Utilization of Spanish Medical Interpreters for Diabetes Education in a Community Health Center

 

 

 

 

 

Utilization of Spanish Medical Interpreters for Diabetes Education in a Community Health Center

 

 

Mariah Scheker, DNP Candidate, AGPCNP-BC

Purdue University School of Nursing

NUR 689: DNP Project II

Co-Chairs: Dr. Edwards & Dr. Gallegos

June 30, 2021

 

 

 

 

 

Executive Summary Draft

Problem Statement and Significance

The burden of diabetes is disproportionately higher among the Hispanic population in the U.S., as more than 12.5 % are diagnosed with diabetes compared to 7.5% of non-Hispanic whites (Center for Disease Control and Prevention [CDC], 2020; U.S. Census Bureau, 2019). In addition to being at greater risk for developing diabetes type 2, Hispanics are also more likely to develop diabetes type 2 at a younger age and more likely to experience complications from diabetes when compared to non-Hispanic whites (CDC, 2020). Social determinants of health (SDOH), such as lower than average incomes and high uninsured rates, adversely impacting their ability to access and afford primary health care services (U.S. Census Bureau, 2018). Aside from having genetic, environmental, socioeconomic, and lifestyle risk factors for diabetes, many Hispanics living in the U.S. encounter language barriers and lack access to culturally sensitive diabetes education (Aguayo-Mazzucato et al., 2019). The language barrier and lack of culturally sensitive education often prevent individuals from asking questions, understanding medical instructions or educational materials, and establishing relationships with health care providers.

Recent evidence-based approaches aimed to reduce these health disparities include the use of Community Health Workers (CHWs) or promotores (the Spanish word for health promoters). The American Diabetes Association (ADA, 2021) advocates for the use of CHWs in cost-effective, patient-centered strategies to improve outcomes and reduce risks of diabetes in underserved communities. Utilization of CHWs for diabetes education is vital to disseminating diabetes self-management education and support (DSMES) to the community, as there is estimated to be only one diabetes educator for at least 1000 people living with diabetes in the U.S. (American Association of Diabetes Educators [AADE], 2017). Based on a review of literature conducted in September 2020, CHWs can be instrumental in improving diabetes outcomes among Hispanic adults in the United States (Aponte et al., 2017; Carrasquillo et al., 2017; Hughes et al., 2016; Kane et al., 2016; Perez-Escamilla et al., 2015; Spencer et al., 2018). Besides lowering hemoglobin A1C (HbA1C), CHW-led diabetes programs were also found to improve diabetes knowledge (Aponte et al., 2017; Kane et al., 2016), blood pressure (Kane et al., 2016), fasting glucose (Perez-Escamilla et al., 2015), quality of life scores (Kane et al., 2016), and diabetes distress and depression scores (Hughes et al., 2016; Spencer et al., 2018). The CHWs in these studies were extensively trained, between 90-160 hours, and they led intensive diabetes education programs, including house visits, phone calls, or meetings at a clinic. Sustainability after the intervention ended (Aponte et al., 2017; Carrasquillo et al., 2017) and reimbursement were the most common concerns mentioned in these studies (Kane et al., 2016; Spencer et al., 2018). There was no evidence in the research that discussed the possibility of providing low-intensity training of diabetes to current Spanish medical interpreters in a public health or clinic setting.

In June 2020, Riggs Community Health Center (CHC) developed a Diabetes Care Management (DCM) program to provide greater assistance and support to their patients with uncontrolled diabetes. At the time, about 500 of their established patients had uncontrolled diabetes with HbA1C greater than or equal to 8.0%. Since there is no bilingual nurse at Riggs CHC, 159 of those Spanish-speaking patients were not initially included in the DCM program. The purpose of this DNP project was to train the Spanish-medical interpreters employed by Riggs CHC in the basics of diabetes management to be utilized as modified CHWs or promotores. A secondary aim was to analyze the preliminary effects on the HbA1C of the contacted patients once they had been included in the DCM program.

Methodology

Phase 1: Training of the Interpreters to be Promotores

Sample and Design. Following institutional review board (IRB) approval, the interpreters at Riggs CHC received three-one-hour training sessions provided by this DNP project author, a bilingual regist

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