JMIR Publications

ABSTRACT

Background:

Participating in a diabetes self-management education and support (DSMES) program improves self-care behaviors, quality of life, and health outcomes. However, language barrier and cultural differences can hinder participation, leaving many Vietnamese Americans (VNA) with limited access to DSMES services.

Objective:

This study aims to evaluate the feasibility, acceptability, and preliminary efficacy of a 3-month Blended Automated Links Augmented by Nurse Call and Engagement (BALANCE) intervention designed to deliver culturally-tailored DSMES in the Vietnamese language, with participants monitored for 12 months afterward to assess sustained effects on key outcomes.

Methods:

An explanatory sequential mixed-methods design was employed, guided by the Practical, Robust Implementation and Sustainability Model (PRISM) framework. Feasibility and acceptability were measured by participation rate of eligible clinics and patients, patient message response rate, and retention rate. Focus groups were conducted to assess adoption and sustainability. A pilot single-arm, prospective interventional trial was conducted with a sample of 88 VNA adults with type 2 diabetes (T2D) from 10 primary care clinics. Surveys were administered at baseline and every 3 months over 12 months. Repeated measures ANOVA assessed changes in clinical outcomes at 3, 6, 9, and 12 months. Qualitative data from in-depth interviews and focus groups were thematically analyzed to validate and expand on quantitative findings. Integrated analysis using joint display enabled meta-inferences across data sources.

Results:

Among 88 participants (mean age 68 years; range 35–86 years). The intervention did not significantly affect glycated hemoglobin A1c (HbA1c) (p=0.631) but led to a statistically and clinically significant reduction in low-density lipoprotein (LDL) (p=0.001) and improvement in exercise performance (p=0.044). Qualitative data from 45 patient interviews reached data saturation, with 80% describing the intervention as “convenient” and “helpful.” Clinic staff (n=18) participated in three focus groups endorsed the intervention as acceptable and feasible. Mixed methods analysis confirmed high feasibility (83% clinic participation, 100% clinic retention) and acceptability (90.9% patient retention). Key barriers to sustainability included limited staffing and supply infrastructure.

Conclusions:

Intervention feasibility and acceptability was demonstrated but requires further refinement to achieve long-term, consistent glycemic control. Findings highlighted that clinic staff workload impacted feasibility, and clinic workflow significantly affected the sustainability of the intervention. Future research should test BALANCE in a fully-powered randomized controlled trial (RCT) to evaluate intervention effectiveness.