Do Low Income Youth of Color See "The Bigger Picture" When Discussing Type 2 Diabetes: A Qualitative Evaluation of a Public Health Literacy Campaign.

Dean Schillinger,Jessica Tran,Sarah Fine

doi:10.3390/ijerph15050840

Abstract

As Type 2 diabetes spikes among minority and low-income youth, there is an urgent need to tackle the drivers of this preventable disease. The Bigger Picture (TBP) is a counter-marketing campaign using youth-created, spoken-word public service announcements (PSAs) to reframe the epidemic as a socio-environmental phenomenon requiring communal action, civic engagement and norm change. Methods: We examined whether and how TBP PSAs advance health literacy among low-income, minority youth. We showed nine PSAs, asking individuals open-ended questions via questionnaire, then facilitating a focus group to reflect upon the PSAs. Results: Questionnaire responses revealed a balance between individual vs. public health literacy. Some focused on individual responsibility and behaviors, while others described socio-environmental forces underlying risk. The focus group generated a preponderance of public health literacy responses, emphasizing future action. Striking sociopolitical themes emerged, reflecting tensions minority and low-income youth experience, such as entrapment vs. liberation. Conclusion: Our findings speak to the structural barriers and complexities underlying diabetes risk, and the ability of spoken word medium to make these challenges visible and motivate action. Practice Implications: Delivering TBP content to promote interactive reflection has potential to change behavioral norms and build capacity to confront the social, economic and structural factors that influence behaviors.

Highlights

Type 2 diabetes has drastically risen in the U.S over the last decade, disproportionately affecting ethnic minority populations
With respect to individual responses to each The Bigger Picture (TBP) public service announcements (PSAs), we evaluated the degree to which participants integrated public health messages based on their responses to the questions: “What was the video about?” and “What was the biggest lesson?” Responses were grouped into one of four categories: participants fully integrated the PSA’s intended message; discussed a theme related, but not central, to the PSA’s intended message; expressed an unrelated message; or did not perceive a message
The Bigger Picture (TBP) is an innovative communication campaign that both features at-risk youth as creators and performers of novel public health content as well as targets at-risk youth. This model is relevant for conditions such as Type 2 diabetes, where exposures are determined by behavioral patterns solidified during adolescence

Summary

Introduction

Type 2 diabetes has drastically risen in the U.S over the last decade, disproportionately affecting ethnic minority populations. The mean prevalence among adult minority populations with diabetes is 21.7%, in comparison to 11.3% among non-Hispanic whites [1]. Type 2 diabetes has historically been coined as “adult-onset” diabetes, it has increased by 30.5% in youth aged 10–19 years between 2001 and 2009 [2]. Among new cases of diabetes among youth, the vast majority of sub-types in white youth represent Type 1 (an autoimmune disease). Among minority youth, one–half to three-quarters of new cases represent Type 2 (a largely environmental disease) [3]. There is an urgent need to engage at-risk youth in preventing an illness that poses substantial risks for disabling complications

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Discussion

Conclusion