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Background: Diabetes affects nearly 26 million people in the United States. Another 79 million people are estimated to have prediabetes.[1]In turn, people with diabetes are at higher risk for diabetic eye disease, a leading cause of vision loss and blindness. Results from the 2004 Los Angeles Latino Eye Study show that Hispanics/Latinos are at higher risk of vision loss and blindness from eye diseases such as diabetic eye disease and glaucoma. In addition, recent National Eye Institute (NEI) statistics show that there has been a 150 percent increase in diabetic retinopathy cases among Hispanics/Latinos in the past decade, and cases are expected to double by 2030. The National Eye Health Education Program (NEHEP) of NEI discovered that CHWs and health professionals who have daily interactions with Hispanics/Latinos, and who play a key role in motivating the people in their communities to have their eyes examined, have not addressed eye complications due to diabetes in detail because they have not been trained or equipped to do so.
Program background: The Diabetes and Healthy Eyes Toolkit was designed specifically by NEHEP to enhance existing CHW diabetes programs with culturally and linguistically appropriate diabetes and eye health educational resources. To ensure materials were scientifically sound, appealed to the end user, and understood by intended audiences, NEHEP undertook a rigorous development process that included obtaining feedback from medical experts, program managers, and end users. Because the toolkit is for CHWs to use at the grassroots level, it is designed to provide them with easy-to-understand, evidence-based information that can easily be shared with the populations they serve. All toolkit materials use plain language and are available in English and Spanish. The toolkit features a flipchart with colorful graphics for use in small group settings, a module that provides background information and activities, and information on proper eye care. CHWs who pilot-tested the toolkit indicated that the information is easy to follow, reading levels are appropriate, and language is culturally sensitive. They also said the toolkit will fill a gap by providing education about diabetes and eye health. NEHEP developed a 90-minute training workshop based on adult pedagogy for the toolkit. The workshop introduces participants to the toolkit and provides opportunities to explore its content, components, and implementation.
Evaluation Methods and Results: Since 2010, more than 1,900 toolkits have been ordered and more than 100,000 toolkits have been downloaded. Also, between September 2011 and April 2013, NEHEP has trained 253 CHWs through 11 workshops conducted across the United States.
Conclusions: The Diabetes and Healthy Eyes Toolkit has helped to increase the capacity of CHWs to address diabetic eye disease among Hispanics/Latinos.
Implications for research and/or practice: Providing culturally and linguistically appropriate curricula for CHWs, such as the Diabetes and Healthy Eyes Toolkit, can help advance Hispanic/Latino health and address the high rates of visual impairment among Hispanics/Latinos.
[1] Centers for Disease Control and Prevention. (2012). Diabetes report card 2012. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Department of Health and Human Services.