Knowledge Users: Women’s Health in Women’s HandsFunding: CUHI seed grant, Faculty of Community Services Ryerson

University

1Vivian W.S. Chan, HBSc; 1,2Lisa Manuel, HBSc, BASc;

3Souraya Sidani, PhD, RN; 2,3

Enza Gucciardi, PhD 1University of Toronto, 2Ryerson University, School of Nutrition, 3Ryerson University, School of Nursing

Background

Higher rates of diabetes among ethnic minority populations

Black African, Black Caribbean, Hispanic, Latin American, South Asian (Harris et al., 1998; King et al., 1998; Creatore et al., 2010)

Women at greater risk for diabetes complications

Cardiovascular disease, coronary heart disease, stroke, and depressive symptoms (Barrett-Connor, et al., 2004; Huxley, et al., 2006; Tuomilehto, et al., 2001; Gucciardi et al., 2008)

Accessible self-management education is essential for ethnic minorities

People from these cultural groups report poorer glycemic control and limited access to diabetes self-management resources and support (Harris et al., 1999;Karter et al., 2000)

Self-management

Diabetes self-management is critical to preventing further complications

Effective self-management is challenging and complex

Requires a lifelong commitment to lifestyle changes involving adherence to medications, nutrition management, regular self-blood glucose monitoring, and a physically active lifestyle

To improve the delivery of diabetes education, we need to identify and deliver education that works best for them

Study Aim Objective:

To identify effective diabetes self-management education (DSME) components for women of African Caribbean/American, Latin American, and South Asian descent

Research question:

What intervention features are most effective in achieving success in HbA1c, anthropometrics, physical activity, and diet outcomes?

Methodology

Literature search

Keywords for Online Databases: adult, type 2 diabetes mellitus, patient care management, patient education, patient-centered care, ethnic groups, and competency-based education

Key Inclusion Criteria: >70% women with type 2 diabetes (or gender-specific results) from cultural populations of interest, primary intervention studies

with comparison groups

9019 abstracts retrieved, 14 studies included

Methodology (Cont’d)

Quality assessment tool (Hawker, 2002; Effective Public Health Practice Project, 1998)

Looking for clarity, appropriateness, biases in entire article, including study aims, study design, methodology, analyses, and results

Scoring:

Percentage allocated based on the presence of these components in the articles

1 article received a rating of “fair”

and 13 were rated as “good”

Data Analysis

A success analysis was used in place of a meta-analysis (Glazier et al., 2006)

Research interventions were analyzed based on its success of a significant outcome (P-value ≤

0.05)

between the intervention and control groups

Only data measured after the intervention was used in the success calculation

Success Rate Difference Calculation

Success Rate

Difference(%)

To see if success of outcomes are better with the feature or without the feature

Studies with significant outcome

WITH feature

All studies WITH feature

Studies with significant outcome

WITHOUT feature

All studies WITHOUT

feature

(%) (%)

Positive Success Rate Differences (%) in HbA1c, Anthropometrics,

Physical Activity, and Diet Outcomes *Success rate difference is based on less than 5 studies; interpret with caution

Positive Success Rate Differences (%) (Cont’d) *Success rate difference is based on less than 5 studies; interpret with caution

Positive Success Rate Differences (%) (Cont’d) *Success rate difference is based on less than 5 studies; interpret with caution

Positive Success Rate Differences (%) (Cont’d) *Success rate difference is based on less than 5 studies; interpret with caution

Recurring Trends Across Three Outcomes

HbA1c, Anthropometrics, and Physical Activity:

Hospital-based intervention setting

Group intervention format

Highly intense intervention (equal or more than 10 sessions)

Incorporating dietitians as an intervener

Recurring Trends Across Three Outcomes

Anthropometrics, Physical Activity, and Diet:

Situational problem solving teaching method

Incorporating multidisciplinary team as interveners

Physiological Outcomes

For HbA1c and Anthropometrics:

Written literature as a mode of delivery

Didactic teaching method

Diet content taught in intervention

Supervised exercise in intervention

Interactive discussion groups in intervention

Behavioural Outcomes

For Physical Activity and Diet:

Negotiated goal setting teaching method

Particular features of interest

Community peer workers and physical activity

Psychosocial content and diet

Limitations

Limited number of studies are included in this literature review due to our inclusion criteria

Only American data; No Canadian data

Not enough studies to do a stratified analysis of success rates between cultures

No South Asian intervention research met our inclusion criteria

Discussion

The recurring successful features across the outcomes may be the future focus for DSME intervention designs

To what extent should programs be flexible? Should we be individualizing or mainstreaming interventions based on specific features?

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