Diabetes has been identified as an epidemic in the U. S. and is continuing to grow in prevalence, especially type 2 diabetes. In addition, the burden of diabetes, including prevalence and risk of complications, is greater for low-income individuals and minority groups, especially Latinos and African Americans. The Healthy People 2010 report notes that the burden of diabetes can be reduced through secondary and tertiary prevention and facilitating optimal self-management. Few controlled studies have focused on strategies to enhance diabetes self-management in minority or other underserved populations. One approach to increasing our reach and impact is to train nonprofessionals or paraprofessionals to work with multidisciplinary diabetes care teams to support optimal diabetes self-management with minimal added expense. The purpose of this study is to develop, implement, and evaluate the impact of an innovative intervention that combines diabetes self-management education, training, and support with aspects of case management delivered by Medical Assistant Coaches (MACs), to support optimal diabetes self-management (and secondary and tertiary prevention) in low-income minority populations with type 2 diabetes. This efficacy trial compares the Medical Assistant self-management coach (MAC) Intervention with """"""""treatment as usual"""""""" (TAU). The target populations will form a total sample of 914 African Americans and Latinos receiving care at five Federally Qualified Health Centers serving low-income individuals in Chicago. The proposed study will use a prospective randomized two-group split-plot repeated measures design. Specifically, it will be a two (treatment groups: TAU, MAC) by four (time: baseline, 6-month, 12-month, 18- month) repeated measures design. The MAC Intervention will be individually tailored based on the Transtheoretical Model and culturally tailored, including Spanish translation where needed. The MAC intervention will be delivered monthly over a one-year period, including both face-to-face contacts during routine primary care visits and regular telephone coaching contacts. The primary outcome variable will be glycemic control measured by HbA1C values. Secondary outcomes include: psychosocial mediators, behavioral outcomes, and short- and longer term biomedical outcomes. If effective in improving glycemic control and/or other measures of diabetes self-management, this intervention has the potential to be easily implemented in other primary care clinics serving minority populations. Furthermore, this intervention has the potential to help contain costs while maximizing our reach and facilitating sustainability. ? ? ?

Agency
National Institute of Health (NIH)
Institute
National Institute of Nursing Research (NINR)
Type
Research Project (R01)
Project #
5R01NR010313-03
Application #
7478359
Study Section
Behavioral Medicine, Interventions and Outcomes Study Section (BMIO)
Program Officer
Cotton, Paul
Project Start
2006-09-27
Project End
2011-07-31
Budget Start
2008-08-01
Budget End
2009-07-31
Support Year
3
Fiscal Year
2008
Total Cost
$657,253
Indirect Cost
Name
University of Illinois at Chicago
Department
Public Health & Prev Medicine
Type
Schools of Public Health
DUNS #
098987217
City
Chicago
State
IL
Country
United States
Zip Code
60612
Hernandez, Rosalba; Ruggiero, Laurie; Prohaska, Thomas R et al. (2016) A Cross-sectional Study of Depressive Symptoms and Diabetes Self-care in African Americans and Hispanics/Latinos With Diabetes: The Role of Self-efficacy. Diabetes Educ 42:452-61
Ruggiero, Laurie; Riley, Barth B; Hernandez, Rosalba et al. (2014) Medical assistant coaching to support diabetes self-care among low-income racial/ethnic minority populations: randomized controlled trial. West J Nurs Res 36:1052-73
Hernandez, Rosalba; Ruggiero, Laurie; Riley, Barth B et al. (2014) Correlates of self-care in low-income African American and Latino patients with diabetes. Health Psychol 33:597-607
Watkins, Yashika J; Quinn, Lauretta T; Ruggiero, Laurie et al. (2013) Spiritual and religious beliefs and practices and social support's relationship to diabetes self-care activities in African Americans. Diabetes Educ 39:231-9
Ruggiero, Laurie; Moadsiri, Ada; Butler, Paula et al. (2010) Supporting diabetes self-care in underserved populations: a randomized pilot study using medical assistant coaches. Diabetes Educ 36:127-31