Patient Component: Education for people living with diabetes
In the past, the CRCPHP has worked in partnership with Mariposa Community Health Center in Santa Cruz County and Sunset Community Health Center in Yuma County to develop and implement an intervention for their adult “patients” with diabetes. These interventions were designed to increase the patients’ knowledge of diabetes as well as their self-management of their illness. Trained community health workers played an important role in these programs. Currently, we are working in partnership with the Chiricahua Community Health Center in Cochise County on a similar program.
The patient component of this latest program includes:
- A series of four “diabetes” classes to educate participants on the effects of diabetes and the importance of careful self-management in reducing its harmful effects on the human body
- Individualized follow-up from community health workers to encourage participants to take on the challenge of self-management and make healthy changes in their lives
- An opportunity to participate in additional program components
See publications and presentations by Ingram.
Family Component: Diabetes and the Family/La Diabetes y La Unión Familiar
The CRCPHP Family Component is based on the Diabetes and the Family/La Diabetes y La Unión Familiar diabetes family intervention that was designed and implemented as part of the Border Health Strategic Initiative (BHSí) model in Santa Cruz and Yuma Counties. The University of Arizona (including CRCPHP staff) collaborated with two Arizona U.S.-Mexico Border agencies (Mariposa Community Health Center and Campesinos Sin Fronteras) to design, implement as a pilot, and evaluate a diabetes education program for families delivered by promotoras/es.
La Diabetes y La Unión Familiar is an integrated family diabetes intervention that addresses primary and secondary prevention of diabetes in a culturally appropriate way. It increases awareness of what constitutes healthy physical activity and food choices, encourages behavior change towards health, and teaches family communication and supportive behavior that increases perceived cohesion, conflict resolution and emotional expression within the family. The intervention consists of home visits, kick off and graduation events, five interactive educational sessions that can be presented in home visits or in multi-family group sessions, and pre- and post-test evaluations.
The development and piloting phases of the family diabetes curriculum were an innovative and unique aspect of the BHSí comprehensive diabetes intervention model. La Diabetes y La Unión Familiar was the first program that focused on the family as a whole (and also allowed for the inclusion of neighbors and friends) to support diabetes management and diabetes prevention.
Starting in 2005, the BHSí family diabetes education program and curriculum were adapted to the CRCPHP comprehensive diabetes intervention research project in Douglas, AZ. The intervention now consists of an initial home visit, pre-test evaluations, a kick off event, five interactive educational sessions presented in multifamily group sessions, a graduation event, one follow-up home visit serving as progress check, and post- and three months follow-up evaluations. The educational materials were expanded to address frequent complications of diabetes, namely cardiovascular disease, and depression and stress (the later uses materials from the SONRISA curriculum that was developed by CRCPHP staff in 2004/2005). The CRCPHP family intervention was piloted in mid-2005. As of December 2006, CRCPHP staff have implemented and evaluated 4 rounds of the family diabetes intervention component.
Steps Forward/Pasos Adelante
The primary prevention component of the CRCPHP activities is an educational curriculum designed to be facilitated by Community Health Workers (CHWs), which focuses on chronic disease prevention and walking groups. The curriculum, Pasos Adelante/Steps Forward, is an expansion of the NHLBI curriculum, Su Corazón, Su Vida, to increase the emphasis on diabetes and encourage participant advocacy. A new focus on walking groups was also added to the curriculum. The CHW-led walking groups, is designed to engage participants in a coordinated effort to increase physical activity through social support. Toward the end of the 12 week program, the CHWs stop walking with the groups but encourage them to continue. This pattern of involvement is meant to encourage the participants to continue to walk together once the program ends. This program was implemented as part of the Border Health Strategic Initiative in Yuma an Santa Cruz Counties from 2001-2003. Mariposa Community Health Center and Regional Center for Border Health/WAHEC staff collaborated with Center investigators to develop, implement and evaluate the intervention. CHWs helped to pilot and modify the Su Corazón, Su Vida curriculum, implemented the program , and participated in the evaluation of the program. The program is currently being implemented in Cochise County as part of the Center activities and is continuing and expanding in Santa Cruz and Yuma counties as part of the Steps to a HealthierUS initiative. As of June 2004, more than 350 people have participated in the program. A pilot validation study comparing self reported physical activity and dietary intake to blood analyses, anthropometry, and pedometer readings is funded by an NIH EXPORT grant (Marie Swanson, PI). To review and download the curriculum, see http://www.borderhealthsi.org/curricula.htm.
See Publications by Staten and Presentations by Scheu, for further information.
Local Special Action Groups (SAGs)
The CRCPHP engages the community through partnerships to help effect policy change and to more efficiently build community capacity. Many of the changes needed to improve health along the border are policy decisions. For example, policy is needed to create sidewalks and parks, change access to junk food in schools, and provide state funding to actually care for uninsured persons who screen positive for diabetes, or other chronic diseases. When action coalitions also become political coalitions, their health promotion interventions may be more effective and sustainable. CRCPHP personnel have been key facilitators and evaluators, initially as part of the Border Health Strategic Initiative and continuing under new funding, of the local CABs, coalitions focusing on policy change related to diabetes prevention and control in Yuma, Santa Cruz and Cochise Counties. Local CAB initiatives have resulted in various policy changes, such as the awarding of two Community Development Block Grants for parks to the town of Gadsden and an unincorporated area of Yuma County. In Cochise County, the school superintendent re-introduced physical education as a direct result of local CAB action and, in some schools, the local CAB has been instrumental in removing soda vending machines. The local CABs are designed to link all of the Community Health Worker (CHW) and school components to a broad coalition of organizations from diverse sectors of the community. While the CHW interventions focus on specific community driven activities, the focus of the CABs is developing and implementing a policy agenda as well as monitoring outcomes and successes. The formalization of these coalitions in both Yuma and Santa Cruz Counties took place in 2001. In Douglas, the CAB was built from the foundation of the Diabetes Working Group in 2002. Health challenges such as diabetes, poverty, the sociocultural and economic dynamics of the border, inadequate access to health care, good nutrition, and opportunities to live physically active lifestyles along the U.S.-Mexico border are too complex for a single intervention, agency or service, working by itself, to effectively address. Such problems call for a coordinated response on the part of the whole community and the need to work through community coalitions. The CRCPHP has joined and provided supportive leadership through community coalitions. Gathering different actors around a coalition table mounts a coordinated multifaceted response to a complex issue and resources can be effectively shared. For example, working through a partnership, the diabetes prevalence survey that initiated the Douglas CAB was completed without support from any single source. Agencies and community members, including CRCPHP staff each contributed money, resources or labor.
See Publications by Cohen et al. and Meister and Guernsey de Zapien and Presentations by Guernsey de Zapien.
The minutes of the CAB and SAG meetings can be found here.
|
