Hello everyone, thank you for joining us for today's webinar. My name is Erica Anna, I have the privilege of joining you as the moderator today. I am teaching faculty in the Department of Nutritional Sciences. I am in the University of Wisconsin Madison in addition to instruction I'm also a public health and community nutritionist, and a registered dietitian nutritionist with family health La Clinica's mobile migrant health services. And so I see that many of you have included your, where you're from in the chat so if you haven't done that yet, please drop that in. Great, thank you everyone for joining wonderful. So become a member of the American Diabetes Association, ADA membership will provide opportunities to network and grow professionally, ADA membership include a variety of professional member benefits including meeting discounts women's interprofessional network when ADA interest groups diabetes pro membership forum professional journals members only webinars members directory standards of medical care and diabetes and diabetes pro quarterly. So as you can see you will have access to lots of great resources as an ADA professional member. So visit professional diabetes.org forward slash membership for more information and that link should be in the chat here shortly thanks Danielle earn continuing education credits for free. Visit professional diabetes.org again forward slash learning to access online opportunities of a variety of diabetes related topics. So before we begin the following our disclosures associated with today's presentation financial relationships include Indiana Department of Health non financial relationships include advisory member of the community health worker, CHW policy forum with Eli, Lily and company. And now I have the privilege of introducing our speaker for today's presentation. Margarita Hart serves as the executive director of the INCHWA and Esperanza ministries serving as a community health worker for over 30 years overseas and in the United States Margarita is passionate. She's a passionate advocate for the community health worker workforce and as an advocate for the immigrant population in the state. She's actively involved in conversations crafting local, state, national and public health strategies. She provides counsel to community leaders concerning the building of coalitions and culturally relevant policy development. She is multilingual and a certified medical interpreter who facilitates culturally appropriate policy improvement and understanding and immigrant people groups. She's also board certified chaplain specializing in end of life care, a consultant for project development and a professional development mentor, helping develop immigrant leaders, a motivational speaker and author, and a Hebrew scholar teaching Christ centered Bible studies. Thank you so much Miss Hart for joining us today we are thrilled that you can be here. Before we begin if you have any questions, as we move through the presentation. Please type them in the q amp a box in your control panel. We will be answering as many questions as we as we can at the end of the presentation. And so without anything further please take it away Miss Hart, thank you. Thank you, Erica. So today, true to our CHW workforce which I so excited to see so many of you. Thank you so much. We're going to do these, these are the things that we're going to cover today. So these are our learning objectives. We want to describe how social determinants of health affect the nutrition of diabetes and outcome, there are diabetes outcomes. We will also discuss how food effects blood glucose and how to read nutrition labels differentiate foods within cultural context and healthy meal plans, and then identify strategies to address SDOH and patient empowerment to improve diabetes care. Well, let's see. Make sure. So first we start with social determinants of health, and how these affect our diabetes outcomes. The CDC has outlined five critical areas of SDOH, access to quality care, health care, education, access and quality, social and community context, economic stability, and neighborhood and built-in environments. So we're going to dive into these. The access to quality health care, we see that some people don't have insurance or are underinsured, and that causes them to have an inability to access health care services. They can't access their primary care provider or even get medications for their diabetes or any diabetes-related technologies or any specialists. They will not be able to access any of that. It causes them to have an inability to or delay maybe to diagnostic testing due to cost, and the utilization of their urgent care system really goes up. It's exasperated by the lack of being able to get maintenance care, and also limited access to care because of transportation. Education and access to quality, people with higher levels of education we have seen are likely to be healthier and live longer. Access to quality of education impacts health literacy, not only health literacy, but all literacy. We know that children who attend poorly performing schools have families who can't afford to send them to college, and so that is most likely to have them stress, increase their stress of living in poverty for the remainder of their lives. There's a lack of school policies as well in place for diabetes care related for the children. Social and community context, we see that many people face challenges and dangers that they really can't control. There are unsafe neighborhoods, there's discrimination and inability to afford the things that they need, and these all can have a negative impact throughout their lives. We see also that economic stability, people who don't have steady employment are more stable financially, are likely to have better health outcomes. Many of those who are finding, who are trouble finding jobs or jobs that are there one year after another where they would have insurance causes them to have challenges with affording healthy foods or their health care or even healthy housing. Living paycheck to paycheck impacts people negatively as it affects their mental well-being. And in built-in environments, we know that people living in places of high violence rates and unsafe water, exposure to secondhand smoke, those all affect our health. We also know that racial and ethnic minorities and low-income families often live and work in places of these high risks. Agricultural workers, for instance, they are exposed to unsafe drinking water, a substandard unsafe cooking, and dilapidated structures. So how do these relate to food insecurity? And that's really what we're trying to take a look at, right? According to the CDC, food insecurities is a term described that when someone cannot access or afford enough safe or nutritious food for their overall health and well-being. We know that processed foods are higher in sugar, saturated fat, and sodium. This increased consumption of these foods can increase their risk for type 2 diabetes. Food and nutrition insecurities causes frequently a link between bigger problems in your health, and they're definitely linked to the SDOH. So we know that those two are very connected. So let's take a step back as we serve our community, as community health workers, and we're serving a person that has diabetes. Let's help them understand what is diabetes. Diabetes is a chronic, long-lasting health condition that affects how your body turns food into energy. Your body breaks down the food into blood glucose, otherwise known as blood sugar, and it releases it into your bloodstream. When your blood glucose increases, it signals your pancreas to release insulin. Insulin is a key to how blood glucose is used in your body cells for energy. So with diabetes, our body doesn't make enough insulin or it can't use it as well as it should. And there's three types of diabetes. First is the type 1. The pancreas doesn't produce insulin, and people with type 1 diabetes must take insulin to manage their blood glucose levels. Type 2, the body does make enough insulin and does not use it the way that it should. So type 2 diabetes is managed with an eating plan, staying active, and medications. The third type is gestational diabetes, or GDM. This is the diabetes that develops during pregnancy. Let's take a case study, true to any CHW, right? Let's take a look at Maria. She's a 38-year-old Hispanic female, a mother of two school-age children. She works at a family restaurant as a waitress. Her husband is not home due to his job. As her parents are getting older, more of the responsibilities of the restaurant and taking care of her parents are falling on Maria because she's the only sibling close by, and so she has no support. Since Maria has no driver's license, she must ride the bus to and from work, and she also relies on school transportation for the children to get to school. So they live in an area that is high violence, and they are home alone while she is at work at night until the dad gets home. Maria does not have much time to get to the store between the restaurant and caring for her children and parents, nor does she have a grocery store nearby that sells healthy and nutritious food. So what she does is she brings food from the restaurant to her home. The lack of healthy food affects Maria's health. She was diagnosed with type 2 diabetes a year ago. And she went to the doctor after concerns about constantly feeling tired, always using the bathroom, and her weight gain. Maria has been noticing pain in her feet, but has dismissed it since she is on her feet all day long. She feels active since she's walking all day, but she doesn't lose weight. This frustration is adding more to her stress. Even though Maria's parents keep telling her to go to the doctor, she cannot afford to go, and the bus line doesn't go out to the specialist for her diabetes. She only takes her medication when she doesn't feel well, so that way she can stretch it out and make it last longer than a month. Due to her working so much, Maria is only really eating one time a day because she doesn't have time to eat any other time, and she eats right before bedtime. So let's take a look at how a CHW can interact with this patient. We have to understand what a CHW is first. A community health worker, or a CHW, is a frontline public health worker who is a trusted member and is also part of that community. They closely understand what is going on in the community. They understand the culture. CHWs can be a part of a cost-effective and evidence-based strategies in its workforce to improve the management of diabetes and cardiovascular risk to the underserved communities. In this slide, you'll see that on one side we have the C3 core roles and competencies. These have been defined nationally, and we kind of use Intwa as an organization supporting the workforce. We use these as our guideline for what are the things that we look for in a CHW. So this is nationally approved and nationally used, and we use it here in Indiana. So let's see how these convert into diabetes patient care. The CHW will be working with diabetes healthcare team to identify and overcome cultural barriers. They will encourage referrals and making connections to programs that are CDC-recognized. They will gain insight into the cultural understanding and the pre-diabetes and diabetes education so that they can tell that to the community and tell the story of how best to use the strategies. They will utilize cultural connections and strategies such as Teach Back and others that will work in their cultural context. They serve as a bridge between the people with diabetes and the diabetes care team. So we see that supporting culturally informed changes in daily routines brings the best success, and the CHWs are equipped to do that. So let's see what happens at this intersection between Maria and the CHW. We know that CHWs understand Maria's social impact factors and her social determinants of health, both of which affect Maria's health choices. So the CHW that works at Maria's provider contacted her to see if she can do a home visit since her records indicate that her monthly medication refills are not being placed. Maria agrees to meet with the CHW after lunch hour rush at the restaurant. And so the CHW will focus on the following things. They will discover the root cause for the prescriptions not being filled. They will make an appointment for Maria with her provider. They will find out what her blood glucose numbers have been, and they will identify any health changes that have happened since her last time she was at the doctor's. So let's ask the audience. From Maria's perspective, what is Maria's most important problem? A, she cannot afford the medication. B, can't read it, let's see. She cannot afford to go to the doctor. Or C, her employer is keeping her many hours to work. Or D, all of the above. Oh, look at the poll. The poll says that all of the above, very good, very good. So let's see what the recommendations from the CHW visit is. The CHW will assist Maria to schedule a telehealth appointment with her provider next week and assist to arrange transportation between Maria's pastor to get her lab work done before she goes to the appointment. They will assist Maria in downloading an app on her phone so that she can track her meals, her A1C levels, and send her reminders and track her physical activity. They will also provide options for several afterschool resources that can assist the kids until 9 o'clock in the evening. That way, it takes a lot of the stress away from Maria. They will provide Maria with information about local food pantries, such as in the churches or the farmers markets, so she can get some fresh fruits and vegetables. So let's take a look at another thing that's important here. How foods affect blood glucose and how to read these nutrition labels. This is important for us as CHWs to communicate to our patients. We need to understand, they need to understand blood glucose. This is the body's main source of energy, which we obtain from food, which circulates in the blood. Blood glucose is also called blood sugar. These are some of the food groups that are important for someone with diabetes to understand. These are the options. These are good for us to know because these are going to be exchanges, and we have to be able to do them in a culturally appropriate way. We have our list of proteins, healthy fats, and carbs. And then we also have our dairy, our grains, and our fruits. It's a good way for us to really naturally talk with our patients to just include some of these items in their food planning process. We also need to explain how blood sugar levels change during the typical day. We know that as soon as we eat, the blood sugar levels go up, and then they come down within two hours on a person that is treating their diabetes or doesn't have diabetes. But someone that is not treating their diabetes, this can be longer, and so that is the problem that they're encountering. We also want to teach our patients how to do some carb counting. This is a great tool for anybody with diabetes who may or may not be taking insulin. This is for either a diabetes type 1 or type 2. Reading the nutrition labels, we're going to see the total carbs serving, including dietary fiber and total sugars. Carbs are measured in grams, and there is not one-size-fits-all for all meal plans. It's all based on age, weight, physical activity, lifestyle, and the type of diabetes. It's important to not pigeonhole the solution. It depends on the particular individual we're working with. Mealtime is also important. It's recommended for people living with diabetes or lack of daily meal structure to have a daily meal routine. Skipping meals can cause blood sugar to drop, that's called hypoglycemia, or to rise too high, hyperglycemia. Eating before or after physical activities can also affect our blood glucose levels. Patients should refer to their provider for mealtime and medication guidance. And then the CHW can help guide them through dose recommendations. It's important for our patients to understand nutrition facts and the labels. One of the most important pieces that I believe when I'm working with a patient is the serving size, because the serving size on a container might be two serving sizes, and they think they're just drinking one serving size. So be sure to make sure that this patient understands to read that top line of your label. Then there's the calories, how many calories per serving size. And it's important to teach our patients how to read the ingredients and the nutrients that are found in that particular food item. And then there's the percentage of daily value. Nutrition fact labels are used to monitor calories and the nutrients of foods in our drinks and counting carbs particularly. We want to choose items with higher dietary fiber, vitamin D, calcium, iron, and potassium. And we want to choose items with lower saturated fat, sodium, and added sugars. The information and nutrition items in the nutrition label is based on a 2,000 calorie a day diet. So have patients defer to their provider to make any adjustments. Also we find hit clues in our label. Sugars are added to some types of food during the process, during processing. Check the ingredients and look for words that end with O-S-E, like fructose, maltose, and any ingredients that include syrup or juice. Those are going to be high in sugar. Foods that are listed under added sugars are listed under total carbs. And foods that may include added sugars that sneak into our diet are salad dressing, yogurt, bread, spaghetti sauce. One of the wonderful ways, this is I found the best way to really teach someone how to plan their meals. Help them understand the ADA diabetes plate method. The diabetes food hub has budget friendly recipes and additional resources. But this graphic is really the most attractive way to teach anyone. But in the food hub, you can find English and Spanish resources as well. So this will give you substitutions and we're going to get into how culture affects these different decisions. So we see that cultural context in healthy meals impacts the outcomes. Cultural influences what and when the individuals will eat. Awareness and understanding and cultural beliefs and practices related to nutrition, such as eating patterns, sources of nutrition is important for appropriately educating and to build a rapport with our patients. A common component of nutrition education has to include the power of connection to that cultural identity when modifying our meals. Cultural awareness of commonly consumed food choices is necessary for appropriate education and for treating our patients from various cultures. For instance, here we see this plate and it has the different options. It's very attractive, very engaging. The hardest thing to change is the water. Trust me, I've experienced that. But here's a Latino plate and this is nice, simple, very easy to see. And they can kind of plan their meals this way and their portions. Here's a Native American example. And then we have another example there, an Asian example. And if you don't know, many communities do have ethnic grocery stores. So it would be a good idea as a CHW to just go visit and see what kind of resources they have or what kind of options they have. There are several myths about cultural foods that they're unhealthy and they shouldn't be a part of the diet. I don't agree with that. Many traditional ingredients have always been healthy and versatile. You can modify the way that you're cooking things. It's important for your patients to learn how to prepare the foods while still keeping their blood sugar targets in range. The CDC cites some examples. Leafy greens are traditional for African-American dishes, also called soul food. Collard greens, mustard greens, all those delicious foods. When a part of a healthy diet, they can help manage the blood glucose. Hoina, which I'm sure I'm mispronouncing, is a popular health food in traditional Latin American foods. It's known as the ancient grain. Legumes like beans and peas and lentils are also important for healthy eating. Lima and navy beans are often found in African-American dishes, pinto and black beans in Hispanic, and lentils and chickpeas in traditional Indian meals. Healthy eating can be about making the foods you love and grew up with fit for your needs of health goals and healthy goals. You can utilize alternate healthier options while maintaining the spices and the flavors of that original food. For instance, the CDC offers a few examples for making these foods. Smothered greens, you can swap out high-sodium, high-fat meats with smoked skinless turkey. Potato curry, instead of using potatoes, in Indian dishes, you can use lentils or cauliflower. Fajita tacos, you can replace fajita with shrimp, fajitas with beef and shrimp for chicken, or make it vegetarian. Part of what we're trying to convey to our patients is to give them that patient empowerment to improve their diabetes care and identifying these strategies to address the SDOH that they face. So patient empowerment is defined by the World Health Organization, or the WHO, as it is a process through which people gain greater control over decisions and actions affecting their health. And this is important because when a person is empowered, they feel they make a difference. They can make more of an informed decision in their health, particularly after COVID. Having this empowerment is important for our patients. A person with diabetes can make a large impact on their health through the choices and the physical activity that they embrace. So how do we start? We listen to know where the barriers are. That's number one. True to any CHW, right? We first have big ears, small mouth, we listen. If we let the patient explain any issues that they're having, identify where they're having these problems, demonstrate to us the use of their diabetes-related supplies and where they're having the problems, please never assume that you know what the issue is. Listen and let them lead the way. Listen to know where the barriers are, and then let the patient explain them, right? We want to also teach them, and here's a couple of examples. Right now with technology, as much as it is, this is a great example of empowerment. When we're accessing, for instance, a patient's online portal at a doctor's office to refill my insulin, say, this can become a barrier. This can create a delay on how I get my insulin or whether I get a refill or even eventually stop follow-up visits because it's difficult to get into the portal. The CHW can teach the patient how to do that or teach them another way of communicating that they're needing a refill. And unfortunately, some of these portals are only in one or two languages, and we have more of a variety of people groups in our community. So we also want to use the teach-back method. In the teach-back method, we see that people can practice helping someone to understand. So we go through the process, teaching them how to do things, and then we let them tell us. So of course, depending on the scenario, this can be a demonstration or it can be a verbal explanation. For example, let's take a patient that is testing their blood glucose. Let's show them step-by-step how to perform their blood glucose test with explanations why they're doing things. The why is important. And then answer any questions that they may have. Have them then show you how they're testing their glucose and then provide feedback for corrections and celebrate and encourage them when they're doing it right. The other thing that we do is educate them. Education gives them access and allows them to know how to access available healthy food that is in their community. We need to teach people how to select the nutrient-dense food choices, how to practice food safety, food safety strategies, how food choices affect their blood glucose, what happens, like do you get sleepy after you eat a lot of bread? Examples like that are really great to give to our patients. How to incorporate cultural foods into our meal planning. We want to celebrate their culture, so how do we do that? And of course, the ever-present budget-friendly ingredients. We need to help them understand how to find budget-friendly ingredients. So overall, there are three steps on these strategies. First, plan. Educate with your registered dietitian, nutritionist, or your care team to help your patients customize the recipes to incorporate cultural foods, include budget-friendly ingredients. So have a talk with the dietitian and explore different options. And then help your patient make a shopping list and stick to it, helping them to learn to shop after they have planned their meals that will keep them from impulse shopping and getting those snacks that sneak into the cart. Address any transportation issues. It's important that your patient has access to healthy foods and to their doctors. So helping them find these resources is very important. Also discuss about fresh, frozen, or canned. Comparing the shelf life of fresh fruits and vegetables to frozen, for instance, and how they're resealable, and how they normally have less sodium and less sugar. And then teach them that if the only option they have is canned foods, then how to find foods with lower sodium and lower sugar and not in heavy syrup. Store brands is another way of saving money. Purchasing store brand versus name brands can save up to 20 to 30 percent, but you want to make sure that they know to read those nutrition labels, because there could be some hidden sodium or sugar increases. Coupons. Coupons are a great way for people to save some money. These are available online or on their phone. They can become members of whatever the store is, and they can compare the cost savings there. Growing a garden, for instance. Balcony gardens are great. You can grow tomatoes. You can grow lettuce. You can grow all kinds of things in a small garden. Food pantries. Connecting to the food pantries, knowing where the food pantries are, and kind of exploring. I like to go and explore these food pantries to know whether or not there are fresh fruits and vegetables in that pantry before I recommend them. That warm handoff that we always talk about as a CHW. So we want to encourage them to stay on track by doing some daily checks. Blood glucose should be checked, or as doctor directs, daily, or whatever the doctor says once a week. Follow the doctor's lead on that one, but teach the patients how to track their numbers, how to jot them down in an app or a piece of paper, a notebook. Regular foot checks, making sure that they know how to use the mirror to check their feet, because that can cause their feet to not be very sensitive, so when they get hurt, they don't realize it. So make sure that they know how to take care of their feet. Medication needs to be taken even when I feel well. That is something that we encourage our patients and encourage them to have pillboxes so they can track and they don't forget, did I take my medicine this morning? So we want to make sure that they know to track their medication. Help them identify safe places where they can go and walk. You know the neighborhood. You're at CHW. You know the safe places. You can recommend those. Make sure that they know how to get to those healthy foods. Encourage them to stay on track by encouraging regular checkups. We want to make sure that they try to get their A1Cs every three months and that they get dental exams, because we know that high glucose levels causes problems with our teeth, and eye exams. There are some places that offer free or low-cost options for this. And always, always follow the registered dietician's nutrition periodically, just to make sure maybe the person has lost weight or maybe something has changed, their activity has increased, and their nutrition needs to be changed. CHWs work long hours, drive long hauls. We work miracles some days. And we really, really care for our patients. We become the experts on our clients' condition and strong advocates for life-changing decisions. CHWs are the coaches of true warriors. So I encourage everyone to just keep up the good work. I love our work. So we've listed some resources so that you can access those. There's a lot of really good things here for CHWs to use. Please access those. And I'm going to open it up for questions. Thank you so much, Margarita. Thank you so much, Mrs. Hart. That was such a wonderful presentation, and just thinking about how, yeah, fantastic, awesome, good comments in the chat. So we are really looking forward to questions now. So if you have any questions, feel free to put them in the chat. I'm happy to read those and share those to Ms. Hart. While we're thinking about the questions that we have, I did want to mention that the ADA diabetes placemats, there's been great interest in those. Those are available through the ADA. There's a link in the chat or will be another link in the chat to access those resources. I use those in practice as well. They're absolutely fabulous. They're so helpful. I guess I have one while we're still thinking and we're still ruminating. So just thinking about the roles and responsibilities of the community health worker and how community health workers work with diabetes in the care team, how they work in the community centers. So we could talk a little bit about that. I see Kaylani has a question here. So how would you motivate the patient in doing all of this? You talked about quite a bit today. Yes. It doesn't get done in one visit, right? A lot of it is relational, particularly people after COVID where they were so isolated. I think it's important to build that rapport and getting them to be, we're their cheerleaders, right? And building that relationship with them and celebrating little steps. But I think it's a process. I've had patients that it's taken almost a year to get them to really, really care for themselves. We find that a lot of patients, they're always helping everyone else. And so they don't have time to prioritize themselves. And so that's really important that we build that rapport, especially with cultural issues where the food is hard to get. That's their identity. They're homesick. They really want to connect with their culture. So I don't know if that answers that, but it takes a while. It takes a while. Be patient. It's a long game. Yes. Wonderful. Thank you. So we have a couple more questions here. Mary Perry. Says community health workers are such an important piece of diabetes self-management. How can diabetes care and education specialists find community health workers? I want to work with one. She says. Yes. Yeah. So I don't know where this person, what state, but most of the states have a, like an intro counterpart where a community health worker association for the workforce. So I would start there. To kind of guide you or the health departments, the state health departments usually have some knowledge, especially right now with a lot of emphasis on CHWs. There were a lot of grants. There was a HRSA grant that went out that was training community health workers. So if your state was a recipient of one of those grants. They were training them so that for the workforce, that was the the purpose of that grant. So I would begin searching health departments, anyone that is a recipient of a HRSA grant, maybe some of the universities that are doing some research usually have community health workers. Wonderful, thank you. Mary Stacey says, do you think that being from a different cultural background is a disadvantage in the community health worker role? No, I think that you can learn, right? We can all learn. I know that, for instance, I'm a Latino woman, Latina woman, and I serve the Burmese community. I had a learning curve. It took me a couple of years to really participate in some of their activities. And what I did is I went to the fun activities to then begin to learn the different culture, the different eating. And I would go to the grocery stores. And I think we can learn those and being sensitive and culturally accepting of the differences. You know, I think that that takes you a long way to really being able to serve the different cultures. And now we're two peas in a pod. I love it. I go and serve them. And I'm familiar with their foods and their traditions and very respectful of those things. I'm always learning. We're always learning new things from each other. So just putting that learning hat on is a good way to do it. Thank you for sharing that. Wonderful. So just a comment here before some more questions. Martina Tatum says, our food pantry does not offer cultural foods, not even diabetic friendly food. I've seen clients coming back with frosted birthday cakes, even though they're diabetic, which is it's tough not being able to influence or affect that food environment. Yes, it is. It is. Have you seen that? And this is where I really encourage our patients to just do a pot garden, you know, to to have pots and grow their tomatoes or some fresh vegetables. But it's really hard to maybe getting to know some farmers in the area. But it's it's hard because a lot of the food pantries really don't have adequate food for them. Yeah. Thank you. Yeah, we're we're thinking about that, too, in Wisconsin. How can we make those connections with local food pantries and with with pantry leadership to influence and make those connections with local growers and producers to to share food? Yeah. So Susie or Susie Rupert says, Margarita, you as a community health worker, how how do you keep yourself healthy to coach your clients? What is your personal technique to avoid overwhelming them? Yeah, I'm telling you, it was rough during covid. Right, because we had so many people so sick and the health system was not able to take care of them. So the CHWs were at the front line. And I learned from that year, year and a half that I needed to take time for myself. And self-care is very important. One of the things that INCHWA does for our health workforce is that we offer mind body medicine. And that's one of the things that we really encourage people to have mindfulness and take a moment. We cannot serve from an empty cup. And CHWs tend to like to run, run, run, run until they drop. And we can't do that anymore. So I try to put a regimen of exercise and mind body medicine, journaling, mindfulness in the middle of the day between patients or between meetings. I take a walk and I really am mindful about the things that I'm looking at, smelling, feeling, eating. It takes it takes commitment to yourself because you can't help anyone if you're sick. So I encourage you to do that. Yeah, well stated. Thank you. So I have the Q&A panel. So I just saw the in the chat. Make sure that you put your your questions in the Q&A panel and then I'll go down those. So I see Ana Garza says, can you talk about portions? Example, wanting to eat tortillas with rice and potato with meat. Yeah, so I try to I mean, obviously you want to go to your nutritionist first. You want to understand what are the needs of that patient? But I personally love tortillas. So I try to make sure to use them as a treat. So if I have been active that day for dinner, I will allow myself to have two tortillas because I want to make sure that I monitor my carbs. So I kind of go for me personally. I use I use with my patients the reward system. Reward yourself. You don't want to just cut them out because that would be so hard. Right. But reward yourself kind of if you've been active today, I did some yard work. That means that translates into maybe I can have one tortilla tonight or two tortillas. But it definitely depends on your nutritionist and your patient care. Just always be aware of what their recommendations are before anything else. But yeah, it's a it's a way to do it. I talk about with my patients, the asset approach. So what can we add? What are those foods based on those placemats from the ADA? What are the foods over to the side that we can add? So I love that. I love those ADA. Those are perfect because they're so easy to get and so easy for the patient to say, oh, yeah, I can do this. Yeah, I love that practical application without being at the point of purchase where you have that grocery store there. Right. You can see the foods and make those those connections. Wonderful. Right. Thank you, Ana, for that question. So Gloria says my family and neighbors are Mexican tortillas and corn based food is a big thing. So how does one start to help community in understanding the importance of change? So let's I think we were just kind of talking about, you know, not that deficit approach to foods are bad. Right. But that was my little interjection, not Gloria's question. So she said, I know that I like to avoid stating not to give up things, but to cut back. So what are your suggestions? Yeah, that's that's exactly it. Yeah. Also substitutes. Right. I mean, now there is wonderful. What is it? I saw spinach tortillas and some vegetable tortillas that maybe are also good substitutes. So just kind of being aware on the trends, what's new. That's good. Yeah. Thank you, Gloria, for that question. Caroline says, do you have any questions for diabetic clients who are unable to cook for themselves due to chronic pain? Oh, yeah. Yeah, I have had a couple of patients like that and just kind of rallying a community around them that, you know, we have Meals on Wheels here in Indiana, in central Indiana, and working with them to see what options they have so that the meal can be delivered to them. Definitely not something that is from McDonald's. I'm not to say McDonald's is bad, but not fast food, food, food, but healthy food, but rallying a community around them. It's really important for people that are not able to do for themselves to have others and helping the patient think through who can who can come in and serve you a meal or have a meal for you on on a weekly basis or something like that. So that takes a little bit of work. Yeah. And, you know, with Family Health La Clinica, this is where our community health workers shine is they they know that community resources and they're able to say we've, you know, been in, you know, northern rural Wisconsin and our community health workers been like, oh, yeah, I have a connection there. Let me text them. And so we see over and over. This is why the community health worker model is so effective. Right. The connections. Definitely. Thank you, Carolyn. And maybe one time for one more question here. So Carlos Lucas says, is there a website for a free pantry delivery for those patients that do not have transportation alone or no support system or surgery? And I think we just kind of talked about that a bit. I wish there was, you know, it depends on each community. And I mean, that's a great project. Do you have any college students, any college students? That's a good way to engage your college community or another community of that maybe can take that up as a project. But yeah, it's I wish everyone had that. And Margarita, you mentioned earlier to Mary Perry's question, you know, thinking about how to identify a lot of locate community health workers. So, you know, Carlos, maybe try your health department, community health worker association. You know, maybe there's HRSA grant infrastructure where you are. So just trying to make those connections. Yeah, we have to think outside the box, right. We have to think creative. Who could be who could we engage? There are a lot of retired folks that are still mobile and maybe want something to do and just kind of connecting them, especially through social media. You get a rally, some people that are really wanting to make a difference in their community. All right, it is eleven fifty. I regret that we are wrapping up. Thank you so much for for joining us today. Thank you so much, Margarita Hart. Thank you for sharing your wisdom, your expertise, your your experience with us. This has been such a great learning opportunity. So this concludes our presentation again. We'd like to thank everybody today. We'd like to thank Margarita Hart. Be sure to complete the post-event evaluation. This will allow you to obtain the CE credit. Two more things. So just a reminder, the ADA placement and placemats that were talked about so often today, those are available through the ADA. There will be a link in the chat for those or there has been a few links so far. And then a recording of the webinar will be available after today's session. So, again, we want to thank you for your time. And that concludes our session. So have have a great week. Thank you.

webinar

Margarita Hart

community health worker

diabetes management

social determinants of health

cultural awareness

nutrition education

patient empowerment

chronic pain