Families Preventing Diabetes Familias Preveniendo la Diabetes A Community-Based Intervention of the San Antonio Metropolitan Health District San Antonio Metropolitan Health District - Linda Hook, Marivel Davila, Lucille Romero Emerging Issues in MCH Conference Call Thursday, December 16, 2004

Background - Bexar County Bexar County Texas, home to San Antonio, nation’s eighth largest city. Slightly over a million residents (1.4 million) of which 56% are Hispanic. In 2003, Bexar County had a diabetes prevalence rate of 10.4%. Diabetes was the fifth leading cause of death.

2002 Diabetes Deaths by Age by Race/Ethnicity for Bexar County 3 Age Deaths

Program Overview - Families Preventing Diabetes A community-based collaborative intervention of the San Antonio Metropolitan Health District, the Texas Diabetes Institute and the House of Neighborly Service. Project is a one-year pilot intervention funded by the Centers for Disease Control.

Purpose – Families Preventing Diabetes To identify families with one or more family members diagnosed with diabetes and assist them with attainment of healthier behaviors to prevent further complications; and To teach families who are at high-risk for developing diabetes prevention strategies for preventing the onset of the disease.

Project Goals – Families Preventing Diabetes To develop and foster a model of diabetes prevention for the community surrounding the House of Neighborly Service that is culturally appropriate and meets the needs of the residents.

Project Area – Families Preventing Diabetes The House of Neighborly Service is a service agency located in the West Side of San Antonio – a predominantly low-income, minority populated area of the city. – 99% of population is Hispanic; – 33% had household income below poverty level in 1999; – Roughly 500 households in two block-group area. Source: 2000 U.S. Census

Project Goals – Families Preventing Diabetes Provide linkage with providers for self- management classes; Provide on-site diabetes prevention classes at HNS; Develop Promotora program for sustainability.

Accomplishments – Families Preventing Diabetes 3 focus groups conducted; 2 promotoras recruited; Staff attended weeklong diabetes class at TDI; 52 pre-assessments completed among participants.

Lessons Learned – Focus Groups Families Preventing Diabetes Three focus groups held among 21 participants August Among those interviewed: – 90% had diabetes, of those who did not, the majority had a near relative living with diabetes; – 90% did not own measuring utensils; – Virtually all of the respondents reported not reading food labels; – Roughly a third of the respondents reported not having funds to purchase test strips for glucometer; – Half of the participants preferred a hands-on approach to learning.

Lessons Learned – Pre-Assessments Families Preventing Diabetes 52 assessments completed, almost all conducted in Spanish. 30% of participants reported being told they were diabetic. Average weight was 164 pounds. Two participants’ glucose levels were greater than 400.

Lessons Learned – Pre-Assessments Families Preventing Diabetes Case 1: Participant had non-fasted glucose of 238 mg/dl. Reported being without diabetes and blood pressure medication for two months. Had been given generic medication, which participant had not recognized and had been afraid to have prescriptions filled.

Lessons Learned – Pre-Assessments Families Preventing Diabetes Case 2: Participant reported being diagnosed with Type 2 diabetes in Since then, had not had any medical follow- up nor had glucose meter and supplies. Her fasting glucose was 332 mg/dl. Had problems receiving medical care due to lack of documentation.

Lessons Learned – Pre-Assessments Families Preventing Diabetes Case 3: Participant diagnosed with diabetes nearly 10 years ago; since then had not had a follow-up or annual exam. Fasting glucose was 349 mg/dl, cholesterol was 264 and triglycerides were over 650 mg/dl. Participant does not own a glucose meter and had been borrowing a family member’s insulin.

Lessons Learned – Families Preventing Diabetes Barriers: – Other issues in participants’ lives besides diabetes. – Fatalistic beliefs when it comes to diabetes. – Foods considered healthy are not staples of participants’ diets. – Lack of safe locations for exercise. – Lack of healthy products available at local grocery stores. – System changes would help community.

Future Plans – Families Preventing Diabetes Self-management and diabetes prevention classes to begin in January, Evaluation to take place once classes end. Promotoras to assist in delivering diabetes prevention class. Develop support/exercise group for HNS participants. Pilot project ends March of 2005.

Future Plans – Families Preventing Diabetes Move from individual, to community to systems. Involve community residents, businesses, schools, churches and social service agencies. Prepare participants to become advocates.

Families Preventing Diabetes Social Marketing Health Teaching Individual Community Systems Collaboration Advocacy Support Outreach Coalition building Policy Resources/Follow-up Screening Community Organizing STEPS MAPP Healthy Start Neighborhood Action Project WORTH Adapted from: Public Health Nursing Practice for the 21 st Century: Competency Development in Population-Based Practice; Minnesota Department of Health, Section of Public Health Nursing Families Preventing Diabetes: A Systems Approach to Better Health

Future Plans – Families Preventing Diabetes Continuation of Year One activities. Development of community-based advocacy group. Encourage group of natural leaders to become “Block Captains”. Work with Block Captains to become advocates for diabetes and community change. Introduce Block Captains to city-wide collaboratives.

Future Plans – Families Preventing Diabetes Work at different levels to address diabetes by: – Encouraging participants to learn and maintain healthy behaviors; – Establishing a community-based advocacy group for their neighborhood; – Promoting moving residents from neighborhood roles to city-wide advocacy activities.