Family-Based, Culturally Responsive Intervention for Chinese Americans With Diabetes: Lessons Learned From a Literature Review to Inform Study Design and Implementation

Abstract

Background: The prevalence of diabetes in the United States is very high, and Chinese peoples with diabetes are estimated to comprise 50% of the total cases. Rates of diabetes continue to rise among Chinese and Chinese American people; however, research regarding effective diabetes interventions for this minority group is sparse.

Objective: A literature review was conducted to determine a study design and interventions for future studies investigating the efficacy of a family-based intervention to improve diabetes care for Chinese Americans.

Methods: The review was conducted from January 2023 to April 2023. The PubMed, CINAHL, ScienceDirect, ProQuest, Google Scholar, Scopus, and Cochrane Central Register of Controlled Trials databases were searched. The key search terms were "diabetes type 2," "Chinese patients," "minority patients," "interventions for diabetes," "diabetes and family," "culturally responsive interventions for diabetic patients," "family education for diabetes," and "diabetes in China."

Results: The initial search retrieved 2335 articles, and 10 articles met the selection criteria to examine the efficacy of family-based interventions for Chinese American people. The review showed that providing multiple sessions of education and counseling for both patients and family members is promising for improving diabetes care. Recruitment of 20 to 60 dyads consisting of a patient and a family member can help assess family dynamics in the process of diabetes care, such as food shopping and preparation, and of diabetes management to further evaluate the efficacy of an intervention. Glycated hemoglobin (HbA_1c) was the most often used primary outcome. Other secondary outcomes included knowledge and efficacy in diabetes management and self-care activities related to diabetes care.

Conclusions: A family-based intervention is essential for optimizing diabetes care for Chinese Americans. Thus, recruitment of a dyad consisting of a patient and a family member is important to investigate the efficacy of a family-based intervention for improving diabetes care in this population. Strategies for improving recruitment and retention of dyads were identified. In addition, technology can be used to promote the delivery of interventions to patients, which in turn increases efficacy. This review can help researchers investigate the efficacy of family-based interventions for promoting diabetes management by designing culturally appropriate study protocols and interventions.

Keywords: Chinese; Chinese Americans; HbA1c; cultural intervention; diabetes; diabetes care; diabetes management; effectiveness; family-based intervention; implementation; intervention; patient; patient education; prevalence; systematic review.