Sugar, Heart and Life: A Guide to Living with Diabetes Stephen Spann, MD Department of Family and Community Medicine

This project was generously underwritten by Mrs. Trinidad Mendenhall Sosa Acknowledgement

Burden of Disease

Prevalence of Diagnosed Diabetes Among US Adults Aged 18 and Older Race/EthnicityPrevalence* Non-Hispanic Whites6.6% Non-Hispanic Blacks8.4% Hispanics7.9% Source of Data: Analysis of the National Health and Nutrition Examination Survey

Texas Diabetes Prevalence Compared to the US AreaPrevalence* Texas 9.7% US 7.2% *Source: Texas Behavioral Risk Factor Surveillance System, Statewide BRFSS Survey, 2008, for persons who are eighteen years of age and older, and include both Type 1 and Type 2 Diabetes. Persons with diabetes include those who report that they have been told by a doctor that they have diabetes. Women who report diabetes only during pregnancy are not included in prevalence. Note: All reported rates (%) are weighted for Texas demographics and the probability of selection and thus are not derived from the simple division of numerator and denominator cases.

Prevalence of Diabetes, US and Texas, * *Source: CDC Behavioral Risk Factor Surveillance System, Statewide BRFSS Survey, 2008, for persons who are eighteen years of age and older, and include both Type 1 and Type 2 Diabetes. Persons with diabetes include those who report that they have been told by a doctor that they have diabetes.

Texas Projected Population Increases by Race/Ethnicity, *

Texas Projected Diabetes Cases *

Levels of A1C Among US Adults 18 and Older with Previously Diagnosed Diabetes (Percent Distribution, SE) Race/EthnicityA1C<7% % (SE) A1C7-8% % (SE) A1C>8% % (SE) Non-Hispanic White62.1 (4.19)21.5 (4.26)16.4 (4.02) Non-Hispanic Black39.2 (6.78)21.2 (5.76)39.6 (8.14) Mexican American30.9 (5.58)22.9 (4.48)46.2 (5.68) Source of Data: Analysis of the National Health and Nutrition Examination Survey

Levels of A1C Among Hispanic Adults ≥ 19 years of age with Previously Diagnosed Type 2 Diabetes Harris County Hospital District Community Clinics (Percent Distribution, SE) Overall/Gender7-8% % (SE) >8% % (SE) Overall (n = 191)26.2 (3.19) 73.8 (3.84) Men (n = 53) Women (n = 138) 20.8 (5.62) 28.3 (3.85) 79.2 (5.62) 71.7 (3.85)

Production and Design Sugar, Heart and Life

Purpose and Development The Diabetes Interactive Telenovela (DIT) was designed in response to the high prevalence of uncontrolled type 2 diabetes among Hispanic primary care patients in Houston’s Harris County Hospital District. Content for development of the DIT storyline was informed by data obtained from six focus groups conducted with 72 primary care patients from three local community health clinics.

Diabetes Interactive Telenovela (Intervention) Conceptual Model of DIT Intervention Personal Factors Literacy / Understanding Attitudes / Beliefs Outcome Expectancies Motivation Behavioral Factors Social Norms Cultural traditions Foods consumed Physical activity Habits Environmental Factors Social support Neighborhood Access to health care Transportation Diabetes Self Efficacy Improved Adherence Diet, Exercise, Medication Improved Glycemic Control (Reduction in HbA1c)

Objectives and Messaging Short-Term Objectives Attitudes, Beliefs, Knowledge changes Long Term Objective Improve diabetes regimen adherence in adult Hispanic men and women Overall Messages in Storyline (sprinkled throughout): With good diabetes control one can postpone or prevent the development of complications Importance of family support for diabetes management and prevention

Primary Topics Diet Physical Activity Medication Adherence Self-Care Family

Primary Storyline To follow a family who is dealing with diabetes management over the course of 1 year

Clip: Victoria Receives Diabetes Diagnosis

Telenovela: Main Components 5 Dilemma Sets Diet (2) Physical Activity (2) Medication Adherence (1) INTERACTIVE TELENOVELA EPISODES 7 Interactive Learning Resources “What is Diabetes?” “Check Out Your Choices” “Claudia’s Recipe Box” “Create-a-Plate” “Diabetes Care Toolbox” “What’s in it?” “Go for the Goal” INFO - MARKET

Interactive Learning Modules

Diabetes Interactive Telenovela Episode Selection Character Selection

Clip: Luis Chooses to Go to the Bar with His Friends

Diabetes Interactive Telenovela Decision Point Consequences Neutral Outcome: The Gonzalez family change a few things in the way they eat and get exercise Undesirable Outcome: The Gonzalez family continue with their usual eating and exercise patterns Desirable Outcome: The Gonzales family carefully watch what they eat and get daily exercise DIT: Five Years Later

Clip: Five Years Later Reflecting on the Family’s Bad Choices

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Questions and Discussion