Integrating Coached Care into Shared Medical Appointments in Adult Latinos with Type 2 Diabetes
A disproportionate number of Latinos share the burden of type 2 diabetes (T2D). Latinos comprise 16% of the U.S. population and the prevalence of self-reported diabetes is 11.9 % compared to 7.1% in non-Hispanic Whites. This dissertation describes three papers that address this disparity. The first is a systematic review and meta-analysis that investigated the effectiveness of diabetes self-management education (DSME) in reducing glycosylated hemoglobin (HbA1c) levels in adult Latinos with T2D. This review suggests that despite the heterogeneity observed in the 20 studies included in the review, DSME has a positive effect on HbA1c in this ethnic group. The second study focused on the disproportionate number of Latinos participating in research studies. Three themes emerged as facilitators for research participation: 1) barriers to access health-related expertise must be lowered; 2) language concordance was critical; and 3) a trusting relationship was essential. Conversely, perceived barriers included childcare, transportation issues, work schedules and ethnic beliefs and practices. The third study compared the effectiveness of shared medical appointments versus shared medical appointments plus coached care on HbA1c, lipid profile (e.g., cholesterol, LDL, HDL triglycerides), weight, body mass index and blood pressure at 12 weeks (short-term). Forty Latino adults with T2D (mean age 51.4±8.5 years; female (80%); HbA1c 10.1±1.2%) participated in a 24-week study. Improvements in glycemic control were similar in both groups at 12 weeks; there were no differences between groups in all other outcomes measured. These papers contribute to the growing body of research involving adult Latinos with T2D and confirm that 1) DSME interventions improve glycemic control; 2) addressing barriers to and facilitators of research participation can potentially reduce health disparities; and 3) SMA and SMA-CC both have the potential to also improve glycemic control. Additional research is needed to identify cultural interventions to improve health outcomes. These include but are not limited to: longitudinal studies with the current cohort of participants to assess efficacy of interventions, reengineering the process of coaching, i.e., pairing participants as dyads to support each other and/or focused interviews to identify barriers and facilitators of self-management behaviors.