Progress 09/01/09 to 08/31/12
Outputs
OUTPUTS: A total of 196 Dining with Diabetes classes were delivered across Pennsylvania providing evidence-based diabetes education to more than 2100 residents in the state. Since the program is open to adults with or at risk for type 2 diabetes and their family members, it provided an opportunity for those at risk for diabetes to also benefit from the program. Due to funding decreases as well as personnel reductions in Extension, the program was offered 17 time in 2011/12 in 14 different counties. Ten of the programs were part of a special Wait-list Control group project conducted in partnership with Joslin Diabetes by four educators in five counties. A total of 91 participants were randomized into either a spring or summer class. Also during this year, a Dining with Diabete Facebook group was established to provide ongoing social support for past or present participants in the program. This is a closed group and is meant to provide a platform for participants to continue to share recipes, strategies and new information with each other. A partnership with the Community Health Collaborative in Philadelphia developed following a presentation at the Pennsylvania Diabetes Action Plan meeting in May, 2011. As a result of that partnership, the Dining with Diabetes program has been translated into Spanish and will be delivered to Latino populations located in Philadelphia, Montgomery, Chester and Lancaster Counties. New partnerships continue to be forged as health insurers and providers are looking to provide cost-effective, accessible means of diabetes education to their patients. A funding proposal submitted to the Centers for Medicare and Medicaid Services in partnership with Joslin Diabetes Center has leveraged the funding provided initially by USDA and Pennsylvania Department of Health to establish the program as a reimbursible, evidenc-based, cost-effective model for diabetes education. PARTICIPANTS: Participants included Jill Cox, MS, RD as PI/Program Manager and Marilyn Corbin as CoPI. Jule Cooper and Suzanne Glenn assiste with data entry and analysis. Two student interns assisted with program delivery. This year, 8 extension educators delivered the program with a healthcare partner or program assistant. Support was provided by Cynthia Myers, Staff Assistant and Diane Maggs, Financial Assistant. Partnering insititutions included Mount Nittany Medical Center, United Mine Workers, General Electric, YMCA Centre County, Faith Centre, Summit Health and the Pennsylvania Medical Association. Collaborating academic institutions included Washington, University of Hawai'i, West Virginia University, New Mexico State University and Joslin Diabetes Center at Harvard University Medical Center. Professional development was provided for the diabetes program team by Sharon McDonald, MS, RD who attended the West Virginia Diabetes Symposium and provided highlights from the conference. TARGET AUDIENCES: A particular challenge this year was reaching some of the ethnically diverse, high risk populations in the state. This is partially due to the fact that no classes were offered in Philadelphia, Pittsburgh or Luzerne counties that are among the more urban regions of the state. Reaching participants who are 65 or older has been consistently successful, which has been beneficial since they have the highest percentage of type 2 diabetes of any age group. Almost half of the participants enrolled this year were 65 or older. There was an increase in the number of slightly younger participants in the 55-64 age range, which had been a goal for this year. Fifty-six percent of the population had an income under $50,000 and 71% had less than a 4 year college degree. PROJECT MODIFICATIONS: The most significant modification in the project this year was the Wait-list control group conducted in partnership with Joslin Diabetes Center. Four educators participated to deliver the program in 5 counties by randomly assigning participants to either a spring or summer class. All participants eventually received the intervention, with the summer group having to wait three months to attend classes. Baseline measurements of both groups were taken prior to randomization. The summer group underwent an additional pre-evaluation so that a total of three data sets were collected on this group as compared with the traditional pre/post conducted on the spring class. Data analysis of this project is underway. Programs were also offered at 7 other sites in the traditional format over the course of the year.
Impacts
Although the number of participants enrolled in the program this year represent about 10% of the total since 2008, the outcomes remain consistent in that both people with or at risk for type 2 diabetes improve in several health parameters upon completion of the program. Both groups continue to see improvements in their A1C levels, blood pressure measurements and waist circumference. Pre/post questionnaires consistently show improvements for people with diabetes in their self-efficacy in managing their diabetes due to changes in knowledge, attitude and behavior. Spefically, they feel more hopeful and that they know exactly what they need to do to prevent complications related to diabetes. For all participants, whether they were previously diagnosed with diabetes or not, there were increases in the number who indicated they exercised for 20 minutes or more when comparing baseline to follow-up. Additionally, the number of those who reported they eat a variety of fruits and vegetables increased as well. As a result of attending the program, 100% of respondents indicated they would use more heart healthy fats in cooking as compared to 20% at baseline. One hundred percent also said they would eat less fried food (43% at baseline) and increase fier and whole grains in their diet (19% at baseline).
Publications
- Cooper, J. A., J. N. Cox, and M. A. Corbin. 2012. Social Media in Diabetes Education: A Viable Option Journal of Extension (Accepted for Publication).
- Berger, M. and J. Cox. 2012. American Diabetes Association 72nd Scientific Session. The Effect of Blood Pressure Control. Poster Presentation. Philadelphia, PA. June 8, 2012. http://extension.psu.edu/healthy-lifestyles/diabetes/publications/cop y_of_diatebes-notes-volumn-2-issue-2-summer-2011/view and http://extension.psu.edu/healthy-lifestyles/diabetes/publications/dia betes-notes-issue-1-volume-3-spring-2012/view.
- Cox, J. (editor). 2012. Diabetes Notes newsletter, Fall 2011, Winter 2012, Fall 2012. http://extension.psu.edu/healthy-lifestyles/diabetes/publications/dia betes-notes-volume-3-issue-2-fall-2012/view.
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Progress 09/01/10 to 08/31/11
Outputs
OUTPUTS: Dining with Diabetes in Pennsylvania is an established evidence-based diabetes education program that has been offered by 23 Extension Educators in 44 counties in the year 2010-2011. A total of 72 classes has been offered during this programming year. County educators have held informational sessions prior to the beginning of the program to help increase recruitment of participants. New partnerships have been formed with health systems and organizations to meet the growing need for diabetes prevention and intervention. County educators were also involved in a presentation at the Pennsylvania Farm Show that was well received by attendees. Additionally, cooking demonstrations and an interactive exhibit at the Pennsylvania Ag Progress Days in August resulted in several connections with potential participants and at-risk family members. A quarterly newsletter has been provided for participants to read success stories from other participants and to continue to provide helpful information for diabetes management. Even with discontinued funding from the Pennsylvania Department of Health, County educators have been able to secure other means of funding or to secure in-kind donations to enable the program to continue. Extension Educators have partnered with new locations to offer the Dining with Diabetes program. In the spring of 2011, a program was offered at a convent in Erie that involved 40 participants in a communal living situation. Additionally, two new worksite opportunities were implemented - one in Montgomery County and the other in Erie. This provided for a new and unique opportunity for delivering the program. A Dining with Diabetes program was offered in Chester County to a Hispanic audience and was delivered completely in Spanish, thus assisting in the goal of reaching more high risk populations. PARTICIPANTS: The Dining with Diabetes program has formed numerous county level collaborations with local health systems and providers. Summit Health in Franklin County has provided an endowment for the second year in a row to support the program. Mount Nittany Medical Center in Centre County has enable their certified diabetes educator to assist the extension educator in teaching the classes. New collaborations are being explored with Capital Blue Cross and Novo Nordisk Company. TARGET AUDIENCES: The Dining with Diabetes program continues to strive to meet the needs of disparate populations within the state of Pennsylvania. Twenty-two percent of participants have a household income less than $25,000 per year. Another 47 percent have an income level betwee $25,001 and $50,000. Forty-nine percent have a high school education or less with another 24 percent having completed some college, but not obtaining a degree. The median age is 65. PROJECT MODIFICATIONS: One significant modification was in the method of A1C testing provided for the participants. With the availability of the A1C Now Self-Check kit provided by Bayer, participants are able to have point of care testing on site.
Impacts
The Dining with Diabetes class that was delivered to a Hispanic audience received a Frankie Award Honorable Mention at the CDC Diabetes Translation Conference in April 2011.Marketing efforts through social media and search engine advertising resulted in a 200-400 percent increase in traffic to the Dining with Diabetes website. All registrations for the program are now conducted online using Cvent registration, which will allow for increased evaluation of marketing techniques. Over 1700 participants have benefited from the Dining with Diabetes program in Pennsylvania as evidenced by the statistically significant improvements in A1C, waist circumference and blood pressure measurements. Inclusion of at risk family members has resulted in identifying those who have pre-diabetes or diabetes (26 percent of family members attending). This subgroup has also shown statistically significant improvements in their bio-markers. All participants have shown statistically significant improvements in health-related behavior changes such as increased physical activity and healthier food choices, increased knowledge and improved attitudes related to diabetes care and prevention.
Publications
- Cox, J. N. and M. A. Corbin. 2011. Extension Educators partner for diabetes education in PA. J. American Association of Family and Consumer Sciences 103(1):19-21.
- Cooper, J. A., J. N. Cox, and M. A. Corbin. 2011. Social media in diabetes education: a viable option J. of Extension(In review).
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Progress 09/01/09 to 08/31/10
Outputs
OUTPUTS: Training for the Dining with Diabetes (DWD) program was conducted in September 2009 and July 2010. Extension educators are now offering the program in 52 counties across the state. Program team conference calls have been held bi-annually to discuss any issues or updates regarding the program. In-services have been held bi-annually (November and March) for educators offering the program. Presentations regarding DWD include an update for EFNEP educators at the PSU Nutrition Links Annual Conference, American Association of Diabetes Educators Meeting in San Antonio 8/10 and a report to the Pennsylvania Department of Health. Poster presentations were also made at two Penn State Research forums as well as the CDC Diabetes Translation Conference in Kansas City in April. DWD in Pennsylvania was acknowledged as a program of excellence at the American Diabetes Association Disparities Conference in Washington, DC. Program demonstrations have occurred in multiple locations across the state including the Pittsburgh Diabetes Expo in November. DWD was also featured in the College Room at Penn State's Annual Ag Progress Days. PARTICIPANTS: Marilyn Corbin, PhD is the Principal Investigator and Project Director. Jill Cox, MS, RD is the Co-PI and Project Manager. Partner organizations include the Pennsylvania Department of Health, Joslin Diabetes Center, Mount Nittany Medical Center, Lewistown Hospital, Merck, Inc., WISEWOMAN program, Penn State Institute for Diabetes and Obesity and Temple University. Professional development opportunities for staff have included an in-service provided by Mary Alice Gettings, MS, RD, CDE on educational updates for diabetes education, AADE webinar hosted at five sites across the state on Motivational Interviewing, Annual in-service in March given by Kelly Karpa, PhD on the Nuts and Bolts of medications used to treat Type 2 diabetes. Healthy Interactions provided training on the Journey for Control Conversation Maps to the educators as well. TARGET AUDIENCES: Dining with Diabetes has been offered at several locations in the community to adults 18 and older who have or are at risk for developing type 2 diabetes. Scholarships are available for those who are in need. Currently 5% of the participants are African American, 5% Native American, 90% white. This is reflective of the population census in Pennsylvania. Educators are working to meet the needs of their communities and decrease health disparities in regards to diabetes care. The Dining with Diabetes curriculum is designed for experiential learning, point of care teaching and interactive education. PROJECT MODIFICATIONS: Nothing significant to report during this reporting period.
Impacts
Evaluation of the program includes pre/post questionnaires,workshop evaluations to determine change in knowledge, attitude and behavior as a result of participating in the program. Objective measures include A1C,lipids,blood pressure and waist circumference measurements. Participants consistently show a significant improvement in all four objective measures upon completion of the program. Many factors contribute to this including their change in food preparation, portion control and physical activity levels. Results from the questionnaires indicate that participants have increased awareness of the important tests related to managing their diabetes. There is evidence of improved self-efficacy regarding what they can do to manage their diabetes. Participants are given hands on experience and strategies for healthy food choices and physical activity options. The practical information, support of peers, positive approach and non-clinical setting of the classes improve their ability to absorb the information regarding diabetes at a pace that is appropriate to make healthy lifestyle changes.
Publications
- Cox, J. 2009. Diabetes Prevention. Lancaster Farming. October, 2009.
- Cox, J. 2010. Program Helps People with Type 2 Diabetes. Center Daily Times.
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