Diabetes Management in the Limited English Proficiency Hispanics in Northeastern Arizona

Background: As of 2018, Hispanics were the third largest affected group living with diabetes in the U.S. Once diagnosed with type 2 diabetes (T2D), a person can learn how to manage the disease through a diabetes self-management education (DSME) program, which educates patients on the skills needed to manage the disease. The problem is that a large portion of this ethnic group does not understand English and/or lives in rural and remote areas; consequently, they cannot communicate easily with their primary healthcare provider. The Hispanic health protection model (HHPM), which mixes concepts from health belief and health promotion, is the conceptual framework used to guide this doctor of nursing practice (DNP) project. The HHPM was created in the U.S. to evaluate the adjustments and outcomes in newly diagnosed T2D Hispanics at a county clinic (Latham & Calvillo, 2013). Objective: To provide a diabetic education program in Spanish to a selected group of patients unable to receive the DSME at their local program due to lack of interpreters. Design: Pretest survey and posttest survey was the method used for this quality improvement (QI) project. Surveys were created utilizing material from the diabetes knowledge questionnaire (DKQ) as well as diabetes facts and self-management solutions from the University of California, San Francisco. Settings: The participants were given the options of completing the surveys and education at either the Diabetes Education Clinic at Summit Healthcare Regional Medical Center (SHRMC) in Show Low, AZ, the city’s community building, or a local library. Participants: Five limited English proficiency (LEP) Hispanics with T2D identified by SHRMC diabetic educator (DE) as patients who were unable to receive the DSME from SHRMC due to lack of interpreter services (IS) participated in this QI project. Measurements: Likert scale questions were used in the surveys. The differences between the pretest and posttest survey question means were evaluated using descriptive statistics. Results: All five participants showed an increase in their baseline knowledge after receiving the DSME. The results showed an in participants’ collective perceived knowledge in the section related to knowledge about T2D. Among the HHPM questions, responses demonstrated an increase in the mean Likert scores after receiving the DSME, the exception being the area addressing cultural beliefs. The mean Likert response was inverted, from 3.6 to 1 demonstrating a change in the initial belief that being stressed or frightened triggers diabetes. Conclusions: This educational explanation in Spanish showed an increase in the participants’ baseline knowledge, which is a positive change. LEP Hispanics with T2D may benefit if SHRMC decides to integrate this DSME into their diabetic education program (DEP) since it is both feasible and easy to replicate. If the program is integrated, then the local PCPs can be informed by the facility and refer the LEP Hispanics to receive the DSME at SHRMC