Diabetes Patient Education in Rural Hispanic Community

Brown, Sharon

Abstract

Patient education is a cost effective approach to improving health outcomes of persons with diabetes; however, culturally-relevant educational approaches for Hispanics who experience non-insulin dependent diabetes 3 to 5 times more frequently than non-Hispanic Whites have not been investigated. The primary purpose of the proposed one-year planning project is to pilot test an intensive diabetes patient education intervention that meets national standards and incorporates instruction on nutrition, self-monitoring of blood glucose, exercise, and other diabetes self-management topics. The culturally-relevant intervention will be provided in Spanish by a master's-prepared clinical nurse specialist, a dietitian, and a community lay worker, each a Hispanic resident of the target rural Hispanic community. Diabetic subjects of NIH-funded longitudinal diabetes studies in the Rio Grande Valley, Texas will serve as the available target sample for the pilot test of the intervention. A total of 50 randomly-selected diabetic subjects will be contacted by telephone to determine the preferred intervention site(s): home, school, church, research field office, county office, or local hospital. Then, five diabetic subjects will be randomly selected; and five family members, one designated by each subject, will participate. The diabetic subjects and family members will meet in a group in the preferred setting for the intervention consisting of eight two-hour educational sessions and one two-hour lay worker-led support group session. Variables measured as indicators of intervention effectiveness will include: diabetes knowledge, diabetes-related health beliefs, health behaviors, weight, and metabolic control (glycosylated hemoglobin and fasting blood sugar). Number of hospitalizations and length of hospital stay variables will be explored. The pilot project will obtain feedback from research subjects and intervention team regarding feasibility of the setting and practicality of family participation. Difficulties with the educational/support group sessions, data collection and analysis procedures, and mechanisms for following intervention effectiveness outcomes will be identified. Other proposed activities include: (1) obtaining consultation on providing health interventions in rural Hispanic settings, statistical design/methods, developing mechanisms for following measures of intervention effectiveness, and measurement of health care utilization/costs; (2) training of the intervention team; and (3) establishing a local community advisory committee. Planning grant activities will lead to a proposal to study efficacy of a culturally- relevant, cost effective, community-based patient education intervention aimed at improving health outcomes of diabetic Mexican-Americans and their families.