Scaling Up a Cardiovascular Disease Prevention Program Among a Diabetic Population Within a Regional Health System in Mexico

Abstract

Mexico is facing an epidemiological crisis due to type 2 diabetes mellitus, and its low-income citizens struggle with intersectional issues associated with the chronic disease. Support groups (GAMs) were established in health centers as a self-management resource for low-income individuals with diabetes. Meta Salud Diabetes (MSD), a 13-week self-management intervention developed to prevent cardiovascular complications, cope with mental health issues, and access health services have been found effective for GAM populations. This dissertation assessed existing federal chronic disease prevention programmatic gaps within Mexico, the mental health benefits of the MSD intervention, and extending reach through an ecological scalable approach. A scoping review was conducted to assess federal policies, regulations, and policies for chronic disease prevention, along with corresponding evaluations. Qualitative methods were used to assess stakeholders’ perspectives on the mental health benefits of the intervention, and to identify opportunities for improvement. A test scale-up was conducted within a Sonoran regional health system using an ecological approach. The intervention was implemented in all five GAMs within the regional health system. Results from studies indicate a need to provide more programs and funding for diabetes self-management among low-income communities, including mental health services. The scale-up test provided evidence on a feasible approach to expanding reach of the intervention, while accounting for existing structures and resources within the regional health system. The findings from this dissertation identify diabetes self-management gaps that MSD fills within health centers and among low-income populations within Northern Mexico. However, the examination of the mental health benefits and scale-up efforts demonstrate a need to address structural and financial issues within the health system.