IFNA Denham June 2013

7/28/2019 IFNA Denham June 2013

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Reversing Trends of Type 2 Diabetes

Risks in Rural Appalachia

Sharon A. Denham, DSN, RN

Professor Emeritus, Ohio University School of Nursing


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Acknowledgements

Centers for Disease Control & Prevention (grants#1H76DP002306-01; #5H75DP002306-02;#1U58DP002785-01

National Diabetes Education Program

Ohio University Voinovich School (Dr. Lesli

Johnson, Laura Milazzo)

Center for Appalachian Philanthropy

Coalition and community people


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Objectives

Provide an overview of the Appalachian region

and its risks for type 2 diabetes

Describe briefly a program of study & practice toprevent type 2 diabetes

Explain promising solutions to address a problemof epidemic proportions


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Microsystem


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Appalachia


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Appalachian Regional

Commission Low income

High poverty

Limited education

Poor living standards

Job deficits

High unemployment

Out-migration

Stagnation

Decline


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National Obesity (2008)


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Diabetes (2008)

The Diabetes Belt


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a e es: o aProblem

Over 346 million people worldwide

25.8 million in USA

79 million pre-diabetes in USA (35% of adults over 20 yearshave it; 50% of those over 65 years; only 7% know)

Cost $174 billion (2007)/$245 billion (2012) = 41% increase

Leading cause of serious complications

Average cost per hospital stay = $18,000


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Strengths of Appalachia

Strong close knit families

Long lived friendships

Well-connected

communities

Can get things done


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Families, PLace & Faith


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Type 2 Diabetes

Common and prevalence underestimated

Inadequate education at time of diagnosis (do not

know where to get help)

Diabetes knowledge lacking

Lack confidence in abilities to change

Slow to seek medical help & question the value

Lack support, healthy environments, & policy

Hard to combat local sabotage


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Family Health Model(Denham, 2003)

Ecological

perspective

Contextual domain

Functional domain

Structural domain


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Family Health Routines

Self-care Safety and precautions

Mental health behaviors

Family care

Illness care

Member care-taking


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Core Functional Processes

Caregiving

Cathexis Celebration

Change

Communication

Connectedness

Coordination


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Formative Research

Diabetes Care: Provider Disparities in theAppalachian Region (Denham, Wood, &Remsberg, 2010)

Diabetes Education in the Appalachian Region:

Providers' Views (Denham, Remsberg, & Wood,2010)

Spirituality: Considering Relationships withHealth and Illness on those in Appalachia (Diddle& Denham, 2010)

The Storied Nature of Health Legacies in theFamilial Experience of Type 2 Diabetes(Manoogian, Harter & Denham, 2010)

Family Inclusion in Diabetes Education (Denham,

Ware, Raffle, & Leach, 2011).


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Qualitative Studies:Type 2 Diabetes & Family

Family Routines Study (13 dyads/26interviews, 3 focus groups, survey data)

Caring for Diabetes: A Family-BasedEducational Intervention for Patients withType 2 Diabetes

Living with Diabetes: Photographic Inquiry

Living with Diabetes: (14 dyads = 42interviews)

Development of a Dietary Routines Survey


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Provide culturally sensitive information

about healthy lifestyles and preventing type

2 diabetes & complications to persons living

in rural Appalachian communities.

Sensitively targeted toolkit focused on

diabetes prevention and care management

from a family and community point-of-view.

Applicable to other chronic

diseases

Health professionals can use the

toolkit to enlist local volunteers

and help community individuals

and families.

Specifically geared for use in

rural places of Appalachia with

focus on health literacy

Diabetes : A Fam ily Matter


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www.diabetesfamily.net
http://www.diabetesfamily.net/http://www.diabetesfamily.net/


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Citizen Action

Provide tools to haveownership (do for vs. do

with)

Empower local people

Acknowledge local needs &perspectives

Use community coalitions

SUGAR Helpers (Support to

Unite Generations in theA alachian Re ion


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States: Kentucky, Ohio,Mississippi, and Virginia

5 year, $2.5 million CDC project,

11 distressed countieswww.diabetesappalachia.net


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Goals

Strengthen coalitions

Map assets & create local

strategic plans

Strategically addressprevention of type 2 diabetes

& complications

Create sustainable actionsto reduce diabetes

complications


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Focus of the Project

Build knowledge

Change behaviors

Create healthier

environments

Develop policy


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Products

Toolkit Materials

Living with Diabetes (film)

Tobaccolachia (film)

Regional Films (3)

Mountains of Trouble (film)

Healthy for GOoD (musicCD)


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County Coalitions

STP

Different than textbook

Partner with lead agencies

Small, but powerfulgroups

Receive $5,000grants/county liaison

Town Hall Meetings

Diabetes education


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Promising Solutions

Healthy for GOoD

Kids Bucks Program

Fun in the Golden Years

Dining with Diabetes

Walking pathsCooking Programs

Turtle Challenge


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Healthy for GOoD(Starts in Families)

Coalitions connect with churches

Church health teams

Training sessions twice a year

Family focused

Mini-grants $225

Community Gardens

Exercise groups

Healthy cooking/meals


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Turtle Challenge8 week physical activityprogram

150 minutes a week (perperson)

5 person teams (providesupport & encouragement)

Champions for ruralcommunities


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What Are the Solutions?

Build strong leadership through mentoring

Build on community strengths

Change is slow - small steps needed

Family, place, & faith

Strengthen local leadership

Stuck in the Story - need to Re-story


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I am the Solution

IN IT FOR THE

LONG HAUL


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Contact Information

Sharon A. [email protected]
mailto:[email protected]:[email protected]

IFNA Denham June 2013

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