Type 2 Diabetes
Conditions
Keywords
community health worker, acceptance and commitment therapy, task shifting, access to care
Brief summary
The goal of this pilot clinical trial is to learn about the feasibility and acceptability of promotores (community health workers) delivering an educational intervention for Hispanic/Latino patients with type 2 diabetes. The main questions it aims to answer are: 1. What is the impact of the ABaCo program on participants' blood sugar management and quality of life? 2. How well are we able to enroll participants and keep them in the ABaCo program? 3. Is this telephone-based, educational ABaCo program acceptable? Participants will be asked to: * Participate in four research visits: provide fingerstick blood samples before and after the program (at 6 months), and complete questionnaires at four times times during the program (before, twice during, and at 6 months). * Participate in the ABaCo program: join seven (7) individual phone call visits with promotores to review educational information about caring for diabetes while keeping connected to life values. Each phone call lasts approximately 45 minutes once per week for six (6) weeks, then a refresher visit is a month later.
Detailed description
This overall project aims to develop an acceptable and feasible Promotores-delivered intervention program for Hispanic/Latino patients with type 2 diabetes. Specifically, this study aims to conduct a mixed-methods, single arm pre-post intervention pilot trial (6 months) on the Acceptance Based Coping (ABaCo) program to * Evaluate feasibility (recruitment and retention) and acceptability (satisfaction) * Establish methods of assessing intervention fidelity * Engage multi-level partners * Estimate the magnitude of potential impact of ABaCo on selected mechanisms and outcomes. Hypothesis: Participants receiving ABaCo will evidence clinically meaningful change from baseline to follow-up on glycemic management and quality of life (primary outcomes) and self-management skills and acceptance coping (secondary outcomes). Procedures: Potential participants will be referred to study staff by the Promotores team at the University Health Robert B Green Campus Family Health Center. They will be contacted by study staff for a phone visit to conduct screening procedures. If eligible, they will be scheduled for an in-person visit at the Texas Diabetes Institute (TDI), where they will be consented, complete a fingerstick HbA1c test, and complete an initial assessment packet. Participants will then receive the intervention (telephone-delivered ABaCo skills program) delivered by one Promotor/a for 6 weeks and again at week 10 (booster visit). There will be phone-based assessments visit at week 6, and again at week 10. They will be invited to participate in an interview to provide feedback on their experiences in the program and study. A final in-person assessment at TDI will be conducted at 24 weeks (6 months) after baseline, including a fingerstick HbA1c test and a final assessment packet. At the study conclusion, all engaged Promotores and clinical partners will also be invited to share their experiences via written and verbal feedback.
Interventions
BEHAVIORALAcceptance Based Coping (ABaCo)
The educational ABaCo protocol consists of core Acceptance & Commitment Therapy (ACT) interventions, culturally and contextually-tailored for this population, and in accordance with clinician-led versions of ACT for diabetes to include (a) identification of patient values, (b) teaching acceptance and brief mindfulness skills, and (c) techniques for engaging in valued activities while coping with difficult experiences (e.g., sugar cravings, distress). It is delivered by a community health worker (promotor/a) over 6 consecutive weeks over the phone, followed by a booster call at week 10.
Sponsors
The University of Texas Health Science Center at San Antonio
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Baylor College of Medicine
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Intervention model description
single arm, pre-post, mixed-methods pilot study
Eligibility
Sex/Gender
ALL
Age
18 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
* Age 18-70 * Diagnosis of Type 2 Diabetes (T2DM) * HbA1c of 7.5% or greater (may be taking oral agents or injectables for T2DM management) * Evidence of avoidance coping (prescreen of \<48.4 on English or a \<52 on the Spanish Acceptance and Action Diabetes Questionnaire) and/or poor self-management skills (prescreen below recommended frequencies in 2 or more sub-scales of the Summary of Diabetes Self-Care Activities) * Self-identifies as Hispanic/Latino * Receiving ongoing care at study site clinic * Preferred language is English or Spanish
Exclusion criteria
* A medical condition or life circumstance that would contraindicate participation * Inability to read/comprehend the informed consent process or study instructions
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Average blood glucose management (HbA1c) | 0, 24 weeks | Glycated hemoglobin (HbA1c) is the average blood glucose levels in past 3 months (HbA1c); higher percentages reflect higher levels of blood glucose (worse blood glucose management). |
| Quality of life: Patient Reported Outcomes Measurement Information System Global-10 | 0, 6, 10, 24 weeks | PROMIS-10 consists of 10 items that assess physical and mental health, functioning, emotional distress, interference, overall quality of life. There are two subscales - Global Physical Health and Global Mental Health. The raw score range for both subscales is 4 to 20, but raw scores are converted to T-scores with a range of 20-80. Higher scores indicate better health. Strong psychometrics. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Diabetes Acceptance: Diabetes Acceptance Scale (DAS) | 0, 6, 10, 24 weeks | DAS is a recently-developed 20-item measure with Likert scale items (1-3) that identifies patients struggling to accept diabetes. Items 11 - 20 are reversed scored. The lowest possible score is 0, and the highest possible score is 60. Higher scores indicate greater diabetes acceptance. It will be used with the AADQ in pilot testing to inform best measures for next trial. |
| Diabetes Acceptance: Acceptance & Action Diabetes Questionnaire (AADQ) | 0, 6, 10, 24 weeks | 11 Likert-type items (1-7): acceptance of distressing diabetes thoughts/feelings and their interference. The range of possible scores is 11-77; higher scores indicate greater non-acceptance of diabetes. Good internal consistency, construct and discriminant validity. |
| Self-management: Summary of Diabetes Self-Care Activities | 0, 6, 10, 24 weeks | 11-item scale assesses five different self-care regimen areas: Diet, exercise, blood-glucose testing, foot care, and smoking. The items are measured by days of the week on a scale of 0-7. The total score range is 0 -77. Higher scores indicate better self-care. For the general diet score, the mean is taken for items 1 and 2. For specific diet, the mean for items 3 and 4 is taken, with item 4 being scored reversed. For exercise scoring the mean is taken for items 5 and 6. Blood glucose is scored by taking the mean for items 7 and 8. While foot care is measured by taking the mean of items 9 and 10. Smoking is measured by item 11 and the number of cigarettes smoked per day. Established, standardized. |
| Diabetes Distress: Diabetes Distress Scale | 0, 6, 10, 24 weeks | 17 Likert-type scale items (1-6) measure diabetes-related distress with subscales of Emotional Burden, Physician Distress, Regimen Distress, and Interpersonal Distress. Total scores range from 17 -102, but an average score is calculated to determine level of distress, with higher scores indicating greater distress. An average score of \< 2 reflects little to no distress, an average score between 2. and 2.9 reflects moderate distress, and an average score of \> 3 reflects high distress. Strong psychometrics. |
| Emotional Distress: Patient Health Questionnaire-4 | 0, 6, 10, 24 weeks | 4-item Likert scale measure (0-3). It is an ultra-brief screener that assesses anxiety and depression. Scores are rated as normal (0-2), mild (3-5), moderate (6-8), and severe (9-12). A total score greater than or equal to 3 on the first two questions suggests anxiety, while a total score greater than or equal to 3 on the last two questions suggests depression. Good psychometric properties. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Acceptability: Ratings | 10 weeks | Satisfaction (acceptability) will be assessed during semistructured interviews with 3 Likert-type scale items: ease of learning; overall satisfaction; likely to recommend (goal: at least 80% report acceptability at an average of 4 or more on 7-pt scale). |
| Acceptability: Interviews | 10 weeks | Interviews will be conducted with participants to understand experiences and opinions on acceptability, satisfaction, feasibility, barriers and facilitators to participation, and seek suggestions for further cultural/contextual tailoring. |
| Feasibility: Recruitment | 24 weeks | Recruitment (goal: n = 20) |
| Feasibility: Retention | 24 weeks | Participant retention (goal: no more than 25% drop-out) |
Countries
United States
Outcome results
None listed