The primary objective of this translational study is to conduct an effectiveness trial of a community-based glucose control intervention program for Korean American immigrants (KAI) with type-2 diabetes mellitus (DM). The self-help intervention program for Korean Americans ( SHIP-DM) focuses on the self-help aspect of DM control by empowering patients through enhanced knowledge of DM and diet, utilizing available technology to develop their ability for self -monitoring their glucose control status, facilitating better communication with their health care providers, and enhancing their health literacy and general problem-solving skills. The SHIP-DM has been developed and pilot tested through a "planning grant" mechanism via NIDDK (R34). Using a randomized experimental design (N=80) in our pilot study, we were able to demonstrate the efficacy and feasibility of the SHIP-DM with KAIs up to 6 months post-intervention. The final analysis suggested that the SHIP-DM was effective in both significantly lowering HbA1c and fasting glucose as well as in improving psychosocial variables in the sample: The reduction of HbA1c levels among intervention group participants (1.19% at 18 weeks and 1.31% at 30 weeks) were not only statistically significant but clinically meaningful, with 10%and 15% of the intervention group achieving the suggested goal of HbA1c <7%. In comparison to the control group, the intervention group showed significant improvement in DM knowledge, self-care activities, DM-related self-efficacy, and their attitudes toward diabetes, depression, and quality of life. In addition, we became aware of the urgent need for disseminating effective interventions which are both linguistically and culturally tailored to KAI. As news of our study spread through media sources in the Korean ethnic community, we became inundated by requests from KAI families and community organizations (including the American Diabetes Association) for type-2 DM educational materials and culturally relevant interventions targeted toward KAI audiences. Because of the resource limitations of the pilot project, we were forced to turn away substantial numbers of KAI with type 2 DM who wanted to participate in our study. To address this critical need within the KAI community, we now propose to build upon our pilot work by conducting a two-phase clinical trial to test the effectiveness of the SHIP-DM in a larger sample of KAI and a longer follow-up (12months) while building important infrastructures for disseminating an array of intervention materials designed to address the health literacy and resources necessities for this vulnerable population.
This application proposes a randomized controlled trial of a community-based behavioral intervention in linguistically isolated Korean immigrants with type-2 DM with endpoint focus on the improvement of (1) glycemic control and BP control, (2) self-efficacy and self-help skills including health literacy skills, and (3) health related quality of life.