Patient Education In the Department of Medicine

Programa de Manejo Personal de la Diabetes
(Spanish Diabetes Self-Management Program)

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Programa de Manejo Personal de la Diabetes a community-based workshop given two and a half hours, once a week, for six weeks. Workshops are facilitated by two trained, certified and active Leaders, one or both of whom are non-health professionals with diabetes themselves. All workshops are given in Spanish without translators.

Spanish-speaking people with type 2 diabetes attend the program in groups of 12-16. Participants may also bring a family member or friend.

The Stanford Patient Education Research Center received a grant from the National Institute of Nursing Research (NINR) for the randomized, controlled study.

Subjects covered include: 1) techniques to deal with the symptoms of diabetes, fatigue, pain, hyper/hypoglycemia, stress, and emotional problems such as depression, anger, fear and frustration; 2) appropriate exercise for maintaining and improving strength and endurance; 3) healthy eating 4) appropriate use of diabetes medications; and 5) working more effectively with health care providers. Participants make weekly action plans, share experiences, and help each other solve problems they encounter in creating and carrying out their self-management program. Physicians and other health professionals both at Stanford and in the community have reviewed all materials in the workshop.

Each participant in the workshop receives a copy of the companion book, Tomando Control de su Salud: Una guía para el manejo de las infermedades del corazón, diabetes, asma, bronquitis, enfisema y otros problemas crónicos, an audio relaxation tape, Casete de Relajación, and an audio exercise tape with booklet, ¡Hagamos ejercicio! All materials are in Spanish.*

It is the process in which the program is given that makes it effective. Classes are highly participative, where mutual support and success build the participants’ confidence in their ability to manage their health and maintain active and fulfilling lives.

Does the Program replace existing programs and treatments?

The Program will not conflict with existing programs or treatment. It is designed to enhance regular treatment and diabetes education.

How was the Program developed?

The Department of Medicine in the School of Medicine at Stanford University received a research grant from the National Institute of Nursing Research (NINR). The purpose of the research was to develop and evaluate, through a randomized controlled trial, a community-based Spanish-language diabetes self-management program that assists Latinos with type 2 diabetes. The study was completed in 2007.

The process of the program was based on the experience of the investigators and others with self-efficacy, the confidence one has that he or she can master a new skill or affect one’s own health. The content of the workshop was the result of focus groups in Spanish with people with diabetes, in which the participants discussed which content areas were the most important for them.

How was the Program evaluated?

Over 500 Spanish-speaking adults with type 2 diabetes were randomized to a usual care control group or to the workshop. Workshop participants were re-randomized to receive 15 months of reinforcement with automated telephone messages or no reinforcement.

What were the results?

At six months, participants, when compared to controls, demonstrated improvement in A1C (-.4%), health distress, symptoms of hypo- and hyperglycemia, and self-efficacy. At 18 months, the only difference between reinforced and non-reinforced participants was that reinforced participants monitored their glucose slighty more. The effects seen at 6 months were largely maintained for both groups at 18 months.**

How can my facility offer the Program?

Organizations interested in offering the program need to purchase a program license (a link for the licensing information page is on the top right side of this page).

Leader trainings for fully fluent Spanish-speaking people (reading, writings and speaking), preferably with diabetes, are 4 days. Most Leaders are peers with diabetes. Stanford does not offer Leader trainings. Licensed organizations may organize Leader trainings.

Master Trainings for fully fluent Spanish-speaking peers or professionals who represent their organizations are 4½ days. We also offer web-based cross-training for those previously trained in the Tomando Control de su Salud. See our cross training page for more information.

 

*For information on these materials, see the materials page.

**Reported in: Lorig KR, Ritter PL, Villa f, Piette JD.. Spanish diabetes self-management with and without automated telephone reinforcement. Diabetes Care 2008:31(3):408-14


 

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