Pilot Feasibility Study of a Digital Storytelling Intervention for Immigrant and Refugee Adults With Diabetes

Abstract

Purpose The purpose of this pilot feasibility project was to examine the potential effectiveness of a digital storytelling intervention designed through a community-based participatory research approach for immigrants and refugees with type 2 diabetes mellitus (T2DM). Methods The intervention was a 12-minute culturally and linguistically tailored video consisting of an introduction, 4 stories, and a concluding educational message. A structured interview was used to assess the intervention for acceptability, interest level, and usefulness among 25 participants with T2DM (15 Latino, 10 Somali) across 5 primary care clinical sites. After watching the video, participants rated their confidence and motivation about managing T2DM as a result of the intervention. Baseline hemoglobin A1c (A1C) and follow-up values (up to 6 months) were abstracted from medical records. Results All participants reported that the intervention got their attention, was interesting, and was useful; 96% reported that they were more confident about managing their T2DM than before they watched the video; and 92% reported that the video motivated them to change a specific behavior related to T2DM self-management. The mean baseline A1C level for the intervention participants was 9.3% (78 mmol/mol). The change from baseline to first follow-up A1C level was −0.8% (−10 mmol/mol) (P<.05). Conclusions Implementation of a digital storytelling intervention for T2DM among immigrant populations in primary care settings is feasible and resulted in self-rated improvement in psychosocial constructs that are associated with healthy T2DM self-management behaviors, and there was some evidence of improvement in glycemic control. A large-scale efficacy trial of the intervention is warranted.

Evaluation of first-person storytelling on changing health-related attitudes, knowledge, behaviors, and outcomes: A scoping review

“…Patients either completed written questionnaires [24, 32-36, 38-42, 44-48, 50-52] or were surveyed in-person and by telephone. [37,43,49] Six studies also used biometric data such as blood pressure and hemoglobin A1C readings taken by medical providers. [24, 36-38, 47, 48], and one used a web browser to collect usage statistics about how often patients accessed FPS or didactic content.…”

“…As shown in Table 2, 10 non-RCT studies, compared to their baseline assessments, reported changes to attitudes, knowledge, behaviors, or clinical outcomes for patients who had been exposed to FPS interventions. Of the 8 non-RCT studies that assessed the impact of FPS on health-related behaviors (e.g., eating more vegetables, using salt substitutes, quitting smoking, or improved foot care) [24,[45][46][47][48][49][50]52], 7 reported positive health behavior change. All four studies that assessed impact on clinical outcomes (e.g., lowering blood pressure or A1C levels) showed improvements compared to baseline.…”

“…All four studies that assessed impact on clinical outcomes (e.g., lowering blood pressure or A1C levels) showed improvements compared to baseline. [47][48][49]52] There was more variation in impact for FPS interventions in changing knowledge and health-related attitudes. Of the 6 non-RCT studies assessing health-related attitudes (e.g.…”

“…Of the 6 non-RCT studies assessing health-related attitudes (e.g. selfefficacy, risk perception, vaccine efficacy) compared to baseline, [24,44,[47][48][49]51], only half (N=3) showed improvements in improving attitudes like diabetes management self-efficacy, or perception of cancer risk. Of the two non-RCT studies assessing health-related knowledge, only one showed improvements over baseline.…”

“…[32,33,35,36,38]. Of these studies, 4 of the 5 RCTs showed positive changes over control groups for at least one of the measured outcomes (attitudes, knowledge, behavior, clinical outcomes) [32,33,35,36] Nearly half of the non-RCT studies explored the use of FPS to change attitudes, knowledge, behaviors, and health outcomes for specific racial and ethnic minority groups, [24,[47][48][49] and all reported positive impact compared to baseline.…”