Using the Handbook for Assessing Social Change in Health to document how community-level improvements have reduced diabetes disparities

In Charleston and Georgetown counties, South Carolina, over 13,000 African Americans have diabetes and high prevalence of diabetes-related amputations, hypertension, and stroke. Since 1999, the REACH Charleston and Georgetown Diabetes Coalition (CGDC) – a community-campus partnership – has implemented culturally tailored targeted actions to improve community conditions, systems, and influence change agents. Community-focused actions include community mobilization with local activists and organizations, media advocacy, health fairs, diabetes awareness classes, support groups, computer training, and distribution of our “My Guide to Sugar Diabetes” booklet. Over 10 months, GCDC performed a 5-year retrospective assessment of change using the Handbook for Assessing Social Change in Health. GCDC formed an Assessment Working Group (AWG) and received guidance from the Handbook author in periodic teleconferences. Our AWG assessed change in the rural community of Northwest Georgetown. AWG members used Handbook worksheets to analyze archived materials, perform semi-structured interviews, and produce descriptions of the community at pre and post. We used the Handbook template to produce a 5-year timeline of targeted actions and changes at multiple levels. In our timeline worksheet, we assessed whether community-level changes contributed to improved health outcomes measured through cross-sectional surveys. Our targeted actions contributed substantially to community-level improvements: community-wide attitudes (reduced stigmatization, increased health awareness, activated patients), skills (coalition building, diabetes self-management), and activities (building a “one-stop-shop” health center, walking groups, healthier eating). These community-level changes contributed to a ~50% reduction in amputations. Community-level change supported by systems change can decrease modifiable risks, improve health, and reduce diabetes disparities.