The epidemic of type 2 diabetes in the United States seems so widespread, so intractable, that only big solutions can make a difference. It feels like we need massive prime-time education campaigns, public fitness initiatives and diet counseling in every school cafeteria and dormitory. And yet for a disease that’s so closely tied to individual lifestyles, access to care and cultural norms about diet, a one-size-fits-all solution probably isn’t going to make a difference. To bring the challenge of addressing type 2 diabetes down to scale, one researcher is doing the opposite and taking the hyperlocal approach.
Arshiya Baig, MD, MPH, assistant professor of medicine, studies disparities in diabetes care, specifically in the Chicago Latino community. In the United States, Latinos are about twice as likely to have type 2 diabetes as non-Hispanic whites. Instead of trying to develop a broad educational program driven by medical professionals, she looked to the support networks already in place to create peer-based focus groups to help Latinos cope with the daily challenges of diabetes.
“The interest is not in actually replacing the medical care with these peer interventions, but more as a supplement,” she said.
The idea of this peer-group approach is that Latinos—or people from any cultural group—may identify more with others like them, who speak the same language, live in the same neighborhoods and go to the same grocery stores and pharmacies.
“Latinos tend to have a lot of barriers to care. One is language. Other factors physicians need to consider include knowing patients’ cultural beliefs and traditions, the foods that they eat, the use of folk remedies and the importance of family, their interaction with the healthcare system, as well as how they perceive the physician patient relationship,” Baig said. “We thought that working with peers from the community who know a lot of these cultural nuances would be able to help others within their community to improve their diabetes management.”
In a recent paper published in The Diabetes Educator, Baig and her colleagues described the findings from focus groups they held at two predominantly Mexican American churches in the South Lawndale/Little Village neighborhood of Chicago as they were designing their intervention programs. Most of the participants preferred group-based intervention to one-on-one counseling on the phone, citing personalismo, or a desire for a formal friendliness with others. While some of them ended up exchanging contact information with others later, they preferred that these relationships arise naturally as opposed to being created formally for an intervention program.
Baig developed a pilot program based on the peer group model called Picture Good Health/Imagínate una Buena Salud, where members of the group use pictures from their neighborhood and personal lives to trigger discussions about their daily challenges with diabetes. The program was a huge success. “I was really impressed by the openness that people felt among strangers in this group, to share something so deep,” Baig told Rob Mitchum last October when he wrote about the project. But what worked this time in Little Village may not work everywhere, even in the same city.
Baig stresses the importance of tailoring this kind of intervention at a very local level. One neighborhood might have a Dominick’s or Jewel well-stocked with fresh produce, while the closest grocery store may be miles away from another. Things may vary within different cultural subgroups as well.
“There may be other resources within the Puerto Rican community on the north side of Chicago, for instance. The foods are very different between Mexican and Puerto Rican cultures. The access to food is very different in those two neighborhoods, perhaps. Those are considerations that go into making sure you culturally tailor any intervention,” she said.
When I asked whether or not it was frustrating that she couldn’t use the same program in multiple communities, she said, “I think the fact that our project is local, it’s more relevant. By using local resources it may actually be cost saving in some sense and sustainable. I actually think that’s a strength of our intervention.”
It would be nice if we could apply one solution to tackle the challenge of type 2 diabetes in every community. But sometimes the best way to solve a problem is right next door.
Baig AA, Locklin CA, Wilkes AE, Oborski DD, Acevedo JC, Gorawara-Bhat R, Quinn MT, Burnet DL, & Chin MH (2012). “One Can Learn From Other People’s Experiences”: Latino Adults’ Preferences for Peer-Based Diabetes Interventions. The Diabetes educator, 38 (5), 733-41 PMID: 22914046