Diabetes Research project Lily (Bertha) González 2/23/15

Transcription

1 Diabetes Research project 2015 Lily (Bertha) González 2/23/15

2 Introduction Diabetes is a significant problem in the Latino community of Yakima. Hispanics/Latinos in Yakima are more likely to have poor glycemic control and diabetes complications and less likely to use diabetes care and self-management education. There are many social and environment factors that interfere with the diabetes control of the Latino individuals; some of these factors are poverty, food insecurity, lack of medical coverage, and low level of education. There is an urgent need to design a more culturally relevant diabetes education model that targets the most important needs of the Latino individual and that takes in consideration the social and environment factors.

3 Incidence of Type II Diabetes Yakima One in ten adults have diabetes in Yakima One in three adults have pre-diabetes Nation One in eleven adults have diabetes One in three adults have pre-diabetes (Chronic disease profile of Yakima CDPY 2014) (Center for disease control CDC 2014 division of diabetes) 15 a 30 % of people with pre-diabetes will develop type II diabetes within 5 years. National Diabetes Prevention Program NDPP

4 Latinos and Type II Diabetes Hispanics have a greater risk of developing type 2 diabetes. The population age-adjusted incidence of diabetes in for people aged 20 years or older was 7.6% for non-hispanic whites and 12.8% for Hispanics, corresponding to a 68% higher risk. (National Diabetes Statistics Report 2014)

5 Risk Factors for Type II Diabetes Being overweight In Yakima approximately 1 in 3 adults (34%) and 1 in 6 children and adolescents (16.2%) are obese. (Yakima Valley Memorial Hospital (YVMH) Community Health Needs Assessment (CHNA) 2013) In Yakima A third of adults do not get any physical activity. (CDPY 2013) Family history of diabetes History of gestational diabetes Impaired glucose metabolism Physical inactivity Older age Race/ethnicity Latinos have higher risk to develop diabetes. (CDC 2014 division of diabetes)

6 When talking about diabetes.. in Yakima not everything is related to genetics and lifestyle, Check the other social and environment factors Yakima is composed of primarily rural communities Yakima is home to over 75,000 migrants and seasonal farm workers YVMH CHNA 2013 In Yakima Half of the populations are none white or Hispanic In Yakima one in five households have income less than the federal poverty One in six households experience food insecurity Five out of six adults age 25 and older do not have a college degree (CDPY 2013)

7 Continuation of social and environment factors Hispanics are more likely than other groups to lack regular health care sources, to use the hospital emergency department or public health clinics, and to experience cultural and socioeconomic barriers to care, including the inability to speak English and low rates of health insurance coverage. (Duggan, C., Carosso, E., Mariscal, N., Islas, I., Ibarra, G., & Holte, S., 2014) In Yakima almost a third of adults under the age of 65 have no medical insurance. (CDPY 2013) The graphic below show the results of a survey at the Yakima Valley Memorial Hospital s Spanish Diabetes classes in 2013

8 Latino Children are in the go for type II diabetes Almost half of 10 th graders do not usually eat dinner with their family Half do not get enough physical activity one in five drink sugar sweetened beverages daily at school One in eight drink soda two or more times a day. (YCCDP 2013) One in six children and adolescents are obese in Yakima ( YVMH CHNA 2013)

9 What services are available for the Latinos with type II diabetes in Yakima Memorial Hospital provides Spanish diabetes classes free of cost for Latinos Classes are in the evening Divided in 4 sessions-3 ½ hours long Provided in a period of 3 months Classes cover clinical and educational components, positive goal setting and motivation. Materials include low-literacy resources. attendance rate does not reflect the amount of Latinos living with diabetes in Yakima. Hispanics are less likely to use diabetes medical and self-management practices, such as obtaining regular medical check-ups and self-monitoring. (Duggan et al. 2014). Below is a mini -video of the Spanish diabetes class. This video was developed in an effort to support the Alzheimer Association Campaign.

10 Why some individuals are not attending the diabetes classes? Barriers to participate in the classes Personal Interpersonal and social Disabilities Lack of awareness and knowledge of diabetes complication Location and time of the classes Beliefs and expectations about diabetes and diabetes treatment Diabetes complications Lack of transportation Lack of childcare Care giving responsibilities (taking care of a chronically sick family member) Lack of support from the family Lack of awareness and knowledge of diabetes complications Work hours

11 The Promotora Explained Everything A cultural relevant diabetes intervention that will help to increase Self-efficacy in the Latino individuals with diabetes in Yakima. The promotora explained everything was an study that consisted in home health parties aimed to improve diabetes self-management among Hispanics. This program trained community health workers/promotoras to deliver educational sessions in private homes. (Helen H. Richardson, The Denver Post) Conclusion This study shows that involving family members and increasing social support are effective strategies for improving health behaviors and chronic health outcomes among vulnerable Hispanics living with diabetes. (Shepherd, B., Megan, D., Hohl, S., Vaughan, C., Ibarra, G., Carosso, E., & Thompson, B., 2014).

12 Findings from the study demonstrated several important considerations regarding the design of diabetes management interventions for rural Hispanic populations: (1) Promotores are critical as they provide social support and encourage behavior change by building relationships based on trust and cultural understanding. (2) Well-designed tools that provide step-by-step examples of healthy behaviors, such as cookbooks, and tools that aid participants to monitor behavior change, such as pedometers and glucose monitors, serve to build skills and improve confidence to achieve goals. (3) targeting households is a promising strategy for individual and family lifestyle changes that benefit the entire family unit.

13 What else can be done to help with the control of diabetes in the Latino Community of Yakima? Institutional Level Community Level Policy Level Seek for grants to develop and Implement a Community health worker/promotora culturally relevant diabetes program Work in collaboration with other health institutions ex. Public health clinics to identified and referral participantspatients to the existent Spanish classes. Recruit bilingual, bicultural health professional like MDs, nutritionist, diabetes educator and mental health professional to provide linguistically and culturally sensitive programs to the Latinos. Provide Spanish diabetes classes at different hours during the day Organize a Health and Diabetes Community Initiative that involve public health clinics, hospitals, schools, warehouses, grocery stores, universities, parks, government, YMCA and lay people from different ages and ethnicities to develop strategies or interventions aim to prevent and manage diabetes. Provide primary care services at low cost or free of charge to uninsured Latinos. Provide diabetes care at low cost or free of charge to uninsured Latinos. Government need to financially support the development of free clinics. Government need to financially support the development of a healthier Yakima ex. safe areas to walk, public swimming pool, walk to school and walk to work programs, bicycling and so on. Government need to keep promoting a healthier menu in schools and universities

14 Conclusion Latino people with diabetes need to be involved in the development and implementation of new diabetes interventions. Social and personal factors must be considered when developing new programs. Collaboration will make a Yakima diabetes initiative more strong. There are several changes that need to happen at the institutional, community and policy level.

15 Reference list Chronic disease profile of Yakima 2014 Shepherd, B., Megan, D., Hohl, S., Vaughan, C., Ibarra, G., Carosso, E., & Thompson, B., Yakima Valley Memorial Hospital Community Health Needs Assessment 2013 Mary-Jane Schneider 2014 page 183,184 National Diabetes statistics report 2014 Duggan, C., Carosso, E., Mariscal, N., Islas, I., Ibarra, G., & Holte, S., Center for disease control 2014 division of diabetes Yakima county Chronic disease profile 2013 Video from Alzheimer Association Western and Central Washington chapter 7

16 Thank you for your time! I would love to hear your comments, questions or suggestions!