Elsevier

Applied Nursing Research

Volume 17, Issue 1, February 2004, Pages 10-20
Applied Nursing Research

Original article
A Culturally competent intervention of education and care for black women with type 2 diabetes

Presented in part at the University of North Carolina School of Nursing Center for Chronic Illness Annual Meeting Key Aspects of Chronic Illness, April 10, 1999, and at the 59th Scientific Sessions of the American Diabetes Association, San Diego, CA, June 21, 1999.
https://doi.org/10.1016/j.apnr.2003.10.009Get rights and content

Abstract

This article reports on the development and pilot feasibility testing of a culturally competent intervention of education and care for black women with type 2 diabetes mellitus (T2DM). Using a one group, pretest posttest quasi-experimental design, the intervention was tested with a convenience sample of 25 community black women with T2DM. The conceptual basis, process, and content of the intervention as well as the feasibility and acceptability of study materials and methods are described. Significant improvements from baseline to 3 months were observed in measures of glycemic control, weight, body mass index, and diabetes-related emotional distress. The findings suggest that a culturally sensitive intervention of nurse practitioner diabetes care and education is beneficial for black women with T2DM, resulting in program attendance, kept appointments, improved glycemic control and weight, and decreased diabetes-related emotional distress.

Section snippets

Theoretical framework

The development of this culturally competent intervention of DM care and education aimed at empowering women with knowledge and skills for DM self-management was informed by the literature; recommendations of the Task Force Committee on Diabetes in Minorities (1989), the Office of Minority Health standards for culturally, and linguistically appropriate services (2001); and by black women with T2DM (Maillet, Melkus, & Spollett, 1996). Cultural context was central to the design of the

Intervention

The 6-week, cognitive-behavioral, culturally competent DM intervention program was developed and led by advanced practice registered nurses (APRNs) trained in DM care and certified as DM educators. All APRNs were trained to implement the education intervention program in standardized manner using the developed curriculum. Cross-Cultural Counseling: A Guide for Nutrition and Health Counselors (1987) was also used as a guide for training the intervention leaders. Two of the four APRNs and the lay

Method

By using a one group, pretest posttest quasi-experimental design, we pilot tested the feasibility of the intervention with a convenience sample of community black women with T2DM.

Results

The sample included 25 black women with T2DM, who had an average age of 52 years (SD = 6.1). They all had a minimum of a high school education, and 55% also had postsecondary education. The majority (69%) was employed either part-time or full-time, and 50% reported an average annual income of less than $15,000. Marital status was evenly distributed among the group; however, the majority (72%) was living alone during the study. The average reported duration of diagnosed DM was 5.4 years (range

Discussion

The findings reveal that this sample of black women with T2DM was similar in demographic and physiologic characteristics to the women who informed the development of the intervention (Malliet & Melkus, 1996). They were midlife, educated women most of whom worked. They all used a usual source of primary health care; however, glycemic control, based on ADA standards of care, was less than optimal. Although 73% of the women were treated with oral hypoglycemic agents and diet therapy, it is

Limitations

A pretest posttest one group design was used to test the intervention feasibility. The outcome effects of the tested intervention on physiologic and psychosocial measures while promising need further testing with a control condition. The women that enrolled for the study were a self-select group of volunteers who may represent black women with T2DM who would benefit the most from a self-management intervention of diabetes education and care. Future testing of the intervention methods and

Implications

In conclusion, the feasibility of the tested intervention was based on low attrition rates, satisfaction with the intervention as evidenced by program attendance and kept appointments, improved glycemic control and weight, and decreased diabetes-related emotional distress. This study provides important data on how black women with T2DM respond to a culturally competent intervention of DM education and care designed to empower them with the knowledge and skills necessary to assume DM

Acknowledgements

We acknowledge the assistance of Dr Margaret Grey, Associate Dean of Reseach and Lorna Grey and Allison Amend for manuscript preparation.

References (48)

  • S Clement

    Diabetes self-management education

    Diabetes Care

    (1995)
  • Cross-cultural counselingA guide for nutrition and health counselors

    U.S. Department of Health and Human Services

    (1987)
  • D.A Dawson

    Ethnic differences in female overweightData from the 1985 national health interview survey

    American Journal of Public Health

    (1988)
  • G.A D’Eramo-Melkus et al.

    Metabolic impact of education in NIDDM

    Diabetes Care

    (1992)
  • Conquering diabetesA strategic plan for the 21st century

    (1999)
  • M Harris

    Health care and health status and outcomes for patients with type II diabetes

    Diabetes Care

    (2000)
  • M.I Harris et al.

    Racial and ethnic differences in glycemic control of adults with type 2 diabetes

    Diabetes Care

    (1999)
  • M.M Heckler

    Report for the secretary’s task force on black and minority health

    (1986)
  • D.I Height

    Black family dinner quilt cookbook

    (1993)
  • I Isolab

    Glyc-Affin GhbAn affinity for accuracy

    (1992)
  • R.C Keyserling et al.

    A diabetes management program for African American women with type 2 diabetes

    The Diabetes Educator

    (2000)
  • R.C Keyserling et al.

    A randomized trial of an intervention to improve self-care behaviors of African-American women with type 2 diabetes

    Diabetes Care

    (2002)
  • S.K Kumanyika et al.

    Theoretical and baseline considerations for diet and weight control of diabetes among blacks

    Diabetes Care

    (1990)
  • S.K Kumanyika et al.

    Models for dietary and weight change in African-American womenIdentifying cultural components

    Ethnicity and Disease

    (1992)
  • Cited by (49)

    • Recruitment and enrollment of participants in an online diabetes self-management intervention in a virtual environment

      2021, Contemporary Clinical Trials
      Citation Excerpt :

      Recruitment was slower than anticipated in the first year of recruitment at both sites (see Fig. 2); therefore, the study team added further targeted strategies. We used research study registries, including those used in a prior diabetes study (co-PI Melkus [11]) in the Connecticut area and the Measurement to Understand the Reclassification of Disease of Cabarrus/Kannapolis (MURDOCK) study at Duke University to access more potential study participants. Enrollment slowed over the holiday timeframes (November to January) for both sites but was not consistently low at either site and did not require an adaptation of recruitment strategies.

    • Transcultural diabetes care in the United States – A position statement by the American Association of Clinical Endocrinologists

      2019, Endocrine Practice
      Citation Excerpt :

      In current AACE chronic care models for adiposity-based chronic disease (ABCD) and dysglycemia-based chronic disease (DBCD), one of the first steps in management is behavioral, specifically motivating the patient, or creating a state of “activation for change” (109,169). This motivation occurs through experiential (consciousness awareness, self-reevaluation, dramatic relief, environmental reevaluation, and social liberation) and behavioral (self-liberation or choosing, counter-conditioning, stimulus control, reinforcement management, and helping relationships) processes and may take advantage of written materials, video, and educational tools from professional medical societies (170). Improved adherence is a critical byproduct of behavioral change.

    • Effectiveness of an intervention to improve diabetes self-management on clinical outcomes in patients with low educational level

      2017, Gaceta Sanitaria
      Citation Excerpt :

      Moreover, it is worth noting that the number of sessions the participants attended was directly associated with the impact of our intervention, and therefore the modest effect might be a result of the low attendance observed in our study. Apart from some exceptions,24 our results are consistent with other previous studies.25–28 The comparison with previous literature however is limited for two main reasons: 1) most of the previous studies were conducted in the U.S., a country with a healthcare system considerably different from the Spanish; and 2) with the exception of the study by Chapin et al.,21 the studies are significantly different to ours in terms of the type of intervention examined and population targeted.

    • Comparison Between Nurse Practitioner and MD Providers in Diabetes Care

      2012, Journal for Nurse Practitioners
      Citation Excerpt :

      Microfilament testing is done at least every year and documented on the chart on foot diagrams. Prior research supports this study of the NP reaching goals for referrals,10,22 but research also demonstrates goal attainment of A1C, HDL, and LDL,22,23,30 which this study did not support. One reason for this discrepancy may be the influx of patients over the 4 years the diabetic clinic was studied.

    View all citing articles on Scopus

    Supported by a grant from The Donaghue Foundation and from Bayer Corporation.

    View full text