The purpose of this article is to describe a culturally competent, dietary self-management intervention designed to improve physiological outcomes, diabetes self-management, and costs of care for high-risk African Americans with type 2 diabetes.
METHODS
A longitudinal, quasi-experimental design was used to evaluate the effectiveness of the intervention for 23 adult African Americans from a physician practice group in rural South Carolina. The intervention consisted of 4 low-fat dietary education classes, 6 discussion groups, and follow-up. Intervention sessions were provided by a dietitian and nurse case managers and framed as social events; families were encouraged to participate.
RESULTS
Data suggest that the intervention significantly improved fat-related dietary habits, Al C values, fasting blood glucose, and frequency of acute care visits. A trend in reduction of lipids and weight also was observed.
CONCLUSIONS
Culturally competent dietary self-management provides a meaningful approach to focused diabetes education for rural African Americans. Integrating nursing case management provides an innovative method of addressing the more global issues of delivery of care to underserved rural populations and decreasing the high costs of care.
Get full access to this article
View all access options for this article.
References
1.
1. South Carolina Department of Health and Environmental Control (DHEC). The Burden of Diabetes in South Carolina 1999. Columbia, SC: South Carolina Diabetes Control Program, Diabetes Initiative of South Carolina, and American Diabetes Association-South Carolina Affiliate; 1999.
2.
2. Colwell JA. Diabetes Initiative of South Carolina: 1999 Annual Report. Columbia, SC: Dept of Health and Environmental Control (DHEC), South Carolina Diabetes Control Program, Diabetes Initiative of South Carolina, and American Diabetes Association-South Carolina Affiliate; 2000.
3.
3. US Department of Health and Human Services (DHHS). Healthy People 2000: National Health Promotion and Disease Prevention Objectives. Boston: Jones & Bartlett Publishers; 1992.
4.
4. South Carolina Department of Health and Environmental Control (DHEC). The Burden of Diabetes in South Carolina 1996. Columbia, SC: South Carolina Diabetes Control Program, Diabetes Initiative of South Carolina, and American Diabetes Association-South Carolina Affiliate; 1996.
5.
5. Centers for Disease Control and Prevention. Diabetes. Available at: http://www.cdc.gov/nccdphp/ddt. Accessed May 27,1999.
6.
6. Rubin RJ, Altman WM, Mendelson DN. Health care expenditures for people with diabetes mellitus, 1992. J Clin Endocrinol Metab. 1994;78:809A-809F.
7.
7. US Bureau of the Census. State population estimates. Available at: http://www.census.gov/population/www/estimates/statepop.html. Accessed August 20, 1999.
8.
8. South Carolina Department of Health and Environmental Control (DHEC). Behavioral Risk Factors Surveillance System. Columbia, SC: South Carolina Dept of Health and Environmental Control (DHEC), Division of Epidemiology; 1998.
9.
9. US Bureau of the Census. United States census 2000. Resident population and apportionment counts. Available at: http://www.census.gov/main/www.census2000.html. Accessed January 18, 2001.
10.
10. Chiu KC, Province MA, Permutt MA. Glucokinase gene is genetic marker for NIDDM in American blacks. Diabetes. 1992;41:834-849.
11.
11. Cowie CC, Harris Ml, Silverman RE, Johnson EW, Rusk KF. Effects of multiple risk factors on differences between blacks and whites in the prevalence of non-insulin-dependent diabetes mellitus in the United States. Am J Epidemiol. 1993;137:719-731.
12.
12. Rewers M, Hamman RF. Risk factors for non-insulin-dependent diabetes. In: Diabetes in America. 2nd ed.Washington, DC: National Diabetes Data Group, National Institutes of Health; 1995:179-208. NIH publication95-1468.
13.
13. Winiarski K.More than half of S C's adults overweight. The State. November 23, 1999: A1-A1,A12-A12.
14.
14. Crespo CJ, Keteyian SJ, Heath GW, Sempos CT. Leisure time physical activity among US adults: results from the Third National Health and Nutrition Examination Survey. Arch Intern Med. 1996;156:93-98.
15.
15. Tull ES, Roseman M.Diabetes in African-Americans. In: Diabetes in America. 2nd ed.Washington, DC: National Diabetes Data Group, National Institutes of Health; 1995: 613-629. NIH publication95-1468.
16.
16. Bennet PH, Bogardus C, Tuomilhto J, Zimmet P.Epidemiology and natural history of NIDDM: non-obese and obese. In: Alberti KGMM, DeFronzo RA, Keen H, Zimmet P, eds. International Textbook of Diabetes. Chichester, England: John Wiley & Sons Ltd; 1992: 148-176.
17.
17. US Bureau of the Census. US Census Bureau state and county quick facts: South Carolina. Available at: http://www.census.gov/cgi-bin/qfd/state?state-45000&Submit.x=15&Submit.y=11. Accessed January 5, 2001.
18.
18. Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977-986.
19.
19. United Kingdom Prospective Diabetes Study Research Group. Efficacy of atenolol and captopril in reducing risk of both macrovascular and microvascular complications in diabetes. BMJ. 1998;317:713-720.
20.
20. United Kingdom Prospective Diabetes Study Research Group. Effect of intensive blood glucose control with mefformin on complications in overweight patients with diabetes. Lancet. 1998;352:854-865.
21.
21. United Kingdom Prospective Diabetes Study Research Group. Intensive blood glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with diabetes. Lancet. 1998;352:837-853.
22.
22. United Kingdom Prospective Diabetes Study Research Group. Tight blood pressure control and risk of macrovascular and microvascular complications in diabetes. BMJ. 1998;317:703-713.
23.
23. Brown SA. A meta-analysis of diabetes patient education research: variations in intervention effects across studies. Res Nurs Health. 1992;15:409-419.
24.
24. Kumanyika SK, Obarzanek E, Stevens VJ, Herbert PR, Whelton PK, Weight loss experience of black and white participants in NHLBI-sponsored clinical trials. Am J Clin Nutr. 1991;53:1631S-1638S.
25.
25. Wing RR, Anglin K.Effectiveness of a behavioral weight control program for blacks and whites with NIDDM. Diabetes Care. 1996;19:409-413.
26.
26. Kumanyika SK, Ewart CK. Theoretical and baseline considerations for diet and weight control of diabetes among blacks and whites. Diabetes Care. 1990;13(suppl 4):1154-1162.
27.
27. Kittler PG, Sucher KP. Diet counseling in a multicultural society. Diabetes Educ. 1990;16:127-131.
28.
28. Kumanyika S, Morssink C, Argurs T.Models for dietary and weight change in AfricanAmerican women: identifying cultural components. Ethnicity Dis. 1992;2:166-175.
29.
29. Maillet NA, Melkus GD, Spollett G.Using focus groups to characterize the health beliefs and practices of black women with non-insulin-dependent diabetes. Diabetes Educ. 1996;22:39-46.
30.
30. Anderson-Loftin W, Moneyham L.Long-term disease management needs of southern African Americans living with diabetes. Diabetes Educ. 2000;26:821-832.
31.
31. Brown SA. Studies of educational interventions and outcomes in diabetic adults: a meta-analysis revisited. Patient Educ Counsel. 1990;16:189-215.
32.
32. Brown SA, Upchurch S, Anding R, Winter M, Ramirez G.Promoting weight loss in diabetes. Diabetes Care. 1996;19:613-623.
33.
33. Brown SA, Hanis CL. A community-based, culturally sensitive education and group-support intervention for Mexican Americans with NIDDM: a pilot study of efficacy. Diabetes Educ. 1995;21:203-209.
34.
34. Brown SA, Hanis CL. Culturally competent diabetes education for Mexican Americans: the Starr County Study. Diabetes Educ. 1999;25:226-236.
35.
35. Glasgow RE, Toobert DJ, Hampson JF. Effects of a brief office-based intervention to facilitate diabetes dietary self-management. Diabetes Care. 1996;19:835-842.
36.
36. McCann BS, Retzlaff BM, Walden CE, Knopp RH. Promoting adherence to low-fat, low-cholesterol diets: review and recommendations. J Am Diet Assoc. 1990;90:1408-1414,1417-1417.
37.
37. McMurry P, Hopkins PN, Gould R, et al. Family oriented nutrition intervention for a lipid clinic population. J Am Diet Assoc. 1991;91:57-65.
38.
38. Sheppard L, Kristal AR, Kushi LH. Weight loss in women participating in a randomized trial of low fat diets. Am J Clin Nutr. 1991;54:821-828.
39.
39. Flegal KM, Carrol MD, Kuczmarski RI, Johnson CL. Overweight and obesity in the United States: prevalence and trends 1960-1994. Int J Obes. 1998;22:39-47.
40.
40. Anderson-Loftin W.In search of a nursing case management model for rural hospitals. Nurs Connections. 1995;8:31-42.
41.
41. Anderson-Loftin W.A nursing case management model for rural hospitals. Nurs Connections. 1997;10:27-38.
42.
42. Anderson-Loftin W.Nurse case managers in rural hospitals. J Nurs Adm. 1999;29:42-49.
43.
43. Anderson-Loftin W, Stiles AS. Development and testing of the Nurse Case Manager Impact Profile. Nurs Connections. 1999;12:5-25.
44.
44. Green VL, Lovely ME, Miller MS, Ondrich JL. Reducing Nursing Home Use Through Community-Based Long-Term Care: An Optimization Analysis. Maxwell School of Citizenship and Public Affairs. Final report to the Office of Assistant Secretary for Planning and Evaluation, United States Dept of Health and Human Services for Grant no. 87MSPE1 8A. Syracuse, NY: Syracuse University.
45.
45. Jenkins C, Colwell J, eds. 5 Year Strategic Plan: Diabetes Initiative of South Carolina 1998-2003. Columbia, SC: Diabetes Control Program, Dept of Health and Environmental Services; 1997.
46.
46. Kristal AR, Shattuck AL, Henry HJ. Patterns of dietary behavior associated with selecting diets low in fats: reliability and validity of a behavioral approach to dietary assessment. J Am Diet Assoc. 1990;90:214-220.
47.
47. American Diabetes Association. Standards of medical care for patients with diabetes mellitus. Diabetes Care. 1999;22(suppl 1). Available at: www.diabetes.org/DiabetesCare/Supplementl99/S32.htm.
48.
48. American Diabetes Association. Nutrition recommendations and principles for people with diabetes. Diabetes Care. 1999b;21(suppl 1). Available at: http://www.diabetes.org/DiabetesCare/Supplementl99/S16.htm.
49.
49. US Department of Agriculture. The Food Guide Pyramid. Hyattsville, Md: USDA Human Nutrition Information Service; 1992.
50.
50. Chen Y-DI, Hollenbeck CB, Coulston AM, Reaven GB, Zhou MY. Why do lowfat, high-carbohydrate diets accentuate postprandial lipemia in patients with NIDDM?Diabetes Care. 1995;18:10-16.
51.
51. Garg A.High monosaturated fat diet for diabetic patients: is it time to change the current dietary recommendations?Diabetes Care. 1994;17:242-246.
52.
52. Anderson RM, Barr PA, Edwards GJ, Funnell MM, Fitzgerald JT, Wisdom K.Using focus groups to identify psychological issues of urban black individuals with diabetes. Diabetes Educ. 1996;22:28-33.
53.
53. Parker M, Quinn J, Viehl M, et al. Issues in rural case management. Fam Community Health. 1992;14:40-56.
54.
54. Weinert C, Long KA. The theory and research base for rural nursing practice. In: Bushy A, ed. Rural Nursing. Vol 1. Newbury Park, Calif: Sage Publications; 1991: 21-38.
57. Pang JF. Counseling patients to adopt and maintain a low-fat diet: a prescription for physicians. Med Exerc Nutr Health. 1994;3:156-170.
58.
58. Fitzwater SL, Weinsier RL, Wooldridge NH, Birch R, Liu C, Bartolucci AA. Evaluation of long-term weight changes after a multidisciplinary weight control program. J Am Diet Assoc. 1991;91:421-426,429-429.
60. Agurs-Collins TD, Kumanyika SK, Ten Have TR, Adams-Campbell LL. A randomized controlled trial of weight reduction and exercise for diabetes management in older African-American subjects. Diabetes Care. 1997;20:1503-1511.
61.
61. Glasgow RE, Perry JD, Toobert DJ, Hollis JF. Brief assessments of dietary behavior in field settings. Addict Behav. 1996;21:239-247.
62.
62. Norusis MJ. SPSS for Windows-Based System User's Guide. Release 6.0. Chicago: SPSS Inc; 1993.
63.
63. Wing RR, Marcus MD, Epstein LH, Salata R.Diabetic subjects lose less weight than their overweight nondiabetic spouses. Diabetes Care. 1987;10:563-566.
