Effective strategies for reaching high-risk minorities with diabetes.

The NDOP goals of enhancing diabetes awareness by increasing screening activities within select African American neighborhoods and involving residents in health promotion activities were met during the course of the project. The coalition focused on principles suggested for diabetes programs directed at African American communities, including involving a target audience, providing a service, empowering people, and respecting cultural diversity. The focus group mechanism facilitated the input of community members into the program design prior to implementation and insured their involvement throughout the project. The screening and education program fostered empowerment by increasing community residents' control, focusing on their strengths, and identifying personal health goals. Funding support from the New York State Department of Health and the American Association of Diabetes Educators' Research Foundation were both essential in implementing the program. The program was well received. Most of the participant evaluations rated the program as excellent or very good. The program sites, although demographically situated within identified African American communities, produced a greater number of Caucasian and Hispanic participants than expected. Although the older group of African American women constituted 25% of the total population screened, it did not reach the desired number of 300 participants. Future programs need to target sites where older African American women are more likely to be found in greater numbers. Key to the program's success was building strong partnerships with community leaders who served as cultural spokespersons for the initiative to ensure participation from the community. Developing this partnership proved to be more challenging than originally anticipated and required a respectful, persevering approach. Yet once the coalition achieved cohesion, the volunteer members were invaluable in planning and implementing program events. Community members eventually took charge of the coalition and organized programs that have extended beyond the 2-year period of the grant. The coalition continues to expand; members have been added and education programs at churches and community meetings are ongoing. Addressing the problem of diabetes in African American communities requires programs that are innovative, culturally and educationally appropriate, and presented regularly. Such ongoing efforts can increase the knowledge in African American communities and ultimately enhance the health outcomes of community members.

Social workers' role in disease management.

This article discusses social work's participation in a new paradigm for health care delivery, disease management. Attempts to improve health care quality havefocused on evidence-based methods of evaluating health care outcomes as well as quality of life issues with which social workers have been traditionally concerned. The fit between social work's ecological perspective and disease management and the needfor social workers to participate as patient case managers on interdisciplinary disease management teams are discussed. Quality and cost benefits can occur when social workers address such issues as adherence, psychosocialfactors, and depression in terms of the patient's global recovery and concurrent enhancement of quality of life. Potential barriers to disease management implementation with social work participation are discussed.

Mental quality of life: an indicator of unmet needs in patients with diabetes.

This exploratory study investigates the quality of life needs of 173 individuals being treated for type 2 diabetes over a six month period of time. It samples patients whose primary care providers practice the most current model for delivering care, diabetes disease management. These physicians utilized a multidisciplinary diabetes education program to facilitate the patient-provider knowledge-based partnership essential in discase management. Patient quality of life changes were measured by the SF-36. A paired samples t-test showed significant diminishment in patients' mental quality of life indicating diminished overall emotional functioning, negatively impacting quality of life; possibly due to the effects of time. Multiple regression results also indicated that patients at risk for major depression and at risk for major depression superimposed on dysthymia experienced significantly diminished mental quality of life. These findings suggest that enhanced mental health assessment and mental health services provided by social workers in diabetes education programs and/or primary care settings would improve patient mental quality of life.

Measuring quality of life in back patients: comparison of Health Status Questionnaire 2.0 and Quality of Life Inventory.

This paper is a reliability and validity test of the Health Status Questionnaire (HSQ) 2.0. In addition, the Quality of Life Inventory (QOLI) is compared with the HSQ 2.0 to assess concurrent validity. The study is unique because these instruments are assessed for the first time using a sample of chronic back patients. Practitioners will therefore now be able to evaluate important quality of life issues and treatment changes in this population. The HSQ 2.0 was generally found to be valid for these patients. However, two scale domains were not differentiated due to unique characteristics of spinal disease patients. The QOLI, due to the limitation of measuring only psychological well-being, did not measure problems specific to back patients.