LOS ANGELES — Looking to make your adult diabetes education program more effective? Consider enlisting the help of patients with controlled diabetes to lead group sessions and educate patients newly diagnosed with the disease, America Bracho, M.D., advised at the annual meeting of the California Academy of Family Physicians.
“The power of community workers is tremendous, and this is an alternative for a busy practitioner,” said Dr. Bracho, executive director of Latino Health Access, a center for health promotion and disease prevention in Santa Ana, Calif. “If you have clients who are from Somalia and you have a person [with diabetes] who speaks their language and is doing well, can that person help? Can you do this with Latinos? This is something that is creative and it doesn't cost that much.”
Effective diabetes education programs “take into consideration the way adults learn, [presume the adults] are competent, have hands-on activities [and] role models, [and] the person with diabetes is involved in the treatment and care,” she said. “If your client is not influencing the treatment, is not helping in the decision making, your client is not self-managed.”
The program at Latino Health Access spans 12 sessions. At the first one, the group leaders ask the clients to describe how they felt when they learned that they had diabetes and to define the disease.
Every client of the program receives a new glucose monitor. “The first rule of adult education is that adults are independent,” Dr. Bracho said. “They are not looking to be dependent on their children or a nurse to measure their glucose.” She added that program participants form “a close relationship” with their glucose monitors.
“We ask them in our focus groups, 'What do you think about the meter?' [They say things like] 'It's my friend. The only one that tells me the truth,'” Dr. Bracho added.
In the session that describes the effect of diabetes on the human body, Dr. Bracho and her associates use nonmedical jargon to educate. They talk about how the human body is like a house. “In that house you have an electrical system and a plumbing system,” they tell them. “There are little pipes behind the eye that get clogged. They get clogged because glucose is a sticky thing. Then you have fats in your blood that get stuck, because the glucose has that little sticky bed and they get stuck until the pipe is clogged.”
The electrical system, they'll say, “has the cables which are the nerves. The glucose is like rats eating the cables and creating short circuits.” At this point, some clients will respond with statements like, “That is happening to me! I feel like I have a rat right here,” Dr. Bracho said as she pointed to her thigh.
She concluded her remarks by advising physicians to ask adult patients newly diagnosed with diabetes “to set goals, follow up, and be the partners of those clients in their journey with diabetes. We need to advocate, to have better programs, and to go out of our comfort zone as doctors because people look at you as one of the main leaders in their cities and towns,” she noted. “You are vital in improving the external conditions that are surrounding this disease. We all need to change. Not just the client. In the end, who defines the success of the intervention is the client.”
The presentation was supported by an unrestricted grant from Pfizer Medical Humanities Initiative.