Cornely Ronald M, Subramanya Vinita, Owen Ashley, McGee Robin E, Kulshreshtha Ambar
Behavioral, Social, & Health Education Sciences Department, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Pilot Feasibility Stud. 2022 May 21;8(1):107. doi: 10.1186/s40814-022-01066-4.
African American (AA) adults are 60% more likely to be diagnosed with diabetes mellitus (DM) and experience more complications than non-Hispanic White adults. Cognitive behavioral therapy (CBT) has shown to be an effective modality for helping patients improve health behaviors and regulate emotional states. Motivational interviewing (MI) addresses participant engagement and motivation. Therefore, MI was combined with CBT as an approach to the process of learning using CBT skills to promote healthy lifestyle choices. We aimed to assess the effects of a culturally tailored CBT/MI intervention on glycemic control in AA participants and understand their perspectives, attitudes, and experiences while participating in this intervention.
Using a randomized, parallel design pilot study (web-based group vs in-person group), 20 participants aged ≥ 18 years, identifying as AA and having a glycosylated hemoglobin (HbA1c) > 8%, were recruited. A CBT/MI intervention was administered in six sessions over 3 months. Participants completed baseline and follow-up assessments on measures for diabetes control (HbA1c), self-efficacy, generalized anxiety, depression, perceived stress, health-related quality of life, and cognitive ability. Post-CBT/MI intervention focus groups were conducted to determine patient perspectives regarding the intervention.
Fourteen participants completed the study, their mean HbA1c improved from 10.0 to 8.9% (t(26) = 0.5, p-value = 0.06). The Diabetes Distress Scale demonstrated decreased distress overall (t(26) = 2.6; p-value = 0.02). The Generalized Anxiety Disorder Scale demonstrated decreased generalized anxiety for all participants (t(26) = 2.2; p = 0.04). Themes identified in focus groups included (1) intervention group social support through information sharing, (2) mental health and personal identities in diabetes understanding and management, and (3) receptivity to CBT/MI intervention positively impacts self-efficacy through improved health literacy.
This group-based, culturally tailored CBT/MI intervention for type 2 DM care was positively received by AA participants and helped improve diabetes control, as demonstrated by the change in HbA1c. There were additional benefits of social support through group interactions and a stronger sense of self-efficacy due to health education. A comprehensive treatment plan using a CBT/MI intervention may be useful in promoting healthy diabetes self-management.
ClinicalTrials.gov , NCT03562767 . Registered on 19 June 2018.
非裔美国成年人被诊断患有糖尿病（DM）的可能性比非西班牙裔白人成年人高60%，且并发症更多。认知行为疗法（CBT）已被证明是帮助患者改善健康行为和调节情绪状态的有效方式。动机性访谈（MI）解决参与者的参与度和动机问题。因此，将MI与CBT相结合，作为一种使用CBT技能促进健康生活方式选择的学习过程方法。我们旨在评估一种文化定制的CBT/MI干预对非裔美国参与者血糖控制的影响，并了解他们在参与该干预时的观点、态度和经历。
采用随机平行设计的试点研究（基于网络的组与面对面组），招募了20名年龄≥18岁、自我认定为非裔美国人且糖化血红蛋白（HbA1c）>8%的参与者。在3个月内分六个阶段进行CBT/MI干预。参与者完成了关于糖尿病控制（HbA1c）、自我效能感、广泛性焦虑、抑郁、感知压力、健康相关生活质量和认知能力的基线和随访评估。在CBT/MI干预后进行焦点小组讨论，以确定患者对该干预的看法。
14名参与者完成了研究，他们的平均HbA1c从10.0%降至8.9%（t(26)=0.5，p值=0.06）。糖尿病痛苦量表显示总体痛苦程度降低（t(26)=2.6；p值=0.02）。广泛性焦虑障碍量表显示所有参与者的广泛性焦虑程度降低（t(26)=2.2；p=0.04）。焦点小组确定的主题包括：（1）通过信息共享获得干预组的社会支持；（2）糖尿病理解和管理中的心理健康及个人身份认同；（3）对CBT/MI干预的接受度通过提高健康素养对自我效能感产生积极影响。
这种基于群体、文化定制的2型糖尿病护理CBT/MI干预受到非裔美国参与者的积极接受，并有助于改善糖尿病控制，如HbA1c的变化所示。通过群体互动获得社会支持以及健康教育带来更强的自我效能感还有其他益处。使用CBT/MI干预的综合治疗计划可能有助于促进糖尿病的健康自我管理。
ClinicalTrials.gov，NCT03562767。于2018年6月19日注册。
