Taking a broad approach to public health program adaptation: adapting a family-based diabetes education program.

Diabetes health disparities among Hispanic populations have been countered with federally funded health promotion and disease prevention programs. Dissemination has focused on program adaptation to local cultural contexts for greater acceptability and sustainability. Taking a broader approach and drawing on our experience in Mexican American communities at the U.S.-Mexico Border, we demonstrate how interventions are adapted at the intersection of multiple cultural contexts: the populations targeted, the community- and university-based entities designing and implementing interventions, and the field team delivering the materials. Program adaptation involves negotiations between representatives of all contexts and is imperative in promoting local ownership and program sustainability.

The impact of promotoras on social support and glycemic control among members of a farmworker community on the US-Mexico border.

PURPOSE: The purpose of this study is to describe the effect of a promotora-driven intervention to build social support as a means to affect self-management behaviors and clinical outcomes in a farmworker community on the US-Mexico border. METHODS: Promotoras implemented a community-based intervention that included support groups, home/hospital visits, telephone support, and advocacy to people with diabetes. A 12-month pre/post study design was used to investigate the relationship between promotora contact, perceived support, and clinical outcomes. Clinical data were gathered from 70 participants during routine physician visits. A pre/post questionnaire was used to measure perceived support and self-management practices. RESULTS: Glycosylated hemoglobin (HbA1c) levels decreased 1% among high-risk participants. Improved HbA1c level was associated with promotora advocacy and participation in promotora-led support groups. Participants reported increased support from family and friends and more comfort speaking about diabetes (la enfermedad) with family and friends. CONCLUSIONS: These findings document improvement in both clinical and social health indicators for Mexican Americans in a farmworker community when a promotora model is used to provide and facilitate culturally relevant support for diabetes self-management practices.