Reversing Trends of Type 2 Diabetes Risks in Rural Appalachia

Sharon A. Denham, DSN, RN Professor Emeritus, Ohio University School of Nursing

Acknowledgements
Centers for Disease Control & Prevention (grants #1H76DP002306-01; #5H75DP002306-02; #1U58DP002785-01 National Diabetes Education Program Ohio University Voinovich School (Dr. Lesli Johnson, Laura Milazzo) Center for Appalachian Philanthropy Coalition and community people

Objectives

Provide an overview of the Appalachian region and its risks for type 2 diabetes Describe briefly a program of study & practice to prevent type 2 diabetes Explain promising solutions to address a problem of epidemic proportions

My Family Microsystem

Appalachia

Appalachian Regional Commission

Low income High poverty

Limited education
Poor living standards Job deficits High unemployment Out-migration Stagnation Decline

National Obesity (2008)

Diabetes (2008)

The Diabetes Belt

Diabetes: A Global Problem

Over 346 million people worldwide

25.8 million in USA

79 million pre-diabetes in USA (35% of adults over 20 years have it; 50% of those over 65 years; only 7% know) Cost $174 billion (2007)/$245 billion (2012) = 41% increase Leading cause of serious complications Average cost per hospital stay = $18,000

Strengths of Appalachia

Strong close knit families Long lived friendships

Well-connected communities
Can get things done

Families, PLace & Faith

Type 2 Diabetes
Common and prevalence underestimated

Inadequate education at time of diagnosis (do not know where to get help) Diabetes knowledge lacking Lack confidence in abilities to change Slow to seek medical help & question the value Lack support, healthy environments, & policy Hard to combat local sabotage

Family Health Model

(Denham, 2003)

Ecological perspective Contextual domain Functional domain Structural domain

Family Health Routines

Self-care Safety and precautions Mental health behaviors Family care Illness care Member care-taking

Core Functional Processes

Caregiving

Cathexis
Celebration Change

Communication
Connectedness Coordination

Formative Research
Diabetes Care: Provider Disparities in the Appalachian Region (Denham, Wood, & Remsberg, 2010) Diabetes Education in the Appalachian Region: Providers' Views (Denham, Remsberg, & Wood, 2010) Spirituality: Considering Relationships with Health and Illness on those in Appalachia (Diddle & Denham, 2010) The Storied Nature of Health Legacies in the Familial Experience of Type 2 Diabetes (Manoogian, Harter & Denham, 2010) Family Inclusion in Diabetes Education (Denham, Ware, Raffle, & Leach, 2011).

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: A Family Matter

Provide culturally sensitive information about healthy lifestyles and preventing type 2 diabetes & complications to persons living in rural Appalachian communities. Sensitively targeted toolkit focused on diabetes prevention and care management from a family and community point-of-view.

Applicable to other chronic diseases

Health professionals can use the toolkit to enlist local volunteers and help community individuals and families. Specifically geared for use in rural places of Appalachia with focus on health literacy

www.diabetesfamily.net

Citizen Action
Provide tools to have ownership (do for vs. do with)
Empower local people Acknowledge local needs & perspectives

Use community coalitions

SUGAR Helpers (Support to Unite Generations in the Appalachian Region

States: Kentucky, Ohio, Mississippi, and Virginia

5 year, $2.5 million CDC project, 11 distressed counties www.diabetesappalachia.net

Goals
Strengthen coalitions

Map assets & create local strategic plans

Strategically address prevention of type 2 diabetes & complications Create sustainable actions to reduce diabetes complications

Focus of the Project

Build knowledge Change behaviors

Create healthier environments

Develop policy

Products
Toolkit Materials Living with Diabetes (film) Tobaccolachia (film) Regional Films (3)

Mountains of Trouble (film)

Healthy for GOoD (music CD)

County Coalitions
STP Different than textbook Partner with lead agencies Small, but powerful groups Receive $5,000 grants/county liaison Town Hall Meetings Diabetes education

Promising Solutions
Healthy for GOoD

Kids Bucks Program

Fun in the Golden Years Dining with Diabetes Walking paths Cooking Programs Turtle Challenge

Healthy for GOoD

(Starts in Families)
Coalitions connect with churches Church health teams Training sessions twice a year Family focused Mini-grants $225 Community Gardens Exercise groups Healthy cooking/meals

Turtle Challenge
8 week physical activity program 150 minutes a week (per person) 5 person teams (provide support & encouragement) Champions for rural communities

What Are the Solutions?

Build strong leadership through mentoring Build on community strengths Change is slow - small steps needed Family, place, & faith Strengthen local leadership Stuck in the Story - need to Re-story

I am the Solution

IN IT FOR THE

LONG HAUL

Contact Information

Sharon A. Denham denham@ohio.edu