COMMUNITY INTERVENTIONS:

TYPE 2 DIABETES RISK PREVENTION

Sharon A. Denham, PhD, RN, CNE

Interim, Associate Dean
Texas Woman’s University, Dallas Campus
 OBJECTIVES
• Identify risks for diabetes associated with residency in a rural
Appalachian county.

• Recognize the importance cultural context has on diabetes risks

and behavioral changes.

• Describe the ways community groups can provide supportive

networks for primary and secondary risks associated with type 2
diabetes.
 205,000 sq. miles
420 counties
25 million residents
42% rural
Lags behind nation
 PURPOSE:
PRESENT FINDINGS ABOUT COALITION ACTIVITIES TO
SUPPORT LIFESTYLE CHANGE BEHAVIORS FROM
PRIMARY AND SECONDARY PERSPECTIVES.
 DIABETES RISKS IN
APPALACHIA
• Physically unhealthy days, mentally unhealthy days, diabetes prevalence of depression, obesity, smoking,
and physical inactivity are all higher than national averages

• Appalachian residents report 14 percent more physically unhealthy days and mentally unhealthy days than
the nation as a whole

• Diabetes mortality rate is primary cause of death per 100,000 population per year - not always noted on
death certificate*

• Diabetes prevalence rate in the Region (11.9 percent) is slightly higher than the nation overall (9.8 percent)

Diabetes mortality rate in distressed Appalachia (30.9%) per 100,000 compared to non-distressed rate
(23.3%) per 100,000* *

Often diagnosed younger than persons in non-Appalachian counties

Many more with pre-diabetes & higher risks for childhood obesity

Lack of considering the disease as serious

High risks for secondary complications (e.g., vision loss, renalfor

* Centers failure, cardiac
Disease Controldisease)
and Prevention, Diabetes FastStats, 2016
* * National Center for Health Statistics (2018)
 FAMILY RESPONSES TO
DIABETES RISKS
• Ethnographic study of Appalachian families
found —- Members of Appalachian families
are inclined to view themselves as healthy as
long as they are not bedfast, can work or
manage usual daily life activities.

• View self as healthy even when obese,

hypertensive, sedentary, or have diabetes.*

• Need to view people within their cultural

context.

* Griffith, Lovett, Pyle, and Miller (2011)

 RISKS FOR MANY
APPALACHIANS
• People under 65 often have disabilities
• Limited access to healthy foods
• Multiple chronic conditions
• Physical and Mental Health Care needs
• Economic risks
• Underinsured
• Inadequate transportation
 Age-Adjusted Prevalence of Diagnosed Diabetes
Among US Adults
2000

Missing data <4.5%

4.5%–5.9% 6.0%–7.4%
7.5%–8.9% ≥9.0%

CDC’s Division of Diabetes Translation. United States Surveillance System available at

http://www.cdc.gov/diabetes/data
 Age-Adjusted Prevalence of Diagnosed Diabetes
Among US Adults
2010

Missing data <4.5%

4.5%–5.9% 6.0%–7.4%
7.5%–8.9% ≥9.0%

CDC’s Division of Diabetes Translation. United States Surveillance System available at

http://www.cdc.gov/diabetes/data
 Age-Adjusted Prevalence of Diagnosed Diabetes
Among US Adults
2015

Missing data <4.5%

4.5%–5.9% 6.0%–7.4%
7.5%–8.9% ≥9.0%

CDC’s Division of Diabetes Translation. United States Surveillance System available at

http://www.cdc.gov/diabetes/data
 DIABETES RISKS:
APPALACHIA
CDC identifies the diabetes belt = 644 counties

Higher risks of obesity, physical inactivity, lower

educational level, higher poverty rates
(generational), less access to health care, higher
numbers of African Americans

Those in Appalachia often diagnosed younger than

those in non-Appalachian counties

May take the disease less seriously

 CDC FUNDED
COALITIONS
Appalachian Diabetes Control & Translation Project - Since
2001 worked in 93 poor rural counties and with 71 coalitions

Diabetes: A Family Matter (low literacy diabetes materials)

Live Health Appalachia - 6 health summits focused on

advocacy, diabetes risks, education needs

Vulnerable Populations funding - Work with distressed

Appalachian counties
 Diabetes:
A Family Matter
• Series of low literacy brochures
• 3 Plays
• Website
• Teaching tools
• Film
Project I - Ohio Counties
Athens
Hocking
Lawrence
Meigs
Perry
Ross
Vinton

Project II
Ohio: Continuing - Athens, Lawrence, Perry, Ross
New - Adams, Brown, Scioto
Kentucky: Carter, Lewis, Rowan
West Virginia: Wayne
* CDC Funded #5H75DP002306-02
 FINDINGS
• County coalitions & community volunteers - Capacity to educate, inform & promote
diabetes awareness, self-management & prevention.

• Informal social & family networks can be effective ways to share diabetes messages.

• County teams can assist community members to access accurate health care information.

• Community work can influence individuals/families to make healthy lifestyle changes.

 STRENGTHENING HIGH RISK RURAL APPALACHIAN
COMMUNITIES TO PREVENT TYPE 2 DIABETES
Region I: 120,000 residents
* Kentucky – Elliott, Lewis, • Strategic plans based on community
Morgan, & Wolfe assessments
* Ohio – Scioto • County goal setting for years 4 - 5
Region II: 70,000 residents • Story - telling interviews
* Virginia – Buchanan, Russell, • Photo-voice projects
Wise
• Website development
Region III: 40,000 residents
• Films about diabetes for three regions
* Mississippi – Kemper, Noxubee,
Winston • Faith-based introduction of Diabetes:
A Family Matter (SUGAR Helpers/health
coaches)
• Work with local health care professionals

** CDC Funded #1U58DP002785-01 5 year $2.5 million project

 COMMUNITY
COALITION WORK
Patience in moving work forward

Obtain community trust

Identify community partners - Town Hall Meetings

Logic models - Goal setting

Create and implement action plans

Interview/film community members - Story-telling about diabetes/3 regional films

Create a music CD

Evaluate outcomes
Create binders for each coalition

Mini-grants of $2,500

Coalition meeting attendance - Quarterly educational

sessions

Team building activities - (Brushy Fork)

Faith-Based Ministries (involve pastors, surveys,

education, newsletters, etc.)
COMMUNITY GARDENS
PHYSICAL ACTIVITIES
 TURTLE CHALLENGE

The obesity epidemic threatens the quality of life, but also

the length of life among people in Morgan County, KY.
The rate of sedentary lifestyle had been reported at
nearly 70%. To address these issues, the Morgan County
Family and Consumer Sciences agent partnered with four
community organizations to conduct a county- wide physical
activity program entitled, the Turtle Challenge, reaching 441
participants. They logged hours of physical activity and
worked in teams within their community, workplace, church,
community group, or family. Participants were challenged
to meet a physical activity goal of 150 minutes per week.
Final reports received indicated that 64% met the goal of
increased physical activity. Many also reported weight loss.

4- to 8-week program using team competitions to build

participants’ levels of activity from as few as 10–15
minutes to the goal of at least 150 minutes of activity a
week.
 HEALTHY FOR GO O D
• Prepare Church Health Teams to bring healthy lifestyle information, events,
activities, and supports to members of local church families and surrounding
communities.

• Identify needs and capacities of local churches related to risks for complications of
diabetes and prevention efforts.

• Involve church families and members in programs that increase health knowledge
and healthy lifestyle behaviors to reduce the risks for complications from type 2
diabetes and reduce the risks for the disease.

• Engage church members, families, and their local communities regularly in healthy
lifestyle behaviors.

• Identify and enact local church policies that increase the health of church
members, families, and others in their community.

• Evaluate church program results in increasing knowledge about health and

numbers of daily healthy behaviors.
FAITH-BASED
ACTIVITIES

Healthy for GOoD

KIDS BUCKS
 STUDY RESULTS
Increased knowledge about diabetes self-management
Increased knowledge about secondary prevention risks
Increased access to healthy food options
Increased access to safe and low cost physical activities
Enhanced self-management diabetes education
Engaged communities
Mountains of Trouble:
What are the Solutions?
BE THE CHANGE