Publications and Products
CDC Response
National Hispanic/Latino Expert Consultant
Group Recommendations
Prepared by
Division of Diabetes Translation
March 1998 |
 |
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Table of Contents
- Chapter 1. Policy
- Chapter 2. Partnership
- Chapter 3. Education
- Chapter 4. Funding
- Chapter 5. Research and Data
- Chapter 6. Health Systems
- Chapter 7. Public Awareness
1
Policy
Problem/Issue Absence of policies within the Division of Diabetes
Translation (DDT) that effectively address diabetes in Hispanic/Latino
populations
Desired Aim
To give Hispanic/Latino populations equitable attention within the DDT
— staff, resources, and programs — in order to effectively address
the prevention and control of diabetes in this population
Recommendations
1. In 1997, the DDT should commit resources to plan, implement, and evaluate
diabetes prevention and reduction strategies for Hispanic/Latino populations,
and to establish a line item in the DDT budget specifically for this purpose
by FY 1998.
2. To commit to further include and represent Hispanic/Latinos in DDT
at all staffing levels to respond effectively to diabetes among Hispanic/Latino
populations
3. To develop and implement policies that ensure Hispanic/Latino communities
involvement in identifying appropriate educational strategies
4. To direct the state diabetes prevention and control programs to fund
community-based organizations and other nongovernmental entities to support
implementation of effective diabetes prevention and control strategies
in Hispanic/Latino communities
5. To incorporate the National Hispanic/Latino Expert Consultant Group
(NH/LECG) recommendations into policies and fund request-for-proposals
or applications beginning in FY 1998
6. To identify existing models that effectively address diabetes in Hispanic/Latino
populations
7. To commit to increase staff assigned to Hispanic/Latino projects,
by adding at least three or four professional staff by the end of FY 1998
8. To promote efforts to standardize effective diabetes education for
Hispanic/Latino clients and their families
9. To send the NH/LECG a yearly report on the status of the recommendations
outlined in this report
Response to Recommendations
1. Philosophy
The Division of Diabetes Translation shares the desired aim. Its strategy
and policy have consciously integrated the appropriate diabetes-related
Hispanic/Latino issues and concerns into the overall work of the division.
This approach will be effective and efficient.
2. Branch Involvement
Responding to these issues is the responsibility of every part of
the division. Both branches in the division continue to have major responsibilities
to address the issues outlined in this report. Examples follow.
A. Staffing
The Program Development and Epidemiology and Statistics Branches
have Hispanic/Latino employees who have proven to be a tremendous asset
as we continue to develop and implement projects, interventions, and strategies
appropriate to these populations. These professionals were not hired to
work only on Hispanic/Latino issues; they were hired because they were
the most qualified for the positions. The division will pursue staff growth
over the next two years.
B. Partnerships
During the past year, we have sought to increase partnerships by
attending and displaying exhibits at conferences of selected Hispanic/Latino
national organizations. In FY 1997, DDT staff attended the National Council
of La Raza conference in Chicago, and we are scheduled to attend the 1998
national conference in Philadelphia, PA. We plan to attend and exhibit
at the COSSHMO national conference in June 1998 in Puerto Rico.
During the past two years, the division has proactively sought to
have relevant Hispanic/Latino issues highlighted with sessions and presentations
at the annual diabetes translation conference.
Hispanic/Latino involvement is continuing through the NDEP. The
division is committed to help affected communities plan, develop, and
implement targeted programs, as evidenced by the Hispanic/Latino workgroup
of the NDEP. This workgroup is actively collaborating with the NDEP to
develop culturally and linguistically appropriate messages, identify trusted
and valued delivery channels, and develop media and community intervention.
C. Publications
Recent publications include
- Building Understanding to Prevent and Control Diabetes Among Hispanics/Latinos:
Selected Annotations, published in September 1996
- Controle su diabetes: Una guía para su cuidado, the Spanish
version of the diabetes patient guide, published in 1997.
D. Special Initiatives
A. Diabetes Focus Group Manual
Scheduled to be published by the spring of 1998, this handbook shows
how to conduct diabetes-related focus groups.
- It helps health professionals carry out valuable research that
can lead to a better understanding of communities targeted by diabetes
control activities, and ultimately, will lead to better communication.
- It addresses focus group research, especially for those with a
limited budget and among racial/ethnic groups disproportionately affected
by diabetes. Four of the 16 focus groups were Hispanic/Latino.
B. National Diabetes Education Program
DDT funded the National Council of La Raza to conduct town-hall forums
to engage Hispanic/Latino communities and populations in developing the
National Diabetes Education Program (NDEP).
C. Evaluation of "Promotores de Salud" Model
DDT is collaborating with the Midwest Latino Health Research, Training,
and Policy Center of the University of Illinois at Chicago Research Prevention
Center to replicate and evaluate the culturally specific diabetes empowerment
educational program, Promotora de Salud (lay health workers)/Paso a Paso.
D. First National Diabetes Satellite Broadcast
During this event, the division incorporated Hispanic/Latino perspectives
into the development, planning, and implementation of the satellite broadcast:
- National talk show host, Susan Rook, who is Hispanic, hosted the
event.
- Hispanic/Latinos were significantly represented in the formal program
-- Jaime Davidson spoke, a newsmagazine segment on the El Paso Promotora
model was aired, and DDT-sponsored Hispanic/Latino audience members
attended at the Atlanta site.
E. Marketing
The division has continued to market the efforts of the National
Hispanic/Latino Expert Consultant Group (NHLECG) to the Centers for Disease
Control and Prevention director; new Surgeon General; the American Public
Health Association; the International Diabetes Federation; and CDC's Diabetes
Translation Advisory Committee.
F. Resources
Increased funding for Hispanic/Latino initiatives in FY 1998 and
FY 1999. See funding chapter for more details.
Ongoing activities will continue to address relevant issues and are
not included in funding figures, so the resources earmarked for Hispanic/Latino
initiatives will always be an understatement of actual effort. A Request
for Proposal (RFP) will be issued in 1998 to fund national minority organizations
(NMOs) to help DDT raise awareness about diabetes, develop community skills
in addressing the impact of diabetes in communities of color, and help
build the necessary diabetes knowledge and skills that will prevent/postpone
the onset of diabetes complications. Raising the community level knowledge
and understanding about diabetes will benefit at least one Hispanic/Latino
national organizations as approved for funding by an objective review
panel.
2
Partnership
Problems/Issues
1. National associations or groups that deal with diabetes lack agendas
with Hispanic/Latino focused issues.
2. Impact of diabetes in Hispanics/Latinos is a large, far reaching,
and financially exhausting problem because of the high prevalence of the
disease.
3. Duplication of programs and services lead to wasted limited financial
resources.
4. Limited diabetes strategy programs intended for Hispanic/Latino communities.
5. Lack of universal standards of care on diabetes treatment in Hispanics/Latinos
leads to poor quality care and compounds the problem in Hispanic/Latino
communities.
Desired Aims
1.To foster representation of Hispanic/Latino-related issues in national
diabetes associations
2. To explore methods that will engage the affected community to assume
responsibility for and financial sharing in the problem of diabetes in
Hispanic/Latino communities
3. To financially strengthen and support existing programs and services
that successfully deal with diabetes in Hispanics/Latinos, while discouraging
the duplication of ineffective or unnecessary services
4. To modify behaviors that may lead to diabetes in Hispanic/Latino communities
and to promote healthy lifestyle changes
5. To promote quality care of people with diabetes in Hispanic/Latino
communities.
Recommendations
1. To encourage dialogue between the DDT and national associations such
as the following: American Diabetes Association (ADA), American Association
of Diabetes Educators (AADE), Juvenile Diabetes Foundation, and the American
Dietetic Association. This will lead to Hispanic/Latino-focused agendas
in national conferences as well as in annual strategic plans
2. To discuss the status of the Diabetes Assistance and Resources (DAR)
program with the ADA, because it is ADA's only formal program that deals
with Hispanics/Latinos; and have DDT ask ADA for a list of other recognized
programs for Hispanics/Latinos
3. For members of AADE to develop a list of certified diabetes educators
who are bilingual or who work with Hispanic/Latino populations; this list
would be a resource for those trying to reach Hispanic/Latino populations
with diabetes
4. To develop collaborative activities between the DDT and other CDC
centers, institutes, and offices, and other governmental agencies to address
mutual concerns of diabetes; for example, HIV, breast cancer, and immunization
5. To explore partnerships with private sector businesses to increase
awareness of the prevalence of diabetes; examples include cosmetic companies
or the entertainment industry
6. To consider including members of the private sector in the membership
of the NH/LECG
7. To identify existing programs and services that work
8. To implement selected diabetes prevention strategies through community
health center partnerships
9. To provide technical assistance to national grassroots organizations
and community-based organizations to develop diabetes prevention and control
programs
10. To educate health providers on the universal standards of care and
issues surrounding the treatment of diabetes in Hispanics/Latinos
11. DDT to develop and support "train-the-trainer" diabetes education
programs with Spanish speakers, because communities often rely on lay
people to provide diabetes-related information (it is imperative that
they spread accurate and uniform information)
Response to Recommendations
1. Several national associations are long-standing
partners of DDT; their representatives have served on our Translation
Advisory Committee and helped plan the National Diabetes Education Program.
Many DDT staffers are members of the national associations previously
mentioned. We will share the National Hispanic/Latino Expert Consultant
Group report with these national associations, and encourage greater attention
to the burden of diabetes among Hispanics/Latinos in the United States
in national and regional forums.
2. Through our ongoing interaction with the American Diabetes
Association, we will support the continued development, expansion, and
dissemination of the DAR program. We have a copy of the latest information
developed under the DAR initiative for Hispanic/Latinos and will send
comments to the cochair.
3. We will explore the feasibility of listing certified diabetes
educators who are bilingual or who work with Hispanic/Latino populations
with the AADE. If they can generate and disseminate such a list/database,
we will advocate that this be a priority activity for AADE.
4. We are collaborating with other CDC centers through our
involvement in employee organizations such as the Association of Latino
Employees of CDC/ATSD (ALECA), workgroups, and committees such as the
Healthy People 2010 workgroup, and objective review panels that are integral
to the funding process of CDC.
Our participation maintains a visibility for diabetes issues and
populations disproportionately affected. We influence program strategies
and policies via these collaborations.
For example, we have worked closely with the National Immunization
Program to develop and implement a media campaign in both English and
Spanish. It was piloted in four states, three of which have large Hispanic/Latino
populations (Florida, Texas, and California). Preliminary evaluation results
of the campaign are promising. We will continue to seek out similar collaborations.
5. Through the planning activities of the NDEP, we have had
some discussions with the private sector that included Hispanic/Latino
representatives from managed care.
A Business Responds to Diabetes partnership has been suggested
and is being explored. At this time, we have no definitive partnership
with the private sector. This does not preclude our partners in state
and local health agencies from building collaborations with private sector
organizations in their communities.
6. The purpose and work of the NH/LECG have been fulfilled.
As DDT requires specific input from Hispanic/Latino representatives in
the future, we will consider members of the private sector for consultations.
7. The process of identifying existing models of programs and
services that work is ongoing. For example, we are currently supporting
an evaluation of the lay health advisor model/ promotora through the University
of Illinois at Chicago Prevention Research Center.
We will continue to provide consultations and technical assistance
to the state-based diabetes prevention and control programs that will
enhance intervention design and evaluation. With additional rigor, we
can promote the replication of selected models with greater confidence.
8. DDT is piloting a systems change model to improve the diabetes
prevention and control services provided to those living with diabetes
who use community health centers. Upon completion, this pilot study is
expected to be replicated in other community health centers throughout
the nation.
9. No existing policies preclude DDT from providing technical
assistance (TA) to national grassroots organizations and community-based
organizations (CBOs).
We will continue to explore other mechanisms that would make such
technical assistance available, such as funding NMOs to provide the technical
assistance or funding CBOs TA programs through the state DPCPs.
10. DDT does not promote a specific set of standards of care
for any population group, although the DDT was instrumental in reviewing
the ADA Diabetes Standards of Care published in June 1997.
Using the ADA Diabetes Standards of Care as a guide, many of the
DPCPs have drafted standards of care via their diabetes advisory councils.
We recommend that people interested in influencing the implementation
of the standards of care be culturally and linguistically appropriate
when treating Hispanics/Latinos by contacting the appropriate state representatives.
A complete listing of the DPCP coordinators in each state is available
through the DDT Internet pages.
11. DDT will pursue the development of a Spanish version of
Diabetes Today, our train-the-trainer course that builds local-level
capacity to assess and respond to the burden of diabetes in the community.
We anticipate that the curriculum will be conceptualized in a Spanish
framework, and written in both English and Spanish.
3
Education
Problems/Issues
1. Lack of clearinghouse information related to diabetes among Hispanics/Latinos
2. Existing diabetes prevention and control programs have not been evaluated
3. Lack of school-based diabetes education and prevention programs
4. Insufficient number of bilingual, bicultural health personnel, other
than physicians, to address the burden of diabetes in the Hispanic/Latino
populations
5. Health professionals, in general, lack proficient skills in diabetes
mellitus (DM) management
6. High prevalence of sedentary lifestyle among Hispanics/Latinos
7. DDT's Diabetes Today Program has not been implemented in Hispanic/Latino
communities
8. Lack of knowledge about proper healthy nutrition for Hispanics/Latinos
9. Health care providers are not aware of using nonconventional medicine
for diabetes management by Hispanic/Latino people living with, or affected
by, diabetes. Desired Aim
1. To establish a clearinghouse for sharing diabetes interventions and
educational material for Hispanics/Latinos and professionals working with
diabetes
2. To establish effective, culturally relevant prevention and education
services
3. To work through all school systems to implement diabetes education
and prevention programs
4. To promote greater involvement of health personnel, other than physicians,
in diabetes education of Hispanics/Latinos at both the professional and
community levels
5. To increase the knowledge base of health service providers in diabetes
management
6. To promote regular physical activity among Hispanics/Latinos
7. To expand the DDT's Diabetes Today Program to reach
the Hispanic/Latino population
8. To promote and improve nutritional habits conducive to diabetes self-management
and control for Hispanics/Latinos
9. To ensure that nonconventional medicine is addressed by the health
care provider in diabetes education with Hispanics/Latinos Recommendations
1. To identify models of diabetes education and prevention materials
and services that are proven effective; including a list of bilingual
programs and educational materials from the ADA, AADE, and other diabetes-related
health organizations
2. DDT to help develop or incorporate more culturally appropriate diabetes
prevention and educational models
3. To implement the Division of Adolescent and School Health Comprehensive
School Health Program Curriculum nationwide (States and territories with
large Hispanic/Latino populations should adapt this program to fit the
Hispanic/Latino culture; these include Arizona, California, Colorado,
Florida, Illinois, New Mexico, New York, Puerto Rico, and Texas)
4. To identify and evaluate models that train community health workers
and collaborate to make these models available to community-based organizations
interested in implementing the programs
To establish diabetes education certification to professionals holding
degrees that are not in the field of health
To encourage the establishment of a Hispanic/Latino lay diabetes
educator (promotores de salud) program with minimum training and
certification standards
5. To establish a training program about diabetes targeted to health
care providers (NH/LECG members recommend that CDC's DDT support national
diabetes training programs for bilingual and bicultural health professionals
to become diabetes educators)
6. To create an awareness campaign that promotes regular physical activity
among Hispanics/Latinos; this may include the promotion of culturally
appropriate and realistic physical activity such as dancing
7. To modify the DDT's Diabetes Today Program model to be more
culturally and linguistically appropriate to the Hispanic/Latino community;
and implement it throughout the state DPCPs, and national, regional, and
local community-based organizations
8. To inventory or develop healthy nutritional and educational cooking
materials for Hispanics/Latinos
9. To educate health professionals about the role nonconventional medicine
plays in diabetes management for Hispanics/Latinos; the use of herbs in
treatment and the role of faith healing should be addressed
10. To conduct a needs assessment to find out specific beliefs and cultural
folk practices that each Hispanic/Latino subgroup has about diabetes care
and control
11. To incorporate these findings into educational programs.
Responses to Recommendations
1. On DDT's agenda is to research the literature and
conduct behavioral research to identify models of diabetes education and
prevention materials and services that are proven effective. Any comprehensive
research design includes the literature search and review of existing
bilingual programs and educational materials currently in existence from
all sources, including from the ADA, AADE, and other diabetes-related
health organizations
2. DDT will help develop or incorporate more culturally
appropriate diabetes prevention and educational models into community
practice.
3. The implementation of the Division of Adolescent
and School Health (DASH) Comprehensive School Health Program Curriculum
nationwide depends on the funding and success of applicants from the state's
departments of education. We will work with DASH to assess which of the
States and territories with large Hispanic/Latino populations are funded
to find out how they are implementing the program to fit the Hispanic/Latino
culture. Priorities will be given to the states of Arizona, California,
Colorado, Florida, Illinois, New Mexico, New York, Puerto Rico, and Texas.
4. The DDT is identifying and evaluating models that
train community health workers through the funding of the Midwest Latino
Health Research, Training, and Policy Center, University of Illinois at
Chicago Research Prevention Center. The Center will replicate and evaluate
the culturally specific diabetes empowerment educational program, Promotores
de Salud (lay health workers/Paso a Paso) and collaborate to make
these models available to community-based organizations interested in
implementing the programs
During the upcoming DDT conference, the division plans a forum to
start discussing the viability of establishing a diabetes education certification
for professionals holding degrees that are not in the field of health.
It will include the feasibility of establishing a Hispanic/Latino lay
diabetes educator (promotores de salud) program with minimum training
and certification standards.
5. The DDT will establish a National Diabetes Training
Center using the Diabetes Today model that will target health care providers
and community leaders. The successful contractor must conceptualize a
similar training program for bilingual and bicultural health professionals
and community leaders. This model should mobilize the community to address
diabetes at the provider, community, and individual level.
6. At this time, DDT does not have plans to create an
awareness campaign that promotes regular physical activity among Hispanics/Latinos.
We do plan to launch a national diabetes awareness campaign through the
NDEP, and the successful flu campaign that is currently being piloted
in four states.
7. The recommendation to modify the DDT's Diabetes
Today Program model to be more culturally and linguistically appropriate
to the Hispanic/Latino community is being implemented. We are writing
the request for contract to establish a National Diabetes Training Center.
The training will be available to the staff from the state DPCPs, and
national, regional, and local community-based organizations .
8. We do not have the human resources at this time to
inventory or develop healthy nutritional and educational cooking materials
for Hispanics/Latinos. We depend on the National Diabetes Information
Clearinghouse (NDIC) to inventory and maintain educational materials.
After extensive focus testing, we have completed updating, the "Controle
su Diabetes - Guía Para el Cuidado de su Salud." This 118-page patient
guide book is being widely distributed through the NDIC and CDC.
9. The recommendation to educate health professionals
about the role that nonconventional medicine plays in diabetes management
for Hispanics/Latinos, such as the use of herbs in treatment and the role
of faith healing, will be addressed in the contract for the National Diabetes
Training Center. The contractor will need to address this issue when developing
the curriculum to reach health care providers that serve Hispanic-Latino
Americans at the local level.
10. Through the NDEP, we funded a major national Hispanic
organization, who conducted townhall meetings in areas where Hispanic/Latino
Americans reside. During these meetings, community members were asked
about their needs, barriers, and recommendations for diabetes care and
control, in order to help CDC and National Institute of Diabetes and Digestive
and Kidney Diseases implement the National Diabetes Education Program
in a culturally and linguistically sensitive way.
11. As stated, these findings will be incorporated in the
NDEP initiative. An ad-hoc Hispanic/Latino workgroup has been formed to
ensure that these recommendations are incorporated into the NDEP strategies.
4
Funding
Problem/Issue Insufficient funding to address the national prevention,
education, and control for Hispanics/Latinos living with or affected by
diabetes. Desired Aim
To increase funding levels for diabetes prevention, education, and control
programs targeting the Hispanic/Latino population. Recommendations
1. To directly fund community-based organizations, nonprofit 501(c)3
organizations and other service providers who provide diabetes prevention
and education services to Hispanics/Latinos
2. To fund grant-writing training for Hispanic/Latino-focused nongovernmental
organizations
3. To establish a funding stream with community and migrant health centers
to provide alternative diabetes programs
4. To fund field/focus group testing of all materials and programs supported
with federal funds that target Hispanic/Latino communities
5. To make sure that requests for assistance or requests for proposals
(RFPs) developed by the DDT and the DPCPs require a multidisciplinary
and comprehensive approach to diabetes prevention
6. To fund Hispanic/Latino train-the-trainer diabetes programs for Spanish-speaking
health care providers
7. Through the RFP process, the DDT and the diabetes prevention centers
will require universities funded for diabetes-related projects build ties
with Hispanic/Latino community-based organizations
8. To fund projects to establish partnerships between certified diabetes
educators and rural providers
9. To provide funding to establish links with the Mexican Diabetes Association
Response to Recommendations
During the past two years, the division has consistently increased
"exclusive" funding for Hispanic/Latino population-focused projects. "Exclusive"
is funding for activities that address Hispanic/Latino populations only
and does not include activities where they were part of a larger effort
that addresses other subpopulations.
In FY 1996, DDT funded convening the NH/LECG and publication of Building
Understanding to Prevent and Control Diabetes Among Hispanics/Latinos:
Selected Annotations, which cost approximately $75,000.
In FY 1997, DDT funded convening the NH/LECG, a cooperative agreement
with National Council of LaRaza for an NDEP project, published the Spanish
version of the patient guide entitled Controle su Diabetes, and
funded cooperative agreement with the University of Chicago to evaluate
the promotora model. Fiscal year 1997 exclusive funding for Hispanic/Latino
initiatives totaled $430,000.
Current plans include increasing funding for Hispanic/Latino initiatives
in FY 1998 and FY 1999. Initially, efforts will focus on funding at least
one national Hispanic/Latino organization that involves the broader community
in diabetes prevention and control activities. National organizations
or affiliates throughout the country would be target grantees. Typically,
the affiliates of selected national organizations would be community-based
organizations.
Establish a regional Diabetes Today Training Center, which
will focus on all populations, but significant money and effort will be
directed to adapting Diabetes Today conceptually and culturally
for Hispanic/Latino populations. The train-the-trainer part of this training
model will target Spanish-speaking health care providers. These projects
will total approximately $500,000 in FY 1998 and $750,000 in FY 1999.
5
Research and Data
Introduction Diabetes is a serious public health problem that
affects minority populations disproportionately, including Hispanics/Latinos.
Even though the Hispanic population comprises many groups that are ethnically
different, most of the diabetes studies have been done in Mexican Americans.
Fewer studies have been done in Puerto Ricans and Cubans, and the data
are now outdated. These studies have been published in peer-reviewed journals,
but there has not been a concerted effort to transfer the data to the
Hispanic/Latino communities in the United States. Problems/Issues
1. Poor dissemination of existing information concerning the impact of
diabetes in Hispanic/Latino communities.
2. Limited data describing the impact of diabetes in Hispanic/Latino
populations. Desired Aims
1. Improve the dissemination of existing data concerning diabetes in
Hispanic/Latino communities.
2. Increase and improve Hispanic/Latino representation in data collection,
surveillance, and program evaluation. Recommendations
1. Develop various Morbidity & Mortality Weekly Report (MMWR)
articles that explore the issues of diabetes in Hispanic/Latino populations.
2. Encourage oversampling of Hispanic/Latino subjects in research conducted
in states that have large Hispanic/Latino populations.
3. Develop a Behavioral Risk Factor Surveillance Survey (BRFSS) that
deals specifically with diabetes and Hispanic/Latino populations; develop
the questionnaire in Spanish. Response to Recommendations
1. The Epidemiology and Statistics Branch, DDT, is currently
working on an article for publication in the MMWR. It will focus on descriptive
epidemiology of diabetes in the Hispanic/Latino population using data
from the 1995 BRFSS. The article will also cover access to care. This
will begin a series of articles in the MMWR that will (1) update the data
on diabetes in the Hispanic/Latino population, and (2) compare the data
available from various surveys such as the BRFSS and the NHANES.
Include the Spanish publications on diabetes on the DDT's Internet
page. Translate other publications into Spanish, such as the National
Diabetes Fact Sheet, and include them on the Internet page.
Encourage DPCPs to disseminate data on diabetes control and prevention
in the Hispanic/Latino populations.
2. Hispanics/Latinos are included in all national surveys
sponsored by the CDC; however, some surveys are limited by small sample
sizes. CDC is currently exploring strategies to address this problem.
Other activities include analyzing the results of the latest National
Health and Nutrition Examination Survey (NHANES III) that includes data
on Hispanics/Latinos with diabetes; this include oversampling of Mexican
Americans. The NHANES IV will also oversample Mexican-Americans.
The DDT will encourage state DPCPs that serve large Hispanic/Latino
population to conduct surveillance of diabetes, to identify critical
areas where surveillance and epidemiologic studies are needed in the
Hispanic/Latino population; and to explore the feasibility of implementing
these studies.
3. A Spanish version of the BRFSS already exists. State
staffers administer this version of the BRFSS, which includes the diabetes
module, in states that have many Hispanics/Latinos in the population.
By 1999, DDT will identify critical areas where surveillance and epidemiologic
studies are needed in the Hispanic/Latino population, and explore the
feasibility of implementing these studies. DDT will explore the feasibility
of implementing diabetes surveillance surveys of sentinels in states that
have a high Hispanic/Latino population.
6
Health Systems
Problem/Issues As currently structured, health systems do not
adequately address the prevention and control of diabetes in Hispanic/Latino
populations Desired Aim
To assure that health systems address diabetes in Hispanic/Latino populations
in a comprehensive and effective manner with an emphasis on prevention.
Recommendations
1. To incorporate nationally recognized diabetes mellitus standards of
care into health care financing initiatives such as managed care, Medicaid,
and Medicare
2. To establish an ongoing dialogue with health care systems that use
health quality management protocols and share the NH/LECG recommendations
3. To inventory and evaluate effective existing health service approaches
that provide diabetes care to Hispanics/Latinos
4. To establish contact with state regulating agencies that implement
health care financing initiatives to monitor the inclusion of DM standards
of care
5. To work through the state DPCPs to influence the simplification of
procedures and forms that providers require to receive diabetes care Response
to Recommendations
1. During FY 1997, a cooperative agreement was established
with George Washington University (GWU), Center For Health Policy, to
develop model diabetes managed care contract language for future Medicaid
managed care contracts. If implemented at the state level, this contract
language will hold managed care organizations legally responsible to provide
the following specific services; and (1) identify and describe the diabetes-specific
benefits that are to be covered, and how that coverage will be determined
and documented (2) describe how diabetes services will be furnished to
plan members, by whom, and under what circumstances.
2. The DDT will continue to explore appropriate entities to
share NH/LECG recommendations including health care systems
3. Region V Clinical Network
During FY 1997, DDT provided funds to the Region V Clinical Network
(RVCN) to support a collaborative project with the Ohio DPCP to develop
a Modified Recognition Program for Model Diabetes Care in three federally
qualified community and migrant health centers in Ohio. The project is
an important piece of examining effective existing health care approaches
and help identify strategies for improvements.
4. The other recommendations in this chapter will be carefully
considered in future program planning and activities.
7
Public Awareness
Problems/Issues 1. Lack of awareness and understanding the seriousness
of diabetes among Hispanic/Latino populations.
2. Because diabetes is a silent and misunderstood disease, it is crucial
to develop prevention strategies that affect the core of Hispanic/Latino
family values
3. Media messages need to be tailored to meet the needs of the Hispanic/Latino
community Desired Aim
To increase awareness and understanding about diabetes and how to prevent
and control it Recommendations
1. To develop a print and electronic media campaign directed at Hispanic/Latino
communities
2. To identify existing successful social marketing and public awareness
campaign models targeting Hispanic/Latino communities
3. To develop a print and electronic media campaign directed at health
professionals that work with diabetes
4. To adapt the prevention marketing initiative (PMI) developed by the
HIV/AIDS Prevention Division to the diabetes program
5. To design a comprehensive diabetes PMI and prevention campaign that
will target the Hispanic/Latino community beginning with children in schools
from kindergarten through 12th grade
6. To collaborate in developing a basic Hispanic/Latino "how-to" package
for local media advocacy
7. To preview and evaluate existing U.S. Department of Health and Human
Services (DHHS) PSAs directed at diabetes health care professionals and
the Hispanic/Latino community
8. To promote the importance of exercise among Hispanic/ Latinos
9. To establish a way to disseminate information about research findings
to Hispanic/Latino communities in an understandable form that Hispanic/Latino
media can use
10. To create a diabetes patient passport, specifically for Hispanics/Latinos,
that is user friendly and follows accepted standards of care.
Response to Recommendations
1. "Diabetes. One Disease. Many Risks" is the
name of a campaign from CDC to reduce the human comorbidity risks faced
by people with diabetes; the first PSA focuses on the increased risk of
death from influenza and pneumonia. The CDC's DDT and the NIP are collaborating
on intervention strategies for this four-state pilot initiative designed
to increase the number of flu shots received by people with diabetes during
the current flu season.
DDT/NIP gave grants to health departments to support program activities
to increase flu vaccination levels in California, Florida, Montana,
and Texas. Three of these states have a large Hispanic/Latino population
base. Media campaign elements in English and Spanish include one television
PSA, one radio PSA, one print PSA, an educational consumer brochure,
one poster, and postcards for health care professionals and consumers.
Other materials are one preprinted article, and media and state kits.
The media campaign was released in the four states on October 1,
1997, in time for prevention efforts for the flu season.
2. We agree that we should identify existing successful
social marketing and public awareness campaign models targeting Hispanic/Latino
communities. DDT can undertake this before the release of any future media
campaigns.
3. As a part of the media campaign that was initiated
in the four states, we included the following in English and Spanish:
a television PSA, a radio PSA, a print PSA, an educational consumer brochure,
a poster, and postcards for health care professionals and consumers. Other
materials are one preprinted article, and media and state kits.
We plan to incorporate more information in Spanish on the DDT Internet
pages (such as the patient guide Controle su Diabetes, Guía para
el cuidado de su salud.
4. We have contacted the HIV/AIDS Prevention Division
and we plan to evaluate the adaptability of their PMI to the diabetes
program.
5. CDC's diabetes program primarily targets adults who
are at risk for type 2 diabetes. To target the Hispanic/Latino community
beginning with children in schools from kindergarten through 12th grade
will require an assessment and evaluation of this recommendation.
6. We have existing U.S. DHHS PSAs directed at diabetes
health care professionals and the Hispanic/Latino community; DDT is previewing
and evaluating these for adaptability.
7. Based on the design of the campaign, future PSAs from the
CDC designed to reduce the human comorbidity risks faced by people with
diabetes may contain messages that promote the importance of exercise
among Hispanic/Latinos.
8. Diabetes research findings and other pubic information for
Hispanic/Latino communities are released through various Hispanic/Latino
media channels and networks, such as Telemundo and Univision.
9. DDT has developed a diabetes patient care handbook in Spanish
entitled Controle su Diabetes, Guía para el cuidado de su salud;
it is designed for various Hispanics/Latinos. Appropriate focus groups
were used to assure cultural acceptability. The booklet is user friendly
and follows accepted standards of care.
Historical
Page last modified: December 20, 2005
Content Source: National Center for Chronic Disease Prevention and Health Promotion
Division of Diabetes Translation
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Diabetes & Me