Comparative Effectiveness of Three Different Delivery Models for a Community-Based Diabetes Prevention and Management Education Program in Older Adults

Abstract

Abstract Objectives The purpose was to compare the effects of three different delivery models for a diabetes prevention and management education (DPME) program on nutrition and diabetes knowledge (NDK), self-efficacy, dietary behaviors, skin carotenoid score (SCS), Body Mass Index (BMI), and fasting plasma glucose (FPG) among older adults. Methods We investigated dietary perceptions and health education needs of the community-dwelling older persons through interviewer-administered questionnaires in Lubbock, Texas (n = 186). This was then used to modify the national Diabetes Prevention Program (DPP), where the core elements were healthy eating within limited budget, enhancing self-efficacy, nutrition misconceptions, and practical problem-solving skills. The intervention was a clustered randomized trial (CRT). We recruited six community centers (two blocks of three). Two centers were randomly assigned to receive DPME through education and support from nutrition professionals (Pro, n = 23), two centers were assigned to trained peer educators (Peer, n = 27), and two centers were assigned to receive written materials (Passive, n = 26). Pro and Peer groups received weekly 45-minuate DPME sessions and the written materials for 10 weeks. Passive group received the DPME written materials on a weekly basis. Outcome measures were assessed at baseline and at the end of the intervention. Results The majority of subjects were Hispanics (72.4%), followed by Caucasians (14.5%) and African Americans (11.8%). Regression models demonstrated a significant improvement in self-efficacy score in Peer group (+0.38 ± 0.24) compared to the other two groups (+0.18 ± 0.32 for Pro and +0.11 ± 0.45 for Passive, P < 0.05). We found significant within-group improvements in NDK (P < 0.01), SCS (P < 0.001), and dietary behaviors (P < 0.001) for both Pro and Peer groups, with no significant differences between the two groups. Passive group did not show any significant changes in any of the outcomes measures. Budget management strategies were the most frequently reported element that empowered participants for changing their dietary behaviors. Conclusions Peer education provides a sustainable resource for diabetes prevention programs for community-dwelling elderly people. Passive information dissemination had no benefits to diabetes prevention for older adults. Funding Sources TTU Start-Up Funds.