Dosage Effects of Diabetes Self-Management Education for Mexican Americans

Abstract

OBJECTIVE -The objective of this study was to compare two diabetes self-management interventions designed for Mexican Americans: "extended" (24 h of education, 28 h of support groups) and "compressed" (16 h of education, 6 h of support groups). Both interventions were culturally competent regarding language, diet, social emphasis, family participation, and incorporating cultural beliefs.RESEARCH DESIGN AND METHODS -We recruited 216 persons between 35 and 70 years of age diagnosed with type 2 diabetes Ն1 year. Intervention groups of eight participants and eight support persons were randomly assigned to the compressed or extended conditions. The interventions differed in total number of contact hours over the yearlong intervention period, with the major difference being the number of support group sessions held. The same information provided in the educational sessions of the extended intervention was compressed into fewer sessions, thus providing more information during each group meeting.RESULTS -The interventions were not statistically different in reducing HbA 1c ; however, both were effective. A "dosage effect" of attendance was detected with the largest HbA 1c reductions achieved by those who attended more of the extended intervention. For individuals who attended Ն50% of the intervention, baseline to 12-month HbA 1c change was Ϫ0.6 percentage points for the compressed group and Ϫ1.7 percentage points for the extended group.CONCLUSIONS -Both culturally competent diabetes self-management education interventions were effective in promoting improved metabolic control and diabetes knowledge. A dosage effect was evident; attending more sessions resulted in greater improvements in metabolic control. Diabetes Care 28:527-532, 2005T wenty-one percent of the U.S. population lives in states bordering Mexico, and Ͼ33% of these individuals live in medically underserved border communities characterized by extreme poverty, pollution, deprivation, poor health, and diminished quality of life (1). Sixty percent of Hispanics, predominantly Mexican Americans who have the lowest rates of insurance coverage of any group, live in border states (2), and diabetes and related morbidity and mortality rates are highest among these border residents (3-6).Traditional approaches to managing diabetes in the U.S. have been perceived by Mexican Americans, in some instances, as culturally insensitive and, thus, have been ineffective (7). We designed and tested nonpharmacological, culturally competent, community-based diabetes self-management interventions in Starr County, a Texas-Mexico border community in which 98% of the residents are Mexican American (8). Promoting attendance at lifestyle programs, i.e., ensuring an adequate "dosage" of the intervention, is a challenge, particularly in underserved groups who may lack transportation and who tend to live chaotic lives, with frequent financial, health, and personal crises. Mexican Americans value social networks, and women are expected to provide health care for family, relatives, and friend...

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