Six Weeks of Diabetes Prevention That Nobody Attends
Your congregation has 210 adult members. A health fair last spring found that 38% of the 62 people screened had an A1c in the prediabetes range. The pastor asks you to run a six-week diabetes prevention series. Most participants will be 55 to 80; about half are Spanish-speaking, many have limited health literacy and no internet at home. The only free room is the fellowship hall, which has a kitchen but no Wi-Fi. Wednesday evenings are booked by choir. A local grocery store will donate $300 of produce. Attendance at past evening events has averaged nine people - the same nine.
1. How do you design the series so it reaches more than the same nine people? Name the specific decisions and the reason for each.
Read the worked answer
- Move it to Sunday after worship. People are already on site, transportation is solved, the kitchen is free, and you borrow the credibility of the service. Wednesday evenings lose to choir, work, and dark.
- Run it bilingually with a trained lay leader, not consecutive interpretation. Interpretation halves the session and marks Spanish speakers as guests. Recruit two promotores from within the congregation and have them co-lead the Spanish group.
- Recruit through existing groups, not the bulletin. Choir, women's society, men's fellowship, the food pantry line. Ask each participant to bring a buddy - social support is the strongest predictor of retention in community programs, and a buddy also halves the dropout problem.
- Add a daytime repeat and phone/home invitations. Caregivers, night-shift workers, and the homebound will never come at 7 p.m. A volunteer makes ten personal calls; personal invitation outperforms any flyer.
- Teach food, not numbers. Fifth-to-sixth grade materials; use rice, beans, tortillas, plantains, and the donated produce; demonstrate portions and swaps in the kitchen rather than talking about carbohydrate counts. Hands-on beats lecture for low health literacy.
- Keep sessions to 60–75 minutes with a shared meal, and use teach-back at the end of every session ("Show me how you'd fill this plate") rather than asking "Any questions?"
- No internet-dependent technology. Flip chart, printed goal sheets, a paper calendar.
2. At session two, Mr. O. asks in front of the group whether he should stop his metformin because "beans and prayer are enough." What do you do?
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Do not debate it in the group and do not endorse it. Answer briefly and neutrally - "That's a good question to ask your doctor; I can't tell anyone to stop a prescribed medicine, but I'll help you get the question answered" - then redirect the session and follow up privately within the week.
Privately, ask what he has heard. Usually there is a specific source: a relative, a video, a sermon on natural healing. Address the actual source rather than the slogan. Affirm what is true in his position - food changes and faith do matter, and both are part of his care - while being unambiguous that metformin is not optional at his A1c.
Close the loop with the prescriber. With his permission, send a note or call the primary provider that week so the message is consistent and he does not have to choose between you and his doctor. If he has already stopped it, treat it as urgent: same-week contact and red-flag teaching for hyperglycemia (thirst, frequent urination, blurred vision, fatigue).
Scope reasoning: a faith community nurse teaches and navigates; she does not prescribe or deprescribe. Clarity matters more than comfort here - a vague answer will be heard as permission.
Document what he asked, the advice given, the prescriber notification, and the plan.
3. How will you know at three and six months whether the series worked? Give two process and two outcome measures plus a realistic data plan.
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Process measures:
- Attendance by session and by language group, and the percentage completing at least four of six sessions (target ≥60%).
- Teach-back pass rate per session, and buddy-pair retention.
Outcome measures:
- Percentage of participants with a repeat A1c or a confirmed screening at six months, arranged through the partner pharmacy - the spring fair is the baseline comparison.
- Self-reported behavior at six months: vegetable servings per day, walking minutes per week, and goal attainment on each participant's own stated goal. Weight where it can be measured privately and consistently.
Data plan that will actually happen: paper forms completed at each session by a volunteer, entered monthly by one named person into a simple spreadsheet. No names in the church office - use participant ID numbers, keep the linkage list in a locked cabinet with the nurse, and report only de-identified aggregates to the pastor and congregation. Collect the three and six month follow-up by phone, since internet-based surveys will fail this group.
State the limitations in your report: self-report is weak, and pre/post knowledge gain is not an outcome. A program that raises knowledge and changes nothing else is a program to redesign, not to celebrate.