JMIR Publications

ABSTRACT

Background:

Chinese Americans, despite facing a disproportionately high burden of type 2 diabetes (T2D), have limited access to evidence-based diabetes self-management programs. Barriers include linguistic, cultural, and systemic challenges, particularly among those with low income and limited English proficiency. There is a critical need for culturally and linguistically tailored interventions that can support diabetes self-management in this population.

Objective:

To evaluate the potential efficacy of a culturally and linguistically tailored intervention (CARE project) on diabetes self-efficacy and self-care among Chinese Americans.

Methods:

A two-arm pilot randomized controlled trial was conducted to evaluate the CARE project between March 1, 2021, and April 21, 2023. The trial included 60 Chinese Americans aged 18 to 70 who had a diagnosis of T2D and a baseline HbA1c level of 7% or higher. Participants were recruited from various healthcare settings in New York City, including community health centers, private primary care providers, NYU Langone Health, and its affiliates, and were randomly assigned to either the intervention group (n=30) or a wait-list control group (n=30). The intervention consisted of two culturally and linguistically tailored educational videos per week for 12 weeks, covering diabetes self-care topics such as healthy eating, physical activity, and medication adherence. These videos were delivered via the WeChat app. In addition, community health workers provided support calls every two weeks. Outcomes were assessed at baseline, 3 months, and 6 months. The primary outcomes included patient-reported self-efficacy for diabetes, diabetes self-care activities, beliefs about diabetes self-care, and diabetes distress.

Results:

Participants had a mean age of 54.3 years. 62% (37/60) were male, 78% (47/60) were married, 58% (35/60) were employed, 70% (42/60) had less than a high school education, and 88% (53/60) had limited English proficiency. Intervention participants demonstrated a greater increase in self-efficacy at 3 months (8.47; 95% CI: 2.44–14.5; adjusted P =.019), reduced diabetes distress at 6 months (-0.43; 95% CI: -0.71– -0.15; adjusted P =.009), and higher adherence to a healthy diet at both 3 months (1.61; 95% CI: 0.46–2.75; adjusted P =.02) and 6 months (1.64; 95% CI: 0.48–2.81; adjusted P =.018).

Conclusions:

The culturally and linguistically tailored intervention showed promise in improving self-efficacy and diabetes self-care among Chinese Americans with T2D, warranting validation through a large-scale RCT. Clinical Trial: ClinicalTrials.gov, NCT03557697, https://clinicaltrials.gov/study/NCT03557697.