Translating Current Dietary Guidelines Into a Culturally Tailored Nutrition Education Program for Korean American Immigrants With Type 2 Diabetes

Abstract

Purpose

The purpose of this article is to describe the process of translating evidence-based dietary guidelines into a tailored nutrition education program for Korean American immigrants (KAI) with type 2 diabetes mellitus (DM).

Methods

Community-based participatory research (CBPR) is a research process involving researchers and communities to build a collaborative partnership. The study was conducted at a community-based organization. In a total of 79 KAI (intervention, n = 40; control, n = 39) with uncontrolled type 2 DM (A1C ≥7.5%), 44.3% were female and the mean age was 56. 5 ± 7.9 years. A culturally tailored nutrition education was developed by identifying community needs and evaluating research evidence. The efficacy and acceptability of the program was assessed.

Results

In translating dietary guidelines into a culturally relevant nutrition education, culturally tailored dietary recommendations and education instruments were used. While dietary guidelines from the American Diabetes Association (ADA) were used to frame nutrition recommendations, additional content was adopted from the Korean Diabetes Association (KDA) guidelines. Culturally relevant intervention materials, such as Korean food models and an individually tailored serving table, were utilized to solidify nutritional concepts as well as to facilitate meal planning. Evaluation of the education revealed significantly increased DM-specific nutrition knowledge in the intervention group. The participants’ satisfaction with the education was 9.7 on a 0 to10-point scale.

Conclusion

The systematic translation approach was useful for producing a culturally tailored nutrition education program for KAI. The program was effective in improving the participants’ DM-specific nutrition knowledge and yielded a high level of satisfaction. Future research is warranted to determine the effect of a culturally tailored nutrition education on other clinical outcomes.

References

1. Schafer RG, Bohannon B, Franz M, et al. Translation of the diabetes nutrition recommendations for health care institutions: technical review. J Am Diet Assoc. 1997;97:43-51.

2. Narayan KM, Gregg EW, Engelgau MM, et al. Translation research for chronic disease: the case of diabetes. Diabetes Care. 2000;23:1794-1798.

3. Rubin RR, Peyrot M, Saudek CD. Differential effect of diabetes education on self-regulation and life-style behaviors. Diabetes Care. 1991;14:335-338.

4. Haffner SM, Hazuda HP, Mitchell BD, Patterson JK, Stern MP. Increased incidence of type II diabetes mellitus in Mexican Americans. Diabetes Care. 1991;14:102-108.

5. Vijan S, Stuart NS, Fitzgerald JT, et al. Barriers to following dietary recommendation in Type 2 diabetes. Diabet Med. 2005;22:32-38. 6. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulponylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352:837-853.

7. Wylie-Rosett J. In: Proceedings from the American Diabetes Association Annual Scientific Sessions ; June 6, 1989.

8. Samanta A, Campbell JE, Spaulding DL, et al. Eating habits in Asian diabetics. Diabet Med . 1986;3:283.

9. Park SY, Paik HY, Skinner JD, Spindler AA, Park HR. Nutrient intake of Korean Americans, Korean, and American adolescents. J Am Diet Assoc. 2004;104:242-245.

10. Lee SK, Sobal J, Frongillo EA Jr. Acculturation and dietary practices among Korean Americans. J Am Diet Assoc. 1999;99:1084-1089. 11. 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;21:203-210. 12. Kim MT, Han HR, Song H, Lee JE, Kim J, Kim KB. A community-based culturally tailored behavioral intervention for Korean Americans with diabetes. Diabetes Educ. 2009;35:986-994. 13. Fitzgerald JT, Funnell MM, Hess GE, et al. The reliability and validity of a brief diabetes knowledge test. Diabetes Care. 1998;21: 706-710.

14. Han HR, Kim KB, Kim MT. Evaluation of the training of Korean community health workers for chronic disease management. Health Edu Res. 2007;9:137-146.

15. Franz MJ, Bantle JP, Beebe CA, et al. Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Diabetes Care. 2002;25:148-198.

16. Korean Diabetes Association Web site. http://www.diabetes .or.kr. Accessed September 28, 2009.

17. Szczepura A. Access to health care for ethnic minority populations. Postgrad Med J. 2005;81:141-147.

18. Resnicow K, Baranowski T, Ahluwalia JS, et al. Cultural sensitivity in public health: defined and demystified. Ethn Dis. 1999;9:10-21. 19. Cooper LA, Hill MN, Powe NR. Designing and evaluating interventions to eliminate racial and ethnic disparities in health care. J Gen Intern Med. 2002;17:477-486.

20. Hawthorne K. Asian diabetics attending a British hospital clinic: a pilot study to evaluate their case. Br J Gen Pract. 1990;40: 243-247.

21. Lee JA, Yeo G, Gallagher-Thompson D. Cardiovascular disease risk factors and attitudes towards prevention among Korean American elders. J Cross Cult Gerontol. 1993;8:17-33.

22. Brown JB, Harris SB, Webster-Bogaert S, Wetmore S, Faulds C, Stewart M. The role of patient, physician, and systematic factors in the management of type 2 diabetes mellitus. Fam Pract. 2002;19:344-349.

23. Nicolucci A, Cavaliere D, Scorpiglione N, et al. A comprehensive assessment of the avoidability of long-term complications of diabetes: a case-control study. Diabetes Care. 1996;19:927-933. 24. Lonner TD. The group as a basic asset to ethnic minority patients with diabetes. Diabetes Educ. 2000;26:645-655.

25. Fisher TL, Burnet DL, Huang ES, Chin MH, Cagney KA. Cultural leverage: interventions utilizing culture to narrow racial disparities in health care. Med Care Res and Rev. 2007;64:243S-282S.

26. Fiscella K, Franks P, Doescher MP, Saver BG. Disparities in health care by race, ethnicity, and language among the insured. Medical Care. 2002;40:52-59.