Original articleA Culturally competent intervention of education and care for black women with type 2 diabetes☆
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.
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Supported by a grant from The Donaghue Foundation and from Bayer Corporation.