Participant experiences during a household-level diabetes education program for rural Hispanics

Issues: Hispanics living in rural areas are at high risk for diabetes. Practitioners must design culturally-relevant interventions targeting diabetes prevention and self-management for this vulnerable population. This study describes participant experiences of a household-level, promotor-led intervention to increase social support, behavioral skills, and self-efficacy and improve diabetes-related behaviors and outcomes. Description: The Home Health Party (HHP) intervention used trained promotores to deliver household-level education sessions and distribute incentives to encourage behavior change. Forty open-ended, structured interviews were administered to a randomly selected sample of 430 intervention participants. Qualitative methods were used to code and analyze the interview transcripts. Lessons Learned: Participants considered the promotor to be a credible role model who imparted advice, demonstrated skills, and provided social support to help them achieve lifestyle changes. Incentives, such as pedometers, allowed participants to tangibly gauge their progress and provided instant gratification. Most participants articulated at least one detail about specific behavior changes they had made and several reported positive impacts on family-level behaviors. Further, respondents reported reduced HbA1C levels, weight loss, and improved well-being. Recommendations: This study highlights important considerations for the design of chronic disease interventions for rural Hispanic populations. Promotores are critical because they encourage behavior change by building relationships based on trust and cultural understanding. Well-designed tools that provide step by step examples of behaviors and aid participants to monitor behavior change improve confidence to achieve behavior change goals. Finally, targeting households is a promising strategy for creating a supportive environment for individual and family lifestyle changes.