Examining Implementation and Effects of a Diabetes Self-Management Education and Support Program for African American Women Living in Boston Public Housing

Abstract

African Americans are disproportionately at risk for type 2 diabetes and have limited access to quality diabetes care. This research used an empirical case study design to examine the implementation of a coordinated diabetes program and its effects on diabetes-related clinical health outcomes. The target population was African American women with type 2 diabetes, who lived in the public housing units of Boston—Roxbury neighborhood. Through their Diabetes Care Coordination Program, Whittier Street Health Center’s clinical team provided diabetes self-management education, support, and comprehensive diabetes clinical care using the Patient-Centered Medical Home (PCMH) model. Diabetes Health Ambassadors were mediators in community outreach, recruitment, and delivery of diabetes education and support to program participants. Rooted in behavior change strategies, the core intervention components included: 1) diabetes self-management education, 2) support for managing diabetes and distress, 3) enhancing access and linkage to care, 4) improving quality of care, 5) community organization, mobilization, and advocacy, and 6) health system and community transformation. A pre-test/post-test within-participant comparison was used to examine diabetes-related clinical health outcomes. The Diabetes Care Coordination Program was associated with modest improvements in diabetes-related clinical health outcomes for program participants (n=148). Results show statistically significant improvements in glycosylated hemoglobin or HbA1c (p=0.016), weight (p=0.021) and diastolic blood pressure (p=0.027) at the 0.05 level of significance (p < 0.05), using a paired t test. Using the PCMH model and Diabetes Health Ambassadors to deliver diabetes care has implications for future research and practice.