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American Diabetes Program

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The Diabetes Empowerment Education Program (DEEPTM) was developed to address lack of diabetes literacy and self-management among ethnic and racial minorities. The DEEPTM model has three components: the training of trainers (TOT), the educational program that includes a facilitator’s manual and the participant’s manual.

TOT is provided at three levels: Peer educator (PE), Lead trainer (LT) and Senior trainer (ST).

PE training covers the contents of the manual and reviews concepts of adult education and facilitation techniques. This 24 hr workshop is intended for community health workers or community members with no professional formal education. PEs facilitate workshops for patients or community residents. Lead training is intended for professionals, or for those with supervisory roles over CHWs. This 24 hr workshop covers curriculum content, adult education, facilitation techniques, cultural competence, motivational interviewing and evaluation of CHWs. LTs may train CHWs and patients. To support this initiative, the training and certification of new PEs and LTs will be conducted without costs to the community clinics participating in KDBH. After three years, certified LTs may apply to become STs. They will be observed and evaluated in their skill and knowledge in conducting a 24 hr training for professionals. STs may train LTs, PEs and patients.

With funds from this initiative, an online training program will be developed which will facilitate outreach and dissemination of DEEP to populations of limited mobility due to the coronavirus pandemic. Classes will be taught applying the same principles of adult education and empowerment that are used in the person-to-person trainings. Trainings will be conducted for 1-hour per day for 8 days to cover the content of the manuals. In addition, trainees will be introduced to the KDBH and program evaluation materials, data collection and data reporting.

The facilitator’s manual covers in 8 modules the information on definition and types of diabetes, risk factors, self-monitoring, physical activity, healthy eating, diabetes complications, engaging the medical team, medications, psycho-social aspects of diabetes (including depression), and self-advocacy. Each module includes lesson content, learning objectives; instructions for implementation of activities and checklist of materials. The manual also includes an implementation guide, a weekly action plan, evaluation forms, appendices (supplemental information), bibliography, glossary and online resources. Program content on cardiovascular health, including diabetes and cardiovascular risk factors (module 2), self-monitoring of blood pressure (module 3), cardiovascular complications (module 6) and medical treatment (module 7) are already part of the educational content but will be enhanced. Information about physical activity (module 4), nutrition (module 5) and stress management (module 8) already cover recommendations for diabetes that are equally relevant to cardiovascular health. The participant’s manual provides the class attendee the same content covered in class, in more graphic form, and includes the weekly action plan and space to add personal notes.

Throughout the self-management education phase (about 8 weeks), participants will receive weekly text messages on their cell phones, intended to maintain engagement and motivation to sustain new health behaviors. This new feature is intended to enhance motivation and to provide support.

At the end of the instructional phase, support groups led by facilitators meet bi-weekly for at least 3 months to review curriculum content and activities, provide self-care updates, and encourage long-term maintenance of healthy behaviors. The weekly text messaging will continue for 3 months after the completion of classes.