IFNA Denham June 2013
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Transcript of 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]