That healthful eating is expensive and traditional cultural practices get in the way of eating right are some of the misconceptions that Doriann Cowan, MS, RD, LD, encounters at the Community Health Coalition in Texas’ rural Caldwell County. About 20 percent of the county’s 40,000 residents live below the poverty line and lack access to many social services and other resources. The Coalition, based in Lockhart, provides grant-funded education services to the county’s uninsured and under-insured, free of charge.
“Our patient population presents a wide variety of socioeconomic-related challenges, including limited education, emotional distress and lack of transportation,” says Cowan, whose primary role is to educate diabetes and pre-diabetes patients on self-management through the Coalition’s Diabetes and Nutrition Education Program. “To address some of these challenges, we provide home-based education for those with limited mobility or lack of transportation,” she says. “Home visits allow me to assess food and living environments that may prevent healthy living but aren’t necessarily apparent in an office visit—for example, refrigeration, electricity, medication storage or pest control conditions.”
For Cowan—who also organizes group education for patients, caregivers and family members—knowledge is the key. A significant part of her job is to address misconceptions about cost and cultural barriers to healthy eating. She leads discussions about cooking methods, ingredient substitutions and recipes, grocery shopping and meal planning.
“The program has shown success in lab value improvements, reduced rate of hospital admissions and improved self-management,” says Cowan, adding that the Coalition recently received a five-year grant to expand services to include obesity, hypertension, high cholesterol and tobacco cessation, and to replicate the diabetes program in neighboring Bastrop County.
“I love food. I love helping people. I love teaching. I like to make things understandable,” says Cowan. “For me, the big picture is empowering people to manage their own health.”