Diabetes project led by Fairbanks School engages residents to transform three Indianapolis communities

By Kirk Johannesen, Communications Consultant, Strategic Communications, Indiana University

An initiative to reduce the burden of diabetes in three areas of Indianapolis, led by the Richard M. Fairbanks School of Public Health at Indiana University Indianapolis, is having a significant impact in reducing blood-sugar levels and actively engaging the community to solve root problems of the disease.

The Diabetes Impact Project – Indianapolis Neighborhoods, also known as DIP-IN, started in 2018 to build resources and connections within the Near Northwest, Near West and Northeast communities. It uses a holistic approach to prevent diabetes or better manage the disease, helping area residents live longer and healthier lives.

People with blood-sugar levels, as measured by an A1C test, that are higher than normal are susceptible to cardiovascular, kidney and circulation problems, limb loss, eye disease, nerve damage and strokes, according to the American Diabetes Association.

“Our ultimate goal really would be that in future generations, we have fewer people with diabetes,” said Lisa Staten, the DIP-IN principal investigator and an associate professor in the Department of Community and Global Health in the Fairbanks School of Public Health. “A very important aspect of this project is that we are working in partnership with communities to address this issue.”

Eli Lilly and Co. has committed $12 million to this eight-year project. Eskenazi Health and the Marion County Public Health Department are key partners along with community residents and organizations in each of the three areas.

Progress is evident. The use of clinical and neighborhood community health workers has increased awareness and education about diabetes. Residents who worked with Eskenazi DIP-IN clinical community health workers over a three-year period saw their blood-sugar levels drop more than people who didn’t meet with community health workers, according to a research paper published in the journal Preventive Medicine Reports. The communities are addressing related issues such as healthy food access, physical activity infrastructure, and stress and mental well-being. They are increasing social connections with projects such as urban gardens, walking paths and community meals.

Ronald Rice, DIP-IN project manager for the Near Northwest area as well as a resident, described the project’s impact as transformational.

“Literally, it’s been like a complete turnaround in this area,” said Rice, who has Type 2 diabetes himself. “It was the people, the residents who got involved that made it happen. The residents now take ownership of this program.”

DIP-IN resulted from conversations involving leaders from the Fairbanks School, Eli Lilly and the Marion County Public Health Department, Staten said. The communities the project serves, home to about 49,000 residents, had an estimated diabetes prevalence of 23.3% compared to 14.7% nationally, according to the research paper.

“It really was something that made sense for us to be actively involved in it,” Staten said. “And especially given the emphasis on prevention it made a lot of sense for public health to be taking the lead.”

Beneficial partnerships

The three areas were selected for the project because of their high rates or risks of diabetes, but also because of existing community structures and partners that could aid the initiative. Many of the community projects are supported by DIP-IN either financially or through participation.

One Near West partner is Friends of Belmont Beach, which fosters community and wellness at a space along the White River that historically was the only swimming hole for the city’s Black residents. Activities include movie nights, the Community Makers Market, yoga classes, nature hikes and gardening demonstrations. Events also provide opportunities for diabetes awareness and information by DIP-IN, said Teddrick Hardy, president of Friends of Belmont Beach and a Near West resident.

“They’ve been wanting to come in and really highlight the importance of diabetes,” Hardy said. “But also with that, bringing the community together to not only talk about diabetes but what other health issues are going on?”

A Near Northwest partner is Aspire House, an organization that strives to eradicate systemic racism and social injustice through revitalization and education. It hosts Sunday Suppers, a monthly community meal from May through October where residents can build friendships and enjoy healthy food. The event also includes a community walk, entertainment and information sharing.

Rice said that Aspire House board member Sharon Clark wanted to get senior citizens more involved and restore some of the local African American culture. The free dinners started in the spring of 2021; 26 people attended at nearby Frank Young Park, which had suffered from disinvestment, gangs and drug use. The popularity of the dinners has grown, and attendance sometimes tops 100, Rice said.

“It’s evolved into an entire ecosystem,” Rice said.

Rice said the meals inspired some residents to connect with a local bookstore to learn more about food and gardening, which he said has also helped them reconnect to their cultural culinary history. And residents retaking control of their neighborhoods has helped reduce crime in the area, Rice added.

“The ripple effects that have happened have been incredible,” Rice said.

In the Northeast area, a former Indianapolis Public Schools building and property near 42nd Street and Keystone Avenue is being turned into a community center with a community garden, walking trail and meditation garden to help with food access, physical activity and stress reduction.

“Our goal is to be an ecosystem of resources, a one-stop shop for health and wellness education — help, hope and healing,” said Hovey Street Church of Christ Pastor Denell Howard, one of the leaders of the project.

Natalie Oslund, the Northeast project manager, said the area currently lacks a community center and is considered a food desert. Also, the life expectancy of area residents is 17 years shorter than in some of the wealthier communities in the greater Indianapolis area, she added.

A community garden started on the former school property in 2021 is the key component of the Plant to Plate Project that originated at Hovey Street Church of Christ and is supported by DIP-IN.

“I thought this was an opportunity to become part of the solution in an area that’s been disincentivized for too long,” said Autumn Lowry, who leads Plant to Plate and owns From the Ground Up Foods.

This year the garden is producing raspberries, blueberries, elderberries, grapes, corn, potatoes, cow peas, bush beans, long beans, tomatoes, herbs and eggs from chickens. Lowry said she expects the yield to be much greater than the 700 pounds of produce last year.

Resident voices

Each area has steering committees where area residents can actively participate in the decisions benefiting their areas. The committees consider and approve funding for community health improvement projects related to four areas:

• Physical activity infrastructure.
• Healthy food access.
• Stress and mental health.
• Social connections.

For example, DIP-IN recently funded a project for the Northeast area called Farm to Fit. Located at Elephant Gardens, the project includes an urban garden, a walking path and a gazebo for yoga classes, and a landscape company provided free labor there for a Juneteenth Day of Service. Belmont Beach, the Sunday Suppers, a walking path at the school property and Faith, Hope and Love Community are a few other examples of projects that the steering committees have supported.

To work with a DIP-IN area, vendors connect with the area’s project manager, who collects information and shares the proposal with Staten to make sure it fits DIP-IN’s mission. If it does, the vendor presents the proposal to the area steering committee for evaluation and discussion before possible approval.

Rice first served on his area’s steering committee before taking on greater roles with DIP-IN.

“It became this new level of information and learning for me, to see how organizations work with residents, how residents can actually take their own destiny in their own hands because they controlled where the money went,” he said. “They controlled the decision-making.”

Hardy, a Near West steering committee member, said he appreciates that residents have a key voice in making decisions.

“It’s all a vote; it’s all fair. Everybody wins,” he said. “And it is showing us a structured approach for all of us individually in our communities to move forward with.”

Key relationships

DIP-IN also has clinical components. It funds four of the six clinical community health workers from Eskenazi Health who work with clients in the DIP-IN areas, as well as one neighborhood community health worker employed at a local community-based organization in each area who focuses on education and building awareness with residents, and engaging community partners.

Community health workers are considered frontline public health workers. They share socioeconomic and cultural backgrounds with the community served, and their shared life experiences help them build trust and liaise between patients and providers, the research paper stated.

Jama Bennett, a Near West community health worker and resident, said she engages residents, community stakeholders and organizations so they can help one another. She does risk assessments of residents and refers them to medical providers and other resources, like yoga and cooking classes. Bennett even encourages residents to get involved with the Near West steering committee so they can have input with project decisions.

“I try to go out and support residents and put resources out in the community regarding awareness, not only of diabetes but information regarding what they would like to see in the neighborhoods,” Bennett said.

Residents have expressed interest in community gardens, improvements to parks, walking and biking paths, better accessibility for the disabled and health fairs for diabetes testing, Bennett said. She added that she hopes to start a walking group in July.

Dasia Andrews, a DIP-IN clinical community health worker employed by Eskenazi Health, said she can have a caseload of up to 100 clients and visits 20 to 25 weekly. She meets with clients in their homes as much as possible but otherwise has phone conversations.

During the first 90 days a client is with DIP-IN, check-ins are every other week; after that they are monthly. Andrews checks on their blood-sugar levels but also asks about any issues with food, housing or transportation, whether they need help with medication refills or medical appointments, or whether a social worker might be needed. Clients typically graduate from the program when they’ve lowered their A1C levels to 6.0 or are in a good self-management position, which includes not having any major social needs.

“The opportunity to work with patients with diabetes is a blessing to me because it’s personal to me,” Andrews said. “My sister passed when I was 13; she was a diabetic.”

Cynthia Webster, a Northeast area resident, has been involved with DIP-IN for nearly a year. While she’s worked with other medical providers for her diabetes off and on for a decade, Webster said Andrews’ in-person, hands-on approach has made a difference.

“I’m a loner; I don’t socialize a lot,” Webster said. “To have someone interact with me, I enjoy it. This gets me to take it more seriously. When she comes to my home, she sees me and I share my test numbers with her.”

Webster said her A1C level has dropped from 11 to 7.0, and she’s lost 23 pounds since joining DIP-IN. Andrews said a lot of her clients’ A1C levels have dropped from 14 or 11 to 6.0 or below, primarily because of adopting a healthier diet and the accountability of working with a community health worker.

Data encouraging

The research paper said the community health workers played a key role in reducing residents’ blood-sugar levels.

“The data told us that community health worker use was successful in overcoming barriers with diabetes, which was important because even though COVID-19 caused restrictions, we still found success with self-management of diabetes,” said first author Elinor Hansotte, who completed her doctorate in health policy and management from the Fairbanks School while participating in DIP-IN.

The paper focused on encounters between Eskenazi DIP-IN clinical community health workers and patients from April 1, 2019, to March 31, 2022. The data focused on the frequency of patients’ A1C tests and the results. Hansotte’s role was to ensure the accuracy of the medical records and analyze the data.

Patients with Type 2 diabetes who were at least 18 years old, had a recent A1C of greater than 7.9 and lived in one of the target areas were eligible to participate. DIP-IN researchers also identified comparison areas that closely matched the intervention areas to compare the impact of using community health workers.

Among the research paper’s highlights:

• Patients working with community health workers had an average decrease of their A1C level of 0.54 units greater than those who did not work with a community health worker. “Statistically it was a significant reduction. We were excited about it because you don’t know initially if you’ll see those numbers,” Hansotte said.
• Patients who met with community health workers were significantly more likely to have at least two A1C tests completed within a year.

In the first year of recruitment, 2019, the mean A1C level for DIP-IN patients who hadn’t yet worked with community health workers was higher than in the comparison patients, 9.39 to 8.79, the paper said. In the last year of the follow-up, 2022, the mean A1C level for DIP-IN patients post-intervention were lower than the comparison patients, 8.89 to 9.13. The proportion of patients with at least two A1C measures per year was higher for DIP-IN patients before and after enrollment.

What’s next?

DIP-IN received eight years of funding, so it has about two years to go. Staten said that project leaders are evaluating options for continuing the work, but eventually there will be a handoff to the residents and community partners. Some things will remain, like walking paths and the gardens, but community health workers could be taken on entirely by Eskenazi or another health system.

“We have other health systems who have looked at this model and incorporated community health workers,” she said.

Staten said that’s a good sign, because the Diabetes Impact Project – Indianapolis Neighborhoods model could be applied to other chronic diseases, such as cardiovascular disease, dementia or Alzheimer’s.

DIP-IN community partners said they have incorporated what they’ve learned from the project to improve organizational structure and evaluate strategies, Staten added, which bolsters her belief that DIP-IN’s impact can be carried on.

“It’s just that empowerment is so huge and it makes a difference about how long things will last and the sustainability,” Staten said. “Because it’s about the residents and people who live there.”