Educating vulnerable populations about diabetes

Health care worker educating a patient with diabetes about nutrition.
Health care worker educating a patient with diabetes about nutrition.

Even in the best situations, educating patients about diabetes can be a challenge. But for clinicians providing health care for vulnerable populations, such as low-income patients, ethnic minorities or immigrants who speak little English, the process is even more daunting.

Health care practitioners may need to navigate language barriers, cultural differences and health-literacy challenges to effectively educate patients.

And the stakes are high when it comes to getting the message across. Diabetes is the seventh leading cause of death in the United States, killing more people each year than AIDS and breast cancer combined, according to the American Diabetes Association1. Complications include heart disease and stroke, vision problems and nerve damage that can lead to amputation.

Diabetes disparities

More than 20.8 million Americans have diabetes, and an additional 6.2 million are not aware that they have the disease. Furthermore, diabetes health risks were not created equally, as the disease disproportionately affects racial and ethnic minorities.

Figures from the U.S. Department of Health and Human Service's National Diabetes Education Program2 indicate that 10% of non-Hispanic whites aged 20 years or older have diabetes compared with:

  • 15% percent of all non-Hispanic blacks
  • 10.5% percent of Hispanics
  • 8.2% percent of Cubans
  • 11.9% percent for Mexican Americans
  • 12.6% percent for Puerto Ricans
  • More than 16% of American Indians and Alaska natives.

Other data show that Hispanic people who live along the U.S.-Mexico border are nearly twice as likely to have diabetes compared with non-Hispanic whites. Similarly, non-Hispanic blacks aged older than 20 years are 1.8 times more likely to have diabetes than non-Hispanic whites of the same age.

And when minorities have diabetes, they often suffer worse outcomes. Hispanics are more likely to have end-stage renal disease and are 50% more likely to die from their diabetes, according to the CDC's Prevention Research Center.3

Complications from uncontrolled diabetes can often be avoided with effective disease is management, but a patient can only manage their disease properly if they understand it.

Luckily, clinicians seeking educational materials for minorities and low-income groups can find plenty of diabetes information online from the National Institutes of Health, the CDC and the National Diabetes Education Program.

But truly educating vulnerable groups is not as easy as handing a patient a brochure and shuffling them out the door. These groups face a number of barriers that can prevent them from getting the care and treatment that they need, so practitioners should take a multi-pronged approach when it comes to diabetes education.

Overcoming language barriers

Patients cannot be expected to understand the complexities of diabetes if health information is provided to them in a language that is not their native tongue. Therefore, clinicians should provide translation services to these patients, or make sure that a family member is present to translate.

A certified patient navigator may also be helpful. These individuals help teach patients about chronic diseases, including diabetes, and guide patients to seek recommended screenings and treatment, according to the U.S. Health Resources and Services Administration. Navigators can also assist people in finding and using community services that offer additional support. Although translators and bilingual staff members were helpful, results of a study published in Diabetes Care4 revealed that those services were not enough to ensure that patients understood their condition.

But data from the Joslin Diabetes Center in Boston revealed that supplementing verbal instructions with educational pamphlets written in a patient's native language effectively helped improve disease understanding and blood glucose control. Clinicians looking for materials that have already been translated can find pamphlets written in at least 18 different languages at the National Diabetes Education Program website.

Maintaining culturally sensitivity

If low-income or minority patients do not see themselves reflected in information provided, they may be less likely to heed its message. Working with local cultural organizations to tailor educational messages can help health care providers overcome these barriers and create targeted messages.

Researchers from the CDC's Prevention Research Center collaborated with the Navajo Area Agency on Aging, the Indian Health Service, tribal health educators, and other community and service organizations to develop materials for older Navajo Native Americans aimed at helping them improve their health.

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