A community-centered approach to diabetes in east harlem

Abstract

OBJECTIVE: Residents of East Harlem, an impoverished, nonwhite community in New York city (NYC), have up to 5 times the mortality and complication rates of diabetes compared with NYC residents overall. To determine potentially remediable problems underlying this condition, a community-based collaboration of health providers, community advocates, and researchers, surveyed East Harlem residents with diabetes to assess their knowledge, behaviors, barriers to care, and actions taken in response to barriers. DESIGN: Telephone interviews.SETTING: The 3 hospitals and 2 community clinics serving East Harlem.PARTICIPANTS: Nine hundred thirty-nine of the 1,423 persons (66%) with diabetes identified from these 5 healthcare sites with 2 or more ambulatory visits for diabetes during 1998 who lived in East Harlem. RESULTS:While most respondents (90%) said they know how to take their medicines, between 19% and 39% do not understand other aspects of their diabetes management. Many limit their diabetes care due to concerns about money (16% to 40%), and other barriers, such as language and transportation (19% to 22%). In multivariate analyses, Latinos (relative risk [RR] = 0.77; 95% confidence interval [95% CI] 0.63 to 0.91) and those who do not keep a diabetic diet due to concerns about money (RR = 0.85; 95% CI 0.70 to 0.99) had poorer health status. CONCLUSIONS:A community-based coalition was able to come together, identify areas of concern in diabetes care and assess the needs of adults with diabetes residing and obtaining care in East Harlem. The coalition found that even among those with access to care there remain significant financial barriers to good diabetes care, and a need to address and optimize how individuals with diabetes manage their disease.

The Role of Community-Based Participatory Research to Inform Local Health Policy: A Case Study

“…Researchers in general internal medicine have increasingly used this approach. [11][12][13][14] By conducting CBPR, health services researchers may be able to directly influence local health policy and the health of local communities. Reducing health disparities in racial/ ethnic minorities provides an example.…”

A model for using community‐based participatory research to address the diabetes epidemic in east harlem

“…In our surveys, more than half of East Harlem adults with diabetes never saw a nutritionist. 34 We also found deficits in the availability of nutritionists in East Harlem. In an additional survey conducted in 2005 of the three large adult medical practices within the three East Harlem hospitals, serving over 100,000 adults yearly, one had a bilingual nutritionist available one 1/2 day per week, one had an English-speaking nutritionist available 1 day per week, and one had no nutritionist available.…”

“…Cost concerns caused 28% to skip meals and prevented 40% from keeping a healthy diet. 34 In our focus groups, participants described how racism and discrimination prevented healthier behaviors. They described how racist food store practices prevented fresh, healthy foods from being sold in East Harlem.…”

“…32,33 The coalition has a community focus and a commitment to improve communication and understanding between clinicians and community members, develop practical and feasible programs based on community realities, and discover and work with assets in the community. 34 Initially, we built trust through outreach and community events. The coalition then turned to research.…”

“…The scarcity of nutritionists is particularly unfortunate because our research showed that patients who had seen a nutritionist were more knowledgeable about diabetes-healthy behaviors such as nutrition and physical activity. 34 Social factors interfered with healthy eating. In our focus groups, adults with diabetes described how family pressure prevented them from cooking and eating healthier foods.…”