Type 2 diabetes mellitus (T2DM) is a serious health problem that disproportionately affects African Americans who have a nation-wide prevalence of 13.3% compared to 8.7% among adults overall. In rural Virginia, studies indicate that rates of diabetes mellitus (DM) are 15% among African American adults, with an even higher rate of 30% among those over age 60. T2DM among African Americans reflects the serious health disparities in the U.S. and is a leading cause of cardiovascular disease, stroke, blindness, end-stage renal disease, and non- traumatic lower limb amputations. A majority of adults with diabetes do not achieve recommended target levels of blood glucose, blood pressure and/or serum lipids, putting them at risk for complications such as cardiovascular and renal disease. African Americans have among the highest rates of complications and inadequate glycemic control. One factor limiting effective self-management is that less than half of adults receive comprehensive diabetes self-management education (DSME), considered essential to managing this complex disease. Recent studies show DSME programs that focus on problem-solving and goal setting are associated with improvements in clinical and behavioral outcomes. However, the kind of DSME program that is acceptable and effective for rural African Americans is unknown, because comprehensive DSME has rarely been available or culturally tailored to the population. This proposed study is a test of the feasibility of conducting a randomized-controlled trial and a preliminary test of the efficacy of a culturally-tailored community-based group DSME intervention on physiologic and behavioral outcomes. The approach will incorporate storytelling and compare results of the initial intervention group to a wait-list control group. Researchers will obtain preliminary data about outcome trends and the best measures for capturing effects of the intervention. The framework for the study is Social Cognitive Theory based on Afro-centric cultural norms. The intervention will include follow-up by a nurse case manager working closely with a community health worker who serves as a cultural and community link with the health professionals. The study site is a rural community known to researchers who conducted two preliminary studies in the community. Twenty-four African American adults will be followed during the two-year study to determine whether problem-focused DSME using storytelling is feasible and effective among rural African Americans, and will identify which measures are most useful for testing efficacy of the intervention for a full scale R-18 to be developed based on findings of this study.
This proposed study will test a new approach to diabetes self-management education among rural African Americans. The approach is designed to fit with the way of life for rural African Americans, and will involve the use of storytelling to promote setting goals and problem-solving to improve management of one's diabetes. This new approach to diabetes education will be delivered to groups and individuals to determine which way is best accepted and has the best results.
| Williams, Ishan C; Utz, Sharon W; Hinton, Ivora et al. (2014) Enhancing diabetes self-care among rural African Americans with diabetes: results of a two-year culturally tailored intervention. Diabetes Educ 40:231-9 |
| Williams, Ishan C; Utz, Sharon W; Jones, Randy et al. (2011) Recruitment of Rural African Americans for Research Projects: Lessons Learned. South Online J Nurs Res 11:8 |
