Effect of Problem-Solving-Based Diabetes Self-Management Training on Diabetes Control in a Low Income Patient Sample

Abstract

BACKGROUND: Lower socioeconomic status is associated with excess disease burden from diabetes. Diabetes self-management support interventions are needed that are effective in engaging lower income patients, addressing competing life priorities and barriers to selfcare, and facilitating behavior change. OBJECTIVE: To pilot test feasibility, acceptability, and effect on disease control of a problem-based diabetes self-management training adapted for low literacy and accessibility. DESIGN: Two-arm randomized controlled trial powered to detect a 0.50% change in A1C at follow-up with a 2-sided alpha of 0.05 in a pooled analysis. PARTICIPANTS: Fifty-six urban African-American patients with type 2 diabetes and suboptimal blood sugar, blood pressure, or cholesterol control recruited from a diabetes registry within a university-affiliated managed care organization. INTERVENTIONS: A group, problem-based diabetes self-management training designed for delivery in an intensive and a condensed program format. Three intensive and three condensed program groups were conducted during the trial. MAIN MEASURES: Clinical (A1C, systolic blood pressure [SBP], diastolic blood pressure [DBP], LDL and HDL cholesterol) and behavioral (knowledge, problem solving, self-management behavior) data were measured at baseline, post-intervention, and 3 months post-intervention (corresponding with 6-9 months following baseline). RESULTS: Adoption of both programs was high (>85% attendance rates, 95% retention). At 3 months postintervention, the between-group difference in A1C change was −0.72% (p =0.02), in favor of the intensive program. A1C reduction was partially mediated by problem-solving skill at follow-up (ß = −0.13, p=0.04). Intensive program patients demonstrated within-

Health‐Literacy‐Sensitive Diabetes Self‐Management Interventions: A Systematic Review and Meta‐Analysis

“…The majority of the interventions were educational programs on diabetes management delivered in-person, via telephone, or via computer multimedia. The remaining studies included medication management facilitation through contact with primary care providers (Crowley et al, 2013), and problem-solving training (Hill-Briggs et al, 2011). Regarding the study population, two studies recruited only participants with low health literacy (Moussa, Sherrod, & Original Article Choi, 2013;Negarandeh, Mahmoodi, Noktehdan, Heshmat, & Shakibazadeh, 2013).…”

“…Health literacy was most commonly measured using the Short Test of Functional Health Literacy in Adults (STOFHLA) and the Rapid Estimate of Adult Literacy in Medicine (REALM). Only six studies selected patients according to a criterion of HbA1C level, which ranged from 6.5% to 8.0% (Cavanaugh et al, 2009;Hill-Briggs et al, 2011;Moussa et al, 2013;Schillinger, Handley, Wang, & Hammer, 2009). The outcomes measured in these studies were highly diverse.…”

“…Only four studies assessed the all three domains in terms of how they were directly or indirectly influenced by the healthliteracy-sensitive diabetes intervention (Hill-Briggs et al, 2011;Khan et al, 2011;Swavely, Vorderstrasse, Maldonado, Eid, & Etchason, 2014;Wallace, Carlson, Malone, Joyner, & Dewalt, 2010). Knowledge and HbA1C were the most frequently measured outcomes in eight and nine studies, respectively.…”

The Relationship Between Maternal Awareness, Socioeconomic Situation of Families and Metabolic Control in Children With Type 1 Diabetes Miletus in an Iranian Population

“…Increases in diabetes prevalence and treatment costs have led to a growing number of studies for controlling this disease. Many of these studies have suggested that diabetic patients care requires changes in their lifestyle and one of the most effective methods for the treatment and control of diabetes is an effective change in patient's condition and lifestyle (5)(6)(7)(8). Subsequently, self-care of diabetic patients and, also, changes in their life style require recognition and knowledge of patients about the principles of diabetic nutrition, monitoring of blood sugar levels and correct usage of insulin (9).…”

Optimizing Diabetes Self-care in Low Literacy and Minority Populations—Problem-solving, Empowerment, Peer Support and Technology-based Approaches

“…2 As such, great emphasis has been placed on implementing behavioral interventions targeting diabetes selfmanagement (DSM) education and skills, particularly among ethnic minority and low-income populations that bear a disproportionate burden of diabetes and have poorer glycemic control. 1 In this issue of the journal, Hill-Briggs et al 3 examined the feasibility, acceptability, and effectiveness of a problem-based, DSM training adapted for low literacy populations on glycemic control. They showed a significant change in hemoglobin A1c that was diminished by controlling for patient's problem-solving skills, suggesting that problem solving is a key component for glycemic control.…”