Rural Collaborative Model for Diabetes Prevention and Management: A Case Study.

Diabetes disproportionately affects racial and ethnic minorities, rural, and impoverished populations. This case study describes the program components and key lessons learned from implementing Vivir Mejor! (Live Better!), a diabetes prevention and management program tailored for the rural, Mexican American population. The program used workforce innovations and multisector partnerships to engage and activate a rural, mostly Hispanic population. Community health worker (CHW) roles were designed to reach and support distinct populations. Promotoras focused exclusively on health education and patient navigators individually coached patients with chronic disease management issues for the high-risk patient population. To extend diabetes health education to the broader community in Santa Cruz County, promotoras trained lay leaders to become peer educators. Multisector partnerships allowed the program to offer health and social services around diabetes care. The partners also supported provider engagement through continuing education workshops and digital story screening to encourage referrals to the program. Multisector partnerships, including partnering with critical access hospitals, for diabetes management and prevention, as well as using different types of CHWs to implement programs that target high- and low-risk populations are innovative and valuable components of the Vivir Mejor!

The Vivir Mejor! Consortium: A Rural, US-México Collaborative Model to Prevent and Treat Diabetes.

The Vivir Mejor! (Live Better!) System of Diabetes Prevention and Care Consortium is a multi-sector partnership to establish an integrated diabetes system of care in Santa Cruz County, Arizona on the U.S.-Mexico border. Major outcomes include improved healthy eating and active living knowledge and behaviors and lowered HbA1c.

Taking a community-based participatory research approach in the development of methods to measure a community health worker community advocacy intervention.

BACKGROUND: Public health advocacy is by necessity responsive to shifting sociopolitical climates, and thus a challenge of advocacy research is that the intervention must by definition be adaptive. Moving beyond the classification of advocacy efforts to measurable indicators and outcomes of policy, therefore, requires a dynamic research approach. OBJECTIVES: The purposes of this article are to (1) describe use of the CBPR approach in the development and measurement of a community health worker (CHW) intervention designed to engage community members in public health advocacy and (2) provide a model for application of this approach in advocacy interventions addressing community-level systems and environmental change. METHODS: The Kingdon three streams model of policy change provided a theoretical framework for the intervention. Research and community partners collaboratively identified and documented intervention data. We describe five research methods used to monitor and measure CHW advocacy activities that both emerged from and influenced intervention activities. DISCUSSION: Encounter forms provided a longitudinal perspective of how CHWs engaged in advocacy activities in the three streams. Strategy maps defined desired advocacy outcomes and health benefits. Technical assistance notes identified and documented intermediate outcomes. Focus group and interview data reflected CHW efforts to engage community members in advocacy and the development of community leaders. APPLICATION OF LESSONS LEARNED: We provide a model for application of key principles of CPBR that are vital to effectively capturing the overarching and nuanced aspects of public health advocacy work in dynamic political and organizational environments.

Salud Sí: a case study for the use of participatory evaluation in creating effective and sustainable community-based health promotion.

Participatory evaluation can be an essential tool for community-based organizations in tailoring programs to the needs of the populations they serve. This article provides a case study of Salud Sí, a promotora-driven health promotion program designed to encourage physical activity, fruit and vegetable consumption, and stress reduction among Mexican American women. Through a partnership between a community health center and an academic institution, we describe how the participatory evaluation framework is applied over a 10-year period throughout the stages of program development, implementation, and sustainability. Partners used the results to identify the essential elements of the health promotion program.