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

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

My Diabetes - My Way The lack of self-care in Latinos/Mexicans with Type II Diabetes

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 be overwhelming for the patient

 Meal planning habits  Activity routines  Changes in lifestyle  Insulin/shots regimen  Daily medication  And life long duration of glucose testing

Adherence rate for oral medication is 50% Adherence rate for lifestyle intervention recommendations is even lower.

Diabetes imposes a substantial burden on the economy of the United States

Total Cost of diagnosis $245 billion, including: $176 billion in direct medical costs $69 billion in reduced productivity Largest Medical expenditures: 43% Hospital inpatient care 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)



One in five have income below the poverty level. (poverty related to low education and lack of money for medication)



Low literacy and low numeracy (hard to understand knowledge and apply skills)



Asymptomatic – patient feels fine with an uncontrolled diabetes - Lack of perceived cues



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)

No adherence is associated with:

Increase in A1C (glucose level) Increase in LDL –bad cholesterol Increase in all cases of hospitalizations Increase in all cases of mortalities.

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 Increase perceived threat 2) First interaction with patient Decrease perceived barriers 3) In class and/or individual appointment Increase self-care abilities General audience All ages All medical vehicles including: Church bulletins, announcements in church and word

• f mouth

Bi-weekly diabetes radio show Communication with providers: Providers need to tell the patient that diabetes education and self-management is part of the diabetes

• treatment. Providers need to encourage patient

to attend diabetes classes and consultation. If patient declines classes offered: Individual consultation Invite them to the support group Encourage them to listen to the diabetes radio show Refer to the free clinic Refer to the health fair Persuade Increase perceived threat Connect with Dial a Ride Provide childcare Offer healthy snacks in classes Invite family members to come Provide short classes Communicate the plan with the provider

Perform a short self-care assessment/pre- evaluation based on HBM components . Vividly explain complications of diabetes as a silent killer (perceived threat). Explain the benefits of acquiring diabetes self- management behavior (perceived benefits). Help the patient believe that adopting the behavior is very easy. (perceived barriers). Teach problem solving & make short, realistic action plans (Self-efficacy). Celebrate, find ways to keep them motivated (perceived cues)

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)

Diabetes Education Campaign Increase perceived threat Patient first interaction Decrease barriers. Classes, individual consultation, support groups. Purpose: Gain self-care abilities, Increase self-efficacy, Keep them motivated-perceived cues Happy, healthy and proactive 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