Supporting ethnic minority youth and their families to become "ePatients"

Liana Gefter
Nancy Morioka-Douglas
Eunice Rodriguez


BACKGROUND:  The CDC reports risk of diagnosed diabetes is significantly higher in ethnic minority populations compared to non-Hispanic white adults.  Additionally, in less than a decade, prevalence of Type 2 Diabetes and prediabetes more than doubled among US adolescents.   The purpose of this study is to evaluate the impact of a school based health program in which Family Medicine residents train healthy at-risk adolescents to become diabetes self-management coaches for family members with diabetes.   Ethnic minority communities have historically been disempowered and distrustful of the medical system, and we hypothesize that for this reason teaching ethnic minority youth to develop the skills and attributes necessary to be “e-patients” is particularly important. The Stanford Youth Diabetes Coaches Program (SYDCP) aims to utilize the most relevant technologies in combination with the in-person benefit of physician interaction to support at-risk high school students and their families to become equipped, enabled, empowered and engaged in their health and health care decisions.  

METHODS: The pilot study includes 97 adolescents from three San Francisco Bay Area high schools serving primarily ethnic minority youth of low socio-economic status.  Physicians came to schools once a week for eight weeks and trained 49 adolescents to become coaches using web-based program curriculum focused on health knowledge, communication, problem-solving, and self-management skills.  Each student coached one family member with diabetes.  Printed program materials were available in Spanish and English.  Student coaches and 48 non-participant students completed pre- and post- test intervention questionnaires, and 15 student coaches and 9 family members with diabetes were randomly selected to give in-depth interviews after participation.  Linear regression was used to determine differences in knowledge and psychosocial assets on pre- and post-tests between student coaches and non-participant students, and NVIVO to analyze interview transcripts.

RESULTS: After controlling for initial score, gender, grade, and ethnicity, student coaches improved from pre- to post-test significantly compared to non-participants on knowledge, belonging, and worth scales. Student coaches reported high satisfaction with the program.  Articulated program benefits included improvement in diet, increased physical activity, improved relationship between student coach and family member, and appreciation for having physicians in the classroom.

CONCLUSION: Overall, this program can increase health knowledge and psycho-social assets (worth and belonging) of at-risk youth and holds promise to promote health literacy and healthy behaviors among at risk youth and their families.  The SYDCP utilizes the inherent altruism of teens to help their family members and the aspirational goals of physicians in training to help communities realize a diabetes education and prevention system that is accessible, sustainable and reproducible - even for under resourced communities.  Lessons learned include 1) web-based curriculum needs to include more engaging technology leveraging best practices as developed by colleagues in the School of Education; and 2) curriculum format needs to maximize time for physician/student interaction and discussion.  Next steps will include: significant revision of teaching modules to incorporate “blended” learning; communication with students via SMS texting; and use of Stanford Open Ed X platform to promote and prolong program engagement and make  content widely available.

maximize time for resident physician/student interaction and discussion.  As such, next steps will include: significant revision of teaching modules to incorporate “blended” learning; communication with students via SMS texting; and use of the Stanford Open Ed X platform to promote and prolong engagement with the program and make refined content widely available.

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