Uncontrolled Diabetes
Conditions
Keywords
Type 2 diabetes, African American, numeracy, self-management, glucose control
Brief summary
Disparities in diagnosis and control of type 2 diabetes mellitus are most evident in African Americans (AAs) with lower socioeconomic status. Health literacy is an important predictor of adequate self-management and control of diabetes. The purpose of this pilot study was to test the feasibility and preliminary efficacy of a health literacy-enhanced diabetes intervention -Prevention through Lifestyle intervention And Numeracy (PLAN) 4 Success-Diabetes, in inner-city, low-income AAs with uncontrolled diabetes. To evaluate the feasibility, acceptability, and preliminary efficacy of the intervention, the investigators conducted a pilot study with 24-week follow-up. The investigators that participation in the PLAN 4 Success-diabetes intervention would be associated with a reduction in glucose outcomes and improvements in psychosocial variables.
Interventions
BEHAVIORALPLAN 4 Success-Diabetes
The study intervention-PLAN 4 Success-Diabetes-consisted of four 1 to 1 ½-hour weekly health literacy training and disease knowledge education sessions for four weeks (4 in-person sessions), followed by two home visits and monthly phone counseling for over 6 months (5 phone sessions). The intervention is theory-driven and builds on von Wagner's model to incorporate key elements such as health literacy, disease knowledge, and self-efficacy for better glucose outcomes.
Sponsors
Brancati Center for the Advancement of Community Care
Center for Community Innovation and Scholarship at the Johns Hopkins University
East Baltimore Medical Center
Shepherds Clinic
John Hopkins Aftercare Clinic
Johns Hopkins University
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Intervention model description
The investigators used a single-arm pre- and post-test design for this pilot study in which the investigators assessed the feasibility, acceptability, and preliminary efficacy of the PLAN 4 Success-Diabetes in inner-city AAs in Baltimore, Maryland. Community-dwelling AAs were recruited via referrals from inner-city federally-qualified health clinics. Nineteen of 30 participants who completed the baseline survey received the study intervention which consisted of four-week health literacy training and disease knowledge education followed by two home visits and monthly phone counseling for over 6 months.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* African Americans residing in Baltimore, Maryland * had uncontrolled diabetes (defined as HbA1C\>7%)
Exclusion criteria
* Unable to give informed consent * Physical or mental health conditions that could limit active participation in the study (e.g., blindness in both eyes, severe immobility, psychiatric diseases) * Hematological condition that would affect HbA1C assay, e.g., hemolytic anemia, sickle cell anemia
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Health literacy as assessed by Literacy Assessment in Diabetes (LAD). | baseline; 12 and 24 weeks | The Literacy Assessment in Diabetes (LAD) has high reliability and validity indices. The items on the LAD are scored as correct/incorrect, with total possible scores ranging from 0 to 60. Higher scores indicated higher health literacy levels. |
| Change in Health literacy as assessed by the Newest Vital Sign | baseline; 12 and 24 weeks | The Newest Vital Sign consists of four items and measures numeracy. After reviewing a nutrition label, participants are asked to answer questions based on some calculation of the nutritional information (e.g., fat, sodium) presented on the label. Total possible scores range from 0 to 4, with one point assigned for each correct response. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Diabetes knowledge measured with the validated Diabetes Knowledge Test | baseline; 12 and 24 weeks | The Diabetes Knowledge Test assesses diabetes knowledge, medications, diet, and management with questions such as What effect will an infection most likely have on blood glucose. Correct responses are given a score of one. |
| Change in Diabetes self-efficacy measured with Stanford Diabetes Self-Efficacy scale | baseline; 12 and 24 weeks | The Stanford Diabetes Self-Efficacy scale assesses participant's efficacy in managing diabetes and maintaining healthy lifestyles. The scale asks how confident participants are in managing different tasks such as eating meals every 4 to 5 hours every day or breakfast every day measured on a Likert scale of 0 not at all confident to 10 totally confident. Participant scores are the means across all items in the instrument. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Change in Diabetes self-care index | baseline; 12 and 24 weeks | This index included seven questions on smoking, alcohol consumption, meal planning, consumption of high fat foods, consumption of high sugar foods, consumption of sodium, and medium or high intensity exercise. These questions were coded into dichotomous responses with participation in healthy behaviors coded as 1 and active participation in negative health behaviors coded as 0. A summary score for the index could range 0-7 and higher scores indicate better self-care. |
| Change in Social support as assessed by modified Medical Outcomes Study-Social Support Survey (mMOS-SS) | baseline; 12 and 24 weeks | mMOS-SS is a shorter version (10 items) of the Medical Outcomes Study-Social Support Survey (MOS-SS) which includes 19 items. The original version was used to measure social support in community dwelling chronically ill persons. mMOS-SS covers emotional and instrumental domains of social support with strong evidence of reliability and validity. Example items include: How often is someone available to take you to the doctor if you need it or How often is someone available who understands your problems? Response options are from all of the time (5 point) to none of the time (1 point) with higher scores indicating higher levels of social support (total score range=10 to 50). |
| Change in Depression status as assessed by the Patient Health Questionnaire (PHQ)-9 | baseline; 12 and 24 weeks | The Patient Health Questionnaire (PHQ)-9 addresses the severity of depressive symptoms based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). The PHQ-9 has 9 items scored from 0 (not at all) to 3 (nearly every day) with total scores ranging from 0 to 27. Individuals are asked whether any symptom(s) have been experienced over the past 2 weeks. Evidence of reliability, validity, sensitivity, and specificity has been reported in community samples. |
| Change in Quality of Life as assessed by the EuroQol Quality of Life scale | baseline; 12 and 24 weeks | It contains the EQ-5D-3L that provides a single index of health status. The EQ-5D-3L assess five domains; mobility, self-care, usual activities, pain/discomfort and anxiety/depressions. Responses show if participants do not have difficulty, have some problems or have severe difficulty within the domains. Summary scores for the sample were created across each of the five items (range 0-2) with higher scores indicating better quality of life. A component of this scale is the EuroQol visual analogue scale (EQ-VAS) which participants can use a number from 0-100 to identify participant's health state. |
Countries
United States
Outcome results
None listed