This pilot study is designed to compare diabetes self-management outcomes and effectiveness between two groups of adult American Indians (AIs) who have been identified as having uncontrolled diabetes mellitus type two (DM2) and have been prescribed insulin but do not take insulin as directed. The experimental group will receive diabetes self-management education (DSME) using the culturally appropriate Talking Circles (TCs) format and the control group will receive DSME using the traditional didactic-classroom format. Talking Circles (TCs) are a cultural means to facilitate teaching and decision-making in AIs and have been identified as an Indian Health Service (IHS) best practice but have not been tested as a means of improving diabetes self-management outcomes. The hypothesis is that the experimental group will have better diabetes self-management adherence and outcomes than will the control group. Goal 1: Test two approaches to DSME in a population of AIs who have uncontrolled DM2. Implement DSME in an experimental group (N=40) using TCs and in a control group (N =40) using traditional DSME. Goal 2: Describe and analyze the TC process and key elements. Audio record, transcribe and analyze the discussion in the TC meetings using content analysis for documentation and future replication. Goal 3: Monitor, compare, and report outcomes of the experimental and control groups at recommended intervals for the duration of the study. Outcomes to be monitored and compared include changes in self-care behavior and quality of life (QOL), and the IHS Standards of Care for Diabetes which include HbA1c, blood pressure, weight, body mass index, foot inspection, depression screen, lipid profile, creatinine, liver enzymes, and eye exam. The study is relevant to public health because it addresses what society can do to improve conditions in which a vulnerable population can be healthy. The diabetes-related death rate for AIs in the United States is 136 per 100,000 and the Healthy People 2010 objective is 25.0 per 100,000 population. AI communities use traditional and cultural approaches to improve health. TCs have been identified as a best practice for AIs but there are no data to indicate its potential to improve diabetes self-management. The desired outcome is that AIs with DM2 who receive culturally appropriate DSME will have improved self- care adherence outcomes and quality of life. In addition, improved outcomes could reduce the burden of disease, decrease diabetes-related death rates and increase the life span for AIs. Results are intended to lead to future multi-site studies to determine whether TCs fulfill their promise in DSME and can be replicated and generalized to improve DM2 outcomes in AIs.
The study is relevant to public health because it addresses what society can do to improve conditions in which a vulnerable population can be healthy. The diabetes-related death rate for AIs in the United States is 136 per 100,000 and the Healthy People 2010 objective is 25.0 per 100,000 population. American Indian communities use traditional and cultural approaches to improve health. The Talking Circle has been identified as a best practice for AIs but there is no data to indicate its potential to improve diabetes self-management. The desired outcome is that AIs with DM2 who receive culturally appropriate diabetes self-management education will have improved self-care adherence, outcomes and quality of life.
