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Opportunities and Challenges for Diabetes Prevention at Two Community Health Centers

¹ Division of Preventative and Behavioral Medicine, Department of Medicine, University of Massachesetts Medical School, Worcester, Massachusetts
² Division of Health Care Quality, Department of Medicine, Baystate Medical Center and Tufts University School of Medicine, Springfield, Massachusetts
³ Center for Quality and Safety Research, Division of Health Care Quality, Baystate Medical Center and School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts
⁴ Division of Internal Medicine, Department of Medicine, Baystate Medical Center and Tufts University School of Medicine, Springfield, Massachusetts

Address correspondence and reprint requests to Milagros C. Rosal, PhD, University of Massachusetts Medical School, 55 Lake Ave. North, S7-755, Worcester, MA 01655. E-mail: milagros.rosal{at}umassmed.edu

OBJECTIVE—Translating evidence-based diabetes prevention interventions to disadvantaged groups is a public health priority that poses unique challenges. Community health centers (CHCs) provide unequaled opportunities to prevent diabetes among poor and minority high-risk groups. This formative study sought to assess structural, processes-of-care (health care quality domains), and patient factors that need to be considered for diabetes prevention at CHCs.

RESEARCH DESIGN AND METHODS—A multimethod approach was implemented to assess system-, provider-, and patient-level factors at two large CHCs serving diverse urban communities.

RESULTS—Medical chart audits (n = 303) showed limited documentation of risks. Provider surveys (n = 74) evidenced knowledge gaps regarding factors associated with increased diabetes risk, efficacy of pharmacological interventions, and low perceived efficacy in promoting patient behavior change. Patient focus groups (two groups) with at-risk Hispanics and African Americans suggested mixed knowledge regarding whether diabetes can be prevented, some knowledge gaps regarding factors related to risk, and multiple challenges for lifestyle change.

CONCLUSIONS—Multiple and multilevel challenges to translating diabetes prevention interventions for the benefit of at-risk populations who seek care at CHCs were observed.

Abbreviations: CHC, community health center

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