Diabetes, Mental Health, and Wellness: Developing Culturally Appropriate Tools to Meet the Needs of American Indians and Alaska Natives

Background: Diabetes and depression are common and costly, yet potentially preventable and treatable conditions. Persons with depression may be at increased risk of developing diabetes, and conversely, those with diabetes are at greater risk for developing depression, particularly if diabetes complications worsen. Depression and other psychosocial issues associated with diabetes often go undiagnosed or insufficiently treated. This is concerning because diagnosing and treating depression early can reduce the risk of diabetes-related complications affecting the heart, nervous system, kidneys, and eyesight. Diabetes and its complications, including depression, disproportionately burden American Indians and Alaska Natives (AIAN). The 2006 Behavioral Risk Factor Surveillance System indicates that the rate of depression was 8.3% in all people with diabetes, but was 27.8% in AIAN people with diabetes. Health care professionals serving AIAN communities informed the National Diabetes Education Program (NDEP), a program jointly sponsored by the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health, of the need for culturally appropriate health communication tools to help address the needs of patients affected by both diabetes and depression.

Program background: The NDEP created the Living a Balanced Life with Diabetes toolkit to help providers increase awareness and make resources more available for persons living with both diabetes and depression. NDEP formed an AIAN psychosocial subcommittee, which searched for existing health communication tools on diabetes and depression and determined their cultural appropriateness for AIAN persons. The psychosocial subcommittee identified health communication tools on diabetes and depression that could be compiled into a toolkit. It also identified information on other psychosocial topics (e.g., self-esteem, tobacco and alcohol use, suicide prevention) to be addressed. This information was used to develop tip sheets specifically for AIANs.

Evaluation Methods and Results: Before the newly developed tip sheets were included in the toolkit, NDEP pilot-tested them with AIAN youth and adults with diabetes to determine if the messages resonated with them. Responses were overwhelmingly positive, informing NDEP that the health messages were clear, concise, and culturally appropriate for AIAN persons. In September 2013, one year after the toolkit’s release, CDC formally evaluated the efficacy of the Living a Balanced Life with Diabetestoolkit. NDEP invited 200 health care providers (nurses, health educators, community health representatives) serving AIAN communities to take an online survey. By the end of the data collection period, 59 of the 200 had completed the survey (a 30% response rate). Responses indicated that: 72% were satisfied with the toolkit; 60% thought the toolkit helped them address diabetes and depression in their patients; and 65% planned to continue using it regularly. Respondents also indicated a need for similar tools to help address other psychosocial issues common in AIAN persons who have diabetes.

Conclusions: Evaluation of the Living a Balanced Life with Diabetestoolkit indicated that it has been helpful for improving health communication with AIAN persons with diabetes.

Implications for research and/or practice: Similar toolkits, developed to reach other underserved groups, might also prove to be helpful resources.