How to Overcome Barriers and Challenges

Once you have worked through the readiness assessment, you should have a better idea of where your strengths and gaps lie in terms of providing a diabetes program. The next steps will be to work through barriers to starting and successfully implementing a new program.

“Things can be so different from one location to the next. …what works here might not work in other places.”

— Diabetes Program Implementer

Our research with food banks across the US surfaced several key findings with implications for program start-up:

KEY FINDING 1

Funding is often a major barrier to starting diabetes programming.

Recommendations
  • Food banks typically have tight budgets and rarely have surplus funding available to cover the costs of diabetes services. To adopt new services will typically require exploring new funding sources to cover program expenses, ideally with funding that can be sustained over time. 
  • Your food bank may seek funding from traditional funders like health-related foundations and healthcare providers, as well as nontraditional ones, like insurance companies or local businesses interested in investments in community health.
  • If your organization has a grants team, you may want to use their expertise to help identify funders and develop funding applications.
  • Important budget lines to include in funding proposals may include personnel costs (e.g., part- and full-time staff salaries, consultants, fringe benefits, and training), diabetes-specific staffing (e.g., diabetes program manager, registered dietitian, and community health worker), rent and utilities (including internet and phones), equipment (e.g., laptops, tables/chairs, projector, and printing), travel, testing supplies (e.g., for HbA1c or blood glucose tests), and marketing/outreach expenses (e.g., costs for running ads). Some costs may be specific to the type of program:
    • Food-based programs: costs for food, storage (especially if refrigeration is needed), distribution/delivery
    • Education-based programs: costs for providing meals for participants (if those are included), diabetes educators, classroom space
KEY FINDING 2

Leadership buy-in and alignment with organizational strategy are important for starting a diabetes program and securing funding. Several food banks noted that leadership support was key to the success of their diabetes initiatives.

Recommendations
  • Engage with leadership to enhance buy-in and position your organization for success (e.g., schedule a meeting with leadership to present concrete evidence about the need for diabetes services in your community).
  • Link your proposed diabetes program to the organizational mission and overall strategic mission and vision.
  • Compile local diabetes data to make an evidence-based case for new services.
  • Describe potential benefits of your proposed diabetes program, including improved health outcomes and community engagement.
  • Be prepared to address questions about funding, staffing, or other resource requirements.
KEY FINDING 3

Partnerships play critical roles in diabetes programming. They can contribute to community knowledge by having on-the-ground expertise and understanding of communities’ needs. They can also help to increase reach by expanding food delivery capacity (e.g., providing grocery deliveries). Partners like healthcare organizations can also assist with generating participant referrals.

Recommendations
  • Build a list of organizations with which your food bank has existing partnerships and consider roles they might play in supporting program needs.
  • Brainstorm a list of potential partners and how they could contribute to your program
  • Create and implement a plan for when and how you’ll reach out to potential partners
  • See Partnerships section for more tips and best practices.
KEY FINDING 4

Highly invested individual champions can play an important role in getting diabetes programs started.

Recommendations
  • Seek out individuals who are passionate about diabetes and health promotion to help spearhead your new program.
  • Potential champions may include food bank employees who have personal experience with diabetes, local community health workers, or other individuals likely to have an interest in diabetes and health.
  • These individuals may help to identify local partners, promote your program to potential participants, advocate for your program to food bank leadership, and participate in program implementation, among other roles.

“Sometimes it was a little bit easier whenever [community health worker] was there, because [she] is fluent in Spanish, and from the community, and I think they feel better that she fits more within their demographics than maybe I do.”

– Diabetes program implementer
KEY FINDING 5

Food bank capacity is often strained and adding additional responsibilities for diabetes services can present challenges.

Recommendations
  • Determine where the gaps are in staffing (e.g., current staffing capacity and skills) and develop a plan to address those gaps (e.g., hiring new staff, bringing on volunteers).
  • Explore opportunities to expand or adapt existing spaces and resources to free up availability for classes (education/support programs) or storage and distribution (food-based programs).
  • Develop a plan to identify new funding sources to cover costs required for your diabetes program.
KEY FINDING 6

Having a team with diverse skillsets and expertise, including areas such as food and nutrition, community insights, and diabetes management knowledge and diabetes education skills, is important for program implementation.

Recommendations
  • Consider including some of these staff roles: nutrition and diabetes educators, community health workers, warehouse/distribution staff, dietitian, nurse, project coordinator, development/grants specialist.
  • Evaluate opportunities to incorporate the following areas of expertise: diabetes, public health, medicine, outreach and recruitment, community engagement.
  • If required expertise is not available, consider training staff (See Other Resources) or bringing on new team members.
    • Other potential training topic areas: trauma sensitivity, cultural sensitivity, and the Health Insurance Portability and Accountability Act of 1996 (HIPAA)

“One person cannot go and do it on their own, you’ve got to have the educator or both educators, and you must have somebody who’s…more like admin that comes with you, which is why we always try to bring the community health worker with us.”

– Diabetes program implementer
KEY FINDING 7

Having a team member with evaluation experience is helpful, especially when looking to collect data to assess program effectiveness, inform program improvements, justify the program to leadership, and attract and sustain funding.

Recommendations
  • If possible, engage existing staff with evaluation expertise to help with designing your evaluation plan.
  • If you don’t have in-house capacity, consider finding help from outside your organization, such as faculty or students from local colleges or universities.
  • Consider incorporating multiple types of evaluation, including formative, process, and outcome evaluation methods.
  • See Evaluation section for more tips and best practices.
KEY FINDING 8

Having a deep understanding of the community (e.g., culture, local norms, community assets) is essential to successful implementation.

Recommendations
  • Engage individuals with knowledge of local community in the design of your diabetes program to help you address issues of cultural competency for the priority audience.
  • Develop a plan to collect information about potential participants to enable you to tailor your approach (See Formative Evaluation section for more information).
Considerations for Inclusive Food Banks
  • Do you have staff from the community and/or who are familiar with the community you want to serve?
  • Are you able to reach individuals who are at increased risk for diabetes (e.g., American Indian/Alaska Native, Asian, Black, and/or Hispanic or Latino communities)?
  • Do you have methods available to understand the needs of your priority population and to ensure that your program approach aligns with those needs, including those of communities particularly impacted?
  • How can you tailor your program approach to ensure cultural appropriateness for the audiences reached (e.g., providing and/or educating participants about foods that are culturally relevant)?
  • Do you have partners that can help you to reach priority audiences?
  • Are you able to deliver programming in ways that are accessible for people with a range of needs–for example, people with disabilities, people with low literacy, and people whose preferred language is not English?