Topical Area: Nutrition Education and Behavioral Science
Despite national efforts, type 2 diabetes continues to rise in the Appalachian region. With concerns about cultural competence and health literacy, we undertook a community-based participatory research (CBPR) approach to program development to maximize effectiveness and cultural relevance for people with type 2 diabetes in Appalachia.
Methods : We conducted a multi-stage project. First, we assessed the educational needs, using a survey measuring diabetes self-management behaviors (diet, exercise, glucose monitoring, foot care, and medication) and conducted six focus groups with people with type 2 diabetes living in East TN. Next, from the focus group participants, a Community Advisory Board (CAB) was formed to review the results and provide input on the design of the education tool. The CAB used a systematic prioritization method to select the education topic and delivery methods. Finally, we piloted the resulting single nutrition education session with the CAB members. Data were analyzed using descriptive analysis for quantitative data and thematic analysis for qualitative data.
Results : Forty-two people participated in this study (66% female; mean age 65.7 years, SD 12), with seven thereafter forming the CAB (57% female). Nutrition was the most raised topic in the focus groups. Comparing the five self-management behaviors, the lowest percentage of participants reported compliance with dietary self-management behaviors (32%). Using adapted Hanlon methodology, the CAB selected ‘nutrition’ as the topic for the education. In addition, CAB specified group interactions, opportunity for asking questions, presence of support person/family, and providing additional resources as critical program characteristics. Accordingly, we developed an interactive session, focused on food groups and meal planning, using social cognitive theory. The session includes basic information about diabetes, meal planning strategies, problem solving, scenarios, and individual action plan. The pilot testing of the session showed that all participants ‘strongly agree’[ed] that the session offers useable, practical information.
Conclusions : The CAB guided the development of a session to respond to the needs and concerns of people with type 2 diabetes in rural Appalachia.
Funding Sources : Humana Foundation