A Pilot Mixed Methods Randomized Control Trial Investigating the Feasibility and Acceptability of a Culturally Tailored Intervention Focused on Beliefs, Mistrust and Race-congruent Peer Support for Black Adults with Diabetes

Overview

Journal Front Public Health

Specialty Public Health

Date 2025 Feb 21

PMID 39980911

Authors

Meng-Jung Wen

Martha Maurer

Annika L Pickard

Makenzie Hansen

Olayinka O Shiyanbola

Affiliations

Soon will be listed here.

Abstract

Introduction: Black adults disproportionately experience poor glycemic control and medication nonadherence, yet few diabetes self-management programs address their unique health beliefs, provider mistrust and sociocultural barriers to taking diabetes medications. This 6-month pilot randomized feasibility trial compared a culturally tailored diabetes self-management program, incorporating beliefs about diabetes, mistrust, and race-congruent peer support to a standard diabetes program.

Methods: An embedded mixed methods design examined the feasibility of the pilot trial, including recruitment, retention, intervention adherence and participant acceptability. Data were collected through participant self-reported questionnaires, field notes, semi-structured interviews, and focus groups. Qualitative content analysis inductively explored participants' feedback on the program, participation barriers and potential strategies to overcome the challenges. Mixed methods integration was implemented using a side-by-side joint display to compare, synthesize and interconnect the quantitative and qualitative results across all feasibility domains.

Results: Thirteen participants (93%) completed the trial, demonstrating high adherence and retention. Community outreach and a prerequisite orientation using motivational interviewing were feasible and appropriate to recruit potential participants. Participants expressed high satisfaction and acceptability, highlighting the importance of peer support, cultural relevant content and a safe space for sharing experiences. Barriers to participation were identified including schedule conflicts and difficulties in engagement.

Discussion: Future large-scale effectiveness trials should consider combining multimedia into recruitment methods, tailoring the program to address medication-taking goals, and addressing social and environmental barriers to support sustained lifestyle changes.

References

Shiyanbola O, Maurer M, Schwerer L, Sarkarati N, Wen M, Salihu E . A Culturally Tailored Diabetes Self-Management Intervention Incorporating Race-Congruent Peer Support to Address Beliefs, Medication Adherence and Diabetes Control in African Americans: A Pilot Feasibility Study. Patient Prefer Adherence. 2022; 16:2893-2912. PMC: 9617564. DOI: 10.2147/PPA.S384974. View

Lagisetty P, Priyadarshini S, Terrell S, Hamati M, Landgraf J, Chopra V . Culturally Targeted Strategies for Diabetes Prevention in Minority Population. Diabetes Educ. 2017; 43(1):54-77. PMC: 5408505. DOI: 10.1177/0145721716683811. View

Hawkins J, Mitchell J, Piatt G, Ellis D . Older African American Men's Perspectives on Factors That Influence Type 2 Diabetes Self-Management and Peer-Led Interventions. Geriatrics (Basel). 2019; 3(3). PMC: 6319245. DOI: 10.3390/geriatrics3030038. View

Shiyanbola O, Brown C, Ward E . "I did not want to take that medicine": African-Americans' reasons for diabetes medication nonadherence and perceived solutions for enhancing adherence. Patient Prefer Adherence. 2018; 12:409-421. PMC: 5865580. DOI: 10.2147/PPA.S152146. View

Wen M, Maurer M, Schwerer L, Sarkarati N, Egbujor U, Nordin J . Perspectives on a Novel Culturally Tailored Diabetes Self-Management Program for African Americans: A Qualitative Study of Healthcare Professionals and Organizational Leaders. Int J Environ Res Public Health. 2022; 19(19). PMC: 9566600. DOI: 10.3390/ijerph191912814. View

Rozenfeld Y, Hunt J, Plauschinat C, Wong K . Oral antidiabetic medication adherence and glycemic control in managed care. Am J Manag Care. 2008; 14(2):71-5. View

Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A . Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health. 2010; 38(2):65-76. PMC: 3068522. DOI: 10.1007/s10488-010-0319-7. View

Gamble V . Under the shadow of Tuskegee: African Americans and health care. Am J Public Health. 1997; 87(11):1773-8. PMC: 1381160. DOI: 10.2105/ajph.87.11.1773. View

Rao D, Meyer J, Maurer M, Shiyanbola O . Perceptions of psychosocial and interpersonal factors affecting self-management behaviors among African Americans with diabetes. Explor Res Clin Soc Pharm. 2022; 3:100057. PMC: 9029920. DOI: 10.1016/j.rcsop.2021.100057. View

10.

. 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes-2024. Diabetes Care. 2023; 47(Suppl 1):S77-S110. PMC: 10725816. DOI: 10.2337/dc24-S005. View

11.

Lawrence D, Ragucci K, Long L, Parris B, Helfer L . Relationship of oral antihyperglycemic (sulfonylurea or metformin) medication adherence and hemoglobin A1c goal attainment for HMO patients enrolled in a diabetes disease management program. J Manag Care Pharm. 2006; 12(6):466-71. PMC: 10437554. DOI: 10.18553/jmcp.2006.12.6.466. View

12.

Perneger T, Brancati F, Whelton P, Klag M . End-stage renal disease attributable to diabetes mellitus. Ann Intern Med. 1994; 121(12):912-8. DOI: 10.7326/0003-4819-121-12-199412150-00002. View

13.

Powers M, Bardsley J, Cypress M, Duker P, Funnell M, Fischl A . Diabetes Self-Management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. J Acad Nutr Diet. 2015; 115(8):1323-34. DOI: 10.1016/j.jand.2015.05.012. View

14.

Schectman J, Nadkarni M, Voss J . The association between diabetes metabolic control and drug adherence in an indigent population. Diabetes Care. 2002; 25(6):1015-21. DOI: 10.2337/diacare.25.6.1015. View

15.

Goldberg J, Kiernan M . Innovative techniques to address retention in a behavioral weight-loss trial. Health Educ Res. 2004; 20(4):439-47. DOI: 10.1093/her/cyg139. View

16.

Williams I, Utz S, Hinton I, Yan G, Jones R, Reid K . Enhancing diabetes self-care among rural African Americans with diabetes: results of a two-year culturally tailored intervention. Diabetes Educ. 2014; 40(2):231-9. PMC: 4692724. DOI: 10.1177/0145721713520570. View

17.

Singh H, Fulton 4th J, Mirzazada S, Saragosa M, Uleryk E, Nelson M . Community-Based Culturally Tailored Education Programs for Black Communities with Cardiovascular Disease, Diabetes, Hypertension, and Stroke: Systematic Review Findings. J Racial Ethn Health Disparities. 2022; 10(6):2986-3006. PMC: 10645635. DOI: 10.1007/s40615-022-01474-5. View

18.

Yancey A, Ortega A, Kumanyika S . Effective recruitment and retention of minority research participants. Annu Rev Public Health. 2006; 27:1-28. DOI: 10.1146/annurev.publhealth.27.021405.102113. View

19.

Sherman L, Hawkins J, Bonner T . An Analysis of the Recruitment and Participation of African American Men in Type 2 Diabetes Self-Management Research: A Review of the Published Literature. Soc Work Public Health. 2016; 32(1):38-48. DOI: 10.1080/19371918.2016.1188742. View

20.

Jones R, Steeves R, Williams I . Strategies for recruiting African American men into prostate cancer screening studies. Nurs Res. 2009; 58(6):452-6. PMC: 2886148. DOI: 10.1097/NNR.0b013e3181b4bade. View