Diabetes Prevention for At-Risk Puerto Rican Adults in a Faith-Based Setting

Purpose:  Diabetes is a growing health threat among Hispanics living in the United States (US), and ranks as the fifth leading cause of death (Heron, 2013).  Current evidence supports diabetes prevention programs for individuals who are at increased risk for diabetes.  However, few interventions exist for Hispanics, and even fewer have focused on Puerto Ricans (Rosal, Borg, Bodnelos, Tellez, & Ockene, 2011), who have the highest rate of diabetes among Hispanics (Centers for Disease Control and Prevention, 2014).  This faith-based study evaluated the impact and feasibility of two key diabetes prevention components—a diabetes health threat message and dietary skill-building exercises—that were culturally-tailored and incorporated spirituality for Puerto Rican adults, who were at-risk for diabetes.

Methods:  A pretest-posttest, concurrent mixed methods design was used to gather data on a purposive sample of 24 Puerto Rican adults, who had a family history of diabetes or believed they were at-risk for diabetes.  Quantitative data included demographic surveys and measures of acculturation, spirituality, health threat perceptions, dietary self-efficacy, and dietary patterns, and biological measures of weight, body mass index, and fasting blood glucose levels.  Qualitative observational data were collected in field notes during each meeting and during focus group interviews.  This faith-based study was conducted in a Spanish-speaking church in the Orlando, Florida area.  The 6-week intervention infused Puerto Rican cultural elements and scriptural, faith-based messages into a diabetes health threat message about the consequences of diabetes, and into dietary skill-building exercises aimed at improving dietary behaviors. The study concluded with a dinner of adapted traditional recipes prepared and shared by the participants.

Results:  Analysis of the quantitative data showed significant increases in participants’ perception of diabetes severity, and there were significant improvements in dietary self-efficacy and dietary patterns at posttest in comparison to baseline.  There were also significant moderate correlations between perceptions of diabetes severity and weight loss, dietary self-efficacy and improved dietary patterns, and also between dietary self-efficacy and fasting blood glucose levels.  Analysis of the field notes indicated that the intervention was well received.  Moreover, the data support feasibility for the intervention that had no attrition and a weekly attendance rate of 58%. 

Conclusion:  Study findings support diabetes prevention intervention strategies that incorporate cultural elements and spirituality into a diabetes health threat message and dietary skill-building exercises to motivate positive dietary behavior change in Puerto Rican adults who are at-risk for diabetes.