QIOs in Action: HSAG Brings Diabetes Education to Rural Native American Communities in California

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HSAG diabetes self-management education peer educators
HSAG diabetes self-management education peer educators

According to a 2017 report from the Centers for Disease Control and Prevention (CDC), Native Americans (American Indians and Alaska Natives) are twice as likely to have diabetes than white populations and are at higher risk of having diabetes than any other racial group in the United States.

Diabetes self-management is a critical strategy for helping Native Americans and other at-risk populations — particularly those in rural locations — control the disease and improve health outcomes.

Recognizing a growing need in Northern California, Health Services Advisory Group (HSAG) — the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) serving Arizona, California, Florida, Ohio and the U.S. Virgin Islands — expanded its diabetes education efforts within the area’s Native American population. Leveraging the Centers for Medicare & Medicaid Services’ Everyone with Diabetes Counts (EDC) program resources and diabetes self-management education (DSME) curricula, as well as engaging key partners such as the California Area Office of Indian Health Service and the Consolidated Tribal Health Project, HSAG is spreading evidence-based interventions to help people with diabetes optimize their ability to self-manage the disease.

They are also helping train the trainers — using curricula such as the Diabetes Education Empowerment Program (DEEP) from the University of Illinois, Chicago (UIC)— to train community members to be peer educators and take the information back to their communities.

Most Native American health programs in California provide diabetes education in their clinics, and those programs aim to be culturally sensitive,” said Monica Giotta, diabetes consultant to the California Area Office of Indian Health Service. But we believe diabetes education and prevention needs to also be based in communities, where they can reach seniors who may not be able to regularly attend a clinic because of transportation challenges.”

HSAG met with both the Consolidated Tribal Health Project and members of the California Area Office of Indian Health Services to determine how to best craft a targeted community-based intervention. After this consultation, HSAG presented a curriculum and described the training process and the expected commitment for hosting DSME classes for each peer educator. The parties then scheduled the first training session in Ukiah, California — a rural community of nearly 16,000 residents, 14 percent of whom are age 65 or older, and four percent of whom are of Native American heritage.


In January 2017, HSAG held its first DSME peer educator class in Ukiah with 17 students. The class included members of the Round Valley, Hopland Band of Pomo, Greenville Rancheria, Sonoma County, Tuolumne MeWuk, United and Warner Mountain tribes, all of whom were trained to be DSME trainers and empowered to take diabetes self-education best practices back to their tribes.

Building on the success of the first training, the Consolidated Tribal Health Project has formed the framework for a local training hub. They are planning to host ongoing diabetes self-management trainings in Ukiah, as well as in the neighboring rural California towns of Fresno, Willows, Santa Barbara and Middletown.