Feasibility and efficacy of a pilot family model of diabetes self-management intervention in the Republic of the Marshall Islands

Jennifer A Andersen; Holly Felix; James Selig; Brett Rowland; Wana Bing; Jonell Hudson; Jack Niedenthal; Henry Otuafi; Sheldon Riklon; Edlen Azures; Ainrik George; Pearl A McElfish

doi:10.1016/j.conctc.2021.100824

Feasibility and efficacy of a pilot family model of diabetes self-management intervention in the Republic of the Marshall Islands

Contemp Clin Trials Commun. 2021 Jul 30:23:100824. doi: 10.1016/j.conctc.2021.100824. eCollection 2021 Sep.

Authors

Affiliations

¹ College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA.
² Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA.
³ Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA.
⁴ College of Pharmacy, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA.
⁵ Republic of the Marshall Islands Ministry of Health & Human Services, Majuro, 96960, MH, USA.

Abstract

Background: The Republic of the Marshall Islands (RMI) faces numerous health disparities, including one of the highest prevalence of type 2 diabetes mellitus (T2DM) in the world. Diabetes self-management education and support (DSMES) has shown efficacy in improving glycemic control and through increases in knowledge and self-management activities; however, there is limited research on DSMES in the RMI. This study evaluated the feasibility and efficacy of a culturally adapted family model of DSMES (F-DSMES) in the RMI. The F-DSME included 8 h of group educational classes delivered in churches by a community health worker.

Methods: This pilot study assessed retention and dosage rates (e.g., class attendance) among the participants with T2DM (n = 41). Efficacy was evaluated by examining pre- and post-intervention differences in HbA1c, knowledge, family support, and self-management activities among those who completed the post-intervention data collection (n = 23).

Results: The results indicate completion of post-intervention data collection and attendance were associated; 70% of participants who completed the post-intervention data collection received at least 6 h of intervention compared to 3 h for those who did not. Although the reduction in HbA1c was not statistically significant, participants demonstrated statically significant increases in knowledge, family support, and an increase in self-management including in checking of blood glucose and feet.

Conclusions: This study provides important information to help address T2DM disparities in the RMI, including the feasibility and efficacy of F-DSMES. Additional research will help in understanding how to translate improvements in knowledge, family support, and self-management activities into improvements in HbA1c. This may include addressing social ecological factors that affect glycemic control.

Keywords: Diabetes self-management education; HbA1c; Marshallese; Pre- and post-intervention; Type 2 diabetes mellitus.