Improving Health Equity and Health Disparities in North Carolina – Minority Diabetes Prevention Program

After working virtually for over a year with this dedicated group of folks, I finally had the pleasure of meeting, in person, the state program lead for the NC Minority Diabetes Program. Kamaria Mason (MS, MPH, RDN, LDN) shared with me during our lunch interview the progress that North Carolina is making in diabetes prevention for minority populations. Here are the highlights from our chat.

First, the program components of the NC Minority Diabetes Prevention Program include:

  1. Community screenings and targeted marketing campaigns
  2. 12-month NC MDPP lifestyle classes (English & Spanish)
  3. Community conversations to build awareness
  4. 6-month NC MDPP alumni classes for ongoing support

What are the key takeaways from your position at NC MDPP?

  • There are several racial-ethnic minority populations residing in North Carolina, and NC MDPP seeks to engage with diverse populations in an effort to increase access to diabetes prevention programs. The populations currently engaging with NC MDPP include: Latinx, African-American, and Native Americans. Meeting people where they are – in their communities and the organizations of interest is a key to success across all groups. If you can do that well, you often see change because you are making health-related programming (in this case, diabetes prevention programming) readily accessible and a more convenient choice.
  • It’s important to be intentional in identifying existing community assets within our target areas – faith based organizations, school systems, healthcare workers, grocery stores, farmer’s markets, parks and colleges. 
  • Food insecurity is a barrier for many populations, so we partnered with grocery stores and farmer’s markets to increase access to produce and other healthy food items. We provided vouchers and matching bucks ($10 for $10) so that NC MDPP participants who were also SNAP (Supplemental Nutrition Assistance Program) recipients could maximize their benefits, receiving even more fresh produce.
  • For physical activity, we realized that many communities had limited access to safe spaces to exercise. In response, we worked with parks and recreation centers to ensure safe places and also with local fitness centers to provide vouchers to encourage and support increased physical activity.
  • NC MDPP has great lifestyle coaches that are invested in the community that they live and serve in. This is vitally important as the lifestyle coaches have made a concerted effort to understand their community’s specific needs. 
  • We are finding that the graduates of the NC MDPP often make the best lifestyle coaches as they’ve successfully gone through the program and want to share their journey with others.

Do you think that the NC MDPP program has had a positive impact overall in promoting disease prevention?

  • Absolutely! And what we did not expect to see was the multi-generational impact – with a  daughter participating in NC MDPP, then recruiting and supporting her mother and grandmother to participate in the program. It has been great to see the influence that NC MDPP has had on many families throughout the state. 
  • It’s also great to see the innovative approaches being adopted due to COVID-19 and how it’s helped the class. One of the lifestyle coaches started a cooking class on Facebook that now reaches >1,000 views!
  • In 2021, several NC MDPP regions piloted a text message-based chatbot program with Wholistics to engage participants during this difficult time. The chatbot provided tips, guidance, links to resources, recipes, workouts and stress reduction techniques. The NC MDPP lifestyle coaches also engaged in the program alongside participants and facilitated virtual group discussions around the topics presented. The pilot users and coaches wanted to continue to receive the support for this program throughout the year so we decided to roll this out to all regions in 2022.

What could NC MDPP have done better?

  • I wish we had known more about El Centro Hispano from the start and the support they could provide us for the Latinx communities (El Centro is a grassroots non-profit community center that works to empower Latino families through education and leadership development.) We learned about El Centro through a staff member who was collaborating with them for other programming. We are still working on a systematic way to engage community organizations and forge strategic partnerships and we rely heavily on the regional coordinators and lifestyle coaches to help us in this effort. It takes a lot of work to identify organizations that are a good fit for an NC MDPP partnership, and it would have been nice to see this organized at the state level.

What are the challenges in promoting diabetes prevention and behavior modification?

  • Getting folks in the door: That’s why community conversations are critical – when you go to the community screening events, engage with them and find out why they don’t participate and what would change that. For example, we found that child care was an issue so we offered that during the classes.
  • Access to fresh healthy foods that are affordable is an issue – so we provide gift cards and vouchers to grocery stores and farmers’ markets and offer cooking classes to teach them how to cook quick, easy and healthy meals for the family.
  • Time to exercise is also an issue, so some of the classes start out with a 30-minute group walk as it’s built into the class curriculum. The participants also organize group walks within their own community to get their 150 minutes of walking in for the week.
  • As for behavior modification, if people want to make the change, they will. In terms of physical activity, many are doing 150 minutes per week. But remember, a lot of factors are outside of their control. And unfortunately, it’s all stacked against them. The way communities were formed in the 60s and 70s impacted the level of investment in parks, recreational centers and grocery stores. In some rural and underserved communities, people were raised on fast food as the system is set up to be always cheaper to go to a McDonald’s than to buy fresh produce at the supermarket. It’s slowly changing with more people embracing local farming and gardening but it takes a community effort to galvanize these changes.

What about children?

  • Kids are malleable but depending on their age, they do not have the autonomy to sustain the health behavior changes that are taught to them. If a parent is reluctant to change, it can be challenging to see sustainable change within pediatric populations. It is important to work with families, kids and their guardians. As a Registered Dietitian for Durham County Department of Public Health, I love teaching family-style cooking classes, showing students and their families quick and affordable options for healthy meals.

How are you leveraging new digital health technologies?

  • Chatbots are great because both adults and kids are able to engage. Again, it’s about reaching them where they are and giving them the opportunity to learn health information from trusted sources. I think kids, especially, will embrace the use of a chatbot.
  • Social media – especially for teens and adolescents for getting their voices heard – is another great way to increase engagement amongst this group.
  • For example, if an organization like El Centro uses WhatsApp group messaging, think how powerful the use of this platform would be to talk about health information and get feedback overall.

Learn more about the NC MDPP Program (NC DHHS/ NC Office of Minority Health and Health Disparities) here:

About Kamaria Mason, MS, MPH, RDN, LDN

Kamaria is a Registered Dietitian Nutritionist who advocates for healthy eating at all stages of life with over 15 years of experience in clinical, public health, and government sectors. Her work is centered on community-based interventions and culturally inclusive programming. She is passionate about working with food systems advocating for sustainable solutions that promote equitable access to healthy and affordable foods within economically marginalized communities.