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Late on a Monday afternoon, a nurse researcher received a call from a community leader in a rural church in Bamberg County, South Carolina. Their annual community health fair was scheduled for the following month, and they were requesting “diabetes screening” using an analysis of glucose in the blood or the “finger stick screening for diabetes.” According to the community leader, the church works with members of the congregation and surrounding community to bring free health services and linkages to health care providers to community members. Many people in this community may see their health care providers only when sick, may have inadequate health insurance coverage, or may be unable to afford to pay for preventive care and recommended screenings. The community leader knows that diabetes is a problem among members of the congregation and the broader community in Bamberg County.

The nurse researcher knows that epidemiologic data from the Behavioral Risk Factor Surveillance System (BRFSS) show that almost 15% of Bamberg County’s 16,000 residents report a diagnosis of diabetes (South Carolina Department of Health and Environmental Control, 2013), a rate nearly twice the national average, and that three quarters of the county’s residents report being overweight or obese. She also knows that about 60% of the county’s population is African American (U.S. Census Bureau, 2014) and that according to national estimates, about 12.6% of non-Hispanic black adults have been diagnosed with diabetes (Centers for Disease Control and Prevention [CDC], 2014). Data and the personal experience of the nurse researcher suggest that Bamberg County’s low median household incomes and rural location restrict residents’ access to comprehensive medical care, opportunities for physical activity, and affordable healthy food options. Moreover, local and state news media recently covered the closure of the area hospital that provided basic resources for diabetes identification and education in the county. Now no diabetes prevention or diabetes self-management education programs are available in the area. Clearly, the church leader is responding to a pressing need in an underresourced community, which is, unfortunately, a typical situation faced by many rural communities across the United States.

The question is: How should the nurse researcher respond to the request from the church leader based on available evidence or recommendations about who to screen for diabetes, how to conduct screenings for diabetes, and whether a community-based event such as a health fair is the best approach?


Questions such as those facing the nurse researcher and church leader arise almost every day. Researchers and health care providers are always looking for ways to meet an expressed need, improve practice, stimulate behavior change among patients, or create or change a program or policy. Using the diabetes screening example, health care providers may wonder how to best screen for diabetes, asking whether it is better to use a survey based on risk factors as recommended by ...

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