Impact of a Culturally Tailored Diabetes Education and Empowerment Program in a Mexican American Population Along the US/Mexico Border: A Pragmatic Study

Silvia Flores-Luevano, Maricela Pacheco, Gurjeet S Shokar, Alok Kumar Dwivedi, Navkiran K Shokar, Silvia Flores-Luevano, Maricela Pacheco, Gurjeet S Shokar, Alok Kumar Dwivedi, Navkiran K Shokar

Abstract

Background: The study purpose was to deliver a diabetes education program under real world conditions and evaluate its effect on diabetes-related clinical, self-management and psychosocial outcomes among Mexican Americans residing along the US/Mexico border.

Methods: A pragmatic study was conducted among adult patients with diabetes in three primary care clinics located along the US/Mexico border. A bilingual culturally tailored diabetes education program incorporating hands-on participatory techniques was delivered in 4 - 8 weekly group sessions. Clinical, self-management and psychosocial outcomes were evaluated pre- and post-intervention with surveys and medical record review.

Results: A total of 209 participants were enrolled; mean age was 58.9 years (range 23 - 94, standard deviation: 11.2); 68.4% were female; 91.1% were Hispanic. Significant improvements were observed in glycated hemoglobin (-1.1%, P < 0.001, n = 79), total cholesterol (-17.2 mg/dL, P = 0.041, n = 63), glucose self-monitoring (+1.3 times a week, P = 0.021, n = 115), exercise less than once a week (-18.2%, P < 0.001, n = 129), nutritional behavior (+2.23, P < 0.001, n = 115), knowledge (+1. 83, P < 0.001, n = 141) and diabetes-related emotional distress (-7.32, P = 0.002, n = 111). Benefits were observed with attendance rates as low as 50%.

Conclusion: A clinic-based culturally competent diabetes education/self-management program resulted in significant improvements in outcomes among Hispanic participants. Experimentally tested culturally appropriate interventions adapted for real world situations can benefit Mexican American diabetic patients even when attendance is imperfect.

Keywords: Culturally competent interventions; Diabetes self-management education; Health education; Hispanics; Mexican American; Type 2 diabetes.

Conflict of interest statement

None to declare.

Copyright 2020, Flores-Luevano et al.

Figures

Figure 1
Figure 1
Flowchart of the study participants. DEEP: Diabetes Education and Empowerment Program; EMR: electronic medical record; PAID: problem areas in diabetes; LDBQ: Latino Dietary Behaviors Questionnaire.
Figure 2
Figure 2
Effect of intervention by sessions attendance. All variables are presented with pre-post changes except for HDL, knowledge and LDBQ (post-pre changes). HDL: high-density lipoprotein; LDBQ: Latino Dietary Behaviors Questionnaire.

References

    1. Centers for Disease Control and Prevention. National diabetes statistics report, 2017. Atlanta, GA: Centers for Disease Control and Prevention, Us Department of Health and Human Services; 2017. . Accessed on August 1, 2019. .
    1. Lin J, Thompson TJ, Cheng YJ, Zhuo X, Zhang P, Gregg E, Rolka DB. Projection of the future diabetes burden in the United States through 2060. Popul Health Metr. 2018;16(1):9. doi: 10.1186/s12963-018-0166-4.
    1. Dall TM, Yang W, Halder P, Pang B, Massoudi M, Wintfeld N, Semilla AP. et al. The economic burden of elevated blood glucose levels in 2012: diagnosed and undiagnosed diabetes, gestational diabetes mellitus, and prediabetes. Diabetes Care. 2014;37(12):3172–3179. doi: 10.2337/dc14-1036.
    1. Alva ML, Hoerger TJ, Zhang P, Cheng YJ. State-level diabetes-attributable mortality and years of life lost in the United States. Ann Epidemiol. 2018;28(11):790–795. doi: 10.1016/j.annepidem.2018.08.015.
    1. The Texas Demographic Center. Diabetes in Texas report 2017. . Accessed on August 15, 2019.
    1. American Diabetes Association. Arlington VA. Statistics about diabetes. . Accessed on August 20, 2019.
    1. Bayer FJ, Galusha D, Slade M, Chu IM, Taiwo O, Cullen MR. Process of care compliance is associated with fewer diabetes complications. Am J Manag Care. 2014;20(1):41–52.
    1. Campbell JA, Walker RJ, Smalls BL, Egede LE. Glucose control in diabetes: the impact of racial differences on monitoring and outcomes. Endocrine. 2012;42(3):471–482. doi: 10.1007/s12020-012-9744-6.
    1. Lee J, Liu C, Sales CE. Racial and ethnic differences in diabetes care and health care use and cost. Prev Chronic Dis. 2006;3:A85.
    1. US Department of Health and Human Services Office of Minority Health. Diabetes and Hispanic Americans. . Accessed on August 22, 2019.
    1. American Association of Diabetes Educators. AADE7 Self-Care Behaviors. . Accessed on August 28, 2019.
    1. Hu J, Wallace DC, McCoy TP, Amirehsani KA. A family-based diabetes intervention for Hispanic adults and their family members. Diabetes Educ. 2014;40(1):48–59. doi: 10.1177/0145721713512682.
    1. Prezio EA, Cheng D, Balasubramanian BA, Shuval K, Kendzor DE, Culica D. Community Diabetes Education (CoDE) for uninsured Mexican Americans: a randomized controlled trial of a culturally tailored diabetes education and management program led by a community health worker. Diabetes Res Clin Pract. 2013;100(1):19–28. doi: 10.1016/j.diabres.2013.01.027.
    1. Pena-Purcell NC, Boggess MM, Jimenez N. An empowerment-based diabetes self-management education program for Hispanic/Latinos: a quasi-experimental pilot study. Diabetes Educ. 2011;37(6):770–779. doi: 10.1177/0145721711423319.
    1. Dauvrin M, Lorant V, d'Hoore W. Is the Chronic Care Model Integrated Into Research Examining Culturally Competent Interventions for Ethnically Diverse Adults With Type 2 Diabetes Mellitus? A Review. Eval Health Prof. 2015;38(4):435–463. doi: 10.1177/0163278715571004.
    1. Ricci-Cabello I, Ruiz-Perez I, Rojas-Garcia A, Pastor G, Rodriguez-Barranco M, Goncalves DC. Characteristics and effectiveness of diabetes self-management educational programs targeted to racial/ethnic minority groups: a systematic review, meta-analysis and meta-regression. BMC Endocr Disord. 2014;14:60. doi: 10.1186/1472-6823-14-60.
    1. Barrera M Jr, Castro FG, Strycker LA, Toobert DJ. Cultural adaptations of behavioral health interventions: a progress report. J Consult Clin Psychol. 2013;81(2):196–205. doi: 10.1037/a0027085.
    1. Pottie K, Hadi A, Chen J, Welch V, Hawthorne K. Realist review to understand the efficacy of culturally appropriate diabetes education programmes. Diabet Med. 2013;30(9):1017–1025. doi: 10.1111/dme.12188.
    1. Haas L, Maryniuk M, Beck J, Cox CE, Duker P, Edwards L, Fisher E. et al. National standards for diabetes self-management education and support. Diabetes Educ. 2012;38(5):619–629. doi: 10.1177/0145721712455997.
    1. Chrvala CA, Sherr D, Lipman RD. Diabetes self-management education for adults with type 2 diabetes mellitus: A systematic review of the effect on glycemic control. Patient Educ Couns. 2016;99(6):926–943. doi: 10.1016/j.pec.2015.11.003.
    1. Hildebrand JA, Billimek J, Lee JA, Sorkin DH, Olshansky EF, Clancy SL, Evangelista LS. Effect of diabetes self-management education on glycemic control in Latino adults with type 2 diabetes: A systematic review and meta-analysis. Patient Educ Couns. 2020;103(2):266–275. doi: 10.1016/j.pec.2019.09.009.
    1. United States Census Bureau. Quick facts Socorro city, Texas; El Paso County, Texas: United States.2013-22017. . Accessed on September 5, 2019.
    1. UIC Midwest Latino Health Research, Training and Policy Center. Diabetes Empowerment Education Program DEEPTM. 6th edition. Chicago, IL. . Accessed on September 2, 2019.
    1. Marin G, Sabogal F, VanOss Marin B, Otero-Sabogal F, Perez-Stable EJ. Development of a short acculturation scale for Hispanics. Hispanic Journal of Behavioral Sciences. 1987;9:183–205. doi: 10.1177/07399863870092005.
    1. Garcia AA, Villagomez ET, Brown SA, Kouzekanani K, Hanis CL. The Starr County Diabetes Education Study: development of the Spanish-language diabetes knowledge questionnaire. Diabetes Care. 2001;24(1):16–21. doi: 10.2337/diacare.24.1.16.
    1. Fernandez S, Olendzki B, Rosal MC. A dietary behaviors measure for use with low-income, Spanish-speaking Caribbean Latinos with type 2 diabetes: the Latino Dietary Behaviors Questionnaire. J Am Diet Assoc. 2011;111(4):589–599. doi: 10.1016/j.jada.2011.01.015.
    1. Fisher L, Polonsky WH, Hessler D. Addressing diabetes distress in clinical care: a practical guide. Diabet Med. 2019;36(7):803–812. doi: 10.1111/dme.13967.
    1. Egede LE, Ellis C. Development and psychometric properties of the 12-item diabetes fatalism scale. J Gen Intern Med. 2010;25(1):61–66. doi: 10.1007/s11606-009-1168-5.
    1. Hawthorne K, Robles Y, Cannings-John R, Edwards AG. Culturally appropriate health education for Type 2 diabetes in ethnic minority groups: a systematic and narrative review of randomized controlled trials. Diabet Med. 2010;27(6):613–623. doi: 10.1111/j.1464-5491.2010.02954.x.
    1. Nathan DM, Kuenen J, Borg R, Zheng H, Schoenfeld D, Heine RJ. the A1c-Derived Average Glucose (ADAG) Study Group. Translating the A1C assay into estimated average glucose values. Diabetes Care. 2008;31(8):1473–1478. doi: 10.2337/dc08-0545.
    1. Brown SA, Garcia AA, Kouzekanani K, Hanis CL. Culturally competent diabetes self-management education for Mexican Americans: the Starr County border health initiative. Diabetes Care. 2002;25(2):259–268. doi: 10.2337/diacare.25.2.259.
    1. Peel E, Douglas M, Lawton J. Self monitoring of blood glucose in type 2 diabetes: longitudinal qualitative study of patients' perspectives. BMJ. 2007;335(7618):493. doi: 10.1136/.
    1. da Silva FAA, Moreira TMM, Menezes LGC. Chronicity, self care, social and family support: how the patient has? Diabetol Metab Syndr. 2015;7(Suppl 1):A202. doi: 10.1186/1758-5996-7-S1-A202.
    1. Peyrot M, Egede LE, Funnell MM, Hsu WC, Ruggiero L, Siminerio LM, Stuckey HL. US ethnic group differences in self-management in the 2nd diabetes attitudes, wishes and needs (DAWN2) study. J Diabetes Complications. 2018;32(6):586–592. doi: 10.1016/j.jdiacomp.2018.03.002.
    1. Castillo A, Giachello A, Bates R, Concha J, Ramirez V, Sanchez C, Pinsker E. et al. Community-based diabetes education for Latinos: the diabetes empowerment education program. Diabetes Educ. 2010;36(4):586–594. doi: 10.1177/0145721710371524.
    1. Song M, Lipman TH. Concept analysis: self-monitoring in type 2 diabetes mellitus. Int J Nurs Stud. 2008;45(11):1700–1710. doi: 10.1016/j.ijnurstu.2008.04.005.
    1. Ryan JG, Jennings T, Vittoria I, Fedders M. Short and long-term outcomes from a multisession diabetes education program targeting low-income minority patients: a six-month follow up. Clin Ther. 2013;35(1):A43–53. doi: 10.1016/j.clinthera.2012.12.007.
    1. Welch G, Weinger K, Anderson B, Polonsky WH. Responsiveness of the Problem Areas In Diabetes (PAID) questionnaire. Diabet Med. 2003;20(1):69–72. doi: 10.1046/j.1464-5491.2003.00832.x.
    1. Imazu MF, Faria BN, de Arruda GO, Sales CA, Marcon SS. Effectiveness of individual and group interventions for people with type 2 diabetes. Rev Lat Am Enfermagem. 2015;23(2):200–207. doi: 10.1590/0104-1169.0247.2543.
    1. Burns RJ, Deschenes SS, Schmitz N. Cyclical relationship between depressive symptoms and diabetes distress in people with Type 2 diabetes mellitus: results from the Montreal Evaluation of Diabetes Treatment Cohort Study. Diabet Med. 2015;32(10):1272–1278. doi: 10.1111/dme.12860.
    1. Fisher L, Glasgow RE, Strycker LA. The relationship between diabetes distress and clinical depression with glycemic control among patients with type 2 diabetes. Diabetes Care. 2010;33(5):1034–1036. doi: 10.2337/dc09-2175.
    1. Texas Health and Huma Services. Austin Tx. Texas Behavioral Risk actor Surveillance System (BRFSS) 2017. . Accessed on October 10, 2019.
    1. Solomon SD, Chew E, Duh EJ, Sobrin L, Sun JK, VanderBeek BL, Wykoff CC. et al. Diabetic retinopathy: a position statement by the American Diabetes Association. Diabetes Care. 2017;40(3):412–418. doi: 10.2337/dc16-2641.

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