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Evidence-Based Disability and Disease Prevention for Elders
Implementing Evidence-Based Models
Lessons Learned in Disease Prevention
Michaela Fogerty, M.S., Diabetes Project Coordinator, Elders in Action, Portland, OR.
Bethea Eichwald, M.S.S., Planner, Planning Department, Philadelphia Corporation for the Aging, Philadelphia, PA.
Nora Barkey, Contract Coordinator, Area Agency on Aging of Western Michigan, Grand Rapids, MI.
Presenters discussed adaptations and lessons learned during the implementation of programs that were based on the Stanford Chronic Disease Self-Management Program. Organizations have found success modifying the program to suit their communities and agree that changing the programs to adapt to cultural differences is often necessary.
What Strategies Successfully Promote Participation of Diverse Populations?
The Kent County Partners on the P.A.T.H. (Personal Action Toward Health) program has used the Stanford Chronic Disease Self-Management Program with diverse populations in Michigan. Initially, many who signed up found the class inconvenient, or forgot to come, so leaders had to think how to keep participants interested.
The Kent County program organizers used a variety of methods to encourage continued participation. To help motivate people to participate in the program, organizers provided medication information, informed the elders' children about the program, incorporated prizes, and emphasized the friendship and social aspects of the program. Participants were also given the flexibility to set their own priorities when developing a self-management program; for example, one person developed an entire program around gardening.
The Stanford Chronic Disease Self-Management Program (CDSMP) has proven successful for white, middle class adults. Harvest Health is an adaptation of the Stanford program administered by the Philadelphia Corporation on Aging (PCA) for older African Americans. The primary modifications to the
CDSMP include discussion of: salty and sweet foods, spirituality, and communicating with a health professional of another race.
Ms. Eichwald described how literacy problems among participants hampered survey data collection. In response, organizers added a seventh class to answer questions and acquire interview-style data, and simplified the language used in the questionnaire.
Ms. Fogerty coordinates the Agency on Aging funded Healthy Changes Program in three Oregon counties. The program is a community-based diabetes education and support group. Much of the area is suburban and rural with low to moderate ethnic diversity; nonetheless, the program has had considerable success in reaching out to people in communities of color.
As Ms. Fogerty noted, lifestyle changes such as improving diet and increasing physical activities can prevent or delay the onset of Type 2 diabetes. Successful prevention programs include both information and behavior change processes. These self-care programs for elders require information, motivating factors, and resources to succeed.
While partly based on the Stanford Model, Healthy Choices differs from the Stanford model in that it is a 26 week, on-going program of one-and-a-half-hour sessions. Leaders have flexibility, and the sessions are not totally scripted. Individuals can join, drop, and re-join as needed. The focus is on physical activity and better nutrition. The program also includes an ombudsman program for groups and for individuals with personal problems (i.e., loss of health care provider, victim of fraud, etc.).
Eighty-one percent of participants were female, and 122 people attended the first session. While some participants attended all 26 sessions, average attendance was 8.7 sessions. Eighty-one percent reported meeting their progress goal, and 93 percent would recommend the program to others.
Healthy Choices identified three factors necessary for successful program implementation:
- Sponsor site capabilities: Sponsors must be "elder friendly," have experience with volunteers, and be able to recruit and supervise group leaders. They also need to be able to recruit target participants and provide staff in support of the program. Sponsors need to provide a comfortable, private meeting room and be able to develop and maintain the partnerships necessary for program implementation.
- Group leaders: Experience leading groups is helpful but not necessary for group leaders. They must have knowledge of diabetes, be seen as a peer of the group they are leading, and be a volunteer, non-professional. Good leaders are personable, not judgmental, and are willing to present the program as developed. Group leaders may not advocate for a belief or a remedy.
- Training of leadership: Leadership training needs to include a basic understanding of diabetes, to acknowledge non-medical program limits, and to utilize the curriculum and the tools of the Leaders Manual. Leaders learn and practice facilitation skills and incorporate community resources, guest speakers, and how to be more culturally relevant.