Healthcare College of Health Sciences School of Medicine UC Irvine

Audio Transcripts

John Billimeck
What are the unique challenges of hiring and retaining the coaches of each ethnicity?

Hiring the coaches for the project was an interesting challenge because our project involves three different ethnic groups, three different languages. We never could’ve done it without having a good connection with each of the clinics where we are doing work.  We are able to go out to the doctors in the clinics to recommend patients who might be good candidates for coaches. We go to support groups and advertise in different ways in the community. Ultimately, if we didn’t have a good connection with the clinics it would not have worked out as well as it has.

It is really valuable for us to have staff that are native speakers in English, Spanish and Vietnamese. This really helped us in the interviewing and selection process and even in the training process.  It allowed us to work in the native language and see how they talk about Diabetes and how they understood the program in their own native language.

Once you find a coach that fits the program, retention is real good because the coaches themselves become invested in the project.  They find a lot of benefit in their own Diabetes management by working with other patients with Diabetes. We find that coaches are really enjoying what they are doing and they are interested in the research aspect of it…especially interested in the dealing with patients and the chance of being able to help somebody.

The only problem that we’ve had with the retention issue is during the training process.  We recruit more coaches than we ultimately keep in the program.  During the training process we find the coaches that are the best fit for the project. The training process is important because it helps deepen the commitment of the coaches that were involved in the program and find those who were not able to commit the time. Most of the coaches that do this work part time on the project. The compensation isn’t that high so for them to stay in the program, they have to be really committed to it and get something out of it themselves. We have been lucky to find a nice team of coaches that have found those benefits and have stayed with us throughout!

Dr. Israel De Alba
What are some of the main challenges that face Latinos patients in managing diabetes?

Some of the main challenges that face Latino patients in managing diabetes are cultural barriers. Latino diabetic patients are less likely to comply with diabetic medications and appointments. This is based on a cultural model. Diabetes is not taken as seriously as in other ethnic groups. This is a big challenge for physicians.

Dr. Sheldon Greenfield
What makes coached care different from other diabetes education programs?

Coach care differs from other diabetes education programs in that its major focus is on patient activation, patients coming to agreement with physicians about the best regiment for them, and there is much less emphasis on facts and education itself.

Grada Christenson

Coach: success story of a patient, impact with their health, and challenges and benefits

I’ve been working on the coach care diabetes project for more than 2 years and during that time I’ve been working with a patient who has type 2 diabetes for more than 10 years. He was very challenged by a grueling work schedule that made it difficult for him to eat regularly. He had a long commute that left little time for him to exercise. He became so motivated through our coaching sessions that he went back to school, he retrained for a different line of work, and he now has a job with regular hours that is a lot closer to home. He’s so motivated that he even sends me information about diabetes and he continues to keep his A1c, blood pressure, and cholesterol at his target goals. It’s really been a lot of hard work but with the support of a coach he is a true success story of the coach care for diabetes program. This program has helped me personally to really stay focus on my personal health, my exercise, and special goal for diabetes. After meeting with my patients and seeing their success story, I am ready to continue managing my blood sugar. I think that my patients really enjoy the one on one contact they receive with a coach without the constraints that are there with a doctor and patient, especially the time constraints. I think that the qualities I have that really help patients are staying focus on the importance of good diabetes management, having empathy for their personal challenges and life situations, and actually a sense of humor. So I think that being a coach has helped me to help patients see the bigger picture of what they are trying to do to improve their health.

Dr. Dara Sorkin:
What are the qualities that make a good coach?

The coaches who work in our project need to be fluent in their native language and they also need to be diagnosed with type 2 diabetes. And I think having a diagnosis of diabetes is important because it allows the coaches to connect with the patients really on a fundamental level. We train the coaches on how to empower the patients and how to develop treatment plans and set goals but I think fundamentally it’s the sense of empathy that our coaches have for the patients that really makes them good at their job. It’s important that the coaches really understand how hard patients struggle everyday to stay in control of their diabetes and I think that because they have type 2 diabetes themselves they really are able to connect with patients. I think also because they share the same ethnicity it also gives them insight in to what the lives are like of the patient they work with. But probably the most important quality of a coach is to find somebody who is really passionate about trying to make a difference in the community and who feels a great sense of pride in trying to make a difference and helping other people. These are the qualities that we found make really good coaches. They need to be driven to try to improve the lives of other people around them and they need to feel a connection of what they are doing is important.

Cecilia Urquiza

Coach: success story of a patient, impact with their health, and challenges and benefits

When one of my patients first started the program, his diabetes was out of control. He had no idea what was going on with his body. After one year of being with our program, his A1c has gone down to 6.7 and he now understands the effects that diabetes can have in his life and in his health. He feels great now that he has maintained his disease under control.

One of the challenges that our patients face is not having health insurance. They come to the clinic and pay with their own money to see a doctor, and then they do not have enough money to pay for their medications.

Personally, the program has had an impact in my own health. Before, I didn’t know much about my disease. Now, I am well informed about the effects that Diabetes has on my life and know how important it is to take care of myself.

The aspect of the program that my patients enjoy the most is the fact that they can talk to me about anything. They ask me questions and gain the knowledge they need to take care of their own health.

The qualities to become a good coach are being responsible, kind, being able to understand what the patient is going through and having an open mind. Many patients come in with other concerns and have no one else to talk to.

Dr. Quyen Ngo-Metzger
Why do you think the patients enjoy the coached care for Diabetes program?

I think that the patients really enjoy and like the coach care program because they really feel like there is a person that they can connect to that really understands what it is like to have the disease. So the fact that the coach actually has diabetes also and also struggles with the daily management of their diet and exercise and medication really helps the patient feel supported and helps the patient open up to the coach and also to their doctors and help them feel encouraged and have more social support and increase their social network especially if they are struggling with their diabetes or struggling in other areas of their lives and struggling with how to make these choices within their own culture and their own environment.

Dr. Sherrie Kaplan
The practice of being a patient

Most of us if we’ve been lucky haven’t had much practice being patients. The skills of if you will patient hood come from kind of  a crude process of trial and error that you practice, most of us practice during our various encounters with different kinds of physicians. The set up of a doctor’s office is designed to not help with recall. It’s very difficult, one, to imagine yourself in the doctor’s office asking questions in a Johnny. It’s the equivalent of having to take, imagine yourself having to take a math test in a Johnny during that 10 minute office visit. You’re not likely to perform well on the math test. So the coach care program is actually premised on the idea of practicing and rehearsing patient hood skills if you will ahead of time so that when it comes to time when you are actually nervous and in the doctor’s office, you’re likely to perform the way you practiced and you’re likely to ask the questions you thought about and rehearsed a little bit during that same 10 to 15 minute period where you’re distracted, you’re nervous, there’s time pressure, you may or may not be dressed. If we can do a good job at coaching our patients, we think that our patients will then be able to participate more effectively and overcome those things, those barriers that are part of a routine doctor office visit.

Herlinda Guzman
Challenges at clinical setting

For the coaches to be in a clinical setting at the beginning of the program was very challenging because they had never worked with doctors and nurses. The coaches learned ways of communicating with their patients without interrupting the flow of the clinic. As time went on, the coaches became more comfortable and more aware, and became part of the clinical environment.

Bich-Chau Tran
Coach: success story of a patient, impact with their health, and challenges and benefits

He is a one of my patient who has a success story for Coach Care Diabetes. He has been participant to this program since 2006 with his A1C is 7.9 and his weight is 175 pounds. After he see the coach, he started to eat diet and do exercise such as eating the brown rice with sesame seeds which is a special food also it’s very popular in Vietnam. For a first 100 days, he just ate only brown rice and sesame seeds, also he does exercise such as yoga everyday. When he lost about 25 pounds, he did stop eating only brown rice and sesame seeds. He start to eat the brown rice & sesame seeds  with meat, vegetables, chicken, fish as well as a  normal meal, but with a small amount. Right now his A1C decrease to 6.8 or 7.0 and his weight is lower than before about 20 pounds. Even he lost a lot of weights, but he feels good and healthy.  Also he does not taking the pill any more, but He still takes the Insulin (15-17 units every morning).   

My patient has some difficult to face with diet and exercise. When he started to eat diet with brown rice and sesame seeds for 100 days without meat, fish or vegetables, he felt always hungry, and he had not a good taste at all. When he started to do exercise with yoga, he felt it’s not easy to do and very hard to learn.

The program impacted my own health such as I know how to control my A1C below 7.0. I could learn from my patient the way to eat diet for control my weight. I could learn from my patients how to do yoga, and massage my knee & foot for my hurt.

My patient is really enjoyed for this program is the Algorithm book which he can read and learns how to control A1C and how to use the medication as well.

I think the qualities to be a good coach such as how to make patients feel comfortable when they come to see their doctor, help patient to know how to control their diabetes , explain well the Algorithm, be nice with patients.