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Culturally adapting an evidence-based diabetes self-management education program for black adults: a pilot mixed
Olubukola Tikare1, Helen Omuya2, Meng-Jung Wen3
1Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, United States.
Introduction:
Black adults in the United States disproportionately experience type 2 diabetes and related complications, yet participation in diabetes self-management education (DSME) is low. Culturally adapted approaches are needed to improve engagement and outcomes. This pilot study evaluated the implementation of a co-designed culturally adapted DSME program for Black adults using the RE-AIM framework and Proctor's implementation outcomes.
Design:
This pilot mixed-methods implementation study evaluated a culturally adapted 6-week group based DSME program delivered in community settings. Thirty-two Black adults with diabetes or prediabetes were enrolled. Implementation outcomes included attendance, retention, and satisfaction. Participant-reported outcomes were assessed at baseline and 6 months, and qualitative interviews explored participant experiences.
Results:
Retention was 100%, with high attendance (86%) and strong satisfaction, indicating high feasibility and acceptability. Participants reported improvements in engagement, empowerment, and self-care behaviors. Qualitative findings highlighted the role of culturally affirming facilitation, trust and group support in promoting participation in DSME. Participants' mean age was 57; 81% were female, and 75% had type 2 diabetes. Participants reported improvements in overall health (12.1%, p = 0.02), patient health engagement (82.8%, p < 0.01), and diabetes empowerment (19.7%, p < 0.01). Self-care behaviors, such as diet, blood glucose monitoring, and foot care, improved significantly. Retention was 100%, with average attendance of 86% and high satisfaction (mean 4.2/5). Qualitative findings highlighted empowerment, accountability, and trust, fostered by culturally affirming facilitation and group support. Participants recommended longer sessions and hybrid formats.
Conclusion:
The program was feasible and acceptable, and was associated with improvements in self-reported self-care and empowerment among Black adults. Findings support further testing in larger trials to assess long-term effectiveness and implementation. Given the single-arm design, findings should be interpreted as exploratory.