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Intervention IP-086: Family-Based Diabetes Intervention for Hispanic Americans

Summary

This family-based, culturally-tailored intervention for adult Hispanics with type 2 diabetes (T2D) provided education to patients and their families on risk factors, symptoms, complications, management, self-efficacy, and family support. The educational intervention integrated cultural beliefs and values to provide information on problem solving skills, self-monitoring techniques, and goal setting for T2D-related health behaviors. Bilingual healthcare workers delivered the intervention. Improved glucose control was reported at post-intervention, but not at six-month follow-up.

Overview

Purpose of Intervention:

To test the efficacy of a family-based, culturally-tailored intervention for adult Hispanics with type 2 diabetes and their family members

Intervention Type:

Research-Tested — Interventions with strong methodological rigor that have demonstrated short-term or long-term positive effects on one or more targeted health outcomes to improve minority health and/or health disparities through quantitative measures; Studies have a control or comparison group and are published in a peer-review journal; No pilot, demonstration or feasibility studies.

Intervention Details

Intervention was Primarily Driven, Led, or Managed by:

Academic/Clinical Researchers Only

Citations:

Hu J, Amirehsani KA, Wallace DC, McCoy TP, Silva Z. A Family-Based, Culturally Tailored Diabetes Intervention for Hispanics and Their Family Members. The Diabetes educator. 2016 Jun;42(3):299-314. Epub 2016 Mar 8. PubMed PubMed Central DOI
Relevance: Main Intervention, Post-Intervention Outcomes
Amirehsani KA, Hu J, Wallace DC, Silva ZA, Dick S. Hispanic Families' Action Plans for a Healthier Lifestyle for Diabetes Management. The Diabetes educator. 2019 Feb;45(1):87-95. Epub 2018 Nov 23. PubMed DOI
Relevance: Post-Intervention Outcomes, Evaluations and Assessments

Adaptation of Another Research-based Intervention:

Contact Information

Primary Contact Name:

Jie Hu

Primary Contact Affiliation:

The Ohio State University, College of Nursing

Intervention URL:

Not available

Primary Contact Email:

hu.1348@osu.edu

Primary Contact Phone Number:

614-688-0394

Results

Intentions

Improve minority health or the health of other populations with health disparities (e.g. rural populations, populations with low SES, and sexual and gender minorities)

Intervention Primary Outcome:

The physiological outcome of glycemic control (A1C %) and the psychological outcomes of physical and mental health-related quality of life among Hispanic American adults with type 2 diabetes

Intervention Secondary Outcome:

The behavioral influences of diabetes knowledge, diabetes self-efficacy, and family support; the behavioral outcomes of self-reported management of diabetes including physical activity, diet, and medications among Hispanic American adults

Key Findings:

There were significant changes over time in A1C (p < 0.001) after adjusting for repeated measures and propensity score weighting. Mean A1C in the intervention group was 7.7% at post-intervention and 8.7% in the attention control group (p = 0.020), after adjusting for baseline differences. A significant difference between groups at 1-month post-intervention follow-up was found (I mean = 7.7% vs. C mean = 9.0%, p = 0.005). There were no significant differences between groups in change over time for either physical or mental health-related quality of life using the physical component summaries (p = 0.678) and mental component summaries (p = 0.154). Intervention patients improved in diabetes knowledge (p = 0.001) and diabetes self-efficacy (p = 0.007) over time (but did not sustain at 6-month follow-up). There were no significant changes in behavioral outcomes, including fruit and vegetable consumption (p=0.934), diabetes medication adherence (p=0.946), and blood sugar testing (p=0.268).

Statistical Method Used:

Longitudinal comparisons of change over time between groups were performed using growth curve modeling. Model-based time-point specific differences were interpreted if omnibus tests for any differences in change over time between groups (i.e., group by time interaction) were significant. Baseline participant characteristics were compared between groups using Chi-square or Fisher’s exact tests for categorical measures, and t-tests or Wilcoxon rank-sum tests for continuous characteristics.

Evaluations and Assessments

Were Any of the Following Assessments Conducted (Economic Evaluation, Needs Assessment, Process Evaluation)?:

Demographic and Implementation Description

Diseases, Disorders, or Conditions:

Type 2 Diabetes

Race/Ethnicity:

Hispanic or Latino

Populations with Health Disparities:

People with Lower Socioeconomic Status (SES), Racial and Ethnic Minority Populations, Underserved Rural Communities

Age:

Young Adults (18 - 39 years), Middle-Aged Adults (40 - 64 years), Older Adults (65+ years)

Socio-demographics / Population Characteristics

Community Type:

Rural

Other Populations with Health Disparities:

Unspecified, People with Low Education

Gender Identity:

Female, Male

Sexual Orientation:

Unspecified

Geographic Location:

North Carolina

Socio-Economic Status:

Low SES

Minority Health and Health Disparities Research Framework

		Levels of Influence
		Individual	Interpersonal	Community	Societal
Determinant Types	Biological	✔
	Behavioral	✔	✔
	Physical / Built Environment
	Sociocultural Environment
	Health Care System

Community Involvement

The community's role in different areas of the Intervention (Choices are "No Role", "Participation", and "Leadership"):

Design:

No Role

Dissemination:

No Role

Evaluation:

No Role

Implementation:

No Role

Outreach:

Participation

Planning :

Participation

Recruitment:

Participation

Sustainability:

No Role

Characteristics and Implementation

Intervention Focus Area:

Behavior Change

Disease Continuum:

Secondary Prevention, Tertiary Prevention

Delivery Setting:

Clinic / Health Care Facility, Houses of Worship

Mode of Delivery:

In-person

Who delivered the Intervention?:

Community Health Worker/Promoters, Healthcare Professional (Physician, Nurse, Technician)

Conceptual Framework

Intervention Theory:

Social Cognitive Theory was used to inform study but is not discussed in the publication.

Intervention Framework:

None

Implementation

Intervention Study Design:

Propensity Scores, Quasi-Experimental (does not require random assignment, but requires a comparison/control group with pre and post intervention outcome assessments)

Targeted Intervention Sample Size:

186

Actual Intervention Sample Size:

180

Start Year:

2012

End Year:

2015

Intervention Exposures

Duration of Intervention/How Long it Lasted:

1-3 months

Frequency of Intervention Delivery:

Weekly

Number of Sessions/Meetings/Visits/Interactions:

7-8 Sessions

Average Length of Each Session/Meeting/Visit/Interaction:

1-2 Hours

Format of Delivery:

Dyad/Group of two (e.g. participant & partner; mother & child)

Highest Reading Level of Intervention Materials Provided to Participants:

Grade 6-7

Impact, Lessons, Components

Produced an impact or change beyond the primary or secondary outcome:

Not Tested

Essential Aspects for Success:

Engage in the Hispanic community and lay health workers who are trusted by the community and population are essential for intervention success.

Intervention Impact:

Not available

Lessons Learned

Key Lessons Learned and/or Things That Could be Changed or Done Differently:

Engage in the Hispanic community, include bicultural and bilingual team; utilize group interactions to share diabetes experiences and identify barriers to self-management; set family goals and action plans for physical activity and healthy eating to promote commitment to behavior change.

Insights Gained During Implementation

Insight Category	Insight Description
Transportation	Provide transportation or incentives for transportation is important for intervention.
Staffing	Bicultural and bilingual team members play important roles in recruitment and retention of the participants.
Recruitment	Engage in Hispanic community and healthcare providers serving for Hispanic/Latino population is the key in participant recruitment.

Intervention Components

Intervention Has Multiple Components:

Assessed Each Unique Contribution:

N/A

Products, Materials, and Funding

Expertise, Partnerships, and Funding Sources

	Used for Implementation	Needed for Sustainability
Expertise
Health Education / Health Literacy	Yes	Yes
Partnerships
Health care facilities (local clinics)	Yes	Yes
Community groups (e.g. faith-based organizations, barbershops, beauty-salons, laundromats, food markets, community centers, cultural associations, tribal groups)	Yes	Yes
Funding Sources
Public funding (e.g., federal, state or local government)	Yes	Unknown

Product/Material/Tools

	Tailored For Language	Language(s) if other than English	Material
Outreach/Recruitment Tools
Newsletters	No		Attachment available for request at the bottom of the page.
Participant Educational Tools
Brochures/Factsheets/Pamphlets	Yes	Spanish	Attachment available for request at the bottom of the page.
Measurement Tools
Non-Standardized Instruments/Surveys/Questionnaires	Yes	Spanish	Attachment available for request at the bottom of the page.

Implementation Materials and Products

	Material
Implementation/Delivery Materials
No Implementation/Delivery Materials provided.
Implementation/Output Materials
No Implementation/Output Materials provided.

Articles Related to Submitted Intervention

	Article
Reports/Monographs
No Reports/Monographs provided.
Additional Articles
Physical activity in Hispanic adults and their family members	Attachment available for request at the bottom of the page.
Qualitative findings	Attachment available for request at the bottom of the page.
Findings of the Intervention study	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5654382/

Materials Available for Request

TRIAD2-pressrelease.pdf
TRIAD study_Family support and diabetes self-management educational presentations.pdf
TRIAD family support and diabetes intervention-Instrument_Spanish.pdf
Hu_Wallace et al_2015 Improving Physical Activity in Hispanics with diabetes and their families-PHN.pdf
Amirehsani Hu Wallace Silva Dick-2018- Hispanic families' action plans healthier lifestyle for diabetes management_.pdf