Managing Diabetes Health Promotion Project Alfreda M. Lewis, RN

Objective Provide culturally specific interventions to enhance health literacy and self-efficacy among African-Americans with diabetes. Provide heightened awareness of Diabetes seriousness through ethnically-adopted means of communication. Translate evidence into clinical practice that will improve the outcomes for ethnic and culturally diverse diabetic patients.

Defining the Problem Seventh leading cause of death in the United States. Leading cause of kidney failure, non-traumatic lower-limb amputations,& new cases of blindness in the U.S. A major cause of heart disease. African-Americans are disproportionately affected. Culturally-appropriate education based on EBP is vitally important for optimal patient outcomes.

Reason & Collaboration The cost for successful treatment of diabetes is staggering; the cost of missed treatments is overwhelming Reducing avoidable risk factors through effective education can markedly reduce diabetes-related complications. Diabetes education has long been held to be the cornerstone of effective diabetes care.

Reason & Collaboration The Balanced Budget Act of 1997 sanctioned demonstration projects that promote quality care and improve patient outcome . Traditional educational programs have not been effective with the African-American population. Studies show that culturally and age-appropriate programs improve outcomes in this population.

Reason & Collaboration Through collaboration with a local MD in Montgomery, Al, the need for specific diabetic educational interventions geared specifically to the African-American population to improve life expectancy and optimal outcomes was confirmed. His African-American pts have HbA1c levels in excess of 9.0-10% with the average fasting FSBS ranging from 180-220. Traditional ADA teachings obviously are not working.

Design of the project Educational interventions were designed using King’s Theory of Goal Attainment Model. The design recognized that primary modes of learning for southern African-Americans are shared cooking situations, storytelling, role modeling, and by trial and error. Spiritual beliefs were intricate to educational sessions

Delivery of Project African-American patients > 19 years old needing diabetic education were identified by the MD. The group session included 7 family and friends. Participant’s perception of the ability to manage self-care was measured pre/post education using Diabetes Self-Efficacy Measurement Tool. The educational session lasted 1-1/2 hours.

Summary of Education Daily fasting FSBS/consistent logging of results. Dietary management using EBP successful carbohydrate counting (see handout). Culturally geared in-home exercises/lifestyle changes (see handout).

Evaluation Project effectiveness was measured using The Diabetes Self-Efficacy Measurement Tool ( an 8-item post-education questionnaire that determines client confidence with providing self-care as taught). Scale ranges from 0 (not at all confident) to 10 (confident). 6 of the 7 participants felt more knowledgeable and capable of diabetes self-care management