Diabetes program focuses on Latino patients
December 1, 1997 3 minutes read
Diabetes program focuses on Latino patients
Bilingual effort wins national award
Diabetes is a major health threat in the Latino community. In fact, Latinos make up 17% of all diabetics. Lack of access to quality education about diabetes and its management leads to even greater health risks for Latinos.
A diabetes management program designed to reduce Latinos’ increased risk for diabetic complications, such as amputations, end-stage kidney failure, and diabetic retinopathy recently received the 1997 Program Excellence Award from the Society for Public Health Education in Washington, DC. The Programma Para el Control de la Diabetes developed by America Bracho, MD, MPH, with Latino Health Access in Santa Ana, CA, uses a bilingual, peer counseling approach that is so unique and successful it has caught the eye of managed care plans.
"I was quite impressed when I first heard about this program and witnessed its results," says Ginger Hahn, MPH, CHES, director of health education at Molina Medical Centers in Long Beach, CA. "This program is so touching. It uses lay leaders who have graduated from previous classes to co-teach the class. It’s a community-based model that really works."
Molina is testing the program with its Medi-Cal patients in three southern California counties. "A lot of patients in the program haven’t had much formal education. Their access to health information was further limited because they speak little or no English," says Hahn.
Families are encouraged to participate
The program 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 says one of the program’s strengths is that it’s very interactive, not just sitting in a room listening to a health educator. "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, Molina’s cultural linguistics coordinator.
"It takes a lot of persuasion from me and then follow-up calls to remind members to attend the class," says Orellana. "It also takes a great deal of urging to get them to attend the first several sessions. After that, participants become involved."
"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."
More important, the clinical results are of participants who complete the program are encouraging. "Latino Health Access has found that hemoglobin A 1c measure taken before the classes began averaged 11.6," says Hahn. "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."
Molina plans to monitor program participants carefully 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."
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