NORTH LAWNDALE DIABETES COMMUNITY ACTION PROJECT -
DESCRIPTION (provided by applicant): The North Lawndale Diabetes Community Action Project addresses Challenge Area Comparative Effectiveness Research and the specific Challenge Topic 05-MD-102 Prevention of Chronic Diseases in Disparity Populations. The Sinai Urban Health Institute, Sinai Health Systems, Rush University Medical Center and a community based organization (Family Focus North Lawndale) are proposing to develop and deliver a multi- level community intervention using a media campaign, community engagement, and individual self- management training by "Diabetes Block Captains (DBC)" in a very poor African American community on the west side of Chicago. Neighborhood residents working as DBCs will conduct household screenings for diabetes and then will engage their neighbors in activities that promote diabetes self-management. This Community Based Participatory Research (CBPR) approach seeks to support residents in changing the culture within the target community, to make diabetes a neighborhood priority, and to address the cultural and social environment to support healthier lifestyles. This is a collaborative research approach, drawing on the strengths of several partners and incorporating full and meaningful participation by the community. Our goal is to survey 2,500 persons in the neighborhood identifying persons with both confirmed diabetes status and those at high risk for the chronic disease over a 12-week recruitment period, with the intention of completing an entire 12-month intervention with 280 enrolled participants. DBCs will make 4 home visits over the course of the intervention, during which they will develop comprehensive action plans to improve diabetes self-management. Our primary aim is to determine whether a multi-level community intervention, featuring an educational campaign, community engagement, and individual self-management training by a "Diabetes Block Captain" will result in a mean reduction of HbA1c greater than 0.5 among persons with type 2 diabetes mellitus living in a medically underserved urban neighborhood. Our 2 secondary goals are to a) demonstrate the cost-effectiveness of a multi-level community intervention resulting from significant improvements in rates of diabetes self-management behaviors among persons with type 2 diabetes mellitus; and b) determine whether this multi-level community intervention can improve early detection of diabetes in a medically underserved urban neighborhood by increasing the number of persons diagnosed by at least 25 percent over a one-year period. Evaluation activities will focus on documenting the process of the intervention and the associated outcomes (effectiveness). Outcomes will be evaluated using a treatment-only quasi-experimental design in which the primary aim will be evaluated by a within-subject comparison of HbA1C, a marker of blood glucose control and demonstrated predictor of diabetes complications and mortality, between baseline and 2 follow-up testing periods. Self-management will be documented by use of the Summary of Diabetes Self-Care Activities measure (SDSCA), a validated instrument assessing general diet, specific diet, exercise, blood-glucose testing, foot care, and smoking behaviors. It will be administered at baseline and 1-yr anniversary follow-up. Poor self-management behaviors often lead to increased numbers of diabetes related hospitalizations and emergency room visits. We will assess whether the intervention has helped reduce costs associated with these chronic disease experiences. Monitoring of the process is particularly important as it will allow for an assessment of the intervention's translatability, documenting the successes and challenges of implementing the program within the target community, and paving the way for the translation of the initiative to other populations. Qualitative methods will supplement quantitative data collection in better documenting issues related to translatability, assessing both community strengths which facilitate implementation and challenges that impede upon it, and the process of addressing any barriers. The study has more than adequate power to detect effect sizes that are clinically meaningful. Substantial attention will be paid to matters of fidelity, uptake and other issues that will influence translatability. The project seeks to maximize the resources which will remain in the community at the end of the study. This includes the continued development of expertise in solving other health problems of the community. The public health relevance is that through this collaborative approach and implementation of an evidence-based intervention it is believed that the North Lawndale Community Action Project will significantly influence diabetes health disparities, ultimately helping to improve health equity. It is estimated that the direct medical care costs per person per year with diabetes is 2.3 times higher than for the person without diabetes. This Community Based Participatory Research (CBPR) approach seeks to support residents in changing the culture within the target community, to make diabetes a neighborhood priority, and to address the cultural and social environment to support healthier lifestyles. The public health relevance is that through this collaborative approach and implementation of an evidence-based intervention it is believed that the North Lawndale Community Action Project will significantly influence diabetes health disparities, ultimately helping to improve health equity.
