L I L Y G O N Z A L E Z M P H - P R I N C I P L E S O F H E A L T - PowerPoint PPT Presentation

My Diabetes - My Way The lack of self-care in Latinos/Mexicans with Type II Diabetes L I L Y G O N Z A L E Z M P H - P R I N C I P L E S O F H E A L T H B E H A V I O R C O N C O R D I A U N I V E R S I T Y F E B R U A R Y 2 5 , 2 0 1 6

The lack of self-care in Latinos/Mexicans with type II Diabetes Behavior Lack of interest in self-management education and lack of self-care Target population Latino/Mexican population from the Diabetes and Wellness program at Yakima Valley Memorial Hospital Applied Theory The Health Believe Model

Diabetes self-care and self- management falls on the patient’s self-commitment Diabetes self-management tasks can Diabetes imposes a substantial be overwhelming for the patient burden on the economy of the United States  Meal planning habits Total Cost of diagnosis  Activity routines $245 billion, including:  Changes in lifestyle  Insulin/shots regimen $176 billion in direct medical costs  Daily medication $69 billion in reduced productivity  And life long duration of glucose testing Largest Medical expenditures: Adherence rate for oral medication is 50% 43% Hospital inpatient care Adherence rate for lifestyle intervention recommendations is even lower. 18% Prescription medication to treat diabetes complications

Why aren’t patients taking care of themselves? Barriers to adherence – results from studies Lack of health insurance links to inconsistent use of medication. • Particular beliefs about illness link to poor medication adherence, ie . “I believe that have diabetes only when my sugar is high and • I do not need to take medication when sugar is normal.” The more schooling/education of the patient, the better self-care • Better self-care in Catholics. • Better self- care in women than in men. • Better self-care abilities in 70 and 80 year olds. • Worse self-care if longer time with diabetes. • Increasing of perceived threat (susceptibility and severity) link with an increase in self care. • Reduction of perceived barriers link with better self-care behaviors . • Younger patients with higher education and greater awareness have better self-care behavior and self-efficacy. •

Barriers to self-care In the Latinos of Yakima Lack of health insurance (consistent with other studies)  No adherence is associated with: One in five have income below the poverty level. (poverty  related to low education and lack of money for medication) Increase in A1C (glucose level) Low literacy and low numeracy (hard to understand  knowledge and apply skills) Increase in LDL – bad cholesterol Asymptomatic – patient feels fine with an uncontrolled  Increase in all cases of hospitalizations diabetes - Lack of perceived cues Increase in all cases of mortalities. Yakima is composed of primary rural communities and is  home to over 75,000 migrant and seasonal farm working families. (Living far away from the city makes it more difficult to participate in classes – no transportation – can’t attend classes or appointments) Almost 50% half of the population are of Hispanic origin.  Monolingual - (Not enough bilingual, bicultural services)

The Health Belief Model (HBM) Helps to predict adherence to medical recommendations The HBM stated that adherence to medical treatment will increase if:  The individual believes he is susceptible to the disease (perceived susceptibility)  They believe the disease has serious consequences (perceived severity)  They believe benefits of the behaviors are feasible and effective (perceived benefits)  They believe barriers are few and easy to overcome (perceived barriers)  They believe they are capable of performing the behavior (perceived self-efficacy)  They respond to cues that motivate action-presence of symptoms (cues to action)

Community Intervention Cambiando La Diabetes - Changing Diabetes Overarching Goals : Increase class attendance and decrease A1C levels 1) Educational campaign 2) First interaction with patient 3) In class and/or individual Increase perceived threat Decrease perceived barriers appointment Increase self-care abilities Perform a short self-care assessment/pre- General audience If patient declines classes offered: evaluation based on HBM components . All ages Individual consultation All medical vehicles including: Church Invite them to the support group Vividly explain complications of diabetes as a bulletins, announcements in church and word Encourage them to listen to the diabetes silent killer (perceived threat). of mouth radio show Refer to the free clinic Explain the benefits of acquiring diabetes self- Bi-weekly diabetes radio show Refer to the health fair management behavior (perceived benefits). Communication with providers: Providers need Persuade Help the patient believe that adopting the to tell the patient that diabetes education and Increase perceived threat behavior is very easy. (perceived barriers). self-management is part of the diabetes Connect with Dial a Ride treatment. Providers need to encourage patient Provide childcare Teach problem solving & make short, realistic to attend diabetes classes and consultation. Offer healthy snacks in classes action plans (Self-efficacy). Invite family members to come Celebrate, find ways to keep them motivated Provide short classes (perceived cues) Communicate the plan with the provider

Cambiando la Diabetes / Changing Diabetes (You can listen the announcement by clicking with your mouse the MP3 square. See translation in the note page please) Classes, individual consultation, Patient first interaction support groups. Decrease barriers. Purpose: Gain self-care abilities, Increase self-efficacy, Keep them motivated-perceived cues Diabetes Education Campaign Happy, healthy and proactive Increase perceived threat patients, self-sufficient and self-confident, capable of taking care of their diabetes successfully!!

Conclusion Through my Community intervention I aim to increase awareness about the seriousness of diabetes if it remains uncontrolled. At the same time, I will move the patient to the next level of change. Changing Diabetes will provide the support the patient needs in order to become a better self-manager. This program is linguistically and culturally sensitive to the needs of the Latino families of the Yakima Valley and is based on human theory.

References Parada, H., Horton, L. A., Cherrington, A., Ibarra, L., and Ayala G. The Diabetes Educator. Correlates of Medication No adherence Among Latinos with Type 2 Diabetes. (2012). 30 (4) 552-561. Retrieved from: http://tde.sagepub.com/content/38/4/552.full.pdf+html U.S Department of Health and Human Services Office of Minority Health. (2014). Diabetes and Hispanics Americans. Retrieved from: http://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlID=63 Brown, S. A., Dougherty, J.R., Garcia, A. A., Kouzekanani, K., & Hanis, C. L. American Diabetes Association (ADA). Diabetes Care. Culturally Competent Diabetes Self-Management Education for Mexican Americans. (2002). 25 (2) 259-268. The Diabetes Educator. (1985). The Health Belief Model Applied to Understanding Diabetes Regimen Compliance. Retrieved from: http://tde.sagepub.com/content/11/1/41.full.pdf+html Baquedano, I., Dos Santos, M. A., Martins, T. A., & Zanetti, M. L. Revista Latino – Americana de Enfermagem. (2110). Self Care of Patients with Diabetes Mellitus Cared for at an Emergency Service in Mexico. retrieved from: http://www.scielo.br/scielo.php?pid=S0104-11692010000600021&script=sci_arttext Washington State Department of Health. (2013). Yakima County Chronic Disease Profile. (2013). Retrieved from: http://c.ymcdn.com/sites/www.wacmhc.org/resource/resmgr/Data_County_Info/YakimaChronicDiseaseProfile.pdf DiClemente , R., Salazar, L., & Crosby, R. (2013). Health Behaviors of the “New “Public Health. Health Behavior Theory for Public Health: Principles, foundations and applications. (pp. 3-26). Burlington, MA. Jones and Bartlett Learning. U.S Department of Health and Human Services. National Cancer Institute. (2005). Theory at a Glance A Guide for Health Promotion Practice. Washingtron State Department of Health. (2013).Yakima County Chronic Disease Profile. Retrieved from: fhttp://c.ymcdn.com/sites/www.wacmhc.org/resource/resmgr/Data_County_Info/YakimaChronicDiseaseProfile.pd American Association of Diabetes Educators. (2015). Diabetes and Physical Activity. Retrieved from https://www.diabeteseducator.org/docs/default-source/practice/practice-resources/synopsis/diabetes-and-physical-activity.pdf?sfvrsn=0 Health grades for hospitals (2013). Retrieved from https://www.hospitals.healthgrades.com/CPM/index.cfm/resources/webinars/the-challenge-of-implementing-a-diabetes-prevention-and-management- program/?mkt_tok=3RkMMJWWfF9wsRomrfCcI63Em2iQPJWpsrB0B%2FDC18kX3RUpK7uffkz6htBZF5s8TM3DVVRHXqdR7kELS7U%3D