Acres of Diamonds: Rediscovering Community Assets in Dallas Backyards
Chavda, Avinash Suresh
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BACKGROUND: Diabetes directly affects 8% of the US population and poses a growing burden to healthcare providers, to the health system, and to society. Cultivating self-efficacy enhances personal agency and enables patients to take an active role in the management of their disease. Effectively cultivating self-efficacy among patients from diverse backgrounds requires a patient-tailored assessment of existing gaps in patients' diabetes self-management skills. Tying patients to existing community health resources through ZIP code-based mapping is an effective patient-tailored intervention that creates long lasting change in diabetes self-management. To this end, a two-armed approach to community resource mapping was taken: In the first arm, existing resources in the categories of exercise, nutrition, and diabetes management were catalogued and mapped across Dallas County ZIP codes; in the second arm, patient awareness of existing resources across the same three categories was mapped across Dallas County ZIP codes. A comparison of each study arm across overlapping ZIP codes showed that resources abound in Dallas, but awareness of these resources is the limiting factor in fostering increased patient self-efficacy. To increase self-efficacy and empower patients to improve self-management of their diabetes, patients should be connected with community resources to tackle the issue of underutilization of community resources and thereby gain "mastery experiences." OBJECTIVE: This project hypothesizes that community resources are plentiful in Dallas and that there is a relative lack of awareness of community resources, limiting patient self-management of diabetes. METHODS: This study mapped community assets in the categories of exercise, nutrition, and diabetes management across the Dallas ZIP codes with the heaviest burden of diabetes. This study then mapped awareness of these same resources and compared both maps to identify a disconnect between community resources and the communities they serve. RESULTS: Sample maps of community assets in several of 14 target ZIP codes were produced with the aid of Google maps, showcasing the abundance of community resources throughout the ZIP codes of Dallas County, including those with poor clinical and socioeconomic measures. Though results may not be representative of individual ZIP codes, awareness of resources appears to vary more directly with these clinical and socioeconomic measures than does true resource distribution. CONCLUSION: This study applies quality improvement and process analysis tools to empirically advance theoretical population health frameworks. Asset cataloguing and geospatial mapping demonstrate an abundance of community resources evenly distributed throughout Dallas but a dearth of resource awareness that loosely correlates with negative community measures. Such measures include median household income, BMI, HbA1C, and crime index. Continued indexing of Dallas County resources with more sophisticated mapping software will yield asset catalogues more consistent in their value to society; and continued awareness surveying is necessary to develop representative ZIP code awareness maps for deep comparison of these objective resource and subjective awareness measures.