QIOs in Action: Promoting Health Equity Through Diabetes Care for the Visually Impaired

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Photo of a DSME class for visually impaired individuals at the Braille Institute in Santa Barbara, California
A DSME class for visually impaired individuals at the Braille Institute in Santa Barbara, California

According to the Centers for Disease Control and Prevention (CDC), 3.4 million Americans aged 40 years and older are either blind (having a visual acuity [VA] of 20/200 or less or a visual field of less than 20 degrees) or visually impaired (having VA of 20/40 or less). In total, visual impairment affects more than three percent of adults over the age of 40 in the United States.

While visual impairment can affect older adults for a variety of reasons, diabetes can significantly increase the likelihood of an individual developing a visual impairment or blindness. Diabetic retinopathy—or light sensitivity due to diabetes-induced damage to blood vessels in the retina — is the most common cause of vision loss among people with diabetes and a leading cause of blindness among working-age adults, according to the National Eye Institute.

The Diabetes Empowerment Education Program (DEEP) curriculum typically used in diabetes self-management education (DSME) courses relies heavily on visually-oriented materials to educate beneficiaries. Recognizing the need to make these materials more accessible, 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 — launched an initiative in 2016 to develop DSME resources for beneficiaries with eyesight limitations.

In August 2016, HSAG approached the Braille Institute of America, a nonprofit organization whose mission is to eliminate barriers caused by blindness and severe sight loss, to determine how they could collaborate to adapt the DSME curriculum so that it could be more effectively taught to the visually impaired. In partnership with the Braille Institute, HSAG leveraged tools like mobile phone applications that can assist in reading labels; applied braille labels for laminated materials; and used talking monitors to enhance the accessibility of resources for visually-impaired beneficiaries.

Results: HSAG hosted its first DSME course adapted for visually impaired beneficiaries in December 2016 at the Santa Barbara Braille Institute campus in Santa Barbara, California. The class included 18 students, all of whom graduated from the program.

The Braille Institute of America team understands the overall potential that DSME has to help their members better self-manage diabetes to improve their overall quality of life,” said Oscar Lopez, project coordinator at HSAG. It is truly rewarding to see this program reaching those most affected by diabetes.”

All 18 graduates from the pilot class have expressed interest in serving their community as DEEP peer educators in the future. In addition, the Braille Institute has invited HSAG to perform its DEEP peer-education classes at its Los Angeles, Santa Barbara and Orange County, California locations.