Educators get out the message to minorities

Programs target high-risk ethnic groups

The message is simple, but getting the word out to minorities about controlling diabetes has been a challenge for the American Diabetes Association (ADA) in Alexandria, VA, and the National Diabetes Education Program (NDEP) in Atlanta.

By interacting closely with members of each ethnic group, NDEP and the ADA say they have learned these techniques:

o Encourage Hispanics to exercise by appealing to their love for dancing.

o Get the message across to African Americans by appealing to them through the churches that are so much a part of life in the black communities.

o Reach Native Americans through their sense of tribal unity and their understanding of the human spirit.

"We had members of the target populations advise us. They set us straight when we were off the mark," says Faye Wong, MPH, RD, associate director of diabetes education in the Division of Diabetes Translation for the Centers for Disease Control and Prevention in Atlanta. She also is CDC director of the NDEP, a partnership between the CDC, the National Institutes of Health, and the National Institute of Diabetes, Digestive, and Kidney Diseases.

NDEP, funded for about $3.5 million in 1998, is spreading its "Control Your Diabetes. For Life" program to include campaigns targeting African Americans, Hispanics, and Native Americans and the health care providers who serve them.

The ADA’s tiered education program ranges from broad-based television, radio, and print public service announcements to a wide variety of printed materials to intimate face-to-face interactive programs in the communities where target audiences live, says Shelly Heath-Watson, MS, diversity program manager for the ADA. The association allocates 38.6% of its $123 million budget to all its information efforts.

"We had the programs generated by our project teams," says Heath-Watson. "The teams gave us cultural nuances and what we needed to be sensitive to and helped us with staff training."

The message to everyone is the same:

- Recognize the risk of diabetes.
- Get tested.
- Control the disease.

Over and over, a wide array of literature informs those who have been diagnosed with diabetes and those who have not to recognize the signs of the disease and to get the care they need to prevent complications. But each minority group is approached in a unique way.

For more than four years, the ADA’s campaign has approached the Hispanic community through a program called DAR (Diabetes Assistance and Resources) which means "to give" in Spanish.

NDEP is currently in the midst of its second wave of materials targeting the Hispanic community through a program launched last June. "There’s a barrier of fatalism in the Hispanic community," says Wong. NDEP’s latest television public service announcement features a stormy sky and the message in Spanish and English:

"Some things in life you can’t control. Fortu-nately, diabetes isn’t one. Take your diabetes seriously so it doesn’t become too serious."

Wong says the materials aimed at the Hispanic community were developed in Spanish to help achieve precision of language, then sometimes translated back into English for mass media distribution. "In the Latin community, there is the myth that a trauma causes diabetes," says Heath-Watson. The myth is addressed through a barrage of various media messages and a plethora of literature available everywhere from doctor’s offices to community centers to churches. (For an example of a Spanish-translated handout, see questionnaire, inserted in this issue.)

The Latinos’ love for dancing is used to encourage exercise through ads called "Get Up and Dance," she explains.

A spiritual approach

"In the African American community, there is a strong sense of faith," says Heath-Watson. "People think if they pray hard enough, God will take it away. So we educate the pastors, and they tell people God can work through doctors."

The ADA program is based on a concept that educators must go where the audience is. "That means community centers, churches, wherever they are," she adds.

A television commercial currently in production for NDEP features a black family reunion and the message that diabetes runs in families and those who care for themselves will be there for their families. Print ads show an older man and a child with the message "I’m controlling my diabetes so I’ll be around for my grandchildren."

The ADA’s African American Program, which began in 1996, offers, among other tactics, a letter from popular gospel recording artists, the Clark Sisters, whose mother died of diabetes. Says the letter sent to black congregations as part of Diabetes Sundays which take place regularly in black churches: "Some things we don’t have control over in our lives, but the good news is that diabetes is a disease we can do a lot about. It can be controlled, and complications don’t have to happen."

Programs targeting Native Americans are just beginning to get off the ground, and not a moment too soon, say Wong and Heath-Watson, since a higher percentage of Native Americans suffer the ravages of diabetes than any other ethnic group. And that audience is fraught with cultural sensitivities, says Wong. "There are more than 500 tribes, and some may look at a commercial and say, That looks like southwestern Indians. That’s not us,’" she says. "So conveying the message is complex."

Because of the many languages, different physical characteristics, and even varied music, the commercial now in production has been carefully crafted to include as many different components as possible "so the message is universal," says Wong.

Many Native Americans believe diabetes is a white man’s disease, and it is caused by being too close to white people and their food, says Heath-Watson. While there may be some basis in truth, at least for the cautions about "white man’s food," the ADA’s "Awakening Our Spirit" campaign to be launched in the fall of 1999 focuses on traditional values and spirituality, traditional foods, cultural roots in exercise, and the sense of community.

"These messages will emphasize awakening our inner spirits to soar once again and to strengthen our determination to fight this epidemic. Each of us will see the role we can play in the fight to eliminate diabetes," states the program’s design team’s letter to Native American communities, their tribal leaders, and elders.

The Asian and Pacific Islander population, also at high risk, has not yet been targeted for a specific campaign, but Wong, who is of Chinese descent, says the Asian American population is an important one to include in campaigns. "There are not enough data, but it’s a problem. Just because you don’t have the numbers, we do have diabetes."

An NDEP focus group is now tackling the thorny issues of a wide variety of cultures and languages ranging from Chinese to Filipino to Vietnamese to Fijian to Japanese and everything in between to find "some commonalities so we can convey the message to them, too," says Wong.

[Faye Wong can be reached at (770) 488-5037. Shelly Heath-Watson can be reached at (703) 299-2013.]