A culturally targeted self-management program for African Americans with type 2 diabetes mellitus

Division of Nursing, Winston-Salem State University, Winston-Salem, North Carolina, USA.
The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmières 12/2012; 44(4):126-41.
Source: PubMed


Inadequate knowledge of the influence of lifestyle on clinical outcomes contributes to the difficulties many African Americans experience with type 2 diabetes mellitus (T2DM). This pilot study examined a 12-week church-based culturally targeted diabetes self-management education (DSME) intervention for middle-aged and older African Americans with T2DM. Quantitative data were collected at baseline and at 12 weeks and included questionnaires and anthropometric measures. There were significant increases in medication adherence (p = .006), healthy eating (p = .009), and foot care adherence (p = .003). The intervention had a clinically significant effect on systolic blood pressure, blood lipids, physical activity, and waist circumference. Church-based culturally targeted DSME interventions may result in improved outcomes for African-American adults with T2DM. The authors discuss the value of community-based interventions that target behavioural changes in populations of chronically ill patients, particularly those who historically have been disenfranchised and/or underserved.

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Available from: Janice Collins-McNeil, Apr 08, 2014
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    • "Previous studies showed that therapy with multiple drugs, poor appointment keeping, poor patient-provider communication, and low patient education were factors which increased poor medication adherence. In addition, medication adherence has also been influenced by local culture and religious affiliations that influence on individual medication behaviors (Peyrot and Rubin 1994; Ciechanowski et al. 2001; Weinger et al. 2011; Rhee et al. 2005; Balkrishnan et al. 2003; Collins-McNeil et al. 2012). Despite the fact that giving due recognition to diabetes mellitus as one of the major health issues of the middle age and the elderly necessitates the gathering of relevant information on medication behaviors and factors associated thereof, studies on patient medication adherence are very limited in Ethiopia (Collins-McNeil et al. 2012; Ho et al. 2009; Wabe et al. 2011; Abebe et al. 2013). "
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    ABSTRACT: Low adherence to prescribed diabetes medications is one of the major reasons to poor glycemic control in developing countries. Therefore, this study attempted to assess the magnitude of medication adherence and factors associated with it among adult persons with diabetes in northwest Ethiopia. This study utilized a cross sectional study design with internal comparison. The study population was adult persons with diabetes attending the Diabetes Referral Clinic of Gondar University Hospital. Adherence was assessed using the eight-item Morisky Medication Adherence Scale (MMAS-8). In addition laboratory tests and chart reviews were carried out to collect relevant data. Ordinary logistic regression was used to identify factors associated with adherence. A total of 391 patients were studied. Based on the MMAS-8 scale, the self-reported adherence to diabetic medication was low for 25.4% [95% CI: 21, 29] of the patients, medium for 28.7% [95% CI: 24, 33], and high for 45.9% [95% CI: 41, 50] of the patients. The Mean (±SD) of glycosylated hemoglobin for the low adherence group was 8.2% (±2.1). It was 8.1% (±2.0), for the medium, and 7.4% (±1.6) for the high adherence group. In the multivariate analysis poor wealth status (AOR = 1.99; 1.15, 3.43), using traditional treatment (AOR = 2.90; 1.03, 8.15), and service dissatisfaction (AOR = 2.23; 1.04, 4.80) were significantly associated with low adherence to prescribed diabetic medications. Over half of the persons with diabetes did not adhere to medications. Adherence was poor among users of traditional treatment and those dissatisfied with services. Developing a more intensive communication strategies and improving the quality of services could improve the level of adherence.
    Full-text · Article · Apr 2014 · SpringerPlus
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    ABSTRACT: Diabetes for Life (DFL), a project of Memphis Healthy Churches (MHC) and Common Table Health Alliance (CTHA; formerly Healthy Memphis Common Table [HMCT]), is a self-management program aimed at reducing health disparities among African Americans with type 2 Diabetes Mellitus in Memphis and Shelby County, Tennessee. This program is one of five national projects that constitute The Alliance to Reduce Disparities in Diabetes, a 5-year grant-funded initiative of The Merck Foundation. Our purpose is to describe the faith-based strategies supporting DFL made possible by linking with an established informal health system, MHC, created by Baptist Memorial Health Care. The MHC network engaged volunteer Church Health Representatives as educators and recruiters for DFL. The components of the DFL project and the effect on chronic disease management for the participants will be described. The stages of DFL recruitment and implementation from an open-access to a closed model involving six primary care practices created a formal health system. The involvement of CTHA, a regional health collaborative, created the opportunity for DFL to expand the pool of health care providers and then recognize the core of providers most engaged with DFL patients. This collaboration between MHC and HMCT led to the organization of the formal health network.
    Preview · Article · Nov 2014 · Health Promotion Practice
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    ABSTRACT: AimThe objective of this study was to assist individuals with type 2 diabetes (T2D) better manage blood glucose control using food. Given that white rice is a commonly consumed staple food for Asian cultures, the aim of this study was to develop a nutritious and easy-to-prepare alternative meal using culturally tailored ingredients.MethodsA ‘rice mix’ comprising 60% white rice and 40% a mix of legumes, nuts and seeds was developed. Eighty-one participants of Asian ethnicity and with T2D were screened with 13 subjects randomised and given the rice mix or white rice (control) as an evening meal. Blood glucose responses were compared between meals and to the American Diabetes Association guidelines together with responses to satiety and desire-to-eat questions.ResultsOver a 3-hour period following consumption, blood glucose concentrations were 21% (95% CI: 6, 36) lower for the rice mix compared with white rice (P < 0.001). The mean length of time that blood glucose exceeded 10 mmol/L was 30 minutes (95% CI: 6, 54) less; and the maximum glycaemic increment above 10 mmol/L was 1.4 mmol/L (95% CI: 0.3, 2.5) less; for the rice mix compared with the white rice. There was no effect on appetite as satiety was not different between meals, although there was a lesser desire to eat fatty foods after consuming the rice mix (P = 0.02).Conclusions The rice mix as an alternative to white rice could be a practical self-help approach to improve blood glucose control in people with T2D. Using education and culturally tailored ingredients may help overcome barriers to dietary change.
    No preview · Article · Jan 2015 · Nutrition & Dietetics
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