Integrating Education, Group Support, and Case Management for Diabetic Hispanics

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DESCRIPTION (provided by applicant): Starr County is a rural Texas-Mexico border community that is 98% Mexican American and has the highest diabetes-related death rate in Texas. Since 1988 we have demonstrated reductions in HbA1c through culturally competent diabetes self-management education, but effects diminished overtime. Results indicated that socio-cultural and personal barriers remained, preventing individuals from achieving optimal health outcomes. The proposed planning study will explore a strategy relatively untested in rural communities that will provide coordination of all aspects of an individual's diabetes care, including participation in our self-management intervention. We propose to conduct a pilot test of our previously tested 'compressed" self-management intervention enhanced by a nurse case manager in order to: 1) Define and refine the role of the nurse case manager (NCM) for a rural border community by conducting focus groups with a variety of groups in Starr County: a) participants in our previous intervention studies; b) physicians practicing on either side of the border who provide diabetes care for Texas border residents; c) local community health officials; d) other health care providers who provide diabetes care (nurses, dietitians, community health workers employed by local hospitals and clinics); e) key authority figures in the community (such as local Catholic priests, County officials); and f) experienced NCMs. 2) Determine the feasibility of employing a diabetes NCM in order to enhance the positive effects of our self- management interventions by comparing 2 groups: a) a combined strategy involving the nurse CM PLUS the "compressed" version of our diabetes self-management intervention previously tested; and b) "compressed" diabetes self-management intervention ALONE. We will conduct a pilot study in Starr County using a pretest/posttest control group design. 96 participants of current genetic studies will be recruited and assigned to 1 of the interventions. We will collect data at baseline and at 3 and 6 months on outcomes we have measured previously-HbA1c, FBG, lipids, blood pressure, knowledge, health behaviors (physical activity, dietary intake, glucose monitoring, and medication usage), and BMI. We plan to add 2 new variables: 1) health care utilization and 2) cost. Minimal data analysis will be performed during the proposed pilot project, since the intent is to determine intervention feasibility. Basic descriptive analyses (means, frequencies) and non-parametric comparisons will be performed; HLM will be used for exploratory purposes. The proposed study is a critical step in determining effective ways of sustaining the effects of diabetes self-management in Mexican American populations.