Recipient Organization
TEXAS COOPERATIVE EXTENSION
(N/A)
COLLEGE STATION,TX 77843
Performing Department
Family Development and Resource Management
Non Technical Summary
Growth in Texas' 60-plus population is projected to escalate from its current 2.7 million to 8.1 million by 2040. Eighteen percent of the elder population is Hispanic/Latino. Along the Texas-Mexico border region, Hispanic elders will continue to outnumber other races and ethnicities. Starr County, pilot site, is located on the Texas-Mexico border in the lower Rio Grande River Valley. Texas Hispanic/Latinos over the age of 65 are disproportionately affected by diabetes prevalence (34.4 percent) than their White counterparts (17.5 percent). Across all racial/ethnic groups, prevalence rates of diagnosed diabetes dramatically increase with advancing age. For Hispanic/Latinos over the age of 65, these rates escalate from 6.8 percent for those 18 to 29 years to 34.4 percent. Coupled with higher prevalence rates, in 2005 Texas Hispanic/Latino mortality rates (52 per 100,000) were more than double Whites (21 per 100,000). Diabetes can significantly impact the quality of life of any elderly person with the disease, including Hispanics/Latinos. Older Hispanic/Latinos with diabetes are at an increased risk for co-morbidity and complications, and these conditions have a disabling effect on these individuals. Compared to nondiabetic elderly, Hispanic/Latino older adults are at an increased risk of disability in activities of daily living, the development of lower body disability, and major cognitive decline. Further, increased rates of comorbidity, disability, and health care use are greater in this cohort than the general elderly population. Proper management is critical to minimize the potential adverse effects of diabetes. Self-management education is the cornerstone for diabetic care and vital for glycemic or blood glucose control. Two measures of effective diabetes management - regular glucose self-monitoring and maintaining the recommended levels of hemoglobin A1c at less than 7 percent A1c - have been shown to reduce risks for disease-related complications. Literature documents lower blood glucose control among Mexican-Americans compared to Whites. Poor diabetes management is greatest among those with no insurance coverage, lower literacy, poor or no English skills, lower educational and income levels, and limited access to transportation. Identifying strategies and resources to provide diabetes education for vulnerable populations can help mitigate this problem. Developed in 2002, the English DWBW version has been cited by the Texas Department of State Health Services as a recommended community-based resource. In 2008, the English DWBW version was offered in 84 Texas counties with 1,527 persons attending the program. Success of the English DWBW version has set the stage for the development of the culturally adapted Spanish DWBW sequel. Similar to its counterpart, the Spanish DWBW version has the potential to offer the following benefits: better blood glucose management, social support by program staff and attendees, increased nutrition and diabetes self-care knowledge, and improved self-efficacy. Collectively, these enhancements will greatly contribute to positive health outcomes, especially among Texas elderly with diabetes.
Animal Health Component
100%
Research Effort Categories
Basic
(N/A)
Applied
100%
Developmental
(N/A)
Goals / Objectives
Below are the goals and objectives that will guide the proposed project: Goal 1: Pilot the Spanish DWBW version focused on older adults and their families who reside in a rural area of Texas. Objective 1:1: Organize a Starr County Diabetes Coalition consisting of health professionals and community stakeholders to help plan, market, and deliver the class series. Objective 1:2: Conduct a marketing campaign to recruit persons over the age of 60 who are diagnosed with type 2 diabetes. Objective 1:3: Train county agents and contracted registered nurses and dieticians to deliver DWBW. Objective 1:3: Implement DWBW at two pilot sites. Goal 2: Evaluate response to the intervention. Objective 2:1: Assess participants' pre- and post-A1c levels. Objective 2:2: Assess participants' pre- and post-knowledge, diabetes self-care behaviors, and self-efficacy using a previously developed, validated instrument. Objective 2:3: Develop a tool to evaluate facilitator instruction. Objective 2:4: Assess facilitators' program delivery. Objective 2:5: Modify the intervention based on evaluation results. Objective 2:6: Publish (post-project year) pilot test results. Goal 3: Ensure availability of the Spanish DWBW version to Texas AgriLife Extension Service county agents, the Cooperative Extension community, and stakeholders. Objective 3:1: Include the Spanish DWBW version as a program available for county agent adoption. Objective 3:2: Develop a Model Plan of Work for the program. Objective 3:3: Provide a link to the program on AgriLife Extension's Family and Consumer Sciences public website. Objective 3:4: Make available Spanish DWBW promotional resources on the eXtension Health Community of Practice
Project Methods
Methods The goal of Spanish Do Well, Be Well con Diabetes (DWBW) is to improve participants' diabetes self-care behaviors. Contracted registered nurses and dieticians, with volunteer assistance, facilitate the delivery of the program. The five weekly educational session topics and novela series are listed below: Cual es diabetes (What is diabetes) . Novela episode #1: Los mitos de la diabetes (Diabetes Myths) Coma sano con diabetes (Eat healthy with diabetes). Novela episode #2: Controlando la cantidad de comida (Portion Control) Sea activo con diabetes (Be active with diabetes). Novela episode #3: Saliendo a comer (Eating Out) Medicinas y diabetes (Medicines and diabetes). Novela episode #4: Hablando con su doctor (Talking to Your Doctor) Prevencion de problemas de la diabetes (Preventing diabetes problems). Novela episode #5: Controlando la diabetes (Taking Control of Diabetes) The group intervention is tailored for low-literacy needs and is communicated through culturally relevant experiences. Eight diabetes self-care practices are taught to promote blood glucose management: eating healthy, regularly checking blood glucose levels, engaging in physical activity, taking medicines, visiting the doctor, having vision exams, taking care of their feet, and having their teeth checked. To encourage social support, family members or friends are invited to attend. Guided by the social learning and self-regulation theories, this intervention focuses on several principals: self-efficacy, social support, role modeling, goal-setting, and self-monitoring. Instructional activities were developed to support these concepts. These strategies include skill-building activities, maintaining a weekly behavioral log, cognitive reframing, and viewing video novelas (soap opera) for role-modeling and reflection. As part of the development process, a team of nutrition and diabetes education experts conducted a content review of the curriculum. Evaluation and Methodologies The two-fold purpose of the pilot project is to evaluate the program's impact on A1c levels, diabetes knowledge, diabetes self-care behaviors, and self-efficacy; and assess the facilitators' delivery of the classes. A prospective, quasi-experimental, repeated-measure design will be used to evaluate the Spanish DWBW version. Hispanic/Latinos over the age of 60 with type 2 diabetes will be assigned to either an intervention or wait-list (control) group. Using county of residence as the assignment criterion, participants residing in Starr County, Texas, will form the intervention group; those living in Hidalgo County, Texas, will form the wait-list (control) group. Because of ethical considerations, those in the wait-list or delayed intervention group will receive their usual and customary diabetes care from their physician during the study period. The intervention will be offered to this cohort after the completion of the project. Clinical assessments (A1c) will be performed at Guajira Family Clinic and Diabetes Care in Rio Grande City and Edinburg, Texas. Institutional Review Board approval will be obtained from Texas A&M University.