1. Access to Diabetes Self-Management Education in Disparate Communities in Austin, TX
Estephanie Olivares, HHSD Program Coordinator
Philip Huang, MD, MPH and Sarah Seidel, DrPH
Results
Program data was collected and analyzed for four Demonstration Years (DY). The Problem Areas in Diabetes Scale (PAID) was used as an evaluation tool to measure quality of life improvement among participants with diabetes. The PAID score measures diabetes related emotional distress, positively associated with HbA1c and short and long term diabetic complications. This tool has been researched for validity, being used in more than 60 scientific papers, and sensitivity in being able to measure changes following educational interventions. Total questioner is 20 questions, low literacy and takes about 5 minutes to complete.
A total of 347 community members was served, 162 of whom had diabetes.
Data for DY4 demonstrate improvement in three important health behaviors:
44% increase in number of days per week participants engaged in physical activity,
22% decrease in the number of sugar sweetened beverages consumed per day,
More than doubling of the number of days per week that food portions were measured.
Participants in the program also reported improved diabetes-related quality of life as evidenced by an average 55% decrease of Problem Areas in Diabetes Scale (PAID) scores across the Demonstration Years.
Background
The Community Diabetes Initiative was created to address significant racial and ethnic disparities in the prevalence of type 2 diabetes among African- American and Hispanic Travis County residents by increasing access to culturally appropriate diabetes self-management education through group support-based classes led by certified community health workers.
Why Community Health Workers
Methods
Share cultural, economic and linguistic characteristics with the individuals they work with
Cultural competency
Ability to build trust
CHW interventions have shown improvements in glycemic control
Evidence of cost effectiveness
Effectiveness in medically underserved communities
Classes utilize the Diabetes Empowerment Education Program Curriculum (DEEP), an evidence-based curriculum delivered as a series of six 90-minute classes in either English or Spanish. Weekly lessons in diabetes management include monitoring, medication, exercise and nutrition, preventing complications and managing stress and depression. Lessons provide take- home tools for engagement and retention of learned knowledge. Classes are offered in community-based locations, such as neighborhood centers, schools, faith-based organizations and clinics and are open and free of cost to the public.
Lessons Learned
External barriers on behalf of the participant can make it difficult in
attending classes such as lack of transportation, child care, and
scheduling. Program changes included providing free bus passes,
child care as needed, and evening classes to address these barriers.
Conclusion
The community health worker model is an effective model for
improving diabetes self-management behaviors and diabetes
related quality of life among these two populations.
Expansion
The Community Diabetes Initiative is planning to expand program
impact by including one month follow-up meets with participants
with diabetes led by CHWs. An expansion of the CHW role will also
include patient navigation in community resources for participants.