A Mixed-methods Approach to Understanding the Perspectives, Experiences and Attitudes of Cognitive Behavioral Therapy for African American Patients with Type-2 Diabetes: A Randomized Parallel Design Pilot Study

Abstract

BackgroundAfrican 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) is a technique that combines traditional care with cognitive and psychosocial techniques. We aimed to assess the effects of CBT integrated with motivational interviewing (MI) on glycemic control in AA participants and understand their perspectives, attitudes, and experiences toward CBT. MethodsUsing 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. CBT was administered in six sessions over three 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 focus groups were conducted to determine patient perspectives regarding the intervention. ResultsFourteen participants completed the study, their mean HbA1c improved from 8.5% to 7.7%. 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; (3) receptivity to CBT/MI Intervention positively impacts self-efficacy through improved health literacy. ConclusionGroup-based CBT 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 like CBT, may be useful in promoting healthy diabetes self-management.Trial registrationThis trial is registered at ClinicalTrials.gov with the identifier NCT03562767. 70 Registered 19 June 2018, https://clinicaltrials.gov/ct2/show/NCT03562767?term=NCT03562767&draw=2&rank=1