Assigment .apa seven . all instructions attached.

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Strengths (What Was Met)

You clearly identified obesity as a major public health issue and supported your introduction with current national data and economic impact, which effectively establishes the significance of the problem.

You defined a specific vulnerable population (low-income, non-Hispanic Black and Hispanic adults in Miami-Dade County) and provided a strong discussion of multiple risk factors, including food insecurity, structural barriers, and environmental influences. These were supported with scholarly evidence, demonstrating strong understanding of social determinants of health.

Your proposed outcome is measurable and clearly stated, including a defined target (5% BMI reduction in 40% of participants within 12 months), which aligns well with assignment expectations.

The literature review includes scholarly, current sources and provides both strengths and limitations of the studies. You appropriately incorporated systematic reviews and meta-analyses, which strengthens the level of evidence.

You demonstrated good synthesis of the literature, particularly in identifying the need for culturally tailored, multicomponent interventions.

The Social Ecological Model (SEM) is an appropriate theoretical framework for this topic, and you did a strong job explaining how each level (individual, interpersonal, community, organizational, policy) applies to your proposed intervention.

References are current, credible, and aligned with in-text citations, meeting graduate-level expectations.

Not Met / Requires Full Development for Week 8 Final Submission

The health promotion program is not fully operationalized. While the proposal outlines general strategies (education, counseling, community partnerships), it lacks:

Clear description of specific program components and activities

Details on implementation (who will deliver the program, where, how often, and in what format)

Clear structure and flow of the intervention

For Week 8, the program must be fully detailed and actionable.

The measurable outcome, although present, requires further clarification:

Specify how BMI reduction will be measured and tracked

Define baseline vs. follow-up measurement points

Clarify how success will be evaluated across participants

Refine this into a fully SMART outcome with clear evaluation methods.

The introduction lacks sufficient local or population-specific epidemiological data. While national data is strong, you should incorporate Miami-Dade-specific or subgroup-specific data to strengthen justification for your targeted intervention.

The vulnerable population section, while strong, has minor areas lacking direct citation support. Some claims regarding structural barriers and environmental limitations would benefit from additional scholarly references.

The literature review does not fully align with required structure:

The assignment requires clear separation of individual article summaries (one paragraph per article)

Followed by a distinct 2–3 paragraph evaluation section

While content is present, the structure should be more clearly organized to meet assignment expectations.

The evaluation of literature could be further deepened by:

More explicit comparison across studies

Identification of gaps in the literature

Stronger linkage between evidence and your proposed intervention design

There are APA and scholarly writing concerns that must be addressed:

Some sentence structure and grammar issues affect clarity

Inconsistencies in reference formatting

Writing should be refined for conciseness and academic tone

HealthPromotionProposalPart1.docx

1

Health Promotion Program Proposal: Part 1

Adelin Dupont

Florida National University

Health Promotion & Role Development in Adv. Nursing Practice

Dr. Nora Hernandez-Pupo

March 28, 2026

Health Promotion Program Proposal: Part 1

One of the most urgent public health crises confronting the United States is obesity which endangers millions of lives and hundreds of billions of healthcare funds each and every year. National Center for Health Statistics showed that in August 2021 to August 2023, the prevalence of obesity in the U.S. was 40.3% and severe obesity was found in 9.4 percent of the adult population, which has increased significantly over the last 10 years (Emmerich et al., 2024). Economic impacts are also concerning: the researchers have already estimated that over $260 billion of direct healthcare spending is linked to obesity every year, and the figures are expected to be more than 385 billion by 2024 once the growth in healthcare costs is considered (Thorpe et al., 2024). Obesity is not a single, individual disease but a multifaceted and multifactorial illness that is not only affected by genetic factors, socioeconomic status, built environment, but also the inequities in the system. The proposal identifies a community-based health promotion initiative to address the problem of obesity among low-income, racial and ethnic minority adults living in urban Miami-Dade County, Florida. The proposed program will aim at realizing a quantifiable 5% decrease in the body mass index (BMI) in at least 40 percent of the participants of the program within 12 months of participation; through culturally-appropriate, evidence-based behavioral interventions based on a multilevel theoretical framework.

Vulnerable Population

The intended audience of this program is non-Hispanic black and Hispanic adults aged between 18 and 64 years who live in Miami-Dade County in Florida and have low-income. The group is a highly vulnerable population as it combines a number of biological, socioeconomic, and environmental risk factors. According to the data provided by the Center of Disease Control and Prevention, the prevalence of obesity in non-Hispanic Black adults in 38 states is at or above at 35 and the situation is the same in 33 geographic areas among Hispanic adults (CDC, 2024). Such contrasts are reflected in Florida in the communities with a high level of poverty and low access to healthy food choices.

The risk of obesity among this population has been well documented because of food insecurity. Since food insecurity people are forced to spend more on obtaining nutritious food than on more affordable and convenient items, they tend to consume energy-dense and nutrient-poor food (Carvajal-Aldaz et al., 2022). In a large cross-sectional study based on the National Health and Nutrition Examination Survey (NHANES), the very low food security individuals were more likely to be obese than their food-secure counterparts (adjusted odds ratios were 43.66) (Rezaei et al., 2024). The U.S. Department of Agriculture reports that, statistically significant food insecurity in 2022 among Black non-Hispanic households was 22.4% and Hispanic households was 20.8% (as cited in Nutrition at Michigan State University, 2023): the target population on Miami-Dade overlaps significantly with these groups, as these figures were higher than the national average in 2022.

This vulnerability is further aggravated by structural barriers. The study of Gastroenterology Clinics of North America has validated that non-Hispanic blacks and Hispanics are more prone to food insecurity, a lack of recreational amenities, and physical barriers to obesity management, such as lack of transportation and time constraints in employment which cuts down adherence to lifestyle treatment programs (Johnson et al., 2023). The combination of these biological and structural risk factors makes this population especially prone to obesity followed by comorbidities such as type 2 diabetes, hypertension, and cardiovascular disease.

Review of Literature

An article in Preventing Chronic Disease (meta-analysis and systematic review) studied 14 randomized controlled trials of multicomponent lifestyle interventions, which include physical activity and nutrition components, in adults with overweight or obesity and multicomponent interventions with a maximum of six months of interventions (Rotunda et al., 2024). The overall mean change in weight difference between the intervention and control groups was found as -2.59kg (95% CI -3.47 to -1.72) and this showed that even short term lifestyle intervention causes statistically significant and clinically significant weight loss. The researchers concluded that 13 to 26-week interventions generated a weight loss of 2.40 kg pooled whereas 13 to less than 26-week had 2.70 kg, indicating that resource-constrained program timeframes are capable of achieving gains. These trials were mostly strong as they used randomized controlled designs and objective weight measurement, but they had many weaknesses as the populations were different in different trials, and there were also few trials where a large percentage of racial and ethnic minority took part, which limits the generalizability of the results to the Miami-Dade target community.

The second set of evidence that has been examined in this paper is narrowed to differences in the access and outcomes of obesity care in minority populations. Writing in Gastroenterology Clinics of North America, Johnson et al. (2023) carried out a systematic review of racial and ethnic differences in the treatment of obesity and discovered that Black and Hispanic patients always gain less weight compared to White patients within the scope of the behavioral lifestyle intervention. The authors explain this disparity by structure such as food insecurity, poor transportation, and disproportional representation in programs, which fail to consider cultural dietary habits and socioeconomic limitations. The strength of the review is the fact that it reviews disparities across the three most important mode of treating obesity which include lifestyle, pharmacologic as well as surgical modalities of treatment. One of the major weaknesses is the fact that the review was not a meta-analysis and could not combine the magnitude of the disparities between the studies, which makes it challenging to measure the exact extent of the disparities. Combined, these two sources form a strong case of designing multicomponent, intensive, and culturally adapted lifestyle interventions not only focusing on the behavior but also the structural forces contributing to the difficulty of changing behavior in low-income minority adults.

Theoretical Framework

A multilevel construct, the Social Ecological Model (SEM) will be used to guide this health promotion program and assume that the individual health outcomes are influenced by the interaction of the factors on the intrapersonal, interpersonal, community, organizational, and policy levels (CDC, as described in OpenStax Population Health for Nurses, 2024). SEM is well-adapted to solve obesity among low-income minority groups because it clearly recognizes that the behavioral change of people, i.e. dietary habits, physical activity, etc. cannot be maintained without the simultaneous alteration of individuals social and physical environment in which they live, work, and receive care.

The program will provide health education, self-monitoring devices, and behavioral counseling at the intrapersonal level to enhance the knowledge of the participants, their self-efficacy, and motivation. On the interpersonal level, group counseling sessions and peer-support networks will be enrolled to the participants that utilize the concept of social support as the mechanism of behavior-change maintenance. At the community level will entail the collaboration with local community organizations, churches, and grocery cooperatives to enhance access to affordable food and secure physical activity in the most underserved communities in Miami-Dade. On the organizational level, the program will collaborate with primary care clinics where uninsured or adult patients on Medicaid Insurance are provided with primary care to incorporate screening and referral to obesity screening in the primary care delivery. Lastly on the policy level, the program will provide data that can be referred to advocate changes in local food policy such as expanding mobile produce markets and produce prescription programs.

It has been confirmed that the interventions based on the SEM at the multilevel are more effective to prevent and manage obesity and single-level interventions based on the individual focus due to their comprehensiveness as they impact the equilibrium of the entire spectrum of structural and environmental factors that maintain the unhealthy behavioral patterns over a long-term period (Hunter et al., as cited in OpenStax Population Health for Nurses, 2024). The multilevel system of the SEM also suits the role of an advanced practice nurse as a communicator and change agent on a community-level since it allows a comprehensive, evidence-based approach to obesity and its related health inequities in Miami-Dade County.

References

Carvajal-Aldaz, D., Cucalon, G., & Ordonez, C. (2022). Food insecurity as a risk factor for obesity: A review. Frontiers in Nutrition, 9, 1012734. https://doi.org/10.3389/fnut.2022.1012734

Centers for Disease Control and Prevention. (2024). New CDC data show adult obesity prevalence remains high. U.S. Department of Health and Human Services. https://www.cdc.gov/media/releases/2024/p0912-adult-obesity.html

Emmerich, S. D., Fryar, C. D., Stierman, B., & Ogden, C. L. (2024). Obesity and severe obesity prevalence in adults: United States, August 2021–August 2023. NCHS Data Brief, (508). https://doi.org/10.15620/cdc/159281

Johnson, V. R., Kendrick, K., Ibrahim, A. A., & Bhatt, D. L. (2023). Disparities in access and quality of obesity care. Gastroenterology Clinics of North America, 52(2), 429–441. https://doi.org/10.1016/j.gtc.2023.02.003

Nutrition at Michigan State University. (2023). Understanding the paradox of obesity and food insecurity. Michigan State University Extension. https://www.canr.msu.edu/news/understanding-the-paradox-of-obesity-and-food-insecurity

OpenStax Population Health for Nurses. (2024). 10.3 Core principles of the socio-ecological model. Rice University. https://openstax.org/books/population-health/pages/10-3-core-principles-of-the-socio-ecological-model

Rezaei, M., Ghadamgahi, F., Jayedi, A., et al. (2024). The association between food insecurity and obesity, a body shape index and body roundness index among US adults. Scientific Reports, 14, 23631. https://doi.org/10.1038/s41598-024-74108-x

Rotunda, W., Rains, C., Jacobs, S. R., Ng, V., Lee, R., Rutledge, S., et al. (2024). Weight loss in short-term interventions for physical activity and nutrition among adults with overweight or obesity: A systematic review and meta-analysis. Preventing Chronic Disease, 21, 230347. https://doi.org/10.5888/pcd21.230347

Thorpe, K. E., & Joski, P. J. (2024). Estimated Reduction in Health Care Spending Associated With Weight Loss in Adults. JAMA Network Open, 7(12), e2449200. https://doi.org/10.1001/jamanetworkopen.2024.49200