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Mariana, a 45-year-old Latina, has just been told she has diabetes. It’s her first doctor visit in a year, but Mariana has heard of diabetes before; her uncle was also diagnosed last year. Mariana lives with her husband, their three children, her mother, and her brother. She works more than forty hours a week to help care for her family. She immigrated to the country recently, speaks limited English, and she doesn’t drive.

Mariana’s home life is not unusual in the Latino community – nor is her diagnosis.

The Latino community makes up one of the fastest growing demographics in the country. From 2000 to 2014, Latinos accounted for more than half of the growth in the total population of the United States. In cities like Boston, Latinos account for 92 percent of the population growth since 1980.

Moreover, poorly managed diabetes is a financial burden – for both the patient and the health care system. These demographic trends mean that if we are to have any success in managing diabetes, it will require effective outreach to the Latino community. The challenge in doing so lies in multiple barriers to providing these communities with the tools needed for effective diabetes care. Failure to meet the needs of diverse cultures with diabetes is a major deficit to the health care system.

Helping Mariana and others in her community manage their diagnosis begins with a better understanding of the Latino culture and educating clinicians on ways to overcome the specific health care obstacles they face.

A commitment with Latinos Health

First and foremost, effective outreach must be truly bilingual

Without this, a prescription indicating “ounces,” could easily be interpreted as “once” – Spanish for “eleven” – a massive difference when considering medication doses. In addition to providing all information, resources and forms are available in Spanish, Tufts Health Plan is working to convert medication labels, so that misinterpretation is avoided at all costs.

But providing written resources is not enough. The Latino community also needs better access to Spanish-speaking consultation and language appropriate community resources which is why the Tufts Health Plan Foundation provides funding support to the Latino Health Insurance Program for Mi Vida, Mi Salud: Supporting Latino Families with Diabetes Program. Through a significant grant, the program will be able to expand training and access for the evidence-based diabetes program for older adults.

Effective intervention requires a deeper understanding of the populations served

 Nurse care managers help members address their important needs quickly, efficiently and as effectively as possible, while also coordinating with their primary care physicians and specialists. This makes cultural education critically important. To that end, Tufts Health Plan is investing in training everyone including care managers, customer service representatives, and even physicians to help them better understand cultural nuances that lead to certain health outcomes.

Our teams work with clinicians to help them understand how traditional cuisine may put Latinos at risk for chronic conditions while teaching effective ways to advise patients on the easy and culturally-appropriate diet changes. Advising on even the simplest things, like increased physically activity, can also be made more effective by understanding the cultural background.

Tufts Health Plan is also helping clinical staff understand the daily life of a patient living with diabetes. During empathy-building exercises these clinicians are given use lancets to draw their own blood and measure glucose levels, wear insulin monitors for an entire day and learn how to administer insulin injections with a dry syringe. This direct experience puts the provider in the patient’s shoes and further helps them understand theirs overall health, physically and emotionally.

Targeted partnerships are key to problem-solving

 LNutrition plays a key role in diabetes prevention and management. Since Tufts Health Plan understands that food is a powerful way to start the conversation about health, it has collaborated with Good Measures, a unique, technology-enabled nutrition program that is powered by nutrition science and can be easily personalized for Latino cuisines. Good Measures helps people with diabetes learn about factors that affect their blood sugar, such as food, activity, medication, and stress and how to manage them. Supported by registered dietitians, members can better manage their conditions, improve their food choices, and optimize their health. Good Measures registered dietitian coaching is available by phone and online, whenever it is most convenient — days, evenings, and weekends. Interpreter services are available for non-English-speaking members.

As we aim to provide better care for our communities it is important to recognize dietary differences and cultural norms when caring for members of diverse backgrounds. At Tufts Health Plan, we recognize the important role we all play in creating better health outcomes, and we can achieve them through compassionate and innovative programs.

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