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Diabetes Care Publish Ahead of Print published online ahead of print November 5, 2007
DOI: 10.2337/dc07-0746
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Original Research

Opportunities and Challenges for Diabetes Prevention at Two Community Health Centers

Milagros C. Rosal, Ph.D.1, Evan M. Benjamin, M.D.2, Penelope S. Pekow, Ph.D.2, Stephenie C. Lemon, Ph.D.1 and Dorothea von Goeler, M.D.2

1University of Massachusetts Medical School, Worcester, MA
2Baystate Medical Center, Springfield, MA

Milagros.Rosal{at}umassmed.edu

ABSTRACT

Objective: Translating evidence-based diabetes prevention interventions to disadvantaged groups is a public health priority which poses unique challenges. Community health centers (CHCs) provide unequaled opportunities to prevent diabetes among poor and minority high-risk groups. This formative study sought to assess structural, processes of care (healthcare quality domains) and patient factors that need to be considered for diabetes prevention at CHCs.

Research Design and Methods: A multi-method approach was implemented to assess system, provider and patient level factors at two large CHCs serving diverse urban communities.

Results: Medical chart audits (n=303) showed limited documentation of risks. Provider surveys (n=74) evidenced knowledge gaps regarding factors associated with increased diabetes risk and efficacy of pharmacological interventions, and low perceived efficacy in promoting patient behavior change. Patient focus groups (2) with at-risk Hispanics and African Americans suggested mixed knowledge regarding whether diabetes can be prevented, some knowledge gaps regarding factors related to risk and multiple challenges for lifestyle change.

Conclusions: Multiple and multi-level challenges to translating diabetes prevention interventions for the benefit of at-risk populations who seek care at CHCs were observed.


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Copyright © 2007 by the American Diabetes Association.