Promotores-Focused Screening and Education to Improve Diabetes Awareness and Self-Care in Low-Income Latino Intergenerational Families

Jerome Seliger
Audrey L. Simons
Carl A. Maida

DOI: 10.2190/SH.5.3.c


Project ALTO-D (Alert Latinos To Overcome Diabetes), a 3-year capacity building and demonstration project, targeted low-income Latino American and Latino immigrant adults and intergenerational families at high-risk for or living with type 2 diabetes. The project took place in a 9-square-mile medium-high density urban area with a population of about 300,000 in the northeast San Fernando Valley of Los Angeles, California. Project ALTO-D screened anyone 18 and older voluntarily presenting at screening venues (churches, parent centers at area elementary schools, and parks). Promotores de Salud ("health promoters") provided post-screening assistance and invited those screened to participate in the primary intervention: Project ALTO-D screened 2,240 participants for diabetes and Promotores provided accompanied referral and case management assistance to 537 (70%) of 765 participants found by the screening to have non-fasting blood glucose levels of 120 and above. A total of 737 persons participated in the Project-developed and-sponsored 16-hour Estilo de Vida Saludable con Diabetes (EVS) ("Healthier Lifestyles with Diabetes") course. Of those 265 persons completing 12 hours or more in the EVS course, self-reported blood glucose levels averaged 42% lower than when they joined the class. Forty-five percent of course participants reported adopting two or more healthy-lifestyle changes as a result of participation. Education and coaching are keys to addressing the enormous gap in knowledge about the mechanisms of diabetes prevention and self-care within the target population, including accessing appropriate medical care. Although we had planned to follow-up all participants completing 12-16 hours of the EVS class to track changes in blood glucose levels and adoption of one or more lifestyle changes for 12 months, the reality was that budget constraints limited follow-up to 30% of them. Follow-up consisted of monthly telephone interviews, in-home visiting and small group meetings. Because persons receiving follow-up were self-selected, the follow-up population was not entirely representative of the project population. Follow-up contacts with individual participants by telephone or in person ranged from 4-14 times.

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