JC2012-01 Effect of Culturally Tailored Diabetes Education in Ethnic M

PowerPoint Presentation: 

Culturally competent Diabetes self-management education for Mexican Americans: The Starr County Border Health initiative Diabetes Care, Brown et al, 2002 Alisson Sombredero PGY-3 Primary Care Effect of Culturally tailored Diabetes education in ethnic minorities with type 2 Diabetes Journal of cardiovascular nursing, 2011

Background: 

Background Major cause of cardiovascular M&M Prevalence: 8.5% Whites vs. 9.5% Hispanics vs.13.3% AA Increase complications in minorities CKD retinopathy and amputations Reasons: Genetic, environmental and cultural. No benefit from traditional DM education

Background: 

Background Poor glycemic control Low rates of participation in education programs Barriers: Language, socioeconomic, life style, health beliefs. Decrease success:

Failure of the traditional model: 

Failure of the traditional model Lack of cultural competency of providers Does not address relevant issues for this particular population.

CTDE: 

CTDE Cultural beliefs Family participation Values Customs Food patterns Language Low literacy Culturally specific educational Materials Health practices

The study: 

The study Meta-analysis: 12 studies, 1495 participants Evaluate effectiveness of CTDEI on glycemic control in ethnic minorities with DM type 2 Previous meta-analysis focus always on non minorities

Methods: 

Methods PubMed, ERIC, PsycINFO, Cochrane RTC with DM educational interventions only in ethnic minority groups with reported HbA1c pre and post intervention. Quality assessment: 6-8 points in scale Comparing interventions to control group, ES Effect Size (difference in HbA1c pre-post )

PowerPoint Presentation: 

Analysis: 3 subgroups: baseline HbA1c, Intervention setting and intervention duration. 12 RCT, 1495 participants, mean age 63.6 years, 68% female. 4 studies include African Americans, 3 Hispanics, 4 Asians, 1 Canadian Portuguese. Mean baseline HbA1c 8.6% 8 studies conducted in US

Intervention: 

Intervention 84% used group education or group/ individual combination 16% individual sessions Control group: 50% Individual care vs. minimal intervention Providers: 36% nurses, 36% dietitians, 5% certified DM educators, 9% pharmacist, psychologist and MSW, 14% non professional staff

Interventions: 

Interventions Duration: 1 session in 12 mo. to 25 bi-weekly sessions Hospital based outpatient 58% community based 42% Bilingual/ bicultural educators Modifying ethnic food recipes Dancing or walking Non English materials Visual aids Attendance of family

Interventions: 

Interventions Diabetes knowledge (symptoms, complications, medications) Self management (Food, activity, glucose monitoring) Psychosocial strategies: coping skills, stress management, problem solving Foster family participation in managing DM. 2/3 of studies.

Outcomes: 

Outcomes The pooled ES of the 12 RCT with CTEDI was -0.29 when measured at last f/u. The result was statistically significant (95%CI -0.46 to -0.13)

Results: 

Results ES of -0.29 suggests that the average patient in the intervention group is better off than 61% of the control group Larger declines in HbA1c compared with controls were seen at 6 mo (ES, -0.41; 95% CI, -0.61 to -0.21) The results at 3 mo and 12 mo showed smaller changes and no significant results. Lower baseline HbA1c >8.5% was associated with a larger ES

Limitations: 

Limitations Selection Bias: analysis of English language RCT Publication Bias: search did not include unpublished data Methodological limitations: none of the RCT were long term f/u Mostly Hispanics and African Americans, no CTED in Native Americans

PowerPoint Presentation: 

To determine in Mexican Americans with type 2 DM the effects of a culturally competent diabetes self-management intervention Prospective, randomized study Texas/Mexico border 256 patients, 35-70 y.o., diagnosed after age 35 years and accompanied by a friend or relative.

Intervention: 

Intervention 52 contact hours over 12 mo Providers: Bilingual Mexican American nurses, dietitians and community workers 3 mo of weekly sessions on nutrition, self monitoring FSBG, exercise and self care. 6 mo of bi-weekly support group sessions to promote behavior changes

Culturally competent approach: 

Culturally competent approach Spanish Mexican based diet Social emphasis Family participation Incorporation cultural health beliefs

Indicators of metabolic control: 

Indicators of metabolic control HbA1c FBS Diabetes knowledge Diabetes related health beliefs Nopales for lunch – Ruth Olivar Millan

Mean and DS for outcome measures 3 to 6 mo: 

Mean and DS for outcome measures 3 to 6 mo Experimental Group HbA1c: 11.81–10.80 BMI and TG Sense of control Barriers Knowledge Controls HbA1c: 11.22–11.64 BMI and TG Sense of control Barriers knowledge

PowerPoint Presentation: 

Statistically significant improvement in HbA1c and Diabetes knowledge in the intervention group

Results: 

Results Experimental groups showed significant lower levels of HbA1c at 6 and 12 mo and higher DM knowledge scores. At 6 mo the mean HbA1c of the experimental subjects was 1.4% below the mean of the control group The mean level of the experimental subjects was still high >10%

Conclusion: 

Conclusion This study confirms the effectiveness of culturally competent DM self management education on improving health outcomes of Mexican Americans, particularly for those with HbA1c >10%

Discussion: 

Discussion How might we implement similar programs at Highland?