Abstract: Conversations with Diabetes Educators in Appalachia: Experiences, Insights and Visions

◆ Morohunfolu Seton, University of Louisville
◆ Lindsay J. Della, University of Louisville
◆ Mary Z. Ashlock, University of Louisville
◆ Katie McDaniel, Wiser Strategies
◆ Tania B. Basta, Western Kentucky University
◆ Kimberly R. Hartson, University of Louisville
◆ Kristi M. King, University of Louisville

Background: In Appalachia, the most economically distressed counties also have the poorest health (Borak, Salipante-Zaidel, Slade, & Fields, 2012). Geographic isolation, limited access to health care, and cultural beliefs contribute to local health outcomes (O’Brien & Denham, 2008). As such, individuals living in Appalachia may postpone seeking medical assistance from health professionals, preferring first to obtain advice from family and social networks. Diabetes educators working in Appalachia are uniquely positioned to highlight health education and community-based diabetes challenges in the region, as they serve to bridge the gap between professional and lay sources of information.

Study Introduction: This study sought insight from diabetes educators working in Southeastern Ohio and Eastern Kentucky. Data were gathered around “wins”, challenges, and the types of assistance these diabetes educators desired for future patient interactions. Specifically, key informant interviews were conducted to explore the following research questions:
What experiences have Appalachian diabetes educators faced in the field? What can be learned from their experiences?

Method: Seven semi-structured key informant interviews were conducted with diabetes educators serving the counties of Bath, Clark, Menifee, Morgan, and Rowan in Kentucky, along with Athens, Holmes, Noble, Gallia in Ohio (some educators served more than one county). All interviews were conducted via telephone. Interviewees were asked a series of questions about their experiences, processes, insights and challenges in their diabetes educator position. Interviews were recorded, de-identified and transcribed for analysis. Two graduate students coded the data for prominent themes that emerged across the discussions using Owen’s (1984) criteria. Faculty members reviewed and aided in the interpretation of the codes and themes identified.

Findings: Several themes emerged from the analysis. Specifically, diabetes educators vocalized issues related to their patients’ managing misinformation, lack of knowledge, and skewed perceptions: “I think that they don’t know the full scope of it. I think that part of it is because we have oral medications out there and people think that their diabetes isn’t very bad because they’re taking a pill.” Another participant added, “I think they assume that if they get online and then they Google diabetes that they’re going to get reliable, current information… and if you can’t – if you don’t have internet access, your neighbor will stand in the backyard and tell you all about it because she got it too.”

Other emergent themes included the personal blame that diabetes educators heard from their patients; the challenge of navigating family and friend relationships; and a strong focus on dietary change (with less discussion about of physical activity). Finally, the need for additional focus and resources aimed at supporting children in the community with a diabetes diagnosis was noted across many interviews. One diabetes educator plainly stated, “I would like to see uh– a child support group because we have several diabetic kids that need more support.”

These findings lend important insights into issues and directions for future diabetes education practice in Appalachian Kentucky and Ohio. This session will further explicate the main themes noted from the interviews and consider their implications.