an age-period-cohort analysis.
_BMC Public Health_,
_22_, 1-14.
[https://doi.org/10.1186/s12889-021-12485-y](https://doi.org/10.1186/s12889-021-12485-y)
Yameny, A. A. (2024). Diabetes mellitus overview 2024.
_Journal of Bioscience and Applied Research_,
_10_(3), 641-645.
[https://doi.org/10.21608/jbaar.2024.382794](https://doi.org/10.21608/jbaar.2024.382794)
**## HealthPromotionProposal2.docx**
Health Promotion Proposal, Part 2
**Exercise Instructions**
**Health Promotion Proposal, Part 2**
**This is a continuation of the health promotion program proposal, part one**, which you submitted previously.
Please approach this assignment as an opportunity to integrate instructor feedback from part I and expand on ideas adhering to the components of the MAP-IT strategy. Include necessary levels of detail you feel appropriate to assure stakeholder buy-in.
**Directions**
You have already completed the steps 1-4.
**Do not resubmit part 1.** Make sure you incorporate any suggested revisions or improvements into your submission according to your instructor’s comments.
**To assist in maintaining harmony between Part I and 2 here you have a reminder of the previous paper outline:**
· 1. Describe the health problem. Using data and statistics support your claim that the issue you selected is a problem. What specifically will you address in your proposed health promotion program? Be sure your proposed outcome is realistic and measurable.
· 2. Describe the vulnerable population and setting. What are the risk factors that make this a vulnerable population? Use evidence to support the risk factors you have identified.
· 3. Provide a review of literature from scholarly journals on evidence-based interventions that address the problem. After completing a library search related to effective interventions for your chosen health promotion activity, you will write a review that evaluates the strengths and weaknesses of all the sources you have found. You might consult research texts for information on how to write a review of the literature found in your search.
· 4. Select an appropriate health promotion/disease prevention theoretical framework or conceptual model that would best serve as the framework guiding the proposal. Provide a rationale for your selection which includes a discussion of the concepts of the selected model
**For this assignment develop criteria 5-8 as detailed below:**
**You will submit just this section 5-8 as an essay. Please do not resubmit Part 1.**
Use a presentation page. Start the body of content with topic 5.
· 5. Propose a health promotion program using an evidence-based intervention found in your literature search to address the problem in the selected population/setting. Include a thorough discussion of the specifics of this intervention which includes resources necessary, those involved, and feasibility for a nurse in an advanced role.
· Be certain to include a timeline. (3 to 4 paragraphs- you may use bullets if appropriate).
· 6. Thoroughly describe the intended outcomes. Describe the outcomes in detail concurrent with the SMART goal approach.
**The SMART goal statement should be no more than one sentence** (1 paragraph).
· 7. Provide a detailed plan for the evaluation of each outcome. (2-3 paragraphs).
· 8. Thoroughly describe possible barriers/challenges to implementing the proposed project as well as strategies to address these barriers/challenges. (2+ paragraphs).
· Finish the paper with a conclusion paragraph (2 paragraphs) without typing the word "conclusion" before the paragraph.
**Paper Requirements**
This assignment is to be submitted as an essay- with an introduction, questions developed at the graduate level, and a conclusion to summarize and synthesize key points. Remember, your Proposal must be a scholarly paper demonstrating graduate school-level writing and critical analysis of existing nursing knowledge about health promotion.
APA must be strictly followed.
Your final assignment should be minimally 5 pages (excluding title page and references).
Finish the essay with your reference page.
**Please review the Grading Rubric for this Assignment.**
s
**## HealthPromotionProposal2.docx**
2
**Health Promotion Proposal: Type 2 Diabetes Mellitus in Vulnerable Populations**
Antonio Estremera
Florida National University
Health Promotion & Role Development in Adv. Nursing Practice
Dr. Nora Hernandez-Pupo
May 31, 2025
**Health Promotion Proposal: Type 2 Diabetes Mellitus in Vulnerable Populations**
Type 2 Diabetes Mellitus (T2DM) is a progressive, chronic metabolic condition typified by insulin resistance and impaired glucose regulation. T2DM is a public health priority because its rapidly growing prevalence and associated devastating complications like cardiovascular disease, nephropathy, neuropathy, and retinopathy impose colossal burdens on healthcare systems and societies. T2DM is estimated to affect 537 million adults in 2021 and is expected to rise to 783 million in 2045 (Yameny, 2024). This increase is due to urbanization, physical inactivity, unhealthy diets, and aging. Low- and middle-income countries account for almost 75% of the diabetes burden, which is glaring evidence of disparities in resources and infrastructure (Sun et al., 2022). The human cost, expressed as mortality and morbidity, and the financial cost, point distinctly to the imperative for effective health promotion interventions to avert and manage T2DM. The proposal, therefore, is based on implementing a health promotion program for the community targeting vulnerable groups to enhance lifestyle behavior, disease care, and the consequent reduction in T2DM occurrences and complications. The program outcome will be gauged using glycemic control (the HbA1c levels) and self-reported adherence to recommended lifestyle as the outcome measures and indicators for success within six months.
**Definition of Vulnerable Population**
This program focuses on low-income, urban minority adults, with a specific focus on African American and Hispanic individuals, who have disproportionately high levels of T2DM and complications. In the US, 37.3 million individuals have diabetes, with type 2 diabetes accounting for 90–95% of the total (Chen et al., 2025). Racial and ethnic minorities carry a disproportionate burden; for instance, American Indian and Alaska Native adults are 2.5 times more likely than their White counterparts to have diabetes, and Hispanic adults report similar rates (CDC, 2024). Such disparities stem from multifaceted social determinants of health like poverty, unhealthy food access, housing instability, and health care access inadequacies (Khavjou et al., 2024). Cultural factors, language use, and health illiteracies further enhance vulnerability, leading to delays in diagnosis, poor disease management, and increased complication rates (CDC, 2024)
These risk factors have been well documented in epidemiological studies. For instance, several ways have been suggested as to how food insecurity can cause higher diabetes risk and related problems. Consumers experiencing food insecurity might buy affordable, energy-packed foods, which can increase their risk of obesity and diabetes. The anxiety that comes with insufficient food may also harm metabolism, possibly leading to weight increase and insulin problems (Maudrie et al., 2022)
**.** These vulnerabilities necessitate culturally tailored health promotion interventions that address individual behaviors and structural barriers to care.
**Review of Evidence-Based Interventions for Type 2 Diabetes Management**
The randomized controlled trial by Ory et al. (2025) evaluated three diabetes self-management education and support (DSMES) interventions among adults with Type 2 Diabetes Mellitus (T2DM) in Texas, covering rural and urban populations. The study compared an asynchronous virtual education program with personalized counseling (vMMWD), a technology-based self-guided support tool (TBES), and a combination. Results showed all three interventions significantly reduced hemoglobin A1c (HbA1c) at 3 and 6 months, with sustained improvements. The combined intervention did not outperform individual modalities, suggesting that each alone effectively improves glycemic control. Similar benefits were observed in rural and urban participants, highlighting broad accessibility. Strengths include the rigorous randomized design, large sample size with high retention (~90%), and inclusion of underserved rural populations. The long follow-up supports the interventions’ lasting effects. Limitations include the inability to track specific engagement metrics within the TBES tool and the lack of differential analysis by race or socioeconomic status, suggesting that tailored strategies may be necessary for diverse groups.
Gerber et al. (2023) investigated a mobile health (mHealth) intervention combining clinical pharmacists and health coaches to improve glycemic control in African American and Latinx adults with T2DM, disproportionately affected by diabetes. The randomized clinical trial included 221 participants from a Chicago urban medical center. The intervention provided remote pharmacist telehealth support and health coaching through home visits, calls, and text messages. After 12 months, HbA1c decreased by 0.79 percentage points, a reduction sustained through 24 months and greater than reductions reported in prior similar trials (0.42–0.45 points). The success was attributed to addressing barriers like transportation and telehealth access, with health coaches facilitating virtual visits and reinforcing medication adherence and lifestyle changes. Strengths include focusing on underrepresented minorities, providing long follow-ups, and integrating social determinants of health. Limitations involve challenges integrating health coaches into healthcare teams, patient technology use variability, and limited economic impact and scalability data.
**Evaluation of Literature on Diabetes Self-Management Interventions**
Both studies provide compelling evidence supporting the efficacy of technology-enhanced self-management interventions for improving glycemic control among adults with T2DM. Ory et al.’s (2025) research advances the understanding that virtual asynchronous education, personalized counseling, or self-guided digital tools can achieve clinically meaningful reductions in A1c across diverse geographic settings, including underserved rural populations. These findings show that these options can work well in many settings and suit patients' preferences. The study also uses a well-designed RCT and tracks lasting results, increasing its findings' reliability outside the study. However, since tracking how patients interact online is challenging, it’s harder to interpret how different doses affect them. Additional studies might look at detailed patient usage and implement interventions flexible to changing patient habits.
Gerber et al. (2023) add to these results by demonstrating that integrating clinical pharmacists and health coaches with mHealth tools can effectively close racial and ethnic minority disparities in glycemic control, including among African Americans and Latinx individuals. The strength of this trial is its culturally appropriate strategy that targets structural barriers, including access to transportation and digital competency, through tailored support and telehealth facilitation. The longer follow-up to 24 months is also beneficial in demonstrating the durability of the effects, a factor of great importance in the chronic disease situation. However, the study identifies limitations in integrating health coaches as part of the conventional healthcare team, which could impact the implementation fidelity and the overall sustainability. Economic evaluations and scalability studies are still critical next steps toward the broader implementation, particularly in resource-scarce settings.
Collectively, the studies reinforce the potential of technology-facilitated, patient-centered diabetes self-care programs but identify significant areas for improvement. Future research must focus on maximizing engagement tracking, tailoring interventions to patient sociodemographic and clinical factors, and solving the implementation barriers in healthcare systems. Additionally, incorporating the social determinants of health, as included in Gerber et al.’s intervention, is vital for reducing disparities and achieving equitable outcomes. Both interventions show that varied T2DM groups need adaptive, accessible, and culturally relevant diabetic care.
**Theoretical/Conceptual Framework**
The Health Belief Model (HBM) is a proper theoretical model to inform this health promotion proposal for Type 2 Diabetes Mellitus (T2DM) among vulnerable groups. HBM studies factors such as how likely someone is to get a disease, how severe they think it would be, the benefits of taking action, what stops them from acting, and cues that motivate them to make healthy choices (Alyafei & Easton-Carr, 2024). Considering the difficulties caused by limited understanding of health information, cultural diversity, and financial restrictions, these constructs matter a lot for understanding lower-income, minority adults’ actions and understanding regarding diabetes.
As a result of the HBM, the program can customize programs that focus on raising diabetes awareness, praising lifestyle changes, and working to reduce difficulties such as access to healthy meals and cultural resources. Community health workers sending reminders and checking on progress, along with opportunities for education and peer support, result in participants feeling encouraged to continue caring about their health. The holistic approach of this model is consistent with the evidence for culturally appropriate diabetes interventions and provides a sound basis for enhancing health outcomes among the target vulnerable groups.
**References**
Alyafei, A., & Easton-Carr, R. (2024, May 19).
_The Health Belief Model of Behavior Change_. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK606120/
Centers for Disease Control and Prevention. (2024).
_National Diabetes statistics report_. Diabetes. https://www.cdc.gov/diabetes/php/data-research/index.html
Chen, X., Zhang, L., & Chen, W. (2025). Global, regional, and national burdens of type 1 and type 2 diabetes mellitus in adolescents from 1990 to 2021, with forecasts to 2030: a systematic analysis of the global burden of disease study 2021.
_BMC medicine_,
_23_(1), 48.
[https://doi.org/10.1186/s12916-025-03890-w](https://doi.org/10.1186/s12916-025-03890-w)
Gerber, B. S., Biggers, A., Tilton, J. J., Smith, D. E., Lane, R., Mihăilescu, D., Lee, J.-A., & Sharp, L. K. (2023). Mobile health intervention in patients with type 2 diabetes.
_JAMA Network Open_,
_6_(9), e2333629–e2333629. https://doi.org/10.1001/jamanetworkopen.2023.33629
Khavjou, O. A., Sun, M., D’Angelo, S. R., Neuwahl, S. J., Hoerger, T. J., Cho, P., … & Zhang, P. (2024). Economic costs attributed to diagnosed diabetes in each US State and the District of Columbia: 2021.
_Diabetes Care_, dc240832.
[https://doi.org/10.2337/dc24-0832](https://doi.org/10.2337/dc24-0832)
Maudrie, T. L., Aulandez, K. M. W., O’Keefe, V. M., Whitfield, F. R., Walls, M. L., & Hautala, D. S. (2022). Food stress and diabetes-related psychosocial outcomes in american indian communities: A mixed methods approach.
_Journal of Nutrition Education and Behavior_,
_54_(12). https://doi.org/10.1016/j.jneb.2022.06.004
Ory, M. G., Han, G., Nsobundu, C., Carpenter, K., Towne, S. D., & Smith, M. L. (2025). Comparative effectiveness of diabetes self-management education and support intervention strategies among adults with type 2 diabetes in Texas.
_Frontiers in Public Health_,
_13_.
[https://doi.org/10.3389/fpubh.2025.1543298](https://doi.org/10.3389/fpubh.2025.1543298)
Sun, P., Wen, H., Liu, X., Ma, Y., Jang, J., & Yu, C. (2022). Time trends in type 2 diabetes mellitus incidence across the BRICS from 1990 to 2019: an age-period-cohort analysis.
_BMC Public Health_,
_22_, 1-14.
[https://doi.org/10.1186/s12889-021-12485-y](https://doi.org/10.1186/s12889-021-12485-y)
Yameny, A. A. (2024). Diabetes mellitus overview 2024.
_Journal of Bioscience and Applied Research_,
_10_(3), 641-645.
[https://doi.org/10.21608/jbaar.2024.382794](https://doi.org/10.21608/jbaar.2024.382794)
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