Using the Handbook for Assessing Social Change in Health to document how systems changes have reduced diabetes disparities

In Charleston and Georgetown counties, South Carolina, over 13,000 African Americans have diabetes and high prevalence of diabetes-related complications. Since 1999, the REACH Charleston and Georgetown Diabetes Coalition (CGDC) has worked to help people better manage their diabetes, help health care providers give better diabetes care, and build community support to sustain these efforts. Systems-focused actions include a diverse partnership, patient assistance programs for low-cost supplies, self-management training, nursing academies to assist minority students enter health careers, data entry for registries, health professional continuing education, and enhanced library resources. GCDC performed a 5-year retrospective assessment of change using the Handbook for Assessing Social Change in Health with guidance from the Handbook author. We used worksheets to analyze archived materials, conduct interviews, and produce community descriptions at pre and post. We created a comprehensive 5-year timeline of targeted actions and multi-level changes. In our timeline worksheet, we assessed whether system-level changes contributed to improved health outcomes measured through cross-sectional surveys. Our analysis demonstrates targeted actions contributed greatly to improvements in multiple systems: health systems (increased access to health care, activated health care providers, improved quality of care and quality improvement systems, diabetes education), local coalitions (501c3 status, fundraising), university (recruitment of minority students, workforce diversity, cultural competency), and public libraries (quality resources, librarian outreach, added grant support). These system-level changes contributed to better adherence to American Diabetes Association guidelines for self-management and care. System-level change supported by community change can decrease modifiable risks, improve health, and reduce diabetes disparities.