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Community to Achieve Engagement Barbara Stetson Ph.D. Department of - - PowerPoint PPT Presentation
Community to Achieve Engagement Barbara Stetson Ph.D. Department of - - PowerPoint PPT Presentation
Working with Individuals, Family & Community to Achieve Engagement Barbara Stetson Ph.D. Department of Psychological & Brain Sciences Background & Application to Diabetes Professor of Psychological & Brain Sciences, Dir.
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Objectives
▪Learn about Ecological Approach to
Diabetes
▪Consider Barriers to Change Across
System Levels
▪Examples of Varied Needs &
Perspectives
▪Examples Successful Community
Programs With Impact Across Levels
▪Take Aways
Working with Individuals, Family & Community to Achieve Engagement
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Diabetes is part of a Complex, Multilayered System
▪ Diabetes self-management takes place in
homes, families, neighborhoods, workplaces, clinics, & community.
▪ People with diabetes are part of complex,
multilayered system; barriers in each layer & interaction may hinder lifestyle management.
▪ Responsibility shared among patients, families,
providers, communities, healthcare systems & payers.
▪ Diabetes prevention and risk reduction may be
viewed within this ecological perspective.
The Ecological Approach to Diabetes
Galiviz & Ali. Ch pp 463-476. In Rodriguez-Saldana (Ed.) 2019. The Diabetes Textbook. Clinical Principles, Patient Management and Public Health Issues. Springer, Cham
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Types and Levels
- f Health
Interventions
The Health Impact Pyramid
Frierden, Am J Public Health. 2010;100:590–595. Age, Gender, Resources, Beliefs, Affect, Social, Provider Communication, Empathy, Program Awareness Immunizations E.g. safe roads, clean water Education, poverty, relative deprivation, exposures
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Barriers to Prevention and Care Across the Continuum
UNDERSTANDING BARRIERS CAN HELP ENGAGEMENT & OUTCOMES
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Young Adults At- Risk for Diabetes
(1 (1st
stor 2nd nddegree
relative; sedentary)
Some Knowledge of Risk Factors Low fruit/vegetable Intake (1.27 /day) Minimal Preventive Care Regular Fast Food Intake (2+ /week) Overweight/Obese (60%)
Low Personal Perceived Risk
Objective and Perceived Diabetes Risks: Considerations for Engagement
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Sedentary Young Adults
Tech Bedtime Routine? Yes 87% Instagram, Tik Tok, SnapChat, YouTube Bedtime Social Media - 89% of days
Daily Routine and Social Influences: Considerations for Engagement
Stetson et al, Unpublished data
Use to Keep up Socially – 79.7% Perceived Stress Levels High
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Older adults with Type 2 diabetes, using insulin
PERCEIVED SOURCES OF DIABETES CARE SUPPORT
2 4 6 Health Providers * Work/Volunteer Neighborhood Personal Family & Friends Diet Support Organizations Media/Policy Age 65 and older Age 50-64
*All subscales positively associated with diabetes self-efficacy and diet adherence in those < age 65. Strongest associations for personal and neighborhood/community support scales. Only diet specific support associated with diet adherence in the older group.
Ward, J.E. et al. (2014). Presentation, Society of Behavioral Medicine Annual Meeting.
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Increase fresh fruits & vegs, wheat bread, lowfatmilk in low income areas
SAMPLE SUCCESSFUL COMMUNITY PROGRAM: CORNER STORES
▪ Assess 29 corner stores in 4 food deserts ▪ Proprietor interest ▪
Surrounding area residential or public housing, likelihood of foot traffic or walk to schools, child-care, churches.
▪ Process identified 5 stores with at least 1 store in each food desert.
3-TIERED CAMPAIGN – BASED ON STAKEHOLDERS KNOWLEDGE, ATTITUDES, EXPERIENCES
▪ Store Owners ▪ Neighbors ▪ Clergy ▪ Housing, Food, Social Service Organizations ▪ Community
Larson et al.. Prev Chronic Dis 2013;10:130008.
NEED FOR SUSTAINABILITY, INCREASE REACH
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Availability promotes engagement
▪ Farm stands paced outside of community sites in
low-income areas of Austin 1 x week increased fruit / vegs among people within walking distance1
▪ Low-income shoppers with diabetes in rural SC
increased fruit / vegs by 1.6 servings per day using incentive program at farmers market located at a health center2
▪ In LA farmers market shoppers, 55% felt the
market increased their community connection3
Sample Successful Community Programs: Farmer’s Markets
1Evans, et al, Health Place;2012, 18(5):1137-43 2fFreedman, et al, Preventive Med, 2013 May;56(5):288-92 3Farmer’s Market Coalition; McCarthy, 2019. Marketumbrella.org
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Take Aways
▪Influences Cut Across System Levels ▪Needs and Perspectives Vary Across
Populations
▪Successful Community Engagement
Considers Stakeholders
▪Interdisciplinary Approaches Maximize
Engagement & Impact
Working with Individuals, Family & Community to Achieve Engagement
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