Healthy Eating and Active Lifestyles for Diabetes (HEAL-D), a culturally tailored self-management education and support program for type 2 diabetes in black-British adults: a randomized controlled feasibility trial

Abstract

IntroductionBlack-British communities are disproportionately affected by type 2 diabetes (T2D). Structured education programs are a core component of T2D healthcare but they are less successful in people from minority ethnic groups. Culturally tailored T2D education has demonstrated greater benefits than usual care. The aim of our study was to evaluate acceptability, fidelity and trial feasibility of the Healthy Eating and Active Lifestyles for Diabetes (‘HEAL-D’) culturally tailored T2D self-management education and support (DSMES) program.Research design and methodsA mixed-methods randomized controlled feasibility trial in black-British adults with T2D was conducted. Participants were assigned to control (usual care) or intervention (HEAL-D; 7 sessions, 14 hours of group-based culturally tailored diet and lifestyle education, behavior change support and supervised physical activity), in a ratio of 1:1. Primary outcomes were recruitment and retention rates, intervention attendance and completion. Fidelity was assessed through observations and qualitative evaluation was undertaken with participants and educators.Results102 patients responded to invitation letters (n=1335); 63 were randomized but 8 were subsequently deemed ineligible due to high baseline glycosylated hemoglogin (HbA1c) requiring intensive medical management or missing baseline HbA1c measurement. Of the remaining 55 participants (27 intervention, 28 control), 69% were female, 47% were of African and 51% were of Caribbean ethnicity. 93% completed the trial, providing end point data. Intervention attendance was high; 85% completed the program (attendance at ≥5 sessions), and 74% attended ≥6 sessions. The intervention was delivered with acceptable fidelity, although the qualitative evaluations identified some areas of structure and format in need of refinement.ConclusionsWe have shown it is feasible to recruit and randomize black-British adults with T2D to a trial of a culturally tailored DSMES program. We have shown the intervention is highly acceptable for both patients and healthcare providers. A future trial should assess clinical and cost-effectiveness of HEAL-D.Trial registration numberNCT03531177.

Co‐designing nutrition interventions with consumers: A scoping review

“…All studies described used either qualitative or mixedmethods design for the co-design process. Studies were 40 for the scoping review process from a range of countries: the United States, [41][42][43][44][45][46][47][48][49][50] Australia, 24,[51][52][53][54][55] the United Kingdom and Ireland, 20,[56][57][58][59][60][61] New Zealand, 21,22,62 Canada 63,64 and Iran 23 (Table 2). Although we did not set limits on the publication date for co-designed interventions, 16 of the included studies were published in the past 5 years.…”

“…Target participants of the intervention were adults with or at risk of chronic disease 23,43,44,55,59,63,64 ; stroke survivors 24,43 ; low-income households 41,42 ; carers or persons with additional needs 56 or intellectual disability 60 ; women after breast cancer treatment 47,48,54 ; adult hospital inpatients 52,53 ; and adults of African-American, 46,49,50 African-Caribbean, 20,57,58,61 Māori and Pasifika 21,22,62 or Appalachian descent. 45…”

“…The focus of nutrition intervention was highly varied. Studies focused on improving lifestyle-related risk factors for chronic disease (e.g., type 2 diabetes or stroke), [20][21][22][23][24]43,44,46,[49][50][51][52]55,[57][58][59][61][62][63][64] promoting health and preventing disease after cancer, 47,48,54 improving diet quality or fruit/vegetable intake, 42,45,56 increasing awareness of lifestyle choices and how the body works among adults with intellectual disabilities, 60 or mitigating frailty in recently hospitalised older patients with nutrition support 52 (Table 2).…”

“…Nutrition interventions were predominately face-to-face delivery 20,23,41,43,44,46,49,50,52,53,[56][57][58]60,61 or delivered via a web page or mobile app. 21,22,42,47,48,59,[62][63][64] One intervention involved text messages only 54 (Table 2).…”

Direct, Indirect and Mixed Methods of Health Education By Nurse and Its Impact on Type 2 Diabetes Patients: A Literature review

“…Several factors that influence compliance were identified. They are lack of knowledge, personal and cultural beliefs, communication and access to health and education services (Goff et al ., 2021). It was further explained that the level of obedience to diabetical treatment was low at around 30-89.7% (Trevisan et al ., 2020).…”