An Innovative Approach to Diabetes Education for a Hispanic Population Utilizing Community Health Workers

Article excerpt

Abstract: Type 2 diabetes disproportionately affects the Hispanic population. New approaches are needed to provide effective education to this population. This evidencebased project utilized community health workers (CHWs) to deliver a culturally relevant diabetes education program to a Hispanic population at a migrant clinic. The program emphasized culturally relevant interventions to improve self-efficacy. Formative evaluation was used to develop and improve the program. Participants showed improvement in diabetes knowledge and diabetes related self-efficacy scores. Outcomes also included improvement in CHWs' diabetes knowledge and development of an educational program that could be utilized in other settings serving Hispanic populations with type 2 diabetes.

Key Words: Type 2 Diabetes, Hispanic, Community Health Worker, Diabetes Education, Self-efficacy

Type 2 diabetes disproportionately affects the Hispanic population. The Centers for Disease Control and Prevention (Centers for Disease Control and Prevention [CDC], 2005) identify that Mexican Americans, the largest Hispanic subgroup in the US, are nearly twice as likely to have diabetes as non-Hispanic whites. The prevalence of type 2 diabetes among Hispanic adults age 20 or older is approximately 2.5 million. Hispanics may also be diagnosed with diabetes at a later stage and require use of oral anti-diabetic medication and insulin sooner following diagnosis than the general population (Coronado, Thompson, Tejeda, Godina, & Chen, 2007). The high incidence of type 2 diabetes combined with cultural and language barriers, lifestyle habits, and barriers to health care access can result in devastating diabetes-related complications in the Hispanic population (Lujan, Ostwald, & Ortiz, 2007). Hispanic migrant farm workers present additional health care challenges due to their transient lifestyle, poverty, lack of resources, and occupational risks (Heuer, Hess, & Klug, 2004).

Improvement in glycémie control that results in decreases in diabetes-related complications is a goal when treating any patient with type 2 diabetes. Achievement of this goal can be difficult when working with the Hispanic migrant population. Long hours in the field or factory leave little time for daily activities, healthy meal preparation, or exercise. The typical high carbohydrate diet of tortillas, refried beans, pork, and beef also contributes to difficulty achieving glycémie control. Diabetes education programs aim to improve diabetes self-care knowledge and management of diabetes. The intent of this project was to utilize existing evidence to develop and implement an educational intervention aimed at improving diabetes related outcomes of this population. This paper presents the resulting innovative, evidence-based approach to diabetes education for Hispanic migrant workers.

Purposes

This project had three purposes:

1) Develop an innovative, evidence-based approach to diabetes education for the Hispanic population receiving care at a migrant clinic.

2) Increase diabetes related knowledge of community health workers (CHWs) employed at a migrant clinic and prepare them to provide diabetes education.

3) Determine the effect of a diabetes education program delivered by bilingual CHWs on post intervention Diabetes Empowerment Scale (DES-SF) scores and Diabetes Knowledge Questionnaire (DKQ-24) scores, and three month post program AlC levels and body mass index (BMI) compared to preintervention DES-SF scores, DKQ-24 scores, AlC levels, and BMI.

PROJECT DEVELOPMENT

The project was completed at a Midwestern migrant clinic managed by a private non-profit organization that has served the health needs of migrant and seasonal farm workers and their families in Minnesota and North Dakota since 1973. The majority of patients served are of Mexican American heritage. The clinic provides acute care services and administers a welldeveloped chronic disease program that aims to reduce the mortality rate and high medical costs for Hispanic persons with chronic disease and to provide access to high quality, culturally sensitive health care services. …