Johns Hopkins Center for American Indian Health

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Family-based diabetes prevention and management for AI youth

Locations: Chinle, Arizona, Shiprock, New Mexico, Tuba City, Arizona, and Whiteriver, Arizona.

Through its Together on Diabetes initiative, the Johns Hopkins Center for American Indian Health sought to address the urgent need for American Indian youth-focused, culturally-appropriate diabetes care and improve health outcomes within four communities: 1) Chinle, Arizona, 2) Shiprock, New Mexico, 3) Tuba City, Arizona, and 4) Whiteriver, Arizona. American Indian Family Health Coaches delivered one-on-one, in-home lessons to youth participants, along with the youth’s support person, usually a family member. The support person’s task was to help reinforce behavior change and enhance communication between the diabetes team and the youth participant’s family.

Context

Current incidence rates of diabetes among this group are up to 9 times that of other racial ethnic groups. While American Indian youth have the highest and fastest growing prevalence of type 2 diabetes of any racial group in the US, the number of diabetes programs that have been designed specifically for American Indian youth is extremely limited. Drawing on a long history of partnerships with the Indian Health Service (IHS) and tribal programs, JHCAIH selected four tribal communities for project implementation. The partner communities included:

  • Chinle, Arizona (Navajo; population 17,000)
  • Shiprock, New Mexico (Navajo; population 45,000)
  • Tuba City, Arizona (Navajo; population 15,000)
  • Whiteriver, Arizona (Apache; population 15,500)

Action

The Johns Hopkins Center for American Indian Health with local partners implemented a diabetes intervention at the individual, familial, and community levels within four sites. This intervention included a structured diabetes self-management education curriculum, enhanced support and access to diabetes care, and community outreach.

Learnings

The JHCAIH Together on Diabetes pilot project identified several important learnings.

  • The Family Health Coach model was successful in reducing A1C among those youth with Baseline values >7, as well as several other clinical outcomes (i.e., BMI and BP).
  • Family involvement is key, while also challenging and means different things for each family
  • Different intervention is content needed for younger and older age groups
  • Family and environmental strengths and stressors must be considered