OBJECTIVE -To determine the effects of a culturally appropriate diabetes lifestyle intervention for Native Americans on risk factors for complications of diabetes. RESEARCH DESIGN AND METHODS-A nonrandomized, community-based diabetes intervention trial was conducted in three Native American sites in New Mexico from [1993][1994][1995][1996][1997]. Participants were assigned to intervention or control based on community of residence. Intervention sessions were held ϳ6 weeks apart over ϳ10 months. The intervention was delivered in site A in family and friends (FF) groups (n ϭ 32); site B received the same intervention in one-on-one (OO) appointments (n ϭ 39); and site C received usual medical care (UC) (n ϭ 33) (total participants, n ϭ 104). Primary change in HbA 1c level was assessed at 1 year.RESULTS -Adjusted mean change in HbA 1c value varied significantly across the three arms at 1 year (P ϭ 0.05). The UC arm showed a statistically significant increase in adjusted mean HbA 1c change (1.2%, P ϭ 0.001), whereas both intervention arms showed a small nonsignificant (P Ͼ 0.05) increase in the adjusted mean change (0.5% and 0.2% for FF and OO arms, respectively). The increase was statistically significantly smaller in the combined intervention arms (0.4%) compared with the UC arm (1.2%, P ϭ 0.02).CONCLUSIONS -Lifestyle intervention has the potential to substantially reduce microvascular complications, mortality, and health care utilization and costs if the change is sustained over time. Diabetes Care 25:78 -83, 2002M any Native American tribes suffer from a high and increasing prevalence of type 2 diabetes; among some Native American adults, the prevalence is Ͼ50% (1). Moreover, Native Americans suffer higher prevalence of many of the complications associated with diabetes (2-8). The high prevalence of type 2 diabetes, combined with a poorer prognosis, contributes to a disproportionately high and increasing diabetes-related mortality rate among Native American populations. In New Mexico, diabetes-related mortality increased by 564 and 1,110% for Native American men and women, respectively, from 1958 to 1994 (9,10).One approach to reducing the disproportionate burden of type 2 diabetes is to develop interventions directed toward reducing the risk factors for the complications of this chronic disease. At the cornerstone of diabetes interventions are diet and physical activity; however, their roles frequently have been dismissed as impossible to achieve by researchers, clinicians, and patients (11,12). Therefore, interventions focus on clinical treatments, such as hypoglycemic medications, which have been shown to reduce microvascular complications in persons with type 2 diabetes (13). Interventions that emphasize a combination of diet, physical activity, and clinical treatments may have the greatest potential to reduce the risk factors for diabetes-related complications (14). There is a paucity of effective diabetes lifestyle interventions for Native Americans with diabetes (15,16).In response to this need, the Native...
Using a strong theoretical framework and community input to design diabetes education sessions may be important factors in participant satisfaction and retention in diabetes lifestyle education sessions.
In minority communities where diabetes is a major health problem, diet and exercise behaviors have cultural intluences that must be acknowledged and addressed for effective education interventions.' This finding is true for Native American communities in which the diabetes prevalence tends to be high and where food is a large part of traditional cultural practices.~ Exercise activities may differ from those generally practiced by surrounding non-Native American communities.' In addition, Native peoples may have different learning styles that can affect the relevance and acceptance of diabetes instruction. 2.1 The purpose of this study was to determine culturally appropriate content and delivery methods for a Native American diabetes education program called Strong in Body and Spirit. This curriculum, which is based on social action theory and the transtheoretical model of stages of change, contains elements that highlight strengths ofNative American communities: stories, emphasis on family and community, videotapes of Native people engaging in healthful behaviors, and Native artwork and images. Methods The target population for the Native American Diabetes Project was adult men and women from eight Rio Grande Pueblo communities in New Mexico. These community members use the Tanoan language group (Tiwa and Tewa languages) and have similar cultural and religious backgrounds; differences between the communities are small. The following methods were used to collect information for curriculum development : (1) meetings with clinic staff, patients, tribal leaders, and tribal health workers; (2) focus group sessions with all constituents; (3) baseline interviews with participants; (4) collaboration between Indian Health Service (IHS) professionals, community members, and university research staff; (5) community member feedback; and (6) pilot testing. 1. Meeting with clinic staff, patients, tribal leaders. and tribal health wor-ker-s. The research staff decided that it was imperative to begin with input from all constituents. In October 1991 staff from an IHS health center, tribal health workers, and patients (n= 12) met to discuss common beliefs about diabetes, what information should be made available about diabetes, and the best approaches for providing this information. Comments were recorded and then used to design patient interviews. A random sample of patients from the health center (n=29) were interviewed in winter 1991 and responses were tabulated. Results of the patient interviews were presented in a follow-up meeting in June 1992. Staff from a different IHS health center and their tribal leaders and tribal health workers (n=10) met in July 1992 to discuss what diabetes education was needed from a community perspective.2. Foclls grollp .sessions with all constituents. A community advisory group was consulted regarding culturally acceptable methods of conducting the focus group sessions. When possible, Native American people were trained as facilitators and conducted the sessions in English. Comments were handwr...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.