A Culturally competent intervention of education and care for black women with type 2 diabetes

Melkus, Gail D’Eramo; Spollett, Geralyn R.; Jefferson, Vanessa; Chyun, Deborah; Tuohy, Beth; Robinson, Tanisha; Kaisen, Anne

doi:10.1016/j.apnr.2003.10.009

Cited by 50 publications

(50 citation statements)

References 35 publications

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“…Specifically, this study examined diabetes-related emotional distress and depression. Consistent with the literature, participation in a lifestyle intervention significantly reduced the symptoms of mental health conditions, namely diabetes-related emotional distress, potentially reducing barriers to diabetes self-management (D’Eramo-Melkus et al 2004; Gabbay et al 2006). In our study, diabetes-related emotional distress dropped even further within the immediate group from 6 to 12 months.…”

Section: Discussionsupporting

confidence: 79%

Influence of a Community Health Worker Intervention on Mental Health Outcomes among Low-Income Latino and African American Adults with Type 2 Diabetes

et al. 2013

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This study investigated the influence of a community health worker (CHW) diabetes lifestyle intervention on mental health outcomes. Our study was guided by the principles of community-based participatory research. Data were collected from 164 African American (N = 94) and Hispanic adults (N = 70) participating in a randomized, 6-month delayed intervention group design for improving glycemic control. The intervention time periods were baseline to 6 months for the treatment group and 6–12 months for the delayed group. Linear mixed models were used to conduct longitudinal analyses of the Problem Areas in Diabetes (PAID) and Patient Health Questionnaire (PHQ) scales. In the model adjusted for demographics, the PAID dropped significantly from pre-intervention to post-intervention within both the treatment and delayed groups (p < 0.05) with an average intervention effect of −6.4 (p < 0.01). The PAID dropped even further within the immediate group from 6 to 12 months. Although the PHQ did not change significantly, the PHQ-2 had an average intervention effect of −0.3 (p < 0.05) in the model adjusted for demographics. This study contributes to an understanding of how a CHW-led diabetes intervention can result in positive mental health outcomes for Latinos and African Americans with Type 2 diabetes. It also highlights the importance of further exploring what factors may contribute to racial/ethnic variation in mental health outcomes for African Americans and Latinos with diabetes and the role CHWs can play.

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Section: Discussionsupporting

confidence: 79%

Influence of a Community Health Worker Intervention on Mental Health Outcomes among Low-Income Latino and African American Adults with Type 2 Diabetes

et al. 2013

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“…Fifteen studies analyzed the impact of the interventions on diabetes knowledge [27,29,32,34,37-39,44,47,48,50,53,56,60,62]. In the majority of studies (nine out of fifteen), diabetes knowledge was only measured immediately after the intervention program was finished.…”

Section: Resultsmentioning

confidence: 99%

“…Twenty studies examined the potential of the interventions to improve self-management behaviors [27,28,30-32,34-36,43-45,50,54,55,57-62]. Behavioral outcomes were heterogeneous, being related in most instances to dietary or physical activity behaviors, but also to behaviors related to blood glucose testing, foot care, or medication adherence.…”

Section: Resultsmentioning

confidence: 99%

Characteristics and effectiveness of diabetes self-management educational programs targeted to racial/ethnic minority groups: a systematic review, meta-analysis and meta-regression

et al. 2014

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BackgroundIt is not clear to what extent educational programs aimed at promoting diabetes self-management in ethnic minority groups are effective. The aim of this work was to systematically review the effectiveness of educational programs to promote the self-management of racial/ethnic minority groups with type 2 diabetes, and to identify programs’ characteristics associated with greater success.MethodsWe undertook a systematic literature review. Specific searches were designed and implemented for Medline, EMBASE, CINAHL, ISI Web of Knowledge, Scirus, Current Contents and nine additional sources (from inception to October 2012). We included experimental and quasi-experimental studies assessing the impact of educational programs targeted to racial/ethnic minority groups with type 2 diabetes. We only included interventions conducted in countries members of the OECD. Two reviewers independently screened citations. Structured forms were used to extract information on intervention characteristics, effectiveness, and cost-effectiveness. When possible, we conducted random-effects meta-analyses using standardized mean differences to obtain aggregate estimates of effect size with 95% confidence intervals. Two reviewers independently extracted all the information and critically appraised the studies.ResultsWe identified thirty-seven studies reporting on thirty-nine educational programs. Most of them were conducted in the US, with African American or Latino participants. Most programs obtained some benefits over standard care in improving diabetes knowledge, self-management behaviors and clinical outcomes. A meta-analysis of 20 randomized controlled trials (3,094 patients) indicated that the programs produced a reduction in glycated hemoglobin of -0.31% (95% CI -0.48% to -0.14%). Diabetes knowledge and self-management measures were too heterogeneous to pool. Meta-regressions showed larger reduction in glycated hemoglobin in individual and face to face delivered interventions, as well as in those involving peer educators, including cognitive reframing techniques, and a lower number of teaching methods. The long-term effects remain unknown and cost-effectiveness was rarely estimated.ConclusionsDiabetes self-management educational programs targeted to racial/ethnic minority groups can produce a positive effect on diabetes knowledge and on self-management behavior, ultimately improving glycemic control. Future programs should take into account the key characteristics identified in this review.

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“…As asserted in previous literature, cultural factors need to be considered in the care of people with diabetes [10]–[14] and in modifying diabetes education programs to determine patients’ knowledge and reading level and in using cultural themes to deliver health messages [10], [15]–[16]. The results in this study further support previous recommendations for the use of community engagement, as described in the CTSA manual “Principles of Community Engagement” (2011), to engage the stakeholders in a mutually responsive and respectful partnership.…”

Section: Discussionmentioning

confidence: 99%

Assessing Knowledge and Attitudes of Diabetes in Zuni Indians Using a Culture-Centered Approach

et al. 2014

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IntroductionThe Zuni Pueblo, in collaboration with the University of New Mexico, have formed the Zuni Health Initiative (ZHI) engaged in community-based participatory research to plan and implement educational interventions to reduce health disparities. We conducted the first phase of ZHI study and identified barriers to healthcare. We concluded that the burden presented by these barriers ultimately translates into a lack of patient activation and engagement in their health care including for diabetes, effectively hindering adoption of healthy behaviors.MethodsCommunity health representatives (CHRs) led 10 one-hour focus group sessions to elicit information on diabetes knowledge and self-management strategies at which a total of 84 people participated. Audiotapes were translated and transcribed by bilingual ZHI staff. We reduced the text to thematic categories, constructed a coding dictionary and inserted the text into NVivo 9 program.ResultsThe focus groups revealed that despite extensive personal or family experiences with diabetes or complications, participants identified knowledge gaps in the disease progression and disease management. However, we gained insight into how many Zunis conceptualize the etiology of diabetes, risk factors associated with diabetes, sources of knowledge and self-management practices.ConclusionWe concluded that many of the Zuni diabetics experience significant impacts on their life when they were diagnosed with diabetes and suffered the plight of stigmatization. We further concluded that developing Zuni culture specific diabetes care should focus on family involvement with continued education.

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A Culturally competent intervention of education and care for black women with type 2 diabetes

Cited by 50 publications

References 35 publications

Influence of a Community Health Worker Intervention on Mental Health Outcomes among Low-Income Latino and African American Adults with Type 2 Diabetes

Influence of a Community Health Worker Intervention on Mental Health Outcomes among Low-Income Latino and African American Adults with Type 2 Diabetes

Characteristics and effectiveness of diabetes self-management educational programs targeted to racial/ethnic minority groups: a systematic review, meta-analysis and meta-regression

Assessing Knowledge and Attitudes of Diabetes in Zuni Indians Using a Culture-Centered Approach

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