Significant racial disparities between non-Hispanic Blacks and Whites exist in the prevalence of diabetes and the story of John Henry, the steel-drivin' man is well known to most Black men in the U.S.; and to most, John Henry is a hero because of his relentless determination. John Henryism is defined as a survival strategy developed among newly freed Black people, one that endorsed the values of hard work, self-reliance, and high effort coping ? all attributes of successful chronic disease self-management. The goal of this research is to develop a culturally-grounded diabetes self-management intervention for adult Black men. Black men are identified as a priority group in need of targeted diabetes self-management interventions. T T with type 2 diabetes that utilizes social support and mobile technology to improve patient-centered outcomes. The primary outcome will be a 0.5% reduction in A1C levels following the intervention. Secondary outcomes will include reductions in diabetes complication risk factors of blood pressure, waist circumference, and cholesterol. Additional outcomes include medication adherence, blood glucose monitoring, and physical activity. The 10-week intervention is comprised of three components: (1) ten group-based social support meetings that will include the formation of two-man partnerships (buddies); (2) a remote-sensing health behavioral technology, the cloud-based Telcare glucometer to facilitate objective monitoring of health behavior; (3) development of gender-sensitive, culturally grounded text messages designed to motivate and remind participants to engage in recommended self- management behaviors. Year one is devoted to designing the group intervention and developing and testing the set of targeted text messages by drawing upon self-determination theory, the diabetes empowerment approach, and research on John Henryism. Given its broad recognition and endorsement among Black men, the story of John Henry and research on John Henryism holds tremendous promise as a conceptual foundation for engaging Black men in a health promotion program. Year two will test the 10-week intervention using a wait-listed control (the men will serve as their own control), repeated measures single arm design (three points in time) with 40 Black men. The study also includes a three-month post-intervention follow-up assessment. Pragmatically, we have chosen to focus on behavior that can be influenced by one-to-one partnerships and small groups. As this targeted research program develops, we will incorporate the influence of family systems and neighborhood contexts within which Black men operate. In summary, Black men with type 2 diabetes can benefit from applying the principles of self-determination, diabetes empowerment, and John Henryism to their own health challenges. The proposed research will develop a gender targeted self-management intervention to assist adult Black men in controlling diabetes through social support and mobile health technology.
The public health relevance of this project is evident in four important issues. First, U.S. ethnic minorities suffer higher rates of diabetes than non-Hispanic Whites. Second, these disparities are evident at every level of socioeconomic status. Third, diabetes is a disease that is modifiable through behaviors that can be controlled directly by the patient. Fourth, many black men need support to control their diabetes. Any intervention that successfully increases preventive behavior will improve overall health and potentially reduce racial disparities.