Testing a Culturally Adapted Diabetes Behavioral Intervention with Chinese Immigrants using CBPR

Background: Chinese Americans have a 30% greater risk than Whites to develop type 2 diabetes (T2DM) and find standard diabetes care disregards cultural health practices. No behavioral diabetes interventions for Chinese Americans are published. We aimed to systematically adapt and test an efficacious small-group intervention, Coping Skills Training, to be culturally acceptable, using Community Based Participatory Research (CBPR) methods. University researchers and Chinatown agencies collaborated. Cognitive-behavioral change strategies included problem solving, communication training, conflict resolution and cognitive restructuring. Methods: The intervention was tested using a delayed treatment repeated measures design with 145 first generation adult Chinese immigrants with T2DM. Data were collected every 2 months after baseline (T1) over 4 time points, with treatment provided after T3. Piecewise multilevel models were fit to estimate changes in outcome immediately and 2 months post treatment, while adjusting for change from T1 to T3. Findings: Statistically significant change (p<.05) in the expected direction for six outcomes was observed for diabetes self-efficacy, diabetes knowledge, bicultural self-efficacy, family emotional support , DQOL-Satisfaction and diabetes distress. Effect size ranged from .25 to .55. Family instrumental support, DQOL-Impact and family conflict changed as expected but not significantly. HbA1C did not change. Prolonged benefits of treatment were not found at T5 suggesting that boosters are needed to maintain change. Overall retention was high (85%) and participants rated the program as highly satisfactory. A culturally respectful intervention affected change in factors associated with successful diabetes self-management. With refinements, the intervention holds promise to improve diabetes disparities in Chinese immigrants.