Partnership between Academia and Community to Improve Diabetes

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Partnership between Academia and Community to Improve Diabetes Outcomes among Latino Immigrants in Lake

Partnership between Academia and Community to Improve Diabetes Outcomes among Latino Immigrants in Lake County, IL Amparo Castillo, MD, MS Midwest Latino Health Research, Training and Policy Center University of Illinois at Chicago Laura Ramirez Director of Programs Diana Gutierrez Director of Community Health Mano a Mano Family Resource Center

2 Mano a Mano Family Resource Center Round Lake Park, IL Mission: to empower

2 Mano a Mano Family Resource Center Round Lake Park, IL Mission: to empower immigrant and underserved families of Lake County to become full participants in American life. www. manoamanofamilyresourcecenter. org

3 Programs Healthy Families Productive Parents Successful Children Engaged Citizens

3 Programs Healthy Families Productive Parents Successful Children Engaged Citizens

Presentations

Presentations

Attendees

Attendees

STRATEGIES: 1. Create effective partnerships to develop policies that support food equity and health

STRATEGIES: 1. Create effective partnerships to develop policies that support food equity and health literacy 2. Support CEED members by exchanging information, providing technical assistance and disseminating successful practices. OBJECTIVES: To increase availability of healthy foods in target 2. To increase physical LEGACY PROJECT: activity 1. To train community 3. To inform and develop health workers on policies and practices diabetes prevention communities that improve health care quality and reduce social 2. To educate families on determinants of healthy preventive and risk factors for CVD behaviors and diabetes

CBPR PRINCIPLES CBPR facilitates collaborative, equitable partnerships in all phases of research Integrates and

CBPR PRINCIPLES CBPR facilitates collaborative, equitable partnerships in all phases of research Integrates and achieves balance between research and action for the mutual benefit of all partners Recognizes community as a unit of identity Builds on strengths and resources within the community Promotes co-learning and capacity building among all partners Involves a long term process and commitment Emphasizes local relevance of public health problems and ecological perspectives that recognize and attend to multiple determinants of health and disease Disseminates findings and knowledge gained to all partners and involves all partners in the dissemination process Involves systems development through a cyclical and iterative process Ref: Israel, Schulz, Parker, et al. 2003.

Training of Community Health Workers in diabetes prevention Grant application to Healthcare Foundation of

Training of Community Health Workers in diabetes prevention Grant application to Healthcare Foundation of Northern Lake County Training of Community Health Workers in diabetes self-management education

Background Increase in Latino immigration Up to 20% of population in Lake County Group

Background Increase in Latino immigration Up to 20% of population in Lake County Group with most sedentary lifestyle Diagnosed with diabetes twice as often as White population Lowest health care coverage

2011 Ma. M obtained Legacy grant from CEED UIC provided technical assistance: How to

2011 Ma. M obtained Legacy grant from CEED UIC provided technical assistance: How to prepare the CHWs to work in health? Potential partnership with Lake County Department of Health UIC offered: Educational curricula Trainings Technical assistance Implementation plan for the long term Plan sought to give sustainability of programs within organization

2011 First round: Diabetes prevention and empowerment CHWs got to know the community Tested

2011 First round: Diabetes prevention and empowerment CHWs got to know the community Tested recruitment strategies Tested implementation Initial data collection efforts First experience on evaluation and reporting Organization tested internal capacity and budgetary issues

2012 - 2013 Second round UIC applied for grant to Healthcare Foundation of Northern

2012 - 2013 Second round UIC applied for grant to Healthcare Foundation of Northern Lake County Collaboration in writing application Collaboration in budget planning Collaboration in reporting to funders Clear and frequent communication between agencies Multiple opportunities for feedback Training of staff geared toward organizational autonomy Full engagement and support to implementation of new program

Methods Design: Qualitative evaluation of the experiences by CHWs and participants Facilitators’ logs Participants’

Methods Design: Qualitative evaluation of the experiences by CHWs and participants Facilitators’ logs Participants’ feed-back Quantitative evaluation of diabetes education impact on biomedical and behavioral factors: Pilot followed single group repeated measures design.

Training of Community Health Workers Diabetes Self-management Education: 4 days Empowerment/Autonomy framework Adult learning

Training of Community Health Workers Diabetes Self-management Education: 4 days Empowerment/Autonomy framework Adult learning methodology Interactive group activities Curriculum Research methods 2 days Data collection instruments Research reporting Ethics- UIC IRB

Table 1. Baseline Characteristics of Participants N= 81 Variable Age, years, mean(SD) 55. 3

Table 1. Baseline Characteristics of Participants N= 81 Variable Age, years, mean(SD) 55. 3 (9. 9) Sex : Female, n(%) 56 (69. 1) Male, n(%) 25 (30. 9) Years diagnosed with T 2 D, years, mean(SD) 10. 5 (7. 9) Years of education, years, mean(SD) 7. 2 (4. 4) Marital Status: Married, n(%) 62 (76. 5) Single/Divorced/Separated/Widowed , n(%) 19 (23. 4) US, n(%) 0 (0) Mexico , n(%) 75 (92. 6) Other , n(%) 6 (7. 4) Place of birth: Results Years living in the US, years, mean(SD) 23. 5 (11. 7) Language: English, n(%) 1 (1. 2) Spanish, n(%) 80 (98. 8) Yes, n(%) 31 (38. 3) No, n(%) 47 (58. 0) Don’t know/ Not sure/Not reported, n(%) 3 (3. 7) Employed for wages/Self-employed, n(%) 32 (39. 5) Unemployed/Unable to work, n(%) 11 (13. 6) Homemaker , n(%) 26 (32. 1) Retired , n(%) 12 (14. 8) Insurance: Employment: Household Income : < 24, 999 per year, n(%) 46 (56. 8) >25, 000, n(%) 7 (8. 7) Don’t know/ Not sure, n(%) 28 (34. 6)

Table 2. Pre- Posttest Changes Observed on Participants Variable Results A 1 C, %

Table 2. Pre- Posttest Changes Observed on Participants Variable Results A 1 C, % BMI, kg/m 2 Blood pressure Systolic, mm Hg Diastolic, mm. Hg Diabetes Self-Care Behaviors, days Follow healthy eating plan in last 7 days Space carbohydrates in last 7 days 5+ servings fruits & vegetables in last 7 days Eat high fat foods in last 7 days Follow healthy eating plan last month At least 30 min physical activity Participate in specific exercise session Test blood sugar in last 7 days Test blood sugar as recommended by doctor Check feet Inspect inside shoes Took recommended diabetes pills Took recommended insulin injection Took at least one aspirin pill Diabetes knowledge, score, Depression, score Diabetes self-efficacy, score Social support, score Quality of Life Physical illness in last 30 days, days Mental illness/stress in last 30 days, days Limitation by physical/mental health, days Baseline mean(SD) N=81 8. 52 (2. 03) 31. 6 (6. 9) Post- test mean(SD) N= 60 7. 97 (1. 83) 31. 1 (6. 5) P value 0. 0001* 0. 095 136. 7 (17. 7) 135. 1(19. 5) 83. 3 (10. 3) 83. 1 (11. 2) 0. 58 0. 86 3. 07 (2. 8) 2. 89 (2. 7) 3. 29 (2. 4) 2. 6 (2. 2) 3. 16 (2. 8) 3. 15 (2. 6) 1. 75 (2. 5) 3. 05 (2. 8) 2. 75 (2. 9) 2. 32 (2. 8) 1. 91 (2. 9) 5. 51 (2. 7) 1. 77 (3. 0) 2. 29 (3. 0) 14. 63 (4. 0) 9. 63 (6. 3) 29. 22 (6. 8) 19. 18 (10. 9) 4. 95 (1. 7) 4. 93 (1. 9) 5. 16 (1. 7) 2. 18 (1. 7) 5. 11 (1. 6) 4. 61 (2. 2) 2. 53 (2. 6) 5. 24 (2. 0) 4. 72 (2. 4) 4. 79 (2. 4) 4. 49 (2. 7) 6. 26 (2. 0) 2. 0 (3. 1) 2. 84 (3. 2) 20. 57 (2. 8) 6. 28 (6. 0) 33. 58 (6. 7) 17. 38 (10. 2) 0. 0001* 0. 186 0. 0001* 0. 115 0. 0001* 0. 031* 0. 51 0. 145 0. 0001* 0. 337 10. 0 (11. 8) 7. 2 (11. 3) 18. 7 (37. 1) 6. 4 (9. 4) 2. 5 (5. 9) 5. 31 (18. 5) 0. 107 0. 006* 0. 012*

Qualitative Results Community Health Workers: Emotional climate: conditions that facilitated disclosure of personal experiences,

Qualitative Results Community Health Workers: Emotional climate: conditions that facilitated disclosure of personal experiences, sharing of feelings, and catharsis “The class was fun and they were happy that the promotoras were motivating them to change their lifestyle. ” Participants’ attitude: participants’ motivation, engagement and receptivity to knowledge “With each activity they were very impressed they were learning new things in a very simple way. ” Knowledge/Content: facts and information participants found important for their own self-care “Participants were complaining because they are told by the doctors what to do but not why they should do it. ” Family involvement: involvement of family members in the learning process “The participants’ children that were able to attend, were very moved and grateful for what was learned in class and committed to talk to the rest of their families to help their parents. ”

Qualitative Results Participants: Answers to the question: What did you like the most? Knowledge/Skills:

Qualitative Results Participants: Answers to the question: What did you like the most? Knowledge/Skills: information gained throughout the course, and how they developed or sharpened self-care skills “Everything, because it is the first time I hear how important diabetes is” Empowerment: participants associated their experience in program with enhancement of self-confidence/awareness/esteem: “I am learning more about diabetes; I feel more confident”; “That we should not be afraid to question our doctor” Methodology: teaching methods, communication or activities in the curriculum “The simplicity of the vocabulary they use to explain to us, and the opportunity to ask questions” Social Support: emotional, instrumental and/or informational support: “That we share personal experiences” “That we are not alone; and that they support us giving us information about diabetes” Family Impact refers to the program effects on family members either directly or tangentially: “The tips to care for the health of my whole family”

2014 Organization applied for their own grant to Healthcare Foundation of Northern Lake County

2014 Organization applied for their own grant to Healthcare Foundation of Northern Lake County Currently implementing continuation of program N=50 UIC continues support, now as contractor Goal: further organizational autonomy, engage Department of Health, enhance relation with clinics

Conclusions Project tested organizational capacity of Mano a Mano in implementing a CHW training

Conclusions Project tested organizational capacity of Mano a Mano in implementing a CHW training and intervention program, and assessing measurable benefits to their community. Community-based participatory action principles guided collaboration that brought together identified needs by a community organization and an academic institution’s available resources. Collaboration serviced important needs in community of minority immigrants in Northern Lake County Collaboration enhanced presence of organization in community.