SAN DIEGO — A community-based education effort to improve foot care among African American males with diabetes in the communities of Charleston and Georgetown, S.C., resulted in a sharp decline in amputation rates, from 79.1 per 1,000 diabetes hospitalizations in 1999 to 31.7 per 1,000 in 2002, Carolyn Jenkins, Dr.P.H., reported at the annual scientific sessions of the American Diabetes Association.
“We often label African American males as hard to reach,” said Dr. Jenkins, professor of nursing at the Medical University of South Carolina College of Nursing, Charleston. “The implications [of this study] are that hard-to-reach [patients] can be reached through family, friends, and community leaders. Volunteers can effectively deliver the message [of proper foot care], and community coalitions can produce outcomes specifically in decreasing amputations.”
In 1999, reducing amputations among African American males was identified as one of the priorities for action as part of the REACH 2010 (Racial and Ethnic Approaches to Community Health): Charleston and Georgetown Diabetes Coalition. Funded by a grant from the Centers for Disease Control and Prevention as a national demonstration project, the coalition's overall goal is to improve foot care and self-management of diabetes for more than 12,000 African Americans in five different health systems in the two communities.
“Our action plan is organized around community-driven educational activities where people live, work, worship, play, and seek health care,” Dr. Jenkins said. “We also focused on health systems change and building a sustainable coalition that can work to maintain the activity after grant funding.”
A key focus of the coalition involves training health professionals, volunteers, and lay educators about proper foot care for adults with diabetes. The coalition includes five African American women who are employed full time as lay educators in their communities, 130 registered nurses who have completed a 2- to 3-day foot care course, and 15 registered nurse wound care specialists.
The lesson for lay educators is called “Check Yourself to Protect Yourself: Take Care of Your Feet.” Dr. Jenkins described the lesson objectives as “standard, focused on taking care of feet, cutting nails, selecting appropriate footwear, checking feet each day using the monofilament, when to notify the health care provider [about concerns], discussing a foot exam with the health [care] provider, and methods for prevention of foot problems.”
Clients receive a book about diabetes self-management (“My Guide to Sugar Diabetes,” available at www.musc.edu/reach
The coalition also enlisted the help of local media by placing ads in newspapers, broadcasting radio talk shows, and airing a 30-minute TV show on foot care that ran 34 times.
Dr. Jenkins reported that between 1999 and 2002, the rate of foot exams among all diabetes patients in the five health care systems improved from 49% to 74%.
Meanwhile, amputations in African American males decreased from 79.1 per 1,000 diabetes hospitalizations in 1999 to 31.7 per 1,000 in 2002.
When African American males who took part in focus groups were asked what made them become more proactive about seeking foot care, they gave comments like “we now know that if we have a foot problem, we don't need to wait for it to get better,” Dr. Jenkins said. “We need to go to our health care providers in 1–2 days.”
When an audience member asked Dr. Jenkins how to win support for such an effort at the community level, she replied, “It's key that we educate policy makers about the problem and show them that we can make a difference. Stay in constant contact with them and share the information and get community members to do the same.”