Diabetes Educational and Community Based Interventions

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A number of Native American and Canadian populations have recognized the importance of lifestyle changes in diabetes prevention (Stolarczyk, Gilliland, Lium, & Owen, 1999). Consequently, Native populations are becoming more actively involved in the planning, implementation, and evaluation of diabetes programs

(Gohdes & Acton, 2000; Joe & Young, 1994; Olson, 1999; Wiedman, 2001). Community interventions have developed with the cooperation of tribal and indigenous organizations, public health agencies, and healthcare professional organizations (Young, 2001). These interventions often focus on community rather than individual responses to diabetes preventive activities. A good example is the program among the Sandy Lake Cree that focused on collective responsibility for the burden of diabetes in their community (Gittelsohn et al., 1995, 1996; Hanley, Harris, Gittelsohn, & Andres, 1995).

A public health campaign of educating tribal members on low-fat diets, cigarette smoking, and exercise was developed by a Mohawk community (Hood, Kelly, Martinez, Shuman, & Secer-Walker, 1987). An important and successful school and community-based project was initiated among the Zuni Indians of New Mexico (Cole et al., 2001; Teufel & Ritenbaugh, 1998). The Zuni Diabetes Prevention Program eliminated soft drinks and snack foods from school vending machines, provided good-tasting water, promoted a school-based wellness and exercise program, and developed supportive social networks. These interventions resulted in increased activity, decreased soft drink consumption, and a decrease in the incidence of hyperglycemia.

A unique curriculum has been adapted and implemented in Pueblo communities (Carter, Gilliland, & Perez, 1997; Gohdes, Rith-Najarian, & Acton, 1996; Teufel & Ritenbaugh, 1998). Most Indian Health Service prevention and treatment programs involve dietary advice, food preparation techniques, and exercise (Broussard, 1991; Indian Health Service, 1990). Culturally targeted educational materials on gestational diabetes have been developed (Rhoades, 2000). Hagey's (1984) innovative pedagogical approach used Native American metaphors in a diabetes prevention narrative incorporated into traditional story-telling for urban Canadian Indians.

However, for most tribes, prevention education, monitoring, and cultural appropriate counseling are lacking or very limited (Carson-Henderson, 2002; Rhoades, 2000). Additionally, a lack of resources and rapid staff turnover confound the problems of education, follow-up, and long-term care. Loewe et al. (1999) add another dimension, namely the fatalism and pessimism on the part of physicians and other healthcare providers for diabetic patients to engage in successful self-management of their illness.

Native American health issues are further complicated by the enormous heterogeneity within and between tribes. There are 554 federally recognized Indian tribes in the United States. Materials developed for one patient population are not easily transferable to others. Carson-Henderson (2002) warns against trait listing of specific characteristics of tribes and the use of trait lists in over-generalizing homogeneity resulting in inappropriate programs and educational materials.

The ADA's Diabetes Assistance and Resource (DAR) Program is an innovative project designed to provide education and motivation to Latinos by working with government agencies and Latino community-based organizations. Recognizing that women are the gatekeepers of a family's health and welfare in Latino communities, the DAR Program developed a successful community-based outreach activity called "Diabetes Home Health Parties" where peer educators, Diabetes Lay Counselors, or Consejeras De Diabetes are trained (Davidson et al. 1994). The ADA has been active in developing educational materials and programs that target U.S. ethnic groups (www.diabetes.org).

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Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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