AMPATH/MAPAS México Builds Bridges for Health for People with Diabetes in Rural Puebla

In honor of World Diabetes Day, the AMPATH/MAPAS México team is shining a light on a growing collaboration to improve diabetes care in some of Puebla’s most underserved communities.

In the spring of 2024, a team led by Dr. Tim Mercer, Dr. Rebecca Cook and Dr. Ricardo Ainslie from The University of Texas (UT) at Austin received a Bold Inquiry Incubator Grant from the university’s Office of the Vice President for Research. Their project, “Developing an Innovative Model for Treating Patients with Diabetes in Rural Mexican Communities,” marks a key step toward improving how diabetes is understood, managed and treated in two rural communities near Puebla, Mexico.

Working with partners from UT’s Dell Medical School, the UT School of Nursing, Department of Educational Psychology, Benemérita Universidad Autónoma de Puebla (BUAP) and Mexico’s National Institute for Public Health, the team set out to learn from the people most affected by diabetes: local residents.  Using focus groups, they conducted a needs assessment in the communities of San Francisco Xochiteopan and Colonia Agrarista Emiliano Zapata, listening to patients, families and promotoras comunitarias (community health workers) share their experiences and challenges in living with and managing diabetes.

"Our plan was to assess community experience with and knowledge of diabetes, as well as to explore barriers to care,” said Dr. Ricardo Ainslie, director of education and research for AMPATH/MAPAS México. “We came to listen, to understand how people in these communities think about diabetes, how they support each other and how they want to be part of the solution. That’s the foundation for any sustainable model of care.”

Through focus groups and individual conversations, alongside community partner, the Fundación Comunitaria Puebla, the team identified a shared need for group-based care models that combine medical support with health education, peer encouragement and home visits. Using the findings, the team has already developed a framework for group diabetes sessions, including educational materials, an intervention map and strategies to ensure participation from all stakeholders.

The needs assessment is part of an AMPATH/MAPAS México initiative to build community capacity and strengthen health systems for non-communicable diseases in rural, underserved communities in Puebla, Mexico, supported by the Indiana University Foundation from a donation of more than $3 million USD from Eli Lilly and Company to Indiana University Foundation. The donation is intended to support Indiana University Foundation in its efforts related to supporting AMPATH. Through this initiative, AMPATH/MAPAS México aims to help 3 million people living in resource-limited settings in Puebla, by 2030.

In the next phase, local medical providers and community health promoters (promotoras) are helping refine the group diabetes education sessions, AMPATH promotoras and pasantes (social service medical trainees) have been conducting home visits to help screen, sensitize and recruit for the official launch of the diabetes group-based care intervention in the two communities. Promotoras and frontline primary care providers and trainees are also receiving training in diabetes self-care and motivational interviewing, a patient-centered communication approach.

For promotoras and participants alike, a community-based diabetes intervention represents a way for their own communities to help find solutions.  Promotoras from AMPATH communities shared:

“The training workshops have helped me a lot, they help me to feel more peaceful.”

“I can explain things and debunk myths about the illness (diabetes).”

People living with diabetes have also expressed enthusiasm for the approach. “I feel alone, so attending a group would help me to feel less alone and to know what is good and what is bad,” said one participant.

By weaving together scientific research, local knowledge and international partnership, AMPATH/MAPAS México is demonstrating what’s possible when communities are placed at the center of innovation.  “The power of this work is in collaboration,” Dr. Ainslie said. “When universities, health systems and communities learn together, we can build models of care that are not only effective but deeply human-centered.”

As the world reflects on the global diabetes challenge this November 14, AMPATH/MAPAS México’s work in Puebla stands as a reminder that solutions start by listening and that the path to better health runs through community.