Diabetes and health disparities: community-based approaches for racial and ethnic populations (original) (raw)
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The Alliance to Reduce Disparities in Diabetes
Health Promotion Practice, 2014
This supplement provides a comprehensive and in-depth examination of proven clinicalcommunity health strategies employed by the Alliance to Reduce Disparities in Diabetes, across five sites located in diverse geographic regions of the United States, including a tribal community. Alliance projects in these communities focused on African Americans, Hispanics/Latinos, and American Indians as priority populations. Each project was implemented with an understanding that there are cultural norms, community characteristics, and health care system challenges that require sustained multicomponent approaches to ameliorate factors that exacerbate poor disease management and health outcomes. The articles increase understanding of what is required to implement evidence-based approaches shaped by local experiences in order to meet the needs of diverse communities affected by diabetes. Lessons learned have generic elements that can be used in other priority populations and settings. Keywords chronic disease; diabetes; community intervention Diabetes in the United States is a serious public health problem that disproportionately affects African Americans, Hispanics/Latinos, Asians, Pacific Islanders, American Indians, and Alaska Natives (Narayan, Williams, Cowie, & Gregg, 2011). Diabetes prevalence is 16.1% in American Indians and Alaska Natives (though rates are higher in some tribes), 8.4% in Asians, 11.8% in Hispanics/Latinos, and 12.6% in African Americans compared to 7.1% in non-Hispanic Whites (Centers for Disease Control and Prevention, 2011). Historically, diabetes-related morbidity and mortality have remained higher among the previously listed racial and ethnic groups
An Integrated Approach to Diabetes Prevention: Anthropology, Public Health, and Community Engagement
Qualitative report (Online), 2013
Diabetes is an enormous public health problem with particular concern within Hispanic communities and among individuals with low wealth. However, attempts to expand the public health paradigm to include social determinants of health rarely include analysis of social and contextual factors considered outside the purview of health research. As a result, conceptualization of the dynamics of diabetes health disparities remains shallow. We argue that using a holistic anthropological lens has the potential to offer insights regarding the nature of the interface between broader social determinants, health outcomes and health disparity. In a primarily Hispanic, immigrant community in Albuquerque, New Mexico, we conducted a mixed methods study that integrates an anthropological lens with a community engaged research design. Our data from focus groups, interviews, a survey and blood sampling demonstrate the need to conceptualize social determinants more broadly, more affectively and more dyna...
The Diabetes Educator, 2014
Purpose-This article reports the results of a community-based, culturally tailored diabetes prevention program for overweight Mexican American adults on weight loss, waist circumference, diet and physical activity self-efficacy, and diet behaviors. Methods-The intervention used content from the Diabetes Prevention Program but culturally tailored the delivery methods into a community-based program for Spanish-speaking adults of Mexican descent. The design was a randomized controlled trial (N = 58) comparing the effects of a 5-month educational intervention with an attention control group. The primary study outcome was weight loss. Secondary outcomes included change in waist circumference, body mass index, diet self-efficacy, and physical activity self-efficacy. Results-There were significant intervention effects for weight, waist circumference, body mass index, and diet self-efficacy, with the intervention group doing better than the control group. These effects did not change over time. Conclusions-Findings support the conclusion that a community-based, culturally tailored intervention is effective in reducing diabetes risk factors in a 5-month program. Diabetes prevalence is estimated to include 25.8 million people of all ages in the United States, resulting in significant morbidity, mortality, and an economic burden of more than $245 billion annually. 1,2 As the fastest-growing minority population in the United States, Mexican Americans have one of the highest rates of diabetes: 11.8% versus 7.1% for non-Hispanic whites. 2 Even more concerning is the estimated 79 million adults in the United States who have prediabetes, most of whom will develop type 2 diabetes within 10 years. 3,4 Prevention of diabetes is clearly a public health imperative. The Diabetes Prevention Program (DPP) clearly demonstrated that intensive lifestyle modification delays or prevents the progression of prediabetes to diabetes, but it required costly resources to promote lifestyle change. 5 Therefore, it is not easily replicated in resource-limited community settings. Community-based diabetes prevention programs offered in convenient and familiar locations have the potential to reach underserved
This supplement provides a comprehensive and indepth examination of proven clinical-community health strategies employed by the Alliance to Reduce Disparities in Diabetes, across five sites located in diverse geographic regions of the United States, including a tribal community. Alliance projects in these communities focused on African Americans, Hispanics/Latinos, and American Indians as priority populations. Each project was implemented with an understanding that there are cultural norms, community characteristics, and health care system challenges that require sustained multicomponent approaches to ameliorate factors that exacerbate poor disease management and health outcomes. The articles increase understanding of what is required to implement evidence-based approaches shaped by local experiences in order to meet the needs of diverse communities affected by diabetes. Lessons learned have generic elements that can be used in other priority populations and settings.
2006
We examine the lessons learned from the exploration of 'cultural appropriateness' during the development and evaluation of a diabetes prevention program for American Indian women living in an urban area of the Southwest United States. The authors, evaluators and program designers, together attempted to assess the cultural appropriateness of the intervention. In doing so, we confronted our own assumptions about 'culture' and 'tradition.' These assumptions were influenced by our respective generational and disciplinary differences. In this manuscript, we reflect on the attendant process of navigating our diverse and sometimes conflicting conceptualizations of 'culture.' We also call attention to unexpected events and changing team dynamics that affected the process. This reflection leads us to consider the role of evaluators, program designers, and participants in assessments of cultural appropriateness of public health interventions and the consequences of such involvement. The lessons learned also concern the need to fully articulate theoretical ideas about how 'culture' can interface with program elements to develop interventions that are contextually responsive to the unique social worlds of participants. q (J. Thompson). 1 Tel.: C1 505 244 3099. 2 Tel.: C1 505 272 5141.
Social and cultural barriers to diabetes prevention in Oklahoma American Indian women
Preventing chronic disease, 2004
The prevalence of diabetes is disproportionately higher among minority populations, especially American Indians. Prevention or delay of diabetes in this population would improve quality of life and reduce health care costs. Identifying cultural definitions of health and diabetes is critically important to developing effective diabetes prevention programs. In-home qualitative interviews were conducted with 79 American Indian women from 3 tribal clinics in northeast Oklahoma to identify a cultural definition of health and diabetes. Grounded theory was used to analyze verbatim transcripts. The women interviewed defined health in terms of physical functionality and absence of disease, with family members and friends serving as treatment promoters. Conversely, the women considered their overall health to be a personal issue addressed individually without burdening others. The women presented a fatalistic view of diabetes, regarding the disease as an inevitable event that destroys health ...
Diabetes is prevalent among African-American and Latino Detroit residents, with profound consequences to individuals, families, and communities. The REACH Detroit Partnership engaged eastside and southwest Detroit families in focus groups organized by community, age, gender, and language, to plan community-based participatory interventions to reduce the prevalence and impact of diabetes and its risk factors. Community residents participated in planning, implementing, and analyzing data from the focus groups and subsequent planning meetings. Major themes included: 1) diabetes is widespread and risk begins in childhood, with severe consequences for African Americans and Latinos; 2) denial and inadequate health care contribute to lack of public awareness about pre-symptomatic diabetes; 3) diabetes risks include heredity, high sugar, fat and alcohol intake, overweight, lack of exercise, and stress; and 4) cultural traditions, lack of motivation, and lack of affordable, accessible stores, restaurants, and recreation facilities and programs, are barriers to adopting preventive lifestyles. Participants identified community assets and made recommendations that resulted in REACH Detroit's multi-level intervention design and programs. They included development of: 1) family-oriented interventions to support lifestyle change at all ages; 2) culturally relevant community and health provider education and materials; 3) social support group activities promoting diabetes self-management, exercise, and healthy eating; and 4) community resource development and advocacy. (Ethn Dis. 2004;14[suppl 1]:S1-27-S1-37)