Biery, Nyann, MS

Coyne, Cathy, PhD

Letcher, Abby, MD

Maldonado, Edgar, MD

Motley, Robert, MD

Rodriguez, Francigna, BS

English

Letcher, Abby S, MD

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of MedicineDiabetes Mellitus Self-management: Comparisonof Curricula Using a PromotoraFrancigna Rodriguez BSLehigh Valley Health NetworkNyann Biery MSLehigh Valley Health Network, nyann.biery@lvhn.orgCathy Coyne PhDLehigh Valley Health Network, Cathy_A.Coyne@lvhn.orgRobert Motley MDLehigh Valley Health Network, Robert_J.Motley@lvhn.orgEdgar Maldonado MDLehigh Valley Health Network, Edgardo.Maldonado@lvhn.orgSee next page for additional authorsFollow this and additional works at: http://scholarlyworks.lvhn.org/medicinePart of the Medical Sciences CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtRodriguez, F., Biery, N., Coyne, C., Motley, R., Maldonado, E., & Letcher, A. (2010). Diabetes Mellitus Self-management:Comparison of Curricula Using a Promotora. LVHN Scholarly Works. Retrieved from http://scholarlyworks.lvhn.org/medicine/72AuthorsFrancigna Rodriguez BS, Nyann Biery MS, Cathy Coyne PhD, Robert Motley MD, Edgar Maldonado MD,and Abby Letcher MDThis poster is available at LVHN Scholarly Works: http://scholarlyworks.lvhn.org/medicine/72Purpose•  Compare 2 diabetes self-management education programs used with a Latino population in Allentown, Pennsylvania•  Describe the roles of a Promotora (a.k.a. Community Health Worker, lay health educator) in diabetes self-management educationBackground•  Previous work shows increased patient activation with use of Promotora•  Disparity among Latinos and other ethnic groups in relation to diabetes and diabetes-related complications •  Need for culturally congruent diabetes management education for Spanish-speaking patientsDiabetes Education Programs•  3 Family Medicine Outpatient Practices  1 residency-based, 2 CHC’s   all promotora-led  weekly program (6 weeks)•  2 Internal Medicine Outpatient Practices  1 Spanish language clinic; clinical team-led education, with physician participation and promotora support  1 residency-based, promotora-led education  monthly program (12 months)•  Both programs based on ADA guidelines and follow a sequential formatQualitative Methods•  Focus groups   6, 12, and 18 month follow-ups•  Observation notes   Promotora roles and interactions   Class format and delivery •  Communications    E-mails   MeetingsQuantitative Methods•  Participants surveyed at    beginning of program    graduation    6, 12, and 18 months after graduation•  Clinical data for each participant:   Intermediate diabetes markers (e.g HgbA1C)   self-management (foot exam, etc.)   Collected at beginning of program and every 3-4 months followingDiabetes Mellitus Self-management: Comparison of Curricula Using a Promotora Francigna Rodriguez, B.S., Nyann Biery, M.S., Cathy Coyne, Ph.D, Robert Motley, M.D., Edgar Maldonado, M.D., Abby Letcher, M.D.L E H I G H  V A L L E Y  H E A L T H  N E T W O R K1st Year Learnings•  Diffi culties   transportation   health problems   social barriers•  One approach does not fi t all   Promotora    patient relationship   portable resource   fl exibility across clinical care sites •  Support Group resources available at one site•  Development of partnership with community-based organization •  Participant desire to “pay it forward”Limitations•  High withdrawal rate•  Each site delivered only one of the 2 curricula•  Timing of classes (variable access) •  Promotora Attrition (one of 2 resigned)Future Research•  Completion of 2nd year of the study to be completed in 2011•  Partnerships between healthcare organizations and community-based organizations•  Cost analyses   ROI   Sustainability •  Self-suffi ciency of support group FM Residency & CHC’s Promotora-ledIM Residency Promotora-led IM Practice Clinical Team-ledDemographics% Male 61.9 37.8 25.9Average Age 50.6 55.6 56.6% Medical Assistance 36.5 68.9 96.3% Uninsured 55.6 22.2 3.7% Income Below $20,000 39.7 53.3 44.4% Income Above $20,000 3.2 8.9 -% on Disability% Refused Income QuestionRecruitment # Enrolled 62 47 26# Completed 46 23 14Clinical DataAverage HgbA1C 9.0 8.8 7.8Average BMI 32.7 34.2 37.1Class CharacteristicsPreliminary Data Prevalence of  Depressive Symptomsusing PHQ-9FM Residency & CHC’s Promotora-ledIM Residency Promotora-ledIM Practice Clinical Team-led% PHQ-9 %  Majorly Depressed – Baseline 14.3 26.7 40.7% PHQ-9 %  Minorly Depressed – Baseline - 2.2 7.4% Completed Class 74.2 48.9 53.8% PHQ-9 %  Majorly Depressed –    Post Class 7.9 - -% PHQ-9 %  Minorly Depressed –    Post Class - - -

Diabetes Mellitus Self-management: Comparison of Curricula Using a Promotora

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Diabetes Mellitus Self-management: Comparison of Curricula Using a Promotora

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