A comparative effectiveness study of two culturally competent models of diabetes self-management programming for Latinos from low-income householdsReportar como inadecuado




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BMC Endocrine Disorders

, 17:46

Diabetes and Metabolism

Abstract

BackgroundDiabetes risk is extremely high for Latinos from low-income households. Health guidelines recommend that individuals learn strategies to self-manage their diabetes, but getting people to adopt required lifestyle changes is challenging and many people are not able to prevent their pre-diabetes from escalating or effectively control their diabetes. Systematic reviews show that culturally competent self-management programs can significantly improve diabetes outcomes and different models for culturally competent programming have been developed.

MethodsThis patient-engaged study will compare the effectiveness of two distinct evidence-based models for culturally competent diabetes health promotion at two sites that serve a large Latino patient population from low-income households: 1 The Diabetes Self-Management Support Empowerment Model, an educational session approach, and 2 The Chronic Care Model, a holistic community-based program. Data collection will involve interviews, focus groups, surveys and assessments of each program; and testing of patient participants for A1c, depression, Body Mass Index BMI, and chronic stress with hair cortisol levels. We will recruit a total of 240 patient-social support pairs: Patients will be adults men and women over the age of 18 who: 1. Enter one of the two diabetes programs during the study; 2. Self-identify as -Latino;- 3. Are able to identify a social support person or key member of their social network who also agrees to participate with them; 4. Are not pregnant participants who become pregnant during the study will be excluded; and 5. Have household income 250% of the Federal Poverty Level FPL or below. Social supports will be adults who are identified by the patient participants. PRIMARY OUTCOME: Improved capacity for diabetes self-management measured through improvements in diabetes knowledge and diabetes-related patient activation. SECONDARY OUTCOME : Successful diabetes self-management as measured by improvements in A1c, depression scale scores, BMI, and circulating levels of cortisol to determine chronic stress.

DiscussionOur hypothesis is that the program model that interfaces most synergistically with patients’ culture and everyday life circumstances will have the best diabetes health outcomes.

Trial registrationThis study was registered with ClinicalTrials.gov on December 16, 2016 Registration #NCT03004664.

KeywordsDiabetes Self-care Cultural competency Hispanic Americans Low-income AbbreviationsA1cHbA1c blood test for glycated hemoglobin or glycosylated hemoglobin to measure blood sugar level

BMIBody mass index

CAHPS-CCThe Consumer Assessment of Healthcare Providers and Systems Cultural Competence Set

CCMThe chronic care model

DKQThe diabetes knowledge questionnaire

DSMSThe Diabetes Self-Management Support Empowerment Model DSMS

FPLFederal poverty level

PAM-13The patient activation measure PAM-13

PCPPrimary care provider

pg-mgPicogram of cortisol per milligram of hair

PHQ-9The patient health questionnaire 9

REDCapResearch Electronic Data Capture - a browser-based clinical and translational research database software program

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Autor: Janet Page-Reeves - Lidia Regino - Cristina Murray-Krezan - Molly Bleecker - Erik Erhardt - Mark Burge - Elaine Bearer - Sh

Fuente: https://link.springer.com/







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