The Hispanic community is disproportionately affected by Type 2 Diabetes. According to the CDC, Mexican Americans, who are the largest Hispanic group in the USA, are identified as being almost twice as likely to be diagnosed with diabetes as compared to the Caucasian population (Athavale et al., 2020). Effective care delivery models are considered essential to improving clinical, quality of life, and healthcare cost outcomes (Golden et al., 2019). The management of the disease in this population is limited by the cultural and language barriers together with barriers to health care access. This results in adverse complications associated with Diabetes Type 2 population. The improvement of glycemic control that results in the reduction of these complications is an objective in the treatment of type 2 diabetes (Golden et al., 2019). Attaining this objective is complicated when working with the Hispanic population due to the extensive time that workers spend at work resulting in a limited period for personal activities. The typical high carbohydrate diet also adversely affects the achievement of glycemic control (Pereze-Escamilla, 2009). A diabetes care delivery model would focus on improving the self-care knowledge and disease management of patients within this community.
This project focuses on utilizing existing evidence and leadership strategies to establish a care delivery model focused on improving diabetes-associated outcomes within the population. This paper outlines an innovative plan for diabetes intervention model for Hispanic migrants.
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Establishing a Clear Purpose and Vision
The establishment of a clear vision is a leadership strategy that will be used to outline the expected outcome of the diabetes care delivery model. A clear vision is long-term and measurable and can be shared with others to achieve the needed objectives (Adnan et al., 2019). The education care delivery models will be based on two clear purposes. The first purpose is the development of an innovative delivery model that will improve the health and access to care of the Hispanic migrant community. Based on this purpose, it is clear that the delivery model will be based on an interventionist model, and the target population is Hispanic migrant workers who have a higher likelihood of being diagnosed with Type 2 Diabetes due to their demographic population. The last purpose will be determining the influence of the care delivery model in improving the health and access to care of the Hispanic migrant community. This test will act as a measure of the effectiveness of the care delivery model and its usefulness in the target population and health issue.
Strategy Delivery: The Use of Cultural Competencies
The Hispanic migrant community is characterized by distinct cultures and beliefs. Accommodating this community's cultural competencies is critical to ensuring that the innovative approach can be applied to this target population. This aspect of the care delivery model will mainly involve the application of planning and delivery skills to ensure that the purpose established for the care delivery model is implemented (Adnan et al., 2019). For strategy delivery, the social, cultural, and economic characteristics of the Hispanic migrant community will be applied in the care delivery model to ensure that the expected outcomes are attained. The care delivery model will be made up of a nurse-led multi-disciplinary team of registered dietitians and medical assistants who will provide clinical management while the bilingual community health-workers deliver culturally-tailored services. Live interventions will be conducted based on an intervention period that ranges from 6 weeks to 24 months, with the session frequency of each intervention being weekly. Each session will include the tailoring of a proper diet plan, blood glucose monitoring, and the provision of needed medications to the individuals involved.
During these sessions, the socio-cultural context of the Hispanic migrant will be taken into consideration, with dietitians focusing on healthy eating on a budget and cultural beliefs ( Pérez-Escamilla, 2009). Foods will be used to demonstrate appropriate portion sizes and the selection of relevant food choices and portion sizes. Due to the recognized traditional foods of this community and their importance to the cultural identity of those involved, existing recipes will be adapted to enhance nutritional value. Family members and friends will be engaged in the interventions due to the focus placed on family and social links by the population. The Hispanic population places a high value on family and other interpersonal relationships (Athavale et al., 2020). Hence, the inclusion of family and friends in live sessions with the multi-disciplinary team will mainly act as a way of motivating changes in behavior.
The care delivery model's interventions will be founded on self-efficacy, which is a belief that an individual can have control over their activities and other events. Self-efficacy is founded on four different components: performance, different experiences, verbal persuasion, and physiologic state (Hejazi et al., 2017). The self-efficacy theory will be applied to act as a framework for understanding behaviors and as a technique for supporting behavioral changes. According to Hejazi et al. (2017), educational care delivery models that support the self-management of diabetes can be further structured to improve diabetes care self-efficacy. In this care delivery model, self-efficacy will be established through the implementation of three distinct methods. Activities included in the live interventions will be used to enhance performance accomplishment. These activities will involve the development of personal diabetes plans and the selection of appropriate diet choices for each patient involved (Hejazi et al., 2017). Vicarious experiences will be established by observing the actions of class leaders within these activities. Lastly, verbal persuasion will be used by regularly encouraging participants throughout the care delivery model.
Delegation and Empowering: The Community Health Workers
For leadership to be conducted properly, existing responsibility has to be distributed by delegating existing roles. The division of responsibility provides leaders with the benefit of enhancing the collective intelligence and adaptability of those who follow them (Zhang et al., 2017). The delegation of responsibility should also be integrated with the motivation of employees. When employees or followers are empowered, they develop a level of synergy that supports the achievement of better outcomes. In this delivery model, the delegation of responsibility and empowering of employees will be conducted to ensure proper collaboration for the attainment of the model’s goal.
Therefore, the first step will be to conduct the training of community health workers (CHW) that will be included in the delivery care model. CHW’s will be involved in a training process that will be made up of eight hours of education that will be complete in eight one-hour sessions. Training will be conducted in the local clinic by the interdisciplinary team of dietitians and nurses that will be engaged in the model. The sessions will be founded on information from the ADA.
The entire interdisciplinary team will also be engaged in weekly meetings to review patient files and create proper comprehensive case management and treatment plans. These sessions will be directed not only at improving the quality of care provided to patients but also ensuring that each member of the team conducts the role. Separate community health workers will be provided with the task of review the content before each meeting to ensure an accurate comprehension and delivery of information to those involved, based on their knowledge of the cases.
The development of this care delivery model will be founded on the multi-disciplinary efforts of different workers, which will include administrators, healthcare providers, nurses, and community health workers. Several team-building efforts will, therefore, be applied throughout the care delivery model. The first strategy will be the inclusion of all team members when developing the care delivery model. Input and suggestions from different team members will be employed in the care delivery model. Group interactions between the different professionals involved will also be encouraged. This interaction is aimed at ensuring that the different group members take an interest in each other. Several benefits will be expected from these team-building strategies. One benefit is that the team members will be motivated and have increased confidence in their capability to effectively fulfill their roles (Zhang et al., 2017). Team building is also expected to increase the health workers' flexibility and ability to adapt according to changes.
Conclusion
Diabetes Type 2 is highly prevalent within the Spanish migrant community, with more and more individuals in the community being diagnosed with the disease. The innovative care delivery model designed to minimize the prevalence of the disease in this community is an educational care delivery model that targets increasing the Diabetes self-management skills of this population. This innovative care delivery model is based on three separate leadership strategies. The first strategy is a clear vision and purpose, which is described by a three-pronged purpose approach for the education care delivery model. The second strategy is the planning and delivery of strategy, which is mainly done by applying the core competencies of the target population, such as the prevalent diet used. The last strategy is the delegation of duties and motivation of employees. This strategy was applied through the application of team-building exercises and the distribution of responsibilities.
References
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Athavale, P., Prata, N., Sokal-Gutierrez, K., Lahiff, M., Najmabadi, A., Landeros, J., ... & Handley, M. A. (2020). An Exploratory Analysis of Factors Associated with Low Risk Perception for Developing Type 2 Diabetes amongst Low-income, Primarily Latina Women with prior Gestational Diabetes Mellitus. https://www.researchgate.net/deref/http%3A%2F%2Fdx.doi.org%2F10.21203%2Frs.2.21040%2Fv1
Golden, S. H., Yajnik, C., Phatak, S., Hanson, R. L., & Knowler, W. C. (2019). Racial/ethnic differences in the burden of type 2 diabetes over the life course: a focus on the USA and India. Diabetologia , 62, 1751-1760. https://link.springer.com/article/10.1007%2Fs00125-019-4968-0
Hejazi, S., Peyman, N., Tajfard, M., & Esmaily, H. (2017). The impact of education based on self-efficacy theory on health literacy, self-efficacy and self-care behaviors in patients with type 2 diabetes. Iranian Journal of Health Education and Health Promotion , 5 (4), 296-303.
Pérez-Escamilla R. (2009). Dietary quality among Latinos: is acculturation making us sick? Journal of the American Dietetic Association , 109 (6), 988–991. https://doi.org/10.1016/j.jada.2009.03.014
Zhang, X., Qian, J., Wang, B., Jin, Z., Wang, J., & Wang, Y. (2017). Leaders’ behaviors matter: the role of delegation in promoting employees’ feedback-seeking behavior. Frontiers in Psychology , 8 , 920. https://dx.doi.org/10.3389%2Ffpsyg.2017.00920
