Together on Diabetes Program: Development, Implementation and Impact of a Paraprofessional-Delivered Home Visiting Program for American Indian Youth at Risk for Diabetes

Introduction:  Reservation-based American Indian (AI) youth are at the forefront of an obesity and type 2 diabetes (T2D) epidemic in the United States. One-third of AI youth are overweight or obese, and their T2D prevalence is 2.6 times higher than US All Races. Often socioeconomically disadvantaged and lacking adequate resources to prevent and treat diabetes, innovative, cost effective and culturally appropriate programs are necessary. Recognizing the potential impact of paraprofessional AI Family Health Coaches (FHCs) on chronic diseases, “Together on Diabetes” (TOD), a diabetes prevention and management intervention, was developed, implemented and evaluated in partnership with 4 southwestern AI communities.  

Methods: The TOD intervention and evaluation protocol was developed through a Community Based Participatory Research process in 4 southwestern reservation communities.  Intervention participants include AI youth, 10-19 years old diagnosed with or at risk for T2D, and a family-based support person. The intervention features a 12-month home-based curriculum informed by the Transtheortical Model and Social Cognitive Theory and delivered by FHCs to youth and support persons. FHCs also conduct case management with youth’s providers and engage participants in community wellness events. Outcomes are assessed at baseline, 3, 6 and 12-months through comprehensive demographic, psychosocial, behavioral and physiological assessments.

Results: Between 2012 and 2014, 257 youth (56.0% males; 43.6% females; 1 missing gender) and 226 support persons were enrolled across 4 sites.  At baseline, 15% (n=33) of youth had T2D, and 85% (n=188) were at-risk.  Of those enrolled, 13.5% were categorized as overweight and 82.6% as obese, and average fat intake was above recommended levels. In the past month, 40.0% experienced food insecurity and 17.2% screened positive for depression. Preliminary 6 month outcome data will be reported, including significant increases in knowledge related to TOD content and perceived quality of life; reduced depression; lower BMI-z scores for girls; and stable BMI-z scores for boys.

Conclusions: This is the first diabetes intervention trial focused on American Indian adolescents, who have the highest risk for diabetes in the US, with important lessons for global diabetes control.  Further affirming the role of paraprofessionals in chronic disease prevention, preliminary findings indicate that it is feasible, and more importantly, potentially highly impactful to train paraprofessionals to effectively deliver a diabetes prevention program to local high-risk youth and family members.  We will present complete baseline and 6 month outcome data of the TOD program cohort, discuss implications of these findings and suggest future directions.