A Culturally Appropriate Self-Management Program for Hispanic Adults with Type 2 Diabetes and Low Health Literacy Skills

Abstract

AcknowledgmentsI would like to acknowledge the members of this capstone committee for their guidance and support during the project. I am indebted, in particular, to the chair of the committee and academic advisor, Professor Ann Gill Taylor, for the innumerable hours given throughout each phase of the project to ensure the success of this endeavor. To her and to the rest of the GEM investigators I am grateful for the opportunity to have been a part of their team, which offered a unique learning experience and a launching pad for this project. A special thank you is given to AbstractThe global diabetes epidemic has disproportionately affected the Hispanic population.Along with the prediction that within the next few decades a great proportion of population growth in the United States will be among the Hispanic population, the accompanying increase in type 2 diabetes (T2D) will greatly impact the U.S. health care system. To reduce the morbidity and mortality from diabetes in this population, culturally appropriate approaches to disease selfmanagement are needed. This project assessed the feasibility of adapting a patient-centered educational intervention that addresses diet, physical activity, and meaningful self-monitoring of blood glucose for a Hispanic population with low health literacy skills. In four 2-hour class and focus group sessions, the educational program was presented in Spanish to nine Hispanic adults with T2D recruited within a rural community health care setting in central Virginia. The participants' feedback during the group sessions clustered around four themes: information and knowledge, motivation and barriers to change, experiences with new behaviors, and personal responsibility. The feedback supported the feasibility of the instructional approach within a group of low health literacy Hispanic adults with T2D. Findings from the project may help in the further development of tools and strategies for improved T2D self-management in the Hispanic American population. 4 Organization of the Capstone ProjectThis capstone project represents the culmination of a scholarly process that began with the candidate's clinical work, participation with a research team conducting an intervention in lifestyle modifications with persons with type 2 diabetes (T2D), a review of relevant literature, and progressed to testing the feasibility of a modified lifestyle educational program with a small group of Hispanic persons with T2D and low health literacy skills. This capstone project is presented in the usual five-section format. In Section I, the candidate presents the context of the problem studied; the core concepts and an overview of the project, including the purpose of testing the feasibility of an educational program in the targeted population; and the theoretical framework used in interpreting the data and presenting the findings. Section II focuses on a review of the literature conducted to determine what is known about patient-centered diabetes education in the U.S. Hispanic population and to identify t...

Barriers and Enablers to Make Lifestyle Changes among Type 2 Diabetes Patients: A Review

“…Time management was mentioned more as a barrier to do physical activity than eating healthily. Difficulties in finding time, stress and fatigue after long working hours were also frequently mentioned as barriers to physical activity (Brunk et al 2017;Ide et al 2018;Kaltman et al 2015;Korkiakangas et al 2011;Lawton et al 2006). This is further supported by a study by Umeh and Nkombua (2018), they found that the barriers to engage in exercise include not having the time (43.9%), not having companions (19.4%), stress (16.3%), and bad climate (10.2%).…”

“…Patient's food habit Five qualitative studies mentioned about food habit as a barrier against following a diabetic diet (Brunk et al 2017;Chary et al 2012;Ide et al 2018;Mansyur et al 2015;Mathew et al 2012;Sapkota et al 2017;Savoca & Miller 2001). Participants clarified that it was very hard to change their eating habit as they had been used to it since they were small (Ide et al 2018).…”

“…Apart from the recommended smaller portion size, they also perceived the diabetic diet as rigid and bland, making it very challenging to follow (Brunk et al 2017;Chary et al 2012;Ide et al 2018), as stated by one of the participants: "I think the hardest thing is to get used to the change in taste… " (Patient, Brunk et al 2017) Lack of self-efficacy Self-efficacy was also seen as a barrier to change in both physical activity and dietary intake (Akumiah et al 2017;Booth et al 2013;Brunk et al 2017;Byers, et al 2016;Chary et al 2012;Ghimire 2017;Ide et al 2018;Klug et al 2008;Malpass et al 2009;Mansyur et al 2015;Sapkota et al 2017). Self-efficacy is very crucial in implementing lifestyle changes as it is the willpower to either start or not to start lifestyle changes (Brunk et al 2017). Most participants felt difficult to control their food intake as they enjoyed food and made no effort to overcome the feeling (Byers et al 2016;Ide et al 2018).…”

“…Despite having a strong family history of T2DM, participants still had no awareness to make lifestyle changes to prevent the disease (Savoca & Miller 2001). Additionally, emotional factors such as isolation, stress or depression, influenced participants to consume large amounts of junk foods as a source of comfort (Brunk et al 2017;Savoca & Miller 2001).…”

“…Adequate knowledge of healthy diets and nutritional needs is very crucial in implementing changes (Sapkota et al 2017). Although they had been diagnosed with diabetes for some time, some participants still lacked in knowledge regarding diabetic diet (Booth et al 2013;Brunk et al 2017). Participants were being fed with too much information at one time that they were unable to recall all of them.…”