Diabetes Self-management Program Research Articles

HbA1c changes in a deprived population who followed or not a diabetes self-management programme, organised in a multi-professional primary care practice: a historical cohort study on 207 patients between 2017 and 2019

BackgroundDiabetes self-management (DSM) helps people with diabetes to become actors in their disease. Deprived populations are particularly affected by diabetes and are less likely to have access to these programmes. DSM implementation in primary care, particularly in a multi-professional primary care practice (MPCP), is a valuable strategy to promote care access for these populations. In Rennes (Western France), a DSM programme was designed by a MPCP in a socio-economically deprived area. The study objective was to compare diabetes control in people who followed or not this DSM programme.MethodThe historical cohort of patients who participated in the DSM programme at the MPCP between 2017 and 2019 (n = 69) was compared with patients who did not participate in the programme, matched on sex, age, diabetes type and place of the general practitioner’s practice (n = 138). The primary outcome was glycated haemoglobin (HbA1c) change between 12 months before and 12 months after the DSM programme. Secondary outcomes included modifications in diabetes treatment, body mass index, blood pressure, dyslipidaemia, presence of microalbuminuria, and diabetes retinopathy screening participation.ResultsHbA1c was significantly improved in the exposed group after the programme (p < 0.01). The analysis did not find any significant between-group difference in socio-demographic data, medical history, comorbidities, and treatment adaptation.ConclusionsThese results, consistent with the international literature, promote the development of DSM programmes in primary care settings in deprived areas. The results of this real-life study need to be confirmed on the long-term and in different contexts (rural area, healthcare organisation).

Peer Ambassador Perspectives in a Culturally Tailored Self-Management Intervention for African Americans with Type 2 Diabetes: A Qualitative Study.

Diabetes disproportionately affects African Americans, leading to higher morbidity and mortality. This study explores the experiences of African American adults who successfully self-manage their type 2 diabetes (called Peer Ambassadors) and provided phone-based peer support in a 6-month culturally tailored diabetes self-management program for African Americans guided by the information-motivation-behavioral skills model. A group discussion using a semi-structured discussion guide was conducted. Qualitative content analysis was used to identify the facilitators and barriers to completing the role of a Peer Ambassador and to develop strategies for overcoming possible challenges in the future. Key informant discussions were conducted in a community location to gain insights into Ambassadors' motivations and challenges in delivering peer support. Three Peer Ambassadors completed ethics training and peer mentor training and received a phone call guide before providing support to their peers. There were four core themes related to Peer Ambassador experiences: (1) Motivation to be a Peer Ambassador, (2) program elements that supported Peer Ambassador role, (3) key elements of achieving engagement, and (4) challenges related to being a Peer Ambassador. This study showed Peer Ambassadors in a culturally tailored peer supported self-management program found fulfillment in sharing experiences and supporting peers. They highly valued educational group sessions for knowledge updates and sustaining their health-related goals, suggesting the potential benefits of recognizing milestones or providing advanced training for future program sustainability. Findings suggest the importance of recruiting motivated patients and providing effective facilitation for peer support roles, including addressing barriers such as time commitment and lack of socialization opportunities.

Uptake of self-management education programmes for people with type 2 diabetes in primary care through the embedding package: a cluster randomised control trial and ethnographic study

BackgroundSelf-management education programmes are cost-effective in helping people with type 2 diabetes manage their diabetes, but referral and attendance rates are low. This study reports on the effectiveness of the Embedding Package, a programme designed to increase type 2 diabetes self-management programme attendance in primary care.MethodsUsing a cluster randomised design, 66 practices were randomised to: (1) a wait-list group that provided usual care for nine months before receiving the Embedding Package for nine months, or (2) an immediate group that received the Embedding Package for 18 months. ‘Embedders’ supported practices and self-management programme providers to embed programme referral into routine practice, and an online ‘toolkit’ contained embedding support resources. Patient-level HbA1c (primary outcome), programme referral and attendance data, and clinical data from 92,977 patients with type 2 diabetes were collected at baseline (months − 3–0), step one (months 1–9), step 2 (months 10–18), and 12 months post-intervention. An integrated ethnographic study including observations, interviews, and document analysis was conducted using interpretive thematic analysis and Normalisation Process Theory.ResultsNo significant difference was found in HbA1c between intervention and control conditions (adjusted mean difference [95% confidence interval]: -0.10 [-0.38, 0.18] mmol/mol; -0.01 [-0.03, 0.02] %). Statistically but not clinically significantly lower levels of HbA1c were found in people of ethnic minority groups compared with non-ethnic minority groups during the intervention condition (-0.64 [-1.08, -0.20] mmol/mol; -0.06% [-0.10, -0.02], p = 0.004), but not greater self-management programme attendance. Twelve months post-intervention data showed statistically but not clinically significantly lower HbA1c (-0.56 [95% confidence interval: -0.71, -0.42] mmol/mol; -0.05 [-0.06, -0.04] %; p < 0.001), and higher self-management programme attendance (adjusted odds ratio: 1.13; 95% confidence interval: 1.02, 1.25; p = 0.017) during intervention conditions. Themes identified through the ethnographic study included challenges for Embedders in making and sustaining contact with practices and providers, and around practices’ interactions with the toolkit.ConclusionsBarriers to implementing the Embedding Package may have compromised its effectiveness. Statistically but not clinically significantly improved HbA1c among ethnic minority groups and in longer-term follow-up suggest that future research exploring methods of embedding diabetes self-management programmes into routine care is warranted.Trial registrationISRCTN23474120, registered 05/04/2018.

Process Evaluations of Diabetes Self-Management Programs: A Systematic Review of the Literature.

To conduct a systematic review of process evaluations (PEs) of diabetes self-management programs (DSMPs). An electronic search using Medline (Ovid), Embase (Ovid), CINAHL (Ensco), Academic Search (Ebsco), and APA PsycInfo (Ebsco). Peer-reviewed, empirical quantitative, qualitative, or mixed-method studies were included if they (1) were a traditional, group-based DSMP, (2) involved adults at least 18 years with T1DM or T2DM, (3) were a stand-alone or embedded PE, and (4) published in English. The following process evaluation outcomes were extracted: fidelity, dose delivered, dose received, reach, recruitment, retention, and context. Additional items were extracted, (eg, process evaluation type, data collection methods; theories; frameworks or conceptual models used to guide the process evaluation, and etc). Due to heterogeneity across studies, studies were synthesized qualitatively (narratively). Sixty-eight studies (k) in 78 articles (n) (k = 68; n = 78) were included. Most were mixed methods of low quality. Studies were typically integrated into outcome evaluations vs being stand-alone, lacked theoretical approaches to guide them, and incorporated limited outcomes such as dose received, reach, and retention. Future research should 1) implement stand-alone theoretically grounded PE studies and 2) provide a shared understanding of standardized guidelines to conduct PEs. This will allow public health practitioners and researchers to assess and compare the quality of different programs to be implemented.

Comparative Study of Diabetes Knowledge, Attitudes, Family Support, Self-efficacy, and Self-management Behaviors Between Cancer Survivors With Diabetes and Diabetes Patients Without Cancer

Background Studies have compared diabetes management quality indicators, focusing on physiological markers such as hemoglobin A1c, between cancer survivors with diabetes and general diabetes patients. However, research comparing differences in diabetes self-management behaviors and the factors influencing them between these groups is lacking. Objectives This study aimed to compare self-management behaviors, guided by the information-motivation-behavior model, between cancer survivors with diabetes and general diabetes patients. In addition, we aimed to identify differences in factors such as diabetes knowledge, attitudes, family support, and self-efficacy that may influence diabetes self-management behaviors in both groups. Methods A total of 125 cancer survivors with diabetes and 126 general diabetes patients participated in this cross-sectional study. A structured questionnaire assessed demographics, diabetes knowledge, attitudes, self-efficacy, and self-management behaviors. Results Regarding diabetes education, 47.0% of cancer survivors and 61.6% of general diabetes patients received education. The cancer survivors had lower diabetes knowledge scores (10.30 ± 4.15, P &lt; .001), a lower perceived value of strict blood glucose control (4.10 ± 0.56, P &lt; .001), and less family support (15.50 ± 7.50, P = .019) than the patients without cancer (13.51 ± 3.84, 4.25 ± 0.65, and 17.57 ± 6.40, respectively). Conclusion This study reveals significant differences in diabetes self-management between cancer survivors and general diabetes patients. Cancer survivors showed lower diabetes knowledge, glucose control perception, and family support. These findings highlight the need for tailored self-management programs for cancer survivors. Implications for Practice This study offers insights for developing tailored diabetes self-management programs and educational interventions for cancer survivors.

Long-Term Results of a Digital Diabetes Self-Management and Education Support Program Among Adults With Type 2 Diabetes: A Retrospective Cohort Study.

The purpose of this study is to examine the long-term impact of a digital diabetes self-management education and support (DSMES) program on A1C among adults with type 2 diabetes (T2DM). Data analyzed were from a retrospective cohort of commercially insured members with T2DM enrolled in the Omada for Diabetes program between January 1, 2019, and January 31, 2022 (n = 1,322). Linear mixed models measured changes in A1C and weight across 12 months (collected at baseline and every 3 months over 1 year) overall and stratified by A1C at baseline (≥8% vs <8%). On average, members were 53.5 years old, 56.9% female, and 71.5% White, with a mean baseline body mass index (BMI) of 36.9 and A1C of 7.6%. Members with baseline A1C ≥8% demonstrated clinically and statistically significant adjusted mean reductions in A1C during follow-up, from 9.48% at baseline to 7.33%, 7.57%, 7.59%, and 7.47% at 3, 6, 9, and 12 months, respectively. Those with A1C <8% maintained glycemic stability (6.73%, 6.50%, 6.54%, 6.62%, and 6.51%, respectively). Collectively, members experienced a -1.17 kg/m2 mean reduction in BMI over 12 months. This study provides real-world evidence that members with elevated baseline A1C (≥8%) enrolled in a digital DSMES program experienced clinically meaningful and statistically significant reductions in A1C. Those with baseline A1C within goal treatment range (<8%) maintained glycemic stability over 1 year. The findings support existing evidence that scalable digital DSMES solutions can help individuals with T2DM manage their condition.

Development of a tool to estimate sugar and caloric contents in alcoholic beverages for a diabetes self-management program in Thailand

Diabetes self-management education and support (DSMES) is recommended as a standard of care for patients with diabetes worldwide. Alcohol consumption is one aspect mentioned within the DSMES program in Thailand where alcohol consumption is the highest among Southeast Asian countries. Many diabetes guidelines suggest limiting alcohol intake to not more than one standard drink per day for adult women and two for adult men if they cannot abstain from drinking. In practice, however, the conversion of alcohol consumption into standard drinks, and nutritional information about the calorie and sugar contents of alcoholic beverages, especially domestically produced spirits, are not commonly available in Thailand. By reviewing the diabetes guidelines internationally and the Thailand alcoholic beverage industry, a visual health education tool to help convert different alcoholic beverages into standard drinks and to provide the calorie and sugar content of alcoholic beverages was developed as a part of the DSMES program. It was finalized following pilot testing and focus group discussions with policymakers, healthcare providers, and type 2 diabetes patients. The personalized counseling tool, integrated with guidelines and culturally tailored to the Thai setting is distributed to counselors/educators. It is a potentially useful tool for patients to make informed choices for their self-management of diabetes.

Utilization of diabetes self-management program among breast, prostate, and colorectal cancer survivors: Using 2006-2019 Texas Medicare data.

Cancer treatment is associated with inferior health outcomes such as diabetes. Medicare provides Diabetes Self-Management Training (DSMT) program to beneficiaries to achieve normal metabolic control and reduce the risk of micro and macro-vascular complications. This study aimed to examine the trend of DSMT utilization among cancer survivors and assess individual characteristics associated with it. The data for this study was from Texas Cancer Registry-Medicare linkage data of patients with prostate, breast, or colorectal cancer diagnosed in 1999-2017. Outcome variables include the number of first-time DSMT users, the number of total users, and the average number of DSMT utilization in minutes. We performed logistic regression and gamma regression to obtain a multivariable-adjusted odds ratio for the association between DSMT utilization and individual characteristics. The number of first-time users has slowly increased over the years (from 99 to 769 per 1,000) but suddenly dropped after 2016. The number of all users (first-time and follow-up users) has increased (from 123 to 1,201 per 1,000) and plateaued after 2016. Determinants including Hispanic ethnicity (O.R. = 1.10) and Medicare-Medicaid dual eligibility (O.R. = 1.25) are positively associated with both the initiation and retention of the DSMT. A barrier to both initiation and retention of DSMT is living in a metropolitan area (O.R. = 0.90). Multi-level strategies to enhance accessibility and availability of DSMT programs for Medicare beneficiaries are highly recommended. Examining the determinants of initiation and retention of DSMT over 14 years provides insights on strategies to meet the needs of cancer survivors and reduce the burden of diabetes on them.

The effect of nurse-led diabetes self-management programmes on glycosylated haemoglobin levels in individuals with type 2 diabetes: A systematic review.

This review aimed to examine the content, frequency, duration, and outcomes of nurse-led diabetes self-management programmes on glycosylated haemoglobin levels in individuals with type 2 diabetes. Diabetes self-management programmes improve glycemic control in individuals with type 2 diabetes to acquire specific behavioural changes and develop effective problem-solving skills. A systematic review was used in this study. PubMed, Science Direct, Cochrane Library, Web of Science, Ovid, CINAHL, Proquest and Scopus databases were searched for studies published in English until February 2022. The risk of bias was assessed using the Cochrane Collaboration tool. This study followed the recommendations of the Cochrane 2022 guidelines and was reported using the Preferred Reporting Items for Systematic Reviews and Meta-analysis. Eight studies with 1747 participants met the inclusion criteria. Interventions included telephone coaching, consultation services and individual and group education. The duration of the intervention ranged from 3 to 15 months. The results showed that nurse-led diabetes self-management programmes had positive and clinically significant effects on glycosylated haemoglobin levels in individuals with type 2 diabetes. These findings highlight the important role of nurses in improving self-management and achieving glycemic control in individuals with type 2 diabetes. The positive outcomes of this review offer suggestions for health care professionals to develop effective self-management programnmes in type 2 diabetes treatment and care.

533-P: The Physiological Effects from Type 2 Diabetes Self-Management Program in a Municipal Setting

There is a lack of knowledge showing the real-life effects of person-centered type 2 diabetes (T2DM) Management programs offered in a municipal setting. The aim of this study is to determine the effectiveness of individualized T2DM management programs for patients with T2DM in a municipal setting on HbA1c and blood pressure (BP). Based on a person-centered and differentiated approach, the intervention consists of education, physical training, cooking classes and/or individual consultations. Methods: The study was conducted during 2018 to 2021 with citizens referred consecutively for T2DM management programs. A total of 308 patients were included. Of these 308, 172, and 131 completed questionaries and physiological measurements at baseline, at end of the program and at 6 months follow-up, respectively. All physiological data was collected by selected health care professionals trained in standard operations procedures. Results: Respondents consist of 60% men, age range primarily from 55-79, 57% have a short education level. At baseline mean HbA1c was 58.5 mmol/mol (IQR: 48.0-64.0). At end of the program, a statistically significant decrease of −6.5 mmol/mol (95% CI: −9.0; −4.1, p&amp;lt;0.001) was observed. At 6 months follow-up this decrease was unchanged as it was showing a decrease of −5.8 mmol/mol (95% CI: −8.8; −2.8, p&amp;lt;0.001) compared to baseline. At baseline mean systolic and diastolic BP was 147.5 mmHg (IQR: 134.2-158.0) and 86.2 mmHg (IQR: 79.6-93.3), respectively. At end of the program and at 6 months follow-up a significant decrease of −10.7mmHg (95% CI: −15.0; −6.3, p&amp;lt;0.001) and −11.8 mmHg (95% CI: −16.4; −7, 2, p&amp;lt;0.001), respectively, was observed for systolic BP when compared to baseline. Conclusion: Person-centered T2DM management programs in a large municipal setting significantly reduce HbA1c and BP on long and short term. These results may be caused by person-centered care and a holistic approach. Disclosure L.A.Helgstrand: None. A.D.Hvidberg: None. C.Glümer: None.

35-LB: The Impact of the COVID-19 Pandemic on A1C Reductions in Patients with Diabetes Mellitus Who Attended an ADA-Recognized DSMES Program

AM Diabetes Centers of America, an independent endocrinology practice in Bartlett, Tennessee, offers a diabetes self-management, education, and support (DSMES) program that has been recognized by the American Diabetes Association (ADA) since 2010. The program typically serves 450-500 participants per year, all from the Memphis/Mid-South area. Per ADA requirements, participants’ pre- and post-program attendance glycated hemoglobin (A1C), weight, blood pressure, and lipids, are reported annually. Of these, A1C was observed as a key metric indicating blood glucose control. Data sets from ADA Chronicle Diabetes were analyzed quantitatively to compare program attendance and A1C reductions between 2013-2019 and the pandemic peak in 2020-2021. From 2013-2018, program attendance grew at an average rate of 26% per year. Attendance dropped by 30% in 2019, but average A1C reduction among participants in 2019 was 0.8%, and average A1C reduction for all participants in 2013-2019 was 0.64% (SD=0.346; p=0.003). In 2020-2021, attendance dropped by an average of 30% per year, and average A1C reduction was only 0.45% (SD=0.05; p=0.035). In the first post-pandemic year, program attendance rebounded by 18% and average A1C reduction was 1.1%. Because a direct correlation exists between waning program attendance and reduced impact upon participants’ A1C levels during COVID-19, and because these trends reversed as soon as pandemic restrictions were lifted, it may be reasonably ascertained that the mandated restrictions on in-person meetings and outside activities were key factors in producing these results. Disclosure K. B. Stoneking: None. K. Latif: None. M. Moore: None. H. White: None.

Economic burden, financial stress, and cost-related coping among people with uncontrolled diabetes in the U.S

Granular information on material deprivation including financial and economic well-being among people with diabetes can better inform policy, practice and interventions to support diabetes management. The purpose of this study was to describe in-depth the state of economic burden, financial stress, and coping among people with high A1c. Data came from the 2019–2021 baseline assessment in an ongoing U.S. trial that addresses social determinants of health among people with diabetes and high A1c who report at least one financial burden or cost-related non-adherence (CRN) (n = 600). Mean age of participants was 53 years. Planning behaviors were the most common financial well-being behavior, while savings was least frequently endorsed. Nearly a quarter of participants report spending more than $300 per month out-of-pocket to manage all of their health conditions. Participants reported spending the most out-of-pocket on medications (52%), special foods (40%), doctor’s visits (27%), and blood glucose supplies (22%). Along with health insurance, these were also the most cited as sources of financial stress and where assistance. Seventy-two percent reported high levels of financial stress. Maladaptive coping was evident through CRN, and less than half engaged in adaptive coping such as talking to a doctor about cost or using a resource to address their needs. Economic burden, financial stress, and cost-related coping are highly relevant constructs among people with diabetes and high A1cs. More evidence-generation is needed for diabetes self-management programs to address sources of financial stress, facilitate behaviors to enhance financial well-being, and address unmet social needs to alleviate economic burdens.

Development of a Supported Self-management Intervention for People With Severe Mental Illness and Type 2 Diabetes: Theory and Evidence-Based Co-design Approach.

Type 2 diabetes is 2 to 3 times more common among people with severe mental illness (SMI). Self-management is crucial, with additional challenges faced by people with SMI. Therefore, it is essential that any diabetes self-management program for people with SMI addresses the unique needs of people living with both conditions and the inequalities they experience within health care services. We combined theory, empirical evidence, and co-design approaches to develop a type 2 diabetes self-management intervention for people with SMI. The development process encompassed 4 steps: step 1 involved prioritizing the mechanisms of action (MoAs) and behavior change techniques (BCTs) for the intervention. Using findings from primary qualitative research and systematic reviews, we selected candidate MoAs to target in the intervention and candidate BCTs to use. Expert stakeholders then ranked these MoAs and BCTs using a 2-phase survey. The average scores were used to generate a prioritized list of MoAs and BCTs. During step 2, we presented the survey results to an expert consensus workshop to seek expert agreement with the definitive list of MoAs and BCTs for the intervention and identify potential modes of delivery. Step 3 involved the development of trigger films using the evidence from steps 1 and 2. We used animations to present the experiences of people with SMI managing diabetes. These films were used in step 4, where we used a stakeholder co-design approach. This involved a series of structured workshops, where the co-design activities were informed by theory and evidence. Upon the completion of the 4-step process, we developed the DIAMONDS (diabetes and mental illness, improving outcomes and self-management) intervention. It is a tailored self-management intervention based on the synthesis of the outputs from the co-design process. The intervention incorporates a digital app, a paper-based workbook, and one-to-one coaching designed to meet the needs of people with SMI and coexisting type 2 diabetes. The intervention development work was underpinned by the MoA theoretical framework and incorporated systematic reviews, primary qualitative research, expert stakeholder surveys, and evidence generated during co-design workshops. The intervention will now be tested for feasibility before undergoing a definitive evaluation in a pragmatic randomized controlled trial.

Associations between depression and diabetes among Latinx patients from low-income households in New Mexico

Depression and diabetes are co-occurring epidemics. This article explores the association between depression and diabetes in a cohort of Latinx patients with diabetes from low-income households. Data were gathered in Albuquerque, New Mexico (U.S.) between 2016 and 2020 as part of a patient-engaged comparative effectiveness trial comparing two culturally appropriate diabetes self-management programs—the Chronic Care Model (CCM) and the standard of care, Diabetes Self-Management Support Empowerment Model (DSMS). We proposed that the program most culturally and contextually situated in the life of the patient would have the greatest impact on diabetes self-management. Participants were enrolled as dyads—226 Latinx diabetes patient participants (PPs) from low-income households and 226 social support participants (SSPs). Data gathered at baseline, 3, 6, and 12 months included a measure of depression and A1c testing. Outcomes between programs were analyzed using longitudinal linear mixed modeling, adjusted for patient demographic characteristics and other potential confounding covariates. Patient A1c had an initial slight decrease at 3 months in both programs. At CCM, patients with a very high A1c (greater than 10%) demonstrated a clinically meaningful decrease in A1c over time. Patients at CCM experienced a large initial decrease in depression and continued to decrease throughout the study, while patients at DSMS showed a slight initial decrease through 6 months, but depression increased again by 12 months, nearly rebounding to baseline levels. A subgroup analysis revealed that a higher baseline A1c was associated with higher depression, and patients with higher A1c achieved greater reductions in depression at CCM than at DSMS. CCM scored higher on Consumer Assessment of Healthcare Providers and Systems cultural competence (CAHPS-CC). Interpretation of results suggests that the more culturally, contextually situated program, CCM, had better outcomes. This study demonstrates that culturally and contextually situating a diabetes intervention can deliver improved benefits for Latinx patients.

Investigating the effects of digital foot self-management program on enhancing self-efficacy and self-care behavior among community-dwelling older adults with type 2 diabetes: A randomized controlled trial.

Diabetic foot self-management intervention programs have been proven to positively influence individuals' behaviors in preventing diabetic foot ulcers. Using digital technologies to deliver programs can facilitate compliance with diabetes self-management programs. However, few studies have focused on the effects of such digital programs on improving the self-efficacy and behaviors of older adults with type 2 diabetes in the community. To evaluate the effects of a digital foot self-management program on self-efficacy, self-care behavior, and Hemoglobin A1c levels. A single-blinded, randomized controlled trial was conducted. The intervention program comprised a 4-week digital foot care program with one face-to-face education session, phone calls once weekly, and LINE messages (social media) three times per research nurse and a follow-up of three months. Patients in the control group received routine care. A total of 100 participants (n = 50 in the control and n = 50 in the intervention groups) completed the study with a mean age of 67.55 (SD = 11.17). The results showed significant improvements in self-efficacy (F = 2187.24, p < 0.01) and self-care behavior (F = 614.71, p < 0.01) in foot care between the groups. The Hemoglobin A1c levels showed a 0.41% reduction over time in the experimental group (t = -3.759; p < 0.01), whereas the control group showed a 0.06% reduction (t = -0.797, p > 0.05). The newly developed digital foot self-management program was effective in community-dwelling older adult patients with type 2 diabetes.

Diabetes Self-Management Program Using Video-Conferencing Technology for Older People with Diabetes: A systematic Review

Purpose: This study was a systematic review to identify components, strategies, and limitations of diabetes self-management intervention using video conferencing technology for the older adults. Methods: This review followed the NECA’s manual and PRISMA guidelines. Seven databases (Pubmed, EMBASE, CINAHL, PsycINFO, RISS, DBpia, and KISS) were searched, and the quality of the studies was evaluated using Joanna Briggs Institute Critical Appraisal Checklist. As heterogeneity between studies, the results of the study were described through qualitative synthesis. Results: Eleven articles were included according to the selection criteria. Interventions dealing with all seven ADCES diabetes self-care behaviors accounted for the majority with five (45.4%). Video conference software such as Zoom was used, and some of the participants were provided with equipment for video conferencing access. In addition, various strategies were applied to overcome the difficulties of participants, such as pre-training for the use of equipment, encouraging participation through family or friends, and using research assistants. Interventions showed positive effects in diabetes clinical indicators, psychosocial indicators, and satisfaction. Conclusion: Researchers need to consider various strategies such as providing equipment or encouraging participation to develop diabetes self-management interventions using video conferencing technology for the older adults.

Protocol for a Pilot Randomized Controlled Mixed Methods Feasibility Trial of a Culturally Adapted Peer Support and Self-Management Intervention for African Americans

Due to diabetes disparities commonly seen among African Americans, it is important to address psychosocial and sociocultural barriers to medication adherence among African Americans with diabetes. Building on our prior work testing a culturally adapted peer supported diabetes self-management intervention for African Americans, this study will conduct a pilot randomized controlled feasibility trial that compares the culturally adapted intervention with a standard diabetes self-management program. Using an intervention mixed-methods design, the six-month trial will be conducted at two sites. Twenty-four African Americans with uncontrolled type 2 diabetes will be randomized to the intervention or control arm. Feasibility and acceptability outcomes in four domains (recruitment, intervention acceptability, intervention adherence, retention) will be collected. Primary clinical outcome (A1C), secondary outcome (medication adherence) and patient-specific psychosocial measures will be collected at baseline, 2 months, and 6 months. Document review, interview and focus groups will be used to gather qualitative data on feasibility and acceptability. Expected results are that the trial protocol will be feasible to implement and acceptable for participants, and there will be a signal of clinically meaningful reduction in A1C and improvements in medication adherence. The results of this trial will inform a future powered large-scale randomized controlled trial testing the effectiveness of the culturally tailored intervention.

Mixed-methods implementation study of a virtual culturally tailored diabetes self-management programme for African and Caribbean communities (HEAL-D) in south London and its scaling up across NHS regions in England: study protocol

IntroductionThe National Health Service Insight Prioritisation Programme was established to accelerate the implementation and evaluation of innovation that supports post-pandemic working. Supporting this, the Academic Health Science Network and National...

An Academic-Community Engagement: A Roadmap for Developing a Culturally Relevant Diabetes Self-Management Program among Vietnamese Americans

Recognizing and addressing culture-specific differences concerning diabetes self-management education and support (DSMES) programs can potentially increase participation among Vietnamese Americans with type 2 diabetes and improve health outcomes. This paper describes the academic-community engagement process used to seek input from the Vietnamese community of Oklahoma to tailor a DSMES program. The Community Engagement Continuum (CEC) (CDC, 2011) was utilized as a conceptual framework to engage with the Vietnamese community. The academic team assembled a community advisory board (CAB) of stakeholders, who were selected to advise the team on intervention development; elicited community feedback; and integrated recommendations to tailor the DSMES program. Twenty-three CAB members participated in a minimum of three community engagement meetings over six months. Meetings were structured to elicit feedback and suggestions to ensure that the tailored program was embedded in Vietnamese cultural practices and accounted for community resources and needs. CAB members identified that education and resources must be provided in the Vietnamese language with special attention to culturally relevant adaptations concerning healthy eating and medication adherence. Application of the CEC framework facilitated the inclusion of Vietnamese community perspectives and beliefs, the identification of potential collaborators, the establishment of trust and relationships, and the development of a culturally relevant DSMES program. This engagement process may serve as a model for other underserved minority populations to develop culturally appropriate health promotion and disease prevention interventions.

Perspectives on a Novel Culturally Tailored Diabetes Self-Management Program for African Americans: A Qualitative Study of Healthcare Professionals and Organizational Leaders.

Background: There is an urgent need for culturally tailored diabetes self-management education to improve health outcomes in African Americans, especially given the disproportionate prevalence of diabetes and medication non-adherence. Stakeholder engagement can guide and enrich the development of these interventions by integrating content directly addressing barriers to African Americans’ adherence with existing community-based diabetes self-management education programs. The aim of this study is to explore stakeholder perspectives on a novel culturally tailored diabetes self-management program for African Americans. Methods: Thirteen semi-structured individual interviews were conducted in a large Midwestern U.S. city with healthcare professionals and organizational leaders serving African American communities and/or providing diabetes education. Transcripts were analyzed using directed content analysis with the Consolidated Framework for Implementation Research and inductive content analysis. Results: Five overarching themes were identified: (1) fulfill needs among stakeholders, (2) creating a supportive and trusting environment to address distrust, (3) building relationships and empowering peers, (4) logistical organization barriers to program implementation and (5) challenges to program acceptance by participants. Conclusion: Stakeholders delineated how the new culturally tailored diabetes self-management program aligned with the needs of African American patients. Perceived challenges and corresponding strategies to address barriers to participation were identified to inform program implementation and sustainability.