July 2010

Grant Results

SUMMARY

Staff at One Economy Corporation created and expanded Manage Your Diabetes, an interactive Web site designed to help people with low incomes and low literacy skills monitor and control their diabetes.

Key Results

  • One Economy launched Manage Your Diabetes on The Beehive, its bilingual (English and Spanish) self-help Web site in November 2007. The expanded Web site, launched in May 2009, has more information and resources and new interactive tools, videos and polls. It is organized into five content zones:
    • Learning Zone: managing diabetes with a five-step action plan
    • Eat to Live: diet is a key to keeping your blood sugar level in check
    • Move More & Stay Active: strategies for working exercise into daily life
    • Live Well & Take Action: health tools and resources for managing the disease
    • Community & Support: a team of health experts supports viewers; viewers can share their stories
  • People visited Manage Your Diabetes more than 123,000 times from November 2007 through March 2010: 87,000 visits to the new Web site from January 2008 through March 2010 and 36,000 visits to the original Web site. This included people using both the English and Spanish content.

Funding

From October 2005 to March 2010, the Robert Wood Johnson Foundation (RWJF) supported this project with two grants totaling $486,981.

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Context

The Problem Addressed

People who manage their diabetes can reduce their risk of serious complications (e.g., heart disease, amputation and blindness), improve their quality of life and reduce or eliminate their need for medications. However, little information was available to help the people who are most likely to have diabetes: those with low incomes and low literacy skills.

RWJF's Interest in This Area

RWJF has worked to improve the quality of care for people with chronic health conditions since the 1970s. RWJF's focus on diabetes began in 2001, when its staff recommended that the Board of Trustees pursue a major initiative for the care of diabetes.

The Diabetes Initiative included two national programs, both aimed to decrease the burden of diabetes by improving patients' self-management in daily living:

  • Advancing Diabetes Self-Management—which supported efforts to improve patient self-management in clinical settings
  • Building Community Supports for Diabetes Care—which supported efforts to increase community resources available to help persons manage their diabetes

The strategy of the programs was to provide tools and resources that help people with diabetes care for themselves. Patients with improved support and knowledge would then make specific changes in their daily behavior, which in turn would make them healthier. See Grant Results for more information.

RWJF has supported efforts to assist people with low health literacy since 1993, when it funded a project to determine the effect of medical illiteracy at public hospitals in Atlanta and Los Angeles. This project yielded a test of functional health literacy for both English and Spanish speakers. See Grant Results on ID#s 019558 and 021118.

Using these two tests, researchers at the Prudential Center for Health Care Research found that patient illiteracy affects compliance with health care instructions. See Grant Results on ID# 030763.

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The Project

Staff at One Economy Corporation created and expanded Manage Your Diabetes, an interactive Web site designed to help people with low incomes and low literacy skills monitor and control their diabetes.

One Economy Corporation is a national nonprofit that works to expand opportunities for low-income people by promoting Internet access in the home. It also sponsors a bilingual self-help Web site called The Beehive, which features financial, health, job, school and family resources in English and Spanish.

Between 2005 and 2007 (ID# 052600), staff of One Economy Corporation:

  • Appointed an advisory group consisting of seven experts and three patients to focus the content and select tools for the site. (See the Appendix for a list of the expert members.) One member, Barry D. Weiss, M.D., an expert in health literacy, helped refine the content for people with low literacy skills.
  • Conducted usability testing of the Web site with six patients from Howard University's diabetes program and refined the site based on their input about content, design and language.

Between 2008 and 2010 (ID# 065131), staff redesigned and expanded Manage Your Diabetes and launched an outreach campaign to increase traffic to the Web site.

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Results

  • One Economy initially launched Manage Your Diabetes on The Beehive, its bilingual (English and Spanish) self-help Web site, in November 2007, during National Diabetes Month.
  • The expanded Web site, launched in May 2009, is organized into five content zones in English and Spanish with more information and resources and new interactive tools, videos and polls. The content zones are designed to make the information and tools easier for people to access:
    • Basics of diabetes: "The Learning Zone" includes a clear definition of the disease, risk factors for diabetes, a five-step wellness plan and FAQs.
    • Eating well: "Eat to Live" describes how to read food labels, control portions, make better decisions about what to eat and deal with sugar cravings.
    • Fitness: "Move More & Stay Active" shows how people can work exercise into their daily lives to help manage diabetes.
    • Managing diabetes: "Live Well & Take Action" includes health tools and resources to inform and inspire people to manage diabetes, such as questions to ask the doctor and a brief lesson on reading medicine labels.
    • Connecting with other diabetics: "Community & Support" lets people with diabetes connect with one another through The Sugar World, a social networking page on Facebook, and access links to diabetes-related resources. This content is new to the expanded Web site.
    Each content zone has information, interactive tools, videos, resources and a poll. Key interactive features include:
    • A Body Mass Index calculator that determines whether a person is normal weight, overweight or obese based on height and weight.
    • A calorie calculator that determines how many calories a person needs per day, based on sex, age, weight, height and activity level.
    • A graphic of the human body on which users can click on different body parts to see which medicines help that part of the body (e.g., aspirin assists the heart by thinning the blood and thereby helping to prevent heart attacks).
    • Graphics of a prescription label and a nutrition label that explain the different parts of these labels. From the nutrition label, people learn about trans fats, calories, cholesterol and more.
    • A portion control tool that lets people see what a healthy meal or snack should look like on a standard-sized plate.
    Videos include a three-part video series, "Living Well with Diabetes," launched in June 2009, which highlights how a 42-year-old woman with diabetes who is also a single parent with two daughters is reaching her goals in managing her diabetes. Each video focuses on one goal:
    • Eat to Live
    • Move More & Stay Active
    • Live Well & Take Action
    This series is available on both pic.tv, the public Internet channel supported by One Economy Corporation, and Manage Your Diabetes. The other videos, covering subjects ranging from becoming active to dealing with the complications of diabetes, also are available on both Web sites. On pic.tv, they are available under the heading Manage Your Diabetes. On the Web site Manage Your Diabetes, they are included in the relevant content zone.
  • People visited Manage Your Diabetes more than 123,000 times since November 2007: 87,000 visits to the new Web site from January 2008 through March 2010 and 36,000 visits to the original Web site. This included people using both the English and Spanish content.
  • One Economy promoted Manage Your Diabetes by partnering with other organizations and using social networking sites. The organization partnered with the Shad Ireland Foundation during the summer of 2009 on a series of events across the country to raise awareness of diabetes and kidney disease prevention. These events revolved around a 4,639-mile cross-country cycling tour by Shad Ireland, a dialysis patient with no kidneys. The tour ended with a health fair in Washington, D.C., and a reception at the Capitol.

    One Economy also partnered with the American Diabetes Association during the 2009 National Diabetes Month (November) to raise awareness of the disease and Manage Your Diabetes.

    Through pages on Facebook and www.RenalResources.org (a social networking site for people with chronic kidney disease), One Economy helped build a community of people interested in learning about diabetes and directed them to Manage Your Diabetes.

    One Economy also promoted the Web site by distributing more than 10,000 bilingual cards to Latino families across the country in the summer of 2009 at events and in a partnership with TodoBebe, a global media company. TodoBebe sent the cards out as part of a house party kit that included coupons, gifts and handouts.

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Lessons Learned

  1. Help people manage diabetes by being responsive to their perceptions and needs in the real world. People with diabetes often have difficulty complying with the advice of their primary care providers on diet and exercise. They view the advice as "all or nothing." Recognizing this, One Economy developed a Web site that helps people take progressive steps toward leading a healthier lifestyle. The Web site offers many options for making healthy changes, such as how to be healthy when eating out or how to get active. (Project Director/David Saunier)
  2. Use online social media and partnerships with community organizations to disseminate health information. By using Facebook and RenalResources.org, One Economy increased traffic to the project Web site. (Project Director/Saunier)

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Afterward

One Economy is maintaining and updating Manage Your Diabetes with support from the Ford Foundation and the Merck Company Foundation. The organization also plans to expand the video series by adding profiles of other people with diabetes.

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GRANT DETAILS & CONTACT INFORMATION

Project

Developing, enhancing and disseminating an interactive online tool for diabetes patients with low income and low literacy

Grantee

One Economy Corporation (Washington,  DC)

  • Maximizing the potential of technology to lessen isolation and decrease literacy barriers to achieve improved health outcomes for low-income people
    Amount: $ 396,610
    Dates: October 2005 to November 2007
    ID#:  052600

  • Enhancing and disseminating a diabetes self-management tool
    Amount: $ 90,371
    Dates: October 2008 to March 2010
    ID#:  065131

Contact

David Saunier
(202) 393-4580
dsaunier@one-economy.com

Web Site

http://www.thebeehive.org/diabetes

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APPENDICES


Appendix 1

Expert Members of the Advisory Group

Cynthia Baur, Ph.D.
Senior Health Communications and E-Health Advisor
Office of Disease Prevention and Health Promotion (ODPHP)
U.S. Department of Health and Human Services
Washington, D.C.

Joanne Gallivan
Director
National Diabetes Education Program
National Institute of Diabetes and Digestive and Kidney Diseases
National Institutes of Health
Bethesda, Md.

Janice B. Harris, R.N., B.S.N., C.D.E.
Program Director
Diabetes Self-Management Program
Howard University
Washington, D.C.

David M. Nathan, M.D.
Professor of Medicine
Harvard Medical School
Director
General Clinical Research Center and Diabetes Center
Massachusetts General Hospital
Boston, Mass.

Michelle D. Owens, Ph.D.
Division of Diabetes Translation
Centers for Disease Control and Prevention
Atlanta, Ga.

Barry D. Weiss, M.D.
Professor of Family and Community Medicine
University of Arizona
Tucson, Ariz.

Deborah Wexler, M.D.
Diabetes Unit
Massachusetts General Hospital
Boston, Mass.

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

World Wide Web Sites

www.thebeehive.org/diabetes. "Manage Your Diabetes" on the Beehive Web site is an interactive tool to help low-income and low-literacy individuals with diabetes carry out the instructions they receive from their physicians. Washington: One Economy Corporation, November 2007.

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Report prepared by: Nina Berlin
Report prepared by: Paul Jablow
Reviewed by: Richard Camer
Reviewed by: Lori De Milto
Reviewed by: Marian Bass
Reviewed by: Molly McKaughan
Program Officer: Albert O. Shar

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