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Nursing, public health schools complete community diabetes study (7-26-99)

The figures are startling: In the last 20 years diabetes has increased threefold in San Antonio. Now one in every four or five people in Bexar County has the disease, according to statistics from the Texas Department of Health and other sources.

That comes as no surprise to the project staff of a recent report to the Texas Diabetes Institute (TDI). The study, "Knowledge and Awareness of Diabetes and the Burden of Diabetes on Families in Central San Antonio," was a collaborative effort of the School of Nursing at The University of Texas Health Science Center at San Antonio and the School of Public Health, San Antonio campus, of the U. T. Health Science Center at Houston.

The community-based study took place within the boundaries of the San Antonio Independent School District, which was subdivided into the eight high school regions. Eight teams of combined graduate nursing and public health students in community assessment courses, taught by Dr. Edward Gruber in the School of Nursing and Dr. Frank Moore in the School of Public Health, conducted the study. They analyzed existing data, interviewed community leaders and health care providers, and held focus groups of community residents in each high school region. A report was written for each region, then the data were combined to provide a complete picture of the study area.

One surprise, says Olive Roen, project director, was the fear the disease creates. "People are truly afraid. It's a great cause of stress within a family."

The challenge facing health care professionals, says Dr. Moore, principal investigator, is how to communicate risk to a population without engendering more fear. The first hurdle is denial. People tend to ignore the symptoms of the disease until they start to have major complications from it, and by then it requires extensive treatment.

Although many community members surveyed knew that diet and exercise were important in controlling the disease, they cited the expense of buying "special foods" and the poor condition of neighborhood streets as reasons for not eating well and exercising. Yet families that had been able to incorporate diet and exercise recommendations into their lifestyles were enthusiastic about the positive health and relationship benefits for the whole family.

Another important finding, say the investigators, is the huge gap between medical and community knowledge of the disease. "Popular knowledge is very limited," says Dr. Moore.

The disease is known as "sugar in the blood" or "high blood sugar," and insulin is widely thought to cause blindness or kidney damage. "Diabetes is where cancer was 30 or 40 years ago," says Roen. "There's a stigma attached."

Investigators found that information must be highly visible and accessible. Focus groups favored pictorial and spoken information over printed material. Most important, the study concluded, education efforts must be personalized and in a family setting, ideally with home visits.

"We see this study as a springboard to identify interventions and set up a community-wide coalition on diabetes," says Dr. Mary Helen Mays, director of special projects with TDI. The organization is looking for highly visible spokespersons, representing multiple facets of the community, says Dr. Mays.

This study is one of many assessments the Texas Diabetes Council is conducting throughout Texas. Over the next four years TDI will identify and evaluate community-based interventions such as school-based initiatives, a media campaign and targeting age-specific groups.

Contact: Will Sansom or Jennifer Lorenzo