JMIR Publications

ABSTRACT

Background:

Although progress has been made in improving the efficacy of Diabetes Self-Management Education (DSME) programs, there continues to be a dearth of research on culturally adapting evidence-based DSMEs for Chinese Americans (CA) with Type 2 diabetes.

Objective:

Through collaborative partnerships with two large community recreation centers and the AHMC hospital network in San Gabriel Valley, California, we developed and pilot tested a culturally tailored DSME program with mHealth technology integration, entitled Culturally Appropriate Strategies for Chinese Americans with Diabetes (CASCADe).

Methods:

The CASCADe program utilized a combined, theoretically driven, and community-participatory approach and was developed based on information gleaned from focus groups, semi-structured interviews, and a questionnaire survey among Chinese American diabetic patients, physicians, and nurses, as well as extensive literature reviews of evidence-based program curricula. A single-group pre- and post-test design with a 3-month study period was then employed to assess the program's preliminary efficacy. The study protocols were registered on ClinicalTrials.gov.

Results:

The CASCADe program consisted of 1) a home visit in the first month for training of monitoring device use and WeChat app (a mobile platform of instant messaging widely used in Chinese population) usage, and acquiring family support, 2) eight weekly sessions over the following two months of a combined format of group classes, games, group exercises, video, and discussions, 3) WeChat follow-up on education tips, monitoring data summary, and group discussion after each of eight weekly sessions. Topics of weekly sessions included recognition of diabetes and its complications, risk factors, nutrition knowledge, dietary practices, exercise, behavioral self-monitoring, medication adherence, and stress management. The monitoring system used a smartphone to coordinate cloud data transmission from a set of wireless devices to capture daily monitoring data on physical activity, body weight, blood pressure, and blood glucose levels. Behavioral self-monitoring was further facilitated by the WeChat app, which provided daily messages related to the diabetes education curriculum, weekly summary reports on monitoring data, feedback, bidirectional one-on-one communication between intervention providers and participants, and group discussions among participants on readings and implications of monitoring results. The pre- and post-comparison from the 3-month pilot trial of the program showed a significant reduction in HbA1c (7.28 vs. 7.68, p=.02), with all but one participant showing a reduction, and 50% achieving >0.5 HbA1c reduction. Significant improvement was also observed in self-efficacy in diabetes management (8.45 vs. 6.16, p=.04), quality of life (2.68 vs. 1.92, p=.007), and stress-coping skills (3.90 vs. 3.09, p=.03) at 3 months after baseline among Chinese American patients with Type 2 diabetes.

Conclusions:

Our pilot study demonstrated the feasibility of implementing our CASCADe program among CAs to improve diabetes self-management skills and yielded promising results, warranting further testing in a larger randomized trial. Clinical Trial: The protocol of the CASCADe intervention delivery and evaluation (i.e., Phase II study) was also registered on the ClinicalTrials.gov Protocol Registration and Results System (ClinicalTrials.gov Identifier: NCT04737499).