Diabetes program focuses on Latino patients
Peer counseling approach wins national award
A new diabetes management program designed to reduce Hispanics’ risk for diabetic complications, such as amputations, end-stage kidney failure, and diabetic retinopathy recently won the 1997 Program Excellence Award from the Society for Public Health Education in Washington, DC. The program, called "Programma Para el Control de la Diabetes," was developed by America Bracho, MD, MPH, executive director of Latino Health Access in Santa Ana, CA, and uses a bilingual peer counseling approach to supply patient education to at-risk members of the Hispanic community.
Results of the program so far have been promising, says Ginger Hahn, MPH, CHES, director of health education at Molina Medical Centers in Long Beach, CA, which is testing the program with its Medi-Cal patients in three southern California counties. "Latino Health Access has found that hemoglobin A1C measures taken before the classes began averaged 11.6," Hahn says. "The same measure taken at the end of the 12 weeks averaged 8.5. I haven’t seen anything else in the literature this good."
The program’s culturally specific focus is important, Hahn adds, because diabetes is a major health threat in the Hispanic community, with Hispanics comprising 17% of all American diabetics. Lack of access to quality education about diabetes and its management leads to even greater health risks, she adds. (For information on an asthma program tailored for Hispanics, see Disease State Management, November 1997, pp. 132-136.)
The program, which uses "lay leaders" who have graduated from previous classes to co-teach current classes, includes 12 two-hour sessions. "Individuals attend every class because they want to, not because they have to," says Bracho. "They are taught by people who live in their community and have experienced their problems."
The program covers the following topics:
• nutrition and cooking;
• eye care:
• foot care;
• exercise;
• blood sugar monitoring;
• routine and urgent physician care.
Family members are encouraged to participate in all phases of the program. "The last session includes a graduation ceremony. Participants invite their family members and cook them a low-fat meal they’ve learned to prepare," says Hahn.
Hahn adds that one particular strength of the program is its interactive focus. "The participants put what they are learning into action through activities such as cooking meals," she says. "One of the best classes is on exercise. Participants take their blood sugar with a glucometer and then take a 20 minute walk and take their blood sugar again. When they see how their blood sugar improves with exercise, they are committed immediately to regular exercise."
In addition to the group sessions, each participant receives a one hour session with a bilingual registered dietician. Molina also uses a bilingual coordinator to encourage health plan members to enroll in the program and attend each class. "It is sometimes initially hard to get members to come out for a class, but once they start participating, they become very involved," says Gloria D. Orellana, the cultural linguistics coordinator for Molina. "I think it takes a personal touch. Gloria takes a lot of time on the phone urging members to participate, " says Hahn. "We also do our best to eliminate barriers to attendance. If transportation is a problem, we send a taxi to get members to the class."
Molina watches participants during the 12-week session to find program graduates who seem more involved and outgoing who might make suitable lay leaders for future sessions, notes Orellana. "Most participants we approach are very open to the idea of sharing what they’ve learned," she says.
Molina plans to carefully monitor program participants to measure long-term effects of the education effort, says Hahn. "The long-term health effects are a big issue for us. We’re looking at that issue very closely."
[For more information on the diabetes program, contact Ginger Hahn, MPH, CHES, director of health education at Molina Medical Centers, One Golden Shore Drive, Long Beach, CA 90802. Telephone: (562) 435-3666. America Bracho, MD, MPH, executive director of Latino Health Access, 1518 North Broadway, Santa Ana, CA 92706. Telephone: (714) 542-7792.]
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