Improving Glycemic Control among Incarcerated Men: A Health Promotion Model

Abstract

Statement of Problem

In California’s state prison system, diabetic inmates are fed the same diet as the rest of the prison population, and many have poor blood glucose control. A current program allows certain inmates to carry glucometers and testing supplies and to test their blood sugar but improvements in glycemic control have been modest. This innovation sought to learn if improved health literacy would result in a reduction in HbA1c in an environment in which no variables such as dietary changes or other rewards were offered. 

Methodology

Utilizing the Health Promotion Model as a framework that includes nursing and behavioral science perspectives, nursing-led education which was supported by other disciplines aimed to improve health literacy. Diabetic inmates who expressed a desire to participate were permitted to carry a glucometer and supplies and were given individualized diabetes education. During scheduled appointments, medical and mental health care providers reinforced information and a dietician was available to help the patient learn more about the meals that were provided to him. Participants were re-assessed for improvements in HbA1c at least every 6 months.

Description of Innovation

Evidence and theory-based strategies were incorporated into the intervention. Research indicates that individuals who are involved in their health care decisions are more likely to take action and make a behavior change; therefore the intervention was aimed at increasing autonomy and participatory behavior. Because research has also shown that self-monitoring strategies increase compliance with goals of glycemic control, inmates were encouraged to test their blood sugar as desired and to keep a record for review. Evidence indicates that social support is a strong predictor of success with changing behavior; therefore a collaborative team acknowledged and encouraged the patient’s effort.

Implications for Research

Further study is needed to develop interventions specifically designed for incarcerated diabetics. Poor health literacy, depression and lack of autonomy may be barriers to glycemic control for incarcerated diabetics. Peer and organizational support, a self-testing program and education may improve glycemic control.