Using Photovoice to Promote Diabetes Self-Management for Latino Adults
Arshiya A. Baig, MD, MPH, FACPAssistant Professor of Medicine
Associate Director of Chicago Center for Diabetes Translation Research
University of Chicago
November 2016
AADE Illinois
3nd Annual Symposium
Financial Disclosures
National Institute of Diabetes and Digestive and Kidney Diseases Diabetes Research
and Training Center (P60 DK20595), Chicago Center for Diabetes Translation Research
(P30 DK092949), and a NIDDK Mentored Patient-Oriented Career Development Award
(K23 DK087903-01A1).
Walgreens gave us 15% discount on photo development
Bayer supplied us with 6 boxes glucometer strips
Roadmap
Latino Demographics and Diabetes Disparities
Community-based Participatory Research and
Photovoice
Using Photovoice in Diabetes
Education
My Background and Focus on Latino health
o Training at UCLA
o Bogota, Colombia: U.S. Fulbright Scholar
o University of Chicago
Ask the Audience: What percentage of the U.S.
population will be Latino by 2050?
A. 15%
B. 30%
C. 50%
D. 75%
The Hispanic population grew by 49% from 2000 to 2015 in the Midwest per the
last U.S. Census.
Currently, Illinois has the fifth largest Hispanic population in the U.S
Relevance to Midwest and Illinois
U.S. Latinos Have Many Barriers to Care
• Socioeconomic:
- Average Latino household owns 7 cents for every $1 held by a non-
Hispanic white household (Duke University 2014)
• Barriers in the built environment—violence, limited space for
exercise, poor access to fresh food
• Language barriers: 76% of U.S. Latinos speak Spanish at home (2011 Census)
• Access to care
Latino Health
Disparities
Ask the Audience: What is the % chance a
Latino born in the U.S. will develop diabetes
in his/her lifetime?
A. 5%
B. 15%
C. 30%
D. 50%
Estimated lifetime risk of developing diabetes
0
10
20
30
40
50
60
Men Women
Pe
rce
nt
Total Non-Hispanic White
Non-Hispanic Black Hispanic
Narayan et al, JAMA, 2003
U.S. Latinos born in 2000 have about a 50% chance of
developing diabetes in their lifetime
53%
45%
27%
31%
6.4
12.511.1
12.6 11.9
8.2
0
10
20
Non-
Hispanic
whites
Non-
Hispanic
blacks
Hispanic Puerto
Rican
Mexican Cuban
% w
ith
dia
be
tes
CDC 2007
Diabetes prevalence is higher among Hispanics and varies by
subgroups
53%
Why such high prevalence of diabetes among Hispanics?
• Genetic predisposition towards insulin resistance and beta cell
dysfunction but unclear why among Hispanics
• High rate of abdominal obesity and greater amount of visceral fat
• Higher rate of conversion from pre-diabetes to diabetes (15%) than
non-Hispanic whites (5-10%)
• Variation in risk may be related to higher proportion of Native
American ancestry
Hispanics also suffer from disparities in diabetes outcomes
• Only 1/3 of Latinos with diabetes achieve optimal glycemic control
• Increased risk of complications:
- Twice the risk of diabetic retinopathy than non Hispanic
whites
- 40% greater risk of nephropathy
• Age-adjusted diabetes death rate is 1.4 times higher than
Hispanics than non-Hispanic whites
• Among Hispanics, the diabetes death rate in 2000 was highest
among:
- Puerto Ricans-- 172 per 100,000
- Mexican Americans-- 122 per 100,000
- Cuban Americans-- 47 per 100,000
Diabetes in Chicago Latinos
• Chicago: 4th largest Mexican-American population in the U.S. (578,000)
• In Little Village (South Lawndale): 83% Latino, 76% Mexican
• Many risk factors for poor health
- 60% below poverty
- 40% high school diploma
- 46% have insurance
- 37 is average BMI
Ask the Audience: Who is familiar with the term
community-based participatory research
(CBPR)?
A. Yes
B. No
C. Maybe
Traditional vs. Partnered Research
• Traditional approach where researcher largely
determines- Questions asked and tools employed
- Interventions developed
- Kinds of results and outcomes documented and valued
• Difficulty of translating scientific findings into clinical
practice
• Many times researchers use communities for research
but then never report the findings to them
Meredith Winkler, 2003,”Community-Based Participatory Research for Health”
A Partnered Approach: Community-Based Participatory Research
(CBPR)
• 1970’s Paulo Freire, a Brazilian educator
– Communities identify own problems & solutions
– Used with communities to understand and begin to create
structural change
• CBPR applies scientifically rigorous methodology in conducting
research partnered with a community
• CBPR is not research method itself but an approach
• Findings are “practical and relevant”
• Research findings can be applied directly to develop policy and
interventions
Jones, JAMA 2007
Wells, JAMA 2009
Project
Designing and Testing a
Church-based Diabetes
Education Program for Latinos
Adults
Church-based Diabetes Education
• Diabetes self-care is cornerstone of
disease management
• Many Latinos do not participate in self-
management education programs
• Churches can provide a familiar,
convenient, and trusted setting for
diabetes education and support
• Churches are central to many
racial/ethnic communities
Our Lady of Tepeyac Church,
Chicago
We Learned How to Tailor the Intervention From Patients
• Focus groups
• Participant concerns:
- Diabetes affects all aspects of life
- Cost of care
- Psychological impact of having diabetes
- Lack of resources to manage diabetes in community
• Preferences
- Interested in group-based education program in church
- Desire diabetes education, support, self-empowerment
- Information on nutrition, exercise, causes, complications
Identify Points of Intervention and Study design
• Formed community advisory board (CAB) for continued
input from patients and stakeholders
• Community involvement in designing intervention and in
study design
• Using local resources and working with other agencies
• Need to tailor the intervention to the church setting and
the community
Ask the Audience: Who is familiar with
photovoice?
A. Yes
B. No
C. Maybe
Using Patient Engaged Research Methods: Photovoice
• Uses power of pictures
• People can identify, represent, and analyze their communities by taking photos
• Photos can be accompanied by stories
• As a way to problem solve and give social support
Background on Photovoice
Photovoice is a community-based participatory research methodology
that engages community members through the use of photos and
storytelling. (Wang, University of Michigan)
33Using Photovoice to Promote Diabetes
Self-Management for Latino Adults
In photovoice, participants take photos of their lives and tell stories
about those photos.
Photovoice has
traditionally been used for
needs assessment.
No studies have assessed
the feasibility and
acceptability of using
photovoice to promote
diabetes self-management.
Study Design: Photovoice
• Intervention participants were given disposable cameras and asked to
take photographs of their lives with diabetes.
• Photos were developed by the academic team and given to the
participants.
• In the weekly classes, participants discussed their photos with the
group and shared their challenges and successes in diabetes self-
care. These exercise was used to promote problem solving and
empower patients to improve their diabetes self care.
• Weekly diabetes self-management classes led by lay leaders trained
in motivational interviewing.
34Using Photovoice to Promote Diabetes
Self-Management for Latino Adults
Study Design
• The lay health educators were trained by a team of a certified diabetes
educator, registered dietitian, and a psychologist with support from a
community pharmacist who served as their diabetes experts for
information support and education.
• The class leaders guided the group photo discussions and took notes
on (1) why the photo was important to the person who took it and (2)
what others in the class discussed regarding the photo.
• Using a codebook derived from prevalent themes, two researchers
coded the photos and the discussion notes.
• Participants evaluated the photovoice activities at 6-month follow-up.
35Using Photovoice to Promote Diabetes
Self-Management for Latino Adults
Educational curriculum
Photovoice
Patient navigation Exercise groups
8-week church-based
diabetesself-
managementintervention
Randomized Study Design
Low intensity High intensity
Receive a 90 min diabetes lecture Picture Good Health
8-week church-based diabetes self-
management intervention
Picture Good Health
3 month measures and mailed lab results
Optional monthly group sessions
Patient navigator to establish PCP if needed
Mailed letter with baseline lab results
6 month measures and mailed lab results
Baseline characteristics
N=100
Age 54 ± 11
% female 81
% 8th grade or less 54
% income less than $30,000 82
% Latino ethnicity 98
% of Latinos reporting Mexican origin 95
% born outside of U.S. 92
% speak “only Spanish” at home 71
% have a source of usual care 93
% insured 49
% in excellent or very good health* 3
% with family history of diabetes 69
*other categories: good, fair, poor
N=100
No. of years with diabetes 8.3 ± 7.9
% with family history of diabetes 69
% with kidney disease 2
% eye disease 25
% hypertension* 56
% high cholesterol 70
% on insulin 25
% on oral meds for diabetes 85
Mean A1c % 8.0 ± 2.0
Mean LDL 108.1 ± 32.0
Mean systolic blood pressure mmHg 119.7 ± 14.4
Change in A1c by Arm (n=76)
Intervention Participants Had More Significant Improvement in
Self-Care at 6-months
Within arm Across arms
Usual Caren=41
Interventionn=41
Intervention effect
Following healthful eating plan
Average number of days per week following eating plan over last month
Having >=5 servings fruit and vegetables
Having high fat foods
Participating in >=30 min physical activity
Participating in a specific exercise session
Testing blood sugar
Testing blood sugar as recommended by healthcare provider
Inspecting the inside of shoes
Checking feet
Taking medications as prescribed
Results
Of 50 participants who were invited to the class, 37
attended at least one class and 26 took photographs.
Of the 26 who took photographs, two participants’ photos
were not available for analysis.
A total of 503 photos were analyzed.
42Using Photovoice to Promote Diabetes
Self-Management for Latino Adults
Ask the Audience: What was the most common
theme for the photos?
A. Participant’s workplace
B. People and family
C. Diabetes care (e.g. Medications, syringes, etc.)
D. Religious elements
E. Nutrition and exercise
Subjects and Themes of Photographs
44Using Photovoice to Promote Diabetes
Self-Management for Latino Adults
Subjects and Themes N=503 n(%)
People 398 (79%)
People, including family, friends, community members 237 (54%)
Children 69 (14%)
Social events or gatherings 92 (18%)
Nutrition and exercise 236 (47%)
Food 121 (24%)
People exercising or exercise equipment 37 (7%)
Water bottles and people actively drinking water 33 (7%)
Soft drinks 32 (6%)
Neighborhood and built environment 195 (39%)
Neighborhood and surroundings 73 (15%)
Outdoor green spaces including parks and gardens 68 (14%)
Bikes, buses, trains, cars, modes of transportation 37 (7%)
Billboards, window, taxi or bus advertisements 16 (3%)
Subjects and Themes of Photographs
45Using Photovoice to Promote Diabetes
Self-Management for Latino Adults
Subjects and ThemesN=503
n(%)
Diabetes specific 165 (33%)
Diabetes self-management class 63 (13%)
Diabetes supplies (strips, glucometers, lancets, scales) 34 (7%)
Medications including pills, insulin, and herbal or
vitamin supplements
18 (4%)
Home life 124 (25%)
Interior and exterior of home 95 (19%)
Pets or animals 16 (3%)
Religious figures, iconography, or ceremonies 41 (8%)
Participant workplaces (e.g. work desk, cubicle) 3 (0.6%)
Themes of
Analysis from
Class Discussions
(N=65 photos)
46
Theme % photos
Social support
Group advice 36 (55.4%)
Group empathy 14 (21.5%)
Group motivation 7 (10.8%)
Importance of social support 5 (7.7%)
Diabetes self-management
Diet or nutrition or eating 17 (26.2%)
Exercise 8 (12.3%)
Taking medications 6 (9.2%)
Testing sugar at home 3 (4.6%)
Cultural traditions 13 (20%)
Importance of family 12 (18.5%)
Emotional health
Concern for family 11 (16.9%)
Ways to cope with stress 8 (12.3%)
Self-motivation 4 (6.2%)
Faith or religion 4 (6.2%)
Group Advice
47Using Photovoice to Promote Diabetes
Self-Management for Latino Adults
Participantexplanation of
photograph
To remember that diabetes patients should be careful when using knifes
because they can get injured and that’s very harmful for
them.
Why the photograph is important to
the participant
Her mom reminds her to be careful
when using knifes
Classroom discussion of photograph
Everyone agrees that they need to be extra careful when using knifes or when they get their nails cut. It is even better to go to a professional to get their nails cut.
Group Empathy
48Using Photovoice to Promote Diabetes
Self-Management for Latino Adults
Participantexplanation of
photograph
It is a photograph of his daughter who died 3 years ago. His mother gave
him the [statue of ] the Virgin Mary.
Why the photograph is important to
the participant
“I have the picture with me at all times and I just wanted to share it with you.”
Classroom discussion of photograph
Thanks for sharing your pain and your loss. They shared
their own experiences of
losing a loved one.
Group Motivation
49Using Photovoice to Promote Diabetes
Self-Management for Latino Adults
Participant
explanation
of
photograph
“At a job, I decided
to smoke less.”
Why the
photograph
is important
to the
participant
“To remember I
decided to start
smoking less
because this would
help my health.”
Classroom
discussion
of
photograph
““It is a good way to
start smoking less
by looking at the
picture. It is good to
stop smoking even
though it is hard to
quit.”
Importance of Social Support
50Using Photovoice to Promote Diabetes
Self-Management for Latino Adults
Participant
explanation
of
photograph
She is part of the
class. She receives
motivation from her
classmates. She feels
that they all speak the
same language with
the class leader. She
is very happy with her
work.
Why the
photograph
is important
to the
participant
Because she
receives support and
inspiration from
everyone in this
program.
Classroom
discussion
of
photograph
Being part of a group
helps them to be
stronger. Learning
how to improve their
life style. Together,
they are fighting to
have a better life.
Diet, Nutrition, and Eating
51Using Photovoice to Promote Diabetes
Self-Management for Latino Adults
Participant explanation of
photograph
Why the photograph is important
to the participant
Classroom discussion of
photograph
“Junk food is nothing but
fats; it is venom for the
body.”
“I shouldn’t eat junk food because
it has a lot of salt and fats.”
“Not only diabetes patients but
everyone should take care of their
health.”
Testing Sugar at Home
52Using Photovoice to Promote Diabetes
Self-Management for Latino Adults
Participant
explanation
of
photograph
“It is very
important to have
a blood exam in
order to know
our blood sugar
level.”
Why the
photograph
is important
to the
participant
“I have to check
my blood sugar
level twice daily.
That way I know
if my blood sugar
level goes up.”
Classroom
discussion
of
photograph
“It is very
important to
know our blood
sugar level.“
Importance of Family
53Using Photovoice to Promote Diabetes
Self-Management for Latino Adults
Participant explanation of
photograph
Why the photograph is
important to the participant
Classroom discussion of
photograph
“Family photo to remind me
that I need to take care of
myself for my family since I
am the head of household,
they will suffer the
consequences.”
“If we don’t take care of
ourselves, we will not be in that
picture anymore. I would like to
have one in the future with
everybody and no one
missing.”
“If we don’t take care of ourselves then
there will be no picture with us in it in
the future and we will not be able to
achieve our goals.”
Cultural Traditions
54Using Photovoice to Promote Diabetes
Self-Management for Latino Adults
Participant
explanation of
photograph
She has an altar with
various Saints. She
made it because she
used to often dream
of the virgin. The
other saints were
presents that she
received.
Why the
photograph is
important to
the participant
She feels that the
virgin Mary helps her
to keep on going with
her diabetes and to
take good care of her
health because of
her daughter.
Classroom
discussion of
photograph
Other participants
also have altars at
home.
Faith or Religion
55Using Photovoice to Promote Diabetes
Self-Management for Latino Adults
Participant
explanation
of
photograph
“For me it
represents life,
faith, and hope.
When I come
here, I feel in
peace and the
best place to
meditate
because I feel
in peace.”
Why the
photograph
is important
to the
participant
“It helps me to
maintain my
faith and that
no matter how
life is, there is
always hope
and a light to
follow.”
Classroom
discussion
of
photograph
“Thanks to God
I found this
place, I feel
comfortable
when I am in
Mass and
receiving invites
for this class.”
Concern for family
56Using Photovoice to Promote Diabetes
Self-Management for Latino Adults
Participant explanation of
photograph
Why the photograph is
important to the participant
Classroom discussion of
photograph
Her parents. Her dad lost his
left leg and some toes. Both of
them have diabetes. Both use a
wheelchair but her dad uses it
only when he goes out.
She brought a picture of her
parents because God has
allowed them to live a long life.
They asked her if her dad uses a
walker because some of the
participants might have some.
Ways to cope with stress
57Using Photovoice to Promote Diabetes
Self-Management for Latino Adults
Participant
explanation
of
photograph
Participant
is in the
forest
where is
peaceful
and quiet.
There, he
can
exercise
and relax
from all the
stress
Why the
photograph
is important
to the
participant
“It’s very
relaxing
being in the
forest”
Classroom
discussion
of
photograph
That is a
great
picture and
is very
relaxing to
walking in
the forest
Self-Motivation
58Using Photovoice to Promote Diabetes
Self-Management for Latino Adults
Participant
explanation
of
photograph
“One-way sign. There
is only one way and I
would like to feel free
as a bird not attached
to this illness.”
Why the
photograph
is important
to the
participant
“Because I love
myself and that love
is motivated by my
family. I need to love
myself to be able to
love others.”
Classroom
discussion
of
photograph
“We only have one
way and it’s the way
to health. You have
various choices but
only one way takes
you to a good health
and will help us guide
ourselves and to
guide our family to
avoid getting
diabetes.”
Participant Satisfaction With Photovoice (N=30)
59Using Photovoice to Promote Diabetes
Self-Management for Latino Adults
0% 20% 40% 60% 80% 100%
How much fun did you have taking photos forclass?
How much did you enjoy talking about yourphotos in class?
How much did you learn about better managing your diabetes from other
participants’ photos?
How comfortable did you feel sharing yourphotos?
How much confidence did you gain inmanaging your diabetes from talking about
the photos?
How much did the photo discussions help youto better manage your diabetes?
How much did sharing photos make you feelmore connected to the people in the group?
Not at all (%)
A little (%)
Some (%)
A lot (%)
Of 50
participants who
were invited to
the class, 37
attended at least
one class and 30
completed the
exit survey.
In Participants’ Words
When asked what they liked about using photos to discuss their lives
with diabetes:
o The pictures help us to remind ourselves of what is good and bad for us. It
is a great method.
o It teaches us to be better people and continue forward. To be more
conscious of our daily lives and remember essential things we had
forgotten about. To be able to coordinate our daily lives and see what we
have.
o It’s a good idea because it helps and you learn more by seeing and talking
about it.
When asked what they would change about the photo discussions:
o Nothing, they have great significance in our lives. The pictures speak for
themselves. We want more time to express their significance.
60Using Photovoice to Promote Diabetes
Self-Management for Latino Adults
Summary of Findings
In a diabetes self-management intervention for Latinos,
participants were satisfied with the photovoice exercise and had
high rates of participation.
61Using Photovoice to Promote Diabetes
Self-Management for Latino Adults
Summary of Findings
Participants’ photos
spurred group
discussion around
diabetes self-
management.
Participants gave advice,
were empathetic, and
motivated the
participants who
presented their photos to
make or sustain healthy
behaviors.
62Using Photovoice to Promote Diabetes
Self-Management for Latino Adults
Limitations
This study used a convenience sample so results may not
be generalizable to all Latinos with diabetes.
63Using Photovoice to Promote Diabetes
Self-Management for Latino Adults
We analyzed the class
discussion using leader
notes which may have not
been complete.
We did not record
participants' stories
regarding the photos.
Conclusion
• Photovoice provided an
effective vehicle to receive
and provide social support
and promote behavior
change.
• Future studies should
consider using photovoice
as a way to encourage
healthy behavior change
and facilitate social
support in a group setting.
64Using Photovoice to Promote Diabetes
Self-Management for Latino Adults
Interpretation of Findings and Dissemination
• Academic publications and presentations
• Town Hall meeting
• CAB continuing to meet
Project
Provider Training
Ask the Audience: What percentage of patients
understand everything that their physician
has said in a visit?
A. 20-30%
B. 40-50%
C. 60-70%
D. 80-90%
66 68 68
57
49
66 69
6156
48
0
20
40
60
80
100
Total White Black Hispanic Asian
Felt Doctor Listened to Them Understood Everything Doctor Said
Note: Population includes adults with health care visits in the past two years.
Source: The Commonwealth Fund. Health Care Quality Survey. 2001.
Hispanics are less likely to understand their doctor and less likely to feel
their doctor listened to them
Percentage of adults ages 18 to 64 reporting
ease of communication during doctor visits, 2001
12 10 1319
14
0
20
40
60
80
100
Total White Black Hispanic Asian
Hispanics are twice as likely as whites to leave the doctor’s office
with unasked questions.
Percentage of adults ages 18 to 64 reporting they had questions
that they did not ask on last visit to doctor, 2001
Note: Population includes adults with health care visits in the past two years.
Source: The Commonwealth Fund. Health Care Quality Survey. 2001.
Provider cultural competency
– “...the ability of health care professionals to communicate with and effectively provide high-quality care to patients from diverse sociocultural backgrounds”
– “Understanding the importance of social and cultural influences on patients’ health beliefs and behaviors; considering how these factors interact at multiple levels of the health care delivery system; and, finally, devising interventions that take these issues into account to assure quality health care delivery to diverse patient populations.”
Provider cultural competency: Why is it important?
• To respond to current and projected demographic changes in the United States
• To eliminate long-standing disparities in the health status of people of diverse racial, ethnic and cultural backgrounds.
• To improve the quality of services and primary care outcomes.
• To improve patient-provider communication and improve patient satisfaction
• To meet legislative, regulatory and accreditation mandates.
Provider’s role in patient-centered care
• Few who speak Spanish fluently
• Goes beyond speaking language however.
• Providers who see many Latino patients may not have a good understanding of their patient’s life challenges and cultural beliefs
“Local Patients, Local Stories”
• We learned about patient challenges with provider
communication in church-based program
• Developed study aimed to address provider cultural
competency and patient centered communication
• Designed training with skill building on patient-
centered communication
• Used a video of patient stories and photos to train
providers on patient challenges AND successes
• Piloted with 42 local healthcare providers and have
noted pre to post-test improvement in cultural
sensitivity
Patients Tell Their Stories
Multi-level approach: Work to Date
• Community– How to mobilize community leaders through evaluation of
formation of Community Advisory Board
• Patient– Church-based education with improvement in self-care
– Texting messaging in health centers to support diabetes self-care
– Review of family based interventions for adults with diabetes
• Provider– Cultural competency assessment
– Training with patient stories
• System– Assessment of resources for Latinos in Midwestern health
centers
– Diabetes group visits in community health centers
Summary and What’s Next?
• Latinos suffer from disproportionately high rates of diabetes
and have many barriers to care
• We need innovative, multi-pronged interventions to tackle
Latino diabetes disparities
• Integrate community partnerships into healthcare systems
to gain trust and utilize local resources
• Ultimately want results that are practical and relevant to
patients and policy makers
Acknowledgements
78Using Photovoice to Promote Diabetes
Self-Management for Latino Adults
• Co-investigators:
• Marshall Chin
• Deborah Burnet
• Michael Quinn
• Amanda Benitez
• Cara Locklin
• Marla Solomon
• Lisa Sanchez-Johnsen
• Sang Mee Lee
• Yue Gao
• Erin Staab
• Little Village Community Advisory Board
• NIH NIDDK K23• University of Chicago DRTC• University of Chicago CTSA
• Chicago Center for Diabetes Translation Research
• Taller de José
• Father Don Nevins
• Juan Acevedo
• Maritza Gomez
• Freddy Vazquez
• Denise Salinas
• María Acevedo
• Ana Piña
• Patricia Fernandez
• Jason Espinoza
• Alexis Lopez
• Matthew Stutz.
• Anghela Paredes
• Catherine Castro
• Louis Philipson
• Peggy Hasenauer
• Kovler Diabetes Center
• Walgreens and Bayer
Thank you.
Questions?
Pre and Post Assessment Questions
Choose the incorrect answer.
3. Photovoice is a methodology that:
a. Uses the power of photographs and storytelling to empower patients and communities.
b. Has been traditionally used to conducted community health needs assessments
c. Has been widely used in public health research
d. Incorporates recorded video for use of health promotion
Language
• 12% of US population speaks Spanish.
• Of these 28% report not speaking English
well or at all.
• 76% of U.S. Hispanics speak Spanish at
home
• Depending on generation as well
Themes and Quotes from Class Discussions (N=65)
82Using Photovoice to Promote Diabetes
Self-Management for Latino Adults
Theme % photos Explanation of photograph Why the important Classroom discussion
Diet or
nutrition or
eating
17
(26.2%)
“Junk food is nothing but
fats; it is venom for the
body.”
“I shouldn’t eat junk food
because it has a lot of salt
and fats.”
“Not only diabetes patients but
everyone should take care of their
health.”
Importanc
e of family
12
(18.5%)
“Family photo to remind me
that I need to take care of
myself for my family since I
am the head of household,
they will suffer the
consequences.”
“If we don’t take care of
ourselves, we will not be in
that picture anymore. I would
like to have one in the future
with everybody and no one
missing.”
“If we don’t take care of ourselves
then there will be no picture with us in
it in the future and we will not be able
to achieve our goals.”
Group
motivation
7
(10.8%)
“At a job, I decided to smoke
less.”
“To remember I decided to
start smoking less because
this would help my health.”
“It is a good way to start smoking less
by looking at the picture. It is good to
stop smoking even though it is hard
to quit.”
Faith or
religion4 (6.2%)
“For me it represents life,
faith, and hope. When I
come here, I feel in peace
and the best place to
meditate because I feel in
peace.”
“It helps me to maintain my
faith and that no matter how
life is, there is always hope
and a light to follow.”
“Thanks to God I found this place, I
feel comfortable when I am in Mass
and receiving invites for this class.”
Self-
motivation 4 (6.2%)
“One-way sign. There is only
one way and I would like to
feel free as a bird not
attached to this illness.”
“Because I love myself and
that love is motivated by my
family. I need to love myself
to be able to love others.”
“We only have one way and it’s the
way to health. You have various
choices but only one way takes you
to a good health and will help us
guide ourselves and to guide our
family to avoid getting diabetes.”
Testing
sugar at
home
3 (4.6%)
“It is very important to have
a blood exam in order to
know our blood sugar level.”
“I have to check my blood
sugar level twice daily. That
way I know if my blood sugar
level goes up.”
“It is very important to know our
blood sugar level.“
Using Photovoice: Some Photos
Main Objective and Aims
We aimed to evaluate the feasibility and acceptability of
using photovoice in a diabetes self-care intervention by
assessing:
84Using Photovoice to Promote Diabetes
Self-Management for Latino Adults
o Participant participation in the photovoice activity
o The themes that emerged from the photographs
o The themes that emerged during class
discussions about the photographs
o Participants’ satisfaction with the photovoice
exercise
Pilot Intervention Study
• Community-based, randomized pilot intervention: intervention vs. usual
care
• 100 participants adults with diabetes recruited from church and community
events
• Followed for 6 months
• Results:
– >30% of participants in both arms improved their self-rated health
– Both arms with significant improvement in diabetes self-empowerment
– Patient satisfaction:
• 79% of intervention participants said they learned a lot about diabetes
• 76% said they gained a lot of confidence in their ability to manage their diabetes.
Pre and Post Assessment Questions
1. Which racial/ethnic group has had the largest increase in diabetes risk in the past 10
years?
a. Whites
b. African-Americans
c. Hispanics
d. All have seen the same increase in diabetes risk
2. The following is the an important concept in community-based participatory research
(CBPR):
a. CBPR projects must address racial/ethnic disparities in health.
b. CBPR excludes the use of scientifically rigorous methods like randomized controlled trials.
c. In CBPR, academic and community partners must equally divide grant funds.
d. In CBPR, the academic and community partnership is best when it begins at the inception of the research idea through implementation and dissemination of research findings.
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