This document is made available electronically by the Minnesota Legislative Reference Library as part of an ongoing digital archiving project. http://www.leg.state.mn.us/lrl/lrl.asp To receive a copy of this report, or for more in£OrnlatllOu" pI, Department of Health at phone number: (651)215-5800 Minnesota Diabetes Control Program in the Center for Health. (TDD number:(6l2)676-5522). Upon request, this publication cim be made available in altl~rn:ath'e t()rmlats large print Dr au<;liotape. This project was funded through Cooperative a,gt,eerrlent rrUJk/v"--,UJ'VV.J':t Centers for Disease Control and Prevention (CDC) DejJartnieltlt Diabetes Control Program. This report was 3v1lilahle its entirety in portable downloadable format on the http://www.health.state.mn.us/divs/voices Printed on recycled paper, with a minimum of 10 Minnesota Diabetes Control Program Center for Health Promotion Family Health Division Minnesota Department ofHealth 717 SE Delaware St., PO Box 9441, Mpls,MN 55440-9441 • • • Preface JtJN 03 1999 H'~'!'''_A II~t klJtj\t.i'~LL UBRAHY • Diabetes and its complications o.ccu.r among Americ~nsof ~I~¥~~'~l~~~~[~~~~~fj~nd •,. ethnic groups. The burden ofthIs dIsease, however, IS heaVIer amonge1derly Americans and certain racial and ethnic populations, especially for people that have • lowerincomes,education levels, and social class. i In response to this critical public health issue, the MinnesotaDepartment of Health's • , Minnesota Diabetes Control Program is working to engage local communities and •,. health care systems in developing a state plan to improve diabetes education and health care services for people of color in Minnesota. To initiate this process, in March 1997, the Diabetes Control Program sponsored 12 focus groups with African • American, American Indian, Hispanic and Hmong (Southeast Asian) people with diabetes in Minneapolis and St. Paul. Partieipants,described their experiences with • diabetes and identified strategies to address diabetes within the health care system and • in their local communities. • The focus group results showed that many participants felt people from their' communities were healthier before they adopted modern American life-styles, - includinghigh fat diet and reduced physicalactivity. They also indicated a strong I need for improved diabetes education and support, and had difficulty translating diabetes concepts from the medical health care system into their cultures. Those that were most satisfied indicated that they received culturally-specific education from respectful, knowledgeable health care providers. This focus·group report summarizes recommendations from the focus group particip~nts. They suggest methods for improving diabetes education and health care "qualityby enhancing cultural competellcy andcommunity action. These recollllllendations will be shared and discussedwith health care providers and communityleaders and then iritegratedintoa state plan of action for improving diabete,s educationand health caresetvicesfor people of color in Minnesota. The plan will be developed and implemented through a collaborative effort between people with diabetes,communityorganizations,health care systems, The Minnesota piabetes ControlProgram, and others who are interested in promoting the health and 'Well-beingof ethnically and racially diverse populations in Minnesota. '.'Those who suffer losses due to diabetes are notjust statistics on a chart. They are people whose.talentsand wisdom are, needed andwhose problems deserve our unified efforts. ]'ogetherwe can join to make life more just and more joyfulfor generations to come." David Satcher, MD, PhD uS Surgeon{}eneral (Formerly Director, Centers for Disease Control and Prevention) Voices From the Community 1 Minnesota Diabetes Control Program Acknowledgments Thank You to All Who Helped Thanks to. all who made this project possible. The following individuals and organizations contributed their expertise, time and resources. We would especially like to thank those individuals who participated in the 12 focus groups. Without their trust, honesty and willingness to share their personal wisdom and experiences with diabetes, . this report would not exist. Focus Group Moderators: Focus Group Assistant Moderators: Doreen Kloehn Doreen Kloehn Angela Lopez YerMoua Trudell Starr Penny Thompson Rev. Thomas Van Leer Focus Group Consultants: Blong Xiong Richard Krueger Mary Anne Casey Community Organizations and Individuals: American Indian Indian Health Board North End Medical Center Family Center Sue Hibbs Nancy Briggs Mary Rose Dr. Harris Naseem Centro Cultural Chicano Lao Family Phillips-Powderhorn Tyrone Gu;zman, Community, Inc. Cultural Wellness Center Lilian Villarreal Mary Azzahir CLUES Senior Program LINKS Pilot City Health Center Shahla Grabow Jeannette Taylor Jones Jan Eide Family Medical Center Martin LutherKing Ramsey Action Programs Ina Erickson Center Senior Nutrition Dorothea Burns Verlene Booker Greater Minneapolis Mmneapolis American St. Paul Black Council of Churches Indian Center Ministerial Alliance Adeline Goodman Green'Central Minnesota Department St. Paul-Ramsey COIll111unity Clinic of Health County Public Health Carmen Suarez' Midtown COIll111ons Ramona Allard-Hendren Jessie Saavedra Lisa Marshall He*nepin County Model Cities St. Paul-Ramsey ¥~dicalCenter, Health Center, Inc. Medical Center Diabetes Center DeuYang ChueXiong Joy l,angley Janet Howard MouaLee Dr. Mehmood Khan Dori,i Gbolo Hennepin County Neighborhood House West Side Community Medical Center Sandy Fuller Health Center Medicine Clinic Rochelle Mercado Sara Hyland Geneva Lawrence Voices From the Community 3 Minnesota Diabetes Control Program • • Cardioygscular Disease Implementation Work Group .. (A Subcommittee Of the. Minnesota Diabetes Steering Committee) • Barbara Barry, RD; MS, CDE Jody Jones, RN Pat Steig • formerly of Diabetes N~rseSpecialist American Heart Association International Diabetes.Centet International Diabetes Center Minnesota Affiliate •~ Scott Franzmeier Carol Lange, RD . Robert Straka, Pharm.D. for111erlyof fonnerlyOf Clinical Pharmacist • American biabetes Association Diabetes Tteatment Center Section of Clinical Pharmacy • Minnesota Affiliate DnitedHospital St. Paul-Ramsey Medical • Center Christine. Jones • Dh'ector ofCommunity i.":'" ., Site Programs • American Heart Association • Minnesota Affiliate • • Focus Group Project Staff • Minnesota Diabetes Control Program " .. ..- •.. Amy Okaya, MPH Martha Roberts, MPH YerMoua .. Acting Core Grant Coordinator Health Educator III Student Worker , =• MinnesotaDiabetes Control Program -­ Minnesota Department.of Health •~ Jim Bluhm, MPH Cynthia Clark, MA Don Bishop, PhD MDCP Coordinator CDC Public Health Advisor Chief • Center for Health Promotion • Jay Desai, MPH Laurel Reger, MBA Sue Lasch, RN, NP-C • Senior Epidemiologist Quality ImprovementSpecialist CQIlHealth Systems Consultant • Anne Kollmeyer, MPH, RD Martha Roberts, MPH John Sonnek, BFA WOLF Project Health Educator III Graphic Designer •,. Coordinator/ Nutritionist Chrystina Xiong ; Clerk Typist Layout, Cover and Page Design: John Sonnek, BFA, Center for Health Promotion, MDH ; Layout: Michele Thieman, Center for Health Promotion, MDH • Proofreading: Mari Mitchell, Center for Health Promotion, MDH • Voices From the Community 5 .'• Minnesota Diabetes Control Program ..~~~<~~«~<~~~"<~ «~<~ < ~~~ •... Table of Contents =It Executive Summary 00000000000000000000000000 9 Project Overview 00000000000000000000000000000 13 Common Themes 0000000000000000 '0 00 0 0 0 0 0 0 0 0 0 0 15 Community Profiles It African American 0 0 0 0 00 00000000000000 00 0 0 27 • American Indian 0 00 000000000000000000000 31 o .. HIspanlc0 . ''", ',' . 35 .. Hmong , ,'.' ..' ' '. ... .. 39 Focus Group Recommendations 00 00000000000000 43 • Appendices •.. Appendix A: ,. 0 0 0 00 0 0 0 0 0 0 0 0 0 Diabetes Focus Group Questions 47 Appel1dixB: Questions Focus Group Participants Had ~~ = about Diabetes • 0 •• 0 •• 00•0000000000•0000000 49 Appendix C: AdditionalResources. 0 ••••••••• 0•0000000•0•0 51 VoicesFrom ti,e Community 7 Minnesota Diabetes Control Program • •! E~e~~ti~~~p~!J.lary • Common Themes • _.. - • VVl1afPartidpantsExperience • • Most patticipants knewdiet, exercise, glucosemonitoring,andregular doctor • visits were important, though malting dietary changes was difficult for many people. • + S0111edid not receive adequate or accurate information about diabetes and proper • self-care from their health care providers. • Participants'experiences with providers differed greatly, depending onthe provider's degree of respect, concern, knowledge about diabetes and cllltural sensitivity. • .• People often lacked economic resources, health insurance,and transportation, which •~ hindeted them from obtaining medical care, healthy food and medicine. • How Participants Feel • • People with diabetes often felt self-conscious, misunderstood, isolated and depressed. ,. At times, people felt they wererestricted access to quality health care and other • resources'because of their ethnicity. ~ People felt theil· communities were healthier before they were affected by modern ~ Amedcan'life-styles and diet. ,. • Some mistmsted western medical providers and the government to act in their best interests. ,.­ How Participants Manage ,. • Many adopted a positive attitude and became more health conscious as a result of having ­ diabetes, including making changes in diet, exercise and stress management. ~ • .-Some gained strength from their sense of spirituality. ~ •