Home-based diabetes symptom self-management education for Mexican Americans

Background: Mexican Americans are affected by type 2 diabetes at twice the rate of non-Hispanic Whites and they suffer higher rates of diabetes-related complications. Because Mexican Americans are more likely to lack health insurance or access to medical care, many may depend solely on self-evaluation and self-management of diabetes and its symptoms. This study provides an essential public health service by pilot testing a symptom-focused, culturally meaningful, diabetes self-management program aimed at reducing barriers to lifestyle modification, increasing health literacy, improving diabetes control and quality of life, and relieving the physical, societal, and economic burdens of Mexican Americans' worsening diabetes prevalence and consequences. The purpose of the study is to 1) determine the feasibility of delivering a culturally-specific intervention focusing on diabetes symptom self-management for Mexican Americans, 2) examine preliminary measures of the intervention's effectiveness and costs, and 3) assess participants' perceptions of the intervention. Methods: This is an ongoing repeated measures randomized controlled trial that will be completed in August 2010. A total of 72 Mexican American adults, aged 25-75, with type 2 diabetes are participating in the study (36 in each group). Participants in the experimental condition receive 8 weekly in-home interactive, tailored, one-on-one educational and behavior modification sessions with a registered nurse focusing on symptom awareness, glucose self-testing, and subsequent appropriate treatment followed by 8 biweekly support telephone call sessions. Participants in the wait-listed control (WLC) condition serve as a comparison for the intervention group at three time points and then receive the home-based portion of the intervention. Data to assess the effects of the intervention (including symptom-related knowledge, self-efficacy, empowerment, quality of life, glucose meter use, A1c, fasting plasma glucose, blood pressure, BMI, lipids,) are collected from participants in both intervention and WLC groups at three points: baseline, immediately post-intervention, and 120 days post-intervention. Results/Conclusions: Descriptive data and preliminary analyses of the effectiveness of the study using hierarchical linear modeling will be presented. Feasibility of translating the intervention into practice and lessons learned in administering a RN-led home-based intervention will be discussed.