Increasing Community Access to Care with Spanish Diabetes Programs

Five years ago, Carla Graves, MS, a registered dietician and diabetes educator, began leading one-on-one educational sessions about gestational diabetes with pregnant Hispanic and Latina women who were patients at the hospital’s clinic. The clinic is the main source of Spanish-speaking referrals to Graves, coming to her shortly after their routine screening tests result in a gestational diabetes diagnosis.

Gestational diabetes is diabetes that’s first diagnosed during pregnancy. It can cause high blood sugar that can affect the health of the expectant mother and her baby. There are things a mother can do to control her blood sugar during her pregnancy, including eating healthy foods, exercising, and, if necessary, taking medication. Once you’ve had gestational diabetes, however, you have a higher risk of getting type 2 diabetes.

Graves’s counseling typically unfolds over two sessions — three, if the mother needs to start taking medication. In the first, she explains what gestational diabetes is and instructs the mother on the importance of healthy eating, describing what that could look like. She also shows them how to use a meter to test their blood sugar. In the second session, they discuss the mother’s dietary preferences, and Graves explains how these could affect her blood sugar.

She says most of the women she works with can speak English, but they’re more comfortable talking in Spanish, which Graves does.

“I think one of the benefits of these sessions is it’s a softer way of communicating with someone,” she says. “I’ve acted as a third-party translator and can tell you that information sometimes gets lost in the translation. But when it’s one-on-one and both people are speaking the same language, you’re able to absorb much more. This was the intent when I was brought on five years ago, that we could provide education directly to patients in their primary language instead of using an interpreter.”

A Growing Need for Spanish-Language Diabetes Education in Chester County

In recent years, Chester County’s population has become increasingly diverse. From 2000 to 2019, the percentage of residents who identify as Hispanic or Latino increased from 4 percent to 7.6 percent — though the actual count is likely even higher — becoming the second-most prominent race or ethnicity in the county.

Chester County Hospital is employing a number of strategic plans meant to heighten awareness of the qualities of physical and mental health and improve access to health care among its communities that have traditionally been underserved.

Offering Spanish versions of popular diabetes programs for the first time is one of these new offerings.

An American adult has a 40 percent chance of developing type 2 diabetes during their lifetime. But a Hispanic- or Latino-American adult has a 50 percent chance. They’re also likely to develop it at a younger age, according to the Centers for Disease Control and Prevention (CDC). Complications also tend to be more severe, too.

Genetics can play a part, but there are also other reasons. Traditionally popular foods in Hispanic and Latino cultures can be high in fat and calories. Hispanics and Latinos also have higher rates of obesity and tend to exercise less than Caucasians, in part because being overweight is sometimes seen as a sign of good health, according to the CDC.

Encouragingly, small lifestyle changes, such as losing a modest amount of weight and exercising regularly, can help prevent, or even reverse, type 2 diabetes.

Online Support and Tailored Programs

With the onset of the pandemic in the spring of 2020, the hospital’s Community Health & Wellness Services quickly shifted all its public programming online. In the process, Graves was offered the opportunity to lead Spanish versions of an established diabetes prevention program and a support group for those living with diabetes and their families.

In addition to her role at Chester County Hospital, Graves also works as the diabetes care coordinator at Community Volunteers in Medicine. This is a clinic in West Chester that serves a largely low-income, Spanish-speaking population. She has witnessed firsthand there how large and urgent the need is for greater awareness of diabetes among the county’s Hispanic and Latino residents in particular.

Graves tailored the curricula so that it’s more relevant to her audiences. For example, the discussion topic for a support group meeting just ahead of Thanksgiving was “How to Survive the Holidays.” Graves replaced many of the American holidays and the foods that are traditionally served during them with more appropriate examples.

Still, there can be a gap. When she first started working at the clinic, most of the patients had immigrated from Mexico. Today, between her clinic sessions and the wellness programs, participants hail from all over Central America. Each culture speaks the language a little (or a lot) differently and has its own set of customs.

How Quickly Change Can Happen

In November, Graves concluded an eight-week program that outlined how participants could prevent diabetes. One participant was a young mother who was just diagnosed with type 2 diabetes. She was there, she told Graves, because she didn’t want to take medication for the rest of her life.

She immediately began implementing what she learned during the classes, walking more and eating healthier. And by the last class, she’d lost 20 pounds. Her A1C level — a measure of blood sugar levels which can be used to diagnose type 2 diabetes and prediabetes — was also no longer in the diabetic range.

Even more, she converted her entire family. Her husband, she said, also lost 20 pounds. And their five-year-old son, who was already showing signs of fatty liver, was more active and eating more nutritiously.

“Even though I’m only speaking to a few people at a time, you just never know who those people are going to spread that message to,” Graves says. “And because there’s so much misinformation out there these days, I take a lot of pride in being able to provide evidence-based guidance.”