Amparo Gonzalez, president of Hispano Latino Diabetes, is director of the Georgia Latino Diabetes Education Program. The program is aimed at teaching health care professionals and Hispanics how to better manage diabetes.
"If you want to change someone's behavior, you have to speak their language and understand their background. Changing behavior is very complex; if you try and do it through interpreters, you're prone to failure from the start," said Amparo Gonzalez, senior research coordinator with the division of endocrinology at the Emory University School of Medicine.
Changing behavior is important in the outcomes of diabetics, and diabetes is a major health concern among Georgia's growing Latino population (now estimated by the U.S. Census Bureau at more than 470,000). Statistics show that of the adult Latinos living in the United States, 25 percent between the ages of 45 and 74 have diabetes — nearly two-and-a-half times the rate for the Caucasian population.
Many Latinos who are newly diagnosed with diabetes at metro Atlanta clinics don't return for follow-up visits that could help them change their diets, increase their levels of physical activity or regulate their medications, Gonzalez said.
"Improving the health of the Latino population was a dream near and dear to my heart," said Gonzalez, RN, BSN, CDE, who is also president of Hispano Latino Diabetes, a nonprofit organization dedicated to helping Hispanics deal with the disease.
Gonzalez left a hospital job to direct the Georgia Latino Diabetes Education Program.
Working in partnership, the American Diabetes Association, Hispano Latino Diabetes and endocrinologists at the Emory University School of Medicine at Grady Memorial Hospital started the program to help improve diabetes care among Spanish speakers. It's funded for two years by a $150,000 grant from the Healthcare Georgia Foundation. Program officials hope to reach 400 patients a year through the program, which is aimed at educating patients and health care professionals.
Gonzalez has trained health care providers to teach classes about diabetes care in Spanish at hospitals and neighborhood clinics in Atlanta and Gainesville.
"We teach in small classes of two to 10 people, and we start by getting close and connected," Gonzalez said. "We talk about what diabetes is and the emotions of having the disease. We make sure everyone understands the disease and its complications by having them explain it back to us in their words."
Once patients understand their diagnosis and feel comfortable talking about it, instructors can teach ways to improve patients' health. The program encourages participants to eat healthy foods native to their countries. Using plastic food models purchased from Columbia, instructors tell students to select what they normally eat and fill their plate.
Instructors can then point out how many carbohydrates participants are eating, compared with what they should be eating to help lessen the effects of diabetes. It's a learning process because people from different countries call foods by different names, and one staple of the Mexican diet can be overlooked by participants, Gonzalez said.
"We find that students often forget to mention the number of tortillas they eat with every meal, because it's such a mainstay of their diet, but the number of tortillas can be part of the problem, so we ask," Gonzalez said.
Once patients see what they are eating and how it affects their health, instructors show them how to select menus aimed at controlling their diabetes.
"Initially, they think they will be hungry, but when they see it on the plate, they are impressed by how much they can eat. We recommend a lot more rice, beans and vegetables and a lot less tortillas," Gonzalez said.
Knowing that many Latinos love fruit juices, instructors show them how the size of a full glass can affect their blood-sugar levels.
"They're really drinking three glasses instead of one, because of the glass size. That's an 'aha' moment for many," she said.
The class also addresses the importance of exercise and encourages participants to increase their activity levels by dancing or playing soccer, activities that are natural to their cultures.
"We've trained about 262 instructors and health care providers so far and reached over 110 patients with diabetes education, and the classes are growing," Gonzalez said.
The program also developed materials the providers can use to discuss the disease with their patients, such as bilingual flip charts, blood-sugar charts and medication lists.
"We knew we had to start with the basics because Latino patients were leaving the doctor's office without any information before. Now they feel good about having something they can understand, and they want to learn more," Gonzalez said.
Gonzalez wants to develop a turnkey approach that will serve as a model for other health care providers nationally.
"We thought if we really listened and developed a program in their own language that was culturally sensitive and helped them solve problems on their own, that we could make a difference," she said. "It's so good to see patients really following up with their care and improving."