179708 Tailoring a community-based type 2 diabetes intervention to a population facing multiple barriers to health care

Monday, October 27, 2008

April C. M. Soward, BA , School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC
Anne H. Skelly, PhD, RN, FAANPBC , School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC
John Carlson, MS , School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC
Jennifer Leeman, DrPH, MDIV , School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC
Dorothy Burns, PhD, RN , School of Nursing, Hampton University, Hampton, VA
BACKGROUND

Diabetes complications disproportionately affect African Americans, and are a major cause of morbidity and mortality. Despite this, few diabetes self-management interventions have been designed which take into consideration the multiple barriers to health care experienced by older, rural, minority women living in poverty.

METHODS

Using a three group experimental design, 174 African American women, 55 years and older, with type 2 diabetes, and an A1C of greater than 7%, were randomly assigned to either the SYMPTOM intervention, the SYMPTOM intervention followed by a telephone booster, or a diet and weight control intervention. The typical participant was 68 years old, widowed (42%), received an income of less than $15,000 (68%), had Medicare/ Medicaid only health coverage (62%), and did not complete high school (51%).

RESULTS

The four 1-hour intervention sessions were delivered in the participant's home and produced a statistically significant improvement in participants at 6 months post-intervention in A1C (p=.003), diabetes symptom distress (p>.001), mental quality of life (p>.001), diabetes knowledge (p=.053), and medication compliance (p>.001).

CONCLUSIONS

Providing a free, in-home, culturally sensitive, one-on-one teaching/counseling intervention with a nurse allows the participant to learn more about their diabetes and diabetes self-care skills by reducing the barriers of transportation and cost. Supplying an environment where the participant has sufficient time to have her questions answered and ability to directly discuss personal barriers to her health care is important. Tailoring an in-home intervention to the needs of elders in rural areas can produce improved health outcomes by addressing barriers.

Learning Objectives:
1. At the end of the session, the participant will be able to identify two barriers to health care for older, rural, African American women. 2. At the end of the session, the participant will be able to describe two components of a successful program which addresses health care barriers for older, rural, African American women with type 2 diabetes.

Keywords: Barriers to Care, Diabetes

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the project manager for the SYMPTOMS Study (PI - Dr. Anne Skelly, NIH/NINR R01-NR 8582-04) on which the abstract is based. I am also a current MPH student graduating in May 2008.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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