6. Formando Nuestro Futuro/Shaping Our Future

Background: Formando Nuestro Futuro/Shaping Our Future (Formando) is a CBPR project focused on type 2 diabetes within the Hispanic farmworker communities in southeastern Idaho. In Idaho and elsewhere in the U.S., Hispanic farmworkers are at risk for many health conditions. This effort, which involved Idaho State University, evolved out of the Hispanic Health Project (HHP), a needs assessment survey conducted in 1998–1999, a review of diabetes charts at a community health center performed in 2000, and a binational ethnographic project conducted in 2001. Interestingly, there was a discrepancy between the community health clinic’s estimate of the magnitude of the diabetes problem and the farmworkers’ estimate.

Methods: The project used CBPR approaches that employed needs assessment and qualitative and quantitative methods. In 2001, to uncover the true effect of diabetes in the farmworker community, the HHP engaged in a binational ethnographic study of families that were split between Guanajuato, Mexico, and southeastern Idaho. A team of university researchers, promotores (community health workers), and students interviewed families in Guanajuato and southeastern Idaho.

Results: Some individuals described causes of diabetes that are congruent with the medical literature: herencia (heredity), mala nutrición (poor nutrition), and gordura (obesity). However, other individuals attributed their diabetes to such causes as susto (fright), coraje (anger), or preocupaciónes (worries). Thematic analysis of the interviews demonstrated that ideas about diabetes were linked to ideas of personal susceptibility; having diabetes was a stigmatized condition that connoted weakness. Individuals with diabetes were seen as weaker and vulnerable to being shocked and physically harmed by situations that others could withstand.

Comments: In 2004, Formando used the results from the ethnographic project to create a dialogue between the health care workers and the community of farmworkers. Currently, promotores visit each family once or twice a year to conduct interviews and collect data on biomarkers of diabetes. A series of educational modules is being presented at each home visit throughout the five-year study. These modules are based on the questions that the participants had during the previous round of visits from the promotores. In this way, the educational component of the intervention builds continuously on the questions and previous lessons that the families have had. The long-term commitment to using the CBPR approach in these agricultural communities is an effective way to engage in health research and to establish real and meaningful dialogue with community members.

Applications of Principles of Community Engagement: Uncovering the hidden health problems of the Hispanic farmworker families requires researchers to use Principle 2, which emphasizes the need to become knowledgeable about the community’s culture, economic conditions, and other factors. The HHP’s success in working continuously with the community of southeastern Idaho farmers is evidence of its long-term commitment to community engagement (Principle 9) and to its ability to establish relationships and work with existing leadership (Principle 3). Finally, the process by which the Formando project evolved and the development of educational modules based on a specific family’s questions about diabetes is illustrative of Principle 8, which stipulates that an engaging organization must be prepared to release control of interventions and be flexible enough to meet a community’s changing needs.