Dawn Satterfield

The ''In-Between People'': Participation of Community Health Representatives in Diabetes Prevention and Care in American Indian and Alaska Native Communities

Respected members of American Indian and Alaska Native communities are a critical resource in helping communities mobilize efforts in diabetes prevention and care. Possessing cultural and historical knowledge and training in health promotion and social support, community health representatives (CHRs) are uniquely equipped to broker the needed relationship between a world shaped by culture and history and the world of conventional scientific knowledge. Grounded in principles of social support and interpersonal communication, as well as an understanding of their community’s strengths and history in health protection, CHRs are bridges distinctively positioned to connect these two worlds. With additional training and mentoring in diabetes care and prevention, CHRs, in their self-described roles as “in-between people,” can serve both as caring and knowledgeable community members and valuable members of the health care team.

Diabetes educators as cultural translators.

care providers in terms of race, sex, or socioeconomic status are likely to ask themselves three major questions when receiving diabetes care: Does this health care provider have goodwill toward me and have my best interests at heart’? Does this provider have the professiona) expertise to help resolve my particular health care problems? Does this health care professional understand my life experiences and those of others like rne’?’ Patients who perceive their provider to be an advocate, as well as competent and respectful, will view that provider as credible. Such relationships engender trust among people of different cultures. Health care professionals will have to be skilled and dedicated to cultivate such perceptions over time. For the purposes of this article, the term ’culture’ refers to individuals and groups with common origins, customs, and styles of living .2 While culture may not always play a crucial role in the treatment of emergencies and acute conditions, cultural dynamics shape the process and outcomes of interventions designed to promote self-care behaviors .3 Culture is especially relevant to the management of a chronic disease such as diabetes be-

Using the Essential Public Health Services as Strategic Leverage to Strengthen the Public Health Response to Diabetes

If current trends continue, health systems will soon be overwhelmed by type 2 diabetes mellitus. Successful population-based diabetes prevention and control efforts require a sound and continually improving infrastructure. In states and U.S. territories, the Diabetes Prevention and Control Programs supported by the U.S. Centers for Disease Control and Preventions Division of Diabetes Translation serve as a fulcrum for building and refining the infrastructure that links diverse and dynamic partners dedicated to increasing the years and quality of life and achieving health equity among people with and at risk for diabetes. The National Public Health Performance Standards offer a conceptual framework that articulates the requisite infrastructure and services provided by an interconnected network of intersectoral partners to strengthen the public health response to diabetes. These standards associated with the Essential Public Health Services are valuable tools to assess the status of the performance of the health systems infrastructure to guide improvement. The process of engaging system partners in a system-wide assessment informs and leverages cross-sectoral assets to improve health outcomes for citizens in communities shouldering the growing burden of diabetes.

Using Quantitative and Qualitative Methods to Pretest the Publication Take Charge of Your Diabetes: A Guide for Care:

Quantitative and qualitative methods used to pretest the guidebook Take Charge of Your Diabetes: A Guide for Care are presented in this paper. Questionnaires were used as the quantitative method (completed by 59 diabetes educators and 301 people with diabetes) and focus groups were used as the qualitative method (3 groups composed of 22 black men and women with diabetes) to examine the relevance, purpose, content, and presentation of the Guide. Findings from between-methods triangulation supported the relevance, clarity Of messages, identification of groups that would be most likely to benefit, readability, understandability, and credibility of the Guide. Specific areas that needed modification were identified. Each evaluation method provided unique data; for example, quantifiable data on intention to change behavior was provided from one method and a recommendation that diversity be maintained was provided from the other method, The relative strengths and limitations of combining quantitative and qualitative approaches are described.

Diabetes Control Programs: New Directions

The diabetes control programs (DCPs), which involve state and territorial health agencies working cooperatively with the Centers for Disease Control and Prevention, offer new opportunities for diabetes educators to expand their scope of practice into public health. The intervention activities of the 40 core-capacity DCPs that are proposed for the next fiscal year are summarized in this paper to provide insight into the new directions of the DCPs. These activities span a range of health-system and community-based approaches and are described by their potential impact on the audience. The interventions are aimed at a variety of intended audiences and partners, including minorities, individuals with diabetes, healthcare providers, and policymakers. As diabetes educators continue to expand their scope of practice, the DCPs offer opportunities to go beyond individual practice behaviors by participating in community development activities, disseminating practice guidelines, changing organizational practices, and advocating for health-related public policy and legislation.

Diabetes educators encourage safe needle practice.

Diabetes educators should lead individuals and communities in recommended needle-disposal practice, not only to promote safety but also to advocate the right of persons with diabetes to be disassociated from the fear of infectious disease prevalent in todays society.Two issues prominent in the late 1980s-the human immunodeficiency virus (HIV) and the environment-remain high on the US agenda for the 1990s. The media’s interest is seemingly insatiable and has prompted major concern and activism on the part of the public. While the public’s perception of danger from uncontained needles is disproportionate to the actual infection risk, patient education must take place to reduce the likelihood of accidental punctures and the resurfacing of medical waste. Diabetes educators should act as advocates and provide the necessary skills and education for individuals with diabetes, as well as for various communities, in the safe disposal of syringes and lancets. The American Association of Diabetes Educators (AADE) has addressed the prevention of blood-bome infections through patient education regarding diabetes self-care procedures. A copy of these guidelines appear on page 259 in this issue of The Diabetes Educator. This paper will describe current practice with respect to needle disposal, epidemiology of blood-bome diseases, and the promotion of safe practices through national recommendations and educa-

Health Promotion and Diabetes Prevention in American Indian and Alaska Native Communities — Traditional Foods Project, 2008-2014

Type 2 diabetes was probably uncommon in American Indian and Alaska Native (AI/AN) populations before the 1940s. During 2010-2012, AI/AN adults were approximately 2.1 times as likely to have diabetes diagnosed as non-Hispanic white adults. Although type 2 diabetes in youth is still uncommon, AI/AN youth (aged 15-19 years) experienced a 68% increase in diagnosed diabetes from 1994 to 2004. Health disparities are related to biological, environmental, sociological, and historical factors. This report highlights observations from the Traditional Foods Project (2008-2014) that illustrate tribally driven solutions, built on traditional ecological knowledge, to reclaim foods systems for health promotion and prevention of chronic illnesses, including diabetes.

Progress Toward Achieving Healthy People 2000 Objectives for Diabetes Patient Education: American Association of Diabetes Educators: The Role of Change Agents in Creating and Tracking Change

From the Department of Endocrinology, Diabetes and Metabolism (Ms Betschart), Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania; Division of Cancer Prevention and Control (Mr German), Division of Diabetes Translation (Ms Satterfield), National Center for Chronic Disease Prevention and Health Promotion, and the Data Monitoring and Analysis Branch (Mr Klein), National Center for Health Statistics, Centers for Disease Control and Prevention, Public Health Service, US Department of Health and Human Services, Atlanta, Georgia. Correspondence to Jean Betschart, MN, RN, CDE, Children’s Hospital of Pittsburgh, 3705 Fifth Avenue, Pittsburgh, PA 15213. Reprint requests to The Diabetes Educator, 367 West Chicago Avenue, Chicago, IL60610. At the 20th Annual Meeting of the American Association of Diabetes Educators (AADE) held in Atlanta, Georgia in 1993, members of a national multidisciplinary workgroup of the Healthy People 2000 effort discussed progress toward achieving one of the publication’s objectives, guiding public health efforts during this decade. Objective 17.14a, one of four objectives in the Healthy People 2000 document that specifically address diabetes, challenges the nation to increase to 75% (from a baseline estimate of 32%) the proportion of people with diabetes who receive formal diabetes education.’ This objective reflects national recognition of the value of diabetes ed-

U.S. Associated Pacific Islands Health Care Teams Chart a Course for Improved Health Systems: Implementation and Evaluation of a Non-communicable Disease Collaborative Model

Summary:The burden of non-communicable disease (NCD) is increasing in the U.S. Associated Pacific Islands (USAPI). We describe the implementation and evaluation of a NCD Collaborative pilot, using local trainers, as an evidence-based strategy to systematically strengthen NCD health care quality and outcomes, focusing on diabetes preventive care across five health systems in the region.