Type 2 diabetes is a major cause of morbidity and mortality in the U.S. and a particular problem for older, African American women; 20% between the ages of 60-74 and 22% over 75 years are diagnosed with the disease. Current interventions to improve diabetes self-care do not take into account cultural and age related differences in familial role, lifestyles, beliefs and function. Therefore, culturally sensitive educational and behavioral strategies are needed to assist these women to maximize their diabetes self-care practices, achieve health goals, and avoid the short and long-term consequences of poor metabolic control. Focusing on the specific symptoms of the individual offers an opportunity to tailor interventions to accommodate sociocultural and functional differences. The goals of the proposed study are to test the effectiveness of a culturally sensitive, symptom-focused disease management intervention in improving diabetes symptom knowledge, self-care practices, and health outcomes (Ale, symptom distress, and quality of life) for older, rural African-American women with type 2 diabetes. The impact of a booster on sustaining the effects of the intervention will also be examined. Using a three group experimental design, 180 African-American women, 60 years and older, with a diagnosis of type 2 diabetes for more than 1 year and an A1C of greater than 7%, will be randomly assigned to either the intervention, the intervention followed by a booster, or an attentional control program. All participants will be evaluated at baseline, immediately after the 3-month intervention, and at 3 and 6 months post-intervention.
The specific aims of the proposed study are to (1) evaluate the effects of the symptom-focused intervention on hemoglobin A1C levels, symptom distress, and perception of quality of life, (2) explore the intervention's effect on diabetes self-care practices and symptom knowledge and their role as mediators of the intervention's impact on health outcomes, and (3) evaluate the impact of a booster intervention on sustaining the effects of the initial intervention. The study will explore two research questions (1) Are the effects of the intervention moderated by functional status and perceived stress? and (2) How cost-effective is the symptom-focused intervention from the perspective of the patient, the health care system and society? The results of this study will inform the implementation of practical, culturally sensitive, nurse-delivered strategies to improve diabetes outcomes in older, African American women with type 2 diabetes in rural communities. ? ?

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Research Project (R01)
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Nursing Research Study Section (NURS)
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Mccloskey, Donna J
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University of North Carolina Chapel Hill
Schools of Nursing
Chapel Hill
United States
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Skelly, Anne H; Carlson, John; Leeman, Jennifer et al. (2009) Controlled trial of nursing interventions to improve health outcomes of older African American women with type 2 diabetes. Nurs Res 58:410-8
Burns, Dorothy; Soward, April C M; Skelly, Anne H et al. (2008) Effective recruitment and retention strategies for older members of rural minorities. Diabetes Educ 34:1045-52
Skelly, Anne H; Leeman, Jennifer; Carlson, John et al. (2008) Conceptual model of symptom-focused diabetes care for African Americans. J Nurs Scholarsh 40:261-7
Leeman, Jennifer; Skelly, Anne H; Burns, Dorothy et al. (2008) Tailoring a diabetes self-care intervention for use with older, rural African American women. Diabetes Educ 34:310-7