As mentioned earlier this week, physicians at the Stanford Center for Education in Family and Community Medicine are working to reduce diabetes rates in the United States using an innovative program called Diabetes Coaches Class. The program, which is the only California-based finalist competing in the 2011 Healthy Living Innovations Awards, trains high-school students to become diabetes self-management coaches for friends and family members.
Interested to know more about the prevention program, I contacted project organizer Nancy Morioka-Douglas, MD. In the following Q&A, she explains what spurred the creation of the Diabetes Coaches Class, how the model is successful in getting teens and their diabetic loved ones to make lifestyles changes, and the potential for implementing the course at schools across the nation.
What was the catalyst for developing the Diabetes Coaches Class?
One of my research interests is the prevention and care of chronic diseases such as diabetes, which disproportionately affect ethnic populations. Another interest has been to provide health education to high-school students in an underserved local community, which I have done for many years. One day, I asked my students to raise their hands if they had a family member with diabetes. Everyone raised a hand. Then I asked how many knew people with complications from diabetes. Almost everyone raised a hand again. As a result, I began searching for an economical, sustainable way to educate high school students about diabetes prevention. A key resource in developing the program was the research of Kate Lorig, DrPH, who is internationally renown for her work in chronic disease self-management groups. She demonstrated that members of the public can be taught how to "coach" diabetic patients to be healthy with a tightly-scripted curriculum to improve health outcomes.
Developing, piloting and validating the efficacy of a tightly scripted curriculum means that it can be duplicated in other places and, if the remote learning sites are faithful in using the curriculum exactly as it is designed, the program will have a positive impact. So we are developing a structured program to promote health coaching by high-school students to make sure that everyone who learns how to coach gets exactly the same curriculum. Through this we envision empowering youth, expanding community capacity and even, perhaps, inspiring youth to work in health related fields. And, this is all done in a way that has minimal cost.
The eight-week, highly structured class was designed to avoid the natural resistance of high-school students to traditional paternalistic health education models. Can you briefly explain how the program accomplishes this goal?
This is done through teaching the students to "coach" family members to do "action planning." Action planning is a specific two-step process in which a health-care coach works with a family member to identify: “What one thing will you do this coming week to be healthy?” and “On a scale of 1 to 10, with 10 being very likely, how likely is it?” Our students learn how important it is to elicit the opinion of the family member about what the person wants to accomplish as opposed to telling the person what to do. As students learn how to do this for others, we encourage them to make their own self-management goals. Goals can be school-related such as "I'm not going to sit by my friends in class," exercise-focused such as "I'm going to walk to school one day per week" or involve other healthy habits.
What aspects of this program offer the potential for it to be expanded and implemented at high schools nationwide?
We're still in the development phase, but by September 2012 we hope to have a curriculum packet that can be downloaded from the web and used to implement the program at schools across the country. The packet would include a syllabus, instructions for getting started, PowerPoint presentation, teaching tips, homework assignments and evaluation tools.
My vision is that under-resourced public high schools would partner with a community health facility or training program to provide this program as an elective class in high schools, which requires eight consecutive weekly 50-minute class sessions. We have found that with such a tightly scripted curriculum, it takes a minimal amount of prep time from either of the two partners. The only supplies that are needed are copying handouts, a PowerPoint projector and classroom space.
Voting for the 2011 Healthy Living Innovation Award ends on Tuesday, May 31. You can cast your vote for Diabetes Coaches here.