Beyond the brochure: Collaborating with adult education for diabetes prevention

Background: A growing body of evidence indicates that limited-English-proficient adults are more likely to experience poor health, inadequate quality of care, higher chronic disease rates, and excess health care costs compared to adults with higher proficiency. The confluence of poor health and limited literacy/English levels suggests an opportunity for public health professionals to collaborate with adult education programs and make positive change in both areas simultaneously. Objectives: The California English-as-a-Second-Language (ESL) Diabetes Prevention Project seeks to leverage the teaching skills of ESL instructors and intrinsic motivation of adult students to incorporate diabetes prevention messages into their classroom instruction. Methods: A Task Force of public health practitioners and ESL instructors was convened by the California Diabetes Program to develop ESL lessons about diabetes prevention. Lessons were implemented by 5 ESL teachers at City College of San Francisco in Fall 2011. Approximately 150 students with varied English proficiency levels, native languages, and educational goals participated in the lessons, which included content on healthy eating, physical activity, and diabetes prevention. Results: Students learned about their personal diabetes risk status and ways to prevent diabetes. Many expressed future intentions to prevent diabetes. Other students had healthy habits reinforced through discussions about health with peers. Most ESL teachers would include diabetes prevention lessons in future classes. The California Diabetes Program learned how to better collaborate with adult education by understanding the challenges of multi-level instruction, the need to simplify health promotion messages, and the benefits of a flexible evaluation plan with multiple measures of change.