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A Multifaceted Approach to Behavior Change Helps Spanish-Speaking Adults With Type 2 Diabetes

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Publication Date: June 2008

Publisher(s): Robert Wood Johnson Foundation

Topic: Health (Health services for the chronically ill)


The Advancing Diabetes Self-Management (ADSM) project at La Clinica De La Raza in Oakland, Calif., uses a multifaceted approach to improve diabetes self-management. It targets Spanish-speaking adults with type 2 diabetes who reside in Oakland. Eighty-five percent of the participants have family incomes at or below 150 percent of the federal poverty level, and the majority of the patients are either uninsured or enrolled in MediCal.

The project's approach is based on the Transtheoretical Model of Change (TTM), a theoretical model of behavior change, and incorporates peer support and patient-centered counseling. Providers at La Clinica are trained in TTM principles and use materials that aid in assessing patients' readiness to change for their clinical practices.

ADSM patients often have difficulty gaining and maintaining control over their diabetes through the traditional health care system, so innovative approaches are required to effectively reach them. Patients are referred to the project by their providers and attend an orientation meeting facilitated by a promotora (community health coach), who provides support throughout the patients' involvement. Patients are invited to take self-management classes and participate in a walking club, home visits and other promotora conferences. Those with depression may attend special support groups facilitated by a mental health professional. Promotoras and providers collaborate to review cases and discuss next steps during quarterly conferences.

Key Lessons:

* By working together with promotoras, providers can gain a greater understanding of patients' needs and the barriers to treatment adherence.

* Promotoras help identify patients' progress using the TTM and apply appropriate intervention tactics.

* Working with promotoras in a patient-centered project rather than providing clinical care alone improves patient outcomes.

* Trained promotoras can recognize and triage depression and implement mental health interventions.


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