This randomized, controlled trial pilot study uses triangulation of methods and a person-environment interaction perspective to explore an intervention (IV) in concert with intensive interviews in a sample of older African-Americans (>65) with non-insulin-dependent diabetes mellitus (NIDDM) and their caregivers/diabetes helpers (CGs). The goal is to refine the IV based on a better understanding of the relationship between the impact of the IV and perceived control (PC) of each partner in the dyad. PC is viewed as pivotal to the management of often uncontrollable illnesses such as NIDDM; yet how PC is influenced by the interactions occurring between individuals within a cultural context, how it influences the response of individuals and families to interventions, and how PC is in turn influenced by these interventions remains poorly understood. Understanding these relationships may be crucial if efforts to promote client control of treatment regimens are to be successful. Further, little is known about African-Americans in relation to diabetes management in the family and issues of control.
The specific aims are to answer the questions: 1) What is the difference between an experimental group (E) receiving a comprehensive diabetes education IV and a control group (C) not receiving the IV over time in diabetes management and the well-being of both dyadic partners?; 2) What is the relationship of PC between the persons with NIDDM and their CGs? Does this relationship depend on group (E vs C) and/or on time?; 3) Does the PC of each dyadic partner mediate the relationship between the IV and the outcomes of well-being and diabetic management?; and, 4) What sociocultural, personal, and interpersonal factors are identified be each dyadic partner during intensive interviews as influencing PC, the management of diabetes, and the impact of the IV? Thirty African-Americans with NIDDM and their designated CGs will be recruited and randomly assigned to either the experimental (E) or control (C) group. E dyads receive the IV, a 3 day education program and 1 day follow-up at 3 months, that emphasizes the relationship between diet and blood glucose, and provides practice in making food choices among preferred, culturally acceptable foods. Both E and C dyads will be interviewed 3 times across 6 months to answer aim 4. Standard analytic techniques specific for each aim will be used, such as repeated measures ANOVA, regression, and qualitative methods. The refined intervention will be tested in a larger sample with the goal to minimize the multiple personal, social, and health costs of this chronic disease that is often managed by advanced practice nurses.
