“While this particular study that I proposed focuses on diabetes prevention, it provides a sense of empowerment to an underserved community that has limited resources and helps these residents to recognize that they still have the power to implement change within their communities.”
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Dr. Vivian talks to us about her research focus in diabetes treatment for African American and Latino populations and her recently funded project which focuses on African American grandmothers as role models to their grandchildren.
Eva Marie Vivian is a professor at the University of Wisconsin-Madison School of Pharmacy. Dr. Vivian has been referred to as “the researcher with a servant’s heart” because of her service to underserved communities in Madison, WI. Her research interests focus on identifying disparities in the treatment of hypertension, diabetes, and other chronic diseases among ethnic minorities, particularly African American and Latino American patients and developing and implementing strategies to reduce and eliminate them.
Shireen: Dr. Vivian talks to us about her research focus and diabetes treatment for African American and Latino populations and her recently funded project, which focuses on African American grandmothers as role models to their grandchild.
Podcasting from Dallas, Texas, I am Shireen. And this is a Yumlish Podcast.
Yumlish is working to empower you to take charge of your health through diet and exercise and reduce the risk of chronic conditions like type two diabetes and heart disease. We hope to share a unique perspective and a culturally relevant approach to managing these chronic conditions with you each week.
Dr. Eva Marie Vivian is a professor at the University of Wisconsin Madison School of Pharmacy. Her research interests focus on identifying disparities in the treatment of hypertension, diabetes, and other chronic diseases among ethnic minorities.
Welcome Dr. Vivian.
Eva: Thank you.
Shireen: So, Dr. Vivian, can you talk to us a bit more about how you found your way to specializing in research and treatment for diabetes as a Doctor of Pharmacy?
Eva: Well, in the early years of my career, I was a clinical pharmacist and I cared for patients with diabetes and hypertension at the VA hospital in Philadelphia. And during that time, I noticed that many of my patients actually faced challenges within their community that often compromised their ability to care for themselves.
For example, in some instances, patients didn't have enough money to pay for their medications and they often did not have access to fruits and vegetables, which I frequently requested that they increase their consumption. So over time, I began to recognize that there are things in an individual's environment, as well as their social environment that actually influenced their health.
And I felt that I should learn more about the community where my patients live.
Shireen: Your research focus is on identifying disparities and treatment of diabetes and African American and Latino patients. Why did you take a special interest in these, in these areas?
Eva: Well, diabetes and hypertension, disproportionately impact people of color, particularly African American.
But there are so many factors that influence the health of these people that we really cannot address within the healthcare system. So, I wanted to learn more about ways to help these people lead a healthy lifestyle. So, I decided to actually translate by clinical research into the community where I could learn more about where people live and play.
And have a better understanding of how to help them lead a healthy lifestyle.
Shireen: So, tell us more about this research. What have you concluded so far?
Eva: Well, what I noticed in the clinical setting is that many of the women who came to my clinic to be managed for their diabetes or accompanied by their children or their grandchildren who actually display the same risk factors for developing type two diabetes.
So, I initially designed a diabetes prevention program, which targeted youth, particularly young people between the ages of eight to 13 years of age. And I trained children in that same age group to be peer coaches for other children. Now that was a very good program, but it was very interesting that after the one-year program in, the children informed me that while they really enjoyed working with their peers, they still felt that their parents and grandparents had the greatest impact on their health. What I also noticed is that the grandmothers, particularly in the African American community, played a large role in the care of their grandchildren.
And those numbers are a lot higher than what is actually indicated in the literature. So, I felt that in order to reach children, it's really important to reach the parents first and particularly the grandparents so that they can model healthy behaviors for their grandchild.
Shireen: I love that. And so more recently received funding from the American Diabetes Association for your research on your novel peer support for diabetes, Healthy Outcomes from Peer Educators, it's just called HOPE.
Can you tell us about how you saw the need for this kind of research and then how you went about developing this program?
Eva: Well, it's very interesting because recent statistics show that over 80% of African American women are overweight or obese, and many of these women are caring for children or grandchildren who may be at risk for becoming overweight or obese as well.
So, we know that children frequently model the behaviors of their caregiver. And since so many grandmothers who carry for grandchildren, I thought it would be great for us to develop a peer support program for grandmothers. And hopefully these grandmothers would change their behaviors and then model those behaviors in front of their grandchildren who will then model similar behavior.
So, the African American grandmother is considered very revered in the African American community. They receive a great deal of respect. So, I felt that they would be an ideal person to target, to start to derail the progression of diabetes in this community.
Shireen: I love that approach. What brought you to even look in that direction or even consider looking at grandmothers in particular as role models for this project?
Eva: Well, I conducted a pilot study, which focused on caregivers in general. And what I found was the majority of the African American children are cared for by their grandmothers. In some cases, the grandmother lived with the family. And the grandmother care for the grandchildren while the parents worked, or in some instances, the grandmother was the legal guardian of the grandchildren.
So, I decided this would be a great way to really address the increasing rise of type two diabetes, particularly in the African American community. So, I actually gathered a group of African American grandmothers. And trained them to serve as peer educators. And during that time period, it was a three-month study.
The grandmothers really enjoyed the training, but what was very interesting is that during this time period, all of the grandmothers, which were about 30, lost at least 5% of their body weight. And so, they were supporting one another, but they also mentioned that when they changed their behaviors, they noticed that their grandchildren changed their behaviors as well.
The grandmothers quit bringing potato chips and candy home, and instead offered fruits and vegetables to their children. And their children were surprised that they even enjoyed eating fruits and vegetables. Also, it empowered these women. On one occasion, a grandmother approached me and indicated that she didn't like the idea that there were vending machines at the community center.
And she requested that I asked the manager of the center to remove the vending machine. I told her that I could do that for her, but I felt it would be more effective if she did it. So, this grandmother took the initiative to start a petition and she collected the signature of over 50 mothers and grandmothers within the community.
And she and three other grandmothers met with the management of the community center and requested that the vending machines be removed. And guess, what the bending machines were removed. So, this provided a sense of empowerment to these grandmothers and help them to recognize that they could in fact change, uh, served aspects of their environment.
And since that time, the grandmothers were very active within their community. For example, during the pandemic, these grandmothers went around the neighborhood and encouraged their neighbors to become vaccinated. They also encouraged people in their community to become registered to vote. So, while this particular study that I proposed focuses on diabetes prevention, it provides a sense of empowerment to an underserved community that has limited resources and helps these residents to recognize that they still have the power to implement change within their communities.
Shireen: And really seeing them as influencers, not only within their own household, but also largely within the community.
Eva: Absolutely. And training people within the community to support others in the community. I think it's very impactful. I think that we have to move outside of the healthcare system and actually go into the neighborhoods where our patients reside.
And so, we could learn as healthcare professionals of the things and some of the challenges that our patients face when they're attempting to lead a healthy lifestyle.
Shireen: In your initial pilot, what kind of, uh, what kind of barriers did you see at that time? That prevented them or that will barriers in providing preventative care?
Eva: For example, it's frequently healthcare providers will tell patients it's important to eat healthy, consume more fruits and vegetables as well as to be more physically active. However, in many instances, some patients reside in rather unsafe neighborhoods, where a woman may not feel comfortable walking in that neighborhood by herself.
So, in my program, a group of women started a walking program and they met together as a group, and they walked around the neighborhood together in groups of seven to ten. They felt that that was safe. Also, one of their concerns was that there were a limited number of grocery stores that offer fresh produce.
And as a result, they relied on like the local drugstore Walgreens to obtain food. So, we actually started working with local grocers to offer more fruits and vegetables at food pantries. So, the residents learned of the fruits and vegetables at the food pantry, and they were able to go there and receive them.
And now in the city of Madison, there are grocers that are going to work together to start a small store, to provide fresh produce for people in underserved communities. These are things that many privileged individuals take for granted, but we don't recognize that often the recommendations that we may make to patients are things that are beyond their reach and that they have no control over.
Shireen: And so, through this, uh, recently funded research. What results do you hope to see and what do you hope to see in the community general as diabetes research advance?
Eva: Well, one of the challenges to the diabetes prevention program, which is incidentally, a program that has been found to be very effective. But one of the challenges that they found in particularly the African American and Latino communities is that there was a high attrition rate.
So, I am actually conducting a study that looks at offering the diabetes prevention program versus the diabetes prevention plus HOPE, which has Healthy Outcomes through Peer Educators. And I anticipate that the participants in the DPP plus HOPE group will remain in the program and benefit from the program.
I anticipate that they will lose weight. They will develop healthy behaviors as a result of their interaction with their peers. The peers understand the challenges of living within that particular community and together they could collectively support one another and perhaps come up with strategies that will help each other lead a healthier lifestyle.
Shireen: That's very helpful.
And as you're looking at, and what I'm hearing you say is that there is this DPP program. It's great as a huge attrition problem. Um, so something needs to happen to keep people in. And so, what you're betting on with your research, Dr. Vivian is to say that it's strong in this community.
It's strong across African American grandmothers. Can you give us some examples and tidbits of what you expect to see or have seen as far as peer support as well?
Eva: I'll go back to the example of the community center. When the grandmother indicated that they didn't want the bending machines and the community center, that a lot of the kids would come in and they would eat candy bars and drink soda.
This really bothered the grandmothers and that the program actually increased her awareness as well as the other participants' awareness that there were things that they were eating that really were compromising their health. It also made them aware of the fact that they needed to become more physically active.
So, taking into consideration that their neighborhood may not be the safest, they sat and brainstormed and thought about ways that they could become physically active. And I worked with them. And as a result, the YMCA is actually offering reduced membership costs to these grandmothers. And now the grandmothers can utilize the YMCA in the winter months.
Which is really wonderful.
Shireen: And that's really the power of it is not only providing the program, but it's a way to unite people who have a shared concern, shared belief around health goals, uh, safety, you know, goals, all of that, and really being able to influence that as well as very interesting to get a very unique approach and sort of bringing these influencers from the community together to drive that change in a collective way.
So, I truly appreciate that.
But with that we’re towards the end of the podcast episode, Dr. Vivian. Can you tell us how can our listeners connect with you and learn more about your work?
Eva: Well, um, please provide them with my email address. It is my last name Vivian at W, as in Wisconsin. I, S as in Sam, C as in cow dot E D U the first three letters of education, feel free to contact me.
I'm more than willing to set up a zoom call and talk to your, um, listeners about this very important issue. Another comment I'd like to make the wonderful thing about this program, is that what I'm doing can be translated to other communities. What I planned to do going forward is training a group of Latino women to serve as peers for people in their community.
Peer support has been found to be effective in alcohol use, excessive alcohol use. And in other settings and I feel that it will be effective in diabetes prevention as well.
Shireen: I appreciate that. And we will put your email address in the show notes and get that out there to folks for our listeners here today, there is a special treat head over to our Facebook or Instagram to participate in our giveaway.
It's a comic book called Hip Hop to Health authored by Dr. Vivian and describes ways that children can decrease their risk of type two diabetes. To participate in this giveaway, answer a very simple question. So again, head to Facebook to Instagram and answer this question, name a way just one, to decrease risk for diabetes, for children. So, head over to Facebook and Instagram and answer this super, super simple question. Name a way to decrease risk for diabetes for children and be entered in this giveaway to this comic book called Hip Hop to Health.
Dr. Vivian, it's been an absolute pleasure. Thank you so very much for your time.
Eva: Thank you. It was a pleasure.
Shireen: Thank you for listening to the Yumlish Podcast. Make sure to follow us on social media @Yumlish_ on Instagram and Twitter and @Yumlish on Facebook and LinkedIn for tips about managing your diabetes and other chronic conditions and to chat and connect with us about your journey and perspective, you can also visit our website Yumlish.com for more recipes advice, and to get involved with all of the exciting opportunities Yumlish has to offer. If you like this week's show, make sure to subscribe so you can hear more from us every time we post.
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