Community-Based Intervention to Improve Diabetes Outcomes in Older African American Women with Multi-Caregiving Burden

点击翻译按钮获取中文摘要

PROJECT SUMMARY/ABSTRACT African Americans (AA) with type 2 diabetes (T2DM) have a higher prevalence of diabetes, poorer metabolic control, and greater risk for complications and death compared to Whites. AA Women (AAW) have a higher rate of diabetes, higher prevalence of visual impairment, higher rate of end-stage renal disease, and higher age-adjusted mortality rate compared to White women. While the reasons for higher diabetes-related morbidity and mortality in AAW have not been clearly elucidated, multi-caregiving responsibilities, or the provision of care (emotional, physical/tangible, financial, spiritual) to parents/grandparents, children/grandchildren, significant others, and their larger community, is a significant barrier to effective diabetes care and contributes to the higher disease burden and increased mortality in AAW with T2DM. This is particularly true for AAW in the Sandwich Generation (adults in their 40s and 50s who are wedged between elderly parents and adult children/grandchildren), and the Club Sandwich Generation (adults in their 50s and 60s, who are wedged between aging parents/grandparents, adult children, and grandchildren), where multi- caregiving responsibilities have resulted in increased stress, poorer glycemic control, and suboptimal self-care behaviors. In addition, there is limited evidence on effective interventions that address multi-caregiving burden in inner city AAW with T2DM. Preliminary data from our group suggests that a community-based, nurse- facilitated, group-based, peer-support intervention that incorporates storytelling, problem solving and goal setting, coping strategies, and diabetes education and skills training may be effective in this population. Therefore, we propose a pilot randomized study to test the feasibility and preliminary efficacy of a novel, community-informed, multicomponent intervention on mitigating stressors associated with multi- caregiving responsibilities to improve diabetes outcomes compared to diabetes enhanced usual care. The long-term goal of the project is to identify effective strategies for improving metabolic control and reducing diabetes complications and mortality rates in AAW with T2DM.