248513 Promotoras changing communities: Diabetes prevention and control

Monday, October 31, 2011

Kirk Smith, MD PhD , Department of Internal Medicine, UTMB, Galveston, TX
Belinda M. Reininger, DrPH , Division of Behavioral Sciences, School of Public Health, Brownsville, TX
Christine Arcari, PhD, MPH , Department of Preventive Medicine and Community Health, UTMB, Galveston, TX
Jennifer L. Gay, PhD , Divison of Behavioral Sciences, School of Public Health, Brownsville, TX
Lisa Mitchell-Bennett, MA , Brownsville Regional Campus, University of Texas - Houston School of Public Health, Brownsville, TX
Jacquelyn Siller , Project Manager, Catholic Charities of CC, Corpus Christi, TX
Martha Martinez, MSN RN CS , Clinic Director of Operations, Mercy Ministries of Laredo, Laredo, TX
Phylis Peters , Proyecto Juan Diego, Brownsville, TX
Objective: University of Texas Community Outreach (UTCO) is a community-based diabetes prevention and control program which utilizes promotoras (community health workers) to facilitate healthy lifestyles in Hispanic communities. Methods: Promotoras in four south Texas counties deliver education, nutrition, and physical activity classes for the community and disease self-management classes for diabetics. Cohort studies and a randomized intervention trial evaluate the health and economic impact of the program. Results: In year one, 26 promotoras guided 2,043 events comprising of 738 general diabetes education classes, 817 fitness activities, 313 nutrition classes and 170 self-management classes throughout the four counties. Among diabetics participating in promotora outreach programs, a community sample of 41 diabetics showed a 7.9% decrease in HbA1c (mean 8.9% vs. 8.2%, p<0.05) between baseline and 3-month follow-up and a clinic sample of 56 diabetics showed an 18.9% decrease in HbA1c (9.0% vs. 7.3%, p<0.01) between baseline and 3-month follow-up. In the clinic sample, diabetics with 6 to 15 months of follow-up maintained a mean HbA1c <7.0%. In the intervention trial, participants (n=1,132) who reported at least one contact with a promotora were 4.2 (95% CI 2.0-8.8) times more likely to meet physical activity guidelines of 150 minutes or more of weekly physical activity and 3.6 (95% CI 1.6-8.4) times more likely to eat fruit for dessert compared to participants who did not interact with a promotora controlling for age, gender, BMI and diabetic status. Conclusions: Initial results indicate a positive impact of the use of promotora outreach on diabetes prevention and control in Hispanic communities particularly for lifestyle changes. Further health impact results from the randomized intervention trial and cohort studies as well as the economic impact of the program will also be presented.

Learning Areas:
Assessment of individual and community needs for health education
Chronic disease management and prevention
Conduct evaluation related to programs, research, and other areas of practice
Implementation of health education strategies, interventions and programs

Learning Objectives:
1. Describe the UTCO model to deliver high-impact, low-cost community-based diabetes prevention and control. 2. Assess the effectiveness of the promotora on diabetes prevention and control.

Keywords: Community-Based Health Promotion, Hispanic

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present as I am the Director of Evaluation for this project.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.