Assessing the Efficacy of a Culturally Informed Adherence Intervention for Rural African Americans with Type 2 Diabetes

Abstract

African Americans (AAs) experience higher rates of type 2 diabetes mellitus (T2DM), and difficulty adhering to T2DM treatment plans. The current study aims were to create a culturally informed intervention for AAs with T2DM and determine its efficacy for increasing treatment adherence, diabetes knowledge, self-efficacy, problem-focused coping, and mindfulness, and reducing emotional distress and HbA1c levels. A focus group with AAs with T2DM was conducted to understand barriers to treatment adherence. Information provided was incorporated into the development of a culturally informed T2DM adherence intervention for AAs. AAs with T2DM experiencing adherence difficulty (N = 20) recruited from a Family Medicine Clinic were randomly assigned to the intervention group (IG, n = 12) and an education comparison group (ECG, n = 8). Measures of adherence, knowledge, self-efficacy, and psychological factors were administered pre- (T1), immediately post- (T2), and 3-months post-intervention (T3). HbA1c levels were abstracted from participants' medical records at T1 and T3. The sample was 50% female, 70% with some college, 50% single, 75% unemployed, with an average age of 50.8 years and T2DM diagnosis length of 6.9 years. No significant group differences were observed on T2 or T3 measures. A significant time effect on healthy dietary behavior adherence reflected increases from T1-T2-T3 [Wilks' Lambda = 0.47, F(2, 10) = 5.52, p = .02]. Within groups, the IG exhibited a significant increase in physical activity adherence [t(11) = -2.34, p = .04] and mindfulness [t(11) = -2.53, p = .03] and approached a significant decrease in depressive symptoms [t(4) = 2.31, p = .07] from T1-T2; and a significant increase in healthy dietary behavior adherence [t(7) = 2.76, p = .03] and significant reduction in HbA1c [t(8) = 2.55, p = .03] from T1-T3. The ECG demonstrated a significant increase from T1-T3 on diabetes-specific self-efficacy [t(4) = 2.83, p = .05]. While no between-group differences were observed, findings indicate this intervention's components hold promise for changing adherence behaviors for rural AAs with T2DM. Future research with a larger sample is warranted to better elucidate treatment effects and adding a long-term follow-up component would allow assessment of longitudinal effects.