Using a Community-Based Collaborative Care Model as a Platform for Successful Interprofessional Education

Introduction

Diabetes continues to be a major national health threat. National efforts to prevent diabetes have yielded lifestyle change programs (LCPs) that aim to reduce primary risks, including overweight/obesity (Ackermann & Marrero, 2007; Diabetes Prevention Research Group, 2002; 2004). The Diabetes Prevention Program (DPP) is a rigorously evaluated lifestyle intervention that has been proven to reduce or delay diabetes onset by up to 50 to 60% with diet changes, physical activity, and modest weight loss among at-risk individuals (Diabetes Prevention Research Group, 2002). National health organizations are making widespread attempts to disseminate evidence-based LCPs like the DPP to curb growing diabetes rates (e.g., CDC, 2018b). These dissemination efforts include educating health professionals on the importance of patient screening and referral to LCPs and partnering with patients in discussing their lifestyle change behaviors and outcomes. They also call for culturally-appropriate lifestyle change programs for high risk minority populations in community settings, recognizing most health settings do not provide these programs and offering LCPs in community settings may be less costly and more accessible (American Medical Association, 2019; CDC, 2018b). Accessibility of evidence-based LCPs could particularly be beneficial to African Americans communities where rates of diabetes tend to be disproportionately high and availability of LCPs are limited or nonexistent (CDC, 2017). Moreover, although reports on engaging health profession students to assist with diabetes prevention are rare (e.g., Gorrindo, Alon & Ladner, 2014), students’ participation as health coaches in community-based LCPs could greatly assist national DPP dissemination efforts. This approach could also provide students with interprofessional opportunities to learn culturally competent ways to collaborate with underserved communities and partner with patients, particularly African Americans on their lifestyle change goals.

This chapter describes the planning, implementation, and outcomes of a pilot study used to test a community-based collaborative care model to disseminate the DPP using interprofessional teams of medical school students in partnership with the African American faith community. Specifically, the objectives of this chapter are first to provide background contextual information a multilevel religiously-tailored diabetes risk reduction intervention study (named Project Faith Influencing Transformation [FIT]) that included a weekly group-DPP component and was originally disseminated and tested in urban Kansas City (KC), Missouri African American churches. The second objective is to highlight the community-student engagement approach that was used to refine the Project FIT group DPP component for feasible implementation and impact as Project FIT 2.0 – a pilot study delivered by interprofessional teams of students serving as health coaches and paired with African American church health workers. The third objective is to describe how student teams and church health workers were trained and how they jointly implemented Project FIT 2.0 as a community-based collaborative care model in urban KC African American churches with volunteering adult participants. The fourth objective is to report on the feasibility and participant weight loss outcomes of the Project FIT 2.0 collaborative care model. The last objective is to provide a discussion of the findings in light of previous DPP research conducted in African American communities. The discussion also highlights future research and practice needed to further understand the impact, scalability, and sustainability of community-based collaborative care models to reduce the growing rates of diabetes.