The purpose of this study was to test efficacy of a family-based, culturally tailored intervention for Hispanics with type 2 diabetes and their family members.
Methods
Hispanic patients with type 2 diabetes and their family members recruited from community clinics and ethnic churches were assigned to groups (N = 186). The intervention group received an 8-week culturally tailored diabetes educational program delivered in Spanish while the attention control group received 8 weekly sessions on general health information and 2 sessions on diabetes after completion of the study. Data were collected at baseline, after intervention, and at 1- and 6-month follow-ups for both patients and families. Comparisons of change over time were performed using growth curve analyses after propensity score adjustment.
Results
Intervention patients improved in diabetes knowledge and diabetes self-efficacy over time (but did not sustain at 6-month follow-up). A1C was lower at 1-month follow-up. Family members had improvements in diabetes knowledge and physical health–related quality of life.
Conclusions
Including families in the interventions may improve glycemic control, diabetes knowledge, self-efficacy, and physical health–related quality of life. However, strategies for sustaining improvements are needed.
Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of diabetes and its burden in the United States, 2014. Atlanta, GA: US Department of Health and Human Services; 2014.
3.
DominguezKPenman-AguilarAChangM-H. Vital signs: leading causes of death, prevalence of diseases and risk factors, and use of health services among Hispanics in the United States—2009-2013. MMWR Morbidity and Mortality Weekly Report. 2015;64:469-478.
4.
American Diabetes Association. Foundations of care: education, nutrition, physical activity, smoking cessation, psychosocial care, and immunization. Sec. 4. In Standards of Medical Care in Diabetes 2015. Diabetes Care. 2015;38:S20-S30.
5.
Agency for Healthcare Research and Quality. 2010 National Healthcare Disparities Report. Rockville, MD: US Department of Health and Human Services; 2011.
6.
MierNSmithMLCarrillo-ZunigaGWangXGarzaNOryMG. Personal and cultural influences on diabetes self-care behaviors among older Hispanics born in the U.S. and Mexico. J Immigr Minor Health. 2012;14:1052-1062.
7.
RosalMCOckeneISRestrepoA. Randomized trial of a literacy-sensitive, culturally tailored diabetes self-management Intervention for low-income Latinos: Latinos en Control. Diabetes Care. 2011;34:838-844.
8.
LongJMSowellRBairanAHoltzCCurtisABFogartyKJ. Exploration of commonalities and variations in health related beliefs across four Latino subgroups using focus group methodology: implications in care for Latinos with type 2 diabetes. J Cult Div. 2012;19:133-142.
9.
ToobertDJStryckerLAKingDKBarreraMOsunaDGlasgowRE. Long-term outcomes from a multiple-risk-factor diabetes trial for Latinas: ¡Viva Bien!Transl Behav Med. 2011;1:416-426.
10.
KingDKGlasgowREToobertDJ. Self-efficacy, problem solving, and social-environmental support are associated with diabetes self-management behaviors. Diabetes Care. 2010;33:751-753.
11.
PrezioEAChengDBalasubramanianBAShuvalKKendzorDECulicaD. Community Diabetes Education (CoDE) for uninsured Mexican Americans: a randomized controlled trial of a culturally tailored diabetes education and management program led by a community health worker. Diabetes Res Clin Pract. 2013;100:19-28.
12.
SpencerMSRoslandA-MKiefferEC. Effectiveness of a community health worker intervention among African American and Latino adults with type 2 diabetes: a randomized controlled trial. Am J Public Health. 2011;101:2253-2260.
13.
ValenMSNarayanSWedekingL. An innovative approach to diabetes education for a Hispanic population utilizing community health workers. J Cult Divers. 2012;19:10-17.
14.
RoslandAMHeislerMChoiHJSilveiraMJPietteJD. Family influences on self-management among functionally independent adults with diabetes or heart failure: do family members hinder as much as they help?Chronic Illn. 2010;6:22-33.
15.
CheslaCAFisherLSkaffMMMullanJTKanterR. Family predictors of disease management over on year in Latino and European American patients with type 2 diabetes. Family Process. 2003;42:375-390.
16.
DenhamSAWareLJRaffleHLeachK. Family inclusion in diabetes education: a nationwide survey of diabetes educators. Diabetes Educ. 2011;37:528-535.
17.
DenhamSA. Family Health: A Framework for Nursing. Philadelphia, PA: FA Davis; 2003.
18.
BrownSAGarciaAAKouzekananiKHanisCL. Culturally competent diabetes self-management education for Mexican Americans the Starr county border health initiative. Diabetes Care. 2002;25:259-268.
19.
AustinPCStuartEA. Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies. Stat Med. 2015;34:3661-3679.
20.
StuartEARubinDB. Best practices in quasi-experimental designs: matching methods for causal inference. In: OsborneJ. ed. Best Practices in Quantitative Methods. Thousand Oaks, CA: Sage; 2007:155-176.
21.
HuJWallaceDCMcCoyTPAmirehsaniKA. A family-based diabetes intervention for Hispanic adults and their family members. Diabetes Educ. 2014;40:48-59.
22.
BodeBWIrvinBRPierceJAAllenMClarkAL. Advances in hemoglobin A1C point of care technology. J Diabetes Sci Technol. 2007;1:405-411.
23.
RothmanRL. The Spoken Knowledge in Low Literacy in Diabetes Scale: a diabetes knowledge scale for vulnerable patients. Diabetes Educ. 2005;31:215-224.
24.
EakinEGReevesMMBullSSFloydSRileyKMGlasgowRE. Validation of the Spanish-language version of the chronic illness resources survey. Int J Behav Med. 2007;14:76-85.
VincentDMcEwenMMPasvogelA. The validity and reliability of a Spanish version of the summary of diabetes self-care activities questionnaire. Nurs Res. 2008;57:101-106.
27.
CraigCLMarshallALSjöströmM. International Physical Activity Questionnaire (IPAQ): 12-country reliability and validity. Med Sci Sports Exercs. 2003;35:1381-1395.
28.
Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2010.
29.
WareJKosinskiMKellerSD. A 12-item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34(3):220-233.
30.
WareJEKosinskiMTurner-BowkerDMGandekB. How to Score Version 2 of the SF-12® Health Survey (With a Supplement Documenting Version 1). Lincoln, RI: Quality Metric, Inc; 2004.
31.
BerglundPHeeringaS. Multiple Imputation of Missing Data Using SAS. Cary, NC: SAS Institute; 2014.
32.
MargolisDJGuptaJHoffstadO. Lack of effectiveness of hyperbaric oxygen therapy for the treatment of diabetic foot ulcer and the prevention of amputation: a cohort study. Diabetes Care. 2013;36:1961-1966.
33.
BrookhartMA. Variable selection for propensity score models. Am J Epidemiol. 2006;163:1149-1156.
34.
NguyenHQAckermannRTBerkeEM. Impact of a managed-Medicare physical activity benefit on health care utilization and costs in older adults with diabetes. Diabetes Care. 2007;30:43-48.
35.
JoffeMMTen HaveTRFeldmanHIKimmelSE. Model selection, confounder control, and marginal structural models: review and new applications. Am Stat. 2004;58:272-279.
Agency for Healthcare Research and Quality. 2014 National Healthcare Quality and Disparities Report Chartbook on Access to Health Care. Rockville, MD; 2015.
SrimanunthipholJBeddowRArakakiR. A review of the United Kingdom Prospective Diabetes Study (UKPDS) and a discussion of the implications for patient care. Hawaii Med J. 2000;59:295-298.
40.
BaigAALocklinCAWilkesAE. Integrating diabetes self-management interventions for Mexican-Americans into the catholic church setting. J Relig Health. 2014;53:105-118.
41.
GarciaAABrownSAWincheilMHanisCL. Using the behavioral checklist to document diabetes self-management behaviors in the Starr county diabetes education study. Diabetes Educ. 2003;29:758-766.
42.
GrahamJEStoebner-MayDGOstirGV. Health related quality of life in older Mexican Americans with diabetes: a cross-sectional study. Health Qual Life Outcomes. 2007;5:39.
43.
CoffmanMJFergusonBLSteinmanLTalbotLADunbar-JacobJ. A health education pilot for Latina women with diabetes. Clin Nurs Res. 2012;22:70-81.
