Spanish Diabetes Self-Management Program

Diabetes self-management education is increasingly recognized in best practice guidelines and reimbursement policies as a critical ingredient of appropriate health services, especially for the Latino population. Latinos, in addition to carrying a heavy burden of diabetes and related comorbid conditions, encounter limited access to health care and health education due to economic, language and cultural barriers. The proposed project is a health status and health care utilization outcome study. It is unique in that: 1) it will evaluate a low-cost replicable, community-based, diabetes education model, 2) it will study the long-term effects of a low-cost, easily replicable reinforcement system, ATDM calls, and 3) it targets Spanish-speakers, who are at high risk for type 2 diabetes, for diabetes-related complications, and who are under-served by existing programs.

The background for this study is derived from our long-standing programs of research on chronic disease self-management and automated telephone disease management (ATDM) as well as the research of others. This research has demonstrated that: 1) Self-management programs and ATDM programs can improve health-related quality of life, metabolic control, and health care utilization. 2) The effects of these programs on health-related quality of life and health care utilization are mediated partially by enhancement of perceived self-efficacy to cope with the consequences of chronic disease. 3) Self-management education has a potential for achieving substantial financial savings through decreased use of inpatient and outpatient health care.

Information about the outcomes of health self-management programs for Latinos is more fragmentary. However, analyses of our Spanish language Arthritis Self-Management Program and analysis of a pilot of our Spanish Diabetes Self-Management Program suggest that self-management programs can be extended successfully to Latinos. Work by Piette has demonstrated that 1) monolingual Spanish speakers can and will use automated telephone disease management (ATDM) calls as part of their care, 2) Latinos will use ATDM calls to access health education, and 3) ATDM-supported diabetes care can improve health-related quality of life, metabolic control and self-management behaviors.

BACKGROUND AND SIGNIFICANCE

Six factors contribute to the significance of the proposed research. These include 1) the growing population of Latinos in the United States, 2) the disproportional burden of diabetes in the Latino population, 3) the costs of diabetes care coupled with decreasing access to care for the uninsured and underinsured, 4) the lack of well developed and evaluated diabetes education interventions for Latinos, 5) growing evidence that psychosocial interventions for diabetes can impact both health status and health care costs, and 6) evidence that perceived self-efficacy is an important mediator of changes in health related quality of life.