Diabetes Awareness & Wellness Network (DAWN)

Summary

The Diabetes Awareness & Wellness Network (DAWN) is a free, membership-based community center in Houston for people with or at risk for diabetes and their caregivers. DAWN makes clear that it is not focused on diabetes diagnosis or treatment – instead it provides diabetes self-management education, intended to complement clinical care received elsewhere. DAWN’s educational offerings include classes on nutrition and cooking, physical activity, prediabetes and prevention, and awareness of diabetes complications.^[1] It has classes available in English and Spanish.

In addition, the DAWN center has several on-site resources available in addition to its class offerings. Any DAWN member with a note of approval from a health provider can use the fitness facilities at the center. In addition, members have access to nutrition and health coaching and goal-setting assistance.^[2] On-site staff are available for support and include a public health nurse educator, fitness trainer, nutritionist, public health educators, community health workers, and a senior counselor.

All of DAWN’s offerings are available for free and do not require insurance – participants only need to enroll as a member. Upon enrolling, participants receive access to diabetes self-management classes, fitness facilities, coaching, and nutrition resources. The center is open both to people with diabetes and prediabetes and to their caregivers, who might share an interest in learning more about diabetes self-management.

DAWN also offers community outreach services including a Mobile Unit. Organizations can request to have the Mobile unit present at community events, where it provides diabetes risk testing and health coaching and distributes educational materials about diabetes awareness, prevention, and self-management.^[3]

The DAWN center and its programs are supported by the Houston Health Department. The center opened in 2013 and is located in the Houston’s Third Ward Multi-Service Center.

Keys to Success

Free for members

Accessibility and affordability are among DAWN’s most obvious, and most important, strengths. Membership is free, and it comes with free access to the wide variety of resources offered by DAWN. In eliminating cost, DAWN eliminates one of the most important barriers that might otherwise prevent a large proportion of people from exploring and using the educational offerings and resources that the DAWN center has to offer.

Emphasis on support, not treatment

DAWN deliberately communicates that it is not a diagnosis, treatment, or care center.^[4] Instead it is a resource for people who choose to take advantage of it – all of the offerings are free, optional, and aimed at developing skills and knowledge for diabetes self-management. By deliberately avoiding any sort of over-medicalization, DAWN achieves two distinct goals: First it creates an open, unintimidating space that avoids the potential sense of failure or stigma that a doctor’s assessment or diagnosis might bring. Secondly, it approaches health from the everyday angle of self-management and community-building, rather than through the often-discontinuous mindset of medical check-ups.

Multiple resources in one location

DAWN creates a powerful setting in which to teach the skills of diabetes self-management, because it provides space for people to learn and practice many different aspects of management all in one place. Through the DAWN center, members can learn about diabetes basics and complications, nutrition, and physical activity and develop peer support networks. Moreover, they have the opportunity to practice these skills in the same place that they learn them. For example, members can work with a nutritionist on dietary goal-setting and planning and take a group cooking class in the same space. Likewise, DAWN offers both physical activity classes and allows its members to use free fitness facilities. By putting education and practice in the same space for a wide range of core self-management skills, DAWN establishes a powerful way for members of the community to better manage their own health.

Meeting people where they are

DAWN’s Mobile Unit works to spread awareness of diabetes and prediabetes by going to groups of people, rather than by waiting for individuals to proactively show up. Community members and organizations can even request for the Mobile Unit to attend local events and spread awareness through informational resources and diabetes risk tests. Through its Mobile Unit, DAWN can raise awareness among people who otherwise might slip through the cracks of the standard healthcare system.

Cost Effectiveness

While the it is hard to measure the direct costs of DAWN, its model has the potential to create substantial long-term cost savings if its members demonstrate measurably improved diabetes self-management. In addition, the focus on skill building for self-management and healthy living, rather than on individual one-to-one treatment and care, has the potential to create health benefits that spread beyond just DAWN members to others in their households or peer groups.

Ability to Inspire

As a program within the health department of a large city engaged in a variety of population health initiatives, including Cities Changing Diabetes^[5] and Go Healthy Houston,^[6] DAWN provides an opportunity to serve as a “proof of concept” pilot for what a community-based diabetes and health promotion center might look like. If DAWN delivers meaningful progress, it can serve as a model for other, smaller cities to take on what might be, for them, a proportionally larger but still worthwhile investment in local health.

Drawbacks & Limitations

While the DAWN center itself provides something of an all-in-one facility for members, it also provides a potential drawback in that the centralized location may present a challenge for some members in accessibility. DAWN’s benefits for members living nearby, or with easy transportation to, the center may not be available to those living in farther neighborhoods of one of the largest cities in the United States. Ideally, a city of millions could have a network of such centers, increasing accessibility for the entire population.

Likewise, the hours and course offerings at the DAWN center fall largely within standard working hours on weekdays. While DAWN  offers evening hours on some weekdays, only a few of its classes are offered after 5pm on weekdays, and the center is closed on weekends.^[7] While this may be unavoidable due to limited resources, it presents a significant downside, as some of the most meaningful benefits that the center can offer may be inconvenient or even impossible for a large proportion of Houston’s adult population to access.