Delivering the Same Intervention to Hispanic/Latinos With Pre-diabetes and Diabetes. Early Evidence of Success in a Longitudinal Mixed Method Study

Abstract

Background Despite nationwide efforts to address the diabetes epidemic and reduce prevalence disparities, higher rates persist among the poor, especially those with limited literacy. Currently, individuals with abnormal glycemia who have pre-diabetes and diabetes qualify for different programs. However, evidence suggests that, for low-income Hispanic/Latinos, offering a single intervention to all those with abnormal glycemia may provide a more culturally acceptable and effective approach. Our objective was to explore the feasibility of such an intervention led by community health workers (CHWs) among low-income Hispanic/Latinos with diabetes and at risk for diabetes. Methods Using a quasi-experimental mixed method design, we assessed weight, glycosylated hemoglobin, diabetes knowledge, and behavior changes of Hispanic/Latinos participants with pre-diabetes and diabetes living in Southern California. Biometric measurements, blood tests, and surveys were collected at baseline and 3 months post-intervention. Interviews and focus group discussions provided qualitative data. Results Although the program was less costly, results exceeded those reported for low-income H/L attending the National Diabetes Prevention Program and did not differ between pre-diabetes and diabetes groups. Instead, including individuals at different stages of the dysglycemic spectrum seemed to have enhanced the intervention. Physician referral and attendance of family/friends were associated with better outcomes. Conclusion Our findings indicate that a joint prevention/self-management intervention led by CHWs for low-income Hispanic/Latinos with diabetes and with pre-diabetes is feasible and cost-effective, providing results that could help reduce the success gap. Incorporating suggestions and replicating this study on a larger scale could help determine whether or not results are reproducible.

Changes in Glycemic Control Following Use of a Spanish-Language, Culturally Adapted Diabetes Program: Retrospective Study

“…In an ideal provider and patient setting, routine meetings with an educator, even at a distance and provided through an mHealth app, maintain active engagement and offer patients a high level of accountability for cocreated health goals [ 30 ]. The role of the provider has additionally been noted as a strong motivator in Hispanic/Latino culture, and a strong rapport with their providers may prompt participants to adopt new lifestyle habits and become better motivated to self-regulate their diabetes self-management behaviors [ 27 , 31 , 32 ].…”

Views, perceptions, and experiences of type 2 diabetes or weight management programs among minoritized ethnic groups living in high‐income countries: A systematic review of qualitative evidence

“…Of the 17 studies, 10 used focus groups, four used semi-structured interviews, two used questionnaires along with interviews, and one used a focus group and 1:1 interviews. Most papers focused on T2D [15][16][17][18][19][20][21][22][23][24][25] and the rest on WM [26][27][28][29][30][31] . From the papers that reported number of individuals interviewed (n = 15), there were a total of 418 individuals from minoritized ethnic backgrounds, with a sample size range of 4-82 individuals.…”

“…From the papers that reported number of individuals interviewed (n = 15), there were a total of 418 individuals from minoritized ethnic backgrounds, with a sample size range of 4-82 individuals. The studies were conducted between 1996 and 2021 in five countries: United States [15][16][17][18][19][20][21][22][23]25,28,29 , United Kingdom 24,27 , Norway 26 , Sweden 30 , and Australia 31 . Most participants were female and from Black African/Caribbean 18,19,24 and Hispanic/Latino [15][16][17][20][21][22][23] ethnic groups.…”

“…The studies were conducted between 1996 and 2021 in five countries: United States [15][16][17][18][19][20][21][22][23]25,28,29 , United Kingdom 24,27 , Norway 26 , Sweden 30 , and Australia 31 . Most participants were female and from Black African/Caribbean 18,19,24 and Hispanic/Latino [15][16][17][20][21][22][23] ethnic groups. Within the studies, the majority (n = 14) used cultural tailoring in the design and delivery of the program [15][16][17]19,20,[22][23][24][25][26][27][28][29][30] , and all studies were based in a community setting.…”

“…Most participants were female and from Black African/Caribbean 18,19,24 and Hispanic/Latino [15][16][17][20][21][22][23] ethnic groups. Within the studies, the majority (n = 14) used cultural tailoring in the design and delivery of the program [15][16][17]19,20,[22][23][24][25][26][27][28][29][30] , and all studies were based in a community setting. Religion was not reported in any study.…”