JMIR Publications

ABSTRACT

Background:

Background. High prevalence of Type 2 diabetes (T2D) and associated complications disproportionately affect low-income Latino adults. Low-income Latino populations also experience disparities in diabetes self-management, including poor medication adherence, physical activity, diet, and glycemic control. To address these challenges, an academic-community partnership developed and evaluated ¡Salud, Salud!, an evidence-based family-centered diabetes self-management education and support (DSMES) program for low-income Latino adults with T2D or prediabetes.

Objective:

This study examined the effectiveness of ¡Salud, Salud! on primary (glycemic control and quality of life) and secondary outcomes (social, psychological, and behavioral factors related to T2D management).

Methods:

Eighty-one adults (mean age 48.90, SD 12.57; 70% female; 82% Latino) with T2D or pre-diabetes enrolled in a 12-week, single-arm quasi-experimental study. ¡Salud, Salud! incorporated individual coaching by Community Health Workers (CHWs), online family-centered DSMES training lessons, and a YMCA family membership. The delivery of ¡Salud, Salud! was supported and facilitated by digital technologies, including a dashboard to deliver intervention content and monitor participants’ engagement in intervention activities. Trained CHWs delivered the program at two Central Texas YMCA locations. Outcomes measured at baseline and 12 weeks (i.e., post intervention) included hemoglobin A1c (HbA1c), quality of life, anthropometrics, self-reported physical activity and diet, mindfulness, perceived stress, and diabetes-related knowledge, self-efficacy, and support. Participant engagement in program activities was also assessed via four index variables: family engagement and support, participation in self-management education, program support and facilitation, and participation in self-monitoring that underlay multiple dimensions of influences on the uptake of ¡Salud, Salud!. Paired t-tests and McNemar’s chi-square tests were used to examine change in outcomes from baseline to 12 weeks. The number of program activities participants completed for each engagement index variable was converted to percentages to estimate the mean proportion of activities completed.

Results:

Forty-eight participants (59%) completed the 12-week posttest. At the end of the program, participants demonstrated a marginally significant reduction in HbA1c (-0.30, p ≤ 0.09) and a significant increase in the proportion reporting good to excellent health from baseline (42%) to posttest (62%; p≤ 0.003). Significant reductions in body weight (-1.30 kg, p = 0.02), body fat percentage (-1.26, p = 0.01), perceived stress (-0.28, p = 0.02), added sugar intake (-2.15 tsp/day, p = 0.001), and time spent sedentary per week (-70.27 min, p = 0.003) from baseline to 12-week posttest. Mindfulness increased significantly (2.21, p = 0.01). Participant engagement in ¡Salud, Salud! varied, with participants exhibiting high completion of program support and facilitation activities (88%), and moderate-to-low completion of participation in self-management training (66%), self-monitoring (56%), and family engagement and support (49%) activities.

Conclusions:

¡Salud, Salud! showed promising preliminary effects on key diabetes-related outcomes. Future research should investigate how to enhance participant engagement and optimize uptake of evidence-based T2D self-management practices among low-income Latino adults with diabetes.