Purpose The purpose of this study is to evaluate the impact of a promotores-led diabetes self-management program by comparing the outcomes (knowledge, beliefs, and HbA1c level) of Mexican American patients with type 2 diabetes who received usual diabetic care in a wait-list control group to those who received self-management education and follow-up by promotores in consultation with clinic providers and staff.
Methods This randomized control study compared the results of 63 patients who attended a promotores-led culturally sensitive diabetes self-management course at a commu- nity clinic with 68 patients in a wait-list, usual-care control group. Participants were Mexican Americans with type 2 diabetes who were patients at the clinic and at least 18 years of age. At baseline, 3 months, and 6 months, the Diabetes Knowledge Questionnaire (DKQ), Health Beliefs Questionnaire (HBQ), and HbA1c levels (drawn by the clinic laboratory) were collected.
Results There was a significant improvement in the intervention group's DKQ scores over time and in treatment by time. The baseline HbA1c level was 7.49 and did not change over time in either group. The DKQ, HBQ, and HbA1c results were significantly affected by age; the DKQ and HbA1c were affected by years with diabetes.
Conclusions The promotores-led diabetes self-management course improved the knowledge of patients with diabetes. Participant baseline HbA1c level was close to therapeutic level (much lower than reported in previous studies), suggesting participants received good medical care within the community clinic.
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References
1.
Centers for Disease Control and Prevention.National Center for Chronic Disease Prevention and Health Promotion. Diabetes Public Health Resource: publications & products-national diabetes fact sheet. http://www.cdc.gov/diabetes/pubs/estimates.htm . Accessed October 28, 2002.
2.
Texas Department of Health.Diabetes prevalence in Texas 2001. Estimated number of diagnosed diabetes in Texas (2001) using 2001 Texas Behavioral Risk Factor Surveillance System (BRFSS). http://www.tdh.state.tx.us/diabetes/pdf/county.pdf . Accessed March 14, 2004.
3.
Harris MI, Flegal KM, Cowie CC, et al. Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in U.S. adults. Diabetes Care. 1998;21:520-524.
4.
Hanis CL, Ferrell RE, Barton SA, et al. Diabetes among Mexican Americans in Starr County, Texas. Am J Epidemiol. 1983;118: 659-671.
5.
Coonrod BA, Betschart J., Harris MIFrequency and determinants of diabetes patient education among adults in the U.S. population. Diabetes Care. 1994;17:852-858.
Mensing C., Boucher J., Cypress M., Weinger, Mulcahy K., Bartak P., et al. National standards for diabetes self-management education. Diabetes Care. 2003;26(suppl 1):S149-S156.
8.
Brown S. (1988). Effects of educational interventions in diabetes care: a meta-analysis of findings. Nurs Res. 1998;37:223-230.
9.
Norris SL, Engelgau MM, Narayan KMEffectiveness of self-management training in type 2 diabetes. Diabetes Care. 2001;24:561-587.
10.
Heitzmann CA, Kaplan RM, Wilson DK, Sandler J.Sex differences in weight loss among adults with type II diabetes Mellitus . J Behav Med. 1987;10:197-211.
11.
Glasgow RE, Toobert DJ, Hampson SE, Strycker LAImplementation, generalization and long-term results of the "choosing well" diabetes self-management intervention. Patient Educ Couns . 2002;48:115-122.
12.
Kaplan RM, Hartwell SL, Wilson DK, Wallace JPEffects of diet and exercise interventions on control and quality of life in non-insulin-dependent diabetes mellitus. J Gen Intern Med . 1987; 2:220-227.
13.
Wing RR, Epstein LH, Nowalk MP, Scott N., Koeske R., Hagg S.Does self-monitoring of blood glucose levels improve dietary compliance for obese patients with type II diabetes. Am Med J. 1986;81:830-836.
14.
Rabkin SW, Boyko E., Wilson A., Streja DAA randomized clinical trial comparing behavior modification and individual counseling in the nutritional therapy of non-insulin-dependent diabetes mellitus: comparison of the effect on blood sugar, body weight, and serum lipids. Diabetes Care. 1983;6:50-56.
15.
Wing RR, Epstein LH, Nowalk MP, Koeske R., Hagg S.Behavior change, weight loss, and physiological improvements in type II diabetic patients. J Consult Clin Psychol. 1985;53:111-112.
16.
Hartwell SL , Kaplan RM, Wallace JPComparison of behavioral intervention and control of type II diabetes mellitus. Behav Ther. 1986;17:447-461.
17.
Mazzuca SA, Moorman NH, Wheeler ML, et al. The diabetes education study: a controlled trial of the effects of diabetes education. Diabetes Care. 1986 ;9:1-10.
18.
Agura-Collins RD, Kumanyika SK, Ten Have TR, Adams-Campbell LLA randomized controlled trial of weight reduction and exercise for diabetes management in older African-American subjects. Diabetes Care. 1997;20:1503-1511.
19.
Campbell LV , Barth R., Gosper JK, Jupp JJ, Simons LA, Chisholm DJImpact of intensive educational approach to dietary change in NIDDM. Diabetes Care. 1990 ;13:841-847.
20.
Gary TL, Bone LR, Hill MN, et al. Randomized controlled trial of the effects of nurse case manager and community health worker interventions on risk factors for diabetes-related complications in urban African Americans. Prev Med. 2003;37:23-32.
21.
Polonsky WH , Earles J., Smith S., et al. Integrating medical management with diabetes self-management training. Diabetes Care. 2003;26:3048-3053.
22.
Glasgow RE, Toobert DJ, Mitchell DL, Donnelly JE, Calder D.Nutrition education and social learning interventions for type II diabetes . Diabetes Care. 1989;12:150-152.
23.
Glasgow RE, Toobert DJ, Hampson SE, Brown JE, Lewinsohn PMDonnelly J.Improving self-care among older patients with type II diabetes: The "sixty something . . ." study. Patient Educ Couns. 1992;19:61-74.
24.
Glasgow RE, Toobert DJ, Hampson SEEffects of a brief office-based intervention to facilitate diabetes dietary self-management. Diabetes Care. 1996;19:835-842.
25.
Franz MJ, Monk A., Barry B., et al. Effectiveness of medical nutrition therapy provided by dietitians in the management of non-insulin-dependent diabetes mellitus: a randomized, controlled clinical trial. J Am Diet Assoc. 1995;95:1009-1017.
26.
Anderson RM , Funnell MM, Butler PM, Arnold MS, Fitzgerald JT, Feste CCPatient empowerment: results of a randomized controlled trial. Diabetes Care. 1995;18:943-949.
27.
Miller DK, Edwards L., Kissling G., Sanville L.Nutrition education improves metabolic outcomes among older adults with diabetes mellitus: results from a randomized controlled trial. Prev Med. 2002;34:252-259.
28.
Taylor CB, Miller NH, Reilly KR, et al. Evaluation of a nurse-case management system to improve outcomes in patients with complicated diabetes. Diabetes Care. 2003;26:1058-1063.
29.
Keyserling TC, Samuel-Hodge CD, Ammerman AS, et al. A ramdomized trial of an intervention to improve self-care behaviors of African-American women with type 2 diabetes . Diabetes Care. 2002;25:1576-1583.
30.
Brown SA, Hanis CLCulturally competent diabetes education for Mexican Americans: The Starr County study. Diabetes Educ. 1999;25:226-236.
31.
Brown SA, Garcia AA, Kouzekanani K., Hanis CLCulturally competent diabetes self-management education for Mexican Americans: the Starr County border health initiative. Diabetes Care. 2002;25:259-268.
32.
Brown SA, Blozis SA, Kouzekanani K., Garcia AA, Winchell M., Hanis CLDosage effects of diabetes self-management education for Mexican Americans: the Starr County border health initiative. Diabetes Care. 2005;28:527-532.
33.
Ingram M., Gallegos G., Elenes J.Diabetes is a community issue: the critical elements of a successful outreach and education model on the U.S.-Mexico border. Prev Chronic Dis.2005;2(1):A15.
Lorig KR, Ritter PL, Jacquez A.Outcomes of border health Spanish/ English chronic disease self-management programs. Diabetes Educ. 2005;31:401-409.
36.
Corkery E., Palmer C., Schechter CB, Frisher L., Roman SHEffect of a bicultural community health worker on completion of diabetes education in a Hispanic population. Diabetes Care. 1997 ;20:254-257.
37.
Gary TL, Bone LR, Hill MN, et al. Randomized controlled trial of the effects of nurse case manager and community health worker interventions on risk factors for diabetes-related complications in urban African Americans. Prev Med. 2003;37:23-32.
38.
Texas Department of Health.Selected facts for Webb County 2000. http://www.tdh.state.tx.us/dpa/cfs00/texas00.PDF . Accessed October 22, 2002.
39.
Deyo RA, Diehl AK, Hazuda H., Stern MPA simple language-based acculturation scale for Mexican Americans: validation and application to health care research. Am J Public Health . 1985; 75:51-55.
40.
Guttman LAA basis for scaling qualitative data. Am Soc Rev. 1944;9:139.
41.
Hazuda HP, Stern MP, Gaskill SP, Haffner SM, Gardner LIEthnic differences in health knowledge and behaviors related to the prevention and treatment of coronary heart disease. The San Antonio Heart Study. Am J Epidemiol. 1983;117:717-728.
42.
Brown SA, Becker HA, Garcia AA, Barton SA, Hanis CLMeasuring health beliefs in Spanish-speaking Mexican Americans with type two diabetes: adapting an existing instrument. Res Nurs Health . 2002;25:145-158.
43.
Given CW, Given BA, Gallen RS, Condon JWDevelopment of scales to measure beliefs of diabetic patients. Res Nurs Health. 1983;25:145-158.
44.
Brown SA, Hanis CLA community-based, culturally sensitive education and group-support intervention for Mexican Americans with NIDDM: a pilot study of efficacy. Diabetes Educ. 1995; 21:203-210.
45.
Garcia AA, Villagomez ET, Brown SA, Kouzekanani K., Hanis CLThe Starr County diabetes education study: development of the Spanish-language diabetes knowledge questionnaire. Diabetes Care. 2001;24:16-21.
46.
Ramos IN, May M., Ramos KSEnvironmental health training of promotoras in colonias along the Texas-Mexico border. Am J Public Health. 2001;91:568-570.
47.
Shojania KG , Ranji SR, McDonald KM, et al. Effects of quality improvement strategies for type 2 diabetes on glycemic control: a meta-regression analysis. JAMA. 2006;296:427-440.
48.
American Diabetes Association.Position statement: standards of medical care in diabetes-2007. http://care.diabetesjournals.org/cgi/content/full/30/suppl_1/S4 . Accessed January 30, 2007.
49.
Whittemore R., D'Eramo Meljus G., Grey M.Metabolic control, self-management and psychosocial adjustment in women with type 2 diabetes . J Clin Nurs. 2005;14:195- 203.
50.
Hill-Briggs F., Cooper DC, Loman K., Cooper LAA qualitative study of problem solving and diabetes control in type 2 diabetes self-management. Diabetes Educ. 2003;29:1018-1028.
51.
Wen LK, Shepherd MD, Parchman MLFamily support, diet, and exercise among older Mexican Americans with type 2 diabetes. Diabetes Educ. 2004;30:980-993.
52.
Pham DT, Fabienne F., Thibaudeau M.The role of health belief model in amputees' self-evaluation of adherence to diabetes self-care behaviors. Diabetes Educ. 1996;22:126-132.
53.
Thackeray R. , Merrill RM, Neiger BLDisparities in diabetes management practice between racial and ethnic groups in the United States. Diabetes Educ. 2004;30:665-675.
54.
Brown AF, Gerzoff RB, Karter AJ, et al. Health behaviors and quality of care among Latinos with diabetes in managed care. Am J Public Health. 2003;93:1694-1698.
55.
Tocher TM, Larson E.Quality of diabetes care for non-English-speaking patients: a comparative study. Qual Diabetes Care. 1998;168:504-511.
56.
Lasater LM, Davidson AJ, Steiner JF, Mehler PSGlycemic control in English- vs Spanish-speaking Hispanic patients with type 2 diabetes mellitus. Arch Intern Med. 2001 ;161:77-82.
57.
Marks G., Solis J., Richardson JL, Collins LM, Birba L., Hisserich JCHealth behavior of elderly Hispanic women: does cultural assimilation make a difference? Am J Public Health. 1987;77: 1315-1319.
58.
Kim S., Love F., Quistberg DA, Shea JAAssociation of health literacy with self-management behavior in patients with diabetes. Diabetes Care. 2004;27:2980-2982.
59.
Caban A., Walker EAA systematic review of research on culturally relevant issues for Hispanics with diabetes. Diabetes Educ. 2006;32:584-595.
