Diabetes connect: African American men's preferences for a community-based diabetes management program

Social network characteristics and type 2 diabetes self-management among Black/African American men: A cross-sectional analysis of support quality and communication patterns

OBJECTIVE

Social networks and social support are critically important for Black/African American men managing Type 2 diabetes (T2D). This study aims to examine how social network characteristics are associated with T2D self-management among Black/African American men.

METHODS

Cross-sectional survey data were collected from Black/African American men with T2D (n = 1225) from February to June 2024. Network composition included percentages of spouses, children, parents, siblings, friends, extended family, and healthcare providers. Network interaction measures included communication frequency, support quality, and perceptions of network members' health behaviors. Self-care activities were measured using the Summary of Diabetes Self-Care Activities scale across diet, physical activity, blood sugar testing, and foot care domains. Multiple regression analyses examined associations between network characteristics and each self-management domain while controlling for demographics.

RESULTS

Diabetes-specific communication frequency was consistently positively associated with all self-care activities (β from 0.09 to 0.18,p < .05). Having very supportive network members was positively associated with diet (β = 0.17,p < .01) and physical activity (β = 0.20,p < .01), though mean social network support showed negative associations with these behaviors (β = -0.13,p = .03; β = -0.14,p = .03). Higher percentages of children were associated with better dietary behaviors (β = 0.06,p = .04), while having spouses (β = 0.06,p = .04), friends (β = 0.06,p = .03), and siblings (β = 0.06,p = .04) was associated with better foot care.

CONCLUSIONS

The quality and content of network interactions appear more important than network size for T2D self-management among Black/African American men. Interventions should focus on fostering quality, disease-specific support rather than expanding social networks. Future programs should leverage existing relationships while considering how different network members influence specific aspects of diabetes management.

Interests and Preferences in Programs to Improve Health Among Men With or at Risk for Type 2 Diabetes in Racial and Ethnic Minority Groups, 2019

Introduction

Men in racial and ethnic minority groups are less likely than non-Hispanic White men to participate in programs designed to improve health, despite having a higher prevalence of type 2 diabetes. We sought to understand 1) the interests and preferences of racial and ethnic minority men, with or at risk for type 2 diabetes, in programs designed to improve health and 2) factors that influence participation and health practices.

Methods

We designed a 43-question web-based survey on facilitators and barriers to participation in a healthy living program. The survey was administered from August 27, 2019, through September 3, 2019. Our analytic sample consisted of 1,506 men at risk for or diagnosed with type 2 diabetes in racial and ethnic minority groups. We conducted descriptive and regression analyses of survey data.

Results

Most men (59%) were interested in participating in a healthy living program and/or program elements such as incentives (67%), male-specific health topics (57%), and the inclusion of family (63%). Flexibility was important, since "exercising when it is convenient for me" was the most frequently selected facilitator of physical activity and "the hours were inconvenient" was identified as a challenge in previous programs. Men in this survey were significantly more likely to be interested in participating in a health improvement program for several reasons, including if they were physically active 150 minutes or more per week (vs not) (adjusted odds ratio [AOR] = 2.2; 95% CI, 1.6-3.0) and had previously been in a healthy living program (vs not) (AOR = 1.5; 95% CI, 1.1-2.1).

Conclusion

Our findings can be useful for recruiting and retaining racial and ethnic minority men with or at risk for type 2 diabetes in programs designed to improve health and ultimately reduce disparities in the prevalence of diabetes.

The Michigan men's diabetes project: perspectives on a peer-led diabetes self-management and support intervention for Black men with type 2 diabetes

BACKGROUND

Black men are more likely to be diagnosed with type 2 diabetes (T2D) compared to non-Hispanic White men, especially those over 55 years of age. Although there is ample evidence around the efficacy of peer-led diabetes self-management and support (PLDSMS) programs in improving diabetes health outcomes, Black men living with T2D experience several barriers to meaningful participation in peer-led programs and program developers face barriers to implementation. This qualitative study aimed to identify perspectives from collaborators on barriers and facilitators that impact the implementation of a PLDSMS intervention for older Black men with T2D.

METHODS

Qualitative data were collected as part of the Michigan Men's Diabetes Project. We used the Tailored Implementation in Chronic Diseases (TICD) Checklist to construct the semi-structured interview guide. TICD domains served as themes. Codes were later generated as a team (N = 3) from chunks of related text. Eight 1-on-1 semi-structured interviews (two researchers, three peer leaders, one community collaborator, two certified diabetes care and education specialists) were conducted between April 13-22, 2022 via Zoom. We engaged in thematic content analysis and used the rigorous and accelerated data reduction (RADaR) technique and Rapid analysis.

RESULTS

Themes included guideline factors; individual collaborator factors; patient factors; professional interactions; incentives and resources; capacity for organizational change; and use of technology. Guidelines for implementing a PLDSMS program for Black men with T2D are lacking. For effective implementation, collaborators need interpersonal and session facilitation skills, flexibility, and cultural awareness. Although Black men with T2D may initially be apprehensive about participating in a PLDSMS program due to lack of knowledge, masculine norms, and stigma, these programs offer a safe space, a sense of brotherhood, and transparency. Having a physician champion is key in supporting organizational changes needed to implement PLDSMS programs in health systems, particularly as PLDSMS is not currently a billable service.

CONCLUSIONS

The PLDSMS program is culturally relevant in engaging older Black men with T2D. In addition to building trust among participants, successful development and implementation of a peer support program requires flexibility and tailored communication strategies. Findings can be used to inform future iterations of PLDSMS programs.

COVID-19 Related Knowledge, Attitudes, and Behaviors Among Black Men with Chronic Health Conditions: A Latent Profile Analysis

Research indicates that Black communities experienced disproportionately higher numbers of confirmed cases and fatalities throughout the COVID-19 pandemic with Black men experiencing marked reductions in life expectancy. Inequities were further magnified by known COVID-19 such as hypertension, diabetes, obesity, and higher prevalence of cardiovascular disease. The current project aimed to assess the knowledge, attitudes, and behaviors related to COVID-19 among Black men with chronic conditions. Specifically, we sought to determine whether COVID-19-related perspectives and behaviors impacted cross-sectional health outcomes. A national sample of Black men (N = 312) who self-reported at least one chronic disease responded to survey questions about their knowledge, attitude, and preventative behaviors (KAP) related to COVID-19. Analyses suggest that unique latent profiles based on COVID-19-related KAP differentially impacted participants' self-reported health and well-being for those low on KAP items. The discussion includes considerations on viral hygiene interventions, misinformation, stigma, and perceptions of discrimination.

Michigan men's diabetes project II: Protocol for peer-led diabetes self-management education and long-term support in Black men

Previous literature has indicated that Black men are twice as likely to develop type 2 diabetes compared to their non-Hispanic White counterparts and are also more likely to have associated complications. Furthermore, Black men have lower access to quality health care, and masculinity norms have been shown to hinder them from seeking the limited care that is available. In this study, we aim to investigate the effect of peer-led diabetes self-management education and long-term ongoing support on glycemic management. The first phase of our study will consist of modification of existing diabetes education content to be more appropriate for the population of interest, Then, in the second phase, we will conduct a randomized controlled trial to test the intervention. Participants randomized to the intervention arm will receive diabetes self-management education, structured diabetes self-management support, and a more flexible ongoing support period. Participants randomized to the control arm will receive diabetes self-management education. Diabetes self-management education will be taught by certified diabetes care and education specialists, while the diabetes self-management support and ongoing support period will be facilitated by fellow Black men with diabetes who will be trained in group facilitation, patient-provider communication strategies, and empowerment techniques. The third phase of this study will consist of post-intervention interviews and dissemination of findings to the academic community. The primary goal of our study is to determine whether long-term peer-led support groups in conjunction with diabetes self-management education are a promising solution to improve self-management behaviors and decrease A1C levels. We will also evaluate the retention of participants throughout the study, which has historically been an issue in clinical studies focused on the Black male population. Finally, the results from this trial will determine whether we can proceed to a fully-powered R01 trial or if other modifications of the intervention are necessary. Trial registration: Registered at ClinicalTrials.gov with an ID of NCT05370781 on May 12, 2022.

Gender differences in psychosocial characteristics and diabetes self-management among inner-city African Americans

AIMS

To characterize differences in psychosocial variables between inner-city African American men and women with type 2 diabetes, and to test if the relationships between psychosocial variables and diabetes self-management behaviours differ by gender.

DESIGN

Secondary analysis.

METHODS

We used baseline data from participants enrolled in the Prevention through Lifestyle Intervention and Numeracy 4 Success-Diabetes study (N = 37). Differences in psychosocial variables between genders were compared using chi-square tests. A two-way analysis of variance was then used to compare self-management scores by different psychosocial characteristics and gender.

RESULTS

There was no statistically significant difference in psychosocial characteristics between genders. High diabetes knowledge and self-efficacy were associated with better self-management behaviours in African American women but not in men. In contrast, high numeracy was associated with better diabetes self-management only in men. Low depression, high health literacy, and high social support were associated with better self-management practices in both genders.

Caring in the recruitment of older African American adults with chronic health disease: An integrative review

OBJECTIVES

The aim of this integrative review is to accrue a comprehensive understanding of caring behavioral characteristics in the recruitment of older African-American adults into health-related research studies centered on chronic diseases.

METHODS

Combined methodologies, Whittemore & Knafl and Kable, Pich & Maslin-Prothero in accordance with preferred items for systematic reviews and meta-analysis, were used to guide the data collection and to report the findings. The data were analyzed based upon recruitment categorization and Kristen Swanson's middle-range theory of caring.

RESULTS

Ten out of 260 publications comprised the final sample. They were analyzed and then aggregated by chronic illnesses, recruitment activities, contact level, and Swanson's five caring behavioral concepts. Select cancers, diabetes, hypertension, and Alzheimer's disease were the chronic illness foci of eight publications. Cardiovascular disease and stroke were the focus of two publications. Only three studies utilized all five Swanson's caring concepts, and the frequently used concept throughout all 10 studies was enabling.

DISCUSSION

Recruitment approaches employed to accrue older African-American adults into chronic illness-related research studies necessitate proactive recruitment strategies that incorporate caring behaviors. Future researchers ought to develop multi-modality recruitment strategies to improve older African-American adults' representation.

Michigan Men's diabetes project (MenD): protocol for a peer leader diabetes self-management education and support intervention

Background

Black men are more likely to be diagnosed with type 2 diabetes (T2D) compared to non-Hispanic White men, and this disparity increases among men over the age of 55. A growing body of literature demonstrates the critical role of gender in the management of health behaviors such as T2D and shows that male gender norms can conflict with healthy behaviors. These studies suggest that tailoring diabetes self-management interventions to address the needs of Black men may be critical to helping them to achieve optimal health outcomes. Further, our own research on Blacks with T2D found gender disparities in participation in diabetes interventions, with males participating at significantly lower rates than females. Peer leaders are trained lay individuals who are used to provide ongoing diabetes self-management support to people with diabetes, particularly in minority communities. However, despite studies showing that diabetes management interventions using peer leaders have been successful, the majority of peer leaders as well as the participants in those studies are women. The limited studies to date suggest that Black men with T2D prefer peer-led, male-to-male T2D programs, however, this research consists primarily of nonrandomized, small sample feasibility studies calling for additional studies to establish the efficacy of these approaches. The proposed study will develop and preliminarily validate the effectiveness of an adapted peer leader diabetes self-management support (PLDSMS) intervention designed to improve diabetes-related lifestyle and self-management behaviors in Black men (over 55) with T2D.

Method

We propose to tailor an existing intervention by 1) our using male peers and 2) modifying the peer leader training content to focus on material appropriate for men. The proposed study includes a developmental phase (development of the intervention with expert feedback, followed by feasibility testing with Black men) and a validation phase [randomized clinical trial (RCT)].

Discussion

If successful, this study will lead to the development and dissemination of an intervention that will address the unique needs of Black men with T2D, helping them to achieve optimal diabetes self-management and health outcomes.

Trial registration

Registered at ClinicalTrials.gov with an ID NCT04760444 on February 17, 2021

Individual-, Community-, and Health System-Level Barriers to Optimal Type 2 Diabetes Care for Inner-City African Americans: An Integrative Review and Model Development

PURPOSE

The purpose of this integrative review is (1) to elucidate the unique barriers faced by inner-city African Americans for type 2 diabetes (T2DM) care; (2) to identify effective interventions/programs for optimal T2DM care at the individual, community, and health systems levels; and (3) to integrate 2 behavioral models and 1 social ecological model for framing interventions for inner-city African American to optimize T2DM care.

METHODS

PRISMA guidelines were followed to systematically search PubMed, PsychInfo, and CINAHL. Integration of models was based on underlying principles of social ecological models.

RESULTS

The search returned 1183 articles. Forty-six articles were synthesized after applying inclusion criteria. Multiple barriers for the individual level, community level, and health system level were identified. Major barriers include lack of knowledge, lack of social support, and self-management support. Interventions identified in this review show that among inner-city African Americans with T2DM, the focus is placed at the health systems level, with very limited focus toward addressing individual- and community-level barriers. Final synthesis includes development of a new integrated model that explains barriers to care across multiple levels.

CONCLUSIONS

These findings highlight the fragmentation that may be occurring between policy, research, and practice for achieving health equity and addressing health disparities for T2DM care among inner-city African Americans. The new model is an important step in the pursuit of equity in T2DM by specifying the complex barriers that occur across multiple levels. The application of this model using the 2017 National Standards for Diabetes-Self Management Education and Support are discussed.

Type 2 Diabetes Self-Management in Non-Hispanic Black Men: a Current State of the Literature

PURPOSE OF REVIEW

This article discusses the state of type 2 diabetes (T2D) self-management research on non-Hispanic Black men with a focus on their knowledge of diabetes, factors that impact T2D self-management and intervention research that specifically targets non-Hispanic Black men with T2D.

RECENT FINDINGS

Studies on T2D knowledge and barriers and facilitators to T2D self-management in non-Hispanic Black men are limited to small qualitative focus group and in-depth interviews. To date, few T2D interventions for non-Hispanic Black men have been developed and tested. Research shows that non-Hispanic Black men's knowledge of T2D may be less than optimal compared to non-Hispanic white men. Factors that influence T2D self-management in non-Hispanic Black men include gender-related values and beliefs, and a range of other psychosocial (e.g., social support) and structural (e.g., access to health care) factors. Interventions with gender-specific programming may show promise. More studies with larger sample sizes and longitudinal designs are needed to develop programming to effectively target this at-risk population.

Electronic, mobile and telehealth tools for vulnerable patients with chronic disease: a systematic review and realist synthesis

OBJECTIVES

The objective of this review was to assess the benefit of using electronic, mobile and telehealth tools for vulnerable patients with chronic disease and explore the mechanisms by which these impact patient self-efficacy and self-management.

DESIGN

We searched MEDLINE, all evidence-based medicine, CINAHL, Embase and PsychINFO covering the period 2009 to 2018 for electronic, mobile or telehealth interventions. Quality was assessed according to rigour and relevance. Those studies providing a richer description ('thick') were synthesised using a realist matrix.

SETTING AND PARTICIPANTS

Studies of any design conducted in community-based primary care involving adults with one or more diagnosed chronic health condition and vulnerability due to demographic, geographic, economic and/or cultural characteristics.

RESULTS

Eighteen trials were identified targeting a range of chronic conditions and vulnerabilities. The data provided limited insight into the mechanisms underpinning these interventions, most of which sought to persuade vulnerable patients into believing they could self-manage their conditions through improved symptom monitoring, education and support and goal setting. Patients were relatively passive in the interaction, and the level of patient response attributed to their intrinsic level of motivation. Health literacy, which may be confounded with motivation, was only measured in one study, and eHealth literacy was not assessed.

CONCLUSIONS

Research incorporating these tools with vulnerable groups is not comprehensive. Apart from intrinsic motivation, health literacy may also influence the reaction of vulnerable groups to technology. Social persuasion was the main way interventions sought to achieve better self-management. Efforts to engage patients by healthcare providers were lower than expected. Use of social networks or other eHealth mechanisms to link patients and provide opportunities for vicarious experience could be further explored in relation to vulnerable groups. Future research could also assess health and eHealth literacy and differentiate the specific needs for vulnerable groups when implementing health technologies.

Older African American Men's Perspectives on Factors That Influence Type 2 Diabetes Self-Management and Peer-Led Interventions

Older African American men are at increased risk of Type 2 Diabetes (T2D) but demonstrate high rates of poor illness management. They also participate in interventions targeting illness management at extremely low rates and are at high risk for dropout from clinical trials. One modifiable factor that has been identified in the literature that contributes to these disparities is health beliefs particular to men. Yet, despite the fact that illness management interventions have been developed to meet the needs of African Americans, none have followed recommendations to use gender-sensitive programming to meet the needs of men. The primary aim of this study was to advance our understanding of the intersection of age, race/ethnicity and gender on T2D self-management among older African American men, and to explore their preferences for a peer-led T2D self-management intervention. Two focus groups were conducted with older African American men (n = 12) over a 6-month period. Sessions lasted 90 min, were audiotaped, and analyzed using thematic content analysis techniques. The most prominent themes included: (a) the influence of gendered values and beliefs on health behavior; (b) quantity and quality of patient-provider communication; (c) social and structural barriers to T2D self-management; and (d) preferences for peer-led T2D self-management interventions. Results suggest that these themes may be particularly salient for T2D self-management in older African American men, and that this population may be receptive to a peer-led T2D self-management intervention.

Understanding Diabetes-Related Distress Characteristics and Psychosocial Support Preferences of Urban African American Adults Living With Type 2 Diabetes: A Mixed-Methods Study

Purpose The purpose of this study is to understand diabetes-related distress (DRD) characteristics and identify psychosocial support preferences of urban African American adults living with type 2 diabetes (T2DM). Methods A 2-phase, mixed-methods sequential explanatory study design was used to gather data. In phase 1, a purposive sample of participants (N = 155) was recruited and asked to complete a written survey. The Diabetes Distress Scale (DDS17) was used to assess DRD, including subscales-emotional burden (EB), regimen distress (RD), interpersonal distress (ID), and physician distress (PD). In phase 2, a subset of phase 1 participants (N = 23) volunteered to attend 1 of 4 gender-stratified follow-up focus groups to contextualize the quantitative survey results. Results Survey findings indicate that on average, participants had moderate levels of DRD (aggregate), RD, and EB but had low ID and PD. During follow-up focus groups, participants described RD and EB as their primary distress types and emphasized that clinicians should prioritize the mental health aspects of T2DM similarly to its physical aspects. Participants expressed a desire for culturally appropriate peer support groups as a psychosocial support resource for distress coping and specifically requested the development of gender-stratified groups and groups for young adults. Conclusions Results support the need to screen for and address diabetes-related distress among African American patients with T2DM. Findings also inform the development of culturally appropriate psychosocial support resources to facilitate diabetes-related distress coping.

The Impact of a Worksite-Based Diabetes Prevention Intervention: A Pilot Study

The purpose of this study was to assess the impact of a program to prevent the development of type 2 diabetes among participants with prediabetes. The program focused on a healthy eating style, behavior modification, daily physical activity, and achieving a healthy weight. This was a retrospective observational analysis of a pilot program designed to prevent diabetes among employees with prediabetes. This intervention involved 12-16 weeks of nutrition counseling with the registered dietitian and participation in physical activity of at least 150 min/week. The primary outcome for this study was the prevention of type 2 diabetes. Secondary outcome measures included changes in the following biometrics: body mass index (BMI), systolic blood pressure (SBP), diastolic blood press (DBP), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol, waist circumference, and triglyceride levels. The diabetes prevention intervention was associated with significant improvements in glucose (-6.6%), A1c (-2.9%), weight (-5.5%), BMI (-5.5%), SBP (-4.9%), DBP (-3.9%), total cholesterol (-5.0%), LDL-C (-7.0%), and triglycerides (-13.9%). After the 12-16-week intervention, the prevalence of prediabetes was reduced by 31% by fasting blood glucose or A1c levels. Baseline A1c, baseline glucose level, age, and number of sessions attended were all significant predictors of the odds of transitioning out of the prediabetes stage, controlling for all other covariates in the model. This pilot study suggests that the implementation of a worksite diabetes prevention intervention can help employees transition from a prediabetes status to no risk of diabetes.

Challenges to Healthy Eating Practices: A Qualitative Study of Non-Hispanic Black Men Living With Diabetes

PURPOSE

The purpose of this study was to explore current dietary practices and perceived barriers to healthy eating in non-Hispanic black men with type 2 diabetes.

METHODS

Four 90-minute focus groups held in September and October 2011 were led by a trained moderator with a written guide to facilitate discussion on dietary practices and barriers to healthy eating. Participants were recruited from the diabetes database at a public safety-net health system in Jefferson County, Alabama. Two-independent reviewers performed content analysis to identify major themes using a combined deductive and inductive approach.

RESULTS

There were 34 male participants aged 18 years and older. Mean years living with diabetes was 9.6 ± 5.9. Sixty-two percent of participants perceived themselves to be in fair or poor health. Participants' self-reported eating practices did not always relate to hunger. Internal cues to eat included habit and response to emotions, and external cues to eat included media messaging, medication regimens, and work schedules. Men identified multiple barriers to healthy eating including hard-to-break habits, limited resources and availability of food at home and in neighborhood grocery stores, and perceived poor communication with health care professionals.

CONCLUSION

Non-Hispanic black men acknowledged the importance of healthy eating as part of diabetes self-management but reported various internal and external challenges that present barriers to healthy eating. Tailored strategies to overcome barriers to healthy eating among non-Hispanic black men should be developed and tested for their impact on diabetes self-management.