Impact of a Culturally-Grounded and Interprofessional Approach to Managing Latino/Hispanic Patients at Risk for or Diagnosed with Type 2 Diabetes Mellitus: A Pilot Study

Author

Jahnavi Yalamanchili, University of the PacificFollow

Date of Award

2024

Document Type

Thesis

Degree Name

Master of Science (M.S.)

Department

Pharmaceutical and Chemical Sciences

First Advisor

Deepti Vyas

First Committee Member

Bhaskara Jasti

Second Committee Member

Sara Mahmoud

Abstract

Background: Despite significant progress in diabetes research, there remain significant health disparities between Hispanic/Latino patients in the United States, particularly those with lower socioeconomic status, compared to non-Hispanic white patients. Previous studies have identified potential reasons behind these disparities, including the need for a multifaceted approach that addresses social determinants of health (SDOH) faced by patients. Social cognitive theory (SCT) stipulates that interventions that promote self-management by improving knowledge, self-efficacy, and problem-solving skills can be successful in improving health outcomes. However, there is a paucity of studies that have evaluated an interprofessional approach to providing culturally relevant care, in particular the development of interventions based on SCT principles. Objective: To investigate the impact of SCT-based culturally relevant hands-on nutrition education and individualized medication therapy management on diabetes outcomes in Hispanic/Latino patients at risk for or diagnosed with type 2 diabetes in a free clinic setting. Methods: This 6-month study employed a quasi-experimental, interventional-led, one-group pre-post longitudinal study design with pragmatic elements. Participants were recruited through recruitment material placed in the clinic, phone calls to potential participants, and active recruitment in the clinic's waiting room. The intervention consisted of three elements: 1) hands-on nutrition and culinary educational sessions that took place on two consecutive weeks and one optional refresher session and 2) case management and medication optimization by a pharmacist and 3) Group support provided by other study participants, pharmacy team, and inclusion of family members when possible. During the sessions, participants received curated dietary training, techniques for portion control, food label literacy, healthy ingredient substitutions, and information on their medications in an attempt to improve self-efficacy and knowledge related to managing their diabetes. After the sessions, social support follow-up occurred every two weeks for the first three months and monthly for the remaining three months via phone calls geared towards identifying any barriers faced by the participant and medication adherence and titration. The primary outcome of the study was A1c, self-efficacy as measured by the “Stanford diabetes self-efficacy scale”, and dietary behavior as measured by “Latino dietary behaviors questionnaire”. The secondary outcomes included lipid profile, renal parameters, weight, physical activity as measured by the “International physical activity questionnaire”, and patient satisfaction. ANOVA with simple contrast or Friedman test was used to measure difference between pre-intervention and 6-month outcomes. A paired t-test or Wilcoxon signed-rank test was used to compare the difference between pre-intervention and 6-month outcomes in physical activity survey, weight, and renal function. Results: A total of 18 participants enrolled in the study. The mean age of the participants enrolled in the study was 53.94 years, with the majority in the age group 45-64 years (55.56%). Around 72.22% (n=13) were diagnosed with type 2 diabetes mellitus (T2DM), while the rest had prediabetes (n=5; 27.78%). The majority of the participants were males (55.56%) and identified as Mexican, Mexican American, or/or Chicano ethnicity (72.22%). The preferred language for communication was Spanish for all the participants. A total of 17 (94.0%) participants completed the 6-month study. This pilot study revealed a clinically significant reduction in A1C (mean pre: 7.79 vs 6-month: 7.38) and total cholesterol (mean pre: 190.92 vs 6-month: 182.42) at six months follow-up. The intervention was successful in improving the self-efficacy (mean pre: 7.57 vs 6-month: 8.69) and dietary behaviors (mean pre: 26.61 vs 6-month: 29.87) at the six-month follow-up. Conclusion: A SCT-based culturally tailored interprofessional intervention addressing diabetes knowledge, self-efficacy, SDOH and social support could be helpful in improving health outcomes.

Pages

144

Recommended Citation

Yalamanchili, Jahnavi. (2024). Impact of a Culturally-Grounded and Interprofessional Approach to Managing Latino/Hispanic Patients at Risk for or Diagnosed with Type 2 Diabetes Mellitus: A Pilot Study. University of the Pacific, Thesis. https://scholarlycommons.pacific.edu/uop_etds/4274