Felicia Hill-Briggs|Mariana Lazo|Mark Peyrot|Angela Doswell|Yi Chang|Martha N. Hill|David M. Levine|Nae Yuh Wang|Frederick L. Brancati
Effect of Problem-Solving-Based Diabetes Self-Management Training on Diabetes Control in a Low Income Patient Sample
Johns Hopkins University|Johns Hopkins Medicine|Johns Hopkins University|Loyola University Maryland|University of Maryland, Baltimore|Johns Hopkins University|Johns Hopkins Medicine|Johns Hopkins University|Johns Hopkins Medicine|Johns Hopkins University|Johns Hopkins University|Johns Hopkins University|Johns Hopkins Medicine|Johns Hopkins University
lower socioeconomic status associated excess disease burden diabetes diabetes selfmanagement support interventions needed effective engaging lower income patients addressing competing life priorities barriers selfcare facilitating behavior changeto pilot test feasibility acceptability effect disease control problembased diabetes selfmanagement training adapted low literacy accessibilitytwoarm randomized controlled trial powered detect 050 change a1c followup 2sided alpha 005 pooled analysisfiftysix urban africanamerican patients type 2 diabetes suboptimal blood sugar blood pressure cholesterol control recruited diabetes registry within universityaffiliated managed care organizationa group problembased diabetes selfmanagement training designed delivery intensive condensed program format three intensive three condensed program groups conducted trialclinical a1c systolic blood pressure sbp diastolic blood pressure dbp ldl hdl cholesterol behavioral knowledge problem solving selfmanagement behavior data measured baseline postintervention 3 months postintervention corresponding 69 months following baselineadoption programs high 85 attendance rates 95 retention 3 months postintervention betweengroup difference a1c change 072 p 002 favor intensive program a1c reduction partially mediated problemsolving skill followup 013 p 004 intensive program patients demonstrated withingroup improvements knowledge p 0001 problemsolving p 001 selfmanagement behaviors p 004 among subsets patients suboptimal blood pressure lipids baseline intensive program yielded clinically significant individual improvements sbp dbp ldl cholesterol patient satisfaction usability ratings high programsa literacyadapted intensive problemsolvingbased diabetes selfmanagement training effective key clinical behavioral outcomes lower income patient sample