Paper
Friday, July 23, 2004
Soul Food Light: A Clinical Trial of a Culturally Competent Dietary Self-Management Intervention for Rural African-Americans With Diabetes
Wanda Anderson-Loftin, PhD, RN, College of Nursing, University of South Carolina, Columbia, SC, USA, Steve Barnett, MD, Fairfield Medical Associates, Winnsboro, SC, USA, and Patra Sullivan, MS, RD, Fairfield Diabetes Education Center, Fairfield Memorial Hospital, Winnsboro, SC, USA.
| Learning Objective #1: Apply principles of culturally competent nutritional intervention to rural community-based diabetes education, practice, and research |
| Learning Objective #2: Use results to promote healthy decision-making in reducing weight, glycemia, and cardiovascular risk factors among high-risk African-Americans in rural communities |
Objective: To determine the effects of a culturally competent, dietary self-management intervention for high-risk rural African-Americans with type 2 diabetes. Design: This was a longitudinal, experimental study. Population, Sample, Setting, Years: The sample of 97 adults with type 2 diabetes was recruited from African-Americans in Fairfield County South Carolina who had at least one high risk factor: elevated glycosylated hemoglobin, lipids, weight, or high fat diet. Study dates were June 2001 - November 2003. Intervention and Outcome Variables: The intervention was dietary self-management education. Primary outcomes were body mass index (BMI), glycosylated hemoglobin, lipids, and dietary behaviors. Methods: Participants were randomly assigned to usual care or intervention, which consisted of four, 1'30" classes in practical low-fat dietary strategies, 5 monthly peer-professional group discussions, and weekly telephone follow-up. The intervention was culturally competent in terms of ethnic beliefs, values, customs, food preferences, language, and learning methods. Findings: BMI and dietary fat behaviors were significantly lower in the experimental group despite intensive glycemic control and cultural factors that tend to promote weight gain. A non-significant trend in reduction of glycosylated hemoglobin and lipids was observed. Participation was 84%; retention in the experimental group was 78% . Conclusions: Culturally competent dietary self-management is effective in improving health outcomes for southern African-Americans, especially those at risk due to high-fat diets and BMI °Ã 35 kg/mm2. Implications: SC is 70% rural, and large percentages of high-risk African-Americans are concentrated in rural areas. The importance of a program that attracts high-risk rural participants, retains large percentages, and achieves significant weight loss, despite barriers of deeply embedded cultural traditions, cannot be overlooked. Larger studies with greater focus on weight management are needed with other southern rural African-Americans, and the extent to which intervention effects are maintained over time needs to be evaluated.
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