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Type 2 Diabetes Education and Community Outreach Initiatives for Vulnerable Populations
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According to the National Diabetes Education Program (U.S. Department of Health and Human Services), diabetes occurs in 7.8% of the overall U.S. population and is the seventh leading cause of death, characterizing diabetes as an epidemic in several U.S. populations.
In an interview with Endocrine Today, Donna Rice MBA, BSN, RN, CDE, FAADE, president, Diabetes Health and Wellness Institute, Baylor Health Care System, Dallas, Texas, discusses the importance of creating community-based diabetes education and outreach programs, specifically in vulnerable populations (ie, populations at greater risk for type 2 diabetes due to race, ethnicity, language spoken, or socioeconomic status).
Diabetes prevention education is essential in affecting the prevalence of diabetes but can be difficult for patients who have limited access to care and resources. As Rice notes, it is important to promote health equity (ie, enabling all individuals to receive the same quality of health care) and offer resources that are beneficial to vulnerable patient populations.
“The educational focus for these patients goes beyond discussing desirable HbA1c results — it is a matter of treating diabetes within their unique framework,” she said. “For example, if the majority of a family’s food is being obtained from a food pantry, how can we help them make nutritious decisions that are culturally economically correct for that person? That is why understanding your target audience and knowing how to specifically treat them is so important.”
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‘Redesigning the care model’
Rice stressed that to provide effective diabetes education and prevention programs, providers and health care facilities must address patients’ socioeconomic and cultural framework in their model of care.
“Health systems need to lead the way in redesigning the care model used when providing diabetes education and care to patients,” she said. “In order for our message to be effective, we must go beyond the walls of the hospital and into the community.”
Rice’s “center without walls” initiative includes hosting diabetes prevention and care seminars at communities’ epicenters, such as churches, community centers, and schools. Targeting specific community groups spreads awareness more effectively, Rice said.
“For example, by promoting healthy eating habits in the school systems and teaching preventive measures against type 2 diabetes to children, they will then take this message home to their families,” she said. “Children become the conduit between their parents and the health care provider, and we cannot underestimate the impact they have in creating change.”
Positive outcomes produce success
The success of these projects lies in the ability for individuals to see positive outcomes which then keeps individuals motivated to continue to make informed, healthy lifestyle changes. Rice notes that the effect is similar to when a person starts exercising. Once a routine is established and the person experiences the benefits, he or she is more likely to continue on. Individuals learning about controlling their blood sugars and hypertension may be similarly motivated.
“No patient wants to experience a heart attack or blindness or an amputation, but they might not realize that they have control over their situation,” Rice said. “It comes down to giving them the right tools to make informed decisions and working within their framework. Some people might only change one small thing, but hopefully those changes will reap a greater control over their diabetes.”
When creating educational diabetes programs for vulnerable populations, sensitivity to a patient population’s specific cultural and socioeconomic needs is key. For example, if the program includes cooking classes to promote meal preparation for patients with type 2 diabetes, the recipes should feature dishes with popular ingredients that are affordable within the community’s specific cultural or socioeconomic range. Such programs should also be headed by a member of the community — for example, a provider who attends the church where a diabetes seminar is held might be a more effective spokesperson because individuals are already familiar with this person.
Offsetting costs
Rice also contends that much can be done to promote diabetes awareness and education without incurring exorbitant costs.
“There are many cost-free incentives that can be offered to members of the community that will help generate leadership and excitement for these programs,” she said.
Train the trainer programs can be a great way to empower individuals who in turn empower other. Schools, churches, and worksites are a great environment to foster this coaching and trust.
Costs can also be offset by partnering with local physicians and community groups willing to volunteer their time or help cover the expenses associated with education initiatives or by applying for local and national health care grants.
Providing resources and tools
Reevaluating physician and provider practice structures is also important. Although health care providers may assume they provide the same care to all patients, their methods of treatment may be interpreted differently by members of different cultures. Learning tools for physicians, such as websites and computer software programs, have been developed to accommodate the cultural variances of patients. The CDC Office of Minority Health and Health Disparities (www.cdc.gov/omhd), as well as the National Diabetes Education Program (www.ndep.nih.gov), provide valuable online resources on this topic.
Referring patients to diabetes educators is another way that primary care physicians can provide patients with additional diabetes education resources without overextending their already busy practice schedules. Diabetes education is reimbursable with most third party payers and Medicare. “With more than 15,000 programs across the United States that qualify for insurance reimbursement, this is a great resource for primary care physicians to recommend to patients, especially because many of these programs already work within the confines of the community structure,” Rice said.—Sara W. Moreno