Training community health promoters to implement diabetes self-management support programs for urban minority adults

Mariceli Comellas, Elizabeth A Walker, Sharon Movsas, Sheryl Merkin, Joel Zonszein, Hal Strelnick, Mariceli Comellas, Elizabeth A Walker, Sharon Movsas, Sheryl Merkin, Joel Zonszein, Hal Strelnick

Abstract

Objective: To develop, implement, and evaluate a peer-led diabetes self-management support program in English and Spanish for a diverse, urban, low-income population. The program goals and objectives were to improve diabetes self-management behaviors, especially becoming more physically active, healthier eating, medication adherence, problem solving, and goal setting.

Methods: After a new training program for peers led by a certified diabetes educator (CDE) was implemented with 5 individuals, this pilot evaluation study was conducted in 2 community settings in the East and South Bronx. Seventeen adults with diabetes participated in the new peer-led 5-session program. Survey data were collected pre- and postintervention on diabetes self-care activities, quality of well-being, and number of steps using a pedometer.

Results: This pilot study established the acceptance and feasibility of both the peer training program and the community-based, peer-led program for underserved, minority adults with diabetes. Significant improvements were found in several physical activity and nutrition activities, with a modest improvement in well-being. Feedback from both peer facilitators and participants indicated that a longer program, but with the same educational materials, was desirable.

Conclusions: To reduce health disparities in urban communities, it is essential to continue program evaluation of the critical elements of peer-led programs for multiethnic adults with diabetes to promote self-management support in a cost-effective and culturally appropriate manner. Practice Implications A diabetes self-management support program can be successfully implemented in the community by peers, within a model including remote supervision by a CDE.

References

    1. Funnell MM, Brown TL, Childs BP, et al. National standards for diabetes self-management education. Diabetes Care. 2007;30:1630–1637.
    1. Walker EA. The Art and Science of Diabetes Self-Management Education. In: Mensing C, editor. Understanding the individual's health behavior and choices. American Association of Diabetes Educators; Chicago, IL: 2006. pp. 2–5.
    1. Fisher EB, Brownson CA, O'Toole ML, Anwuri VV. Ongoing follow up and support for chronic disease management in the Robert Wood Johnson Diabetes Initiative. Diabetes Educ. 2007;33:202S–207S.
    1. Kim M, Berger D, Matte T. Diabetes in New York City: Public Health Burden and Disparities. Department of Health and Mental Hygiene; New York, NY: 2006.
    1. Caban A, Walker EA, Sanchez S, Mera M. It feels like home when you eat rice and beans: perspectives of urban Latinos living with diabetes. Diabetes Spectrum. 2007;21:120–127.
    1. Caban A, Walker EA, Schechter CB. Depression, discrimination, and quality of life for urban Hispanics. Diabetes. 2006;(suppl):A421.
    1. Davis KL, O'Toole ML, Brownson CA, Llanos P, Fisher EB. Teaching how, not what: the contributions of community health workers to diabetes self-management. Diabetes Educ. 2007;33:208S–215S.
    1. Mauldon M, Melkus GD, Cagganello M. Tomando: a culturally appropriate diabetes education program for Spanish-speaking individuals with type 2 diabetes mellitus: evaluation of a pilot project. Diabetes Educ. 2006;32:751–760.
    1. Dan C, James WW, Elizabeth AP. CoDE: community diabetes education for uninsured Mexican Americans. Proc Baylor Univ Med Cent. 2007;20:111–117.
    1. Kosh T, Kralik D. Chronic illness: reflections on a community-based action research program. J Adv Nurs. 2001;36:23–31.
    1. Hill-Briggs F, Gemmel L. Problem solving in diabetes self management and control: a systematic review of the literature. Diabetes Educ. 2007;33:1032–1050.
    1. Hill-Briggs F. Problem solving in diabetes self management: a model of chronic illness self-management behavior. Ann Behav Med. 2003;25:182–193.
    1. [July 1];Lifestyle Balance. 2008 .
    1. Strecher VJ, Seijts GH. Goal setting as a strategy for health behavior change. Health Educ Behav. 1995;22:190–200.
    1. Bandura A. Social Foundations of Thought and Action: A Social Cognitive Theory. Prentice Hall; Englewood Cliffs, NJ: 1986.
    1. New York City Department of Health and Mental Hygiene . NYC Public Health Detailing Program: Clinical Tools. New York City Department of Health and Mental Hygiene; New York: 2008. [February 11]. .
    1. Feste C. The Power to Be Well. Humedico; Minnetonka, MN: 2006.
    1. National Institute of Health [June 8];National Diabetes Education program. 2007 .
    1. American Diabetes Association [November 22];2007 .
    1. Toobert DJ, Hampson SE, Glasgow RE. The summary of diabetes self-care activities measure: results from 7 studies and a revised scale. Diabetes Care. 2000;23:943–950.
    1. Bonsignore M, Barkow K, Jessen F, Heun R. Validity of the five-item WHO well-being index (WHO-5) in an elderly population. Eur Arch Psychiatry Clin Neurosci. 2001;251:II27–II31.
    1. Brewer NT, Weinstein ND, Cuite CL, Herrington JE. Risk perceptions and their relation to risk behavior. Ann Behav Med. 2004;27:125–130.
    1. Walker EA, Caban A, Schechter CB, et al. Measuring comparative risk perceptions in an urban minority population: the risk perception survey for diabetes. Diabetes Educ. 2007;33:103–110.
    1. Hultquist CN, Albright C, Thompson DL. Comparison of walking recommendations in previously active women. Med Sci Sports Exerc. 2005;37:676–683.
    1. Bravata DM, Spangler CS, Sundaram V, et al. Using pedometers to increase physical activity and improve health: a systematic review. JAMA. 2007;298:2296–2304.
    1. Lin EHB, Katon W, Rutter C, et al. Effects of enhanced depression treatment on diabetes self-care. Ann Fam Med. 2006;4:46–53.
    1. Charon R. Narrative Medicine: Honoring the Stories of Illness. Oxford University Press; New York, NY: 2006.
    1. Fisher TL, Burnet DL, Huang EL, Chin MH. Cultural leverage: interventions using culture to narrow racial disparities in health care. Med Care Res Rev. 2007;64(suppl 5):243S–282S.
    1. Kaplan SA, Calman NS, Golub M, Davis JH, Ruddock C, Billings J. Racial and ethnic disparities in health: a view from the South Bronx. J Health Care Poor Underserved. 2006;17:116–127.

Source: PubMed

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