Andersen Jennifer A, Felix Holly, Selig James, Rowland Brett, Bing Wana, Hudson Jonell, Niedenthal Jack, Otuafi Henry, Riklon Sheldon, Azures Edlen, George Ainrik, McElfish Pearl A
College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA.
Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA.
Contemp Clin Trials Commun. 2021 Jul 30;23:100824. doi: 10.1016/j.conctc.2021.100824. eCollection 2021 Sep.
The Republic of the Marshall Islands (RMI) faces numerous health disparities, including one of the highest prevalence of type 2 diabetes mellitus (T2DM) in the world. Diabetes self-management education and support (DSMES) has shown efficacy in improving glycemic control and through increases in knowledge and self-management activities; however, there is limited research on DSMES in the RMI. This study evaluated the feasibility and efficacy of a culturally adapted family model of DSMES (F-DSMES) in the RMI. The F-DSME included 8 h of group educational classes delivered in churches by a community health worker.
This pilot study assessed retention and dosage rates (e.g., class attendance) among the participants with T2DM (n = 41). Efficacy was evaluated by examining pre- and post-intervention differences in HbA1c, knowledge, family support, and self-management activities among those who completed the post-intervention data collection (n = 23).
The results indicate completion of post-intervention data collection and attendance were associated; 70% of participants who completed the post-intervention data collection received at least 6 h of intervention compared to 3 h for those who did not. Although the reduction in HbA1c was not statistically significant, participants demonstrated statically significant increases in knowledge, family support, and an increase in self-management including in checking of blood glucose and feet.
This study provides important information to help address T2DM disparities in the RMI, including the feasibility and efficacy of F-DSMES. Additional research will help in understanding how to translate improvements in knowledge, family support, and self-management activities into improvements in HbA1c. This may include addressing social ecological factors that affect glycemic control.
马绍尔群岛共和国（RMI）面临众多健康差异，包括全球2型糖尿病（T2DM）患病率最高的地区之一。糖尿病自我管理教育与支持（DSMES）已显示出在改善血糖控制以及通过增加知识和自我管理活动方面的功效；然而，关于RMI地区DSMES的研究有限。本研究评估了一种文化适应型家庭模式的DSMES（F-DSMES）在RMI的可行性和有效性。F-DSME包括由社区卫生工作者在教堂开展的8小时小组教育课程。
这项试点研究评估了T2DM患者（n = 41）的留存率和参与率（如上课出勤率）。通过检查完成干预后数据收集的患者（n = 23）干预前后糖化血红蛋白（HbA1c）、知识、家庭支持和自我管理活动的差异来评估有效性。
结果表明干预后数据收集的完成情况与出勤率相关；完成干预后数据收集的参与者中有70%接受了至少6小时的干预，而未完成的参与者为3小时。虽然HbA1c的降低没有统计学意义，但参与者在知识、家庭支持方面有统计学上的显著增加，并且在自我管理方面有所增加，包括血糖检测和足部检查。
本研究提供了重要信息，以帮助解决RMI地区的T2DM差异问题，包括F-DSMES的可行性和有效性。更多研究将有助于理解如何将知识、家庭支持和自我管理活动的改善转化为HbA1c的改善。这可能包括解决影响血糖控制的社会生态因素。
