Resilience-based Diabetes Self-management Education: Perspectives From African American Participants, Community Leaders, and Healthcare Providers

Abstract

Purpose The purpose of this qualitative, focus group study was to further refine the Resilience-based Diabetes Self-management Education (RB-DSME) recruitment process and intervention, build greater trust in the community, and identify strategies to enhance its sustainability as a community-based intervention in African American church settings. Methods Six 2-hour focus groups (N = 55; 10 men and 45 women) were led by a trained moderator with a written guide to facilitate discussion. Two sessions were conducted with individuals diagnosed with type 2 diabetes mellitus (T2DM) who participated in previous RB-DSME pilot interventions and their family members, two sessions with local church leaders, and two sessions with community healthcare providers who care for patients with T2DM. Two independent reviewers performed content analysis to identify major themes using a grounded theory approach. The validity of core themes was enhanced by external review and subsequent discussions with two qualitative methods consultants. Results There was expressed interest and acceptability of the RB-DSME program. Church connection and pastor support were noted as key factors in building trust and enhancing recruitment, retention, and sustainability of the program. Core themes across all groups included the value of incentives, the need for foundational knowledge shared with genuine concern, teaching with visuals, dealing with denial, balancing the reality of adverse consequences with hope, the importance of social support, and addressing healthcare delivery barriers. Conclusion Focus groups documented the feasibility and potential effectiveness of RB-DSME interventions to enhance diabetes care in the African American community. In clinical practice, inclusion of these core themes may enhance T2DM self-care and treatment outcomes.

Understanding Diabetes-Related Distress Characteristics and Psychosocial Support Preferences of Urban African American Adults Living With Type 2 Diabetes: A Mixed-Methods Study

“…34 For African Americans in particular, peer support groups provide a culturally sensitive safe space to vent about the frustration of managing T2DM day in and day out as well as learn from others. Participants’ expressed desire for culturally sensitive diabetes support resources closely mirror findings in a recent focus group study by Lehrer and colleagues, 35 where African American participants of a resilience-based diabetes education program highlighted the benefits of interacting with similar others in support groups. Similar to the current study, participants in the Lehrer et al 35 study indicated that African American peer support groups provide an empathetic environment, where attendees are reminded that others also live with T2DM and face similar difficulties when it comes to managing the condition.…”

“…Participants’ expressed desire for culturally sensitive diabetes support resources closely mirror findings in a recent focus group study by Lehrer and colleagues, 35 where African American participants of a resilience-based diabetes education program highlighted the benefits of interacting with similar others in support groups. Similar to the current study, participants in the Lehrer et al 35 study indicated that African American peer support groups provide an empathetic environment, where attendees are reminded that others also live with T2DM and face similar difficulties when it comes to managing the condition. Participants in the current study also emphasized the importance of offering gender-specific support groups, a request primarily voiced by male focus group participants where they noted that men and women might experience distinctly different T2DM stressors that affect their mental health.…”

Prescription Medication Use Among Community-Based U.S. Adults With Chronic Low Back Pain: A Cross-Sectional Population Based Study

“…As African Americans are more likely to have a lower quality of life due to pain [39], and less likely to receive care for chronic pain [21], interventions aimed at improving coping strategies and healthcare access may specifically benefit African Americans. Community involvement and church-based self-management programs have been effective in improving health outcomes and wellbeing among African Americans [26, 50]. Several strategies have also been developed to target healthcare providers’ racial bias when caring for African Americans with pain, including perspective-taking [14], and shared decision-making [13, 46].…”

Healthcare Professionals’ Views of Factors Influencing Diabetes Self-Management and the Utility of a mHealth Application and Its Features to Support Self-Care

“…Each FGD comprised 2 to 5 HCPs and lasted approximately 65-100 minutes. A discussion guide was developed based on existing literature ( 33 – 36 ) and the study team’s expertise and pilot tested. The guide incorporated open-ended questions on different aspects of diabetes management.…”

“…Each FGD comprised 2 to 5 HCPs and lasted approximately 65-100 minutes. A discussion guide was developed based on existing literature (33)(34)(35)(36) and the study team's expertise and pilot tested.…”