Community Psychology Interventions Can Help Bring Diabetes Under Control

It is estimated that 17 percent of all Egyptian adults have diabetes, according to the 2017 statistics by the World Health Organization’s Eastern Mediterranean Regional Office.

Ithar Hassaballa, assistant professor in the Department of Psychology, says community-based interventions can step in to  be more sustainable for the health and well-being of individuals with chronic conditions.

“Public health was one of the disciplines that started community psychology,” Hassaballa said. “It focused on prevention of these issues using behavioral methods ,such as behavior change strategies. A lot of public health issues are related to behaviors of communities."

Before joining AUC in Fall 2017, Hassaballa completed her PhD in behavioral psychology, with a focus on community health and development. It was also there that she had worked on her main research-based community intervention, which was for a group of African-American women with Type 2 Diabetes (T2D) in Durham, North Carolina (NC).

The same concept, she believes, can be applied in Egypt – where Type 2 Diabetes is on the rise.

Involving the Community

“Community psychology is multidisciplinary; it’s sociology, public health, economics, politics,” she stated. “But it is also all about including participants as decision makers.” It is not impossible, but unlikely, to sustain any type health and development program over time if community members are not
active participants.

The first advantage is that in a bottom-top approach, participants are able to cater the intervention to their own needs. “For women in Durham, NC, running outside as exercise was not an option because in that community, running outside could be perceived as running away from a crime scene or having committed a crime,” she explained. “The Durham Diabetes Program participants decided they could create mall walking groups – it is a safe environment, and it is comfortable enough to walk indoors in the state’s harsh winters and humid summers. They were able to commit themselves to this and hold each other accountable. Without the participation of the women, who are the community experts, the program would not have been successful.”

Hassaballa perceives this type of community participation as one of Egypt’s strengths. “Social support is huge here. People have no issues asking each other for help,” she noted. “It’s the way people live here. Nearly everyone is family-oriented. It’s key to addressing problems, stress levels and other behavioral issues.”  

With this motivation in mind, the assistant professor is ready to start working this summer. The first step will be a literature review to detect the gaps in terms of T2D, where she would be able to determine what people understand and believe about diabetes and which behaviors related to the condition are prevalent.

Another observation that will be confirmed with data are some of the weaknesses that contribute to the high level of diabetes among Egyptians. “People are, unfortunately, only physically active within their daily routine – so no extra exercise. There are high stress levels, high number of smokers and nutrition issues. What we know is that these environmental and social factors play a larger role than genetics,” she stated. “Starting in the fall, I will create a team of students to begin our research.”

Hassaballa wants to take advantage of being at AUC, where not only can she apply for a research grant, but start with the smaller community of students for surveying, connect offices and universities working in chronic diseases with international organizations and collaborate with departments that have experience in addressing diabetes. But she stressed that all these bodies aren’t as important as the community members. “People need to feel like it’s theirs, like the entire program is their baby,” she said. “We have to provide opportunity. We have to train people on how to make their own decisions and be active participants. If you come in and make a decision on behalf of a community, it will fall apart when you leave or when funding ends. No one will be interested. We want people to carry it on afterward on their own.”

Making a Difference

Hassaballa chose to join AUC because of its community psychology program. She currently teaches two undergraduate courses and one graduate course. She believes that one of AUC’s strengths is students not being afraid to express their opinions.

Students in her Community Psychology course are currently conducting focus groups related to smoking at AUC. “They are currently looking into student views on the [Tobacco-Free Campus Policy] as well as strategies for assuring that the smoking spaces on campus meet the students’ needs,” she stated.

But it’s not just within AUC that community psychology is being put into use; it’s around Cairo as well. The same class is going into Al Shorouq and conducting focus groups with psychosocial workers in the district’s schools. “My students are trying to find the challenges and recommendations for assuring that the roles are fulfilled, but not burdened by the amount of students who need help,” she explained. “They go into the community, implement, carry out interviews. They’re trying to make improvements by including participants and their ideas.”

One of Hassaballa’s major experiences at the University of Kansas was working collaboratively with the World Health Organization in Africa to improve community health. During the Ebola outbreak in 2014, her team effectively used community toolbox – the largest community-building resource online – to evaluate training modules and adapt them to the African context; address educational, economic and social determinants of health; and provide prevention methods. With AUC going through some changes to promote a healthier campus, Hassaballa’s expertise in examining gaps and providing solutions will benefit the community in taking significant steps toward these changes. “I know AUC is moving toward promoting a healthy AUC," she said, "so I want to connect with that and engage as many students and faculty members as possible, whether those in community psychology, athletic facilities, marketing or communication.”

To make a real difference, awareness and empowerment go hand in hand, according to Hassaballa, and we need to hold community members accountable in order to move forward toward prevention, change and development. “We need to look at the surrounding environment as a whole,” she asserted. “It’s related to the behavior of everyone – including politicians, researchers, those who design buildings – not just those who are affected. Understanding these issues is where behavioral psychology comes in and where community psychology can play a role.”