TABLE 4.

Nurses Minimize Logistical Barriers for Individuals With Comorbid SMI and Diabetes

Barrier	Challenges	Highlights	Interactive Opportunities
Limited transportation resources	Various and unreliable modes of transportation affect reliability	Various transportation methods are used to get to and from class including personal vehicles, public transportation, specialty transportation for disabled participants, rides from friends/family, and bicycles	Reimbursement is provided for parking and bus passes
Inconsistent class location	Inconsistent attendance alters group process and opportunities to learn	Consistent attendance fosters development of informal relationships and concern when participants are absent	Promotional activities include confirmation letter and welcome gift; weekly reminder calls; follow-up hand-written letters and phone calls; door prizes at each session; peer educator phone calls to encourage attendance; refreshments consistent with American Diabetes Association dietary guidelines provided at each class
Class times	Morning classes are difficult	Feedback and experience helps to identify what times work best	Mid-afternoon classes allow participants time to manage morning challenges
Participant contact	Some participants’ phones are disconnected, their numbers are changed, or they have only limited minutes	Participants provide a secondary contact the nurse can call if needed	Electronic medical records are a resource for finding alternate contact information when necessary; participants are sent hand-written notes to their last known address