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A Randomized Trial of a Church-Based Diabetes Self-management Program for African Americans With Type 2 Diabetes

From the Department of Nutrition, Schools of Public Health and Medicine and Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill (Dr Samuel-Hodge); Department of Medicine, School of Medicine and Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill (Dr Keyserling); Department of Biostatistics, School of Public Health and Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill (Dr Park); Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill (Mr Johnston, Dr Gizlice); Department of Biostatistics, School of Public Health and Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill (Dr Bangdiwala). Dr Park is currently at Family Health International, Research Triangle Park, North Carolina.

Correspondence: Thomas C. Keyserling, MD, MPH, CB# 7426, 1700 Martin Luther King Blvd, Chapel Hill, NC 27599-7426 (jato{at}med.unc.edu).

Purpose

This study developed and tested a culturally appropriate, church-based intervention to improve diabetes self-management.

Research Design and Methods

This was a randomized trial conducted at 24 African American churches in central North Carolina. Churches were randomized to receive the special intervention (SI; 13 churches, 117 participants) or the minimal intervention (MI; 11 churches, 84 participants). The SI included an 8-month intensive phase, consisting of 1 individual counseling visit, 12 group sessions, monthly phone contacts, and 3 encouragement postcards, followed by a 4-month reinforcement phase including monthly phone contacts. The MI received standard educational pamphlets by mail. Outcomes were assessed at 8 and 12 months; the primary outcome was comparison of 8-month A1C levels.

Results

At baseline, the mean age was 59 years, A1C 7.8%, and body mass index 35.0 kg/m²; 64% of participants were female. For the 174 (87%) participants returning for 8-month measures, mean A1C (adjusted for baseline and group randomization) was 7.4% for SI and 7.8% for MI, with a difference of 0.4% (95% confidence interval [CI], 0.1-0.6, P = .009). In a larger model adjusting for additional variables, the difference was 0.5% (95% CI, 0.2-0.7, P < .001). At 12 months, the difference between groups was not significant. Diabetes knowledge and diabetes-related quality of life significantly improved in the SI group compared with the MI group. Among SI participants completing an acceptability questionnaire, intervention components and materials were rated as highly acceptable.

Conclusions

The church-based intervention was well received by participants and improved short-term metabolic control.

This version was published on May 1, 2009

The Diabetes Educator, Vol. 35, No. 3, 439-454 (2009)
DOI: 10.1177/0145721709333270


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