Minority adults are at a disproportionate risk for developing type 2 diabetes, a challenging illness to manage that is a
leading cause of morbidity and mortality in the U.S. Evidence indicates that lifestyle change programs, which incorporate healthy eating, physical activity and modest weight loss, can prevent or delay the development of type 2 diabetes. Yet, access to diabetes prevention programs is limited, particularly among minority and low-income adults.
To help address the issues with access to diabetes prevention programs, we designed a study to link existing community resources—public housing communities and a homecare agency— to minority and low-income adults at-risk for type 2 diabetes. Public housing communities provide housing at reduced rental costs for families of low socioeconomic status. We chose this setting because these communities often have the space and personnel to support a community-based program. The homecare agency consists of nurses who monitor and implement healthcare in a home environment, and are trusted health professionals in public housing communities.
We worked collaboratively with homecare nurses and residents of public housing to modify a diabetes prevention program to meet the needs of the community (e.g., low health literacy, family focused, culturally relevant, limited resources). We then evaluated the effect of a six-month diabetes prevention program provided by homecare nurses compared to a one-month enhanced standard care condition. Community health workers assisted nurses in the delivery of the programs.
The 67 participants were primarily female (79%), racial and ethnic minorities (76% non-white), had a high school education (72%), were unemployed (73%), unpartnered (83%), with an average age of 40 years, and an average of three children. Approximately half of the sample had elevated depressive symptoms (51%). Thus, our program reached adults with multiple health risks.
Homecare nurses were able to implement the program as intended; however, attendance at classes was sub-optimal, particularly with the six-month program. We did not see any difference between groups on any health outcomes, possibly because both groups received a similar program. What was promising was that there were significant improvements in health behaviors in both groups. Participants increased fruit and vegetable intake, low-fat eating, meal planning and improved nutrition behavior and physical activity. Participants decreased sugar drink intake, unhealthy snacking and triglycerides. They also reported improved stress management and decreased depressive symptoms. We did not see significant changes in BMI, glucose, cholesterol or blood pressure.
These findings suggest that brief diabetes prevention programs can dramatically improve the health behaviors of a high-risk, vulnerable population. Collaborating with a homecare agency and key stakeholders, and providing the program by homecare nurses was highly acceptable to nurses and participants, and offers a feasible and potentially sustainable way to improve access to diabetes prevention programs. Future dissemination and evaluation of health promotion programs for residents of public housing communities are urgently needed.
This study was funded by the Robert Wood Johnson Foundation .
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