Building CommunityOwned Diabetes Prevention & Management in Rural Guatemala through International Collaboration Mary Ann Morris, MScN, RN; Jean Charman, RD,CDE Selkirk College
Background Estimated prevalence of diabetes in adults in Guatemala is 10.9%, with fewer than half aware of their disease & only 20% receiving adequate care Limited access to medications, monitoring, & information 66% of Guatemalans live in poverty; 73% of Indigenous population live in poverty, 23% in extreme poverty 36 year civil war in Guatemala from 19601996 Cooperative of Nuevo Horizonte, population of 500, founded in 1998 by excombatants of the URNG following signing of Peace Accords Achievements include: housing, potable water, schools, daycare, economic projects, self governance, greenspace Renewed community focus on health; diabetes identified by membership as a growing concern with request for assistance extended Ten year practice partner relationship between Nuevo Horizonte & UVic/Selkirk College BSN program; recent involvement of certified diabetes educators Professional practice informed by IDF (2011) & WHO (2013) global action plans on diabetes & NCDs
“Health is a human right. This is our collective struggle now.” Figure 1. Mural on women’s coop store – Selkirk College nursing students & local youth, May 2014
Participatory Approach Photo 5. Maynor’s family garden, December 2014
Research Findings
Build on strengths & resources within the community Utilize Guatemala food guide (“family cooking pot”) & locally available foods
May 2014 diabetes & cardiovascular risk screening (N=100)
Support health promoter capacity in diabetes through Train the Trainer model of education Practice popular education with participants as expert, learning as a process of discovery, & social context as pivotal to choice Community controls the research focus, process, and pace = shift in power balance
Figure 2.
Figure 3.
Lifestyle Questions
Orient all initiatives toward social action & community ownership of diabetes as a collective health challenge
Research Questions What is the prevalence of type 2 diabetes & cardiovascular risk in the Cooperative of Nuevo Horizonte?
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Figure 4.
With limited funds & external support can the members of Nuevo Horizonte begin to reduce diabetes incidence, improve management, & develop community ownership?
December 2014 post intervention results (N=20) N= Attended ≥ 1 education session
Variable
N
Test P value
Weight (kg)
20
t test 0.0015
Pre: 69.4 Post: 67.7
Pre: 51.8 93.6 Post: 53.3 93.6
September 2013 April 2014 Community consultation to determine parameters of diabetes program
BMI
20
t test 0.0021
May 2014 Diabetes & cardiovascular risk screening Youth workshop on diabetes, involvement in screening, & creation of mural depicting health as human right
Pre: 30.1 Post: 29.3 Pre: 96.3 Post: 94.2 Pre: 128 Post: 117
Pre: 24.1 36.5 Post: 22.2 35.2 Pre: 85.3 105 Post: 81.1 102 Pre: 110 172 Post: 90 160
Comments: Diastolic BP & FBG – no statistically significant change. A number of people reported behaviour changes, an increase in knowledge and awareness, and more optimism about their health.
Photo 1. Pop & snacks at a local store, photos of the disappeared, emerging typical meal
Timeline
September 2014 Health promoter (HP) training leading to cocreation of 6 diabetes education workshops highlighting shared leadership, peer support, diet, exercise, meds, & stress HP facilitate 2 workshops with people living with diabetes (PLWD) incorporating SMART goals to support behaviour change Primary consultation with PLWD in collaboration with HP Equipo Azucar (Team Sugar) initiate walking program
Waist circ. (cm) 17
t test 0.018
Systolic BP
t test 0.019
20
Comments
15 decreased 2 maintained 3 increased
Wilcoxon rank sum P value 0.005
Figure 6
Progress to date Research results shared with PLWD, community council members, & HP
Photo 3. Health promoter Luvia teaching about diabetes at September workshop 2014
PLWD receiving medical followup & are part of the active peer support group Equipo Azucar 4 people now receiving insulin, others on oral meds
October – December 2014 HP facilitate 4 diabetes education workshops with PLWD Walking program ongoing
Vegetable garden at high school and more family homes Equipo Azucar collectively sharing: purchase of insulin & syringes, medical transportation, glucometer, & proposal development for materials & program support
December 2014 Repeat biometric assessment & primary consultation of PLWD in collaboration with HP; additional screening Meal preparation with PLWD & HP using shared local ingredients Identify barriers to exercise alternatives chosen (dance, women’s soccer)
Next Steps Participate in International Diabetes Day activities Liaise with regional community groups to build awareness & develop networks regarding diabetes prevention Photo 4. Healthy meal preparation in the coop restaurant kitchen using shared local ingredients, December 2014
• Shift roles to share power, knowledge, and experiences • View diabetes as both personal and collective, biological and social • Facilitate opportunities for youth involvement •Create partnerships at local, regional, national, and international levels Photo 2. Equipo Azucar and walking program
Mean Range (95% CI) (pre & post intervention
Carry out screening in surrounding village at request Develop communitybased diabetes prevention & management training centre References Chevalier, J.M & Buckles, D.J. (2013). Participatory action research:Theory and methods for engaged inquiry (2013). London:Routledge Taylor & Francis Group Coop Nuevo Horizonte. (2012) History. Retrieved from http://coopnuevohorizonte.org/en/the-coop/history/ IDF. Spotlight on Guatemala. Retrieved 28 October, 2015 from http://www.idf.org/spotlight-guatemala IDF(2011). Global diabetes action plan 2011-2021 WHO(2013). Global action plan for the prevention and control of noncommunicable diseases 2013-2020 Conflict of Interest Disclosure This poster contains the trade name Coca Cola in a photo. This poster does not cover any unapproved uses of specific drugs, other products or devices.