'It's in our interest to learn this stuff'
CHARLESTON, W.Va. -- After Sunday church at Shiloh Baptist, Regina Elzy slipped downstairs to Chronic Disease Self Management class. "We'd praise God, then go learn how to take care of the bodies God gave us.
"When I got home, my husband and I'd go over what we did in class, so we got a twofer," she said.
"Diabetes, we both have it," she said. "That's life, and you deal with it. We enjoy life, and we sure don't want to have a leg amputated or be on kidney dialysis.
"The class teaches you how to hold all that off. It teaches you how to lower your stress and bring your blood sugar down. So it's entirely in our interest to learn this stuff."
"This stuff" is the six-week Chronic Disease Self-Management Course created by Stanford University School of Medicine.
"Doctors can only do so much for you," John Elzy said. "You've got to do the rest. So the more you know about how to take care of yourself, the better. Information is power. That class was packed with information."
Now the Centers for Disease Control is urging states to spread the class statewide, as a way to fight obesity and chronic disease. West Virginia is "trying to figure out how to do that," said Chuck Thayer of the state Bureau of Public Health.
Since 2003, Marshall University has trained about 150 people statewide to lead the course in their own communities, at churches, fire halls, senior centers. "That's how it came to be in our church," Elzy said. "Some of our people got trained."
The people in her class had diabetes, arthritis and heart disease. "The same things helped us all: exercise, stress reduction, good eating, dealing with depression," she said. "You learn more about your disease and how to talk about it with doctors. Everyone lost a little weight."
More than 500 West Virginians have taken the class in the past two years. They rated it 4.7 out of a possible 5, according to a West Virginia University analysis. After the class, they reported they went to the doctor about half as much: 1.9 visits in three months, compared with 3.7 visits before.
"We'd read a chapter a week and set personal goals, then talk about it the next week," Elzy said. "The next week, you'd hear how people did, what worked for them. We gave each other ideas. It made you realize you're not alone."
"That class caused John and me to make changes in our daily lives," she said. "We used to eat three big meals a day, but we switched to five little ones, to keep our blood sugar level. And we started planning ways to stay active instead of leaving it up to accident. I walk down to get the newspaper every day, for instance, instead of getting it delivered."
"With as much chronic disease as we have, I don't think you can offer that class too much," said Perry Bryant, director of West Virginians for Affordable Health Care.
The idea is to offer it where people naturally are, "instead of making them come to us," said Marshall Medical School professor Richard Crespo.
In St. Albans, Betty and Doc Halstead, both in their 80s, took it at the senior center. "Best we've had," Betty said. "Practical and useful."
In Lincoln County, Melisa Ferrell took it at the Mud River Volunteer Fire Department. "It helped me understand my husband, how his mood will change depending on what he eats and when he eats."
In Dunbar, "the people kept meeting after the class was over, because they thought it was that valuable to them," said Rev. James Patterson of the Partnership of African-American Churches.
"We've proved that West Virginians like this class, that it works, and that it can be put on for very little money," said Sally Hurst, program coordinator .
The problem: So far, the class has been offered fairly randomly. There's been no predictable schedule. The leaders have been volunteers, so the class has been offered when there was a place and willing leaders.
Now the state Bureau of Public Health wants to get organized about it, paying Marshall to train "master trainers" who can in turn train others to deliver the class. "If we can get one master trainer in each part of the state, that would be great," Thayer said.
"It's easy to train people," Hurst said. "The leaders' guide is straightforward, like a cookbook, one, two, three, do this, then this. If you follow it -- and if everyone has the book that goes with the course -- it works."
"Our goal is to make it possible for West Virginians to take a self-management class if they want to, no matter where they live," Thayer said. In one county, it might be offered by WVU Extension, a senior center in the next county, and a community health center in the next.
Eventually, he aims to get enough classes organized to post a statewide schedule online, he said. "That will take some organizing to make the pieces come together," he said.
The pieces are there. "Everyone wants to do this, and everyone's trying to figure out how," said Robert Roswell, director of the state Bureau of Senior Services.
"A lot of churches would probably like to do something like this," said Jeff Allen, director of the West Virginia Council of Churches.
Marshall will train employees of most of the county health departments this fall and winter.
Medicaid could become a major referral source in late 2013, as Medicaid begins to pay doctors and clinics to provide care management for obese people with diabetes. "CDSM would be an appropriate part of that," said Medicaid medical director Jim Becker.
In Kentucky, the Legislature gives every county health department a yearly grant to provide at least two diabetes self-management classes a year. West Virginia provides no such grants. West Virginia's training is funded with a Centers for Disease Control Community Transformation Grant, but there are no funds to actually put on the classes.
"It might make sense to hire a few people to go from place to place putting on these classes and training people to lead them," Roswell said. Maybe interested agencies could cooperate to get it going.
"We've got a long way to go," Crespo said, "but we've made a good start."
Reach Kate Long at firstname.lastname@example.org or (304) 348-1798
"The Shape We're In" has been partially funded by a Dennis A. Hunt Fund for Health Journalism fellowship, administered by the California Endowment Health Journalism Fellowships at the University of Southern California's Annenberg School for Communication and Journalism.
Read more about CDSM and watch video at http://www.selfmanagementonline.org.
1. Want to find a diabetes self-management class in West Virginia? Many hospitals, community health centers and other organizations already offer classes. The Gazette has assembled a list. Find a link to it at the top of this story at www.wvgazette.com/theshapewerein or click here
2. For more information and a video about CDSM classes in West Virginia: http://www.selfmanagementonline.org/
3. The national CDSM website: http://patienteducation.stanford.edu/programs/cdsmp.html