The DISC (Diabetes in Social Context) Study-evaluation of a culturally sensitive social network intervention for diabetic patients in lower socioeconomic groups: a study protocol

Charlotte Vissenberg,Barend Jc Middelkoop,Karien Stronks,Giel Nijpels,Paul Jm Uitewaal,Diana Geraci,Vera Nierkens

doi:10.1186/1471-2458-12-199

Abstract

BackgroundCompared to those in higher socioeconomic groups, diabetic patients in lower socioeconomic groups have less favourable metabolic control and experience more diabetes-related complications. They encounter specific barriers that hinder optimal diabetes self-management, including a lack of social support and other psychosocial mechanisms in their immediate social environments. Powerful Together with Diabetes is a culturally sensitive social network intervention specifically targeted to ethnic Dutch, Moroccan, Turkish, and Surinamese diabetic patients in lower socioeconomic groups. For ten months, patients will participate in peer support groups in which they will share experiences, support each other in maintaining healthy lifestyles, and learn skills to resist social pressure. At the same time, their significant others will also receive an intervention, aimed at maximizing support for and minimizing the negative social influences on diabetes self-management. This study aims to test the effectiveness of Powerful Together with Diabetes.Methods/DesignWe will use a quasi-experimental design with an intervention group (Group 1) and two comparison groups (Groups 2 and 3), N = 128 in each group. Group 1 will receive Powerful Together with Diabetes. Group 2 will receive Know your Sugar, a six-week group intervention that does not focus on the participants' social environments. Group 3 receives standard care only. Participants in Groups 1 and 2 will be interviewed and physically examined at baseline, 3, 10, and 16 months. We will compare their haemoglobin A1C levels with the haemoglobin A1C levels of Group 3. Main outcome measures are haemoglobin A1C, diabetes-related quality of life, diabetes self-management, health-related, and intermediate outcome measures. We will conduct a process evaluation and a qualitative study to gain more insights into the intervention fidelity, feasibility, and changes in the psychosocial mechanism in the participants' immediate social environments.DiscussionWith this study, we will assess the feasibility and effectiveness of a culturally sensitive social network intervention for lower socioeconomic groups. Furthermore, we will study how to enable these patients to optimally manage their diabetes. This trial is registered in the Dutch Trial Register: NTR1886

Highlights

Compared to those in higher socioeconomic groups, diabetic patients in lower socioeconomic groups have less favourable metabolic control and experience more diabetes-related complications
Growing evidence suggests that in addition to social support, other psychosocial mechanisms in the immediate social environments of diabetic patients such as social influence and social engagement have a major influence on diabetes self-management (DSM) as well
Diabetic patients in lower SE groups in particular seem to be confronted with strong psychosocial mechanisms that have an adverse effect on their DSM and seem to experience more difficulties in coping with these mechanisms

Summary

Introduction

Compared to those in higher socioeconomic groups, diabetic patients in lower socioeconomic groups have less favourable metabolic control and experience more diabetes-related complications They encounter specific barriers that hinder optimal diabetes self-management, including a lack of social support and other psychosocial mechanisms in their immediate social environments. Achieving optimal glycaemic control requires the diabetic patient to take part in a complex set of tasks: adhere to dietary advice and medications, engage in regular physical activity, quit smoking, and monitor blood glucose levels, known as diabetes self-management (DSM) [4] These tasks seem to be more challenging for diabetic patients in lower SE groups [5,6,7]. Barriers to DSM among lower SE groups include a lack of knowledge of diabetes, low self-efficacy, low perceived control, and low health literacy [5,7,12]

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