“Get back on the horse and start over again”: Long-Term Effects of a Diabetes Self-Management Education (DSME) Program in an Underserved Population

Abstract

Purpose: The purpose of this retrospective, mixed methods study is to examine the relationship between participation in an interdisciplinary diabetes self-management education (DSME) program at an urban primary health care center and patients’ perceived knowledge and skills, as well as clinical markers, on four cohorts of patients over a two-year period. Methods: Participants, mainly African-American females, responded to survey questions including self-care behaviors, perceived knowledge, and self-efficacy. The researchers also reviewed the participants’ clinical records for glycosylated hemoglobin (HbA 1c) and body mass index (BMI) data and compared these to similar patients in the health center who had not participated in the DSME program. Additional analysis involved a cross comparison of earlier cohorts (2014-15) to later cohorts (2016-17). Results: Quantitative analysis showed strong statistical evidence that those in the DSME program had more control over their BMI as compared to the control group. The results also suggested that those in the program after 2016 had more control over their HbA1c than those in the program before 2016, although this evidence was more limited. Qualitative themes that emerged highlighted the participants’ valuing most what they learned about nutrition, exercise, and disease management. Conclusions: Population specific DSME programs can help produce both quality of life and clinical improvements that persist over time in underserved populations. This study was limited by a small sample size.