Study Setting and Data Collection

Data for this study was collected from participants at Operation Lone Star (OLS), an annual public health emergency preparedness exercise along the Texas-Mexico border. The event is a collabora- tion between various organizations, including local departments of health, the Texas Department of State Health Services, the U.S. military, institutions of higher education, and a myriad of community organizations and volunteers. The event also provides free primary, dental, and vision healthcare services to community residents. In 2015, OLS events and services took place during the week of July 27–31 at five locations across the South Texas Border from Brownsville to Laredo. Data collection for this study took place at one of the locations in Hidalgo County (home to over 800,000 people) [16] which was attended by almost 3000 county residents (children and adults) over the course of the week. As in other Texas-Mexico border counties, the overwhelming majority of the population is of Hispanic or Latino origin (92%) [16]. The county is characterized by high poverty rates (a third of the population lives below the federal poverty level) and low educational attainment (36% of individuals 25 years and over do not have a high school degree) [16]. Lack of healthcare coverage is a main challenge with 43% of individuals 18–64 years old being uninsured in 2015 [17].

We employed a convenience sampling design. Data was collected in-person by trained student interviewers, some of whom were bilingual (English and Spanish). Students approached OLS attendees, who were waiting to receive health services at various stations, with information about the study and invited them to participate. Based on the participant’s preferred language, interviews were conducted in either English or Spanish. After completing the anonymous interview, participants were provided with educational material about diabetes and a bottle of water.