Purpose The purpose of this pilot study was to evaluate a culturally tailored intervention for rural African Americans. Social Cognitive Theory provided the framework for the study. Methods Twenty-two participants were recruited and randomly assigned to either Group or Individual diabetes self-management (DSME). Group DSME included storytelling, hands-on activities, and problem-solving exercises. Individual DSME sessions focused on goal-setting and problem-solving strategies. Sessions were offered in an accessible community center over a 10-week period. Results Outcomes included glycosylated hemoglobin (A1C), self-care actions, self-efficacy level, goal attainment, and satisfaction with DSME. Participants in both Group and Individual DSME improved slightly over the 3-month period in self-care activities, A1C level, and goal attainment. Although differences were not statistically significant, trends indicate improved scores on dietary actions, foot care, goal attainment, and empowerment for those experiencing Group DSME. Conclusions The culturally tailored approach was well received by all participants. Improvements among those receiving Individual DSME may indicate that brief sessions using a culturally tailored approach could enhance self-care and glycemic control. Additional testing among more participants over a longer time period is recommended.

Purpose According to the World Health Organization, quality of life (QOL) includes physical and mental health, emotional well-being, and social functioning. Using an adaptation of Andersen's behavioral model, we examined the associations between the three dimensions of QOL and needs and health behaviors in a nationally representative sample of adults 65 years and older. Methods A representative sample from the 2005–2006 National Health and Nutrition Examination Survey (NHANES) was used. NHANES over-samples persons 60 years and older, African Americans, and Hispanics. Frequencies and distribution patterns were assessed, followed by bivariate and multiple regression analyses. Results These older adults reported high levels of QOL. However, associations between needs and health behaviors and QOL varied across dimensions. Activities of daily living (ADL) were associated with all three dimensions. Depression was associated with two dimensions and memory problems with one dimension. Physical activity was linked to social functioning, and health care utilization was linked to emotional well-being. Conclusions The differences in associations with different dimensions of QOL confirm that this is a multidimensional concept. Since depression, memory problems, and ADL function were all associated with some dimension of QOL, future interventions to improve QOL in older adults should include screening and treatment for these problems.

Purpose The proportion of people over 65 years of age is higher in rural areas than in urban areas, and their numbers are expected to increase in the next decade. This study used Andersen’s behavioral model to examine quality of life (QOL) in a nationally representative sample of community-dwelling adults 65 years and older according to geographic location. Specifically, associations between 3 dimensions of QOL (health-related QOL [HQOL], social functioning, and emotional well-being) and needs and health behaviors were examined. Methods The 2005–2006 National Health and Nutrition Examination survey was linked with the 2007 Area Resources File via the National Center for Health Statistics’ remote access system. Frequencies and distribution patterns were assessed according to rural, adjacent, and urban locations. Findings Older adults reported high levels of QOL; however, rural older adults had lower social functioning than their urban counterparts. Older blacks and Hispanics had lower scores than whites on 2 dimensions of QOL. Associations between QOL and needs and health behaviors varied. Although activities of daily living were associated with all 3 dimensions, others were associated with 1 or 2 dimensions. Conclusions The lower scores on social functioning in rural areas suggest that rural older adults may be socially isolated. Older rural adults may need interventions to maintain physical and mental health, strengthen social relationships and support, and increase their participation in the community to promote QOL. In addition, older blacks and Hispanics seem more vulnerable than whites and may need more assistance.

Purpose The purpose of this study is to test the feasibility of conducting a community-based randomized controlled trial evaluating a culturally tailored community-based group diabetes self-management education (DSME) program among rural African Americans. Methods Thirty-two African American rural adults with type 2 diabetes were recruited and 25 adults were retained and participated in an interventional study designed to test the effectiveness of the “Taking Care of Sugar” DSME program for the 2-year follow-up. Participants were selected from rural central Virginia. Primary outcomes variables included average blood sugar levels, cardiovascular risk factors, and general physical and mental health. These outcomes were assessed at baseline, 3 months, 6 months, and 12 months post baseline. Results From baseline to 3-month follow-up assessment, participants exhibited significant improvement on several physiological and behavioral measures. Given the small sample size, hypothesis testing was limited. Results show change from baseline over time, illustrating that the primary outcome of A1C decreased, although not significant. Additionally, participants reported more knowledge about diabetes self-management and personal care skills (ie, exercise and foot care) that persisted over time. The feasibility of the culturally tailored DSME was established, and participation with the program was high. Conclusions A community-based group DSME program using storytelling is feasible. This research will help to inform clinicians and health policymakers as to the types of interventions that are feasible in a larger rural population. If such a program is carried out, we can improve knowledge, reduce complications, and improve quality of life among rural African Americans.

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