Improving Diabetes Management
Diabetes Lay Educators on the Move
Diabetes Initiative
Providing Comprehensive Diabetes Care in One Location
YMCA Collaboration Focused on Promoting Exercise
Improving Diabetes Management
2007, Bluegrass Farmworker Health Program
top
Bluegrass Farmworker Health Center (BFHC) collaborated with the Lexington Fayette Health Department to teach a series of diabetes self-management classes in Spanish to diabetic farmworker patients. The four-week class was based on the
Living Well with Diabetes curriculum developed by the Kentucky Diabetes Prevention and Control Program, which is focused on giving patients the tools and knowledge to manage and control their diabetes. Two local health department staff developed and taught the classes and provided Spanish language support. The BFHC outreach program coordinated the advertising, registration, and child care as well as provided space for the classes.
Immediately preceding the classes, BFHC outreach specialists offered individual instruction on how to use glucometers and self-monitor blood glucose levels. Each class included a healthy snack and interactive instruction. A walk-in-place exercise tape was the highlight of many classes. Incentives such as glucometer strips, medication boxes, gift cards, calendars, exercise tapes, and recipe books were included as part of the program. BFHC also provided bus tokens and child care to participants to overcome some of the typical barriers farmworkers face in taking advantage of this type of program.
Diabetes continues to rank 2nd in all diagnoses seen at the BFHC and self-management is recognized as critical to the successful management of this illness. This program was the first Spanish-language diabetes self-management series to be taught in the state. In addition to barriers such as child care and transportation, this program alleviated the language barrier which has kept farmworkers from accessing classes such as this one in the past. By collaborating with the local health department, the BFHC was able to offer a valuable learning opportunity that was responsive to the needs of the patient population. The class was very successful, graduating 11 participants who attended all six classes in the series.
Since the class series ended, the BFHC and health department have continued to provide follow-up activities with graduates through a monthly support group. In addition to the original participants, some of whom drive 70 miles to attend the monthly meeting, many interested family members and friends also attend to learn about diabetes prevention.
Diabetes Lay Educators on the Move
2006, Migrant Health Services, Inc.
top
Migrant Health Services, Inc. added the Diabetes Lay Educator Program as an outreach component to its diabetes program in 2000. Diabetes Lay Educators (DLE) were recruited from a pool of natural leaders within the farmworker population. The DLEs migrate with the populations they serve between Minnesota, North Dakota and Texas to foster and maintain continuity of diabetes care. They assist in the provision of direct service and health education to farmworkers, their families, peers and health care providers in each of the communities where they migrate. They also participate in research projects and contribute to the success of the overall diabetes program across three states.
The DLEs are able to prevent gaps in services and education that might normally occur during migration because the DLEs come from within the communities they serve and they migrate with these same populations, even when farmworkers return to their home bases in Texas. With this truly mobile outreach model, a diabetic patient can stay with the same support group throughout the full migration loop, resulting in a unique and effective opportunity to build ongoing trusting relationships with his/her DLE. DLEs also provide crucial “insider” information on farmworker health care beliefs, practices, and cultural issues to health care providers who do not have continuous interaction with farmworkers so that they can better understand and be responsive to their migrant populations.
Diabetes Initiative
2005, Panhandle Community Services, Community and Migrant Health Center
top
Through its Southwest Nebraska Migrant Study, PCS found that the diabetes risk in the SW Nebraska migrant population is nearly 7 times the Healthy People 2010 target of 2.5%. In response, PCS has begun integrating the Bureau of Primary Health Care’s diabetes Health Disparities Collaborative diabetes program into its migrant program.
The Health Disparities Collaborative is a population-based care model that seeks to improve clinical practice and generate and document better health outcomes for underserved populations. By participating in this initiative, PCS not only has access to national resources and information-sharing, but is able to share its own successes and challenges in order to improve what is known about effective diabetes management for MSFW populations.
Providing Comprehensive Diabetes Care in One Location
2005, Migrant Health Service, Inc.
top
Migrant Health Service, Inc., (MHSI) in conjunction with providers from the surrounding community, holds “Diabetes Cluster Clinics” seven times during peak season in which farmworkers are able to access a multidisciplinary diabetes team consisting of lay health educators, outreach workers, a diabetes educator, a nutritionist, an ophthalmologist, a hygienist, a physician or mid-level nurse specializing in podiatry, MHSI clinical staff, and a phlebotomist. At locations throughout the service area in Minnesota and North Dakota, patients are able to cycle through what would normally take up to eleven outreach and clinical office visits in 3-4 hours time, addressing issues such as nutrition, diet, exercise, eye and foot care. At the final station, patients meet with a nurse who reviews the patient’s overall findings and makes any necessary referrals for further care.
By holding the Diabetes Cluster Clinics, Migrant Health Service, Inc. has successfully made services more accessible to farmworkers in an area of particular health concern, diabetes. This practice meets the needs of farmworkers who may not have time for more than one office visit, and also allows farmworkers and MHSI to save on medical costs by cutting down on the need for multiple appointments. The practice has also successfully integrated services offered through MHSI with those of area practitioners to the benefit of farmworker patients.
YMCA Collaboration Focused on Promoting Exercise
2008, Migrant Health Service, Inc.
top
In 2006, Migrant Health Service, Inc (MHSI) received a small grant from the Blue Cross Blue Shield Foundation of Minnesota to purchase YMCA memberships for migrant and seasonal farmworker families. The YMCA waved enrollment fees and adjusted the price to fit the unique needs of the agency and its patients. The relationship has been very successful; as of September 2007, a total of 19 families (77 individuals) have benefited from MHSI’s partnership with the YMCA.
With this project, MHSI clients have utilized facilities in multiple locations that would have been unattainable to them normally. The nurses and program staff have been determined to make the project a success so that families have a safe and fun atmosphere to exercise and become motivated to engage in healthy lifestyles. Staff recruited members for enrollment, accompanied them on tours of the YMCA facility, provided interpreting services for them in Spanish, and enrolled them in fitness classes.
Participants in the program are required to have at least one family member attend the YMCA a minimum of eight times per month to maintain the membership. One family, a 79-year old gentleman and his wife, has averaged 23 visits per month! The combination of medication, nutrition, and exercise helps the gentleman manage his Type 2 diabetes, hypertension, and hyperlipidemia. Their participation in the program has served as a true inspiration and proof that healthy living can occur at any age. Another success story comes from a woman who goes to the YMCA about 10 times a month and has lost more than 20 pounds and 2½ inches off her waist since starting with the program. The success of this initial collaboration with the YMCA has prompted the MHSI Chronic Disease Program to seek additional funding to continue the program.
