REACH 2010 Seattle King County Diabetes Coalition Challenges

REACH 2010 Seattle & King County Diabetes Coalition Challenges and Rewards of Diabetes Interventions among Culturally Diverse Populations Roxana Chen, REACH Evaluation Manager Max Chan, REACH Program Consultant Cheza Garvin, REACH Principal Investigator

Acknowledgments • • • REACH 2010 Coalition Center for Multi. Cultural Health International Community Health Services Sea Mar Community Health Centers Public Health - Seattle & King County REACH 2010 is funded by The Centers for Disease Control & Prevention

REACH 2010 Seattle & King County Diabetes Coalition • MISSION • “The mission of the REACH Coalition is to reduce diabetes health disparities experienced by communities of color. Through strong partnerships, we will support the empowerment of individuals, families, and communities, and create sustainable long-term approaches to prevention and control of diabetes utilizing all appropriate community resources in King County. ”

REACH 2010 Seattle & King County Diabetes Coalition • Target populations: African American, Hispanic, Latino, specific Asian and Pacific Islander groups. • Lead agency: Public Health-Seattle & King County • Community Partners: The Center for Multi. Cultural Health, International Community Health Services, and Sea Mar Community Health Centers • Service Programs: Diabetes Education Classes, Support Groups, Self Management of Chronic Diseases, Case Coordination and management of the Diabetes Registry (DEMS/CDEMS)

Challenges of working with culturally and racially diverse populations 1. Mistrust, Distrust, Broken Trust • Government • Agencies • Research institutions

Challenges of working with culturally and racially diverse populations (cont. ) 2. Language and Cultural Barriers • Access to and availability of linguistically, culturally appropriate services • Availability of appropriate learning materials • Differences in learning and test-taking styles

Challenges of working with culturally and racially diverse populations (cont. ) 3. Demographics • Income • Education • Age • Acculturation

Recruitment • Need to build Community Relationships and Trust! – Community events, meetings – Faith and spiritual communities – Civic clubs – Community members/leaders ( Board of Directors) – Family and Mutual Assistance Associations • Development of in-language media and materials • Site-specific recruitment (e. g. , churches, fairs, temples, barber shops) • Research component can “freak” people out

Retention • Need to build Individual Relationships and Trust! • Staff and Organizations must have “community qualifications” – experience, history, and relationship with the community and clients • Bilingual/Bicultural staff who can relate with clients • Accessible sites (e. g. , senior lunches, churches, clinics, senior housing, temples) • Accessible Information (Linguistically, Culturally, Visually) • Translation of materials (Concept versus Literal)

Retention (cont. ) • Programs/Interventions open to everyone, free • Social Setting. Create safe social environment within program/intervention (e. g. , “real” food, “talk stories, ” family oriented) • Support Groups • Incentives: Gifts. Food. Knowledge. Contribution to community. • Research explanation - “service to the community”

Evaluation/Survey Challenges • Logistics of administering pre/post surveys and consent forms in multiple languages are complicated. • Lots of time and $$$ needed to translate materials and hire bilingual survey administrators/evaluators • IRB. Can be a stickler or slow things down if we need to make any changes on the survey or consents • No one likes to take a test, even if it’s not graded. • Western style of testing is “foreign” to our clients. Confusion over Pre/Post tests and Likert scales

Evaluation/Survey Challenges (cont. ) • Clients may feel embarrassment, shame, guilt or humiliation when tested. They do not want to disappoint the teacher or be viewed as a failure or non -compliant. • Level of education, literacy, acculturation and visual acuity impacts time needed to administer survey. • Mistrust of government and research • Fear of signing consent forms, providing personal info • Fidelity of the data collected. Does the survey mean the same thing across so many different groups?

Final Recommendations • Hire Bilingual/Bicultural community liaison staff, ideally people already connected to the community. • Incentives. Always a hit. • Use Tailored Graphics and Illustrations. • Translation – Have a Review Committee (diverse and reflective of target population) review curriculum, materials, surveys for appropriateness and understandability. – Back Translation – Field Test survey in its multiple languages.

Final Recommendations (cont. ) • Survey administration logistics – Budget for One-on-one survey administration. Expensive, but often works best. – Have flexibility to do one-on-one, group, inhome, or mailed surveys – Hire Bilingual/Bicultural survey administrators. – Train/Prepare staff to explain pre and posttest surveys and concepts in different ways. – Private site/room/space to explain survey • To address distrust of government or research, help participants understand their value, what they can contribute to their community by participating.

Successful Recruitment/Outreach Approaches

Rewards • Equipping people with diabetes with knowledge and confidence in how to care for themselves and the health of their loved ones.

Rewards • Empowering families and communities to prevent and control diabetes

Resources For more information about the REACH 2010 Seattle & King County Diabetes Coalition, visit our website at: • http: //www. metrokc. gov/health/reach/index. htm For additional information about this presentation, contact: • Roxana Chen, MPH, REACH Evaluation Manager roxana. chen@metrokc. gov • Cheza Garvin, Ph. D, MSW, MPH, Principal Investigator cheza. garvin@metrokc. gov