The Precede-Proceed Model for School Going Children with Diabetes Comprehensive Nursing Paper Sample

The Precede-Proceed Model for School Going Children with Diabetes Comprehensive Nursing Paper Sample

Executive Summary

Diabetes mellitus comprises metabolic diseases characterized by chronic hyperglycemia resulting from insulin secretion defects, insulin action, or both. Diabetes development involves the interaction between genetic and non-genetic factors, even though the disease can only be controlled. Still, people diagnosed with the disease can live a quality life through various medical interventions. However, the number of people with diabetes keeps on rising across the globe. There is a general assumption that children are not prone to the danger of diabetes; hence there is less concern about diabetes in children. However, recent statistics from the World Health Organization indicate that the number of children living with diabetes has increased for the past few decades. In the United States, 2.8 million people live with diabetes, and about 230,000 of this population are school-going kids below the age of 19 years (Peter. At el, .2017). This is due to increased risk factors such as family history and environmental factors such as exposure to viral diseases that are likely to contribute to diabetes development. The critical risk factors also include damaging immune systems in a child’s body, geographical area, race, or ethnicity, where Asian, Black, Hispanic, and Indian America are at higher risks, overweight, and inactiveness.(The Precede-Proceed Model for School Going Children with Diabetes Comprehensive Nursing Paper Sample)

The increase of diabetes’ cases among children results from a lack of knowledge about diabetes in children and the accessibility of this knowledge at the community level. The few with the knowledge find it uncomfortable to manage their condition when in the company of their peers in school, as the fear of being discriminated against. Hence the majority find it hard to use insulin and take their glucose level while at school. The school managements and teachers lack the necessary support for diabetes students. This includes food provided by the school for eateries. The majority of the diabetes students are forced to carry their food to school to follow the diet necessary for diabetes patients. As diabetes involves the patients taking care of themselves most of the time, it is significant for the patient to have both a sense of responsibility and commitment when managing their condition to ensure improvement or maintenance of the quality of life.(The Precede-Proceed Model for School Going Children with Diabetes Comprehensive Nursing Paper Sample)

The predisposing, reinforcing, and enabling constructs in educational diagnosis and evaluation (PRECEDE) and the policy, regulatory, and organizational constructs in educational and environmental development (PROCEED) are the foundations of the PRECEDE-PROCEED model. (The Precede-Proceed Model for School Going Children with Diabetes Comprehensive Nursing Paper Sample)The model is majorly applied as a planning model, particularly in health promotion and health education. The model considers various planning techniques and various evaluation techniques (Peter. At el, .2017).  The model provides personal and community-based interventions with the idea that to solve health bizarrely, and we need to focus on the desired result.  Based on the model’s structure, we can design, evaluate, and implement programs for interventions for diabetes for school-going children. The model’s primary focus is to benefit communities by involving all the needed stakeholders and community resources. Precede–Proceed remains the most comprehensive and one of the most used approaches to promoting health (Barasheh et al., 2017). (The Precede-Proceed Model for School Going Children with Diabetes Comprehensive Nursing Paper Sample)

Introduction

The healthcare issues selected to be addressed by the PRECEDE-PROCEED model is diabetes in childhood and adolescence. The incidence of diabetes in the general population has risen to epidemic levels, with a prevalence of 10.9% in the United States. There are two types of diabetes type 1, type 2, other types, and gestational diabetes mellitus (GDM). Type 2 Diabetes Mellitus (T2DM) is common as it accounts for more than 90% of the 26.8 million cases. More than 230,000 children and adolescents aged 20 and below have been diagnosed with diabetes mellitus (Barasheh et al., 2017). The increasing occurrence of T2DM in childhood and adolescence has been attributed to change in the children’s lifestyle in terms of more sedentary life and less healthy food, with obesity being the leading cause of insulin resistance associated with T2DM.(The Precede-Proceed Model for School Going Children with Diabetes Comprehensive Nursing Paper Sample)

With the growing incidence of diabetes, it is imperative to develop interventions that facilitate diet and lifestyle management during and after school hours is essential for these children’s lives. Healthcare workers and institutions should be at the forefront of educating the parents or guardians on how to provide care for these children at home and even prepare them for school. Besides, within the institutions, the prevention and management of diabetes should be prioritized to limit and alleviate the epidemic disease. Through the PRECEDE-PROCEED model, a tool created for personal and community-based interventions guide, this paper provides a road map on the efficiency of handling the cases of children with diabetes, either in the school setting or while at home. PRECEDE-PROCEED model’s primary focus is to benefit communities by involving all the needed stakeholders and community resources. Secondly, the paper guides on the necessary strategies to create awareness among teenagers in controlling and managing and prevent diabetes.(The Precede-Proceed Model for School Going Children with Diabetes Comprehensive Nursing Paper Sample)

Graphic Organizers for the Planning Model

The PRECEDE –PROCEED, model,

The above table represents the PRECEDE –PROCEED model’s flow, which guides the analysis and intervention development. The model provides an eight-phase framework that practitioners follow step-by-step to plan, implement and analyze a program and its effectiveness. The First Phase of the model is social assessment; at this phase, the practitioners identify the health beliefs and the value impacted on the targeted population. (The Precede-Proceed Model for School Going Children with Diabetes Comprehensive Nursing Paper Sample)The second phase is epidemiological behavioural and environmental diagnostic assessments. In this phase, the practitioner identifies the problem and influences that are likely to support or hinder it. The practitioners also identify certain behaviors associated with the study area based on community factors and prevalence data. This includes environment, culture, political, economic, and family environments, giving the practitioner a clear picture of the targeted population. Phase three is the educational and ecological assessments, focusing on understanding the problem on an individual level. Phase four administrative and policy assessment is the final Phase of PRECEDE part of the model; the practitioner is required to identify the existing similar or supportive program, implement it into the community, policies, and interventions. Phase five is the beginning of PROCEED part of the model. It is the implementation phase, where all planned in the PRECEDE part is implemented in the community.  Phase six is carried out simultaneously with the implementation phase, evaluating the program’s effectiveness (Garcia et al., 2019). Phase seven and eight are essential for the program’s analysis and success and future adjustment and recommendation to apply for such program. (The Precede-Proceed Model for School Going Children with Diabetes Comprehensive Nursing Paper Sample)

Phase 1: Social Assessment

            In this phase of the model, the investigation identified factors that impact the health outcome and the quality of life among children living with diabetes. Different data collection methods were employed, including interviews with key informants, surveys, and focus group discussions with targeted populations (parents, teachers, and children). The results showed that more than 60% of children do not understand the risks of diabetes, while 54% of parents do not find it necessary for their children to be screened for diabetes as they assume the disease is rare for children. On the other hand, 52% of teachers were not aware of handling students with Diabetes (Barasheh et al., 2017).  With more than 210,000 children dragonized with Diabetes across United States, approximately 5000 cases annually, and the diabetes patient being a risk factor for covid 19 complications, it is imperative to develop a comprehensive intervention to address diabetes mellitus among school-going children and adolescents.(The Precede-Proceed Model for School Going Children with Diabetes Comprehensive Nursing Paper Sample)

In this regard, however, several aspects are taken into account when assessing health status. The three main dimensions are: Measuring health status, quality of life, and health measurement. Health measurements are administered through clinical methods, taking into account temperature, blood pressure, and other body tests (Garcia et al., 2019). Measures of quality of life help determine the expectations and the hopes of a person taking into consideration a person’s life circumstances. This is mainly accomplished via interviews and various instruments such as a stethoscope for asthma patients (Peter. At el, .2017). Measures of health care are determined by numerous factors such as injury response effectiveness, medication or therapy effectiveness.(The Precede-Proceed Model for School Going Children with Diabetes Comprehensive Nursing Paper Sample)

Phase 2: Epidemiological, Behavioral, and Environmental Assessment

             In this phase, the investigation concentrated on the existing data related to chronic diseases and narrowed it down to diabetes. According to the American Association of Diabetes, Diabetes is a chronic disease that affects the body system’s ability to control glucose levels in the blood. For the health promotion program, three different schools and parents from communities within Savanna in Georgia were selected for the assessment requirements. The assessment’s objective focused on evaluating the nature and the state of the children’s lifestyle concerning diabetes, both type 1 and 2 (Gielen et al. 2018). The development of the need assessment plan was the first procedure in this assessment. The procedure takes into account the goals of clarification, audience selection, sampling of the general population. The data results from the assessments showed that obesity predisposes children to diabetes type 2, which is mostly due to poor diet, sedentarism, and lack of physical exercise.(The Precede-Proceed Model for School Going Children with Diabetes Comprehensive Nursing Paper Sample)

 A healthy diet and physical exercises are the essential activities that a patient must manage diabetes, regardless of age. There were no effective measures to ensure that children took the proper physical exercises in cases. Consequently, studies indicated that more children sustained sedentary behaviors such as sitting for more hours watching TV shows and playing video and mobile games during weekends and holidays (Garcia et al., 2019). Lack of awareness, inadequate support from parents and guardians on behavioral actions and low engagement in physical activities increase obesity, subsequently leading to T2DM.(The Precede-Proceed Model for School Going Children with Diabetes Comprehensive Nursing Paper Sample)

Besides, most schools have inadequate supplies to supplement the healthy diet in the school menu. This forces children with diabetes to bring their lunch and snacks to avoid hypoglycemia. The selection of foods in schools does not fit the medical conditions, contributing to worsening glucose control among the children living with Diabetes (Garcia et al., 2019).      According to the assessment conducted, there is a minimum coverage of chronic health issues in class. The teaching about chronic diseases is not given any coverage on the school syllabus as it is mostly viewed as the work of the social workers or public health workers to educate people (including teachers and students) about chronic diseases. Inadequate knowledge from the teachers on how to handle diabetes students plays a role in schools’ inefficiency to handle the students with Diabetes as Barasheh et al. (2017) argued that less than 46% of teachers and other schools employees know how to manage diabetes in students.(The Precede-Proceed Model for School Going Children with Diabetes Comprehensive Nursing Paper Sample)

Therefore, it is essential to provide the required education on diabetes to the teachers and students, which decreases the risks of school attending age students developing diabetes and improve the management of disease among the student living with it (Gielen et al. 2018). The program would also involve parents, ensure that the right diet is available in schools, and develop a culture that encourages physical exercises while discouraging sedentarism and pushing the adaptation of this culture at a policy level.(The Precede-Proceed Model for School Going Children with Diabetes Comprehensive Nursing Paper Sample)

Phase3: Educational and Organizational Assessments

In this phase, the investigation identified the predisposing, enabling, and reinforcing factors that contribute to insufficient knowledge of diabetes among the school children and their teachers and parents.(The Precede-Proceed Model for School Going Children with Diabetes Comprehensive Nursing Paper Sample)

The Predisposing factors

Children who develop a chronic disease like diabetes have a heavy burden that also affects their families. Children with Diabetes present symptoms of polyuria (excessive urination), polydipsia (excessive drinking), and blurry vision (Garcia et al., 2019). Low awareness of the need for children to monitor their glucose levels to stabilize the disease is of utmost importance; according to Azar et al. (2017), close to 60% of students measure their blood glucose at school, with many not even getting insulin during school hours.(The Precede-Proceed Model for School Going Children with Diabetes Comprehensive Nursing Paper Sample)

Enabling Factors

            The enabling factors include the availability, accessibility, and affordability of diabetes resources in the schools and community as this undermines teachers and parents’ efforts.(The Precede-Proceed Model for School Going Children with Diabetes Comprehensive Nursing Paper Sample) Although education about diabetes is widely available, even with interactive education, re-education is necessary to create awareness of the aggriviating factors of diabetes and the roles of different stakehoders in eradicating the menace among school-going children adolescents. According to Barasheh et al. (2017), to educate and retain information about their disease, there needs to be repetition.(The Precede-Proceed Model for School Going Children with Diabetes Comprehensive Nursing Paper Sample)

The accessibility of diabetes resources in schools is one of the critical factors to promote the awareness and increase the knowledge of teachers and school personnel about managing diabetes students; it would also positively affect the community by guiding diets and early identification of diabetes symptoms (Garcia et al., 2019). While enabling accessibility is critical, the health program facilitates collaboration with public health systems and stakeholders to ensure affordability in managing diabetes among school-going children and adolescents.(The Precede-Proceed Model for School Going Children with Diabetes Comprehensive Nursing Paper Sample)

Reinforcing Factors

The investigation identified reinforcing factors such as peer influence, social support, influence from policymakers, and information dissemination through media. There are few established policies to provide a better diet or diets that accommodate students with different nutritional needs(Barasheh et al., 2017). Children have a limited understanding of healthier products and may be influenced by the products available. Hence, adjustments to dietary options focus on encouraging healthier eating and limiting the consumption of fast foods and low nutritional value meals.(The Precede-Proceed Model for School Going Children with Diabetes Comprehensive Nursing Paper Sample)

Education

Inclusion of education about diabetes through policy frameworks to improve children’s awareness and engagement in sustainable lifestyles in institutions. This includes education on managing and controlling diabetes within the school environment for diagnosed children as well as teacher training on diabetes. At the core of the initiative is implementing preventive health promotion measures while also enabling and reinforcing better management and diabetes control in diagnosed school-going children and adolescents. Besides, it is crucial to provide the necessary information on diabetes in the teacher-student environment and other platforms for conveying the information.(The Precede-Proceed Model for School Going Children with Diabetes Comprehensive Nursing Paper Sample)

Phase 4: Administrative and Policy Assessments

In this phase, the program engages stakeholders in implementing the school’s strategies within the community. This accounts for the roles of teachers, the school management, the education officers, and support staff in creating a healthier environment. The program also incorporates healthcare practitioners and public health specialists, who actively guide and lead on the institution-specific measures. Therefore, in this phase, the main focus is on identifying the various required policies, resources, supports, and available facilities required for the implementation. Furthermore, the phase also involves the evaluation of the health promotion program.(The Precede-Proceed Model for School Going Children with Diabetes Comprehensive Nursing Paper Sample)

The program involves the improvement of the school’s cafeteria diet to decrease high-calorie diets and decrease sweets. The focus is to ensure proper nutrition and healthier choices for children and adolescents (Moshki et al., 2017).(The Precede-Proceed Model for School Going Children with Diabetes Comprehensive Nursing Paper Sample) As part of Healthy People 2020, the overarching goals include creating physical environments that promote good health. Another of its goals is heathypeople.Gov (2020), to reduce the disease burden of Diabetes mellitus (Garcia et al., 2019). (The Precede-Proceed Model for School Going Children with Diabetes Comprehensive Nursing Paper Sample)

The cost of implementing changes in the school menu and providing healthier alternatives may play a role in the implementation of programs. Perceived barriers to such changes included lack of training and time for modified meal preparation, low student acceptance of modified meals, and higher costs of such meals (Barasheh, at el., 2017). Even with the nationwide perception that school lunch should offer healthier products, it still is not tailored to diabetes students.(The Precede-Proceed Model for School Going Children with Diabetes Comprehensive Nursing Paper Sample)

Phase 5: Implementation

            This phase focuses on how the program will be adopted, implemented, and maintained in the targeted communities and institutions.  As in cases like this, strategies are adopted, implemented, and supported in various community ways. However, it is essential to note that theories of change used in designing the post-assessment intervention include theories at the individual, interpersonal, and community levels.  The intervention addresses the predisposing factors, assess the children’s knowledge level to manage diabetes, and provides knowledge on how to adjust their diets and include exercise and medication. On the enabling factors, the intervention focuses on assessing the existing educational programs, the availability of resources at the community level, the accessibility, and affordability of these resources schools. Lastly, the intervention analyzes the impact of peer influence and social support, the positive influence of policymakers and the role of media information dissemination. After planning the intervention, the proposed program will be implemented as one of the chronic disease interventions and specifically under diabetes for school-going children and adolescents.(The Precede-Proceed Model for School Going Children with Diabetes Comprehensive Nursing Paper Sample)

 To ensure the strategies are well implemented and maintained, various measures will be considered, such as holding regular seminars on diabetes, which will involve teachers, students, parents, and healthcare experts at least twice a month before pursuing the inclusion of diabetes management in the school syllabus. Additionally, teachers would get advanced community health education and psychological teaching on how to handle the diabetes students socially, and means to reduce peer influence. This includes the various means of encouraging participation of diabetes students in sports such as basketball as it will decrease peer pressure and also increase their life quality as they indulge in physical exercises.(The Precede-Proceed Model for School Going Children with Diabetes Comprehensive Nursing Paper Sample)

  The use of educational booklets, which will be issued to the parents, on the pre-conditions of diabetes, the management of it in case their children are diagnosed with it.  Also, the quick accessibility of healthcare professionals at school should be part of the management plan for school children with diabetes. These students, if not regularly evaluated by their doctors, should at least be evaluated at the school nurse office to monitor weight and proper glucose control for a blood glucose measurement and assistance with insulin administration, and compliance (Gielen et al., 2018). There is also a need to coordinate with the available counselling centers. They can be essential in providing social and physiological guidance to students with diabetes issues. The facilities will also help parents. Narrowing it down, every child living with diabetes should have the basic knowledge of diabetes, which includes: testing and recording of blood sugar, kind of food to eat at any time, taking medicine when necessary, recognition and treating both low and high and how to handle themselves when sick (Manios et al., 2018).(The Precede-Proceed Model for School Going Children with Diabetes Comprehensive Nursing Paper Sample)

Phase 6: Process Evaluation

            The evaluation phase will determine effectiveness of the program in meeting the set-guidelines and processes. As it is important to keep logs of the implementation progress, which includes providing data of progress and control, shared with the necessary healthcare provider for adjustments and further recommendations. Further assessment of the process can be made by completing a survey that includes satisfaction with the program and glucose control values and recommendations for menus to consider and possible additions when looking for likes and preferences to improve program compliance.(The Precede-Proceed Model for School Going Children with Diabetes Comprehensive Nursing Paper Sample)

Phase 7: Impact Evaluation

In this phase, the investigation focus on identification of the immediate respond of the program on the awareness of diabetes among school going children. Thus, the impact evaluation will take into consideration, the evaluation of the changes in predisposing, reinforcing, enabling, as well as behavioral factors after the intervention activities.(The Precede-Proceed Model for School Going Children with Diabetes Comprehensive Nursing Paper Sample)

Phase 8: Statistical Analysis

In the last phase of the model, it involve data analysis which in our case will use different statistical software, such as Microsoft Excel and MathLab statistical software. To define the effects of the intervention, repeated measures analyses of variance will be done. The goal of this phase is to determine the long-term effect of the program.(The Precede-Proceed Model for School Going Children with Diabetes Comprehensive Nursing Paper Sample)

However, the results of the first assessment are significant as it will help in gauging the responsibilities and the adaption timescale of the education, provide to the targeted population. The change in the social behavior of the peers and community at large on matters of children living with diabetes. Additionally, the results will be useful in the formulation of a strategic plan that will be helpful in tackling the countrywide campaign on diabetes among children.(The Precede-Proceed Model for School Going Children with Diabetes Comprehensive Nursing Paper Sample)

Summary

Diabetes is a chronic disease that adversely affects children. Currently, more than 210,000 school-age children in the United States suffer from it. In order to provide better opportunities for school children, it is essential to adjust the availability of low-calorie and balanced foods to treat disease, as well as the inclusion of exercise and medication. There are no predisposing factors for type 1 diabetes. Educating children about illness may not be enough, but helping them create and adopt healthier lifestyles may be the best way to deal with disease burden and reduce the chance of obesity and other chronic related conditions.(The Precede-Proceed Model for School Going Children with Diabetes Comprehensive Nursing Paper Sample)

The Precede-Proceed Model is a very useful tool that focuses on the goals of a specific intervention. This approach provides a structured way to correctly identify the root of the problem and measure, evaluate and achieve the desired results. Schoolchildren with diabetes continue to be victims of a lack of suitable lunch options during school hours, a lack of educator knowledge, and the high cost of many menu improvement initiatives.(The Precede-Proceed Model for School Going Children with Diabetes Comprehensive Nursing Paper Sample)

The Precede-Proceed model provides the tools to bring about positive change, as well as ways to measure and improve it, to achieve goals that many organizations and initiatives have tried but will not benefit students with diabetes. When it comes to dealing with diabetes, it is essential to know that control is possible even without a cure for the disease. Proper diet, exercise, and medication are keys to management, but education and knowledge must be paramount in the management of diabetes. The Precede-Proceed model guides the step to achieve the goal of proper glucose control as the model strengthens the quality and credibility of a program. The management of diabetes can significantly prosper if; the right steps are taken in the implementation of the model. The right educational and communication approaches must be adopted to make it more effective. If properly conducted, the target group can significantly benefit long after the expiry of the program.(The Precede-Proceed Model for School Going Children with Diabetes Comprehensive Nursing Paper Sample)

References

Azar, F. E., Solhi, M., Nejhaddadgar, N., & Amani, F. (2017). The effect of intervention using the PRECEDE-PROCEED model based on the quality of life in diabetic patients. Electronic physician, 9(8), 5024.(The Precede-Proceed Model for School Going Children with Diabetes Comprehensive Nursing Paper Sample)

Barasheh, N., Shakerinejad, G., Nouhjah, S., & Haghighizadeh, M. H. (2017). The effect of educational program based on the precede-proceed model on improving self-care behaviours in a semi-urban population with type 2 diabetes referred to health centres of Bavi, Iran. Diabetes & Metabolic Syndrome: Clinical Investigation & Reviews, 11, S759-S765.(The Precede-Proceed Model for School Going Children with Diabetes Comprehensive Nursing Paper Sample)

Garcia, M. L., Gatdula, N., Bonilla, E., Frank, G. C., Bird, M., Rascón, M. S., & Rios-Ellis, B. (2019). Engaging intergenerational Hispanics/Latinos to examine factors influencing childhood obesity using the PRECEDE–PROCEED Model. Maternal and child health journal, 23(6), 802-810.(The Precede-Proceed Model for School Going Children with Diabetes Comprehensive Nursing Paper Sample)

Gielen, A. C., McDonald, E. M., Gary, T. L., & Bone, L. R. (2018). Using the precede-proceed model to apply health behaviour theories. Health behaviour and health education: Theory, investigation, and practice, 4, 407-29.

Manios, Y., Androutsos, O., Lambrinou, C. P., Cardon, G., Lindstrom, J., Annemans, L., … & Makrilakis, K. (2018). A school-and community-based intervention to promote healthy lifestyle and prevent type 2 diabetes in vulnerable families across Europe: design and implementation of the Feel4Diabetes-study. Public health nutrition, 21(17), 3281-3290.

Moshki, M., Dehnoalian, A., & Alami, A. (2017). Effect of precede–proceed model on preventive behaviors for type 2 diabetes mellitus in high-risk individuals. Clinical nursing investigation, 26(2), 241-253.(The Precede-Proceed Model for School Going Children with Diabetes Comprehensive Nursing Paper Sample)

Peter, H., Jones, S., Cross, D., Hall, M., & Stevensons, M. (2017). The PRECEDE-PROCEED Model: applications to planning a child pedestrian injury prevention program. Injury prevention, 3, 282-287.

Kharroubi, A. T., & Darwish, H. M. (2015). Diabetes mellitus: The epidemic of the century. World journal of diabetes, 6(6), 850–867.(The Precede-Proceed Model for School Going Children with Diabetes Comprehensive Nursing Paper Sample) https://doi.org/10.4239/wjd.v6.i6.850

Ziegler, R., & Neu, A. (2018). Diabetes in Childhood and Adolescence. Deutsches Arzteblatt international, 115(9), 146–156. (The Precede-Proceed Model for School Going Children with Diabetes Comprehensive Nursing Paper Sample)https://doi.org/10.3238/arztebl.2018.0146

Los E, Wilt AS. Diabetes Mellitus Type 1 in Children. [Updated 2020 Jun 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. (The Precede-Proceed Model for School Going Children with Diabetes Comprehensive Nursing Paper Sample)Available from: https://www.ncbi.nlm.nih.gov/books/NBK441918/

Temneanu, O. R., Trandafir, L. M., & Purcarea, M. R. (2016). Type 2 diabetes mellitus in children and adolescents: a relatively new clinical problem within pediatric practice. Journal of medicine and life, 9(3), 235–239.(The Precede-Proceed Model for School Going Children with Diabetes Comprehensive Nursing Paper Sample)

Sapra A, Bhandari P. Diabetes Mellitus. [Updated 2020 Nov 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551501/(The Precede-Proceed Model for School Going Children with Diabetes Comprehensive Nursing Paper Sample)