Avocados. Plantains. Yams. Papayas. Limas.
These are choices you don’t usually see on a food pyramid prepared for the general population. But they are familiar foods in the Latino community, so they are on the food charts and meal plans that a UConn psychology graduate student designed to help diabetics in Hartford – where the population is nearly one-third Puerto Rican – choose a healthy diet.
Chandra Osborn, a Ph.D. student working with Professor Jeffrey Fisher, is trained in the IMB model, named for “information, motivation, behavior skills,” that Fisher and his colleagues developed in the late 1980s to change the risky behavior of patients infected with HIV.
The model has had demonstrated success with HIV patients and prevention. This has led Fisher, the director of UConn’s Center for Health/HIV Intervention and Prevention (CHIP), and researchers at the center to extend the model to other at-risk health populations.
When she learned at conferences that Latinos and African-Americans are twice as likely as the general population to have diabetes and that Puerto Ricans are among those with the highest rate of the disease, Osborn wanted to find out whether the IMB model could influence the behavior of at-risk Latino diabetics.
“I decided something needs to be done,” she says.
Osborn designed an assessment to help Latinos in Hartford manage their diabetes. Nearly 13 percent of Puerto Ricans in the city have been diagnosed with diabetes, and many more may have the disease and not know it.
With the support of Noemi Cruz, a nutritionist at Hartford Hospital, Osborn’s program was introduced to 118 diabetic patients in the hospital’s adult primary care clinic. Many of the clinic’s patients do not receive personal counseling about managing their diabetes because they lack medical insurance.
The patients were surveyed about their habits and health. They were given a test to measure their average glucose level over three months and a diet plan, based on their activity level, weight, and height.
Half of them became a control group for the study, and half received more extensive counseling. Their risk factors were assessed and discussed with them individually by a Spanish-speaking community health worker, who discussed with them a diet and exercise plan tailored to their needs.
The IMB model guiding the program proposes that if patients have information, motivation, and behavior skills, they will be inclined to make healthy changes in their lifestyle.
Low-income diabetics do not have the resources to join a gym or fitness club, so the health worker recommended alternatives, such as walking to the market, climbing stairs, and joining friends for Latin dancing – anything that fit into a patient’s lifestyle and social patterns.
Chandra Osborn, a graduate student in psychology, displays some of the items she included in food charts and meal plans to help Latino diabetics in Hartford.
|Photo by Peter Morenus
Patients at the clinic often have had little formal education and do not know much about diabetes.
“They often think that only sugar raises their glucose, not carbohydrates,” Osborn says. She developed a flip chart in Spanish, explaining what a carbohydrate is.
“Many of them asked to have the flip chart pages copied,” she said.
Osborn ordered brochures in Spanish from the American Diabetes Association and had a meal plan designed that is illustrated with foods in the local Puerto Rican diet – such as papayas, coconut milk, and familiar seasonings.
The community health worker was trained to teach the patients how to read food labels and how to judge the size of a single serving. The patients were taught what they should eat and how many portions to eat per day.
“This population sometimes skips breakfast, has a light lunch and a big dinner,” Osborn said.
At the clinic they were shown how to space their carbohydrate consumption more evenly.
After their first counseling session in the spring, patients left with a set of goals for diet and exercise. Follow-up sessions now underway are determining whether they have modified their behavior and whether their biological measures, such as weight and average glucose level, have changed.
If the program works, it could be implemented in Amigos en Salud, or “Friends in Health”, classes that serve Latinos in hospitals around the country.
Osborn’s project required hiring and training a Spanish-speaking health worker and developing questionnaires and brochures in Spanish. She financed this with seed money from Fisher, her adviser, and an $83,000 National Institutes of Health grant she was awarded as a minority pre-doctoral student (she is half Samoan).
Osborn came to UConn to study with Fisher after graduating from Cal State San Marcos. After she receives her Ph.D., she plans to continue working with Latino diabetics.
“I have tons of ideas on how to expand on this and improve it,” she says.