Training Collaboration Bringing Diabetes Education to the Underserved People of Rural Appalachia

Due to the rural nature of Kentucky’s Appalachian counties, it can be a challenge to provide services and resources. But Qsource Quality Improvement Advisor Nancy Semrau, Registered Nurse (RN) and Licensed Diabetes Educator (LDE), looked forward to bringing training to residents of this area.

She knows diabetes self-management education and support (DSMES) is a proven intervention for empowering persons with diabetes to acquire the information, skills and confidence they need to manage their health. “DSMES can help prevent and lessen the severity of complications resulting from diabetes such as kidney disease, neuropathy, amputations, loss of vision, heart failure and stroke,” explained Semrau.

Using lessons learned from the Everyone with Diabetes Counts (EDC) program, Qsource offers DSMES courses to individuals as well as a train-the-trainer program to increase the numbers of diabetes course facilitators. The EDC program aims to improve clinical outcomes of A1C, lipids, blood pressure, weight, and eye and foot exams for people with diabetes.

In July 2015, the Kentucky Health Center Network (KHCN) distributed an email promoting Semrau’s classes. That caught the attention of staff at the Mountain Comprehensive Health Corporation (MCHC), a multi-location practice which serves a rural population at nine locations in five Appalachian counties. Semrau eagerly organized classes at two of those locations and trained two RNs to facilitate Diabetes Empowerment Education Program (DEEP) DSMES courses. MCHC has had six people trained, and these Peer Facilitators (PFs), RNs and a registered dietitian, have conducted 17 DSMES courses and had 171 people attend at least one of their sessions.

In April 2017, with guidance from Qsource, one of MCHC’s original PFs, Chasity Eversole, RN, became a Kentucky LDE. “Since the Commonwealth regulates the practice of diabetes education, the license gives her a legal scope of practice to provide the education,” said Semrau.

Eversole feels fortunate to have the opportunity to provide diabetes education to patients at several clinic locations.

“Too often participants have said they previously had no diabetes education. I love the fact that the DEEP curriculum is broken up into easy-to-understand sections with hands-on activities and visuals that make it easier for participants to understand. At the end of each module, participants provide positive feedback on the information that they are presented with. Many have said they wished they would have taken the class sooner,” said Eversole.

“This proactive and engaged organization has a high level of commitment to improving the health outcomes of its patients,” according to Semrau. She believes the success of this partnership is rooted in having a driven champion supported by her organization. “Our collaboration was built on extensive communication, support and mutual respect.”

Ernestine Hill, one of the MCHC PFs trained this year said, “As an RN, the DSMES course has been the most rewarding in providing another level of care to our Diabetic patients. The response and confidence patients have shown in a better understanding of their diabetes, is immeasurable. We have reached rural areas, provided education and care, which otherwise would not have been available.”

“Becoming a Diabetes PF and teaching patients with diabetes how to better care for themselves and their loved ones is hands down the most rewarding assignment I have ever completed as a nurse,” according to Marcella Fields, RN, another MCHC PF trained this year.

As a result of the positive relationship, MCHC referred Faith Moves Mountains (FMM) to Semrau. FMM is an initiative led by the University of Kentucky’s Department of Behavioral Science. A series of projects aimed at improving the health and wellbeing of Appalachians, FMM is grounded in the concept that churches are the heartbeat of communities. Working with local pastors, congregations and community organizations, researchers team up to provide communities with evidence-based research projects aimed at decreasing health disparities.

In Fall 2017, FMM received a $3.1 million grant from the National Institute of Health to continue their work, this time with a diabetes focus. In this project, researchers intend to reduce adverse outcomes by educating people with Type 2 Diabetes about self-management and training community-based facilitators to help coordinate health care services.

Through the partnership with Semrau, FMM was able to send eight team members to an Qsource Peer Facilitator Training.

“The training we received from Nancy and her team was second to none,” said FMM Project Manager, Tiffany Scott. “Thru the partnership, we were able to have our team members trained locally in the Diabetes Empowerment Education Program (DEEP). This was a huge advantage and cost saving for our project. Over the next five years, FMM plans to deliver the DEEP Program to more than 40 participating sites, serving more than 1200 participants,” Scott added.

“As of March 2018, three of FMM’s staff achieved Lead Trainer certification through the University of IL, Chicago, reported Semrau. “The FMM partnership has helped build a sustainable program which will continue to grow and educate numerous people with diabetes in the underserved counties of our Commonwealth.”

Through the training collaboration with Qsource, dedicated staff at both MCHC and FMM are educating more people in rural Appalachia. For more information about bringing courses to your area, please contact Semrau. (