Alliance to Reduce Disparities in Diabetes

Chicago Team at Midwest SGIM 2014 Annual Meeting

Helping communities help themselves: The importance of a collaboration between communities and academic institutions at a farmer's market to provide culturally tailored nutrition and diabetes education

Midwest Regional Meeting of the Society of General Internal Medicine
September 4-5, 2014
Chicago, IL 

Authors
T.S. Roberson, M.C. Solomon, Y. O'Neal, D.J. Rowell, N. Geary, M.E. Peek & M. Chin

Abstract
Needs and objectives: 1) To develop an academic/community collaboration integrating community nutrition education for residents/ patients with diabetes living on the South Side of Chicago. 2) To assess the effectiveness of trained community members providing nutrition education to other community members at a local farmer’s market. 3) To increase awareness about the importance of eating fresh fruits and vegetables and utilization of community resources such as the farmer’s market to purchase them.

Setting and participants: The South Side of Chicago is 87% African-American, 29% of its residents are below the poverty level and 23% have not completed high school. Residents have disproportionately limited access to fresh produce and healthy food, as well as resources for education about healthy nutrition. Such factors have been associated with higher diabetes prevalence and morbidity within local communities. Community-based strategies to provide nutrition education can be effective, but are often not sustainable because they rely on volunteer health professionals (e.g. dietitians, certified diabetes educators) rather than trained community members themselves.

Description: Physician investigators at the University of Chicago started a seven year initiative called Improving Diabetes Care and Outcomes on the South Side of Chicago (the “South Side Diabetes Project”), which integrates interventions at multiple levels across the health care system and community to the health of residents with diabetes. The Experimental Station is a non-for profit incubator that works with government, non-profit organizations and the private sector to test and advocate for models to enhance food access among vulnerable communities. The South Side Diabetes Project and the Experimental Station’s 61st Street Farmer Market have collaborated in the implementation the Food Rx program, where physician-signed “prescriptions” for healthy food can be redeemed for free fresh produce at the Farmer’s Market (located in a food desert on the South Side of Chicago). In 2013, we expanded our collaboration through the development of an innovative, culturally-tailored program to train peer health leaders to lead nutrition tours the Farmer’s Market. Community members were recruited through multiple venues (e.g. health centers, community-based organizations, the University of Chicago service departments [e.g. food services], community centers). A multidisciplinary team developed the curriculum, which was taught by a registered dietitian. Peer health leaders were given a complete script and farmer’s market tour guidelines during the training.

Evaluation: 36 community members completed the 2-hour training and pre/post surveys, which included sociodemographic information and nutrition knowledge. In addition, pre/post surveys are conducted of tour participants at every Farmer’s Market, with measures of nutrition knowledge and behaviors (e.g. shopping/dietary patterns, behavioral goals), food insecurity, and experience measures (e.g. satisfaction). The majority of trainees were African American (83%) and female (69%). The average age was 45 years (range: 17 – 74). Approximately one-third (37%) had type 2 diabetes and 14% were graduates of our team’s diabetes education program. Each trainee has conducted on the average of three tours. To date, over 200 community members have participated in the weekly tours led by these peer health educators. Feedback from the peer leaders and community members has been uniformly positive. Local politicians (e.g., local aldermen, Governor Pat Quinn, state representatives) have visited the Farmer’s Market and given favorable reviews of the peer educator program. Survey data analyses are currently underway.

Discussion/reflection/lessons learned: Preliminary evidence suggests that a peer health educator model for community-based nutrition education can be feasible, well-received and effective. Moreover, combining peer health education and a community resource for healthy food (e.g. farmer’s market) is a promising venue to provide sustainable, culturally-tailored diabetes and nutrition education within low-income African-American communities. More research is needed regarding behavioral and health outcomes of such interventions.