UCLA

Background: Preventing premature morbidity and mortality for adults with Type 2 Diabetes Mellitus (T2DM) increases the quality and quantity of life lived in healthier communities. Low-income Hispanic adults with T2DM living in South Los Angeles are at high risk for complications (of T2DM) due to language barriers, low health literacy, and limited access to the highest quality healthcare.

Objective: A quality-improvement project was developed that incorporated evidence-based education and personal week-to-week coaching to improve diet and exercise for 34 adults with Type 2 Diabetes Mellitus (T2DM).

Methods: Sixteen of 34 adults completed the first and last study visit and 12 coaching follow-up calls from the Advance Practice Registered Nurse in a Federally Qualified Healthcare Center (FQHC). Participant characteristics were limited to: adults aged 18 or over, have a BMI at or above 25 kg/m2, are monolingual Spanish speakers, with fewer than 12 years of formal education or award of a General Education Development (GED) certificate, diagnosed with T2DM, and prescribed oral hypoglycemic agents by one of five in-clinic providers. The Diabetes Knowledge Questionnaire (DKQ-24) evaluated diabetes and self-care knowledge, and the difference between the baseline and final visit was estimated for 16 participants, as were Glycated Hemoglobin (HbA1c) levels and body mass index (BMI). Bivariate associations were evaluated using a Student’s t-Test for continuous variables and a chi-square test for categorical variables (e.g., years of education:<8, 8-11, 12, 12 or more years).

Results: Results indicate that completers show a 1.8 lb. reduction in weight after the 12 weeks of intervention, on average (p=0.0074). In addition, there was a modest reduction in BMI, -0.3125 (SD: 0.43) kg/m2 (p=0.0102). Corresponding to this, the HbA1c followed the same trend and showed a modest reduction over the intervention period (-0.375%, SD: 0.43, p=0.0035). In addition, participants showed DKQ-24 scores that were statistically significantly greater than 0 at baseline. Diabetic knowledge improved between baseline and the last study visit (Δ correct=4.94 questions correct, p<0.001).

Conclusions: A community-based education program plus weekly coaching using evidence-based criteria holds promise to improve self-care and health outcomes for low-income Hispanic adults with low educational attainment and T2DM.

Keywords: Community-based education, coaching, Hispanics, diabetes, low-literacy