A mixed-methods approach to understanding the perspectives, experiences, and attitudes of a culturally tailored cognitive behavioral therapy/motivational interviewing intervention for African American patients with type 2 diabetes: a randomized parallel design pilot study

Abstract

Background African American (AA) adults are 60% more likely to be diagnosed with diabetes mellitus (DM) and experience more complications than non-Hispanic White adults. Cognitive behavioral therapy (CBT) has shown to be an effective modality for helping patients improve health behaviors and regulate emotional states. Motivational interviewing (MI) addresses participant engagement and motivation. Therefore, MI was combined with CBT as an approach to the process of learning using CBT skills to promote healthy lifestyle choices. We aimed to assess the effects of a culturally tailored CBT/MI intervention on glycemic control in AA participants and understand their perspectives, attitudes, and experiences while participating in this intervention. Methods Using a randomized, parallel design pilot study (web-based group vs in-person group), 20 participants aged ≥ 18 years, identifying as AA and having a glycosylated hemoglobin (HbA1c) > 8%, were recruited. A CBT/MI intervention was administered in six sessions over 3 months. Participants completed baseline and follow-up assessments on measures for diabetes control (HbA1c), self-efficacy, generalized anxiety, depression, perceived stress, health-related quality of life, and cognitive ability. Post-CBT/MI intervention focus groups were conducted to determine patient perspectives regarding the intervention. Results Fourteen participants completed the study, their mean HbA1c improved from 10.0 to 8.9% (t(26) = 0.5, p-value = 0.06). The Diabetes Distress Scale demonstrated decreased distress overall (t(26) = 2.6; p-value = 0.02). The Generalized Anxiety Disorder Scale demonstrated decreased generalized anxiety for all participants (t(26) = 2.2; p = 0.04). Themes identified in focus groups included (1) intervention group social support through information sharing, (2) mental health and personal identities in diabetes understanding and management, and (3) receptivity to CBT/MI intervention positively impacts self-efficacy through improved health literacy. Conclusion This group-based, culturally tailored CBT/MI intervention for type 2 DM care was positively received by AA participants and helped improve diabetes control, as demonstrated by the change in HbA1c. There were additional benefits of social support through group interactions and a stronger sense of self-efficacy due to health education. A comprehensive treatment plan using a CBT/MI intervention may be useful in promoting healthy diabetes self-management. Trial registration ClinicalTrials.gov, NCT03562767. Registered on 19 June 2018

Barriers to medication adherence in sickle cell disease: A comprehensive theory‐based evaluation using the COM‐B model

“…Additionally, identifying and restructuring thinking through the use of CBT has been studied in other chronic health conditions 52 . There has been evidence to suggest combining MI and CBT may lead to greater improvement in long‐term treatment adherence; however, future studies in SCD are warranted 53,54 . Assessing patients’ knowledge, motivations, and perceptions and providing support on an ongoing basis are essential for healthcare providers to address the complex needs and barriers for each patient and improve medication adherence.…”

Cognitive behavioral treatment to improve psychological adjustment in people recently diagnosed with type 2 diabetes

“…Psychological treatments including CBT, have sought to improve therapeutic adherence, develop adequate coping strategies, promote emotional regulation, and reduce disease-related distress (Anguiano–Serrano, 2014 ), usually based on goal setting and problem solving (Fredrix et al, 2018 ; McSharry et al, 2020 ). Motivational interviewing (MI) has been included as part of various CBT intervention protocols to increase participants’ engagement in medical treatment (Cornely et al, 2022 ) and to improving their perception on the importance of behavior change (Li et al, 2020 ).…”

“…However, within the limitations of the reviewed studies, it is observed that some of them do not specify the time since diagnosis (González et al, 2020 ; Wroe et al, 2018 ); others include participants who have lived with T2DM for six years or more (Berry et al, 2017 ; Cornely et al, 2022 ; Li et al, 2020 ; Martino et al, 2020 ; Steffen et al, 2021 ; Theodoropoulou et al, 2019 ; van Bastelaar et al, 2011 ) or exclude newly diagnosed people (Xu et al, 2020 ). It has been reported that people newly diagnosed with T2DM show high rates of depression and anxiety (Ryu et al, 2021 ), which can affect blood glucose levels (Chai et al, 2018 ).…”

“…In addition, not all studies include a follow-up stage (Berry et al, 2017 ; González et al, 2020 ; Soriano et al, 2020 ), and those who do, report follow-up periods up to three months (Cornely et al, 2022 ; Lawn et al, 2009 ; Li et al, 2020 ), which can result insufficient to detect clear effects (Berhe et al, 2020 ). Few studies have included longer follow-up periods, from which only two have reported measures up to six months; still, authors report high rate of withdrawal or a limited number of participants in their studies (Selçuk-Tosun & Zincir, 2019 ; Steffen et al, 2021 ).…”