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New AgriLife Extension diabetes programs use ethnic, cultural perspectives

A presenter explains nutrition labels

By Paul Schattenberg

Recognizing the need for a culturally relevant type 2 diabetes self-management education program for the state’s Hispanic and African-American population, a team from the Texas A&M AgriLife Extension Service has developed two new programs.

The ¡Sí, Yo Puedo Controlar Mi Diabetes! and Wisdom, Power, Control programs were designed to be culturally appropriate and to address the dietary needs and food preferences of two of the state’s major ethnic groups, said Dr. Ninfa Pena-Purcell, AgriLife Extension health specialist in family development and resource management in College Station.

According to data from the Texas Diabetes Council, both the state’s non-Hispanic blacks and Hispanics have a higher prevalence of diabetes than their white, non-Hispanic counterparts, with the greatest disparity occurring in the 65-plus age group. It also shows that adults with a better education have a lower prevalence of diabetes.

“These new programs were developed after extensive input from focus groups and interviews with numerous Hispanic and African-American residents throughout Texas,” Pena-Purcell said.

“We’d already been addressing diabetes awareness and management through the Better Living for Texans and ‘Do Well, Be Well with Diabetes’ program, but we saw how diabetes information could be presented in a more ethnically and culturally relevant and acceptable manner.”

She said the new programs are primarily designed and targeted for limited-resource individuals.

“To implement these programs, AgriLife Extension family and consumer sciences county agents will coordinate with local health professionals to help plan and teach the class series,” she said. “And due to the financial needs of these audiences, we’re focused on keeping the cost of the programs nominal.”

Program classes are approximately two hours once a week for six or seven weeks. They are taught by trained health professionals who instruct them on practical lifestyle skills to better control  diabetes. Educational materials are provided.

Program components address self-care skills, improving eating habits and maintaining good nutrition, increasing physical activity, prevention of diabetes complications and improving the quality of life for those with type 2 diabetes.

“Both programs contain materials consistent with the American Diabetes Association’s national standards of care, including emphasizing self-regulation as key to diabetes control,” she said.

“Proper management is critical to minimize the potential negative effects of diabetes, and self-management education is the cornerstone for diabetic care and vital for blood glucose control.”

She said program information is presented in a way to address any cultural misconceptions about diabetes and to engage the intended audience.

“For example, the Yo Puedo program is targeted at a more limited-resource, Spanish-speaking audience and includes a series of short ‘novelas’ or video soap operas to help deliver health messages in a culturally relevant manner,” Pena-Purcell said. “The Wisdom, Power Control program places a little more emphasis on ethnic food preferences and community support, such as how a participant’s church might play a role in supporting diabetes management efforts.”

She said input from her focus groups and individual discussions also showed both ethnic groups were more inclined to seek support from their family members.

To date, the Yo Puedo program has been piloted in six South Texas counties with predominantly Hispanic populations, with funding provided through a grant from the U.S. Department of Agriculture’s National Institute for Food and Agriculture. Ninety-five percent of the almost 200 participants from these counties were Hispanic and 84 percent were female. More than 60 percent had an annual income of $20,000 or less and more than a third had not completed high school.

A small-scale pilot of the Wisdom, Power, Control program has been implemented in Fort Bend County and in Beaumont, she said. And the USDA-NIFA has provided almost $200,000 in funding to implement a large-scale program pilot in the East Texas counties of Cass, Grimes, Harrison, Jasper, Jefferson, Smith and Waller.“The Yo Puedo program has also now been recognized by the Texas Diabetes Council of the Department of  State Health Services as a best practice program and information on it may be found on their website,” Pena-Purcell said. The website is http://www.dshs.state.tx.us/diabetes/ .

“We plan to work closely with another Texas A&M University System institution, Prairie View A&M University and the university’s Cooperative Extension Program, to implement this effort in those counties,” Pena-Purcell said.

She said evaluations from program participants already demonstrate there has been significant improvement in diabetes self-care behaviors, increased self-confidence about diabetes self-care and increased overall knowledge of diabetes by these participants.

“The Texas Diabetes Council has estimated the health-care and related costs of diabetes to the state of Texas to be in excess of $12 billion,” she said. “The health-care cost savings and lost-wage savings from programs like these to improve diabetes self-management will be significant. Making diabetes self-care information more acceptable to ethnic groups disproportionately affected by the disease makes both practical and economic sense.”

For more information about these programs, contact Pena-Purcell at 979-845-1804 0r npurcell@ag.tamu.edu.

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