2. Presenter Disclosures (1)The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: Elizabeth Bertera PhD Silvia Martinez, EdD “ No relationships to disclose ”

3. Presenter Disclosures Elizabeth M. Bertera, PhD Silvia Martinez, EdD

4. Talking Fotonovelas to Educate Older African Americans about Diabetes and High Blood Pressure Elizabeth M Bertera, PhD Associate Professor, School of Social Work, Howard University, Washington DC ebertera@howard.edu Silvia Martinez, EdD Assistant Professor, Dept of Communication Sciences and Disorders, Howard University, Washington DC smartinez@howard.edu Presented at the Annual Meeting of the American Public Health Association, Philadelphia, PA, November 8, 2009 The project was supported with funding from the Centers for Medicare & Medicaid

5. Study Purpose The purpose of this study is to evaluate an educational intervention, Talking Fotonovelas. The purpose of this study is to evaluate an educational intervention, Talking Fotonovelas. Skill building activities are integrated into the session and tailored to age, culture, and lower literacy. Skill building activities are integrated into the session and tailored to age, culture, and lower literacy. The Talking Fotonovelas, produced with standard application software, contain photographs and dialogue bubbles, similar to comic books, that include images and voice-over using participants from the community. The Talking Fotonovelas, produced with standard application software, contain photographs and dialogue bubbles, similar to comic books, that include images and voice-over using participants from the community.

6. Outcome Variables Increased Self-efficacy Related to Nutrition and Physical Activity. Increased Self-efficacy Related to Nutrition and Physical Activity. Improved health knowledge, attitudes and practices about nutrition and physical activity. Improved health knowledge, attitudes and practices about nutrition and physical activity. Separate scales measure outcomes for diabetes and hypertension. Separate scales measure outcomes for diabetes and hypertension.

7. Study Hypotheses H 1 Older African Americans will improve their knowledge, attitudes and practices (KAP) related to diabetes and high blood pressure. H 1 Older African Americans will improve their knowledge, attitudes and practices (KAP) related to diabetes and high blood pressure. H 2 Improvement in diabetes and high blood pressure KAP will be positively associated with increases in self-efficacy after exposure to the Fotonovelas. H 2 Improvement in diabetes and high blood pressure KAP will be positively associated with increases in self-efficacy after exposure to the Fotonovelas. H 3 Improvement in diabetes and high blood pressure KAP will be positively associated with increases in self-efficacy after exposure to the Fotonovelas, even after controlling for moderator variable effects (higher health literacy, higher educational attainment, higher exposure to FT and younger age). H 3 Improvement in diabetes and high blood pressure KAP will be positively associated with increases in self-efficacy after exposure to the Fotonovelas, even after controlling for moderator variable effects (higher health literacy, higher educational attainment, higher exposure to FT and younger age).

8. Design for Talking Fotonovelas (TF) Study: 200 intervention and 200 comparison group participants Study Group Year 1 Year 2 Intervention Groups Focus Groups Pre 1, TF#1 (N=50) Post 1 Pre 2, TF#2 (N=50) Post 2 Pre 3, TF#3 (N=50) Post 3 Pre 3, TF#3 (N=50) Post 3 Pre 4, TF#4 (N=50) Post 4 Pre 4, TF#4 (N=50) Post 4 Comparison Surveys Baseline (N = 100) Post Survey (N = 100)

9. What are you putting on the chicken? I use onion powder.

10. We put our forks down between bites. It help us to chew well and enjoy our food. We put our forks down between bites. It help us to chew well and enjoy our food.

11. KAP & Self-Efficacy Gaps Identified by Focus Group Results (based on NDEP Guidelines) Know when and how to test your blood glucose Know when and how to test your blood glucose Eat regular meals that contain a variety of healthy, low-fat, high-fiber foods, including fruits and vegetables each day; eat smaller portions of meat, fish and poultry Eat regular meals that contain a variety of healthy, low-fat, high-fiber foods, including fruits and vegetables each day; eat smaller portions of meat, fish and poultry Get physical activity each day:30-60 min on most days Get physical activity each day:30-60 min on most days Follow your foot care plan: check feet every day Follow your foot care plan: check feet every day Keep all appointments and have feet, eyes, and kidneys checked at least once a year Keep all appointments and have feet, eyes, and kidneys checked at least once a year Visit your Dentist twice a year; brush & floss daily Visit your Dentist twice a year; brush & floss daily Seek help if you feel down Seek help if you feel down

12. Baseline Survey Demographics Sample Characteristic Percent (N=58) Female81 African American 95 High School Education or more 70 Annual Income < $20,000 96 Average Age 72

13. Diabetes Treatment Status Sample Characteristic Percent (N=58) Dx of Diabetes by an MD Dx of Diabetes by an MD59 Takes Diabetes Medication 40.4 Takes Insulin 3.5

14. Hypertension Treatment Status Sample Characteristic Percent (N=58) Dx of Hypertension by an MD 87.9 Takes High BP Medication 89.7 Check Blood Pressure Regularly 44.8

15. Diabetes Related Goals – Next 12 Months (% Strongly Agree)

16. Current Behavior and Behavioral Intention: Nutrition & Physical Activity (% Strongly Agree)

17. Diabetes Self Efficacy Scores (1=Not at all Confident, 10=Totally Confident)

18. Pre and Post Assessments

19. Skill Building to Improve Portion Control

20. Summary Knowledge and self-efficacy gaps identified by focus groups and baseline survey Knowledge and self-efficacy gaps identified by focus groups and baseline survey Participants show strong interest in learning how to manage diabetes and hypertension through healthier eating and increased physical activity. Participants show strong interest in learning how to manage diabetes and hypertension through healthier eating and increased physical activity. Initial recruitment of African American older adults through Senior Housing and Senior Center partners has been successful. Initial recruitment of African American older adults through Senior Housing and Senior Center partners has been successful.

21. Implications There is an unmet need for diabetes and hypertension education in the African American older adult community. There is an unmet need for diabetes and hypertension education in the African American older adult community. Nutrition and physical activity topics are the areas of greatest interest and need. Nutrition and physical activity topics are the areas of greatest interest and need.

22. Acknowledgement Agnelli Sybel, MPH, MPA, Research Program Project Specialist Agnelli Sybel, MPH, MPA, Research Program Project Specialist Gregory Bacourt, Research Assistant and PhD student, School of Social Work Gregory Bacourt, Research Assistant and PhD student, School of Social Work Olivia Drake, MFA, Research Assistant and PhD student, School of Communications Olivia Drake, MFA, Research Assistant and PhD student, School of Communications Claudia Thorne, MSW, LISW, Research Assistant and PhD student, School of Social Work Claudia Thorne, MSW, LISW, Research Assistant and PhD student, School of Social Work