Type 2 diabetes affects more than 24 million people, and African Americans are disproportionately burdened by this disease. Diabetes is a psychologically and behaviorally demanding chronic disease. Individuals with diabetes typically experience greater stress than non-diseased individuals, and emotional stress worsens diabetes due to physiological effects on blood glucose regulation and reduction in adherence to diabetes self-care behaviors. Optimal long-term diabetes care requires an emotionally and mentally healthy patient - that is, a resilient patient. Most research, however, has focused on risk factors and adherence to diabetes management guidelines rather than enhancing psychosocial qualities that build resilient and thriving responses, enabling the patient to make healthy lifestyle choices and control the condition. This study uses the transactional model of stress and coping and self-regulation theory to address physical and emotional components of the disease, integrating a culturally competent resilience curriculum with diabetes self-management education.
Aims are to: 1) further refine our resilience-based diabetes self-management education (RB-DSME) intervention and our RB-DSME participant workbook and facilitator instruction manual based on focus groups with key individuals from the target community;2) determine the feasibility of offering the RB-DSME in community churches for African Americans diagnosed with type 2 diabetes using the refined participant workbook and facilitator manual;and 3) examine the intervention's effectiveness at 3 and 6 months post-study entry by comparing an experimental group who receive the RB-DSME intervention and a comparison group who receive standard diabetes self-management education (DSME). Three experimental and three comparison groups, each including eight weekly class sessions plus two follow-up bi-weekly support group meetings, will be taught by a certified diabetes educator (CDE) with 1-2 mentors in each group. Our working hypothesis is that both experimental and comparison group participants will show significant improvements in diabetes knowledge, but experimental group participants will show significantly greater improvements in psychological well-being, diabetes self-management behaviors, and physiological markers of obesity, type 2 diabetes, and CVD than the comparison group. Our long-term goal is to make our resilience curriculum accessible to African Americans with type 2 diabetes delivered by nurse or dietitian CDEs in broad community settings, enabling individuals to more effectively cope with stress and manage their type 2 diabetes in order to avoid its serious consequences.
Healthy People 2010 emphasizes that current diabetes programs are limited in their ability to produce and sustain changes in the behaviors of persons with diabetes. There is a critical need for interventions that provide diabetes self-management skills integrated with resilience and coping strategies so that patients can more effectively manage their stress, and thereby reduce the physiological burdens associated with this disease. Helping African Americans with type 2 diabetes to enhance their resilience may enable them to improve their long-term adherence to healthy lifestyle choices, thereby decreasing obesity and delaying the progression of type 2 diabetes.