Mauldon Maria, Melkus Gail D'Eramo, Cagganello Mayra
The Fair Haven Community Health Center, New Haven, Connecticut (Ms Mauldon, Ms Cagganello)
Yale University School of Nursing, New Haven, Connecticut (Dr Melkus)
Diabetes Educ. 2006 Sep-Oct;32(5):751-60. doi: 10.1177/0145721706291999.
The purpose of this study was to pilot test the feasibility, acceptability, and efficacy of a culturally appropriate and culturally relevant Spanish-language cognitive-behavioral diabetes self-care educational intervention for Hispanic Americans with type 2 diabetes mellitus.
The study site was an urban community health center in the Northeast, at which 16 Latino patients with type 2 diabetes mellitus were recruited. This was a 1-group pretest-posttest pilot study, during which qualitative and quantitative data were collected on demographic, physiologic (HbA1c, body mass index, lipids), psychosocial (diabetes-related distress and health beliefs), knowledge, and language-based acculturation variables at baseline, 3 months, and 6 months. Data were collected using questionnaires, laboratory data, and chart review. The intervention was culturally appropriate in terms of language, social emphasis, nutritional guidance, and acknowledgment of cultural health beliefs. Descriptive and inferential statistical analysis was used to evaluate response variables of glycemic control, lipid levels, and psychosocial and knowledge outcomes. The intervention acceptability process was evaluated by attendance and attrition.
This pilot study demonstrated excellent acceptance for and feasibility of this intervention. Most study participants (9 women, 7 men) were middle-aged married individuals who had had diabetes mellitus for an average of 8 years; English was a second language for all of them. Most were overweight and had suboptimal glycemic control and lipid profiles and moderate levels of knowledge at the outset of the study. Most had received a one-on-one diabetes educational session prior to the intervention. Over the 6 months of the study, most of both men and women showed an increase in knowledge scores, improvement in lipid profiles, and reduction in HbA1c levels. Men demonstrated a temporary increase in emotional distress much greater than that reported by women during the first 3 months of the study.
The findings suggest that a culturally relevant type 2 diabetes mellitus educational program, particularly one that addresses different learning needs and styles of men and women, can have a positive impact on Hispanic Americans with diabetes. Implications for practice include awareness of gender-based differences in response to self-management education, the importance of providing realistic samples of meals prepared in a manner consistent with American Diabetes Association principles, and the rationale for offering a brief and focused refresher course 6 to 9 months following this type of intervention.
本研究旨在对一项针对患有2型糖尿病的西班牙裔美国人的、文化上适宜且相关的西班牙语认知行为糖尿病自我护理教育干预措施进行试点测试，评估其可行性、可接受性和有效性。
研究地点为东北部的一个城市社区健康中心，招募了16名患有2型糖尿病的拉丁裔患者。这是一项单组前测-后测试点研究，在此期间，在基线、3个月和6个月时收集了关于人口统计学、生理指标（糖化血红蛋白、体重指数、血脂）、心理社会因素（糖尿病相关困扰和健康信念）、知识以及基于语言的文化适应变量的定性和定量数据。数据通过问卷调查、实验室数据和病历审查收集。该干预措施在语言、社会重点、营养指导以及对文化健康信念的认可方面都符合文化要求。使用描述性和推断性统计分析来评估血糖控制、血脂水平以及心理社会和知识成果等反应变量。通过出勤情况和人员流失情况来评估干预措施的可接受性过程。
这项试点研究表明该干预措施具有极高的可接受性和可行性。大多数研究参与者（9名女性，7名男性）为中年已婚人士，平均患糖尿病8年；英语是他们所有人的第二语言。大多数人超重，血糖控制和血脂状况欠佳，在研究开始时知识水平中等。大多数人在干预前都接受过一对一的糖尿病教育课程。在研究的6个月期间，大多数男性和女性的知识得分都有所提高，血脂状况有所改善，糖化血红蛋白水平有所降低。在研究的前3个月，男性的情绪困扰出现了暂时的大幅增加，比女性报告的情况更为严重。
研究结果表明，一项与文化相关的2型糖尿病教育项目，尤其是一个能够满足男性和女性不同学习需求和方式的项目，可能会对患有糖尿病的西班牙裔美国人产生积极影响。对实践的启示包括意识到自我管理教育反应中基于性别的差异、提供符合美国糖尿病协会原则的实际餐食样本的重要性，以及在这类干预措施实施6至9个月后提供简短且重点突出的复习课程的理由。
