Empowering Communities to Overpower Diabetes

Eva Vivian, Beatriz Jimenez Cadilla

Professor Eva Vivian, in the School of Pharmacy's Pharmacy Practice Division, and fourth-year PharmD student Beatriz Jimenez Cadilla at a training for Peers Empowering Peers coaches at Cavalry Baptist Church in Milwaukee.

With Baldwin grant, Professor Eva Vivian and UWM collaborator launch community-based diabetes management and prevention program

By Katie Gerhards
Photos by Ingrid Laas

Each year, 1.5 million Americans are diagnosed with diabetes, for a total of more than 30 million Americans living with the disease, according to American Diabetes Association, and another 84 million have prediabetes. Of the diagnosed cases, the vast majority are Type 2 diabetes, which is often the result of lifestyle, diet, exercise, and family history.

“So many of us are at risk because of our age, gender, weight, lack of activity—we are all at risk,” says Sandra Underwood, professor in the University of Wisconsin–Milwaukee College of Nursing. “These are issues that we all need to be mindful of not only for our own health but for the health of our families and communities.”

Underwood is a partner in the Peers Empowering Peers project, led by Eva Vivian, professor in the University of Wisconsin–Madison School of Pharmacy’s Pharmacy Practice Division. Vivian won a grant from the Baldwin Wisconsin Idea Endowment to launch the project, which aims to equip African American community members with information and strategies for healthy lifestyles that prevent and manage Type 2 diabetes, in Milwaukee, Wis.

“I hope this type of program is replicated in other areas of Milwaukee and around Wisconsin, where people can reach each other within their community and provide support,” says Vivian. “Empowering community members to promote wellness is an irreplaceable strategy to improve the health of the community as a whole.”

In further recognition of her work with community engagement, Vivian has also been named an inaugural fellow of the Morgridge Center for Public Service, which aims to enhance collaboration between UW–Madison and local communities. As one of the first-ever Morgridge fellows, she will create a course for the School of Pharmacy focused on the fundamental principles of community-based participatory research (CBPR).

“Empowering community members to promote wellness is an irreplaceable strategy to improve the health of the community as a whole.” –Eva Vivian

“Through the course, I would like to engage students in various community activities so they can experience first-hand how community members with diverse skills and expertise can assist researchers in developing culturally appropriate interventions that facilitate participant recruitment and retention,” Vivian explains.

The Peers Empowering Peers project strongly relies on those principles, and was built with a Milwaukee community’s unique needs and values in mind.

Starting in September 2018, program leaders and peer coaches trained by Vivian and Underwood will hold a series of sessions based on the Centers for Disease Control’s Prevent T2 curriculum to teach community members how to live healthier lives through everything from balanced meals to stress management.

Recognizing an underserved need

The collaborative relationship between Underwood and Vivian started when the two were introduced through the Wisconsin Well Woman Program, which is also a sponsor of the Milwaukee Peers Empowering Peers Project.

Professor Sandra Underwood

UW Milwaukee College of Nursing Professor Sandra Underwood at the Peers Empowering Peers coach training at Cavalry Baptist Church in Milwaukee. Underwood partnered with School of Pharmacy Professor Eva Vivian to launch the project.

Vivian had started similar initiatives in Madison, Wis., inspired by what she was seeing in her clinical practice at Access Community Health Centers. Many of her patients live in low-income communities where grocery stores aren’t readily accessible, or where they don’t feel safe going for a walk. She saw that many of her diabetes patients also had to work multiple jobs because they have limited incomes, which comes with a great deal of stress, especially when there are children involved.

“All of these things affect their health and their ability to manage blood glucose levels,” says Vivian. “By the time I saw them in the clinic, they were already on a downward trajectory. As a pharmacist and diabetes educator, I thought there had to be a better way.”

So she partnered with various community organizations to offer diabetes education classes throughout Madison at different community centers, including Meadowood Neighborhood Center. Through the Baldwin grant, she has able to replicate these initiatives to Milwaukee.

“We don’t realize we’re eating ourselves into poor health,” says Jaqueline Smith, who volunteered to be a peer coach in Milwaukee. “The African American community is very prone to diabetes.”

Smith, who will also help supervise the program’s peer coaches, chairs the Mildred Leigh Gold Health Ministry at Cavalry Baptist Church in Milwaukee, which joined the Peers Empowering Peers program and provides meeting spaces and a network of health-minded community leaders who can help recruit members of the congregation and neighborhood who would benefit from diabetes education.

With the other peer coaches and program leaders, Smith attended trainings in August at Cavalry Baptist Church to learn more about diabetes and meet the other participants and involved health care providers. As a retired social worker assistant, she has seen first-hand how pervasive diabetes is in her community.

“We want to hear from our participants and know what their choices are and what they would like to improve, because that’s really how we are going to make an impact.” –Sandra Underwood

“I’m hoping the project will further involve our community and bring an awareness of diabetes and the fact that it’s not just sugar that’s the cause,” Smith says. “Because of my involvement in social work and in the health ministry, I know what we’re up against, but I am very optimistic because we need to change people’s attitudes.”

Beatriz Jimenez Cadilla, a fourth-year PharmD student at the UW–Madison School of Pharmacy, has a special interest in public health issues surrounding underserved populations and jumped at the chance to get involved with the project through the PharmD program’s independent study research elective. She attended the peer coach trainings and developed a survey to gauge the role of food insecurity on the self-care habits of individuals with diabetes in the Peers Empowering Peers project, and also helped to plan the educational sessions based on community feedback.

“After witnessing the trainings and seeing how motivated the community is, I feel like this is something that will have a significant impact on the community members and will continue to do so for years to come,” Jimenez Cadilla says.

Peers Empowering Peers training at Cavalry Baptist Church in Milwaukee.Peers Empowering Peers training at Cavalry Baptist Church in Milwaukee.Peers Empowering Peers training at Cavalry Baptist Church in Milwaukee.Peers Empowering Peers training at Cavalry Baptist Church in Milwaukee.Peers Empowering Peers training at Cavalry Baptist Church in Milwaukee.Peers Empowering Peers training at Cavalry Baptist Church in Milwaukee.Peers Empowering Peers training at Cavalry Baptist Church in Milwaukee.Peers Empowering Peers training at Cavalry Baptist Church in Milwaukee.Peers Empowering Peers training at Cavalry Baptist Church in Milwaukee.Peers Empowering Peers training at Cavalry Baptist Church in Milwaukee.Peers Empowering Peers training at Cavalry Baptist Church in Milwaukee.Peers Empowering Peers training at Cavalry Baptist Church in Milwaukee.Peers Empowering Peers training at Cavalry Baptist Church in Milwaukee.Peers Empowering Peers training at Cavalry Baptist Church in Milwaukee.Peers Empowering Peers training at Cavalry Baptist Church in Milwaukee.Peers Empowering Peers training at Cavalry Baptist Church in Milwaukee.Peers Empowering Peers training at Cavalry Baptist Church in Milwaukee.Peers Empowering Peers training at Cavalry Baptist Church in Milwaukee.Peers Empowering Peers training at Cavalry Baptist Church in Milwaukee.

Encouraging healthy lifestyles

Over the course of the 16-week program, Smith and other peer coaches—including a dietitian, wellness trainer, two retired nurses, and a chef—will support Vivian, Underwood and other involved health care professionals as they present strategies for finding the time for exercise, tracking activity, managing stress, maintaining a healthy lifestyle and detecting, managing and even preventing diabetes.

Marvin Brown, the peer coach chef, will also lead sessions about how to grocery shop and cook with health in mind. But he won’t just be providing basic nutritional recipes—Brown will be taking cues from the community about how to adapt family and cultural recipes to be more conducive to health. For example, instead of red beans and rice, he’d cook red beans and quinoa or cauliflower.

“The goal is to adapt what is presented so that it is consistent with the values and needs of the culture of the population,” says Underwood. “We want to hear from our participants and know what their choices are and what they would like to improve, because that’s really how we are going to make an impact.”

“They will be able to share their limitations and barriers they experienced while participating in the program and how they were able to overcome them. This is the true meaning of the Peers Empowering Peers program.” –Beatriz Jimenez Cadilla

Bidirectional communication between facilitators and participants is central to the effectiveness of the program. If community members are given generic or unrealistic advice, they’re less likely to be able to make impactful changes in their daily routines. But by getting to know each member, understanding their constraints and unique challenges and tailoring programming to address those concerns, real change can take root.

“The connection between Dr. Vivian and the community members is indescribable,” says Jimenez Cadilla. “She listens emphatically to the community’s ideas, needs and recommendations. She isn’t there to give instructions—she is there to inspire others.”

Peers Empowering Peers participants will attend a weekly meeting, complete with a wellness walk and a healthy lunch prepared by Brown, and throughout the week peer coaches will follow up with participants to gauge how the program is impacting lifestyles and to provide additional support. Participants who complete 16-week program will then have the chance to serve as a peer coach for future sessions.

“They will be able to share their limitations and barriers they experienced while participating in the program and how they were able to overcome them,” says Cadilla. “This is the true meaning of the Peers Empowering Peers program.”

Read about another program within the School of Pharmacy geared toward improving community health in Wisconsin and abroad.