Diabetes prevalence among Latino families/vulnerable populations
Hispanic/Latino Americans are a diverse group that includes people of various cultures and races. Hispanics are the largest minority in the United States and have higher rates of diabetes in both adults and children as compared to other racial/ethnic groups. (1) Latinos are among the fastest growing groups in the United States and, yet, as a whole have low access to medical care and poor general health partly due to sociocultural factors related to economic status. Adults in the United States have a 40 percent chance of developing type 2 diabetes as compared to the 50 percent chance of Hispanic and Latino adults causing higher rates of diabetes-related complications such as kidney failure and vision loss. Hispanics/Latinos are most prevalent to diabetes which can be linked to their cultural values, food, genetics, education levels, and social support systems. (2)
Healthy Eating Plate for Hispanic/Latino Diabetes Prevention
Food used in celebrations of Hispanic/Latino culture is usually high in fat and calories and consumed late at night, which can be a factor for weight gain. In the Latino culture, when someone visits their home, they usually offer food or snacks and turning down food can be seen as an insult.
HEBNI Nutrition Consultants, Inc. in partnership with MHP Salud have created Sabor y Salud, Mexican Hispanic Edition, a resource for Hispanic/Latinos to learn about best practices when choosing to eat heathier. This brochure was designed to help Hispanic/ Latino communities build nutritious plates with familiar fresh foods. Inside you will find information on portion sizes, nutrition facts and tips to help individuals adopt healthier eating habits. The brochure teaches easy ways to read food labels by breaking down the nutrition facts section into easy-to-read parts. Also included in the brochure are different food suggestions for each of the five sections of the plate: grains, breads, cereals, proteins, vegetables, fruits, and dairy. The brochure includes relatable ways to manage and measure portions when building a healthy plate. This resource is available on the MHP Salud webpage for download. (3)
Community Health Worker (CHW) Interventions Addressing Diabetes Prevention
CHWs are trusted members of the community and work in both clinical and non-clinical settings. CHWs provide the community with health education and referrals to health and social services. CHWs meet participants where they are and know how to find hard to reach Hispanic/Latino participants as they are from the same community they serve. CHWs can address diabetes within their communities as they speak the same language and take the time to meet with participants and their families. While their primary role is often linking vulnerable populations to the health system, CHWs may assist in other roles. These can range from cultural mediation, culturally appropriate education, care coordination, case management, systems navigation, coaching and social support, advocacy, capacity building, and outreach. Through these roles, CHWs offer support to patients with diabetes and those at risk of developing diabetes in a unique culturally appropriate manner. (4)
Using a Family Centered Approach to Promote Healthy Life Changes
Vivir una Vida Plena (Living a Fulfilling Life) (VUVP) is a program dedicated to promoting the adoption of a healthy lifestyle among individuals at high risk for or diagnosed with the early stages of chronic diabetic kidney disease (CDKD). MHP Salud in partnership with Blue Closs Blue Shield of Texas works with the Latino community to educate and promote health through this program. Vivir una Vida Plena uses a participant-centered approach that provides education, support and skill building to help participants live healthier lives. CHWs at MHP Salud enroll program participants via door-to-door outreach in predominantly Latino/Hispanic neighborhoods. Participants are linked to clinical partners and receive a free lab test to determine their risk for or if they are diagnosed with early stage of CDKD. Participants are screened for their risk of diabetes and then enrolled in disease self-management education classes led by CHWs.
These classes consist of six weekly sessions, where participants learn how to manage CDKD. Throughout the classes, CHWs will share practical tips, suggestions, and strategies to build confidence in managing chronic illness and symptoms, such as fatigue, pain, shortness of breath, disability, and depression. The six sessions consist of the following topics: Diabetes and Hypertension, Healthy Eating, Recipes, Physical Activity and its benefits, Stress Management and Relapse. Participants will have their blood pressure, weight, and BMI calculated at session one and then again at session six.
Additionally, CHWs will promote action planning and goal setting techniques to help participants achieve a healthier lifestyle. Upon completion, CHWs follow up with participants to ensure they have access to the resources they need. (i.e., medical assistance programs, health insurance, and specialist visits). MHP Salud’s CHWs also encourage participants to attend a free follow-up lab screening with clinical partners and incorporate program topics into their daily life. (5)
Hispanic/Latinos are known for strong family connections and sharing meals together so when a member of the family must change what/how he or she eats for their diabetes management, this can affect the whole family. CHWs at MHP Salud encourage the whole family unit in their weekly sessions to promote the most effective outcome for participants. CHWs incorporate the “healthy plate” to teach participants about portion sizes, carbohydrates, fats, dairy, proteins, and what foods can go within the healthy plate.
In the recipe session in the VUVP program, participants can interchange their own healthy recipes with other participants. “In one session, participants shared how they replace lard (manteca) with olive oil when preparing the dough (masa) for tamales”- Elida Perez. Elida also shared how the participants learn the importance of knowing what they can eat and when to eat it as the time of consumption is very important when taking medications for diabetes management. Healthy eating can be achieved when the participants understand the components to make a healthy plate with food they like, have access to, and can afford. (4)
The VUVP program goes over the benefits of physical activity to diabetes management in their sessions with participants. CHWs can suggest physical activity to participants such as 30 minutes of walking which the whole family can participate in. However, participants should follow doctors’ orders on physical activity as well as their physical capabilities. According to the National Institute of Diabetes and Digestive and Kidney Diseases, 150 minutes or more of exercise per week can help a person delay, prevent, or manage diabetes. Exercise is most important when managing diabetes as cells can take up glucose and use it for energy whether insulin is available or not. Also, losing weight and getting exercise regularly are good ways to delay or prevent diabetes. (6)
Challenges and barriers
Like all programs, VUVP has faced some challenges and barriers due to the pandemic such as the fear of participating in group sessions. Transportation to and from clinic lab appointments and to the sessions has also been a barrier for some participants. Other challenges participants have faced is making changes that affect the whole family as members of the family that do not have diabetes are often reluctant to change.
My work as a CHW in the program Vivir Una Vida Plena plays a big role in the lives of my participants. When the participants first join the program, I can see they are lost and do not know how to manage their diabetes diagnosis or where to even begin with their diabetes management. After attending our program, I see the change in the participants’ motivation to make lifestyle changes. It is very satisfying to see their growth as they incorporate what we have gone over in our sessions such as nutrition, stress management and physical activity. – Elida Perez, CHW at MHP Salud.
This publication is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of awards as follow: Health Outreach Partners (HOP) National Training & Technical Assistance National Cooperative Agreement totaling $847,285.00 with 0 percent financed with non-governmental sources and MHP Salud National Training & Technical Assistance Cooperative Agreement totaling $678,959.00 with 0 percent financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the U.S. Government. For more information, visit www.HRSA.gov.