A culturally adapted, social support-based, diabetes group visit model for Bangladeshi adults in the USA: a feasibility study

Abstract

Background Interventions focused on weight loss can prevent, delay, and improve management of type 2 diabetes (T2D). However, implementation of these programs is challenging in diverse populations. South Asians have higher risk for T2D, yet to date, there have been limited programs for this community in the USA. The aim of this project was to develop and test the feasibility of a tailored group visit model for Bangladeshis with type 2 diabetes (T2D) or prediabetes based in primary care. Design Mixed-methods single-arm feasibility study. Setting An academic health center-based primary care clinic in Atlanta, Georgia. Participants Bangladeshi adults > 18 years old with T2D or prediabetes Methods In conjunction with a community-academic board, we conducted focus groups to tailor an existing evidence-based curriculum to a culturally acceptable intervention. Fourteen participants enrolled in the 16-week program focusing on healthy diet, exercise, and weight loss. The primary feasibility outcomes were number of sessions attended and participant satisfaction with the intervention. Weight, blood pressure, cholesterol, and HbA1C were measured at beginning and end of study. Participants were asked to evaluate each session on level of satisfaction. One tailed paired t tests were used to test significance of pre-post changes in outcomes. Results Key themes from the formative focus groups (n = 50) were closely tied to sociocultural beliefs and included: dietary patterns, physical activity perceptions, and healthcare access concerns. In the intervention, 10 of 14 participants had baseline and follow-up data. Participant attendance averaged 50%. Statistically significant reductions in mean weight (− 2%, 95%CI: − 3.1, 0.2 kg), systolic/diastolic blood pressure (− 12.7 mmHg [95%CI: − 23.2, − 2.2]/− 3.7 mmHg [95%CI: − 7.6, − 0.1], respectively), and triglycerides (− 62.6 mg/dl, 95%CI: − 123.1, − 2.0) were noted. Overall, participants reported high levels of satisfaction with the program. Conclusion A lifestyle program based in primary care is feasible and acceptable for Bangladeshi immigrants. Larger studies testing the effectiveness of group programs, in primary care, to improve cardiometabolic factors are important. Trials registration ClinicalTrials.gov; NCT03861546. Registered 28 February 2019.

Systematic review of the barriers and facilitators to dietary modification in people living with type 2 diabetes and pre‐diabetes from South Asian ethnic populations

“…The programme was associated with a 2% reduction (0.2 kg) in weight, a 12.7 mmHg absolute reduction in blood pressure and a lower of triglycerides by 62.6 mg/dL. 24…”

“…Shah et al was a mixed methods single-arm feasibility study which recruited American Bangladeshi adults from a primary care setting living with T2DM or pre-diabetes. 24 Shah et al created a community programme that involved tailored group visits. Fourteen participants were enrolled in the programme and four participants did not complete the programme due to schedule conflicts or comorbid health conditions.…”

“…27 Shah et al further comments how participants reported that clinicians or translators from the SA community could facilitate access to health information; however, a direct quote to supplement this is not provided. 24…”

“…Qualitative Patel et al 27 Qualitative Penn et al 29 Qualitative Singh et al 25 Qualitative Lawton et al 28 Qualitative Greenhalgh et al 26 Qualitative Pardhan et al 30 Qualitative Shah et al 24 Note: The Joanna Briggs institute critical appraisal tools 14 were utilised to assess the risk of bias in the qualitative studies (n = 7). The tool assessed studies for the extent to which potential bias in its design, conduct and analysis have been addressed.…”

“…17 Cultural adaptation to diabetes continues to an issue in the SA community and tailored intervention similar to that conducted by Shah et al appear to be beneficial for these individuals. 24 There is no study that met our predefined inclusion criteria that compared different community interventions or explored in detail how T2DM advice should be tailored to ethnic minorities. The present review could give insight into themes that could be explored in future qualitative studies to investigate how these interventions should be adapted best for SALWC.…”