1

Community-Based Diabetes Interventions in Latino Population

Aaliyah Anaya

California State University, Channel Islands

HLTH 499

Dr. Winans

March 5, 2021
 2

Community-Based Diabetes Interventions in Latino Population

Diabetes is a serious public health problem at global, national, and local levels. In the

United States, diabetes disproportionately affects people of Latino descent who are nearly twice

as likely to have diabetes as non-Hispanic whites (Cruz et al. 2013). With the initiation of the

Affordable Care Act, many previously un-insured Latinos have entered into primary care.

Foreign-born Latinos or those with limited literacy often find it difficult to engage with the US

Health System. Given the costs and consequences of inadequate diabetes risk management,

innovative approaches are needed to better over-come barriers to effective care in this

population. Health systems together with local communities can integrate the elements of

community-based programs that are effective across the range of care to enhance patient-

centered outcomes and ultimately lead to self-efficacy diabetes management. Diabetes programs

should offer accessible information and resources throughout the community and deliver it in a

format that is understood, regardless of literacy and socioeconomic status among the Latino

population.

Language and Culture Barriers to Effective Diabetes Care

Although many Latinos achieve excellent diabetes management, there are several barriers

that are common within this population. One barrier for many Latinos is lack of or limited

English proficiency. Language is a critical determinant of healthcare utilization (Guntzviller

2017). Separate from language proficiency is the concept of cultural proficiency, which describes

the ability of healthcare providers to recognize and work within common Latino cultural beliefs

and practices. Ethnographic research has identified four key constructs within Latino culture:

‘Confianza’ (trust) and ‘personalismo’ (the expectation of being dealt with in a caring and

personal manner) influence health-seeking behavior in general, while ‘familismo’ (family) and
 3

‘respecto’ (respect) influence how Latinos engage with healthcare. This is called the Latino

construct of confianza which plays a role in healthcare because it is important for Latinos to

build a trusting relationship with healthcare providers, but language and cultural barriers can

disrupt this process and lead to poorer health outcomes (Larkey et al. 2001). Latinos seek warm

and friendly treatment from their healthcare providers. This explains why many Latinos rely on

community-based organizations and clinics for their primary care. However, low rates of health

insurance coverage, socioeconomic challenges and immigration-related issues all complicate

healthcare for Latinos with diabetes. Thus, culturally interventions are needed to address this

alarming disease that burden the Latino population.

Preventative Intervention

A region in Charlotte town North Carolina has one of the fastest growing Hispanic

communities in the country. This population has experienced disparities in health outcomes and

diminished ability to access healthcare services. A study was implemented to use key principles

of community-based participatory research to identify how diabetes negatively affects the

Charlestown Hispanic community and develop a community-based intervention that positively

impacts diabetes and improves overall community health (Philis-Tsimikas 2014). Diabetes

education programs that follow the community-based approach aim to improve diabetes self-care

knowledge and management. The intent of this project was to utilize existing evidence to

develop and implement an educational intervention at improving diabetes related outcomes of

this population. Although community-based participatory research has shown to promote

positive health outcomes, there are only a handful of published studies that demonstrate the

practicality of this type of intervention to influence health care outcomes (Philis-Tsimikas 2014).
 4

Another project was completed at a Midwestern migrant clinic that administered a

diabetes education program for its Latino population. The program utilized the use of community

health workers (CHWs). Community health workers are defined as “laypersons with differing

degrees of health-related training who act as cultural mediators between patients, community

resources and the greater healthcare system” (Valen et al. 2012). Today there are an increasing

number of studies attempting to examine the influence of the model among Latinos. The

program wanted to test the hypothesis that a CHW is effective as the type 2 diabetes educator for

Latinos. After 1 year, the research team found that individuals in the intervention experienced

significant diabetes improvement leading them to conclude that CHWs can serve as the primary

patient educator in the absence of a more highly educated personnel (Valen et. al 2012).

Another type of intervention to overcome barriers faced by Latinos involves peer-based

diabetes management. This model is defined as support from a fellow patient who shares the

same condition and thus, shares heuristic knowledge (Philis-Tsimikas et al. 2013). Peer support

provides informational and emotional support. A study implemented a peer support intervention

known as Project Dulce (Sweet Project), which is an American Diabetes Association recognized

care management program in San Diego to improve health and access to care of undeserved

people with type 2 diabetes. This program utilized peer educators that lead weekly two hours

classes and integrated educational content (Philis-Tsimikas et al. 2013) To date, there has been

extensive review evaluating this model that demonstrates its effectiveness on reducing diabetes

health disparities among Latinos.

Conclusion

One potential solution for rapidly improving health outcomes and reducing health

disparities these is the use of community based participatory research to identify and address the
 5

relationship between social determinants and health outcomes and transform those findings into

community-based interventions. The two studies on community-based interventions on the use of

community health workers and peer educators demonstrated two effective approaches in

delivering education for diabetes among the Latino population. The Dulce Project program has

applied a community-based approach, following the model of other successful intervention

programs.
 6

References

Cruz, Y., Hernandez-Lane, ME., Cohello, J.I. et al. (2013). The effectiveness of a community

health program in improving diabetes knowledge in the Hispanic population: Salud y

Bienestar (Health and Wellness). J Community Health 38, 1124–1131. https://doi-

org.ezproxy.csuci.edu/10.1007/s10900-013-9722-9

Dulin, M.F., Tapp, H., Smith, H.A. et al. (2011). A community based participatory approach to

improving health in a Hispanic population. Implementation Sci 6, 38. https://doi-

org.ezproxy.csuci.edu/10.1186/1748-5908-6-38

Dulin, M.F., Tapp, H., Smith, H.A. et al. (2012). A trans-disciplinary approach to the evaluation

of social determinants of health in a Hispanic population. BMC Public Health 12, 769.

https://doi-org.ezproxy.csuci.edu/10.1186/1471-2458-12-769

Guntzviller, L.M., King, A.J., Jensen, J.D. et al. (2017). Self-efficacy, health literacy, and

nutrition and exercise behaviors in a low-income, Hispanic population. J Immigrant

Minority Health 19, 489–493. https://doi-org.ezproxy.csuci.edu/10.1007/s10903-016-

0384-4

Larkey, L. K., Hecht, M. L., Miller, K., & Alatorre, C. (2001). Hispanic cultural norms for

health-seeking behaviors in the face of symptoms. Health education & behavior: the

official publication of the Society for Public Health Education, 28(1), 65–80.

https://doi.org/10.1177/109019810102800107

Philis-Tsimikas, A., Gallo, L.C. (2014) Implementing community-based diabetes programs: the

Scripps Whittier Diabetes Institute Experience. Curr Diab Rep 14, 462. https://doi-

org.ezproxy.csuci.edu/10.1007/s11892-013-0462-0
 7

Valen, M. S., Narayan, S., & Wedeking, L. (2012). An innovative approach to diabetes education

for a Hispanic population utilizing community health workers. Journal of cultural

diversity, 19(1), 10–17.