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Circles of Care for the Prevention/Management of Diabetes
Susan Klein and Myra Royal

Problem:
A 2004 survey of community food pantry participants indicated that three times as many food pantry participants (15.55%) as County residents (5.4%) had been diagnosed with Diabetes. Food Pantry participants receive food packages when they are out of food and this is provided on an emergency basis. Because of limited incomes, the food pantry participants are unlikely to receive education to manage this chronic disease. Education for managing diabetes usually is a feature of private pay insurance.

Extension Response:
ISU Extension (ISUE) and Primary Health Care (PHC) joined together to request funding from Healthy Polk 2010 to screen possible diabetic people at food pantries and to provide a series of classes to educate diabetics on how to manage their disease successfully. Healthy Polk 2010 provided $9000 for the project to cover materials for teaching, some staff cost recovery and transportation for participants. PHC staff used the American Diabetes Association screening tool at seven food pantries in the Polk county area with 300 participants. The screening tool indicates the risk for diabetes. The participants with a score of 10 or greater were invited to an informational meeting regarding the risk of diabetes, offered a blood test to determine diabetes and invited to a four-part educational program to manage and/or lower the risk of diabetes. Workshops were taught by ISUE staff (Susan Klein and Myra Royal). The series of classes used the Healthy Diabetes Plate curriculum from Idaho Cooperative Extension. Each lesson centered on food selection for diabetic participants and the importance of exercise to help control diabetes. After each lesson participants were provided an incentive, usually a package of food items. The instructors would also teach the group how the food in the package could fit in a diabetic diet. One lesson the participants went to a restaurant to learn how to read the menu with diabetes in mind. While doing this specific screening, the committee also developed and presented four community diabetes education programs targeting minority populations. Topics addressed were diabetes, hypertension, stroke and diet.

Impact:
At the informational meeting 15 participants had a blood screen and all were found to not be diabetic. 17 of the 116 participants with scores above 10 had indicated they would like to participate. We determined that because of their screening score we would do the workshop series anyway to work with pre-diabetic education.

  • Information learned from the diabetes screening survey at the seven food pantry sites:
    • 29% of Spanish speaking diabetes surveys were at 10 or higher. The highest was 27. This is a group that needs additional education.
    • 38.5% of English speaking scored 10 or higher. The highest score was 24.
    • 57.25% of the English speaking diabetes surveys were overweight or obese-a leading factor in controlling diabetes.
    • 75% Spanish speaking and 52% English speaking were under the age of 45. Putting the statistic of age and incident of diabetes together shows potential for early on-set of diabetes is great for both populations. Working with pre-diabetic participants is vital.
  • Just because a person is screened as being at risk for diabetes does not mean they will be interested or excited about changing behaviors to limit their risk for diabetes.
  • Phone calls to potential participants showed a wide variety of responses. Some were very engaged and ready to learn while others were less excited. This population has many factors pulling on their attention and health is not necessarily at the top of their list. This is especially true of health issues that are chronic but not at the acute stage.
  • Even with addressing barriers such as transportation most participants were not able to set aside the time to work on lifestyle behaviors due to demands such as hunger and homelessness.
  • One idea that has occurred to us is that we need to seek participants where they already gather. This was illustrated by the engaged groups at the senior centers.
  • Classes do not work for food pantry populations and we need to be available at the food pantry sites to do such steps as blood glucose screens and mini-education sessions, probably one-on-one. Time limit suggested would be 5-10 minutes. We would need to use referral information to health care such as The PHC Diabetes Collaborative.
  • Even though there were 20African Americans (41% of African Americans completing survey) who scored 10 or higher on the survey and were invited to the informational meeting, none chose to participate. At the senior sites, primarily in the AE Casey Making Connections Neighborhoods, we worked with and were well received by the African-American community. The participants at the Senior centers asked to have additional diabetes classes. Again the valuable lesson learned is that we need to reach this audience where they regularly convene.
  • Not until a relationship is established will the majority of people readily follow through on behavior changes.

Contacts:

Susan B. Klein
Iowa State University Extension
Nutrition/Health Field Specialist
5201 NE 14th Street
Des Moines, IA 50313
Phone 515-261-4213; Fax 515-263-2704
Email sklein@iastate.edu		 Myra Royal
Field Specialist/Families
Polk County Extension
5201 NE 14th Street Suite A
Des Moines, IA 50313
Phone 515-261-4212; Fax 515-263-2704
E-mail mroyal@iastate.edu

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Last update: August 17, 2006  
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