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Culturally Adapted Shared Medical Appointments in Primary Care: An Innovative Approach to Reduce Health Disparities among Low Income Latinos Living with Type 2 Diabetes


Diabetes presents a major public health problem worldwide and in the United States. Diabetes is among one of four non-communicable diseases being targeted by the World Health Organization. It is estimated that there are 422 million adults living with diabetes worldwide, that is 1 in 11 people. Likewise, 1 out of 11 people in the U.S. have diabetes, a total of 29 million people. The American Diabetes Association in the U.S. has created standards for the medical care and diabetes self-management education and support (DSMES) for people with diabetes. Over the last 20 years DSMES has proven effective in improving physiological and psychosocial outcomes. Despite this, only half the people living with type 2 diabetes are currently at goal for their A1C and only 48% ever attend a program for DSMES. Shared Medical Appointments (SMA) have been proposed as one way of redesigning care to bridge this gap. Evidence from the last 15 years supports the implementation of SMA. This dissertation presents three manuscripts. The first is an integrative literature review on the effectiveness of SMA in treating type 2 diabetes. The second, describes the cultural adaptation process of ALDEA, (Latinos con Diabetes en Acción), a culturally adapted SMA program for Latinos with type w diabetes. The third manuscript describes the ALDEA SMA study. This is a six-month study of the effectiveness of ALDEA, a culturally adapted SMA clinic, for adult Latinos with type 2 diabetes, to improve hemoglobin A1C (A1C), low density lipoprotein (LDL) and blood pressure, compared to usual primary care (UPC). This quasi-experimental matched-controlled study included measures at baseline, 3 and 6 months. Results showed that after six months of treatment, SMA participants had achieved target A1C and had significantly greater reductions in mean A1C values compared to UPC . There were no statistically significant differences in the percentage of participants who achieved target LDL and blood pressure at 6 months between ALDEA and UPC. Results are clinically significant and provide initial evidence that ALDEA is an effective program that can potentially reduce health disparities in diabetes outcomes for adult Latinos.

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