Sara Hoerlein, BA

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Sara Hoerlein, BA Alyssa Tinley-Doty, MA
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Background

• Rates of type 2 diabetes is increasing, 1 with
  Hispanic Americans having a 3 times higher rate
  than non-Hispanic whites. 2
• Age-adjusted mortality from coronary heart
  disease (CHD) is increasing in women with
  diabetes. 3
• There is a shortage of culturally appropriate CHD
  studies that specifically include Latina/Hispanic
  women,4and participation of Latina/Hispanic women
  in available CHD studies is low.5

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Viva Bien! Background

• 5 yr randomized control study for Latinas based
  on the Mediterranean Lifestyle Program (MLP).
• Funded by NHLBI in partnership with Kaiser
  Permanente and Oregon Research Institute.
• Aim of study To reduce the risk of CHD in
  Latinas with type 2 diabetes through a lifestyle
  behavior change intervention.

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Viva Bien! Background (Cont.)

• 280 women randomized to the study
• 140 control and 140 intervention
• 259 with Kaiser Permanente insurance
• 21 from a community health clinic
• Self-Identified as Latina/Hispanic
• Type 2 diabetes diagnosis
• Ages 35-70 (Average age 58)

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Viva Bien! Background (Cont.)

• Four overlapping waves, each lasting 2 years.
• Two assessments each at baseline, 6, 12 and 24
  months
• Weight/BMI
• Waist and hip measurements
• Blood pressure
• Ankle brachial index
• Surveys
• Blood work looking at hemoglobin A1C,
  cholesterol, triglycerides

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Viva Bien! Background

• Intervention women attend
• 2 ½ day retreat
• Meetings once a week for four hours, decreasing
  in frequency every 6 months.
• Weekly meetings include 1 hour each of
• Physical Activity
• Stress Management
• Potluck
• Social Support
• (Smoking Cessation support given as needed)

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Pilot Data

• 13 Women participated for 3 months
• 70 of the 76 outcomes tested indicated
  improvement
• Increase in fiber consumption
• Decrease in saturated fat consumption
• Decrease in BMI
• Increase in social support received around diet
  and exercise
• 91 of participants reported that they enjoyed
  the program

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Questions

• How can this program be translated into a viable
  community program?
• What has worked in the Viva Bien! program, and
  what has not?

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Methods

• In-depth qualitative interviews with 5 of the 12
  interventionists (majority of whom are bilingual
  and/or bicultural), chosen because of
• Their length of time on the study
• Number of waves they participated in
• Their depth of engagement
• It is important to get the perspective of all of
  the players in the study
• The responses are from the interventionists
  perspectives

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Barriers and Suggestions Structure and Format

• More Variety
• Frequency change
• Length

Time

• Provide taxis
• Location
• Meeting times

Transportation

• More Variety
• Frequency change
• Length
• New Techniques

Components
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Barriers and Suggestions Life gets in the Way

• Social Support Activities
• Problem solving
• Asking for support
• Setting limits

Personal

• On-site childcare
• Hybrid Program

Inclusiveness

• Women
• Potluck food frequency
• Program
• Volunteer staff

Affordability
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Issues and Suggestions Communication and Culture

• Bilingual Staff
• Separate classes

Language

• Appropriate literacy
• Media

Materials

• Assumptions
• Individual/Group
• Common ground
• Promotoras

Culture
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Viva Bien! Positives

• Staff support
• Participants support
• Diet and Social Support
• Single venue for multiple components

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Limitations Further Steps

• The interventionists perspectives are just one
  part of the picture.
• Get participants viewpoints via
• In depth qualitative interviews
• Focus groups
• Study exit surveys
• Viva Bien! is a very resource intensive program
  that may be difficult to disseminate in its
  entirety.

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Questions?

• For further questions please feel free to e-mail
• Alyssa Tinley-Doty
• alyssa.doty_at_kp.org
• Sara Hoerlein
• sara.l.hoerlein_at_kp.org

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References

• Mokdad, A.H., Bowman, B.A., Ford, E.S., Vinicor,
  F., Marks, J.S., Koplan, J.P. (2001). The
  continuing epidemics of obesity and diabetes in
  the United States. Journal of the American
  Medical Association, 286, 1195-1200
• Cowie, C.C. Eberhardt, M.S. (1995).
  Sociodemographic characteristics of persons with
  diabetes. Chapter 6, 85-116 Burke, J.P,
  Williams, K. Gaskill, S.P., Hazuda, H.P.,
  Haffner, S.M., Stern, M.P (1999). Rapid rise
  in the incidence of type 2 diabetes from 1987 to
  1996. Archives of Internal Medicine, 159,
  1450-1456 Mokdad, A.H., Ford, E.S., Bowman,
  B.A., Nelson, D.E., Engelgau, M.M., Vinicor, F.
  et all (2000). Diabetes trends in the US
  1990-1998. Diabetes Care, 23, 1278-1283.
• GU, K., Cowie, C.C., Harris, M.I. (1999).
  Diabetes and decline in heart disease mortality
  in US adults. Journal of the American Medical
  Association, 282, 1132.
• Amaro,, H., de la Torre, A. (2002). Public
  health needs and scientific opportunities in
  research on Latinas. American Journal of Public
  Health, 92, 525-529. Whitfield, K.E., Clark, R.,
  Weidner, G., Anderson, N.B. (2002).
  Sociodemographic diversity and behavior medicine.
  Journal of Consulting and Clinical Psychology,
  70, 463-481 Juarbe,T. C. (1998). Risk factors
  for cardiovascular disease in Latina women.
  Progress in Cardiovascular Nursing, 13, 17-27.
• Brown, S.A., Garcia, A.A., Winchell, M.
  (2002). Reaching underserved populations and
  cultural competence in diabetes education.
  Current Diabetes Reports, 2, 166-176.