AUBURN UNIVERSITY — Longstanding Southern traditions of cooking and eating often clash with the dietary requirements needed to manage diabetes. In particular, type 2 diabetes is consistently problematic in Alabama, which has ranked among the top three states for diabetes for the past several years.
One of the problems is a lack of access to accredited education about culturally tailored healthy lifestyles and other diabetes management behaviors. Research shows that while education alone is often not enough for persons to decide to fully adhere with all diabetes self-management behaviors, it is a critical foundational component for those who do.
To combat the problem, Auburn and Tuskegee universities recently teamed with East Alabama Medical Center’s Diabetes and Nutrition Center in Opelika to develop “Reaching Out for Better Health,” a project funded by the American Association of Diabetes Educators, or AADE. The collaboration was one of only 10 funded nationwide. The Blue Cross Blue Shield of Alabama Caring Foundation also supported the research aspects of the project.
“We want to help empower people who have diabetes while also measuring the impact of accredited diabetes self-management education,” said Jan Kavookjian, associate professor in the Department of Health Outcomes Research and Policy in Auburn University’s Harrison School of Pharmacy. “This includes the outcomes of knowledge gain, establishing self-management behaviors and clinical outcomes.”
The Reaching Out program’s primary objective is to increase access to diabetes self-management education and training for people considered at high risk for diabetes and its complications. Since diabetes affects a large segment of the African-American population, the project targeted the community of Tuskegee and surrounding rural areas with the goal of increasing access to the Diabetes and Nutrition Center classes.
“We networked directly with members of the Tuskegee community who served as community advocates and we held the classes at familiar, convenient facilities in the Tuskegee area, rather than requiring patients to make the 25-mile drive to Opelika,” said Amie Hardin, co-principal investigator and manager of the EAMC Diabetes and Nutrition Center.
Hardin planned and coordinated two separate 10-week series of classes in Tuskegee to educate participants and take measurements such as blood sugar, blood pressure and other health indicators.
Local businesses and grocery stores provided coupons and gift cards specifically for purchasing fresh fruits and vegetables for those enrolled in classes, and each participant received a canvas tote bag filled with educational materials and a free glucose meter with strips for the duration of the 10-week classes.
“The community involvement was important,” said Faye Hall-Jackson, a Tuskegee University faculty member who helped recruit community advocates. “They helped support the attendance and retention of participants in the classes, particularly people who needed transportation.”
Alveta Reese, assistant professor of nursing at Tuskegee University was also a key contributor to the community advocate role and helped to tailor processes and communication in a manner culturally appropriate for the Tuskegee community.
The researchers wanted 40 adults with diabetes or pre-diabetes to participate in order to meet AADE requirements, but the program was so well received in the community that 46 participants signed up for the classes, including a few community leaders.
The first class was held with members of a diabetes support group, established by retired nurse Lilly Hall, that had been meeting for more than two years at the Greenwood Missionary Baptist Church in Tuskegee. The second class was held within the medical practice facility of Dr. Thomas Holt, a family practice physician.
Content for the classes was derived from the “AADE7 Self-Care Behaviors,” which are healthy eating, being active, taking medication, monitoring, healthy coping, problem solving and reducing risks.
“Three of our 10 weekly classes covered diet and nutrition topics since healthy eating is among the most challenging of the diabetes-management behaviors, particularly in the South where fried foods reign supreme,” Hardin said.
Kavookjian reported, “We are excited about the overall results because the target outcomes all went in the desired direction by the end of the education.”
At the completion of the 10-week courses, the participants’ knowledge of diabetes management increased by 15 percent, the average weight went down by 2.5 pounds, the average body mass index decreased from 30.8 to 30.4 and average Hemoglobin A1C decreased from 7.4 to 7.2. After the classes ended, participants also reported being active an average of 4.4 days per week compared to four days a week at the program’s start, and sticking with their diabetes diet an average of 5.3 days per week compared to 4.8 days before the classes.
The class organizers and participants gathered for a reunion in March in Tuskegee at the Greenwood Missionary Baptist Church to review the project, to provide education about talking to their loved ones about healthy behaviors and to look at long-term effects.
“We hope the participants will continue to use information from the classes to make healthy eating choices, among other healthy behaviors, and will keep practicing the excellent habits they developed,” said Kavookjian.