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Culturally tailoring patient education and communication skills training to empower African-Americans with diabetes

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Translational Behavioral Medicine

ABSTRACT

New translational strategies are needed to improve diabetes outcomes among low-income African-Americans. Our goal was to develop/pilot test a patient intervention combining culturally tailored diabetes education with shared decision-making training. This was an observational cohort study. Surveys and clinical data were collected at baseline, program completion, and 3 and 6 months. There were 21 participants; the mean age was 61 years. Eighty-six percent of participants attended >70 % of classes. There were improvements in diabetes self-efficacy, self-care behaviors (i.e., following a “healthful eating plan” (mean score at baseline 3.4 vs. 5.2 at program’s end; p = 0.002), self glucose monitoring (mean score at baseline 4.3 vs. 6.2 at program’s end; p = 0.04), and foot care (mean score at baseline 4.1 vs. 6.0 at program’s end; p = 0.001)), hemoglobin A1c (8.24 at baseline vs. 7.33 at 3-month follow-up, p = 0.02), and HDL cholesterol (51.2 at baseline vs. 61.8 at 6-month follow-up, p = 0.01). Combining tailored education with shared decision-making may be a promising strategy for empowering low-income African-Americans and improving health outcomes.

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REFERENCES

  1. Norris SL, Engelgau MM, Narayan KM. Effectiveness of self-management training in type 2 diabetes: a systematic review of randomized controlled trials. Diabetes Care. 2001;24:561-587.

    Article  PubMed  CAS  Google Scholar 

  2. Wing RR, Goldstein MG, Acton KJ, et al. Behavioral science research in diabetes: lifestyle changes related to obesity, eating behavior, and physical activity. Diabetes Care. 2001;24:117-123.

    Article  PubMed  CAS  Google Scholar 

  3. Peek ME, Cargill A, Huang E. Diabetes health disparities: a systematic review of health care interventions. Med Care Res Rev. 2007;64:101S-156S.

    Article  PubMed  Google Scholar 

  4. Lanting LC, Joung IM, Mackenbach JP, Lamberts SW, Bootsma AH. Ethnic differences in mortality, end-stage complications, and quality of care among diabetic patients: a review. Diabetes Care. 2005;28:2280-2288.

    Article  PubMed  Google Scholar 

  5. Mokdad AH, Bowman BA, Ford ES, Vinicor F, Marks JS, Koplan JP. The continuing epidemics of obesity and diabetes in the United States. JAMA. 2001;286:1195-1200.

    Article  PubMed  CAS  Google Scholar 

  6. US Department of Health and Human Services. Agency for Healthcare Research and Quality. National Healthcare Disparities Report [Internet]. 2009. Available from http://www.ahrq.gov/qual/measurix.htm#quality. Accessed February 20, 2011.

  7. Smedley B, Stith A, Nelson A. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington: National Academies Press; 2002.

    Google Scholar 

  8. Rothman R, Malone R, Bryant B, Horlen C, DeWalt D, Pignone M. The relationship between literacy and glycemic control in a diabetes disease-management program. Diabetes Educ. 2004;30:263-273.

    Article  PubMed  Google Scholar 

  9. Rhee MK, Cook CB, El-Kebbi I, Lyles RH, Dunbar VG, Panayioto RM, et al. Barriers to diabetes education in urban patients: perceptions, patterns, and associated factors. Diabetes Educ. 2005;31:410-417.

    Article  PubMed  Google Scholar 

  10. von Goeler DS, Rosal MC, Ockene JK, Scavron J, De Torrijos F. Self-management of type 2 diabetes: a survey of low-income urban Puerto Ricans. Diabetes Educ. 2003;29:663-672.

    Article  Google Scholar 

  11. Horowitz CR, Colson KA, Hebert PL, Lancaster K. Barriers to buying healthy foods for people with diabetes: evidence of environmental disparities. Am J Public Health. 2004;94:1549-1554.

    Article  PubMed  Google Scholar 

  12. Peek ME, Odoms-Young A, Quinn MT, Gorawara-Bhat R, Wilson SC, Chin MH. Racism in healthcare: its relationship to shared decision-making and health disparities: a response to Bradby. Soc Sci Med. 2010;71:13-17.

    Article  PubMed  Google Scholar 

  13. Garfield SA, Malozowski S, Chin MH, Narayan KM, Glasgow RE, Green LW, et al. Considerations for diabetes translational research in real-world settings. Diabetes Care. 2003;26:2670-2674.

    Article  PubMed  Google Scholar 

  14. Gary TL, Genkinger JM, Guallar E, Peyrot M, Brancati FL. Meta-analysis of randomized controlled trials of educational and behavioral interventions in type 2 diabetes. Diabetes Educ. 2003;29:488-501.

    Article  PubMed  Google Scholar 

  15. Charles C, Gafini A, Whelan T. Shared decision-making in the medical encounter: what does it mean? (Or it takes at least two to tango). Soc Sci Med. 1997;44:681-692.

    Article  PubMed  CAS  Google Scholar 

  16. Charles C, Gafni A, Whelan T. Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model. Soc Sci Med. 1999;49:651-661.

    Article  PubMed  CAS  Google Scholar 

  17. Diabetes Mellitus Interagency Coordinating Committee (DMICC). Advances and emerging opportunities in diabetes research: A strategic planning report of the DMICC [Internet]. 2010. Available from: http://conferences.thehillgroup.com/DRSP/PDF_508/DRAFT_DSP_10-TranslationalResearch.pdf. Accessed February 20, 2011.

  18. Anderson RM, Funnell MM. Patient empowerment: myths and misconceptions. Patient Educ Couns. 2010;79:277-282.

    Article  PubMed  Google Scholar 

  19. Paterson B. Myth of empowerment in chronic illness. J Adv Nurs. 2001;34:574-581.

    Article  PubMed  CAS  Google Scholar 

  20. Olivarius NF, Beck-Nielsen H, Andreasen AH, Horder M, Pedersen PA. Randomized controlled trial of structured personal care of type 2 diabetes mellitus. BMJ. 2001;323:946-947.

    Article  Google Scholar 

  21. Parchman ML, Zeber JE, Palmer RF. Participatory decision making, patient activation, medication adherence, and intermediate clinical outcomes in type 2 diabetes: a STARNet study. Annals Fam Med. 2010;8:410-417.

    Article  Google Scholar 

  22. Stewart MA. Effective physician-patient communication and health outcomes: a review. Can Med Assoc J. 1995;152:1423-1433.

    CAS  Google Scholar 

  23. Peek ME, Tang H, Cargill A, Chin MH. Are there racial differences in patients’ shared decision-making preferences and behaviors among patients with diabetes? Med Decis Making. 2011;31:422-431.

    Article  PubMed  Google Scholar 

  24. Cooper AR, Roter DL, Johnson RL, Ford DE, Steinwachs DM, Powe NR. Patient-centered communication, rating of care, and concordance of patient and physician race. Ann Intern Med. 2003;139:907-915.

    PubMed  Google Scholar 

  25. Levinson W, Hudak P, Feldman JJ, Frankel RM, Kuby A, Bereknyei S, et al. “It’s not what you say…”: racial disparities in communication between orthopedic surgeons and patients. Med Care. 2008;46:410-416.

    Article  PubMed  Google Scholar 

  26. Peek ME, Wilson SC, Gorawara-Bhat R, Quinn MT, Odoms-Young A, Chin MH. Barriers and facilitators to shared decision-making among African-Americans with diabetes. J Gen Intern Med. 2009;24:1135-1139.

    Article  PubMed  Google Scholar 

  27. Peek ME, Odoms-Young A, Quinn MT, Gorawara-Bhat R, Wilson SC, Chin MH. Race and shared decision-making: perspectives of African-American patients with diabetes. Soc Sci Med. 2010;71:1-9.

    Article  PubMed  Google Scholar 

  28. Cegala DJ, McClure L, Marinelli TM, Post DM. The effects of communication skills training on patients’ participation during medical interviews. Patient Educ Couns. 2000;41:209-222.

    Article  PubMed  CAS  Google Scholar 

  29. Cooper-Patrick L, Gallo JJ, Gonzales JJ, et al. Race, gender, and partnership in the patient–physician relationship. JAMA. 1999;282:583-589.

    Article  PubMed  CAS  Google Scholar 

  30. HealthyPeople 2020. Health communication and health information technology [Internet]. 2011. Available from: http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=18. Accessed September 14, 2011.

  31. Powers MA, Carstensen K, Colon K, Rickheim P, Bergenstal RM. Diabetes BASICS: education, innovation, revolution. Diabetes Spectr. 2006;19:90-98.

    Article  Google Scholar 

  32. Alliance to Reduce Disparities in Diabetes. Improving diabetes care and outcomes on the South Side of Chicago [Internet]. 2011. Available from: http://ardd.sph.umich.edu/university_chicago.html. Accessed September 14, 2011.

  33. Clark NM, Brenner J, Johnson P, Peek ME, Spoonhunter H, Walton J, et al. Reducing disparities in diabetes: the alliance model for health care Improvements. Diabetes Spectr. 2011;24(4):226-230.

    Article  Google Scholar 

  34. Mari Gallagher Research and Consulting Group. Examining the impact of food deserts on public health in Chicago [Internet]. 2006. Available from: http://www.marigallagher.com/site_media/dynamic/project_files/1_ChicagoFoodDesertReport-Full.pdf. Accessed February 20, 2011.

  35. Glanz K, Rimer BK, Lewis FM. Health Behavior and Health Education: Theory, Research and Practice. San Francisco: Wiley & Sons; 2002.

    Google Scholar 

  36. Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. Am J Health Promot. 1997;12:34-48.

    Article  Google Scholar 

  37. Schillinger D, Piette J, Grumbach K, Wang F, Wilson C. Closing the loop: physician communication with diabetic patients who have low health literacy. Arch Intern Med. 2003;163:83-90.

    Article  PubMed  Google Scholar 

  38. Merriam SB, Caffarella RS. Learning in Adulthood. 2nd ed. San Francisco: Jossey-Bass; 1999.

    Google Scholar 

  39. Houston TK, Allison JJ, Sussman M, et al. Culturally appropriate storytelling to improve blood pressure: a randomized trial. Ann Intern Med. 2011;154:77-84.

    PubMed  Google Scholar 

  40. Hornung CA, Eleazer GP, Strothers HS, et al. Ethnicity and decision-makers in a group of frail older people. J Am Geriatr Soc. 1998;46:280-286.

    PubMed  CAS  Google Scholar 

  41. Tolnay SE. The African American “Great Migration” and beyond. Annu Rev Sociol. 2003;29:209-232.

    Article  Google Scholar 

  42. James D. Factors influencing food choices, dietary intake, and nutrition-related attitudes among African Americans: application of a culturally sensitive model. Ethn Health. 2004;9:349-367.

    Article  PubMed  Google Scholar 

  43. Peek ME, Quinn MT, Gorawara-Bhat R, Odoms-Young A, Wilson SC, Chin MH. How is shared decision-making defined among African-Americans with diabetes? Patient Educ Couns. 2008;72:450-458.

    Article  PubMed  Google Scholar 

  44. Cegala DJ, Broz SL. Physician communication skills training: a review of theoretical backgrounds, objectives and skills. Med Educ. 2002;36:1004-1016.

    Article  PubMed  Google Scholar 

  45. American Diabetes Association. Standards of medical care in diabetes: 2010. Diabetes Care. 2010;33:S11-S61.

    Article  Google Scholar 

  46. Peek ME (Executive Producer). Shared Decision-Making: the importance of being involved in your healthcare [DVD]. Chicago, IL: Monica Peek; 2009.

  47. Healthy Interactions. The U.S. Diabetes Conversation Map® Program [Internet]. 2009. Available from: http://www.healthyinteractions.com/conversation-map-programs/conversation-map-experience/current-programs/usdiabetes. Accessed September 14, 2011.

  48. Heisler M, Vijan S, Anderson RM, Ubel PA, Berstein SJ, Hofer TP. When do patients and their physicians agree on diabetes treatment goals and strategies, and what difference does it make? J Gen Intern Med. 2003;18:893-903.

    Article  PubMed  Google Scholar 

  49. Toobert DJ, Hampson SE, Glasgow RE. The summary of diabetes self-care activities measure: results from 7 studies and a revised scale. Diabetes Care. 2000;23:943-950.

    Article  PubMed  CAS  Google Scholar 

  50. Bunn H, O’Connor A. Validation of client decision-making instruments in the context of psychiatry. Can J Nurs Res. 1996;28:13-27.

    PubMed  CAS  Google Scholar 

  51. Cranny A, O’Connor AM, Jacobsen MJ, et al. Development and pilot testing of a decision aid for postmenopausal women with osteoporosis. Patient Educ Counsel. 2002;47:245-255.

    Article  Google Scholar 

  52. Lerman CE, Brody DS, Caputo GC, Smith DG, Lazaro CG, Wolfson HG. Patients’ perceived involvement in care scale: relationship to attitudes about illness and medical care. J Gen Intern Med. 1990;5:29-33.

    Article  PubMed  CAS  Google Scholar 

  53. Zimmerman GL, Olsen CG, Bosworth MF. A 'stages of change' approach to helping patients change behavior. Am Fam Physician. 2000;61:1409-1416.

    PubMed  CAS  Google Scholar 

  54. McDonald PE, Wykle ML, Mistra R, Suwonroop N, Burant CJ. Predictors of social support, acceptance, health promoting behaviors, and glycemic control in African Americans with type 2 diabetes. J Natl Black Nurses Assoc. 2002;13:23-30.

    PubMed  Google Scholar 

  55. Trief PM, Grant W, Elbert K, Weinstock RS. Family environment, glycemic control, and the psychosocial adaptation of adults with diabetes. Diabetes Care. 1998;19:241-245.

    Article  Google Scholar 

  56. Hendricks LE, Hendricks RT. The effect of diabetes self-management education with frequent follow-up on the health outcomes of African-American men. Diabetes Educ. 2000;26:995-1002.

    Article  PubMed  CAS  Google Scholar 

  57. Peek ME, Wilkes AE, Roberson T, Goddu A, Nocon R, Tang H, et al. Mobilizing Chicago's South Side to reduce diabetes disparities: a case study. Health Aff. (in press)

  58. Chin MH, Walters AE, Cook SC, Huang ES. Interventions to reduce racial and ethnic disparities in health care. Med Care Res Rev. 2007;64:7S-28S.

    Article  PubMed  Google Scholar 

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Acknowledgments

This research was supported by the University of Chicago CTSA Pilot Grant Award Program, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) (R18DK083946 and the Diabetes Research and Training Center [P60 DK20595]), and the Merck Company Foundation. Dr. Peek is supported by the Mentored Patient-Oriented Career Development Award of the NIDDK (K23 DK075006). Support for Dr. Chin is provided by an NIDDK Midcareer Investigator Award in Patient-Oriented Research (K24 DK071933).

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Correspondence to Monica E Peek MD, MPH.

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Implications

Research: Culturally -tailored diabetes empowerment programs can improve self-efficacy, behaviors, and clinical outcomes among African-Americans. However, more work is needed to identify effective strategies to enhance shared decision-making among this population. Our findings may have relevance for other racial/ethnic minorities and vulnerable populations with diabetes health disparities, and this research should be extended to other populations (e.g., Hispanics) to assess its feasibility and potential effectiveness.

Practice: African-Americans patients with diabetes often want to be more active in their diabetes care, both in self-care activities and in shared decision-making (SDM). While dynamic classroom instruction may be sufficient to change self-care behaviors, patients may likely need encouragement and support from their health care providers in order to enhance SDM within clinical encounters.

Policy: Sustaining behavioral change and ultimately reducing diabetes disparities among African-Americans will require a comprehensive approach that links empowered patients to motivated health care providers, integrated health systems, and community resources.

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Peek, M.E., Harmon, S.A., Scott, S.J. et al. Culturally tailoring patient education and communication skills training to empower African-Americans with diabetes. Behav. Med. Pract. Policy Res. 2, 296–308 (2012). https://doi.org/10.1007/s13142-012-0125-8

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