Translating Diabetes Evidence

into a Targeted Culturally

Sensitive Toolkit

SHARON A. DENHAM, DSN, RN

PROFESSOR,
OHIO UNIVERSITY SCHOOL OF NURSING
 Project Support

Center for Diabetes Control & Prevention

(National Diabetes Education Program)
(2005-2008)

Ohio Department of Health Diabetes Prevention and

Control Program
Ohio University’s Appalachian Rural Health Institute
(ARHI)
Ohio University, Diabetes Research Initiative (DRI).
Ohio University’s Office of Research and Sponsored
Projects Challenge Grants
 Translating Research to Practice

Scholarly inquiry
Theoretical perspectives
Research, research, research = empirical
knowledge
Translating evidence into practice
Nursing practice
 Denham: Family Health Studies (3)

Families with pre-school children

Economically disadvantaged families’

with young children

Intergenerational responses to family

health during bereavement and loss
 Family Health:
A Framework for Nursing
(Denham, 2003)
Health

Health experienced when a person can

fulfill personal goals, enjoy life, & live up to
their capacity.

Health is primarily influenced by family

member interactions over time.
Family Health

The complex systems, interactions, relationships,

and processes with potential to maximize
individual and family well-being.

Dynamic interactions and complex processes

within a household context.

Family plays more important roles than

occasional medical encounters.
Ecological Perspective of Family

Environment is like a set of nesting dolls.

Environments & persons have relationships that
influence one another.
Environments & persons affect one another even
when persons are not present.
Environment has a unique organization or schema
that can be investigated & understood.
Environments are dynamic, interactive & change
over time.
(Bronfenbrenner, 1979, 1986)
 Family Health Model
(Denham, 2003)

 Contextual domain
 Functional domain
 Structural domain
 Type 2 Diabetes

Approximately 95% of cases

Doubled from 5.6 to 15.8 million in 20 years
23.6 million Americans (7.8% of population)
Global concerns
Family focus has primarily been on type 1 diabetes
Mostly urban focused attention
Need for culturally sensitive educational materials
Appalachia
 Appalachian Sub-Culture
Kind and outgoing
Openhearted and helpful
Independent and proud
Family values
Strongly tied to place
Spiritual beliefs or faith in God
Strong moral values
A sense of community
Commitment and dedication to work
Mutual respect
Hospitality
 Ohio University
Appalachian Rural Health Institute

Studies of southeast Ohio

Diabetes rates as high as other national
minority groups (11.3%)
Obesity epidemic
 Formative Research Findings

Environmental Scan of Appalachia

(Winter, 2006)
* Health Professionals and Diabetes Indicators
* Diabetes Education
* Diabetes Print Media

Qualitative Studies (2007)

* Living with Diabetes in the Appalachian Region
 Qualitative Studies:
Type 2 Diabetes & Family

Family Routines Study (13 dyads/26 interviews, 3

focus groups, survey data)
Caring for Diabetes: A Family-Based Educational
Intervention for Patients with Type 2 Diabetes
Living with Diabetes: Photographic Inquiry
Living with Diabetes: (14 dyads = 42 interviews)
Development of a Dietary Routines Survey
 Diabetes: Cultural Perspectives
Strong family ties (family disease)
Gain information from family & friends
Family input before decision-making
Narratives and story-telling
“Stuck in the Story”
Lack of health professionals
 Diabetes Educators

May lack knowledge & skills about families.

May not know ways to educate multiple family
members.
May include family members.
May have few tools for ‘intentional’ family focus.
 Diabetes Self-Management

Family knowledge about diabetes often limited.

Family health routines (support and sabotage).
Family and individual skills, motivation, resources,
etc. over time.
Dedication to Kimberly Malone
Aims of the Diabetes Program & Toolkit

Healthy lifestyles, diabetes prevention, & diabetes

self-management
Type 2 diabetes (primarily)
Rural focus
Citizen Action in Appalachian communities
 The Storied Lives of Diabetes

Lived experiences versus biomedical accounts.

Narrative competence and clinical care.
Diabetes as a Family Disease: More than individual
problem (extended kin networks, place, faith, etc.).
Health legacies.
Need to reconstruct stories.
 Community Perspectives

Ecological context
Diversity
Geography
Multiple interacting sectors
More than traditional ideas of health care
 Material Development

Low literacy and Health Literacy

Cultural identification (avoid stereotypes)
Empowerment
Living with diabetes
 Material Development

Novel approaches/innovative ideas

Interdisciplinary input
Web 2.0 availability
Multiple types of audiences
Citizen Action

Give local people a voice.

Collective actions to improve the quality of life of
community people.
Cooperate to positively mobilize community resources
to address local health concerns.
Empowerment of local residents.
Acknowledgement of local perspectives.
 Citizen Action

Train the trainer model

Community coalitions
SUGAR Helpers (Support to Unite Generations in
the Appalachian Region)
 SUGAR Helpers

SUPPORT to
UNITE
GENERATIONS in the
APPALACHIAN
REGION
SUGAR Helper Education

Diabetes Educators Manual

Local recruitment
Use SUGAR Helper Manual
Educational program (six sessions/2 hours)
Goals: Communication skills, knowledge, and
networks
 Materials
Diabetes Educator Manual
SUGAR Helper Manual
Series of brochures
Series of posters
Fotonovellas
Bookmarkers
Film
3 Plays
Recruitment materials
Toolkit activities (family, group, & community)
 Website
www.diabetesfamily.net
Sharon A. Denham, DSN, RN
Ohio University, School of Nursing
E365 Grover Center
Athens, Ohio 45701
740-593-4494

denham@ohio.edu