UTRGV'S AHEC Program:

The journey to serving the

medically underserved.

About

Caleb Mata

Caleb Mata is currently an Exercise Science student in his final semester of his undergraduate career at UTRGV. He is a member of the VaquerosMD Program and the AHEC Scholars Program. His goal is to enter medical school in hopes of becoming a physician and practice in the RGV to not only treat our medically underserved community but also place focus on utilizing exercise as a form of preventative medicine.

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The goals of the AHEC Program include:

-Improve patient access to health care in rural and underserved areas in the RGV

-Develop and enhance training networks within South Texas communities, academic institutions, and community-based organizations

-Educate students across multiple disciplines about the social causes of health and health inequalities

Our Focus Areas

Mission

Module 1: Health Disparities in the RGV

1. What historical health disparities research has been done with the elderly Hispanic individuals living in rural areas or colonias in the RGV?

2. What research is being conducted currently on the elderly Hispanic population in rural areas?

The mission of the South Texas Diabetes and Obesity Institute is to advance the health of South Texas and the world through cutting edge research on diabetes, obesity, and related disorders. Using state of the art resources and tools, the faculty and staff of the STDOI conduct research on a broad range of diseases and conditions related to diabetes and obesity. Building on a long history of work with minority populations and international research, STDOI scientists are committed to reducing health disparities in the Rio Grande Valley and to improving health across the globe.

3. Based on your research, what possible research or interventions do you recommend that will address the Health Disparities in the RGV?

Community-based programs to educate and promote healthy behaviors, such as exercise and proper nutrition
Access to affordable healthcare services, including preventive care and disease management
Addressing social determinants of health, such as education, employment, and poverty

4. Define the "Built Environment," and how this potentially can affect Health Disparities in the Rio Grande Valley?

The "Built Environment" refers to the human-made surroundings that provide the setting for human activity, including buildings, roads, parks, and other infrastructure. The built environment can significantly influence health disparities by affecting access to healthcare services, opportunities for physical activity, and exposure to environmental hazards.

In the RGV, the built environment in colonias, which are unincorporated and low-income settlements, often lacks essential infrastructure like potable water, sewage systems, and paved roads. This lack of resources can contribute to health disparities by limiting access to healthcare, recreational opportunities, and other resources that promote health and well-being.

Area Health Education Centers Program

1. When was the AHEC program established at UTRGV?

September 1, 2017

2. Who is in charge of the AHEC program and how are they funded?

John Ronnau, PhD

Senior Associate Dean for Community Health Partnerships

Director of the Area Health Education Centers (AHEC) Program

U.S. Dept. of Health and Human Services

Health Resources and Services Administration (HRSA)

University of Texas Rio Grande Valley School of Medicine

3. Where are the AHEC Clinics located in the Rio Grande Valley and why were they placed in those locations across the Rio Grande Valley?

These centers were strategically placed to serve the diverse and medically underserved communities in each region.

4. Where is the AHEC main office located?

John Austin Pena Facility

5. Built Environment of AHEC Clinics

La Victoria AHEC

San Carlos AHEC

Analysis

Since I am most familiar with these AHEC locations, I will be providing an analysis of the Built Environment based on multiple factors below.

Walkability: A major resource lacking in both locations is the lack of sidewalks or safe walking paths connecting residential areas to the clinics and other essential services like grocery stores, schools, and parks (exception being San Carlos). Walkability promotes physical activity and can help people maintain a healthy weight.
Green spaces: While there are nearby parks and green spaces, the issue of walkability produces a barrier to individuals wanting to utilize these spaces. Green spaces encourage physical activity, social interaction, and stress reduction, which can contribute to overall health and well-being.
Accessibility: Transportation introduces a major issue to those who do not have access to reliable vehicles or means of transportation. Since these clinics are located in rural and underserved areas, this produces another barrier of people receiving adequate medical treatment. Access to healthcare services is a critical factor in addressing health disparities.
Public transportation: There appears to be a lack of public transportation options available for people to reach these clinics. Convenient and affordable public transportation can help reduce disparities in access to healthcare.
Safety: The area around the clinics poses as a potential threat to safety of the individuals attempting to engage in forms of physical activity like walking or biking. People are more likely to engage in physical activity in areas where they feel safe.
Land use: There is a lack of mixed-use development in the area around these clinics, meaning there is not an equal amount of residential, commercial, and recreational spaces co-existing. Mixed-use areas tend to promote higher levels of physical activity.

Reflection

Throughout this module, I have gained valuable insight into the health disparities affecting the Hispanic population in the Rio Grande Valley. I have learned about the critical role that AHEC clinics play in providing healthcare services to underserved communities, helping to reduce health inequalities and improve overall health outcomes. The importance of these clinics in the RGV cannot be understated, as they bridge the gap in healthcare access for many vulnerable populations.

Moreover, I have delved into various research studies conducted in the region, which have shed light on the complex interplay between socioeconomic factors, the built environment, and health disparities such as obesity and diabetes. These studies emphasize the need for culturally tailored interventions and targeted public health initiatives to address the unique challenges faced by the Hispanic community in South Texas.

References

Area Health Education Centers (AHEC): UTRGV School of Medicine. UTRGV. (n.d.). Retrieved March 12, 2023, from https://www.utrgv.edu/school-of-medicine/about/community/area-health-education-centers/index.htm

Cheryl M. Kelly, PhD, Jeffrey S. Wilson, PhD, Elizabeth A. Baker, PhD, MPH, Douglas K. Miller, MD, Mario Schootman, PhD, Using Google Street View to Audit the Built Environment: Inter-rater Reliability Results, Annals of Behavioral Medicine, Volume 45, Issue suppl_1, February 2013, Pages S108–S112, https://doi.org/10.1007/s12160-012-9419-9

Deans (Utrgv School of Medicine). UTRGV. (n.d.). Retrieved March 12, 2023, from https://www.utrgv.edu/school-of-medicine/about/deans/index.htm

Instant google street view. Instant Google Street View. (n.d.). Retrieved March 12, 2023, from https://www.instantstreetview.com/

Lovasi, G. S., Hutson, M. A., Guerra, M., & Neckerman, K. M. (2009). Built environments and obesity in disadvantaged populations. Epidemiologic reviews, 31, 7–20. https://doi.org/10.1093/epirev/mxp005

Mier, N., Wang, X., Smith, M. L., Irizarry, D., Treviño, L., Alen, M., & Ory, M. G. (2012). Factors influencing health care utilization in older Hispanics with diabetes along the Texas-Mexico border. Population health management, 15(3), 149–156. https://doi.org/10.1089/pop.2011.0044

Mier, N., Smith, M. L., Carrillo-Zuniga, G., Wang, X., Garza, N., & Ory, M. G. (2012). Personal and cultural influences on diabetes self-care behaviors among older Hispanics born in the U.S. and Mexico. Journal of immigrant and minority health, 14(6), 1052–1062. https://doi.org/10.1007/s10903-012-9639-x

Rianon, N. J., Smith, S. M., Lee, M., Pervin, H., Musgrave, P., Watt, G. P., Nader, S., Khosla, S., Ambrose, C. G., McCormick, J. B., & Fisher-Hoch, S. P. (2018). Glycemic Control and Bone Turnover in Older Mexican Americans with Type 2 Diabetes. Journal of osteoporosis, 2018, 7153021. https://doi.org/10.1155/2018/7153021

Sallis, J. F., Floyd, M. F., Rodríguez, D. A., & Saelens, B. E. (2012). Role of built environments in physical activity, obesity, and cardiovascular disease. Circulation, 125(5), 729–737. https://doi.org/10.1161/CIRCULATIONAHA.110.969022

Module 2: Diabetes Needs in the Rio Grande Valley

1. Compare the overall population of diabetics in the RGV and within each county of Starr, Hidalgo, Willacy, and Cameron county.

This data shows adults aged 20+ diagnosed with diabetes compared to each of the counties in the Rio Grande Valley. Hidalgo comes in at the highest with 13.5% and Willacy at the lowest with 6.7%

2. Are there any major differences in diabetes in geographic regions in the RGV and within specific populations, such as professionals working men and women, the elderly, kids?

This data shows older adults aged 55+ diagnosed with diabetes compared to each of the counties in the Rio Grande Valley. This data shows individuals with Medicare insurance, therefore it may not be fully representative of the population, since some individuals may not be covered by insurance. In comparison to the previous data, there's a clear discrepancy between values characterized by population age.

3. Define and describe the obesity rates of individuals within the RGV.

This indicator shows the percentage of adults aged 18 and older who are obese according to the Body Mass Index (BMI). The BMI is calculated by taking a person's weight and dividing it by their height squared in metric units (BMI = Weight (Kg)/[Height (m) ^ 2]). A BMI >=30 is considered obese.

4. Define and describe the obesity rates of UTRGV students and faculty.

This proxy data recorded by American College Health Association shows the BMI percentages of undergraduate college students. While it is not representative of UTRGV students/faculty, it is reasonable to conclude that the rates of obesity regarding our population may be higher than the national average.

5. Research any faculty, department or institute at UTRGV that has defined the prevalence of Metabolic Syndrome on campus with faculty and/or students.

This journal conducted by Gonzalez et al. researched the prevalence of Metabolic Syndrome from a pool of Kinesiology students at UTRGV. Results indicated that 10% of the sample met 3 out 5 criteria for Metabolic Syndrome.

6. How do individuals in rural areas approach diabetes?

Although not a UTRGV study, this study provides a valuable insight to the prevalence of Metabolic Syndrome in the RGV. Just under 50% of individuals in the pool of 3,414 individulas residing in Cameron County were found to have Metabolic Syndrome.

This study conducted by Mier et al. provides data on the perspectives of Mexican-Americans with diabetes living in the RGV. Results indicated that most people identified barriers such as lack of time, facilities, depression etc. Therefore, there was an unwillingness change due to high external locus of control for these individuals.

7. If individuals in rural areas wanted to exercise outdoors where in their home areas could they do this safely?

For individuals in rural areas who want to exercise outdoors safely, there are several options to consider. The availability of these options will depend on the specific rural area, its infrastructure, and the 'Built Environment' as discussed previously. Some general suggestions for finding safe outdoor exercise spaces in rural areas include:

Local parks and recreation areas: Look for parks, playgrounds, or other public recreation spaces where you can walk, run, play sports, or engage in other physical activities. These spaces are usually maintained by local government or community organizations and may have designated walking paths, sports facilities, or play areas.
Walking and biking trails: Many rural areas have walking, hiking, or biking trails that are designed for outdoor exercise. These trails can be found in local parks, nature reserves, or along scenic routes. Check for maps or signage in your area to identify trails suitable for exercise.
School facilities: Some areas may have schools with sports facilities, playgrounds, or open fields that can be used for outdoor exercise when school is not in session. Check with the school to find out if these facilities are available for public use and what the rules are for accessing them.

Reflection

Reflecting on Module 2, I have gained a deeper understanding of the diabetes needs in the RGV. By examining the prevalence of diabetes in different counties and populations, I've become more aware of the disparities that exist within the RGV community. I've also learned about the importance of addressing obesity rates, as they are closely related to diabetes prevalence.

This module has highlighted the significance of gathering accurate data and conducting research to better understand the health challenges faced by residents in the RGV. I've come to appreciate the value of utilizing this data to inform and develop targeted interventions for managing diabetes and promoting overall health. By focusing on the specific needs of the RGV population, we can create more effective strategies for reducing the burden of diabetes in the region.

References

Connect, R. G. V. H. (n.d.). RGV Health Connect. RGV Health Connect :: Home. Retrieved March 20, 2023, from https://www.rgvhealthconnect.org/

Gonzalez, J., Davenport, M., Renolla, E., Cartagenas, A., Escamilla, D., Chandler, K., Jorgensen, L., Gray, R., & Soojin Yoo. (2015). Metabolic Syndrome at a Predominantly Hispanic Institution in South Texas among Kinesiology Majors 18-30 Years Old. TAHPERD Journal, 83(3), 8–12.

Fisher-Hoch, S. P., Vatcheva, K. P., Rahbar, M. H., & McCormick, J. B. (2015). Undiagnosed Diabetes and Pre-Diabetes in Health Disparities. PloS one, 10(7), e0133135. https://doi.org/10.1371/journal.pone.0133135

Mier, N., Medina, A. A., & Ory, M. G. (2007). Mexican Americans with type 2 diabetes: perspectives on definitions, motivators, and programs of physical activity. Preventing chronic disease, 4(2), A24.

Obesity Data. Obesity Data | Texas DSHS. (n.d.). Retrieved March 20, 2023, from https://www.dshs.texas.gov/obesity-texas/obesity-data

The University of Texas Rio Grande Valley. UTRGV. (n.d.). Retrieved March 20, 2023, from https://www.utrgv.edu/health-services/resources/index.htm

Undergraduate student reference group - acha.org. (n.d.). Retrieved March 20, 2023, from https://www.acha.org/documents/ncha/NCHA-III_FALL_2022_UNDERGRADUATE_REFERENCE_GROUP_DATA_REPORT.pdf

Wu, S., Fisher-Hoch, S. P., Reininger, B., & McCormick, J. B. (2016). Recommended Levels of Physical Activity Are Associated with Reduced Risk of the Metabolic Syndrome in Mexican-Americans. PloS one, 11(4), e0152896. https://doi.org/10.1371/journal.pone.0152896

Module 3: Sarcopenia in An Elderly Hispanic Diabetic Population

To evaluate Teresa for sarcopenia, it's essential to work with healthcare professionals who can perform a thorough assessment. This process may involve the following steps:

1. Medical History and Physical Examination

A healthcare professional should review Teresa's medical history and conduct a physical examination to evaluate her overall health and identify any factors contributing to muscle loss.

2. Functional Assessment

A functional assessment, such as the Short Physical Performance Battery (SPPB) or handgrip strength test, can help determine the extent of her muscle weakness and functional limitations.

3. Body Composition Analysis

A Dual-energy X-ray Absorptiometry (DXA) scan (left) or bioelectrical impedance analysis (BIA) (right) can provide information on Teresa's body composition, including lean muscle mass, fat mass, and bone density.

Sarcopenia Evaluation

4. Blood Tests

Blood tests can help identify any underlying nutritional deficiencies or medical conditions that may contribute to sarcopenia.

Sarcopenia Intervention

After a thorough evaluation, the healthcare team can develop a personalized intervention plan for Teresa. This plan may include the following components:

1. Resistance Training

Engaging in regular resistance training exercises can help increase muscle strength and mass. I would recommend for Teresa to follow a guided program tailored to her fitness level and abilities.

-Hand Grip

-Overhead Arm Raises

-Arm Curl w/Resistance Band

-Wall Push-ups

-Chair Dips

-Back Leg Raise

-Side Leg Raise

-Chair Stand

-Toe Stand

2. Aerobic Exercise

In addition to resistance training, incorporating aerobic exercises like walking, cycling, or dancing can help improve overall fitness and cardiovascular health. Encourage Teresa to gradually increase her daily activity levels.

3. Nutritional Counseling

A nutritionist can help Teresa develop a balanced meal plan that includes adequate protein, healthy fats, and complex carbohydrates. I would encourage her to consume lean protein sources, such as poultry, fish, and legumes, and incorporate more fruits and vegetables into her diet.

4. Social Support from Family and Friends

I would encourage Teresa's daughter, Patricia, to be actively involved in her mother's care and provide support during her exercise routine and dietary changes. This involvement can help Teresa feel more comfortable with the interventions and increase her adherence to the plan.

5. Telehealth

In rural areas, telehealth services can be utilized to provide ongoing support and guidance for patients like Teresa. Regular video consultations with healthcare professionals, such as her nutritionist or physical therapist, can help track her progress, answer questions, and make any necessary adjustments to her intervention plan.

6. Fall prevention

Due to her age and muscle weakness, it is essential to address fall prevention as part of Teresa's intervention plan. I would encourage her to perform balance exercises and create a safe home environment by removing potential tripping hazards and installing handrails or grab bars where needed.

7. Mental Health

It's crucial to address the psychological aspects of Teresa's health as well. I would encourage her to maintain social connections and engage in stress-reducing activities, such as meditation or deep-breathing exercises, to improve her mental wellbeing and overall quality of life.

Module 4: Functional At Home Exercise Program

Diabetes-Friendly Home Workout for Rural Communities

Welcome to the Diabetes-Friendly Home Workout program! This exercise plan is designed to help individuals living in rural areas of the Rio Grande Valley improve their glycemic control, functional strength, and cardiovascular fitness. I have taken into account the built environment and limited access to equipment, providing a program that can be safely performed at home with minimal resources.

Equipment Needed

Full Workout

Warm-Up (5-10 minutes):

March in place
Arm circles
Leg swings
Ankle rolls
Shoulder rolls

Workout:

1. Squats (3 sets of 10-12 repetitions)

Modification: Chair squats
Progression: Squat with water bottles/canned goods
2. Push-Ups (3 sets of 8-10 repetitions)
Modification: Wall push-ups or push-ups on knees
Progression: Regular push-ups
3. Resistance Band Rows (3 sets of 10-12 repetitions)
Modification: Lower resistance band or fewer repetitions
Progression: Increase resistance or add a pause at the peak contraction
4. Stationary Lunges (3 sets of 10 repetitions per leg)
Modification: Lower step height
Progression: Add water bottles/canned goods for extra resistance
5. Standing or Seated Overhead Press (3 sets of 8-10 repetitions)
Modification: Use lighter water bottles/canned goods
Progression: Increase weight or add resistance band

Cool Down (5-10 minutes):

Seated forward bend
Quad stretch
Hamstring stretch
Chest stretch
Triceps stretch

Introduction Video

Warm up

Squat Demonstration

Push-Up Demonstration

Resistance Band Rows

Switching Lunges

Overhead Press

Cool Down

Reflection

Reflecting on Module 3, I've come to understand the significant impact of sarcopenia, particularly in underserved communities like the one where Teresa lives. This experience has shed light on the challenges faced by individuals with limited access to healthcare resources and emphasized the importance of tailored interventions to address their unique needs. The knowledge gained from this module will be crucial in developing effective interventions for individuals like Teresa, as it highlights the need for a multifaceted approach that considers the specific challenges faced by underserved populations. By taking these factors into account, we can work towards improving health outcomes and reducing health disparities for individuals living with sarcopenia and other chronic conditions.

References

Bellomo RG, Iodice P, Maffulli N, Maghradze T, Coco V, Saggini R. Muscle Strength and Balance Training in Sarcopenic Elderly: A Pilot Study with Randomized Controlled Trial. European Journal of Inflammation. 2013;11(1):193-201. doi:10.1177/1721727X1301100118

Bluejay health: Bluejaytelehealth™. BlueJay health | BlueJayTelehealth™. (n.d.). Retrieved March 28, 2023, from https://www.bluejayhealth.com/products/TeleHealth

Centers for Disease Control and Prevention. (2021, October 20). Radiation in healthcare: Bone Density (Dexa Scan). Centers for Disease Control and Prevention. Retrieved March 28, 2023, from https://www.cdc.gov/nceh/radiation/dexa-scan.html#:~:text=DEXA%20(dual%20x%2Dray%20absorptiometry,the%20hip%20and%20the%20spine.

Go4Life from the National Institute on Aging. Go4Life from the National Institute on Aging | HealthInAging.org. (n.d.). Retrieved March 28, 2023, from https://www.healthinaging.org/tools-and-tips/go4life-national-institute-aging

How bia works. How BIA works | Tanita Corporation. (n.d.). Retrieved March 28, 2023, from https://www.tanita.com/en/howbiaworks/

Rolland, Y., Czerwinski, S., Abellan Van Kan, G., Morley, J. E., Cesari, M., Onder, G., Woo, J., Baumgartner, R., Pillard, F., Boirie, Y., Chumlea, W. M., & Vellas, B. (2008). Sarcopenia: its assessment, etiology, pathogenesis, consequences and future perspectives. The journal of nutrition, health & aging, 12(7), 433–450. https://doi.org/10.1007/BF02982704

Short physical performance battery. Physiopedia. (n.d.). Retrieved March 28, 2023, from https://www.physio-pedia.com/Short_Physical_Performance_Battery

What is MyPlate? MyPlate. (n.d.). Retrieved March 28, 2023, from https://www.myplate.gov/eat-healthy/what-is-myplate

YouTube. (2017, October 18). Short physical performance battery (SPPB). YouTube. Retrieved March 28, 2023, from https://www.youtube.com/watch?v=N_rJOGhQqZ4

Reflection

Throughout Module 4, I have learned the importance of creating a diabetes-friendly home workout for individuals living in rural communities of the Rio Grande Valley. By designing an exercise program that takes into account the built environment and limited access to equipment, we can help these individuals improve their glycemic control, functional strength, and cardiovascular fitness. This module has highlighted the significance of providing accessible and adaptable workout routines that can be performed safely at home with minimal resources. It has also emphasized the importance of understanding the physiological mechanisms behind exercise and glucose control. By incorporating these lessons, we can create tailored interventions that make a positive impact on the lives of diabetic individuals in rural communities, ultimately empowering them to better manage their health and well-being.

References

Centers for Disease Control and Prevention. (2022, November 3). Get active! Centers for Disease Control and Prevention. Retrieved April 9, 2023, from https://www.cdc.gov/diabetes/managing/active.html#:~:text=The%20goal%20is%20to%20get,%2C%20shoulders%2C%20and%20arms).

Chen, L., Pei, J. H., Kuang, J., Chen, H. M., Chen, Z., Li, Z. W., & Yang, H. Z. (2015). Effect of lifestyle intervention in patients with type 2 diabetes: a meta-analysis. Metabolism: clinical and experimental, 64(2), 338–347. https://doi.org/10.1016/j.metabol.2014.10.018

Colberg, S. R., Sigal, R. J., Fernhall, B., Regensteiner, J. G., Blissmer, B. J., Rubin, R. R., Chasan-Taber, L., Albright, A. L., Braun, B., American College of Sports Medicine, & American Diabetes Association (2010). Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes care, 33(12), e147–e167. https://doi.org/10.2337/dc10-9990

Dugan, Joy A. CSCS, MPH, PA-C. Exercise recommendations for patients with type 2 diabetes. JAAPA 29(1):p 13-18, January 2016. | DOI: 10.1097/01.JAA.0000475460.77476.f6

Go4Life from the National Institute on Aging. Go4Life from the National Institute on Aging | HealthInAging.org. (n.d.). Retrieved April 7, 2023, from https://www.healthinaging.org/tools-and-tips/go4life-national-institute-aging

Ivy, J. L. (2004). Regulation of muscle glycogen repletion, muscle protein synthesis and repair following exercise. Journal of Sports Science & Medicine, 3(3), 131-138.

Marcus, B. H., Selby, V. C., Niaura, R. S., & Rossi, J. S. (1992). Self-efficacy and the stages of exercise behavior change. Research quarterly for exercise and sport, 63(1), 60–66. https://doi.org/10.1080/02701367.1992.10607557

Pirzadeh, A., Mostafavi, F., Ghofranipour, F., & Feizi, A. (2015). Applying Transtheoretical Model to Promote Physical Activities Among Women. Iranian journal of psychiatry and behavioral sciences, 9(4), e1580. https://doi.org/10.17795/ijpbs-1580

Richter, E. A., & Hargreaves, M. (2013). Exercise, GLUT4, and skeletal muscle glucose uptake. Physiological Reviews, 93(3), 993-1017.

Sheri R. Colberg, Ronald J. Sigal, Jane E. Yardley, Michael C. Riddell, David W. Dunstan, Paddy C. Dempsey, Edward S. Horton, Kristin Castorino, Deborah F. Tate; Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association. Diabetes Care 1 November 2016; 39 (11): 2065–2079. https://doi.org/10.2337/dc16-1728

Clinical Exercise Physiology Reflection

Throughout the semester, working on the various modules has been a transformative experience, providing me with valuable insights into the complexities of health disparities, particularly in the Rio Grande Valley, and the critical role of exercise, nutrition, and lifestyle interventions in addressing these challenges. The modules have touched upon various aspects of health and wellness, including the influence of the built environment, the specific needs of diabetic individuals, and the importance of understanding and addressing sarcopenia in older adults. As a result, I have gained a comprehensive understanding of the factors that contribute to the health disparities in underserved communities and the need for tailored, community-centered interventions.

One of the key takeaways from the modules has been the importance of considering the unique needs and circumstances of each population. This is particularly evident in the case studies, where designing interventions for diabetic individuals in rural communities required considering the built environment and limited access to resources. This experience has shown me that effective healthcare solutions must be adaptable and inclusive, ensuring that the most vulnerable populations have access to the tools and information needed to manage their health.

The modules have also reinforced the importance of evidence-based practice, as each assignment involved researching and analyzing credible sources to develop effective interventions. This has not only deepened my understanding of the health issues at hand but also honed my critical thinking and analytical skills, which are essential for a successful career in healthcare.

As I reflect on the lessons learned throughout this semester, I am grateful for the opportunity to delve into the multifaceted challenges facing underserved communities in the Rio Grande Valley. This experience has broadened my perspective and inspired me to continue pursuing a career in healthcare, with a focus on addressing health disparities and promoting wellness for all. I firmly believe that by applying the knowledge and skills gained from these modules, along with maintaining a strong sense of professionalism, I will be better equipped to make a meaningful difference in the lives of individuals and communities in need.