FHLS components | Description | Adaptation |
---|---|---|
Health educator recruitment | Placed ads in local newspapers; set minimal qualifications as health education experience. | Employed well-connected individuals from the local community with less than minimal qualifications. |
Patient recruitment | Patient recruitment led by physicians or self-referral from clinic recruitment posters. | Clipped patient eligibility referral sheets to medical charts to prompt physician recruitment efforts. |
Patient incentives | Incentives included a tote bag, glucose monitors and strips, and/or blood pressure monitor. | Incentives remained the same throughout the implementation. |
Class sessions | Set curriculum. | Natural variation of teaching style using suggested curriculum. |
Program materials | Posters, brochures, workbooks, low-literacy format, flipcharts for diabetes and hypertension, incentives (magnets, calendars, tote bags, medication pill box, medication compliance worksheet, food sheets). | All program materials were used and appreciated by patients and clinic staff. A few health educators enhanced materials, even though it was discouraged by project staff. Translated materials according to various Spanish-speaking cultures. |
Program manuals | Developed by project staff and used in all clinic sites for standardized training and implementation. | The clinic training schedule was adapted to the needs of each clinic site. |
Patient retention and follow-up | 6 month commitment from patients. | Scheduled patient's health education appointments in conjunction with medical appointments. |
Technical assistance | Offered support to health educators via e-mail or telephone, as needed. | Need for daily support to health educators was much greater than anticipated by project staff. |
Staff incentives | Not included in the original design. | Frequently requested to increase staff buy-in. |