Background
The prevalence of diabetes mellitus (DM) diagnosed in Hispanic Americans (HA) is reported to be 12.1%, compared to 7.4% in non-Hispanic Caucasian Americans. A 2018 health questionnaire conducted at a local Hispanic health fair demonstrated that HA attendees reported their main health concern as DM and diabetes management.
Objective
The purpose of this interventional research study was to explore initial understanding of DM among the HA population and examine whether a targeted health education intervention would help further clarify or increase HA understanding of diabetes.
Keywords
Diabetes, Diabetes Management, Hispanics/Latino
Methods: Design
This study was a non-experimental, educational intervention with pre- and post-test design held at a County Health Department. Snowball sampling was used to inform the Hispanic community about the event. This study was conducted from a sample of HAs with pre- and post-tests (n=17) who were 18 years old or older using the Revised Michigan Diabetes Knowledge Scale (RM-DKS) and questions from the American Diabetes Association website, translated into Spanish. After participants completed their pre-tests, diabetic-friendly foods were served to provide ideas for diabetes prevention and management. Diabetes education was presented in Spanish by a medical doctor and nutrition specialist. A community liaison from the Health Department presented resources local to the area to help with prevention and local support. A question and answer session was provided after the three speakers. Participants completed the same post-test survey after the intervention in order to assess the effectiveness of the education about diabetes done by the interdisciplinary healthcare team.
Results
A paired sample t-test showed overall positive acquisition of knowledge (p=0.038). From time 1 to time 2, gains were seen in knowledge about: purchasing diabetic foods, importance of losing weight and eating fiber, eating a high protein/low carb diet, impacts on kidneys and other parts of the body, cooking oils, importance of regular check-ups with healthcare provider, diabetes diagnosing methods, diabetes potential to cause stroke or other complications, and their understanding of whether HA are at a higher risk of developing diabetes. Losses were seen in categories of the cause of diabetes, physical activity, food preparation and which types of foods to eat, and risk factors for DM associated with ethnic groups.
Limitations of Study
Monetary incentives were not used to promote the study due to funding constraints. During the intervention, paper consent forms and surveys were used, and the research team found them difficult to manage. A control group was not used in this design. Knowledge of participants’ intent to attend was not formalized before the intervention occurred. This made it difficult to plan for the amount of space, quantities of food, and copies of surveys and consent forms needed for the research event. The research team was small to manage the group event (n=3). In the future, recruiting extra research assistants for the delivery and management of the intervention would be advisable. Lastly, even though participants were given the opportunity to consume a variety of diabetic friendly foods throughout the intervention, some of them went back for seconds and some even thirds. In addition, some of them were consuming larger portions of carbohydrates then what is recommended. This unlimited access might have presented a false impression that the amount of diabetic friendly foods was not important in the management of diabetes.
Recommendations
As novice researchers, we learned several lessons from designing and executing this intervention. Advertisement through social media, personal and professional contacts, and contact with peer groups showed effectiveness to recruit this population. We suggest presenting the information in the native language of the targeted population, as we did, as participants expressed appreciation for this consideration. When considering scheduling of the event on a Friday night, this was an effective time for the intervention, potentially because of the weekend hours. Several participants brought their Hispanic/Latino friend or family member to share the meal and be part of the intervention. Providing food helped incentivize participation. In the future, researchers should consider what constitutes an appropriate “start time” and allow for late arrivals, in order to take advantage of participants’ willingness to be involved, even if they miss taking the pre-test survey. We recommend securing a more accurate count of participants who will be attending the intervention in order to plan and ensure sufficient supplies and food. We also recommend participants being served their meal instead of serving it buffet style so that they have a better idea how much of each macronutrient they should be eating, since portion control can influence blood glucose levels. It is recommended that researchers contact participants three to five days in advance of the intervention to encourage participation. For study management, using electronic consent forms and surveys may prove to be more efficient throughout the study instead of using paper copies.
These novice researchers learned that the Hispanic/American population identified a need concerning their health education, were eager and willing to receive education relating to DM, and showed improvement in several areas of DM knowledge during the intervention. It is unknown why certain questions showed a loss of knowledge from time 1 to time 2. A qualitative inquiry might be considered to inform the data regarding this information. Future studies could focus on other novel ways to engage this population to promote their personal health, including longitudinal studies to demonstrate knowledge retention over time.
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