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Tailoring a Diabetes Self-Care Intervention for Use With Older, Rural African American Women

From the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Funded through grant R01 NR008582 from the National Institute of Nursing Research to the School of Nursing, University of North Carolina at Chapel Hill.

Correspondence to Jennifer Leeman, MDiv, DrPH, University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, NC 27599-7460 (jleeman{at}email.unc.edu).

Purpose

The purpose of this study was to tailor a diabetes management intervention to the cultural and age-related needs and preferences of older, rural African American women.

Methods

Findings from exploratory research, clinical experience, and review of the literature were used to inform the development of a culture- and function-specific intervention. Findings informed the design of the intervention, format of intervention delivery, format of intervention materials, and training provided to interventionists. Intervention materials were reviewed by a community advisory board, and the intervention was pilot tested with 43 women.

Results

The intervention's delivery was tailored to the needs of older African American women through the use of 1-hour, in-home sessions that used a storytelling format to share information. The design of the intervention individualized its content to each woman's symptom experience, self-care practices, and coping strategies. Extensive training sensitized intervention nurses to coping strategies (spirituality, church, family) and barriers to self-care (functional limitations, stress, the multi-caregiver role) that are common among older African American women. Intervention materials were culturally sensitive and in large-print format.

Conclusions

African American women's cultural background may have a strong influence on health behaviors and beliefs. Older women's health behaviors are further influenced by changes in their functional abilities. Therefore, the authors tailored a diabetes self-care management intervention to be specific to older African American women's cultural and functional differences. An initial pilot of the intervention found high levels of participant satisfaction with the intervention, improvements in diabetes self-care practices, and a trend toward greater metabolic control.

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