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North Lawndale has one of the highest rates of diabetes in the City of Chicago. It is estimated that the direct medical care costs per person per year with diabetes is 2.3 times higher than for the person without diabetes. Sinai Urban Health Institute (SUHI) was awarded a highly-competitive major grant by the National Institutes of Health (NIH) to undertake the Block by Block North Lawndale Diabetes Community Action Program. SUHI’s proposal was ranked in the top 3% of requests received by NIH and will provide $1 million over two years.
“It is unreasonable to expect that people will change behavior easily when so many forces in the social, cultural, and physical environment conspire against such change.” Instituteof Medicine
The growing prevalence of Type 2 diabetes in the US has been well documented. It is estimated that the direct medical care costs per person per year with diabetes is 2.3 times higher than for the person without diabetes. HbA1C has come to be used as a measure of diabetes management, self-care and risk for development of diabetes complications. It has been estimated that a one percent reduction in A1C values can reduce total healthcare costs for a patient with type 2 diabetes by up to $950 per year. In another study managed care patients with type 2 diabetes who improved or achieved glycemic control saved $369 per patient per year in total diabetes related costs as compared to those with higher A1C levels. Previous studies have demonstrated higher HbA1C levels and poorer glycemic control among African-Americans. This means that diabetes related healthcare costs for African-American pertaining to improved HbA1C levels are not being realized.
Although health professionals and demographers will describe the North Lawndale community on Chicago’s west side as “extremely low socio-economic status” and “medically underserved,” residents know their neighborhood has many strengths and assets. In fact, in 1966, Martin Luther King, Jr., picked North Lawndale as the base for the northern civil rights movement and moved his family there. Following King’s assassination, rioting, crime, unemployment and physical deterioration led to neighborhood decline. The North Lawndale Diabetes Community Action Project is driven by the residents, demanding improved diabetes outcomes and a share of health equity.
The North Lawndale Diabetes Community Action Project builds on community strengths to increase the early detection of diabetes and involves an entire neighborhood in efforts to enhance self-management by those with the disease. Our community-academic partnership proposes a neighborhood engagement approach to ameliorating the impact of diabetes on the lives of 10,000 adults living in a well-defined section of the North Lawndale neighborhood.
The Sinai Urban Health Institute, Sinai Health Systems, Rush University Medical Center and a community based organization (Family Focus North Lawndale) are proposing to develop and deliver a multilevel community intervention using a media campaign, community engagement, and individual self-management training by "Diabetes Block Captains." Neighborhood residents working as Diabetes Block Captains will conduct household screenings for diabetes and then will engage their neighbors in activities that promote diabetes self-management. This Community Based Participatory Research (CBPR) approach seeks to support residents in changing the culture within the target community, to make diabetes a neighborhood priority, and to address the cultural and social environment to support healthier lifestyles.
To reduce the impact of type 2 diabetes mellitus on the health of residents of North Lawndale through a replicable multi-level strategy developed and implemented through a collaboration between the community and an academic health center.
1) To determine whether a multi-level community intervention, featuring an educational campaign, community engagement, and individual self-management training by a “Diabetes Block Captain” will result in a mean reduction of HbA1c greater than 0.5 among persons with type 2 diabetes mellitus living in a medically underserved urban neighborhood.
2) To demonstrate the cost-effectiveness of a multi-level community intervention resulting from significant improvements in rates of diabetes self-management behaviors among persons with type 2 diabetes mellitus.
3) To determine whether this multi-level community intervention can improve early detection of diabetes in a medically underserved urban neighborhood by increasing the number of persons diagnosed by at least 25% over a one-year period.
The foundational bases for the Block by Block North Lawndale Diabetes Community Action Program are:
Block by Block North Lawndale Diabetes Community Action Program has three (3) target audiences:
The Block by Block North Lawndale Diabetes Community Action Program seeks to support residents in changing the culture within North Lawndale to make diabetes (and health in general) a neighborhood priority and to impact the environment to support healthier lifestyles. Activities include an educational campaign, community engagement, and individual self-management support by Diabetes Block Captains to ultimately improve rates of diabetes self-management behaviors. Subsequently, through this multi-level community intervention, it is hoped that early detection of diabetes in North Lawndale will increase and people will live better and healthier lives.
Diabetes Block Captains will conduct 2,500 neighborhood household surveys to identify residents within North Lawndale who actually have or are at risk of developing Type 2 Diabetes. (Eligible persons who complete the survey will be mailed a $15 gift card.) The project seeks to enroll 280 residents with Type 2 Diabetes into the intervention phase of project and will be assigned a Diabetes Block Captain who will make 4 home visits over 12-18 months, during which they will work with the individuals to develop action plans focused on small, consistent, lifestyle changes to improve self-management of the disease.
Poor self-management behaviors often lead to increased numbers of diabetes-related hospitalizations and emergency room visits. Those persons who have been diagnosed with Type 2 Diabetes will be educated (or re-educated) around the risks for short-term and long-term consequences of not managing the disease (e.g., amputations, dialysis, nerve damage, loss of vision, erectile dysfunction) and be encouraged to eat better, become more physically-active, take their medications, follow doctor’s orders, undergo regular testing, and comply with foot care routines.
The major risk factors for developing Type 2 Diabetes include: having family members with the disease, being obese/overweight, not being physically active, having unhealthy eating habits, and being over age 45. Those North Lawndale residents with risk factors will be encouraged to participate in community-wide events related to the Block by Block North Lawndale Diabetes Community Action Program campaign messages that are intended to reduce their chances of developing the disease.
A particular emphasis for the community-at-large is the list of campaign messages and making small-but-consistent lifestyle changes to support those in their circle of influence who have or at risk of developing Type 2 Diabetes.
It is intended that formal and informal community partners will support North Lawndale residents and the Block by Block North Lawndale Diabetes Community Action Program by offering cooking classes and diabetes-friendly menus, hosting events, workshops, and meetings.
Block by Block North Lawndale Diabetes Community Action Program seeks to maximize attendance and participation in North Lawndale resources that are often underutilized, such as fitness classes and community gardens.
The Block by Block North Lawndale team presented on their research at this year's annual American Public Health Association (APHA) conference in Denver, Colorado. Click here to view the presentation.
The Lawndale Diabetes Project Kick-Off Press Conference
When: April 20, 2012,10:00-11:30 a.m.
Where: Mount Sinai Hospital, Glasser Auditorium
Who: Elected officials, municipal leaders, community leaders and members
Why: Diabetes is exacting a terrible toll on our communities. Sinai Health System has teamed up with Blue Cross and Blue Shield of Illinois to address diabetes among North and South Lawndale residents.
Click here for event flyer.
For more information regarding this project, please send an email to Joseph West, Sc.D., Program Director at firstname.lastname@example.org or to Avonella Rogers, Program Coordinator at email@example.com.