Families Preventing Diabetes Through a Community-Based, Collaborative Health Model

1. Families Preventing Diabetes Through a Community-Based, Collaborative Health Model For All It’s Worth: Leading with Values and Vision September 2005 Marivel Davila, Management Analyst San Antonio Metropolitan Health District

2. Bexar County • Bexar County, Texas - 10th largest city in the U.S. (San Antonio). • In 2003, 1.4 million residents called Bexar County home: -Hispanic 801,697 56% - non-Hisp. White 503,373 35% - Black 103,672 7% - Other 33,054 2% Source: 2003 Health Profiles; San Antonio Metropolitan Health District

3. Diabetes in Bexar County • Statistics • • 11% of Bexar County’s population were informed of being diabetic compared to 6% of Texas’ population; • • Diabetes was 5th leading cause of death; • Unhealthy Habits • • 31% of population do not read food labels; • • 80% indicated not eating adequate amounts of fruits; • • 84% reported not eating adequate amounts of vegetables. • Source: State of CDC 2004; SAMHD 2003 Health Profiles; 2002 Community Health Assessment and Health Profiles

4. Health Model Most diabetes education programs center around self-management or Type II diabetes in children. A health information model which invites families to participate in healthy eating and physical activities is beneficial to all!

5. “Families Preventing Diabetes” Overarching Goal San Antonio Metropolitan Health District Texas Diabetes Institute House of Neighborly Service “To develop a collaborative model for provision of diabetes self-management and prevention education to families through nutrition and physical education classes”

6. “Families Preventing Diabetes” Goals and Objectives • Recruit 50 families to participate in self-management and prevention classes; • Tailor self-management and prevention curriculum to the community; • Develop promotora (community health worker) program to assist with delivery of classes; • Utilize promotora program for sustainability of the project.

7. “Families Preventing Diabetes” Planning Phase •Three focus groups conducted: - Most were Spanish-speakers and preferred this language; - 90% of participants were diabetic and were interested in learning how to control their diabetes; - most did not own measuring utensils and virtually all did not read food labels when grocery shopping; - wanted an instructor who understood them and taught by example.

8. AccomplishmentsDiabetes Classes 52 participants recruited; 18 participated in all 8 classes; Conducted 8 classes on-site at HNS; Collapsed self-management and prevention classes into one.

9. AccomplishmentsDiabetes Classes • Families encouraged to bring family member; • Introduced new foods to participants; • Held demonstrations of healthy food preparation.

10. AccomplishmentsPre- and Post Assessments Among 18 who participated in all 8 sessions during the two-month period: - number considered to be high risk for premature death dropped from 5 to 3; - number considered to be low risk increased from 5 to 7; - number who had high blood pressure dropped from 4 to 3!

11. AccomplishmentsAM Aerobics Class Run by one of the Promotoras; Meets daily for 1 hour Monday thru Friday; Boosts participants’ self-image; Acts as a support group.

12. AccomplishmentsWalking Group • Meets weekly for 1 hour; • Serves as time for strengthening friendships and bonding; • Serves as question and answer time with the nurse; • Participants continue to meet on their own.

13. Barriers • Retention of participants; • Differing philosophies among collaborators with “provision” of health information; • Placing clinical staff in an unstructured setting.

14. Sustainability/Next Steps • Pilot project funded for 3 more years; • HNS awarded funding from local philanthropic group to continue project; • Model will be replicated in another location in San Antonio.

15. Families Preventing Diabetes San Antonio Metropolitan Health District, House of Neighborly Service, Texas Diabetes Institute Families Preventing Diabetes