Predictions are that between 45 and 55% of Hispanics born in the year 2000 will get diabetes at some time in their lives. Our health care system must be prepared to respond with culturally appropriate, clinically sound, and cost effective care. Science has documented the positive impacts on health status and cost when tight glycemic control is achieved.
Our aim i s to evaluate the incremental benefit of a culturally sensitive diabetes care and self-management program for clinical, behavioral and cost outcomes utilizing 2 unique interventions separately and combined. Models have been developed that adapt the traditional acute illness model, on which our health care system is based, to one that can respond adequately to the rising prevalence of chronic disease-The Chronic Care Model. Another relevant theoretical model that has been shown to promote effective self-management and sustainable positive health outcomes are the Resources and Supports for Self Management (RSSM) approach developed in the context of the RWJ Foundation's diabetes initiative. The RSSM views successful self-management as dependent on supports and resources at multiple levels of influence, including individual, social, health care, and community. The theoretical model is ideally suited to the Latino population, given its emphasis on unique cultural perspectives, collaboration, and the roles of family, friends, and community in treatment. The effectiveness of these 2 models in culturally diverse, high risk Latino populations has yet to be scientifically evaluated. Project Dulce is a diabetes care and self-management program that employs the theoretical framework of the Chronic Care Model and the Resources and Supports for Self Management approach in ethnically diverse populations served in San Diego County's safety net. Project Dulce addresses each component of the social-ecological self-management framework. The RSSM model acknowledges that successful self-management and continuous, quality clinical care are interwoven and equally important to optimal diabetes control. Thus, we have combined the RSSM framework and Wagner's chronic care model in developing an intervention strategy. This strategy must now be tested. ? From a public health perspective this research may demonstrate culturally appropriate approaches that lead to positive behavior change and are clinically effective in the Latino diabetic population. ? ?
| Philis-Tsimikas, Athena; Fortmann, Adelaide; Lleva-Ocana, Leticia et al. (2011) Peer-led diabetes education programs in high-risk Mexican Americans improve glycemic control compared with standard approaches: a Project Dulce promotora randomized trial. Diabetes Care 34:1926-31 |
| Fortmann, Addie L; Gallo, Linda C; Philis-Tsimikas, Athena (2011) Glycemic control among Latinos with type 2 diabetes: the role of social-environmental support resources. Health Psychol 30:251-8 |
| Fortmann, Addie L; Gallo, Linda C; Walker, Chris et al. (2010) Support for disease management, depression, self-care, and clinical indicators among Hispanics with type 2 diabetes in San Diego County, United States of America. Rev Panam Salud Publica 28:230-4 |
