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Penn Nursing Student Develops Holistic Diabetes Education Tool that can be Tailored for Global Communities

Early this year, Natalie Ball, BSN, RN, Nu’14, was named a delegate to the US-Mex Forum for Cooperative, Understanding and Solidarity (FoCUS) program. A group of 30 outstanding students from the United States and Mexico, the cohort benefits from a range of academic and cultural opportunities as they work on projects in preparation for the bi-annual FoCUS Summit, which brings all Delegates together at Stanford and ITAM.

Following the ITAM conference this spring, Natalie and her team began a collaborative project focused on diabetes education in Oaxaca, MX in partnership with the local non-profit, En Via. In the course of just a few months, Natalie and her group, comprised of a biomedical engineer, a chemist, a pre-med student, a linguistics student, and a physician, conceptualized and researched a dynamic diabetes education program, edDiabetes. At the recent FoCUS Summit at Stanford University held over the first weekend of November, they were given the Outstanding Delegate Presentation award for exactly that work.

What began as a question to Fundación En Vía – a non-profit organization in Oaxaca, Mexico that supports social and community development through microfinance, responsible tourism, and education – has developed into a culturally sensitive, holistic diabetes education tool that can be thoughtfully tailored to communities in need. Natalie felt strongly from the beginning that whatever project she was going to work on had to be rooted in necessity. “We didn’t want to be the ones going into a community and saying, ‘this looks like a big problem for you…we’re going to solve it.’ We wanted to help a community solve a problem that they had identified themselves,” she says.

When Natalie and her team were initially connected with En Vía, they were told that diabetes education, prevention, and management were the major issues identified by the women in the community. Although there was a small program in place, the women wanted to expand it. This helped give shape to edDiabetes. She explains: “We’re piloting the program in Oaxaca, but ultimately we are creating a website that will provide a toolkit for adapting our diabetes education program to any community interested. Organizations, educators, clinicians, students…or anyone, can access the site to find the tools they need to deliver diabetes education, with the first tool always focused on community surveys, partnerships, and community- based participatory research.”

With some 422 billion people diagnosed with diabetes around the world and the US associated spend at roughly $300 billion a year, it is an expensive pandemic. Natalie hopes that edDiabetes can be part of the solution, one which is centered on four major tenets:

  • Access to diabetes education should be provided through a culturally sensitive, patient-centered approach. This includes language and literacy-level sensitivity, and requires a program that can be used in low-resource communities;
  • That patients must play a central role in coordinating their own health care. Tailored education programs built in partnership with community members that are either suffering or at risk for diabetes is essential;
  • Diabetes must be addressed holistically, considering the social determinants of health, including economic stability, education, social and community context, health and health care, as well as neighborhoods and the built environment; and
  • The education materials developed must be easily shared, so that they can be translated and disseminated throughout the world.

Natalie explains, “Type 2 diabetes is complex and multifactorial. It is a disease that is largely preventable but without proper access to prevention and education, the disease progresses resulting in lowered quality of life, multiple co-morbidities, and other chronic disease. But with edDiabetes, we are trying to solve that by implementing a low-cost strategy for prevention, management, and education that is individually tailored to each community.

Longer-term, Natalie hopes that, “this project can be implemented in communities all over the world. Wherever it starts, the first step will always be to establish a community partnership and identify community needs. Then you can specifically adapt the program to that community. There will always be a lesson plan, reinforced with an interactive activity sensitive to the resources available in the community. The emphasis is always focused on culturally sensitive, holistic, patient-centered diabetes education.”

Natalie will be travelling to Oaxaca to put edDiabetes to the test this coming spring. “At the end of the day, the community members know most about what their needs are, what works for them, what doesn’t, and what resources are available to them,” she says. From providing safe-spaces to address depression—a common comorbidity, to effecting lifestyle changes such as exercise, she understands that a holistic and customized approach is key in helping global communities manage this disease.