© 2007 Association of State and Territorial Health Officials Diabetes and Women’s Health the American Diabetes Association, American. Public Health …
Diabetes and Womens Health:
Evaluating Progress and Future Needs
Diabetes and Womens Health: Evaluating Progress and Future Needs
Assessment for Partners of the National Public Health Initiative on Diabetes and Womens Health
This report was made possible through a cooperative agreement with CDCs National Center on Chronic Disease Prevention and Health Promotion Award No U58/CCU324349-01 ASTHO is grateful for their support The Association of State and Territorial Health Officials ASTHO is the national non-profit organization representing the state and territorial public health agencies of the United States, the US Territories, and the District of Columbia ASTHOs members, the chief health officials of these jurisdictions, are dedicated to formulating sound public health policy, and to assuring excellence in state-based public health practice To download an electronic version of this report, visit the ASTHO Web site listed below For reprint requests or to obtain permission to reproduce this report, please contact publications@asthoorg
Association of State and Territorial Health Officials 2231 Crystal Drive, Suite 450, Arlington, VA 22202 202-371-9090 Fax 571-527-3189 wwwASTHOorg
wwwStatePublicHealthorg
Diabetes and Womens Health: Evaluating Progress and Future Needs
Assessment for Partners of the National Public Health Initiative on Diabetes and Womens Health
Executive Summary 3 Introduction3 Program Description 3 Evaluation Methods 4 Results 4 Conclusions 13 Recommendations13 Appendix A: Action Steps - Description Of Programs Related To The Priority Action Steps15 Appendix B: Ways In Which Cosponsors Could Help Organizations Meet Their Technical Needs 20 Appendix C: Organizations That Should Be Included In Initiatives Efforts 21 Appendix D: Success Stories22 Appendix E: Organizations Participating in Survey 23
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Executive Summary
This report gives the results of a survey sent out to all the partners of the National Public Health Initiative on Diabetes and Womens Health The purpose of the survey was to evaluate the partners progress on specific objectives and strategies outlined in the initiative and ask about their future needs Results found that the most common priority for the organizations is to encourage and support diabetes prevention and control Participants
also expressed interest in more partnering and networking opportunities The survey found that the capacity to give and receive technical assistance within the Initiative can be improved ASTHO recommends the following to improve this capacity: Hold networking events to encourage more collaboration between the CDC and partners Provide training to the partners so that they are equipped to provide technical assistance to other partners within the Initiative Provide additional technical assistance in evaluating progress related to the priority action steps Accountability requires evaluations to be an important component of any program or policy
issue For more information on the Initiative, visit wwwcdcgov/diabetes/projects/womenhtm The purpose of this assessment for Partners of the National Public Health Initiative on Diabetes and Womens Health is to evaluate the partners progress in implementing strategies associated with the National Agenda for Public Health Action NAPHA and to determine what technical support these organizations may need to advance the goals of the Initiative This report will first describe the program and evaluation methods, then describe the results in the
following categories: Organizational background Implementation of priority action steps Partners and networking opportunities Perception of and attitude toward the initiative Technical assistance and resources
Introduction
In 2002, the Association of State and Territorial Health Officials ASTHO and four co-sponsors - the American Diabetes Association, American Public Health Association, American Association of Diabetes Educators, and Centers for Disease Control and Prevention CDC formed The National Public Health Initiative on Diabetes and Womens Health Initiative The major goals of the Initiative are to raise awareness about the impact of diabetes on womens lives across the life stages and to identify priority action steps that organizations from the public, private, and voluntary sector can implement to address this important health
Additionally, the summary, conclusions, and recommendations based on the survey results will contain further information about the progress of the Initiative Finally, Appendix A contains descriptive information about the programs related to the Priority Action Steps, Appendix B contains ways in which cosponsors could assist organizations in
meeting their technical assistance needs, Appendix C contains organizations that should be included in Initiative efforts, Appendix D contains success stories, and Appendix E lists the partners who participated in this survey
Program Description
The major goals of the Initiative are to raise awareness about the impact of diabetes on womens lives across the life stages from adolescence to the older years, and to identify priority action steps that organizations from the public, private, and voluntary sector can implement to address this important health issue Ten priority action steps are spelled out in the Initiatives national action plan, The National Agenda for Public Health Action, a blueprint for
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addressing diabetes and womens health over the next three to five years In the 2003 A Call to Action working meeting, partners identified key strategy areas that their organizations could begin or continue to focus on in their efforts to combat diabetes These included research/surveillance, communication/ education, advocacy/policy, and services/ programs Since the Initiatives inception, the
co-sponsors have enlisted the support of organizations nationwide The public, private, and non-profit organizations were selected because of their involvement in womens and/or diabetes issues These partners have been working to develop and expand the key strategy areas for the past three years The final phase of this Initiative will involve preparing and implementing the National Public Health Action Plan on Diabetes and Womens Health, including translating strategy recommendations into concrete operational programs and policies for relevant agencies and organizations
Results
Organizational Background There were a variety of types of organizations participating in the survey Participants reported on organizational characteristics such as founding date, number of staff, and number of advisory board or board of director members Large organizations, employing more than 100 staff members, made up the biggest share of organizations that participated 386 and employ over 100 staff members Seven percent employ 52 to 100 staff, 228 percent employ 11 to 50 staff, and 316 percent employ ten or fewer staff members Twenty-six percent of organizations reported that 11 to 20 members compose
their advisory board or board of directors, while 223 percent have fewer than 10 members and 148 percent have 21 or more members on their boards Most participants 37 selected not applicable in response to this question Organizational Focus
Evaluation Methods
ASTHO used an online survey, composed of 37 items, to collect the evaluation data The survey items included both open-ended and close-ended questions Questions asked participants to report on their work in reference to the priority action steps, what support they may need to better meet the action steps, how they perceive their relationship with the Initiative, and how the Initiative is related to their work Participants were partners in the Initiative All of the approximately 350 partners were selected to participate in the evaluation with the exception of the four co-sponsors Seventy-one partners responded to the survey n71 There were three attempts to increase sample size that did improve the response rate Survey responses were downloaded into SPSS for frequency and cross-tab analysis Partners were asked to report the level of government at which their organization works national, state or local, the life stage on which
their organization focuses, and the strategy area of focus Level of Government The largest percent of participants 479 reported working at the state level, 437 percent worked at the national level, and 310 percent worked at the local level Some organizations work at more than one level and were allowed to indicate this in the survey Therefore, percentages here add to greater than 100 percent
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Life Stage Focus The life stage focus of organizations is displayed in Table 1 Respondents were asked to indicate what life stage was the focus of their organizations women and diabetes work or programming Response options included general, adolescence, reproductive, middle, and/or elder Respondents were instructed to check all that apply, thus percentages shown here add to greater than 100 percent
Table 1 Life Stage Foci
Reproductive General Elder Middle Adolescence
Number
71 45 13 12 7
Percent
1000 634 183 169 99
Participants were asked whether or not their organization had a health policy agenda related to women and diabetes While 78 percent of participants reported currently implementing an
agenda related to health policy and 39 percent of participants reported fully implementing a health policy agenda and evaluating it, the majority of participants 785 reported that their organizations did not have a health policy agenda and were not considering developing one About a third of participants 314 reported they did not have a health policy agenda but that their organizations were considering developing one Almost ten percent of participants reported that their organizations were currently developing a policy agenda Implementation of Priority Action Steps Respondents were asked to report what priority action steps as developed by the Women and Diabetes Initiative they focused on in the past, focus on currently, and/or would like to focus on in the future Table 3 displays these results Respondents were instructed to check all that apply, thus percentages shown here add to greater than 100 percent The most common focus both in the past and currently was on encouraging and supporting diabetes prevention and control programs Expanding community-based health promotion education, activities and incentives along with encouraging health care providers to promote risk assessment
and quality care were among the top past and current priority action steps The least common priority action steps were conducting public health research, strengthening advocacy and policy, fortifying community programs for women, and encouraging healthcare coverage and incentives
Strategy Area Focus The strategy area focus of organizations is displayed in Table 2 Respondents were asked to indicate the women and diabetes strategy area they use in their organization Response options included advocacy/policy, health care, media, research/surveillance, state/community programs or services, and communication/ education Respondents were instructed to check all that apply, thus percentages shown here add to greater than 100 percent Table 2 Strategy Area
Communication/Education State/Community Programs or Services Health Care Research/Surveillance Advocacy/Policy Media
Number Percent
47 36 33 29 23 19 662 507 465 408 324 268
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Table 3 Priority Action Steps: Past, Current And Future Efforts Action Steps
Strengthen advocacy and policy 8 Expand community based health promotion education, activities
and incentives Encourage and support diabetes prevention and control programs Fortify community programs for women Expand population based surveillance Educate community leaders Encourage health care providers to promote risk assessment and quality care Ensure access providers Encourage incentives to trained health care and Past Efforts N Past Efforts 113 Current Efforts N 10 Current Efforts 141 Future Efforts N 22 Future Efforts 310
19 20 9 10 14 16 11 9 6
268 282 127 141 197 225 155 127 85
25 28 13 20 19 23 20 13 10
352 394 183 282 268 324 282 183 141
21 19 17 11 17 20 13 13 0
296 268 239 155 239 282 183 183 00
healthcare
coverage
Conduct public health research
The participants were asked, in general, if they would act on priority action steps in the future The majority of participants 852 agreed that they will act on the priority action steps in the future The most commonly identified action step for future priority was strengthening advocacy and policy 31 Expanding community-based health promotion and education, activities and incentives 296 was also one of the top three future action steps along with encouraging and supporting diabetes prevention and control
programs 268 None of the organizations indicated they planned to focus on conducting public health research in the future Few partners indicated that they would focus on expanding population-based surveillance 155, ensuring access to trained health care providers 183, or encouraging healthcare coverage and incentives 183 in the future In addition to the data collected on past and current priority action steps efforts, participants were asked to report how long their organization had been working on each of the priority action steps The responses are illustrated in Table 4
For priority action steps 1, 2, 3, 9 and 10, most participants indicated their organization had been working on the action step for 10 or more years For priority action steps 4-7 most participants indicated their organization had been working on the action steps for 3 to 6 years Participants were also asked whether their organizations evaluate their progress on the priority action steps Half 50 of the participants reported that they did evaluate progress They were also asked whether they have been able to sustain momentum in working on priority action steps The majority of organizations 678 reported being able to
sustain their momentum in working on the priority action steps Lastly, the majority 678 indicated that the priority action steps were a main concern in their organizations
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Table 4 Amount of time organizations have been working on each priority action step
Priority Step
1 Strengthen advocacy and policy 2 Expand community based health promotion education, activities and incentives 3 Encourage and support diabetes prevention and control programs 4 Fortify community programs for women 5 Expand population based surveillance 6 Educate community leaders 7 Encourage health care providers to promote risk assessment and quality care 8 Ensure access to trained health care providers 9 Encourage healthcare coverage and incentives 10 Conduct public health research
0-2 years N
5 357 2 80 3 125 5 313 1 77 3 158 5 227 5 278 4 235 3 273
3-6 years N
2 142 10 400 7 292 6 375 5 385 7 369 8 363 5 278 3 177 3 273
7-10 years N
3 214 5 200 5 208 1 63 3 231 4 211 4 181 3 167 3 177 1 91
10 years N
4 286 8 320 9 375 4 250 4 308 5 263 5 227 5 278 7 412 4 364
Partners/Networking Opportunities Participants were
also asked about current and future networking opportunities Participants reported their key partners The top five partners were: public health professionals 310, providers 296, health departments 254, community leaders 197, state and local health associations 183, and experts in the field 183 In addition, participants provided names of other organizations who they felt should be included in Initiative efforts These are referenced in Appendix C Participants also identified those organizations with which they would be interested in networking The top 10 organizations were: the CDC 239, other partners working on the same priority action steps 141, healthcare providers 113, policy makers 99, community leaders 99, state health departments 99, experts in the field 85, public health professionals 70, state and local health associations 70, and higher education 56
Perceptions of and Attitude toward Initiative Participants were asked several questions regarding their perceptions of the Initiative and how the Initiative affects their work First, participants were asked whether involvement in the Initiative strengthened their efforts in their work on women and diabetes About half 563 felt
that their efforts had not been strengthened by their involvement in the Initiative and that their efforts would have taken place regardless of their involvement The remainder of participants 437 reported that their efforts were strengthened by the Initiative Second, participants were asked to report on the ways in which the Initiative helped their organization with their work on women and diabetes The response options reflect the goals set for the Initiative in finding ways to help partner organizations Table 5 illustrates the results They were allowed to select as many as applied Third, respondents were asked to report the extent to which the Initiative advanced the
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organizations work in the priority areas For each priority area respondents rated the extent to which the Initiative advanced their work on a scale of 1 to 5 with 1 indicating not at all and
5 indicating very much Table 6 illustrates these results
Table 5 Ways in which the Initiative helped organizations with their work on women and diabetes
N Raised awareness Provided a framework for action Provided the latest research on
womens health Provided related products/materials Conducted conferences for networking Provided technical assistance 11 10 6 5 5 2 155 141 85 70 70 28
Table 6 Extent to which the Initiative advanced organizations work in priority areas
N Ensure access to trained health care providers Encourage and support diabetes prevention and control programs Educate community leaders Encourage health care providers to promote risk assessment and quality care Expand community based health promotion education, activities incentives Strengthen advocacy and policy Expand population based surveillance Encourage healthcare coverage and incentives Fortify community programs for women Conduct public health research 15 22 15 19 21 15 11 13 10 8 Mean 373 350 340 337 329 327 309 285 290 275 Standard Deviation 103 130 135 112 123 153 130 134 088 149
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The area in which respondents indicated the Initiative has advanced their work the most was ensuring access to trained health care providers mean373, SD103 Other areas in which the Initiative enhanced organizations work included encouraging and supporting diabetes
prevention and control programs mean350, SD130, educating community leaders mean340, SD135, expanding community based health promotion education, activities and incentives mean329, SD123 and strengthening advocacy and policy mean327, SD153 Additionally, respondents were asked to report the extent to which the Initiative was responsible for the work their organization had completed and the extent to which they felt part of the Initiative The majority of organizations 613 indicated that they would have done only some or none of their completed work without the Initiative One organization reported that they did not see themselves as part of the Initiative About 66 viewed themselves as a small part of the Initiative, and of those, most of them 636 felt that the Initiative does affect their work About 30 percent saw themselves as a key part of the Initiative Half of those felt that the Initiative did affect their work
A crosstab analysis was performed to determine if an association existed between how partners viewed the Initiative and their implementation of priority action steps However, this analysis revealed that there was no statistically significant association between the number
of priority action steps organizations engaged in and how strongly they viewed themselves as part of the Initiative Finally, respondents were asked to report the strength of their partnership with co-sponsors Most organizations 563 viewed their relationship with co-sponsors as a strong collaborative partnership Thirty-one percent viewed the relationship as a loose partnership, while 125 percent viewed the co-sponsors as working individually Technical Assistance and Resources Table 7 lists examples of technical assistance and resources that organizations are interested in providing in the future Results are organized in three categories: interested, not equipped, interested, somewhat equipped, and interested, fully equipped
Table 7 Technical assistance and resources organizations are interested in providing by category Not equipped N
Developing diabetes products Providing best practices information Writing journal articles Highlighting statistics on organization website Conducting one-on-one consultations with staff Peer coaching/ mentoring Conducting presentations/trainings Developing technology based learning opportunities 7 99 7 99 6 85 0 00 6 85 3 42 0 00 1 14
Somewhat
equipped N
0 00 0 00 7 99 8 113 2 28 4 56 10 41 0 00
Fully equipped N
0 00 3 42 0 00 0 00 0 00 0 00 0 00 0 00
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The activities for which respondents were most interested in providing technical assistance or resources included providing best practices information, writing journal articles, and conducting presentations/trainings However, among these activities, few respondents indicated that they were fully equipped to deliver technical assistance and resources In fact, only three of the 10 respondents indicating they were interested in providing best practices information felt they were fully equipped to do so while the other seven respondents indicated they were not equipped Of the 13 respondents indicating they were interested in providing technical assistance/resources for writing journal articles only seven indicated that they were somewhat equipped to provide this technical assistance while the other six indicated they were not equipped Finally, all 10 respondents that indicated that they were interested in providing technical assistance or resources for conducting presentations and
trainings reported being only somewhat equipped to provide such technical assistance Other, less frequent areas for which respondents indicated they were interested in providing technical assistance/resources included developing diabetes products n7, highlighting statistics on organization Web site n8, conducting one-on-one consultations with staff n8, and peer coaching/mentoring n7 In these areas none of the respondents indicated that they were fully equipped to provide technical assistance/resources With the exception of developing diabetes products for which all respondents indicated that they were not equipped, respondents were split in reporting that they were
either not equipped or somewhat equipped to provide these resources Respondents were also asked to indicate whether they were already providing or would like to receive technical assistance and resources in different areas Table 8 displays these results The area in which respondents indicated the Initiative has advanced their work the most was ensuring access to trained health care providers mean373, SD103 Other areas in which the Initiative enhanced organizations work included encouraging and supporting diabetes
prevention and control programs mean350, SD130, educating community leaders mean340, SD135, expanding community based health promotion education, activities and incentives mean329, SD123 and strengthening advocacy and policy mean327, SD153 Additionally, respondents were asked to report the extent to which the Initiative was responsible for the work their organization had completed and the extent to which they felt part of the Initiative The majority of organizations 613 indicated that they would have done only some or none of their completed work without the Initiative One organization reported that they did not see themselves as part of the Initiative About 66 viewed themselves as a small part of the Initiative, and of those, most of them 636 felt that the Initiative does affect their work About 30 percent saw themselves as a key part of the Initiative Half of those felt that the Initiative did affect their work
Table 8 Technical assistance/resources organizations are providing or would like to receive by area Already Already Would like to Already Providing Providing Receive N Providing N Conducting presentations/trainings 4 56 2 28 Developing diabetes products 3 42 2 28
Providing best practices information 3 42 6 85 Highlighting statistics on organization 3 42 0 00 website Conducting one-on-one consultations 3 42 0 00 with staff Peer coaching/ mentoring 3 42 0 00 Writing journal articles 2 28 0 00 Developing technology based 0 00 0 00 learning opportunities
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Table 9 Strategy areas for which organizations are interested in providing technical assistance Interested, not equipped N 6 85 4 56 3 42 0 00 0 00 3 42 4 56 0 00 Interested, somewhat equipped N 3 42 9 127 3 42 4 56 5 70 10 141 4 56 4 56 Interested, fully equipped N 0 00 0 00 0 00 0 00 0 00 0 00 0 00 4 56
Research and surveillance Prevention Capacity building Program development Mobilizing community partnerships Educating communities Developing policies Evaluation
Table 10 Strategy areas for which organizations are already providing technical assistance or would like to receive technical ass 
istance Already Providing N 8 7 7 6 5 5 4 0 Already Providing 113 99 99 85 70 70 56 00 Would like to Receive N 3 2 3 2 3 5 6 3 Would like to Receive 42 28 42 28 42 70 85 42
Program development Capacity building
Mobilizing community partnerships Prevention Educating communities Evaluation Developing policies Research and surveillance
The most frequently identified area for which respondents were already providing technical assistance/resources was conducting presentations and trainings 56 None of the respondents indicated that they are already providing technical assistance/resources for developing technology based learning opportunities The areas for which respondents indicated they would like to receive technical assistance/resources included providing best practices information 85, developing diabetes products 28, and conducting presentations/trainings 28 None of the respondents asked to receive technical assistance in writing journal articles, highlighting statistics on organization websites, conducting one-on-one consultations with staff, peer coaching/mentoring, or developing technology based learning opportunities
Additionally, respondents were asked to report the extent to which they felt equipped to provide technical assistance for each strategy area Table 9 displays these results The only area in which any organization is interested and fully equipped to give technical
assistance is the evaluation process 56 About 14 percent and 13 percent of respondents reported that their organizations were interested and somewhat equipped to provide technical assistance in educating communities and prevention respectively Finally, respondents were asked to report which strategy areas their organizations were providing
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technical assistance or would like to receive TA Table 10 displays these results Table 11 shows statistically significant relationships between the type of work undertaken and the type of strategy area technical assistance needed eg those organizations that undertook work to expand
population-based surveillance were more likely to report needing technical assistance in research and surveillance than those organizations that did not undertake such work It may be that those organizations undertaking the work listed are simply more likely to report needing TA, regardless of technical assistance topic
Table 11 Relationship between priority action steps and strategy area technical assistance needs Priority Action Steps Expanded community-based health
promotion education, activities and incentives Technical Assistance Needs Research and surveillance Program development Mobilizing community partnerships Educating communities Evaluation Encourage and support diabetes prevention and control programs Research and surveillance Program development Mobilizing community partnerships Educating communities Developing policies Evaluation Research and surveillance Prevention Capacity building Program development Mobilizing community partnerships Educating communities Developing policies Educate community leaders Evaluation Research and surveillance Prevention Capacity building Program development Mobilizing community partnerships Educating communities Evaluation Encourage health care providers to promote risk assessment and quality care Evaluation P 002 002 002 002 000 004 004 004 004 004 000 000 003 003 000 000 000 004 001 001 003 003 001 001 001 000 003
Expand population based surveillance
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Conclusions
Despite the relatively small sample size 71, there are some interesting findings from this survey and evaluation The goal of the survey was to
evaluate the partners progress in implementing strategies and determine technical assistance needs Some of the analysis was not statistically significant due to the total number of respondents, and some information may need follow-up or further evaluation However, based on the analysis, it is possible to make some conclusions and recommendations for further implementation of the Women and Diabetes Initiative
Most organizations viewed their relationship with co-sponsors as a strong collaborative partnership The activities for which respondents were most interested in providing technical assistance or resources included providing best practices information, writing journal articles, and conducting presentations/trainings However, few respondents indicated that they were fully equipped to deliver technical assistance/resources The most frequently identified area for which respondents were already providing technical assistance/resources was conducing presentations and trainings The only area in which any organization is interested and fully equipped to give technical assistance currently is the evaluation process
The most common priority action step in the past and
currently is to encourage and support diabetes prevention and control programs The majority of participants agreed that they will act on the priority action steps in the future Only half of the participants reported that they evaluate progress related to the priority action steps Participants expressed interest in networking and partnering opportunities, especially with the CDC About half of the participants reported that they felt their efforts had not been strengthened by their involvement in the Initiative However, they did report that the most common way the Initiative helped their organization was to raise awareness and provide a framework for action Very few reported that the Initiative provided technical assistance The area in which respondents indicated the Initiative advanced their work the most was ensuring access to trained health care providers
Recommendations
Partners expressed interest in more networking and partnering, especially with the CDC It would be beneficial to hold networking events to encourage more collaboration between the CDC and their partners The capacity for technical assistance by the co-sponsors and their partners can be further developed
Currently, the perception of the partners is that they do not receive much technical assistance from partnering within the Initiative In addition, very few respondents mentioned that they were fully equipped to provide technical assistance It may be useful to provide training to the partners so that they can be equipped to provide technical assistance to other partners within the Initiative It may be especially useful to provide more technical assistance in evaluating progress related to the priority action steps In order to improve accountability, evaluation must be an important component of any program or policy
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Appendix A: Action Steps - Description Of Programs Related To The Priority Action Steps
Action Steps - Description Of Programs Related To The Priority Action Steps
Strengthen advocacy and policy
Participated in annual Advocacy Day at state capitol Established a Diabetes Council Working on expanding members Will establish short term and long term goals Promote health
Worked with hearing officers at the Department of Motor Vehicles to educate them about diabetes and driving issues Participate in advocacy efforts with Diabetes Coalition of California and with national groups like ADA Worked on a Wellmark grant to enlarge and strengthen and enlarge our Diabetes Network We ask assistance of this group to address policy and advocacy Worked through our governor appointed diabetes council Assisted in coordination of annual womens health conference, September 2006 theme is women and diabetes Devoted newsletter to educating consumers about the connection between diabetes/obesity and incontinence Produced several live satellite broadcasts to educate the community, also created toolkit for the prevention and management of diabetes Test piloted Diabetes Family Affair, Implement Live Healthy GA-Sr Taking Charge Nutrition DM self management Worked with the North Dakota Diabetes Partnership in the past and currently with the Dakota Diabetes Coalition; trained 5 people in Diabetes Today community-based diabetes education program Programs are implemented in the community that target high risk populations, programs implementing both the prevention and control
of the disease Worked with coalitions and other groups to promote health enhancing community based programs Have field staff in five regions that perform community building, education, health promotion and implement diabetes care quality improvement In our network meetings and educational sessions over the Iowa Communications Network we encouraged networking and provision of materials and ideas for the diabetes self management programs to use Offered diabetes refresher classes for seniors Contracted with a community based walking program in Las Cruces, New Mexico to encourage walking among Hispanic women ages 35 to 54 The statewide West Virginia Diabetes Prevention and Control Program has strengthened interventions at the state and community levels for all persons with diabetes Many of these reach women Devoted newsletter to educating about the connection between diabetes/obesity and incontinence
Expand community based health promotion education, activities incentives
Encourage and support diabetes prevention and control programs
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Have conducted training with stakeholders
Met one on one with several partners to promote health Promote registry Promote increase HbA1c testing, eye exam, foot exam Contracted with NMSU who works with county extension agents to provide Kitchen Creations, a cooking class for people with diabetes and their families Funded 15 regional diabetes coalitions in New York State Funded through diabetes control and prevention program We are Californias state program on diabetes and assist other states and local health programs We assumed responsibility for the DPCPs and welcomed and accepted encouragement and support of other Iowa diabetes stakeholders
Fortify community programs for women
No Response
Expand population based surveillance
We have welcomed and appreciated the support of an epidemiologist in our area She is currently moving into a new position but we look forward to a replacement for her We currently collect, analyze, and report data related to pregnancy and diabetes Overall program surveillance addresses women Data is shared with key partners and stakeholders, primarily WIC Worked with collaborative to gather local clinic data Met with health education clinic to gather data Worked with senior citizen
group to gather data We have FTE biostatistician who works to improve surveillance using California Health Interview Survey, BRFSS, and other data sources The program now has a full time epidemiologist and annually collects BRFSS data and limited data collection using the YRBSS Engaged local business leaders and policy makers in local initiatives
Educate community leaders
Educational programming is provided at conferences and in publications including on-line Worked with the New York Diabetes Coalition, a partnership of private health care providers and managed care organizations to implement diabetes standards of care Devoted newsletter to educating about the connection between diabetes/obesity and incontinence Contracted with NM Health Care Takes on Diabetes to develop diabetes provider practice guidelines Diabetes Standards of Care published on Ohio Department of Health diabetes Web site, work with Diabetes Alliance medical advisory committee
Encourage health care providers to promote risk assessment and quality care
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The state has developed both inpatient and outpatient
guidelines for treating diabetes Ongoing provider education and assessment continues on the utilization of both sets of guidelines Encouraged WIC to include information to clients about prevention and management of GDM or diabetes Provided training to stakeholder on diabetes Looking to train the trainer for the community Development of medical treatment algorithms for latest quality diabetes treatment
Ensure access to trained health care providers
Currently working with federally qualified health centers involved with the diabetes collaborative The state provides on-going trainings for health professionals; a school cluster was developed that provides intense 90 hour training for school nurses in the state Funded diabetes coalitions to increase access to care and remove barriers to care Devoted newsletter to educating about the connection between diabetes/obesity and incontinence Provided on-going skill building trainings and technical support to CDEs and other providers Provided monthly continuing education programs for health care professionals via videoconference Worked on diabetes directory for private clinics to educate staff of other resources Directory for clients
to access diabetes resources Allow for private clinic and health education to direct clients Have provided diabetes curriculum training for community health workers-promotores As we are the professional organization, our efforts in G also address this action step By appropriately including interventions in existing plans of care, needs may be covered Also have mechanisms to communicate benefits to payer groups We offer technical assistance and have many opportunities to encourage health care coverage and incentives Have published papers focusing on research done through our diabetes program
Encourage healthcare coverage and incentives
Conduct public health research
Not specified
Increased general awareness Online and print publications on diabetes and related topics Presented at national meetings to educate physicians who care for women with diabetes Research in preconception counseling for both women with diabetes and the healthcare providers who serve them We have expanded our community based programs into additional counties which also increases surveillance and education in these areas WISEWOMAN Program
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Worked with the ADA and other stakeholders to develop legislative briefs on diabetes and women Worked to train champions from sororities Continue to conduct research on midlife women and sustainable motivation and participation Developed community program to identity and refer women with pre-diabetes Distribution of materials to womens health centers DPCP has existed in North Dakota since 1987, always has been a strong partnership between health department and diabetes providers in the state Presented Inpatient Management of Hyperglycemia to all nursing staff in the organization to improve management of all patients with diabetes Research in preconception counseling for both women with diabetes and the healthcare providers who serve them We are attempting to provide train the trainer education to our grantees and partners who then share with their local community partners and leaders We have updated our Womens Continence Center Web site to include issues for women with diabetes Working with diabetes educators to educate school personnel Developed and expanded on an annual basis a statewide diabetes surveillance system Developed consensus
guidelines Distribution of materials to womens health providers Increase awareness Met with community level professionals to advocate change how physical activity is promoted for women Researched hypo and hyperglycemia in inpatient Researched preconception counseling for both women with diabetes and the healthcare providers who serve them We see incontinence issues as an important motivation for women to choose lifestyle change and ensure good treatment to improve or prevent incontinence Have had a diabetes research analyst/epidemiologist in the program for the past five years, many projects and reports initiated and completed Offered an annual statewide diabetes conference for health professionals Our focus on women with diabetes and incontinence issues Partnered with BCBS in the Diabetes Care Provider Report project Provided funding to local communities to develop programs Speaker for the Diabetes Initiative of South Carolina programs to educate health providers
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The state established the Diabetes Emergency Medical Fund that provides 400 annually for an
emergency need related to the persons diabetes Offered annual diabetes forum for community leaders to educate and empower them around diabetes Our research included population-based surveys Worked with Blue Cross Blue Shield on diabetes coverage
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Appendix B: Ways In Which Cosponsors Could Help Organizations Meet Their Technical Needs
Worked in a more collaborative manner
AADE: educators/speakers CDC: programs/literature
Continues education, data, and training
Cosponsors are unable to assist our organization because organization issues are related to lack of funding and staff time
Have symposiums at their meetings on incontinence and type 2 diabetes
I think that NICOA would work best with other organizations with education and promotional aspects of our service They may also help us in coming up with different facts at doing an evaluation process
Offered on-line trainings and/or electronic documents about best practices/evidence based approaches
Offered training opportunities
Our program is not organizationally located in the same area/branch as the womens
health program or the WIC program; therefore, these programs may not collaborate
Provided funding or advocate to state legislators Give us tools/best practices Work with national groups and develop collaborative relationships that filter down to the states
Provided ideas for how to develop and distribute information to populations at risk and who have difficulty accessing information for whatever reason Provided/shared data on how consumers in these populations access and use health information or dont
Provided simple and brief sound bites of information that we can share with partners to direct them to further information
Shared information through newsletters; conduct periodic updates during CDC state program conference calls
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Appendix C: Organizations That Should Be Included In Initiatives Efforts
AARP CMS Medicaid, Medicare University Medical Centers and nutrition degree programs American Diabetes Association CDC WISEWOMAN and Diabetes Any organization working with those who have diabetes and willing to serve including those who have diabetes,
organizations of faith and physicians Diabetes Initiative of South Carolina Lesbian health organizations National Association of Continence NAFC National Indian Health Board State and Federal agencies National Institute of Diabetes Digestive Kidney Diseases National Womens Health Information Center State medical schools American Dietetic Association AADE AWHONN ACOG American Health Association Women In Business State Womens Health Program more collaborative efforts between womens health and diabetes program in each state State WIC programs that are funded through USDA Food stamp recipients Womens and parenting organizations Women legislators
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Appendix D: Success Stories
Development of preconception education programs
Created the standards of care for Guam in 2002
Day before Mothers Day, health fair at Columbiana Mall Diabetes Education table with information on diabetes and prevention of diabetes The display board was on prevention of diabetes
Directed consumers to work done by Initiative and its partners for additional information on topics
Helped consumers understand that
there is help Obese women can change the diet and exercise habits to become less likely to become diabetic We have also enlightened women about communicating with their physicians and getting in touch with support groups
The education has helped me with education to the seniors
Nationally educating women with type 2 diabetes that urinary incontinence is a common, chronic, and costly health problem We were involved in a Wal Mart campaign
Offered support groups and refresher education Diabetes groups have started talking with each other and sharing success and failures
Our Basic Guidelines for Diabetes Care packet is an extremely popular item for clinicians We developed a treatment algorithm for women with gestational diabetes to recommend the proper care during and after their pregnancy
Participated and assisted in conducting CDD Womens Health Council WHC diabetes and depression survey, and participating in development of WHC Web site
Provided quality technical assistance and educational programs along with networking opportunities
Support groups
The awareness the CDC program has provided to the problem of diabetes and women, in concert with other evolving
epidemics relative to metabolic syndrome and heart disease - all that require physical fitness to attain or maintain health - have been instrumental
The ODPCP has partnered with the Womens Health Coordinator to co-sponsor the annual Womens Health Kickoff in September 2006 which will focus on diabetes in women
The program has recently been collaborating with the State WIC program in developing a variety of educational, referral materials, and nutrition counseling guides for registered dietitians to use with gestational diabetes
The West Virginia Diabetes Prevention and Control Program will now be assessing the issue of diabetes and pregnancy The Program will convene stakeholders to make policy recommendations based on findings
Training champions Educating public health professionals
Collaborated on an effort to diagnose and treat seniors in selected senior center sites across Georgia
Worked with our office of womens health to provide training and education through video and other conferences
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Appendix E: Organizations Participating in Survey
Women and Infants Hospital Ohio Department of Health- Ohio Diabetes Prevention and Control Program Guam Diabetes Prevention and Control Program Centers for Medicare and Medicaid Services National Kidney Foundation DHHS Office on Womens Health Region X Nebraska Health and Human Services Kansas Department of Health and Environment Middle Georgia Area Agency on Aging Centers for Disease Control American Diabetes Association Health Resources and Services Administration, Department of Health and Human Services California Diabetes Program Pennsylvania State University North Carolina Division of Public Health/Diabetes Prevention and Control Branch National Womens Health Resource Center Ministry of Health Services The National Alliance for Hispanic Health Department of Health and Human Services- Office of Womens Health New York State Department of Health, Diabetes Prevention and Control Program Association of Asian Pacific Community Health Organizations American Physical Therapy Association Diabetes Multicultural Coalition City of Independence Health Department Texas Department of State Health Services- Diabetes Prevention and Control Program
Independent Consultant Institute of Human Nutrition Upper Peninsula Diabetes Outreach Network Medical University of South Carolina Ohio Diabetes Prevention and Control Program/Ohio Department of Health Connecticut Department of Public Health National Council of Womens Organizations Georgia Department of Human Resources National Womens Health Resource Center Lexington Medical Center
The National Center for Women and Wellness Florida AM University Indiana State Department of Health West Virginia Bureau for Public Health/Division of Health Promotion and Chronic Disease West Virginia Bureau for Public Health Employee Assistance Program Pennsylvania Diabetes Prevention and Control Program Illinois Department of Human Services Kaiser Permanente Naomi Berrie Diabetes Center University of California, San Francisco Centers for Disease Control/National Center for Health Statistics Nevada State Health Division Michigan Department of Community Health Autoimmune Disease Association Idaho Department of Health and Welfare, Diabetes Prevention and Control Program University of Pittsburgh Nevada State Health Division American Physical Therapy Association New Mexico Diabetes Prevention and Control
Program National Association for Continence Arizona Department of Health Services EyeCare America National Indian Council on Aging North Dakota Department of Health South Dakota Diabetes Prevention and Control Program Iowa Department of Public Health- Diabetes Prevention and Control Delaware Division of Public Health, Diabetes Prevention and Control Program Virginia Department of Health American Public Health Association
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202 371-9090 tel 571 527-3189 fax 2231 Crystal Drive, Suite 450 Arlington, VA 22202 wwwasthoorg Diabetes Womens Health JUNE 2007 PUB-0706006
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Source:sh.lsuhsc.edu
