Culturally Tailored Diabetic Self-Management Education in the African-American Type 2 Diabetic in a Faith Based Organization

Abstract
Diabetes Mellitus is a major public health concern in the United States (U.S.). It is well documented that minority groups are at higher risk and possess higher disease prevalence in the U.S. Specifically, the African-American community suffers with a higher prevalence of diabetes, morbidity, mortality and disease burden than most other minorities and the white community. The literature supports that self-care activities to manage diabetes translate into better glycemic control. Moreover, education programs based upon the Health Belief Model (HBM) and the construct of self-efficacy (SE) have demonstrated statistically significant increases in self-care behaviors and improved glycemic control for those with diabetes. However, there is some evidence that patients report perceived prejudices and distrust of the U.S. healthcare system by African-American citizens. As a result, the African-American church may offer a trusted space for the African-American to learn about health promoting behaviors. This Faith Based Organization (FBO) served as the setting for the delivery of a 4-week culturally tailored Diabetic Self-Management Education (DSME) program to 8 African-American adults who have Type 2 Diabetes in Portsmouth, Virginia. A family nurse practitioner led the culturally sensitive DSME. Diabetes knowledge scores did not improve after the DSME training intervention utilizing Wilcoxon Signed Ranks Test (z = -.577, p = .564) but The Diabetic Empowerment Scale scores did improve after DSME training (z = -2.527, p = .012). Satisfaction scores were above 96 % for all study participants. Future evaluations of culturally sensitive DSME training programs should pursue randomized controlled studies in an FBO, incorporate literacy and numeracy evaluations prior to intervention and measures of hemoglobin A 1 C, knowledge of diabetes and empowerment to further evaluate efficacy of this training approach over the standard of care.
Keywords: African-American, Type 2 Diabetes Mellitus, Health Belief Model, Self-Efficacy, Faith Based Organization, Diabetes Self-Management Education