Initiating Culturally-Directed Education for Hispanic Adults with Type 2 Diabetes Mellitus

BACKGROUND:

The U.S. Hispanic population has the highest rate of Type 2 diabetes mellitus (T2DM), which is influenced by socio-economic status and language barriers. Current evidence suggests that the delivery of culturally-directed Diabetes Self-Management Education (DSME) with the use of an interpreter can reduce diabetes-associated complications.

LOCAL PROBLEM:

The project took place at a free clinic in North Carolina. The purposes of this project was to create a culturally-directed DSME bundle for Hispanic adults with the use of a Spanish interpreter to improve understanding of T2DM management.

METHODS:

The Johns Hopkins Nursing Evidence-Based Practice Model (JHNEBP) was the guiding framework to evaluate the effectiveness of DSME education. Pre- and post-intervention data were measured to evaluate diabetes knowledge, self-efficacy, and HbA1c levels.

INTERVENTIONS:

Private DSME sessions were piloted with a Spanish interpreter to seven Hispanic adult patients with T2DM. Two survey instruments translated to Spanish were used to evaluate the reported impact of knowledge and self-efficacy before and after the education session. HbA1c levels were measured prior to initiation of DSME session and 3 months following the DSME session.

RESULTS:

Diabetes knowledge, measured by the SKILL-D survey, increased significantly demonstrated by Wilks’ lambda = .068, F(2,3) = 20.461, p = .018. Diabetes self-efficacy, measured by the DES survey, increased significantly demonstrated by Wilks’ lambda = .060, F(2,3) = 23.516, p = .015. HbA1c levels decreased significantly from (M = 10.8; SD = 2.167) to (M = 6.98; SD = 1.18); [t(6) = 4.01 = p = [<.004].

CONCLUSIONS:

Results show that diabetes knowledge and self-efficacy significantly increased and HbA1c levels significantly decreased by integrating DSME into standard of practice. Evaluation of baseline knowledge and empowerment in the patient’s primary language is a crucial first step in providing culturally-directed education to improve understanding of T2DM management.