Implementation and outcomes of the Balanced Living with Diabetes program conducted by Cooperative Extension in Rural Communities in Virginia

dc.contributor.authorRafie, Carlinen
dc.contributor.authorHosig, Kathy L.en
dc.contributor.authorWenzel, Sophieen
dc.contributor.authorBorowski, Shelbyen
dc.contributor.authorJiles, Kristina A.en
dc.contributor.authorSchlenker, Eleanoren
dc.coverage.countryUnited Statesen
dc.description.abstractIntroduction: Adult onset diabetes is a significant health issue in rural communities that are disproportionately suffering from the health, social and financial costs of the disease. Despite this, over half of rural counties in the USA lack access to diabetes selfmanagement programs, which are effective at improving diabetes management. The Cooperative Extension System (CES) is a nationwide education network that provides research-based information and programs in nearly 3000 counties in the USA to improve the health and wellbeing of rural and urban communities. This study evaluated the implementation and outcomes of a lifestyle management program, Balanced Living with Diabetes (BLD) conducted by community-based educators who are part of the CES in rural Virginia, to address the gap in diabetes education in these communities. BLD is grounded in social cognitive theory and has shown efficacy to modify dietary and physical activity behaviors resulting in improved glycemic control in people with type 2 diabetes. Methods: The study evaluated the implementation and effectiveness of BLD programs conducted by the CES in 16 rural counties over 2 years. Program adoption, reach, context, and barriers and facilitators to implementation were evaluated through program outcome data and extension educator interviews. Program outcomes included change in weight, glycosylated hemoglobin (A1C), diabetes knowledge, self-management practices, diet and physical activity behaviors, and self-efficacy from baseline to 12-week assessment. Results: Extension educators conducted 30 programs, reaching 290 residents, with a 58% mean retention rate. The program resulted in a significant increase in diabetes and food knowledge, fruit, vegetable, and whole grain intake, use of the plate method, exercise, and diabetes management self-efficacy. A1C decreased significantly in participants with diabetes (mean reduction=0.345±1.013; p=0.001). The program was conducted twice in 11 counties, and once in five counties. Barriers to program adoption in the five counties included limited community interest, competing program priorities of the extension educator, and loss of extension personnel to conduct the program. Participant communication materials and systems to enhance program sustainability were developed in response to educator feedback. Process evaluation indicated that the program was highly acceptable to extension educators and program participants. Conclusion: The CES is an effective network for implementation of diabetes lifestyle-management programs in underserved communities, and the BLD program is effective at increasing lifestyle behaviors and self-efficacy that improve glycemic control in people with type 2 diabetes. Collaboration by Virginia’s CES with a variety of community partners, including healthcare and social service providers, increases the reach and sustainability of extension diabetes programs. The CES in the USA is well positioned to fill the gap in diabetes education in rural communities as part of a chronic care model.en
dc.description.versionPublished versionen
dc.identifier.citationRafie C, Hosig K, Wenzel SG, Borowski S, Jiles KA, Schlenker E. Implementation and outcomes of the Balanced Living with Diabetes program conducted by Cooperative Extension in rural communities in Virginia. Rural and Remote Health 2021; 21: 6620. /10.22605/RRH6620en
dc.identifier.orcidRafie, Carlin [0000-0002-1402-5650]en
dc.identifier.orcidHosig, Kathryn [0000-0001-9418-8830]en
dc.identifier.orcidWenzel, Sophie [0000-0002-6961-3820]en
dc.rightsCreative Commons Attribution 4.0 Internationalen
dc.subject1110 Nursingen
dc.subject1117 Public Health and Health Servicesen
dc.subject1303 Specialist Studies in Educationen
dc.titleImplementation and outcomes of the Balanced Living with Diabetes program conducted by Cooperative Extension in Rural Communities in Virginiaen
dc.title.serialRural and Remote Healthen
dc.typeArticle - Refereeden
pubs.organisational-group/Virginia Techen
pubs.organisational-group/Virginia Tech/Agriculture & Life Sciencesen
pubs.organisational-group/Virginia Tech/Agriculture & Life Sciences/Human Nutrition, Foods, & Exerciseen
pubs.organisational-group/Virginia Tech/Veterinary Medicineen
pubs.organisational-group/Virginia Tech/Veterinary Medicine/Population Health Sciencesen
pubs.organisational-group/Virginia Tech/Faculty of Health Sciencesen
pubs.organisational-group/Virginia Tech/All T&R Facultyen
pubs.organisational-group/Virginia Tech/Veterinary Medicine/CVM T&R Facultyen


Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
Implementation and Outcomes of the Balanced Living with Diabetes program_Rafie.pdf
431.5 KB
Adobe Portable Document Format
Published version