Diabetes program, co-sponsored by the Community Health Access Network (CHAN) of Type 1 and Type 2 diabetes in small group sessions that typically last …
Early Prevention of Diabetes Improved Access to Health Care: The Feasibility of Addressing Healthy Border 2010 Objectives with Community Coalitions in Colonias in South Texas
Final Report
Report to: Dr Marta Fournier, TDSHS-Region 11 OBH Program Director 601 West Sesame Dr, Harlingen, TX 78550
By: Dr Ann V Millard Associate Professor Contract Director South Texas Center, School of Rural Public Health, TAMUS Health Science Center 2101 South McColl Rd, McAllen, Texas With the Assistance of: Ms Esmeralda Sánchez, BA, Ms Bonny Medina, CCHW, and Ms Ester Carbajal, CHW
2/14/07
Re: Early Prevention of Diabetes Improved Access to Health Care DSHS Contract No 7097097093D-2007, Attachment No 01 DSHS Purchase Order No 0000319865 Contractor: TX AM University System Health Science Center DSHS Program: Office of Border Health Term: August 01, 2006 THRU December 31, 2006 SRPH Account No 400041-OBH-EPD 8/1/06-12/31/06
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Early Prevention of Diabetes Improved Access to Health Care DSHS OBH Document No 7097097093D-2007, Attachment No 01 Purchase Order No 0000319865; Contractor: TX AM University System Health Science Center Term: August 01, 2006 THRU December 31, 2006
Early Prevention of
Diabetes Improved Access to Health Care: The Feasibility of Addressing Healthy Border 2010 Objectives with Community Coalitions in Colonias in South Texas Final Report, February 14, 2007 Executive Summary This project addressed Healthy Border 2010 objectives in the areas of diabetes and access to health care Specifically, we examined the feasibility of engaging in early prevention of diabetes through communitybased planning to enhance physical activity and/or nutrition in colonias We also improved access to health care for colonia residents through health education and referrals These activities link to Healthy Border 2010 areas and objectives and to the Strategic Plan for the Prevention of Obesity in Texas: 20052010 Our project team included promotoras who recruited colonia residents to participate in this project Those who participated in planning the intervention were 6 to 10 women representing that number of families in one colonia, including about 40 people Attendance at planning meetings fluctuated, but no family dropped out of the project Furthermore, the participants expressed enthusiasm about the possibility of a project, and they requested that it include information and
activities involving both physical activity and nutrition For the risk assessment phase of the project, the promotoras recruited 30 adults to respond to an interview and have their body mass index measured The nutritional risk assessment dealt with how frequently they ate fruits and vegetables We found that they eat fruits and vegetables a little more than twice a day 21 times daily on average for fruits and vegetables combined, for 29 respondents In addition, their rice intake is well less than once a day 038 times daily on average, and they eat beans almost once daily 098 times daily On the basis of these reports, the respondents have quite low intake of fruits and vegetables, in contrast to the recommended 7 to 10 times per day Their physical activity levels also are low Of the 9 participants with remunerated work, only 22 engage in vigorous physical activity on the job Of all participants, when not at work, more than half engage in walking 3 days/week on average Only 13 engage in vigorous physical activity during their leisure time, on an average of 325 days/week Of the 30 respondents in the risk assessment, 90 have BMIs 25 That includes 86 of the women participants and 100 of
the men Therefore, participants with the genetic background to develop type 2 diabetes have a significant behavioral risk factors for developing type 2 diabetes The colonia residents participated in developing a plan for an intervention They decided to form a group that would engage in walking, beginning at 6 pm each night, and that would include women plus those family members who decided to accompany them The project team also will schedule nutrition classes for the group members We are pleased to report that the planning phase of this project proved feasible and we look forward to the implementation phase 2
Re: Early Prevention of Diabetes Improved Access to Health Care, Term: August 01, 2006 THRU December 31, 2006 DSHS Contract No 7097097093D-2007, Attachment No 01; DSHS PO No 0000319865, Office of Border Health Contractor: TX AM University System Health Science Center
Table of Contents Acknowledgments Introduction Healthy Border 2010 areas and objectives that the project addressed Project goals related to the Strategic Plan for the Prevention of Obesity in Texas: 2005-2010 TDSHS 2006 Process of Colonia Recruitment Process of Risk Assessment Instruments and Methods of Risk
Assessment Body Mass Index Assessment Risk Assessment Results Table 1 Table of deliverables of this project Increasing Access to Medical Care Table 2 Increasing access to medical care, August through December, 2006 4 5 5 5
5 6 7 9 9 11 12 13
Feasibility of Engaging in Planning Early Prevention of Diabetes with Community Partnerships 14 Table 3 Participatory project principles involving colonia residents 15 Plan for a Program in Physical Activity and Nutrition to be Initiated in Phase 2 Relationship to Healthy Border 2010 Areas and Objectives Relationship to the Strategic Plan for the Prevention of Obesity in Texas: 2005-2010 Conclusions 18 18 19 19
Appendix Appendix 1 Scope of Work, Document no 7097097093D-2007, Attachment no 01, 21 Purchase order no 0000319865 Contractor: Texas AM Univ System Health Science Center DSHS Program: Office of Border Health Term: August 01, 2006 - December 31, 2006 Early Prevention of Diabetes Improved Access to Health Care: The Feasibility of Addressing Healthy Border 2010 Objectives with Community Coalitions in Colonias in South Texas Appendix 2 Risk assessment instrument 3
Re: Early Prevention of Diabetes Improved Access to Health Care, Term:
August 01, 2006 THRU December 31, 2006 DSHS Contract No 7097097093D-2007, Attachment No 01; DSHS PO No 0000319865, Office of Border Health Contractor: TX AM University System Health Science Center
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Acknowledgments We thank Dr Marta Fournier, TDSHS-Region 11 OBH Program Director, for her guidance on this project and for the training sessions sponsored by her office and provided by Dr Belinda Reininger We thank other members of the Office of Border Health and DSHS, including Ms Kassie Rogers and Ms Diana Garcia, for their ideas on various methodological issues Additional thanks are due to Dr José Antu of the Laredo Health Department for information on the program there We thank Dr Reininger for information about her surveys and the training on project planning and participatory projects; the advice of Dr Nelda Mier also provided valuable guidance to this project We thank Ms Edith de Lafuente of the Office of Border Health in Harlingen and Ms Lupita Guerrero, Public Health Technician, Laredo Health Department for providing ongoing information of various kinds and for their cheerful encouragement Access provided by Dr Isidore Flores and his team members to the social networks
developed by the First-Aid Project was crucial to the success of this project Our experience with the project of Dr Elena Bastida and Mr Armando Dominguez also provided us with information to use in planning our project In addition, we thank the colonia residents for their interest in this project, their cooperation with all the measurement processes, and their participation in program planning
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Re: Early Prevention of Diabetes Improved Access to Health Care, Term: August 01, 2006 THRU December 31, 2006 DSHS Contract No 7097097093D-2007, Attachment No 01; DSHS PO No 0000319865, Office of Border Health Contractor: TX AM University System Health Science Center
Early Prevention of Diabetes Improved Access to Health Care: The Feasibility of Addressing Healthy Border 2010 Objectives with Community Coalitions in Colonias in South Texas
Final Report February 14, 2007 The purpose of this project was to address Healthy Border 2010 objectives in the areas of diabetes and access to health care Specifically, we examined the feasibility of engaging in early prevention of diabetes through community-based planning to enhance physical activity and/or nutrition in colonias We also improved
access to health care for colonia residents through health education and referrals This project addressed the following Healthy Border 2010 areas and objectives:
Diabetes reduce both the mortality rate of diabetes and the need for hospitalization; Access to Health Care ensure access to primary care or basic health care services Healthy Border 2010:vii
Furthermore, in relation to diminishing risk factors for diabetes, the project addressed the Strategic Plan for the Prevention of Obesity in Texas: 2005-2010 regarding the following goals TDSHS 2006:35: Goal 1: Increase awareness of obesity as a public-health issue that impacts the quality of life of families Goal 2: Mobilize families, schools, and communities to create opportunities to choose lifestyles that promote healthy weight Goal 3: Promote policies and environmental changes that support healthful eating habits and physical activity Goal 4: Monitor obesity rates and related behaviors and health conditions for planning evaluation and dissemination activities The plan for the project is shown in Appendix 1, Scope of Work We carried out the following activities:
Process of Colonia Recruitment We examined the
feasibility of partnering with social networks in colonias By working with promotoras familiar with the colonia networks, project team members opened the door to participation in this project First, two promotoras visited colonias to explain the project and see who was interested in participating A number of colonias are interested in participating in such a project The promotoras recruited 30 participants Although it had been anticipated that the 30 would be divided among four colonias, the promotoras found it more effective to recruit them from two colonias The remaining colonias will be incorporated into the project in Phase 2 of the project
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Re: Early Prevention of Diabetes Improved Access to Health Care, Term: August 01, 2006 THRU December 31, 2006 DSHS Contract No 7097097093D-2007, Attachment No 01; DSHS PO No 0000319865, Office of Border Health Contractor: TX AM University System Health Science Center
Weekly group meetings were scheduled with colonia residents, and they discussed options of a physical activity or nutrition program They would like to have both They are enthusiastic about the idea of a program that will lower their risks of developing diabetes, heart
disease, and cancer They specifically requested: a As part of the program, they would like to have checking of cholesterol levels, blood sugar levels, and blood pressure Some people commented that it is expensive to go to a clinic to get these measures checked If we are to do the checking as part of our program, they would like it to be at night, with a meeting starting at 7 pm, so that their spouses can participate They would like to have the apparatus for checking blood pressure and blood sugar right there in the colonia They would like it to be handled similarly to the first-aid kit; that is, one person could have it in their house, and various people could use it when they wanted to One participant said, If I feel dizzy, I would like to be able to check my blood pressure I would like to know whether I need to go to the doctor b They would like to have aerobics One of the people who spoke up about this thinks that you need exercise machines, such as treadmills, to participate in aerobics In another colonia, we have participated in delivering a program in aerobics with a colonia resident as aerobics instructor She is enthusiastic, creative, and pretty knowledgeable In that
colonia, one resident also has a videotape with dance music and a group of men and women doing aerobics, instructing the audience in doing various steps The women colonia residents have used both resources to increase their physical activity, although they say that having an instructor makes them exercise harder c Some are interested in losing weight and one requested a diet book She probably is not aware of the approach of eating better balanced meals, rather than dieting per se We have several recipes for healthful plates, and we can share these with the group Also, we can request a visit from a nutritionist to discuss ideas about how to lose weight and be healthy through improved nutrition d An additional concern is the large number of colds that people are getting They would like something to prevent colds gripa They mentioned vaccinations, like a flu vaccination, and vitamins Process of Risk Assessment Second, the promotoras and project team carried out a needs assessment regarding behavioral risk factors for diabetes It is known that the prevalence of diabetes is high in colonia populations; however, the risk factors that lead to this high prevalence have not been specified
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Re: Early Prevention of Diabetes Improved Access to Health Care, Term: August 01, 2006 THRU December 31, 2006 DSHS Contract No 7097097093D-2007, Attachment No 01; DSHS PO No 0000319865, Office of Border Health Contractor: TX AM University System Health Science Center
Instruments and Methods of Risk Assessment The project team reviewed several approaches to identifying risk factors Instruments reviewed were: 1 Monterey County Behavioral Risk Factor Survey IMPACTO II - 2000 in English and Spanish; validated It was developed on the basis of the Behavioral Risk Factor instrument developed by the Centers for Disease Control
2 Comportamientos de Riesgo para Enfermedades Crónicas, 18 a 65 años Marzo del 2005 Secretaria de Salud, Subsecretaria de Prevención y Promoción de la Salud, Dirección General de Epidemiología y Comisión de Salud Fronteriza México-Estados Unidos Behavioral Risk Factors for Chronic Diseases, 18 to 65 years of age March 2005 Secretary of Health, Subsecretary of Prevention and Health Promotion, General Director of Epidemiology and US-Mexico Border Health Commission Reasons for using this instrument are as follows It is available in Spanish Second, because it is
set up as a telephone questionnaire, it is more useful for a face-to-face interview than a written questionnaire would be Because some colonia residents have low literacy levels, and many are not used to dealing with questionnaires, a face-to-face instrument is preferable Third, this instrument is being used widely in the border region, providing a basis for comparison with other border populations Finally, although the questionnaire is relatively long, colonia residents find it easy to answer and straightforward The instrument elicits data on the frequency of consuming various foods We have more confidence in recall data on food frequency than on the amount of food that someone ate Furthermore, the analysis of amounts of food eaten is much more laborious and therefore, much more costly, than the analysis of food frequency In this project, therefore, we are not attempting to work on amounts of food consumed but instead focus on the variety of food eaten on a typical day or in a typical week We found an aspect of the food frequency questions problematic and developed a way to solve the problem Normally, a food frequency questionnaire asks how often during a typical week a person
eats a specific food, or how often during the past week someone ate it In the case of the Secretary of Health questionnaire, however, the questions asked for frequency per day, week, month, or year Our approach to this issue is to code items eaten less often than once a week as zero, as though they are not eaten Our decision rests on the fact that we seek information about typical, routine patterns of eating, not an exact inventory of all foods eaten during a year We refined some of the items for the use in Spanish of limited-income people in South Texas The project team carried out this work and narrowed the instrument to focus on risk factors for diabetes and patterns of physical activity and nutrition The results document needs for intervention, assist in orienting the specific approach of the intervention, and provide pre-intervention baseline data 7
Re: Early Prevention of Diabetes Improved Access to Health Care, Term: August 01, 2006 THRU December 31, 2006 DSHS Contract No 7097097093D-2007, Attachment No 01; DSHS PO No 0000319865, Office of Border Health Contractor: TX AM University System Health Science Center
3 Cuestionario Internacional de Actividad Física IPAC Noviembre
del 2002 Formato Telefónico Largo–Últimos 7 Dias International Questionnaire on Physical Activity November, 2002 Long Telephone Interview Format–the Last 7 Days Source: Los Cuestionarios Internacionales de Actividad Física IPAQ, por sus siglas en inglés; Booth, ML 2000 Assessment of Physical Activity: An International Perspective Research Quarterly for Exercise and Sport, 71 2: s114-20; wwwipaqkise The module on physical activity comes from this questionnaire The reasons for choosing this instrument were that it was available in Spanish, in a format designed for face-to-face interviews, and it has been successful in data collection with some populations in Mexico, although it has not been pretested with border populations Dr Nelda Mier, who has expertise in physical activity surveys, recommended it after a thorough review of other instruments available in Spanish or English The IPAC interviews began their development in Geneva, Switzerland, in 1998 and have been tested in 14 sites in 12 countries, with extensive attention to their reliability and validity They are designed for international comparison, which makes them useful for our more international region of Texas We
pretested items from both the long and short IPAC interview formats Pretesting led to changes in the instrument, based on project participants reactions and interviewers observations The changes and observations were as follows: Some of the questions were too long and needed to be broken up into two sentences, one giving instructions and the other posing the question Participants commented that the question, Time spent commuting or traveling by car, bus, etc, in a seated position should have a response rounded to hours, not expressed in minutes Several questions ask to note time in hours and minutes Some participants did not think it was necessary to denote minutes, but others felt it was fine It was left in the survey for those that might answer in minutes Participants suggested changing specific phrases or words to make the questions easier to understand The phrase trabajo pago o no pago was changed to trabajo pagado o no pagado, the word desplazo was changed to traslado, the phrase no caminatas was changed to no camine Clarification of actividad vigorosa and actividad moderada was necessary throughout the survey The question and examples of these activities were repeated as
necessary Question 8 Part 2 includes the word tranvía when discussing motor vehicles The group did not reach a consensus about what this word meant It was interpreted in various ways and the participants suggested omitting this word The participants understood the question with the remaining examples of motor vehicles Question 26 required clarification for some people about the time spent sitting during the day Interviewers clarify that question by specifying that it only includes time spent awake General comments: o The words such as usualmente and nuevamente were used quite often throughout the survey in asking the questions or giving instructions The suggestion was made to omit these words in several places because it made the questions too long to the listener when 8
Re: Early Prevention of Diabetes Improved Access to Health Care, Term: August 01, 2006 THRU December 31, 2006 DSHS Contract No 7097097093D-2007, Attachment No 01; DSHS PO No 0000319865, Office of Border Health Contractor: TX AM University System Health Science Center
the investigator read the question Sometimes it was so long that they asked the interviewer to repeat the question o Several questions were also
considered long because the instruction was read together with the questions The suggestion was made to list instructions prior to the question to make the question istelf clearer to the individual answering ie question 4, 14, 16, 18, 22, and 24 o A few people mentioned that they walked or rode a bike sometimes, but had not done so in the past 7 days that we asked about because of the weather They thought we should ask the question in general so they would be able to answer For the purpose of this project, we have adopted the long questionnaire It was noted that the shorter version had vaguer questions, which made them more difficult to answer This instrument was designed to pilot test the intervention When and if the instrument is applied to a larger population, it would be practical to use it with a sample of that population to gather baseline and post-intervention data This is an important consideration in view of the length of the instrument In addition, it is important to note that the information elicited with the instrument comes from self report, resulting in potentially biased data
Body Mass Index Assessment In contrast to the above instrument that we developed, which
elicits data from project participants, we also collected data on height and weight to calculate body mass index BMI This effort was planned to allow us to examine the feasibility of assessing changes in BMI The advantage of these measurements is that they do not depend on self-report In addition, because the project aims to enhance patterns of physical activity and/or food intake, a hoped-for outcome is to improve BMIs in those who are overweight
Risk Assessment Results Description of the Participants Most participants are middle-aged females with at least a primary school education Specifically, the average age of the participants is 43 years; almost three quarters are women All participants are Hispanic Nearly all have completed primary school, and more than one quarter have completed high school Only 10 have less than a primary school education All participants responded to the questionnaire in Spanish, and among immigrants, 83 speak only Spanish, while 8 speak some English, and another 8 speak both Spanish and English equally If this information is used as a proxy variable for acculturation, we would conclude that their acculturation to the United States is relatively weak
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Re: Early Prevention of Diabetes Improved Access to Health Care, Term: August 01, 2006 THRU December 31, 2006 DSHS Contract No 7097097093D-2007, Attachment No 01; DSHS PO No 0000319865, Office of Border Health Contractor: TX AM University System Health Science Center
Behavioral Risk Factors The behavioral risk factors that we examined were fruit and vegetable intake and patterns of physical activity The ideal intake of fruit and vegetables would be 7 to 9 servings per day, total The ideal pattern of physical activity would be the equivalent of walking for at least half an hour daily at a vigorous pace, so fast that it is not possible to talk while walking Our survey provides a general picture of eating and physical activity behaviors We chose to elicit food frequency data because self-report makes it very difficult to quantify amounts of various foods that are eaten, and the analysis of dietary composition is much more laborious and therefore, much more costly than the analysis of food frequency data Table 2 item 3 provides a summary of information about behavioral risk factors for diabetes The participants in this project eat fruits and vegetables insufficiently According to
the reported food frequency data, they eat fruits and vegetables, with the total for the two categories of food combined, a little more than twice a day 21 times daily on average In addition, their rice intake is well less than once a day 038 times daily on average, and they eat beans almost once daily 098 times daily On the basis of these reports, the respondents have quite low intake of fruits and vegetables They engage in insufficient efforts at physical activity Note that of the 9 participants with remunerated work, only 22 engage in vigorous physical activity on the job Of all the participants, when not at work, more than half engage in walking 3 days/week on average Only 13 engage in vigorous physical activity during their leisure time, on an average of 325 days/week The nutrition and physical activity data therefore indicate that the behavioral risk factors for diabetes and other chronic diseases are substantial in this population
Body Mass Index The entire group of participants in this project includes 30 people, of whom 90 have BMIs 25 That includes 86 of the women participants and 100 of the men Table 1, item 4 This measure alone indicates that 90 of colonia residents
have significant risks of health problems that could be lowered through enhanced patterns of physical activity and nutrition For those with the genetic background to develop type 2 diabetes, the high BMI is a significant factor increasing their risk of developing the disease The 90 with a high BMI all have significantly increased the risk of circulatory system diseases and cancer Therefore, on the basis of BMI alone, a participatory intervention program to improve patterns of physical activity and nutrition is warranted
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Re: Early Prevention of Diabetes Improved Access to Health Care, Term: August 01, 2006 THRU December 31, 2006 DSHS Contract No 7097097093D-2007, Attachment No 01; DSHS PO No 0000319865, Office of Border Health Contractor: TX AM University System Health Science Center
Table 1 Deliverables of this project
Measure in the evaluation Number of participants Attrition of participants
1 Participation in project activities
Attending meetings for planning program Needs assessment diabetes risk factors Needs assessment BMI Referrals for medical care screening fliers distributed Completed program plan on diabetes risk factors 6 to 10 people 30 30 239 10 wives/mothers
fluctuation
fluctuation
2 Needs assessment 30 respondents unless noted otherwise
Sociodemographic data Age Gender Ethnicity Education, grades completed in school No schooling or only attended kindergarten Primary school 1st - 6th grades Junior high school 7th - 9th grades High school 10th - 12th grades Some college or technical school College graduate Refused to answer Language facility Answered questionnaire in Spanish Acculturation for immigrants, proxy variable Language spoken at home Spanish only More Spanish than English Both Spanish English equally Only English 3 Behavioral risk factors for diabetes A Nutrition/dietary intake Food frequency: times/day fruits and vegetables 29 respondents rice beans B Physical activity Activity at work for the 9 people reporting that they have remunerated work Walking 5 people, ave 42 days/wk Moderate physical activity does not include walking; 5 people, ave 4 days/wk 43 16 Males, 27 100 Hispanic 10 40 20 27 3 0 0 100
Females, 73
83 8 8 0 average times eaten/day
21 038 098
56 56
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Re: Early Prevention of Diabetes Improved Access to Health Care, Term: August 01, 2006 THRU December 31, 2006 DSHS Contract No 7097097093D-2007,
Attachment No 01; DSHS PO No 0000319865, Office of Border Health Contractor: TX AM University System Health Science Center
Vigorous physical activity 4 people, ave 44 days/wk Activity in leisure time Walking 16 people, ave 3 days/wk Moderate physical activity does not include walking; 5 people, ave 34 days/wk Vigorous physical activity 4 people, ave 325 days/wk 4 Objective data, risk factor for diabetes BMI 25, all participants Women Men
22 16 17 13
90 86 100
Summary on Risk Factors According to the survey and measurements of BMI, the participants have substantial risk factors for developing type 2 diabetes, given a genetic propensity for the disease, and for other chronic disease such as circulatory system disorders and cancer Intake of fruit and vegetables is quite low, as are physical activity levels Although colonia life in many ways discourages people from increasing physical activity because of the lack of sidewalks, parks, and household space for exercising, the participants are eager to take part in a program to increase their physical activity Similarly, with limited budgets, cooking equipment, and cooking fuel, participants may find it difficult to improve their
eating habits Nonetheless, the residents are eager to improve their health and prevent chronic disease
Increasing Access to Medical Care The project connected colonia residents with immediate needs for medical care to appropriate community and private healthcare providers We also provided general information about health resources in the county to colonia residents through information given directly by the promotoras and with fliers that they distributed During the course of delivering the monthly reports, the program team received a request from the Office of Border Health to include the GIS Geographic Information Systems address for the colonias where information was provided for access to medical care At that point, we began to keep records of the referrals that linked colonia names to referral points and reasons for the referrals, as shown in the table below The total number of people directly contacted and provided with information about access to medical care, including screening tests, was 239 Table 2 Through providing information to colonia residents, this project provided health education to improve health literacy In addition to providing benefits to colonia residents
and contributing to the Healthy Border 2010 goals, this aspect of the project was required for ethical reasons It would be unethical to carry out a project with a population who has poor access to medical care if we did not make every effort to refer those in need to healthcare providers 12
Re: Early Prevention of Diabetes Improved Access to Health Care, Term: August 01, 2006 THRU December 31, 2006 DSHS Contract No 7097097093D-2007, Attachment No 01; DSHS PO No 0000319865, Office of Border Health Contractor: TX AM University System Health Science Center
Table 2 Increasing access to medical care, August through December, 2006
Referred to Colonia GIS Address
Month
Numbers Adults Children 1 6
Aug Aug
Nuestra Clinica del Valle Planned Parenthood - Pap smear Hidalgo Co Health Dept Clinic - Donna - Pap smear Hidalgo Co Indigent Healthcare Program Su Clinica Familiar - uterine problemas CHUD Tx AM colonias program - Diabetic retinopathy exam Well Woman Clinic - Pap smear Health Fair, Pharr - Information on diabetes Valley Transit: transportation to eye exam Hidalgo County Indigent Program UTPA Off of Border Health Triny Soto El Milagro Clinic
Colonia OT N 26 12713 W 98 24333 South
Tower Estates N 26 08889 W 98 06626 Tierra Bella N 26 07747 Pantera N 26 09199 Whitewings 2 N 26 09823 varias colonias
Aug
1 W 98 03119 6 W 98 07040 1 W 98 06030 10 10
Aug Aug Aug
Sept Sept
varias colonias varias colonias
7 60
Sept Oct Oct Oct
1 Sanchez Ranch N 26 05835 Sanchez Ranch N 26 05835 Sanchez Ranch N 26 05835 Carlos Acres N 26 13571 Sanchez Ranch N 26 05835 Sanchez Ranch N 26 05835 Carlos Acres N 26 13571 Sanchez Ranch N 26 05835 4 W 98 13517 1 W 98 13517 1 W 98 13517 3 W 98 24900 1 W 98 13517 2 W 98 13517 1 W 98 24900 1 W 98 13517
Nov Nov Nov Nov Nov
Planned Parenthood Hidalgo County Indigent Program UTPA Program-Triny Soto Well Woman Clinic El Milagro Clinic
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Re: Early Prevention of Diabetes Improved Access to Health Care, Term: August 01, 2006 THRU December 31, 2006 DSHS Contract No 7097097093D-2007, Attachment No 01; DSHS PO No 0000319865, Office of Border Health Contractor: TX AM University System Health Science Center
Dec
Nuestra Clinica del Valle - Information on Health Programs
Dec
El Milagro Clinic - Information on Health Programs
Dec
Univ Texas Med Branch - Information on Health Programs
Dec
Planned Parenthood Pap smear
Sanchez Ranch N 26
05835 Pantera N 26 09199 Rancho Blanco N 26 08973 Sanchez Ranch N 26 05835 Pantera N 26 09199 Rancho Blanco N 26 08973 Sanchez Ranch N 26 05835 Pantera N 26 09199 Rancho Blanco N 26 08973 Sanchez Ranch N 26 05835
18 W 98 13517 12 W 98 07040 10 W 098 07350 18 W 98 13517 12 W 98 07040 10 W 098 07350 18 W 98 13517 12 W 98 07040 10 W 098 07350 2 W 98 13517 239
0 0 0 0 0 0 0 0 0 0
Total direct referrals
Feasibility of Engaging in Planning Early Prevention of Diabetes with Community Partnerships This project examined the feasibility of engaging in planning early prevention of diabetes with community partnerships through working with the social network members to design physical activity programs and/or nutrition programs focused on families and their social networks The interventions were to target risk factors for diabetes and shall take place in the colonia neighborhoods Limiting factors in the planning process were several, at different levels 1 We met with people in colonias that lacked a community center; therefore, we needed to meet with them at their homes The process of organizing such a meeting was developed by the promotoras, and involved planning a time for the meeting
within the following few days, developing a list of those who accept the invitation to attend, and calling the morning of the meeting to confirm that the meeting would occur This process is laborious, but it seems to be the best way to ensure that a meeting takes place 2 Regarding ideas about physical activity, people are interested in aerobics and other kinds of activity that they have seen on TV or learned about otherwise The limitations in the colonias, however, largely revolve around space and transportation In the colonias, there are often empty 14
Re: Early Prevention of Diabetes Improved Access to Health Care, Term: August 01, 2006 THRU December 31, 2006 DSHS Contract No 7097097093D-2007, Attachment No 01; DSHS PO No 0000319865, Office of Border Health Contractor: TX AM University System Health Science Center
lots that could be used to make space for physical activity; however, the lots would have to be cleaned, ie, mowed, cleared of any garbage and junk, and probably, leveled In the case of areas with access to a community center, it would be easier to locate space for physical activity, and if the center were air conditioned, it would be that much more attractive People
lack the transportation to go to the schools to take advantage of playgrounds; in addition, women seem somewhat reluctant to leave home They are worried about thieves Observations of groups in colonias reveal that aerobics, when a carport is available, or walking groups are the main two options for women to get exercise Aerobics is regarded as a womens activity, and men have jokingly expressed reluctance to engage in it Walking is not acceptable in areas where it is not safe, or where the Border Patrol tends to cruise to pick up people to find out whether they have documents Consultation over what physical activity to do is thus somewhat limited because of these realities 3 Given a choice of physical activity or nutrition classes, people say they want both This is consistent across colonias and age groups 4 Colonia residents seek other health information They gladly provide blood samples for measuring blood glucose They are also interested in their cholesterol levels, and many have heard of HDLs and LDLs They also want to know their blood pressure It is commendable that they seek this information, and access to it also motivates colonia residents to participate in health projects 5
See also the principles of working with colonia residents below
Formative Assessment of the Feasibility of the Project Formative evaluation of the project: a Participation of community partners generally has been impressive Even during the coldest days of the winter, community partners have met regularly once a week to discuss the project b Community partners are responsive to the project plan to collect before and after data with questionnaires and measurements of height and weight c The community partners also were fully cooperative in planning a program involving physical activity and nutrition Their participation tended to be brief and to the point, without long-winded discussion d Similarly, the community partners wanted to begin implementing the plan immediately On the basis of intensive interaction during meetings in several colonias of different sizes, a number of principles were developed The list of principles was begun in October and was updated monthly 15
Re: Early Prevention of Diabetes Improved Access to Health Care, Term: August 01, 2006 THRU December 31, 2006 DSHS Contract No 7097097093D-2007, Attachment No 01; DSHS PO No 0000319865, Office of Border Health
Contractor: TX AM University System Health Science Center
These are principles for researchers and public health staff who are working with colonia communities in participatory projects, meaning that community members are to be involved in designing and implementing the project at each step Table 3 Participatory project principles involving colonia residents 1 Meetings with colonia residents, mechanics: a Decide on a principal meeting time and stick to it Additional meetings can be added, but the major decisions should be made at the main meeting time Colonia residents lead busy lives, they work on different shifts, and they may not have the flexibility of middle class people to change their schedules b If men are to participate in the project, the main meeting time should be at night to take advantage of the availability of those who work days For such meetings, child care needs to be arranged if there is to be any sort of presentation where it is important for the parents to hear clearly what is being said c Child care is best provided adjacent to the meeting, so that parents will know immediately if there is any problem with their children d Meetings with women only are best
held in the mornings at 11 am during the school year Children return from school around 3 pm and their mothers want to have time to get ready beforehand; thus the early afternoon generally is not a good time for a meeting At such meetings with women, their preschool children are likely to be present Meetings scheduled for 2 pm generally are canceled by the colonia residents, even after they agree to them in the first place The reason is the press of events during the day Other meeting times: 10 am is sometimes too early because some women are still bathing and preparing their young children for the day; 12:30 pm seems to be possible for women in some colonias When school is not in session, women have less flexibility and less time for meetings because of their responsibilities in child care e Family activities on Saturday afternoons have been suggested by a number of colonia residents Their reasons are that most men are off work by then, children are not in school, and most women also could free time at that point f It is advisable to circulate a flier with the times for the meetings listed, perhaps in calendar format as with school children, since colonia residents are used to
that form of communication g When a project gathers data, it is best to do so when a complete week is available, and to plan to do so early in the week Then any additional people who miss the meeting where data are collected can be contacted and ideally, data can be collected from them as well on a later day in the same week
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Re: Early Prevention of Diabetes Improved Access to Health Care, Term: August 01, 2006 THRU December 31, 2006 DSHS Contract No 7097097093D-2007, Attachment No 01; DSHS PO No 0000319865, Office of Border Health Contractor: TX AM University System Health Science Center
2 Participation levels a Families will come and go from any project over the course of several weeks It is important to allow people to join a project if they want to Such a principle engenders good rapport and allows more colonia residents to gain some benefit from a project, even if they do not participate throughout the project period Therefore, each project session should be self-contained to some degree That is, it should be possible for people to participate in a session and get something out of it even if they have not attended earlier sessions b Typically, husbands attend meetings
less often than wives They need encouragement to attend meetings, and it is important that an activity such as aerobics not become the focus of an intervention if men are to be included Aerobics is considered a womens activity by most male colonia residents c It is possible in a 12 week intervention to achieve an attendance level of 70 at meetings on the part of a few families An attendance level of 50 is a more achievable goal
3 Community support for an intervention a Colonia residents are motivated to attend and participate by the availability of blood sugar and cholesterol readings They want to know their test results, what is the desirable level, and what their results signify Do their results warrant a trip to the doctor, or are they within normal, healthy limits? b Colonia residents find a 10- to 12-week intervention doable On the basis of the experience of one large colonia, it would be possible to continue an intervention for a longer period It is possible that a trailing off of the intervention would be successful in encouraging participants to sustain new patterns of physical activity and nutrition
4 Oral and written materials a Oral materials are welcome at meetings,
and colonia residents find that meetings are times to chat among themselves, identify common problems, and sometimes, find common solutions b Meetings provide useful occasions for people to voice their ideas about health and to find out whether nutritionists or physical activity specialists concur with those ideas, or have other ways to think about health issues Some ideas that have come up at community meetings of colonia residents are: that it is good to skip meals in order to lose weight, that eating a lot of salt will help you to lose weight, that exercise in the morning is more healthful than in the afternoon, and that some people cannot do some kinds of exercise perhaps there is an absence of the idea of gaining strength through increasing exercise levels; it is not yet clear c Written materials are also useful for residents Recipes are valued in the case of nutrition interventions 17
Re: Early Prevention of Diabetes Improved Access to Health Care, Term: August 01, 2006 THRU December 31, 2006 DSHS Contract No 7097097093D-2007, Attachment No 01; DSHS PO No 0000319865, Office of Border Health Contractor: TX AM University System Health Science Center
d Nutritional and physical
activity information in simple language and without a great deal of technical detail is useful It is best to avoid trying to teach the same way as in the classroom in the university, but key concepts can be taught effectively e Colonia residents also want to know the reasons for various suggestions They wish to reason about their health habits, not just follow orders from experts Generally, many lessons were learned in the formative evaluation of this project Women are available for participation if they are approached by someone in whom they have confidence, whom they have known for some period of time, and who is working with programs that have brought them immediate, tangible benefits In this regard, the First-Aid Kit Project provided an excellent basis for recruiting participants in this program
Plan for a Program in Physical Activity and Nutrition to be Initiated in Phase 2 The principal physical activity in this program will be walking Women in the group will gather beginning at 6 pm and family members may join them A small group will gather and pick up others as they pass their houses At the end of the walk, people will drop off as they reach their houses Additional
physical activities will be made available by the project team to see what else appeals to colonia residents The nutrition classes will be scheduled with Texas AM Extension instructors, either those of Hidalgo County or those from the District 12 Extension Office in Weslaco Additional resources may be available from the Universidad Tecnológico de Monterrey, which has a nutrition program that has occasionally sent nutrition students who were completing their degrees to give lessons in the lower Rio Grande Valley and from nursing and dietetics programs at South Texas College and the University of Texas-Pan American
Relationship to Healthy Border 2010 Areas and Objectives This project links to the Healthy Border 2010 areas and objectives in the following ways: Diabetes: The longterm project goal is to reduce both the mortality rate of diabetes and the need for hospitalization, because the project developed steps to design an intervention for early reduction of risk factors for diabetes The project is oriented mainly toward the general population, to increase physical activity and/or improve nutrition to bring about improved health and reduced body mass index In this way, the project
addresses and plans to reduce, in the general colonia population, the major behavioral risk factors leading to diabetes Access to Health Care: The project has provided referrals for medical care and distribution of information on clinics orally and through fliers help to meet the goal of improving access to health care 18
Re: Early Prevention of Diabetes Improved Access to Health Care, Term: August 01, 2006 THRU December 31, 2006 DSHS Contract No 7097097093D-2007, Attachment No 01; DSHS PO No 0000319865, Office of Border Health Contractor: TX AM University System Health Science Center
Relationship to the Strategic Plan for the Prevention of Obesity in Texas: 2005-2010 In relation to the Strategic Plan for the Prevention of Obesity in Texas: 2005-2010, the project addresses the goals as follows: Goal 1: Increase awareness of obesity as a public-health issue that impacts the quality of life of families The project addresses this goal through examining the feasibility of working with a community coalition to plan an intervention to reduce diabetes risk factors That is, the project staff has informed the colonia residents of the links of physical activity and nutrition to risk of
diabetes This was a necessary step before planning an intervention Goal 2: Mobilize families, schools, and communities to create opportunities to choose lifestyles that promote healthy weight
The project addresses this goal by working with families and communities, ie, with the social networks in the colonias, to examine the feasibility of designing an intervention that will encompass lifestyles that promote healthy weight For example, the Latino 5-A-Day recipe book may be feasible to use with the communities It may be feasible to show that buying foods such as soda, cookies, and candy are more expensive than fresh fruits and vegetables available at flea markets and roadside stands Goal 3: Promote policies and environmental changes that support healthful eating habits and physical activity The project addresses this goal through examining the feasibility of working with community members to seek ways to bring about positive community-level changes in physical activity, eating patterns, and perceptions of healthy weight for height in children and adults Goal 4: Monitor obesity rates and related behaviors and health conditions for planning evaluation and dissemination activities
The project addresses this goal through examining the feasibility of using the instruments noted above to assess behavioral risk factors for obesity and to assess prevalence of excess BMI The results will be used as a baseline needs assessment that can be revisited periodically during the implementation of the intervention, in Phase 2 of this project
Conclusions Generally, the program is moving along well The colonia residents are enthusiastic about participating and they have volunteered ideas quite freely regarding their own assessment of their needs They are aware of chronic health issues and seem to have a good general orientation about them, but they need 19
Re: Early Prevention of Diabetes Improved Access to Health Care, Term: August 01, 2006 THRU December 31, 2006 DSHS Contract No 7097097093D-2007, Attachment No 01; DSHS PO No 0000319865, Office of Border Health Contractor: TX AM University System Health Science Center
better information They want access to screening for blood sugar levels, cholesterol, other blood lipids, and blood pressure They desire both physical activity and nutrition programs to decrease their risk of chronic disease On the other hand, they face
constraints in regard to enhancing their nutrition and physical activity levels This project is designed to take those constraints into account in designing a culturally and economically appropriate intervention
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Re: Early Prevention of Diabetes Improved Access to Health Care, Term: August 01, 2006 THRU December 31, 2006 DSHS Contract No 7097097093D-2007, Attachment No 01; DSHS PO No 0000319865, Office of Border Health Contractor: TX AM University System Health Science Center
Appendix 1 Attachment No 1: Scope of Work DOCUMENT NO7097097093D-2007 ATTACHMENT NO 01 PURCHASE ORDER NO 0000319865 CONTRACTOR: Texas AM Univ System Health Science Center
DSHS PROGRAM: Office of Border Health TERM: August 01, 2006 THRU: December 31, 2006
SECTION I SCOPE OF WORK: Contractor shall address the Early Prevention of Diabetes Improved Access to Health Care: The Feasibility of Addressing Healthy Border 2010 Objectives with Community Coalitions in Colonias in South Texas CONTRACTOR shall address Healthy Border 2010 objectives in the areas of diabetes and access to health care Specifically, the agency shall examine the feasibility of engaging in early prevention of diabetes through
community-based planning to enhance physical activity and/or nutrition in colonias The agency shall also improve access to health care for colonia residents through health education and referrals This project includes the following Healthy Border 2010 areas and objectives:
Diabetes reduce both the mortality rate of diabetes and the need for hospitalization; Access to Health Care ensure access to primary care or basic health care services Healthy Border 2010:vii
Furthermore, in relation to diminishing risk factors for diabetes, the project addresses the Strategic Plan for the Prevention of Obesity in Texas: 2005-2010 regarding the following goals TDSHS 2006:35: Goal 1: Increase awareness of obesity as a public-health issue that impacts the quality of life of families Goal 2: Mobilize families, schools, and communities to create opportunities to choose lifestyles that promote healthy weight Goal 3: Promote policies and environmental changes that support healthful eating habits and physical activity Goal 4: Monitor obesity rates and related behaviors and health conditions for planning evaluation and dissemination activities
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Re: Early Prevention of Diabetes Improved
Access to Health Care, Term: August 01, 2006 THRU December 31, 2006 DSHS Contract No 7097097093D-2007, Attachment No 01; DSHS PO No 0000319865, Office of Border Health Contractor: TX AM University System Health Science Center
CONTRACTOR shall carry out the following activities, listed here in priority order: 1 Examine the feasibility of partnering with social networks in colonias By working with promotoras familiar with the colonia networks, project team members will open the door to participation in this project Schedule Month 1: promotoras will visit colonias to explain the project and see which colonias are interested in participating Months 2-4: continue to visit colonias and recruit new participants as needed Expected number of participants to be recruited: 30 2 Carry out a needs assessment regarding behavioral risk factors for diabetes It is known that the prevalence of diabetes is high in colonia populations; however, the risk factors that lead to this high prevalence have not been specified To identify these risk factors, the assessment instrument will draw items from the lengthy IMPACTO II, provided in English and Spanish and validated by the Monterey County California
Health Department see Appendix B It is based on the Behavioral Risk Factor instrument developed by the Centers for Disease Control Some of the items have been refined for the usage in Spanish of limited-income people in South Texas; other items will need such refinement The project team will carry out this work and narrow the instrument to focus on risk factors for diabetes with a focus on physical activity and nutrition The results will document needs for intervention, assist in orienting the specific approach of the intervention, and provide pre-intervention baseline data Schedule Month 1: pilot test and refine the instrument Months 2-3: apply the instrument Expected number of participants, 30 from four of the 33 social networks active in our current project 3 Make a related needs assessment of body mass index BMI based on height and weight measurements This effort will allow us to examine the feasibility of assessing changes in BMI Schedule Months 2-3: measure height and weight of colonia residents Expected number of participants, 30 Note: Controls are not included in this project because it is a feasibility exploration or pilot project; however, a larger project needs to
include controls to test whether the intervention is successful in promoting more healthy measures of BMI 4 Increase access to medical care The project will link those with immediate needs for medical care to appropriate community and private healthcare providers The project will
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Re: Early Prevention of Diabetes Improved Access to Health Care, Term: August 01, 2006 THRU December 31, 2006 DSHS Contract No 7097097093D-2007, Attachment No 01; DSHS PO No 0000319865, Office of Border Health Contractor: TX AM University System Health Science Center
also inform colonia residents in general of the availability of healthcare This aspect of the project will involve health education to improve health literacy In addition to providing benefits to colonia residents and contributing to the Healthy Border 2010 goals, this aspect of the project is required because of ethical reasons It would be unethical to carry out a project with a population who have poor access to medical care if we did not make every effort to refer those in need to healthcare providers Schedule Months 1-4: refer those with immediate medical needs to the clinics and inform other colonia residents of the availability of
clinic services orally and with fliers Expected number of referrals: 120 Expected number of fliers to be distributed: 500 5 Examine the feasibility of engaging in planning early prevention of diabetes with community partnerships through working with the social network members to design physical activity programs and/or nutrition programs focused on families and their social networks The interventions shall target risk factors for diabetes and shall take place in the colonia neighborhoods Schedule Month 1: invite social networks to participate in the project Months 2-4: planning with community partnerships Expected number of participants, 30 6 Evaluation shall be a formative assessment of the feasibility of the project The elements of the project to be evaluated will be: a Participation of community partners: number of participants and duration in project b Response to needs assessments: number of respondents and number willing to have measurements taken of height and weight c Participation of community partners in planning a program involving physical activity and/or nutrition: number of participants, number who discontinued their participation, and whether the plan is completed
d Response of community partners to the concept of implementing the plan Schedule Months1-4: Count participants and track their continuing involvement in all project activities Complete a table showing number of participants and rates of attrition Month 4: Complete a written plan with community partners about a program in physical activity and/or nutrition to be initiated in Phase 2 of the project to begin in October, 2006 Expected number of participants, 30
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Re: Early Prevention of Diabetes Improved Access to Health Care, Term: August 01, 2006 THRU December 31, 2006 DSHS Contract No 7097097093D-2007, Attachment No 01; DSHS PO No 0000319865, Office of Border Health Contractor: TX AM University System Health Science Center
CONTRACTOR shall submit a final report that is a formative evaluation to measure the feasibility of the methods in this project The evaluation will include but not be limited to a database or Excel spreadsheet providing information on rates of participation in project activities and pilot study data on needs assessments and referrals The agency shall provide the program design for physical activity and/or nutrition enhancement The agency shall submit the
final report to DSHS within forty-five 45 days of the end of the contract period The report will include:
Table 2 Deliverables of this project
Measure in the evaluation Number of participants Attrition of participants
1 Participation in project activities
Attending meetings for planning program Needs assessment diabetes risk factors Needs assessment BMI Referrals for medical care Distribution of information on clinics measured as no of fliers delivered Completed program plan on diabetes risk factors x x x x x x x
x
2 Needs assessment - pilot project results on 30 people:
Sociodemographic data Age Gender Ethnicity Education, grades completed in school Language facility Acculturation for immigrants 3 Behavioral risk factors for diabetes, , for 30 people: A Nutrition/dietary intake Food frequency: times/week fruits and vegetables fast food fried food sweets B Physical activity: intensity duration Activity at work Activity in leisure time 4 Objective data, risk factor for diabetes of BMI 25, for 30 people Women Men mean standard deviation percentages male and female percentages Hispanic, Anglo, others mean standard deviation speaking Spanish, English Acculturation scale scores
mean standard deviation
means standard deviations means standard deviations means standard deviations means standard deviations means standard deviations means standard deviations
percentage percentage
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Re: Early Prevention of Diabetes Improved Access to Health Care, Term: August 01, 2006 THRU December 31, 2006 DSHS Contract No 7097097093D-2007, Attachment No 01; DSHS PO No 0000319865, Office of Border Health Contractor: TX AM University System Health Science Center
This report will link to the Healthy Border 2010 areas and objectives in the following ways: Diabetes: 1-4 in Table 2 involve steps with the goals of reducing both the mortality rate of diabetes and the need for hospitalization, because they encompass steps in designing an intervention for early reduction of risk factors for diabetes That is, the project is oriented mainly toward the general population, to increase physical activity and/or improve nutrition to bring about improved health and reduced body mass index In this way, the project will address and plan to reduce, in the general colonia population, the major behavioral risk factors leading to diabetes Access to Health Care: result 1, specifically
referrals for medical care and distribution of information on clinics orally and through fliers, has the goal of improving access to health care
In relation to the Strategic Plan for the Prevention of Obesity in Texas: 2005-2010, the project will address the goals as follows: Goal 1: Increase awareness of obesity as a public-health issue that impacts the quality of life of families The project will address this goal through examining the feasibility of working with a community coalition to plan an intervention to reduce diabetes risk factors That is, the project staff will inform the colonia residents of the links of physical activity and nutrition to risk of diabetes This will be a necessary step before planning an intervention Goal 2: Mobilize families, schools, and communities to create opportunities to choose lifestyles that promote healthy weight
The project will address this goal by working with families and communities, ie, with the social networks in the colonias, to examine the feasibility of designing an intervention that will encompass lifestyles that promote healthy weight For example, the Latino 5-A-Day recipe book may be feasible to use with the communities It
may be feasible to show that buying foods such as soda, cookies, and candy are more expensive than fresh fruits and vegetables available at flea markets and roadside stands Goal 3: Promote policies and environmental changes that support healthful eating habits and physical activity The project will address this goal through examining the feasibility of working with community members to seek ways to bring about positive community-level changes in physical activity, eating patterns, and perceptions of healthy weight for height in children and adults Goal 4: Monitor obesity rates and related behaviors and health conditions for planning evaluation and dissemination activities The project will address this goal through examining the feasibility of using the instruments noted above to assess behavioral risk factors for obesity and to assess prevalence of excess BMI The results will be used as a baseline needs assessment that can be revisited periodically during the 25
Re: Early Prevention of Diabetes Improved Access to Health Care, Term: August 01, 2006 THRU December 31, 2006 DSHS Contract No 7097097093D-2007, Attachment No 01; DSHS PO No 0000319865, Office of Border Health
Contractor: TX AM University System Health Science Center
implementation of the intervention, in a following project DSHS shall upon request from the CONTRACTOR, provide guidance and consultation regarding diabetes prevention, colonia health, working with community coalitions, related issues, and the project scope and budget CONTRACTOR shall submit reports and invoices to DSHS according to the following schedule: August–report due September 15, 2006 September–report due October 15, 2006 October–report due November 15, 2006 November–report due December 15, 2006 December–report due January 15, 2007 Final report–due February 15, 2007 Monthly reports shall detail activities and milestone accomplishments during the month Final report will evaluate the feasibility of a project involving a community coalition to reduce diabetes risk factors and improve access to health care in South Texas colonias Final report shall include but not limited to a database or Excel spreadsheet providing results from the project: rates of community participation, results of needs assessments, and evaluation of project feasibility SECTION II SPECIAL PROVISIONS: None SECTION III BUDGET: Monthly Reports
5@2,000 ea10,000 Final Report 1@4,000 ea 4,000
Total expenditures for this contract not to exceed 14,00000
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Re: Early Prevention of Diabetes Improved Access to Health Care, Term: August 01, 2006 THRU December 31, 2006 DSHS Contract No 7097097093D-2007, Attachment No 01; DSHS PO No 0000319865, Office of Border Health Contractor: TX AM University System Health Science Center
Appendix 2 Risk assessment instrument for this project
COMPORTAMIENTOS Y SU SALUD
18 AÑOS Y MAYOR
For the project, Early Prevention of Diabetes Improved Access to Health Care: The Feasibility of Addressing Healthy Border 2010 Objectives with Community Coalitions in South Texas Directed by Dr Ann V Millard, South Texas Center, Texas AM School of Rural Public Health Sponsored by Dr Marta Fournier, Office of Border Health, State Department of Health Services, Texas Project Team: Ann V Millard, PhD, Esmeralda Sanchez, BA, Bonny Medina, CCHW, and Ester S Carbajal, CHW
27 Noviembre 2006
Adaptada de la SECRETARIA DE SALUD SUBSECRETARIA DE PREVENCIÓN Y PROMOCIÓN DE LA SALUD DIRECCIÓN GENERAL DE EPIDEMIOLOGÍA COMISIÓN DE SALUD FRONTERIZA MÉXICO-ESTADOS UNIDOS y Los Cuestionarios Internacionales de Actividad
Física IPAQ, por sus siglas en inglés; Booth, ML 2000 Assessment of Physical Activity: An International Perspective Research Quarterly for Exercise and Sport, 71 2: s114-20; wwwipaqkise
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Re: Early Prevention of Diabetes Improved Access to Health Care, Term: August 01, 2006 THRU December 31, 2006 DSHS Contract No 7097097093D-2007, Attachment No 01; DSHS PO No 0000319865, Office of Border Health Contractor: TX AM University System Health Science Center
Introducción Buenos días tardes
Soy personal de la Universidad de Texas AM, Escuela de Salúd Publica Rural Mi nombre es_________________________ Estamos realizando un estudio para conocer los hábitos de salud de la población como son: sus actividades físicas, nutrición, y diferentes actividades de prevención de enfermedades crónicas que realiza la población
En el cuestionario no existen respuestas correctas o incorrectas; si alguna pregunta le causa incomodidad, tiene la libertad de NO CONTESTARLA, sin embargo, para nosotros es de gran utilidad que responda la mayor cantidad de preguntas posibles
Absolutamente todas sus respuestas son confidenciales y ninguna persona puede ser identificada a través de este cuestionario, ya que
los resultados se presentarán en forma de resumen por lo tanto, no es necesario registrar su nombre
De antemano, agradecemos su participación y cooperación
Instrucciones para el entrevistador
Lea cada una de las preguntas el entrevistado asegurándose de que las entienda correctamente y encierre en un círculo cada una de las respuestas Cuando el entrevistado le conteste, es necesario que verifique que la respuesta marcada sea la indicada Cuando se encuentre con preguntas que no sean aplicables, las preguntas siguientes se le indicarán con notas y pases para saltar a las preguntas subsiguientes
Nombre del entrevistador:______________________________________________________________
Hora de inicio de la entrevista: ___ ___
Hora de término de la entrevista: ___ ___
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Early Prevention of Diabetes Improved Access to Health Care DSHS OBH Document No 7097097093D-2007, Attachment No 01 Purchase Order No 0000319865; Contractor: TX AM University System Health Science Center Term: August 01, 2006 THRU December 31, 2006
CONTENIDO
MÓDULO 1: DISCAPACIDADESERROR BOOKMARK NOT DEFINED MÓDULO 2: DIABETES MELLITUS ERROR BOOKMARK NOT DEFINED MÓDULO 3: ALIMENTACIÓN ERROR BOOKMARK NOT DEFINED
MÓDULO 4: ACTIVIDAD FÍSICAERROR BOOKMARK NOT DEFINED MÓDULO 5: ACCESO Y UTILIZACIÓN DE LOS SERVICIOS DE SALUDERROR DEFINED BOOKMARK NOT
MÓDULO 6: DATOS DEMOGRÁFICOS ERROR BOOKMARK NOT DEFINED
10/31/06, Antecedentes de esta encuesta La mayoría de estas preguntas vienen de la Encuesta, Comportamientos de Riesgo para Enfermedades Crónicas, 18 a 65 años Marzo del 2005 Secretaria de Salud, Subsecretaria de Prevención y Promoción de la Salud, Dirección General de Epidemiología y Comisión de Salud Fronteriza México-Estados Unidos El módulo sobre actividad física es Cuestionario Internacional de Actividad Física IPAQ Noviembre del 2002 Formato Telefónico Largo–Últimos 7 Dias See Booth, ML 2000 Assessment of Physical Activity: An International Perspective Research Quarterly for Exercise 29
Re: Early Prevention of Diabetes Improved Access to Health Care, Term: August 01, 2006 THRU December 31, 2006 DSHS Contract No 7097097093D-2007, Attachment No 01; DSHS PO No 0000319865, Office of Border Health Contractor: TX AM University System Health Science Center
and Sport, 71 2: s114-20; wwwipaqkise
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Re: Early Prevention of Diabetes Improved Access to Health Care, Term: August 01, 2006 THRU
December 31, 2006 DSHS Contract No 7097097093D-2007, Attachment No 01; DSHS PO No 0000319865, Office of Border Health Contractor: TX AM University System Health Science Center
Información del respondiente
Nombre
_____________________________________
Teléfono
________________________________
Nombre de la colonia
______________________________________
Dirección ________________________________________________________________ calle ciudad
Cuánto tiempo tiene de vivir en esta colonia?
_________
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Re: Early Prevention of Diabetes Improved Access to Health Care, Term: August 01, 2006 THRU December 31, 2006 DSHS Contract No 7097097093D-2007, Attachment No 01; DSHS PO No 0000319865, Office of Border Health Contractor: TX AM University System Health Science Center
Módulo 1: Discapacidades 11 Tiene usted ahora algún problema de salud que requiera el uso de equipos especiales tales como bastón, silla de ruedas, cama o teléfono especial? Incluye uso ocasional o en circunstancias especiales 41 1 Si 2 No 7 No sabe/ No está seguro 9 No responde Módulo 2: Diabetes mellitas 21 Alguna vez le ha dicho un doctor que usted tiene diabetes? 73 1 Sí 3 No go to question 724 4 No, dijo que
tenía pre-diabetes o que estaba al límite 7 No sabe / no esta seguro 9 No responde 22 Qué edad tenía cuando le dijo que usted tenía diabetes? 74 Edad en años 7 No sabe/ no está seguro 9 No responde SOLAMENTE MUJERES: 23 El doctor le dijo que tuvo Diabetes solamente durante el embarazo y no en otro tiempo? 75 1 Si 2 No 7 No sabe/ no está segura 9 Se niega a contestar 24 Cuál de las siguientes opciones cree que pueden retardar la presencia de la diabetes? Conteste todas las opciones que apliquen 724 1 2 3 7 9 Actividad física Nutrición Medicina No sabe/ no está seguro Se niega a contestar
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Early Prevention of Diabetes Improved Access to Health Care DSHS OBH Document No 7097097093D-2007, Attachment No 01 Purchase Order No 0000319865; Contractor: TX AM University System Health Science Center Term: August 01, 2006 THRU December 31, 2006
25 Usted cree que la diabetes puede ser curada? 725 1 2 7 9 Si No No sabe/ no responde Se niega a contestar
26 Tienen o tuvieron su padre, su madre o sus hermanos biológicos diabetes? 726 1 2 7 9 Si No No sabe/ no está seguro Se niega a contestar
Módulo 3: Alimentación Las siguientes preguntas son acerca de los alimentos que usualmente come o bebe
Por favor dígame que tan frecuente usted come o bebe cada uno, por ejemplo, dos veces a la semana, tres veces al mes, y así sucesivamente Recuerde, yo solamente estoy interesado en la comida que usted come Incluye toda la comida que come en casa y fuera de ella 1 Qué tan seguido consume los siguientes alimentos? Indique el número de raciones, solamente conteste una opción por pregunta Para todas las otras opciones, cheque el cuadro apropiado 2 1a Jugos frescos de frutas como por ejemplo naranja, uva o tomate? 2a a __ __Día b __ __Semana c __ __Mes d __ __Año e __ __Nunca f No sabe/ no está seguro g Se niega
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Early Prevention of Diabetes Improved Access to Health Care DSHS OBH Document No 7097097093D-2007, Attachment No 01 Purchase Order No 0000319865; Contractor: TX AM University System Health Science Center Term: August 01, 2006 THRU December 31, 2006
1b Jugos: enlatados y frescos 2b a __ __Día b __ __Semana c __ __Mes d __ __Año e __ __Nunca f No sabe/ no está seguro g Se niega 1c Sodas coca cola, bebidas no dieteticas, etc 2c a __ __Día b __ __Semana c __ __Mes d __ __Año e __ __Nunca f No sabe/ no está seguro g Se niega
1d Bebidas de dieta, sodas o agua mineral 2d a __
__Día b __ __Semana c __ __Mes d __ __Año e __ __Nunca f No sabe/ no está seguro g Se niega 34
Early Prevention of Diabetes Improved Access to Health Care DSHS OBH Document No 7097097093D-2007, Attachment No 01 Purchase Order No 0000319865; Contractor: TX AM University System Health Science Center Term: August 01, 2006 THRU December 31, 2006
1e Fruta fresca no incluye jugos 2e a __ __Día b __ __Semana c __ __Mes d __ __Año e __ __Nunca f No sabe/ no está seguro g Se niega
1f Nopal, cactus 2f a __ __Día b __ __Semana c __ __Mes d __ __Año e __ __Nunca f No sabe/ no está seguro g Se niega
1g Vegetales frescos, ensaladas 2g a __ __Día b __ __Semana c __ __Mes d __ __Año e __ __Nunca f No sabe/ no está seguro 35
Early Prevention of Diabetes Improved Access to Health Care DSHS OBH Document No 7097097093D-2007, Attachment No 01 Purchase Order No 0000319865; Contractor: TX AM University System Health Science Center Term: August 01, 2006 THRU December 31, 2006
g Se niega 1h Papas no incluye papas a la francesa, papas fritas, papas chips 2h a __ __Día b __ __Semana c __ __Mes d __ __Año e __ __Nunca f No sabe/ no está seguro g Se niega
1i Zanahorias 2h a __ __Día b __ __Semana c __
__Mes d __ __Año e __ __Nunca f No sabe/ no está seguro g Se niega
1j Frijoles, lentejas, garbanzos 2j a __ __Día b __ __Semana c __ __Mes d __ __Año e __ __Nunca f No sabe/ no está seguro g Se niega
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Early Prevention of Diabetes Improved Access to Health Care DSHS OBH Document No 7097097093D-2007, Attachment No 01 Purchase Order No 0000319865; Contractor: TX AM University System Health Science Center Term: August 01, 2006 THRU December 31, 2006
1k Harina de avena y otros cereales 2k a __ __Día b __ __Semana c __ __Mes d __ __Año e __ __Nunca f No sabe/ no está seguro g Se niega
1l Arroz 2l a __ __Día b __ __Semana c __ __Mes d __ __Año e __ __Nunca f No sabe/ no está seguro g Se niega
1m Otros vegetales cocinados 2m a __ __Día b __ __Semana c __ __Mes d __ __Año e __ __Nunca f No sabe/ no está seguro g Se niega
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Early Prevention of Diabetes Improved Access to Health Care DSHS OBH Document No 7097097093D-2007, Attachment No 01 Purchase Order No 0000319865; Contractor: TX AM University System Health Science Center Term: August 01, 2006 THRU December 31, 2006
1n Sopas con pasta o sopas enlatadas 2n a __ __Día b __ __Semana c __ __Mes d __ __Año e __ __Nunca f No sabe/ no
está seguro g Se niega
1o Carnes rojas 2o a __ __Día b __ __Semana c __ __Mes d __ __Año e __ __Nunca f No sabe/ no está seguro g Se niega
1p Carne de cerdo, pancita, chorizo de puerco 2p a __ __Día b __ __Semana c __ __Mes d __ __Año e __ __Nunca f No sabe/ no está seguro g Se niega
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Early Prevention of Diabetes Improved Access to Health Care DSHS OBH Document No 7097097093D-2007, Attachment No 01 Purchase Order No 0000319865; Contractor: TX AM University System Health Science Center Term: August 01, 2006 THRU December 31, 2006
1q Carnes frías, jamón 2q a __ __Día b __ __Semana c __ __Mes d __ __Año e __ __Nunca f No sabe/ no está seguro g Se niega
1r Pollo, pavo y otras aves 2r a __ __Día b __ __Semana c __ __Mes d __ __Año e __ __Nunca f No sabe/ no está seguro g Se niega h No sabe/ no está seguro i Se niega
1s Pescado, ceviche, atún y otros mariscos 2s a __ __Día b __ __Semana c __ __Mes d __ __Año e __ __Nunca f No sabe/ no está seguro g Se niega
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Early Prevention of Diabetes Improved Access to Health Care DSHS OBH Document No 7097097093D-2007, Attachment No 01 Purchase Order No 0000319865; Contractor: TX AM University System Health Science Center Term: August 01,
2006 THRU December 31, 2006
1t Huevos 2t a __ __Día b __ __Semana
c __ __Mes
d __ __Año e __ __Nunca f No sabe/ no está seguro g Se niega
1u Tortillas de harina 2u a __ __Día b __ __Semana c __ __Mes d __ __Año e __ __Nunca f No sabe/ no está seguro g Se niega
1v Pan dulce, roles o pan bimbo pan de barra 2v a __ __Día b __ __Semana c __ __Mes d __ __Año e __ __Nunca f No sabe/ no está seguro g Se niega
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Early Prevention of Diabetes Improved Access to Health Care DSHS OBH Document No 7097097093D-2007, Attachment No 01 Purchase Order No 0000319865; Contractor: TX AM University System Health Science Center Term: August 01, 2006 THRU December 31, 2006
1w Tortillas de maíz 2w a __ __Día b __ __Semana c __ __Mes d __ __Año e __ __Nunca f No sabe/ no está seguro g Se niega
1x Agua embotellada incluye agua del WaterMill, etc 2x a __ __Día b __ __Semana c __ __Mes d __ __Año e __ __Nunca f No sabe/ no está seguro g Se niega
2 Qué tipo de aceite o grasa para cocinar usa usualmente? 3 a Aceite vegetal o margarina b Manteca de cerdo, tocino c Otro f No sabe/ no está seguro g Se niega a contestar
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Early Prevention of Diabetes Improved Access to Health Care DSHS OBH Document No
7097097093D-2007, Attachment No 01 Purchase Order No 0000319865; Contractor: TX AM University System Health Science Center Term: August 01, 2006 THRU December 31, 2006
Modulo 4: Actividad Física Estas preguntas se referirán acerca del tiempo que usted utilizó siendo físicamente activoa en los últimos 7 días Por favor responda cada pregunta aún si usted no se considera una persona activa Por favor piense en aquellas actividades que usted hace como parte del trabajo, en el jardín y en la casa, para ir de un sitio a otro, y en su tiempo libre de descanso, ejercicio o deporte Piense acerca de todas aquellas actividades vigorosas y moderadas que usted realizó en los últimos 7 días Actividades vigorosas son las que requieren un esfuerzo físico fuerte y le hacen respirar mucho más fuerte que lo normal Actividades moderadas son aquellas que requieren un esfuerzo físico moderado y le hace respirar algo más fuerte que lo normal Parte 1: Actividad física relacionada con el trabajo La primera sección es relacionada con su trabajo Esto incluye trabajos con salario, agrícola, trabajo voluntario, clases, y cualquier otra clase de trabajo no pagado que usted hizo fuera de su casa No incluya
trabajo no pagado que usted hizo en su casa, tal como limpiar la casa, trabajo en el jardín, mantenimiento general, y el cuidado de su familia Estas actividades serán preguntadas en la parte 3 1 Tiene usted actualmente un trabajo o hace algún trabajo no pagado fuera de su casa? Sí No Pase a la PARTE 2: TRANSPORTE
Las siguientes preguntas se refieren a todas las actividades físicas que usted hizo en los últimos 7 días como parte de su trabajo pagado o no pagado Esto no incluye ir y venir del trabajo Durante los últimos 7 días 2 Cuántos días realizó usted actividades físicas vigorosas levantar objetos pesados, excavar, construcción pesada, o subir escaleras como parte de su trabajo? 42
Early Prevention of Diabetes Improved Access to Health Care DSHS OBH Document No 7097097093D-2007, Attachment No 01 Purchase Order No 0000319865; Contractor: TX AM University System Health Science Center Term: August 01, 2006 THRU December 31, 2006
Piense solamente en esas actividades que usted hizo por lo menos 10 minutos continuos _____ días por semana Ninguna actividad física vigorosa relacionada con el trabajo Pase a la pregunta 4 No sabe/No está seguroa 3 Cuánto tiempo en total le toma realizar
actividades físicas vigorosas en uno de esos días que las realiza como parte de su trabajo? _____ horas por día No sabe/No está seguroa Piense solamente en esas actividades que usted hizo por lo menos 10 minutos continuos Durante los últimos 7 días 4 Cuántos días hizo Usted actividades físicas moderadas como cargar cosas ligeras como parte de su trabajo? Por favor no incluya caminar _____ días por semana No actividad física moderada relacionada con el trabajo pregunta 6 5 Cuánto tiempo en total le toma realizar actividades físicas moderadas en uno de esos días que las realiza como parte de su trabajo? _____ horas por día 43
Early Prevention of Diabetes Improved Access to Health Care DSHS OBH Document No 7097097093D-2007, Attachment No 01 Purchase Order No 0000319865; Contractor: TX AM University System Health Science Center Term: August 01, 2006 THRU December 31, 2006
_____ minutos por día
Pase a la
_____ minutos por día
No sabe/No está seguroa Durante los últimos 7 días 6 Durante los últimos 7 días, Cuántos días caminó usted por lo menos 10 minutos seguidos como parte de su trabajo? Por favor no incluya ninguna caminata que usted hizo para trasladarse de o a su trabajo _____
días por semana Ninguna caminata relacionada con trabajo Pase a la PARTE 2:
7 Cuánto tiempo en total pasó generalmente caminado en uno de esos días como parte de su trabajo? _____ horas por día _____ minutos por día
No sabe/No está seguroa
Parte 2: Actividad física relacionada con transporte Estas preguntas se refieren a la forma como usted se ha trasladado de un lugar a otro, incluyendo lugares como el trabajo, las tiendas, el cine, entre otros Durante los últimos 7 días 8 Cuántos días viajó usted en un vehículo de motor como un tren, autobús, automóvil, u otra clase de vehículo de motor? _____ días por semana No viajó en vehículo de motor Pase a la pregunta 10
9 Cuánto tiempo gastó usted en uno de esos días viajando en un tren, autobús, automóvil, u otra clase de vehículo de motor? _____ horas por día 44
Early Prevention of Diabetes Improved Access to Health Care DSHS OBH Document No 7097097093D-2007, Attachment No 01 Purchase Order No 0000319865; Contractor: TX AM University System Health Science Center Term: August 01, 2006 THRU December 31, 2006
_____ minutos por día
No sabe/No está seguroa Ahora piense únicamente acerca de montar en bicicleta o caminatas que usted hizo
para trasladarse a o del trabajo, haciendo mandados, o para ir de un lugar a otro Durante los últimos 7 días 10 Cuántos días montó usted en bicicleta por al menos 10 minutos continuos para ir de un lugar a otro? _____ días por semana No montó en bicicleta de un sitio a otro 12 Pase a la pregunta
11 Usualmente, Cuánto tiempo gastó usted en uno de esos días montando en bicicleta de un lugar a otro? _____ horas por día _____ minutos por día No sabe/No está seguroa
12 Durante los últimos 7 días, Cuántos días caminó usted por al menos 10 minutos continuos para ir de un sitio a otro? _____ días por semana No camine de un sitio a otro Pase a la PARTE 3: TRABAJO DE LA CASA, MANTENIMIENTO DE LA CASA, Y CUIDADO DE LA FAMILIA
13 Usualmente, Cuánto tiempo gastó usted en uno de esos días caminando de un sitio a otro? _____ horas por día _____ minutos por día 45
Early Prevention of Diabetes Improved Access to Health Care DSHS OBH Document No 7097097093D-2007, Attachment No 01 Purchase Order No 0000319865; Contractor: TX AM University System Health Science Center Term: August 01, 2006 THRU December 31, 2006
No sabe/No está seguroa Parte 3: Trabajo de la casa, mantenimiento de la casa, y
cuidado de la familia Esta sección se refiere a algunas actividades físicas que usted hizo en los últimos 7 días en y alrededor de su casa tal como como arreglo de la casa, jardinería, trabajo en el césped, trabajo general de mantenimiento, y el cuidado de su familia Durante los últimos 7 días 14 Piense únicamente acerca de esas actividades físicas que hizo por lo menos 10 minutos continuosCuántos días hizo usted actividades físicas vigorosas tal como levantar objetos pesados, cortar madera, palear nieve, o excavar en el jardín o patio? _____ días por semana Ninguna actividad física vigorosa en el jardín o patio Pase a la 15 Cuánto tiempo dedica usted en uno de esos días haciendo actividades físicas vigorosas en el jardín o patio? _____ horas por día _____ minutos por día
pregun
No sabe/No está seguroa 16 Nuevamente, piense únicamente acerca de esas actividades físicas que hizo por lo menos 10 minutos continuos Durante los últimos 7 días, Cuántos días hizo usted actividades físicas moderadas tal como cargar objetos livianos, barrer, lavar ventanas, y rastrillar en el jardín o patio? _____ días por semana Ninguna actvidad física moderada en el jardín o patio Pase a la pregunta
18
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Early Prevention of Diabetes Improved Access to Health Care DSHS OBH Document No 7097097093D-2007, Attachment No 01 Purchase Order No 0000319865; Contractor: TX AM University System Health Science Center Term: August 01, 2006 THRU December 31, 2006
17 Usualmente, Cuánto tiempo dedica usted en uno de esos días haciendo actividades físicas moderadas en el jardín o patio? _____ horas por día _____ minutos por día
No sabe/No está seguroa Piense únicamente acerca de esas actividades físicas que hizo por lo menos 10 minutos continuos Durante los últimos 7 días 18 Cuántos días hizo usted actividades físicas moderadas tal como cargar objetos livianos, lavar ventanas, estregar pisos y barrer dentro de su casa? _____ días por semana Ninguna actvidad física moderada dentro de la casa Pase a la PARTE 4: ACTIVIDADES FíSICAS DE RECREACIÓN, DEPORTE Y TIEMPO LIBRE 19 Usualmente, Cuánto tiempo dedica usted en uno de esos días haciendo actividades físicas moderadas dentro de su casa? _____ horas por día No sabe/No está seguroa Parte 4: Actividades física de recreación, deporte y tiempo Esta sección se refiere a todas aquellas actividades físicas que usted hizo en los últimos 7 días
únicamente por recreación, deporte, ejercicio o placer Por favor no incluya ninguna de las actividades que ya haya mencionado 20 Sin contar cualquier caminata que ya haya usted mencionado, durante los últimos 7 días, Cuántos días caminó usted por lo menos 10 minutos continuos en su tiempo libre? 47
Early Prevention of Diabetes Improved Access to Health Care DSHS OBH Document No 7097097093D-2007, Attachment No 01 Purchase Order No 0000319865; Contractor: TX AM University System Health Science Center Term: August 01, 2006 THRU December 31, 2006
_____ minutos por día
_____ días por semana Ninguna caminata en tiempo libre Pase a la pregunta 22
21 Usualmente, Cuánto tiempo gastó usted en uno de esos días caminando en su tiempo libre? _____ horas por día _____ minutos por día
No sabe/No está seguroa Piense únicamente acerca de esas actividades físicas que hizo por lo menos 10 minutos continuos Durante los últimos 7 días, 22 Cuántos días hizo usted actividades físicas vigorosas tal como aeróbicos, correr, pedalear rápido en bicicleta, o nadar rápido en su tiempo libre? _____ días por semana Ninguna actividad física vigorosa en tiempo libre Pase a la pregunta 24
23 Usualmente, Cuánto
tiempo dedica usted en uno de esos días haciendo actividades físicas vigorosas en su tiempo libre? _____ horas por día _____ minutos por día
No sabe/No está seguroa Nuevamente, piense únicamente acerca de esas actividades físicas que hizo por lo menos 10 minutos continuos Durante los últimos 7 días
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Early Prevention of Diabetes Improved Access to Health Care DSHS OBH Document No 7097097093D-2007, Attachment No 01 Purchase Order No 0000319865; Contractor: TX AM University System Health Science Center Term: August 01, 2006 THRU December 31, 2006
24 Cuántos días hizo usted actividades físicas moderadas tal como pedalear en bicicleta a paso regular, nadar a paso regular, jugar dobles de tenis, en su tiempo libre? _____ días por semana Ninguna actvidad física moderada en tiempo libre Pase a la PARTE 5: TIEMPO DEDICADO A ESTAR SENTADOA 25 Usualmente, Cuánto tiempo dedica usted en uno de esos días haciendo actividades físicas moderadas en su tiempo libre? _____ horas por día _____ minutos por día No sabe/No está seguroa
Parte 5: Tiempo dedicado a estar sentadoa Las últimas preguntas se refieren al tiempo que usted permanence sentadoa en el trabajo, la casa, estudiando, y en su
tiempo libre Esto incluye tiempo sentadoa en un escritorio, visitando amigosas, leyendo o permanecer sentadoa o acostadoa mirando television No incluya el tiempo que permanence sentadoa en un vehículo de motor que ya haya mencionado anteriormente Durante los últimos 7 días 26 Cuánto tiempo permaneció sentadoa en un día en la semana? _____ horas por día _____ minutos por día
No sabe/No está seguroa 27 Cuánto tiempo permaneció sentadoa en un día del fin de semana? _____ horas por día _____ minutos por día
No sabe/No está seguroa 49
Early Prevention of Diabetes Improved Access to Health Care DSHS OBH Document No 7097097093D-2007, Attachment No 01 Purchase Order No 0000319865; Contractor: TX AM University System Health Science Center Term: August 01, 2006 THRU December 31, 2006
Módulo 5: Acceso y utilización de los servicios de salud 51 Tiene algún tipo de cobertura de atención de la salud, incluyendo seguro de salud, planes prepagados, o seguros de salud del gobierno, como Medicare o Seguro Popular? 21 1 Sí 2 No 7 No sabe/ no está seguroa 9 Se niega a contestar 52 En los últimos 12 meses hubo algún momento en que necesitó atención médica pero no la pudo obtener debido al costo? 24
1 Sí 2 No 7 No sabe/ no está seguroa 9 Se niega a contestar
Módulo 6: Datos demográficos 61 Sólo pregunte si es necesario 1 1 Hombre 2 Mujer 62 Cuántos años tiene? 2 __ __ Edad en años cumplidos 7 No sabe/ no está seguroa 9 Se niega a contestar 63 Cuál es el grado o año escolar más alto que terminó? 4 1 2 3 4 5 6 9 Nunca fue a la escuela o sólo fue al jardín de niños Primaria Secundaria Preparatoria Algunos estudios en universidad o escuela técnica Graduado de la universidad Se niega a contestar
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Early Prevention of Diabetes Improved Access to Health Care DSHS OBH Document No 7097097093D-2007, Attachment No 01 Purchase Order No 0000319865; Contractor: TX AM University System Health Science Center Term: August 01, 2006 THRU December 31, 2006
64 Actualmente usted? 5 1 2 3 4 5 6 7 8 9 Es empleado asalariado Trabaja por cuenta propia Ha estado desempleado por más de 1 año Ha estado desempleado por menos de 1 año Es ama de casa Es estudiante Está jubilado No puede trabajar Se niega a contestar
65 Aproximadamente, cuánto pesa sin zapatos? 6 Redondee las fracciones al número siguiente __ __ __ __ peso libras/kilogramos 7 No sabe/ no está seguroa 9 Se niega a contestar 66
Aproximadamente, cuánto mide sin zapatos? 7 Redondee las fracciones al número anterior __ __/ __ __ Estatura pies/pulgadas/metros/centímetros 7 No sabe/no está seguroa 9 Se niega
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Early Prevention of Diabetes Improved Access to Health Care DSHS OBH Document No 7097097093D-2007, Attachment No 01 Purchase Order No 0000319865; Contractor: TX AM University System Health Science Center Term: August 01, 2006 THRU December 31, 2006
Nota para entrevistador: Anote lo que dice la persona, clarifique el país si no indican en su respuesta y marque la respuesta apropiada 67 En donde empezo la escuela? __________________________________ 1 2 3 7 9 México Estados Unidos Otro especifique pais__________________________________ No sabe/ no está seguro Se niega
68 Qué lenguaje habla usualmente en casa? 12 1 2 3 4 5 6 7 8 9 Solamente español Más español que inglés Ambos, español e ingles por igual Más ingles que español Solamente inglés Lengua indígena Otro No sabe/ no está seguro Se niega
69 Usted lee ingles? 13 1 2 7 9 Sí No No sabe/ no está seguroa Se niega
610 Usted lee español? 14 1 2 7 9 Sí No No sabe/ no está seguroa Se niega
Esa fue mi última pregunta Cada una de las respuestas serán
analizadas para proporcionarnos información acerca de los hábitos de salud de la población que vive a lo largo de la frontera México-Estados Unidos Muchas gracias por su tiempo y su cooperación
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Source:borderhealth.org
