1 

Programa de Manejo Personal de la 

Diabetes (Spanish Diabetes 

Self-Management Program)

Program Description

Programa de Manejo Personal de la Diabetes (Spanish Diabetes Self-Management Program) is designed to help 

Spanish-speaking adults with type 2 diabetes self-manage and improve their blood glucose levels, understand 

how their health problems affect their lives, and improve their general health. The program is based on selfefficacy theory and focuses on the medical, emotional, and role management of living with diabetes.

The program is delivered over 6 weeks through 21⁄2-hour workshop sessions (12–16 participants) that are held 

weekly in a community setting (e.g., senior center, church, library, hospital). Using a highly detailed manual, two 

trained peer leaders, one or both of whom must have diabetes, facilitate the workshop sessions. The sessions 

are highly interactive and cover the following subjects: (1) techniques to deal with the symptoms of diabetes, 

including fatigue, pain, hyperglycemia, hypoglycemia, stress, and emotional problems (e.g., depression, anger, 

fear, frustration); (2) appropriate exercises for maintaining and improving strength and endurance; (3) healthy 

eating; (4) appropriate use of medications; and (5) how to work more effectively with health care providers. 

Participants develop weekly action plans, share experiences, and help each other solve problems they encounter 

in creating and carrying out their self-management programs. Each participant receives a copy of the companion 

book (Tomando Control de su Salud: Una guía para el manejo de las enfermedades del corazón, diabetes, asma, 

bronquitis, enfisema y otros problemas crónicos), an audio relaxation CD (Relajación muscular progresiva y un 

jardín de flores), and an audio exercise CD with a booklet (¡Hagamos ejercicio!). All workshop sessions are 

facilitated in Spanish without translators, and all participant materials are in Spanish.

Before delivering the workshop, peer leaders must complete a 4-day Leader Training. Peer leaders also must be 

fluent in Spanish. Training is available for individuals to become master trainers, who then are qualified to train 

others to lead the workshop sessions.

Descriptive Information

Areas of Interest Health and wellness

Outcomes

Review Date: April 2013

 Health status

 Diabetes management self-efficacy

Ages 

 18–25 (Young adult)

 26–49 (Adult)

 50–60 (Older adult)

 61–74 (Older adult)

 75–84 (Older adult)

Genders  Female 

 Male 
2 

Races/Ethnicities Hispanic or Latino

Settings

 Church

 Community-based organization

 Continuing care retirement community

 Health center

 Home

 Outpatient

 Senior center

 Other community settings

Geographic Locations

 Urban

 Suburban

 Rural

Funding Partially/fully funded by National Institutes of Health

Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the 

developer.

Implementation History

Programa de Manejo Personal de la Diabetes was first offered as part of a 

randomized controlled trial in 2002 and was first disseminated to the public in 2008. It 

is currently being implemented in 20 States, the District of Columbia, and Puerto Rico, 

as well as in Argentina, Colombia, Costa Rica, Guatemala, Panama, and Spain. 

Approximately 2,000 participants have received Programa de Manejo Personal de la 

Diabetes. A list of organizations implementing the program can be found 

at http://patienteducation.stanford.edu/organ/dsmpspansites.html

Adaptations

The program has been adapted for use by American Indians and English speakers, as 

well as Australian and Canadian users. The program also has been adapted for online 

use, and the program materials have been translated into Chinese.

Quality of Research

Review Date: April 2013 

Documents Reviewed 

The documents below were reviewed for Quality of Research. The research point of contact can provide 

information regarding the studies reviewed and the availability of additional materials, including those from 

more recent studies that may have been conducted.

Study 1

Lorig, K., Ritter, P. L., Villa, F., & Piette, J. D. (2008). Spanish diabetes self-management with and without 

automated telephone reinforcement: Two randomized trials. Diabetes Care, 31(3), 408–414. PubMed abstract 

available at http://www.ncbi.nlm.nih.gov/pubmed/18096810

Supplementary Materials

Stanford Patient Education Research Center. (2012). Program fidelity manual: Stanford self-management 

programs 2012 update. Palo Alto, CA: Author. 
3 

Outcomes 

Outcome 1: Health Status 

Description of Measures

Health status was assessed with the following measures:

 A1C BIOSAFE kits. Each participant self-administered the BIOSAFE Laboratories 

Dried Blood Spot Hemoglobin A1C Assay, which indicates the average level of a 

person’s blood sugar over the past 3 months. The assay requires three 50-μl 

drops of capillary whole blood to be placed on a specialized paper card and dried. 

The card is then placed in a waterproof outer envelope for shipping via regular 

mail to BIOSAFE Laboratories for testing.

 Health Distress Scale. Using a scale ranging from 0 (none of the time) to 5 (all of 

the time), participants were asked to indicate how much time during the past 

month (1) they were discouraged by their health problems, (2) they were fearful 

about their future health, (3) their health was a worry in their life, and (4) they 

were frustrated by their health problems. Higher scores indicate greater 

frequency of distress about health.

 Spanish Hypoglycemia Scale. Participants were asked whether they had each of 

the following symptoms of hypoglycemia (i.e., low blood sugar) in the past week: 

morning headaches, nightmares, night sweats, lightheadedness, shakiness or 

weakness, intense hunger, or times when they passed out, fainted, or lost 

consciousness, even for a short time. Response options include “no,” “yes,” and 

“don’t know.” The scale score is the sum of the number of “yes” responses, and 

a higher scale score indicates that the participant had a higher number of 

hypoglycemia symptoms in the past week. 

 Spanish Hyperglycemia Scale. Participants were asked whether they had each of 

the following symptoms of hyperglycemia (i.e., high blood sugar) in the past 

week: increased thirst, dry mouth, decreased appetite, nausea or vomiting, 

abdominal pain, frequent urination at night (getting up to urinate three or more 

times a night), or severely high blood sugar (blood glucose readings of 300 mg or 

higher). Response options include “no,” “yes,” and “don’t know.” The scale 

score is the sum of the number of “yes” responses, and a higher scale score 

indicates that the participant had a higher number of hyperglycemia symptoms in 

the past week. 

 A single item from the National Health Survey, which participants used to selfrate their health: “Would you say your health in general is excellent, very good, 

good, fair, or poor?”

Key Findings

A randomized controlled study with a longitudinal follow-up compared the effects of 

Programa de Manejo Personal de la Diabetes with participants who received the 

program immediately after random assignment (intervention group) and those who 

received the program after 6 months (wait-list control group). All participants (i.e., 

those in the intervention group and those in the wait-list control group who received 

the intervention) were assessed at baseline, at 6 months after baseline, and at 18 

months after baseline. (The 6-month assessment was used as the control group’s 

baseline in the 18-month follow-up analyses.) Findings included the following:

 From baseline to the 6-month follow-up, participants in the intervention group 

had a greater improvement than control group participants in A1C levels (p = .04), 

health distress (p = .009), symptoms of hypoglycemia (p = .042), and symptoms 
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of hyperglycemia (p < .001). All analyses controlled for demographic variables, 

baseline levels of the outcomes, and baseline activity limitation (a measure of the 

impact of disease on role activities) due to baseline differences on this variable.

 From baseline to the 18-month follow-up, all participants who received the 

intervention had improvements in A1C levels (p = .03), health distress (p < .001), 

symptoms of hypoglycemia (p = .002), symptoms of hyperglycemia (p = .005), 

and self-rated health (p < .001).

Studies Measuring 

Outcome Study 1

Study Designs Experimental

Quality of Research Rating

(0.0–4.0 scale) 3.6 

Outcome 2: Diabetes Management Self-Efficacy 

Description of Measures

This outcome was assessed with the Spanish Diabetes Self-Efficacy Scale, which 

consists of 8 items regarding the participant’s confidence in his or her ability to 

manage aspects of diabetes. Using a scale ranging from 1 (not at all confident) to 10 

(totally confident), participants rated each item (e.g., choosing appropriate foods, 

knowing what to do when blood sugar is higher or lower than it should be). The scale 

score is the mean rating for the items, with higher means indicating greater diabetes 

management self-efficacy.

Key Findings

A randomized controlled study with a longitudinal follow-up compared the effects of 

Programa de Manejo Personal de la Diabetes with participants who received the 

program immediately after random assignment (intervention group) and those who 

received the program after 6 months (wait-list control group). All participants (i.e., 

those in the intervention group and those in the wait-list control group who received 

the intervention) were assessed at baseline, at 6 months after baseline, and at 18 

months after baseline. (The 6-month assessment was used as the control group’s 

baseline in the 18-month follow-up analyses.) Findings included the following:

 From baseline to the 6-month follow-up, participants in the intervention group 

had a greater improvement than control group participants in diabetes 

management self-efficacy (p < .001). The analysis controlled for demographic 

variables, baseline levels of the outcome, and baseline activity limitation (a 

measure of the impact of disease on role activities) due to baseline differences on 

this variable.

 From baseline to the 18-month follow-up, all participants who received the 

intervention had an improvement in diabetes management self-efficacy (p < .001).

Studies Measuring 

Outcome Study 1

Study Designs Experimental

Quality of Research Rating

(0.0–4.0 scale) 3.4 
5 

Study Populations 

The following populations were identified in the studies reviewed for Quality of Research.

Study Age Gender Race/Ethnicity 

Study 1

 18–25 (Young adult)

 26–49 (Adult)

 50–60 (Older adult)

 61–74 (Older adult)

 75–84 (Older adult)

 61.9% Female 

 38.1% Male 

100% Hispanic or Latino

Quality of Research Ratings by Criteria (0.0–4.0 scale) 

Criterion 

Ratings 

Outcome 1 

Ratings

Outcome 2 

Reliability of Measures 3.9 3.8

Validity of Measures 3.2 2.5

Intervention Fidelity 3.1 3.1 

Missing Data and Attrition 3.8 3.8

Potential Confounding 

Variables 3.4 3.4 

Appropriateness of Analysis 4.0 4.0

Overall Rating 3.6 3.4 

Study Strengths 

According to the study article, Spanish measures were translated from English, back translated, and standardized 

through a consensus meeting of all translators. Measures then underwent standard psychometric testing, including 

internal consistency, test-retest reliability, convergent validity, and discriminant validity. Peer leaders received 4 days 

of training in the use of the detailed protocol, and a fidelity manual was available. Intensive follow-up resulted in very 

few missing data. Comparisons of study completers and noncompleters indicated that these groups did not differ on 

most baseline characteristics. Individuals were randomized into intervention and wait-list control groups. Data 

analyses were appropriate for the measures used and the study design, including analyses of covariance that 
6 

controlled for demographic variables, baseline levels of the outcome, and variables with significant baseline 

differences between intervention and control groups. Paired t-tests were used to compare scores from baseline and 

18-month assessments. 

Study Weaknesses 

Variations among Spanish-speaking cultures could affect the validity of the measures. Although measures underwent 

psychometric testing, there was little discussion about the validity results for each measure. As noted by the 

investigators, because program participants could not be blinded, there is the possibility of an attention effect. The 

absence of a control group for the longitudinal study limits the interpretation of the data from the 18-month assessment. 

Readiness for Dissemination

Review Date: April 2013 

Materials Reviewed 

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can 

provide information regarding implementation of the program and the availability of additional, updated, or 

new materials.

González, V., Lorig, K., Sobel, D., & Minor, M. (2007). Tomando Control de su Salud: Una guía para el manejo de 

las enfermedades del corazón, diabetes, asma, bronquitis, enfisema y otros problemas crónicos. Boulder, CO: 

Bull Publishing Company.

González, V., Lorig, K., Villa, F., Marin, M., Alvarez, S., & Rosas, M. (2009). Programa de Manejo Personal de la 

Diabetes: Manual de los instructores. Palo Alto, CA: Stanford Patient Education Research Center.

González, V., Lorig, K., Villa, F., Marin, M., Alvarez, S., & Rosas, M. (2012). El Programa de Manejo Personal de la 

Diabetes: Guía para el taller de entrenadores (master trainer manual). Palo Alto, CA: Stanford Patient Education 

Research Center.

Stanford Patient Education Research Center. (1995). ¡Hagamos ejercicio!: Guía ilustrada para el disco de 

ejercicios [Booklet]. Palo Alto, CA: Author.

Stanford Patient Education Research Center. (2008). Implementation manual: Stanford self-management 

programs 2008. Palo Alto, CA: Author. Retrieved 

from http://patienteducation.stanford.edu/licensing/Implementation_Manual2008.pdf

Stanford Patient Education Research Center. (2010). Stanford self-management fidelity tool kit (volume 1). Palo 

Alto, CA: Author. 
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Stanford Patient Education Research Center. (2012). Program fidelity manual: Stanford self-management 

programs 2012 update. Palo Alto, CA: Author. Retrieved 

from http://patienteducation.stanford.edu/licensing/FidelityManual2012.pdf

Stanford Patient Education Research Center. (2013). Certification guidelines. Palo Alto, CA: Author. 

Stanford Patient Education Research Center. (2013). Master trainer agreement and certification form. Palo Alto, 

CA: Author. Retrieved from http://patienteducation.stanford.edu/licensing/CDSMPMT_auth.pdf

Stanford Patient Education Research Center Facebook page, https://www.facebook.com/pages/StanfordPatient-Education-Research-Center/144537370630?ref=sgm

Stanford Patient Education Research Center Web 

Site, http://patienteducation.stanford.edu/programs_spanish/diabetesspan.html

Stanford University. (1995). Programas educativos para la salud: ¡Hagamos ejercicio! [CD]. Palo Alto, CA: Author.

Stanford University. (1995). Programas educativos para la salud: Relajación muscular progresiva y un jardín de 

flores [CD]. Palo Alto, CA: Author.

Stanford University. (2012). Manejo Personal de la Diabetes: T-trainer’s manual. Palo Alto, CA: Author.

Other dissemination materials:

• Participant health survey

• Sample message from electronic mailing list

Readiness for Dissemination Ratings by Criteria (0.0–4.0 scale) 

Criterion Rating 

Implementation Materials 3.4

Training and Support 3.4

Quality Assurance 3.4

Overall Rating 3.4

Dissemination Strengths 

Program materials provided to support implementation are extensive and detailed. Materials identify program 

requirements, including who should implement the program, the target population, and detailed recommendations 
8 

(based on experience) to help ensure successful implementation. The implementation guide addresses issues related 

to cultural competence. The participant book, Tomando Control de su Salud, is easy to follow, with large print. The 

Stanford Patient Education Research Center Web site provides an overview of the program, including training 

schedules and cost information. Three levels of training are available—leader, master trainer, and train the master

trainer—and certification requirements for each level are expected to strengthen fidelity. The corresponding training 

manuals are easy to follow; each level of training appears to engage participants with didactic and interactive 

activities. The fidelity manual includes tools for assessing whether a peer leader is implementing the program with 

fidelity, and the results of the assessment may indicate whether the peer leader needs further training. The 

corresponding fidelity toolkit contains an exhaustive “must do” checklist and sample scenarios, agendas, and visuals. 

Course evaluations and client health surveys are available in Spanish to help evaluate participant outcomes and 

program quality. Extensive Spanish-language evaluation materials for assessing client outcomes are available for 

download from the Stanford Patient Education Research Center Web site.

Dissemination Weaknesses 

The audio exercise CD is outdated, and the corresponding illustrated booklet does not offer a sufficient explanation 

on how to perform the exercises or address the types of challenges an older adult with type 2 diabetes may face (e.g., 

feeling faint, falls). Sample menus do not sufficiently incorporate a dietary sampling of ethnic foods across common 

Latino subgroups. The training manuals contain some formatting inconsistencies, which reduce their overall quality. 

The Stanford Patient Education Research Center Web site lists training information and requirements for multiple selfmanagement programs and cross-trainings that involve more than one program, which may be confusing to potential 

implementers. The fidelity manual and toolkit are available in English only and, thus, may not be accessible to peer 

leaders who only speak Spanish. It is unclear how the provided measures can be used to assess program outcomes.

Costs

The cost information below was provided by the developer. Although this cost information may have been 

updated by the developer since the time of review, it may not reflect the current costs or availability of items 

(including newly developed or discontinued items). The implementation point of contact can provide current 

information and discuss implementation requirements.

Implementation Materials 

Item Description Cost 

Required by 

Developer 

Tomando Control de su Salud: Una guía para el manejo 

de las enfermedades del corazón, diabetes, asma, 

bronquitis, enfisema y otros problemas crónicos

$15.16 per participant book Yes

Programas educativos para la salud: ¡Hagamos ejercicio!

(Spanish Exercise Program) $9.60 per CD and booklet Yes

Programas educativos para la salud: Relajación muscular 

progresiva y un jardín de flores (Spanish Relaxation 

Program)

$9.60 per CD No
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Item Description Cost 

Required by 

Developer 

Implementation Manual: Stanford Self-Management 

Programs 2008 (English only)

Free (available for download 

from the Stanford Patient 

Education Research Center 

Web site)

No

Program license, valid for 3 years

 $500 for organizations 

offering up to 30 

workshops and 6 

Leader Trainings over 

the 3-year period

 $1,000 for organizations 

offering 31–90 

workshops and 12 

Leader Trainings over 

the 3-year period

Yes

4-day, off-site Leader Training for at least 2 people per 

organization (includes reproducible Manual de 

los instructores; Tomando Control de su Salud: Una guía 

para el manejo de las enfermedades del corazón, 

diabetes, asma, bronquitis, enfisema y otros problemas 

crónicos; ¡Hagamos ejercicio! CD and booklet; and 

Programas educativos para la salud: Relajación muscular 

progresiva y un jardín de flores CD)

Free, if offered by master 

trainers from a licensed 

agency

Yes

4-day, off- or on-site Master Trainer Training (includes 

reproducible Master Training Manual; reproducible 

Manual de los instructores; Tomando Control de su Salud: 

Una guía para el manejo de las enfermedades del 

corazón, diabetes, asma, bronquitis, enfisema y otros 

problemas crónicos; ¡Hagamos ejercicio! CD and booklet; 

and Programas educativos para la salud: Relajación 

muscular progresiva y un jardín de flores CD)

 Off-site training at the 

developer’s site: $900–

$1,600 per participant 

(lower cost for 

nonprofessionals with 

chronic illness)

 On-site training: $16,000 

for up to 24 

participants, plus trainer 

travel expenses

No

Phone and email technical assistance Free No

Electronic mailing list for master trainers Free Yes

Fidelity manual and toolkit for Stanford selfmanagement programs (English only)

Free (available for download 

from the Stanford Patient 

Education Research Center 

Web site)

No
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Additional Information

The trainings are conducted in Spanish without interpreters, and peer leaders and trainers must be able to 

speak, write, and read Spanish fluently. Bulk discounts are available for the participant book, the Spanish 

exercise CD and booklet, and the Spanish relaxation CD. In addition to the program licensing options provided, 

other configurations are available upon request. T-training, which trains participants to conduct Master Trainer 

Training, is available through a free apprenticeship with a trainer from Stanford University. The Stanford Patient 

Education Research Center offers free technical assistance to help implementers use or adapt the free 

downloadable evaluation measures to fit the needs of their communities; however, evaluation is not a required 

part of the program’s implementation.

Other Citations

Jernigan, V. B., & Lorig, K. (2011). The Internet diabetes self-management workshop for American Indians and 

Alaska Natives. Health Promotion Practice, 12(2), 261–270. PubMed abstract available 

at http://www.ncbi.nlm.nih.gov/pubmed/20534807

Lorig, K., Ritter, P. L., Laurent, D. D., Plant, K., Green, M., Jernigan, V. B., & Case, S. (2010). Online diabetes selfmanagement program: A randomized study. Diabetes Care, 33(6), 1275–1281. PubMed abstract available 

at http://www.ncbi.nlm.nih.gov/pubmed/20299481

Lorig, K., Ritter, P. L., Villa, F. J., & Armas, J. (2009). Community-based peer-led diabetes self-management: A 

randomized trial. Diabetes Educator, 35(4), 641–651. PubMed abstract available 

at http://www.ncbi.nlm.nih.gov/pubmed/19407333

Translational Work

The Stanford Patient Education Research Center, part of the Department of Medicine at the Stanford University 

School of Medicine, has developed, tested, and evaluated self-management programs in English and Spanish for 

individuals with chronic health problems over the past 30 years. The first program was the Arthritis SelfManagement Course, which became the prototype for other self-management programs. Programa de Manejo 

Personal de la Diabetes was developed and piloted in Spanish and is modeled after Tomando Control de su 

Salud, the Spanish version of the Chronic Disease Self-Management Program developed for Spanish speakers. 

Programa de Manejo Personal de la Diabetes is offered by more than 60 organizations throughout the United 

States, the District of Columbia, and Puerto Rico and, internationally, in Argentina, Colombia, Costa Rica, 

Guatemala, Panama, and Spain.

U.S. organizations with licenses to provide Programa de Manejo Personal de la Diabetes were approached by 

the Director of the Stanford Patient Education Research Center, Dr. Kate Lorig, with a request for information 

about their experiences in translating the program in their own communities. Responses from eight 

organizations, which include health centers, national nonprofit organizations, and State and local health 

departments, are summarized here in relation to the six categories of translational work. 
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Planning/Partners 

All eight organizations have strong collaborative relationships with public, private, and nonprofit organizations, 

including the Administration for Community Living’s Administration on Aging, health foundations, public health 

services departments, county aging and adult services departments, parks and recreation departments, housing 

authorities, organizations for health care professionals, churches, community-based groups, and senior centers. 

The planning process and the establishment of partnerships were often facilitated by the advisory committee or 

stakeholder team, composed of representatives of State Units on Aging, Medicaid programs, county 

governments, community-based organizations, AARP, universities, and others.

Adoption 

Organizations decided to adopt Programa de Manejo Personal de la Diabetes for several reasons: (1) the 

program meets an unmet need in the communities served by the organizations, where there are high levels of 

poverty and high percentages of Hispanic residents with diabetes; (2) scientific and anecdotal evidence supports 

the use of the program; (3) the program was developed specifically for Spanish-speaking individuals with 

diabetes, with an emphasis on self-management and skill building to empower participants to better care for 

themselves; (4) the program is manualized and structured, and the 6-week workshop series allows for 

information to be imparted at a slower rate to avoid overwhelming older adults with a large amount of 

information communicated in 1 or 2 days of diabetes classes; (5) integrating the program into existing services 

was an ideal alternative to the usual practice of referring patients to other programs; and (6) graduates of the 

program are eligible to become peer leaders.

Reach/Recruitment 

Organizations focused on areas with the highest levels of poverty and health disparities, as well as areas with 

underserved and uninsured Latinos. Participants were recruited during community-based events and at housing 

facilities for older adults, senior centers, health centers, community centers, churches, city-sponsored 

lunchrooms, and hospitals. An effective recruitment tool was word-of-mouth: participants who enjoyed the 

workshop and saw results shared their experiences with their peers and health care providers, which led to 

subsequent referrals. Hosting agencies and other community partner groups helped with recruitment by 

announcing new workshops. Other recruitment efforts included advertising in regional newspapers and 

specialized publications targeted to the senior population; using brochures and flyers; using a Web site to post 

workshop information, information about the advisory committee, and former participants’ testimonials; and 

using social media (i.e., Facebook). One organization mentioned participating in meetings of organizations as an 

effective way of reaching organizations and their constituents. To recruit eligible individuals, this organization 

also partnered with a medical provider that offered free glucose, cholesterol, blood pressure, and glaucoma 

screenings. Incentives (e.g., key chains, pens) were sometimes offered to participants, and some organizations 

ended their workshops with a graduation ceremony, which included certificates and a token gift for each 

participant who completed the program. Although initial interest in the program was often high, most 

organizations reported that they experienced some challenges with participant recruitment, including

participants’ lack of commitment to the full 6-week program, low literacy skills, lack of transportation, and lack 

of child care. One organization helped overcome participants’ literacy concerns by emphasizing that they did not 

need to take notes or pass an exam to complete the program.
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Implementation 

The implementation process included assessing the need for bilingual and bicultural staff; identifying, training, 

and coordinating peer leaders and master trainers; coordinating workshop dates, times, and locations; recruiting 

participants; supervising workshop leaders and ensuring that they adhered to the curriculum; collecting and 

analyzing data; and reporting program results. Mechanisms were developed to purchase and distribute 

incentives for participation. One organization offered a class before the first workshop session began, which 

helped peer leaders and participants complete forms and become familiar with the content of the program. One 

successful strategy was to hold regular team meetings to focus on strengths and challenges, as well as establish 

prompt corrective actions when needed. Positive relationships with the advisory committee and other 

community leader partners were extremely helpful in implementing the program. One organization maintained 

ties with the developer’s master trainers and included its own master trainers in the developer’s electronic 

mailing list to keep staff up to date on the content of the program. The organizations identified several 

challenges to implementation, including finding new community settings to host sessions and trained peer 

leaders to expand facilitation of the program. Workshop scheduling was more complex than anticipated, usually 

because of competing activities for participants or the community setting hosting the session. Another barrier 

was the unanticipated need for child care for the participants’ caretakers; many participants were older adults, 

and their caretakers often had to attend the workshops. One organization reported that some participants were 

unable to complete the series for a number of reasons (e.g., extended personal illness, caregiving 

responsibilities, difficulties arranging transportation, unexpected travel), which led to an accommodation that 

allowed participants to return to a later series in order to complete the program.

Effectiveness 

Positive outcomes in self-reported health and health management–related indicators were reported by six of 

the eight organizations, either anecdotally or through statistical analyses of data. These outcomes included 

improvements in nutrition, physical activity, symptoms of hypoglycemia, self-perception of health, and 

symptoms of depression. Participants also had a decrease in health care utilization (e.g., physician visits, 

emergency room visits, nights spent in the hospital) and improved relationships with health care professionals. 

Participants reported that they had more confidence in their management of diabetes, in their ability to prevent 

discomfort from interfering with activities, and in their use of relaxation techniques. They also reported that 

they had a strengthened social support network.

Maintenance 

Most of the eight organizations were committed to continuing and expanding the program through funding 

from governmental agencies, foundations, corporations, individuals, and special events. Organizations must 

ensure that community partners remain engaged, as collaboration with established community partners is key. 

One organization is building infrastructure to receive referrals from health partners and provide follow-up 

services, as well as to provide program-related outreach and education to health groups in the community. One 

organization’s partner agency is pursuing strategies for obtaining insurance reimbursement through Medicare, 

which may provide an option for delivering services to older adults. Several organizations experienced the 

ongoing challenge of managing staff turnover and maintaining a large pool of peer leaders. This concern can be 

addressed by ensuring that peer leaders are not overworked and by taking advantage of available trainings (e.g., 

Leader Training, Master Trainer Training). One agency has paired up with local colleges to train public health 

students to be peer leaders, in exchange for credits toward their degree.
13

References Describing Site’s Translational Work, by Category 

Site With 

Translational 

Work 

Planning/ 

Partners Adoption 

Reach/ 

Recruitment Implementation Effectiveness Maintenance 

Citrus Health 

Network Reference 1 Reference 1 Reference 1 Reference 1 — Reference 1 

Dignity Health at 

Mercy and 

Memorial 

Hospitals

Reference 2 Reference 2 Reference 2 Reference 2 Reference 2 Reference 2 

Healthy Aging 

Regional 

Collaborative, 

Health 

Foundation of 

South Florida

Reference 3 Reference 3 Reference 3 Reference 3 Reference 3 Reference 3 

American 

Diabetes 

Association–

Colorado Area

Reference 4 Reference 4 Reference 4 Reference 4 Reference 4 Reference 4 

Office for Health 

Promotion, 

Puerto Rico 

Department of 

Health

Reference 5 Reference 5 Reference 5 Reference 5 Reference 5 Reference 5 

San Diego 

County Health 

and Human 

Services Agency, 

Behavioral 

Health Services, 

Salud Program

Reference 6 Reference 6 Reference 6 Reference 6 Reference 6 Reference 6 

Center for Health 

Futures at 

Florida Hospital 

(Central Florida)

Reference 7 Reference 7 Reference 7 Reference 7 Reference 7 Reference 7 

Island Peer 

Review 

Organization

Reference 8 Reference 8 Reference 8 Reference 8 Reference 8 Reference 8 
14

Reference 

Number Reference 

1 Documentation submitted by Citrus Health Network, Inc., February 2013

2 Documentation submitted by Dignity Health at Mercy and Memorial Hospitals, February 2013

3 Documentation submitted by the Healthy Aging Regional Collaborative, Health Foundation of 

South Florida, February 2013

4 Documentation submitted by the American Diabetes Association–Colorado Area, February 2013

5 Documentation submitted by the Office for Health Promotion, Puerto Rico Department of Health, 

February 2013

6 Documentation submitted by the San Diego County Health and Human Services Agency, Behavioral 

Health Services, Salud Program, February 2013

7 Documentation submitted by the Center for Health Futures at Florida Hospital (Central Florida), 

February 2013

8 Documentation submitted by Island Peer Review Organization, Inc., February 2013

Contacts

To learn more about implementation or research, contact:

Kate Lorig, Dr.P.H. 

Stanford Patient Education Research Center, Stanford 

University School of Medicine

(650) 723-7935

lorig@stanford.edu

Additional program information can be obtained through the following Web site: 

http://patienteducation.stanford.edu/programs_spanish/diabetesspan.html