EDUCATION AND GROUP SUPPORT FOR DIABETIC HISPANICS

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Patient education and group support are cost effective approaches to improving health outcomes of persons with diabetes; however, culturally- relevant approaches for Hispanics who experience non-insulin dependent diabetes 3 to 5 times more frequently than non-Hispanic whites have not been investigated. The primary purpose of the proposed project is to conduct a prospective, randomized clinical study to determine the efficacy of a culturally-relevant, community-based intervention that meets national standards and that is aimed at improving the health of diabetic Mexican- Americans and their families. The intervention is provided in Spanish and is directed by a Hispanic master's-prepared clinical nurse specialist, assisted by a nurse practitioner, dietitians, and community lay workers. Key elements of the intervention include: (1) instruction on nutrition, self-monitoring of blood glucose, exercise, and other pertinent topics relevant to diabetes self-management; and (2) group support to promote behavioral changes. Diabetic adults residing in a rural Texas-Mexico border community will serve as the available target sample. Over a four-year period, a total of 256 diabetic subjects will be randomly selected from patient rosters of previous diabetes studies conducted by the co-PI; and family members or friends, one designated by each subject, will participate as support persons. Subjects will be randomly assigned to enter the intervention or to a wait-list control group that will receive the intervention after one year. The diabetic subjects and support persons will meet in small groups in the county agricultural extension offices for the intervention consisting of twelve weekly two-hour educational sessions and nine monthly two-hour support group sessions. The primary outcome variables will be indices of metabolic control, particularly glycosylated hemoglobin, as well as fasting blood sugar levels and other physiological indicators of diabetes metabolic status. Other variables measured as indicators of intervention effectiveness in the diabetic subjects will include: diabetes knowledge, diabetes-related health beliefs, health behaviors, and body weight. Some of these variables also will be measured on the support group persons in order to determine the benefits of the intervention on persons who may not yet have diabetes but who are at high risk for developing it. Path analysis and growth curve analysis will be used to determine the cumulative degree of change in metabolic control over time and to explain the mechanisms by which change occurs.