Stti_translating Diabetes Evidence Into A Targeted Culturally Sensitive

Translating Diabetes Evidence into a Targeted Culturally Sensitive Toolkit

SHARON A. DENHAM, DSN, RN PROFESSOR, OHIO UNIVERSITY SCHOOL OF NURSING

Project Support Center for Diabetes Control & Prevention (National Diabetes Education Program) (2005-2008) Ohio Department of Health Diabetes Prevention and Control Program Ohio University’s Appalachian Rural Health Institute (ARHI) Ohio University, Diabetes Research Initiative (DRI). Ohio University’s Office of Research and Sponsored Projects Challenge Grants

Translating Research to Practice

Scholarly inquiry Theoretical perspectives Research, research, research = empirical

knowledge Translating evidence into practice Nursing practice

Denham: Family Health Studies (3) Families with pre-school children Economically disadvantaged families’

with young children Intergenerational responses to family

health during bereavement and loss

Family Health: A Framework for Nursing (Denham, 2003)

Health

Health experienced when a person can

fulfill personal goals, enjoy life, & live up to their capacity. Health is primarily influenced by family

member interactions over time.

Family Health The complex systems, interactions, relationships,

and processes with potential to maximize individual and family well-being. Dynamic interactions and complex processes

within a household context.

Family plays more important roles than

occasional medical encounters.

Ecological Perspective of Family Environment is like a set of nesting dolls. Environments & persons have relationships that

influence one another. Environments & persons affect one another even when persons are not present. Environment has a unique organization or schema that can be investigated & understood. Environments are dynamic, interactive & change over time. (Bronfenbrenner, 1979, 1986)

Family Health Model (Denham, 2003)

 Contextual domain  Functional domain  Structural domain

Type 2 Diabetes Approximately 95% of cases Doubled from 5.6 to 15.8 million in 20 years 23.6 million Americans (7.8% of population) Global concerns Family focus has primarily been on type 1 diabetes Mostly urban focused attention Need for culturally sensitive educational materials

Appalachia

Appalachian Sub-Culture Kind and outgoing Openhearted and helpful Independent and proud Family values Strongly tied to place Spiritual beliefs or faith in God Strong moral values A sense of community Commitment and dedication to work Mutual respect Hospitality

Ohio University Appalachian Rural Health Institute Studies of southeast Ohio Diabetes rates as high as other national

minority groups (11.3%) Obesity epidemic

Formative Research Findings Environmental Scan of Appalachia (Winter, 2006) * Health Professionals and Diabetes Indicators * Diabetes Education * Diabetes Print Media

Qualitative Studies (2007)

* Living with Diabetes in the Appalachian Region

Qualitative Studies: Type 2 Diabetes & Family Family Routines Study (13 dyads/26 interviews, 3

focus groups, survey data) Caring for Diabetes: A Family-Based Educational Intervention for Patients with Type 2 Diabetes Living with Diabetes: Photographic Inquiry Living with Diabetes: (14 dyads = 42 interviews) Development of a Dietary Routines Survey

Diabetes: Cultural Perspectives Strong family ties (family disease) Gain information from family & friends Family input before decision-making Narratives and story-telling “Stuck in the Story” Lack of health professionals

Diabetes Educators May lack knowledge & skills about families. May not know ways to educate multiple family

members. May include family members. May have few tools for ‘intentional’ family focus.

Diabetes Self-Management Family knowledge about diabetes often limited. Family health routines (support and sabotage). Family and individual skills, motivation, resources,

etc. over time.

Dedication to Kimberly Malone

Aims of the Diabetes Program & Toolkit Healthy lifestyles, diabetes prevention, & diabetes

self-management Type 2 diabetes (primarily) Rural focus Citizen Action in Appalachian communities

The Storied Lives of Diabetes Lived experiences versus biomedical accounts. Narrative competence and clinical care. Diabetes as a Family Disease: More than individual

problem (extended kin networks, place, faith, etc.). Health legacies. Need to reconstruct stories.

Community Perspectives

Ecological context Diversity Geography Multiple interacting sectors More than traditional ideas of health care

Material Development Low literacy and Health Literacy Cultural identification (avoid stereotypes) Empowerment Living with diabetes

Material Development Novel approaches/innovative ideas Interdisciplinary input Web 2.0 availability Multiple types of audiences

Citizen Action

Give local people a voice. Collective actions to improve the quality of life of

community people. Cooperate to positively mobilize community resources to address local health concerns. Empowerment of local residents. Acknowledgement of local perspectives.

Citizen Action Train the trainer model Community coalitions SUGAR Helpers (Support to Unite Generations in

the Appalachian Region)

SUGAR Helpers SUPPORT to UNITE

GENERATIONS in the

APPALACHIAN REGION

SUGAR Helper Education

Diabetes Educators Manual Local recruitment Use SUGAR Helper Manual Educational program (six sessions/2 hours) Goals: Communication skills, knowledge, and networks

Materials Diabetes Educator Manual SUGAR Helper Manual Series of brochures Series of posters Fotonovellas Bookmarkers Film 3 Plays Recruitment materials Toolkit activities (family, group, & community)

Website

www.diabetesfamily.net Sharon A. Denham, DSN, RN Ohio University, School of Nursing E365 Grover Center Athens, Ohio 45701 740-593-4494 [email protected]