A Randomized Trial of a Church-Based Diabetes Self-management Program for African Americans With Type 2 Diabetes
ABSTRACT This study developed and tested a culturally appropriate, church-based intervention to improve diabetes self-management. Research Design and Methods This was a randomized trial conducted at 24 African American churches in central North Carolina. Churches were randomized to receive the special intervention (SI; 13 churches, 117 participants) or the minimal intervention (MI; 11 churches, 84 participants). The SI included an 8-month intensive phase, consisting of 1 individual counseling visit, 12 group sessions, monthly phone contacts, and 3 encouragement postcards, followed by a 4-month reinforcement phase including monthly phone contacts. The MI received standard educational pamphlets by mail. Outcomes were assessed at 8 and 12 months; the primary outcome was comparison of 8-month A1C levels.
At baseline, the mean age was 59 years, A1C 7.8%, and body mass index 35.0 kg/m(2); 64% of participants were female. For the 174 (87%) participants returning for 8-month measures, mean A1C (adjusted for baseline and group randomization) was 7.4% for SI and 7.8% for MI, with a difference of 0.4% (95% confidence interval [CI], 0.1-0.6, P = .009). In a larger model adjusting for additional variables, the difference was 0.5% (95% CI, 0.2-0.7, P < .001). At 12 months, the difference between groups was not significant. Diabetes knowledge and diabetes-related quality of life significantly improved in the SI group compared with the MI group. Among SI participants completing an acceptability questionnaire, intervention components and materials were rated as highly acceptable.
The church-based intervention was well received by participants and improved short-term metabolic control.
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ABSTRACT: Lay liaisons can improve health care outcomes, especially in underserved communities.The American journal of nursing 07/2012; 112(7):63-8. DOI:10.1097/01.NAJ.0000415960.92674.9d · 1.32 Impact Factor
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ABSTRACT: Background To assess the effects of peer support at improving glycemic control in patients with type 2 diabetes. Methods Relevant electronic databases were sought for this investigation up to Dec 2014. Randomized controlled trials involving patients with type 2 diabetes that evaluated the effect of peer support on glycated hemoglobin (HbA1c) concentrations were included. The pooled mean differences (MD) between intervention and control groups with 95% confidence interval (CI) were calculated using random-effects model. The Cochrane Collaboration’s tool was used to assess the risk of bias. Results Thirteen randomized controlled trials met the inclusion criteria. Peer support resulted in a significant reduction in HbA1c (MD −0.57 [95% CI: −0.78 to −0.36]). Programs with moderate or high frequency of contact showed a significant reduction in HbA1c levels (MD −0.52 [95% CI: −0.60 to −0.44] and −0.75 [95% CI: −1.21 to −0.29], respectively), whereas programs with low frequency of contact showed no significant reduction (MD −0.32 [95% CI: −0.74 to 0.09]). The reduction in HbA1c were greater among patients with a baseline HbA1c ≥ 8.5% (MD −0.78 [95% CI: −1.06 to −0.51]) and between 7.5 ~ 8.5% (MD −0.76 [95% CI: −1.05 to −0.47]), than patients with HbA1c < 7.5% (MD −0.08 [95% CI: −0.32 to 0.16]). Conclusions Peer support had a significant impact on HbA1c levels among patients with type 2 diabetes. Priority should be given to programs with moderate or high frequency of contact for target patients with poor glycemic control rather than programs with low frequency of contact that target the overall population of patients. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1798-y) contains supplementary material, which is available to authorized users.BMC Public Health 05/2015; 15(1). DOI:10.1186/s12889-015-1798-y · 2.32 Impact Factor