Method of Developing a Culturally Tailored Diabetes Intervention for American Indians.

BACKGROUND: American Indians have the highest prevalence of type 2 diabetes compared with any other racial or ethnic group. OBJECTIVE: Developing a culturally tailored diabetes prevention and management intervention is one way to reduce diabetes-related health disparities among American Indian populations. The purpose of this article is to describe our approach for developing a diabetes prevention and management intervention study using Kolb's Experiential Learning Theory as the framework. METHODS: To ensure the intervention study was culturally meaningful and relevant we used community-based participatory principles by partnering with a team of nurse researchers, tribal diabetes educators, tribal leaders, and tribal community members who were involved in all aspects of the study process. We conducted seven focus groups predominantly in rural American Indian communities in Oklahoma. Using focus group findings, the team collaboratively designed and developed a multi-generational diabetes prevention and management intervention study. The intervention group sessions will focus on ways to prevent and manage diabetes while the control group sessions will focus on general health education topics that have been identified by the team as important and relevant. CONCLUSIONS: Family interventions that involve multiple generations and provide emotional and behavioral support to those with type 2 diabetes and family members at risk may provide our best chance at improving diabetes-related outcomes and reducing health disparities in this critical population.

Developing a culturally tailored multigenerational intervention to prevent and manage type 2 diabetes in American Indian families living in rural settings: Findings from a focus group study.

The study purpose was to understand the characteristics of interventions that would be most relevant and beneficial to address the diabetes-related needs and challenges of rural American Indians/Alaska Natives (AIAN) with type 2 diabetes (T2D) and their families. In an exploratory study design, we held a total of seven focus groups in Florida and rural Oklahoma. Groups included 3-13 individuals (62 total, 77% were female, mean age 55.3 [11.4] years and mean duration of diabetes 10.4 [SD 9.1] years) who were referred by staff from HealthStreet, Consent2Share mechanism, and by tribal educators. All groups were moderated by the same American Indian research team member using a discussion guide with open-ended questions, followed by probes. Findings revealed themes centered on optimal intervention components, barriers to type 2 diabetes-prevention and management (T2D-PM), personal experiences with T2D, and impact of family behaviors on T2D-PM. Findings indicate that the participants desire diabetes programs that include family members and a hands-on, culturally meaningful approach. Creating an intervention based on the AIAN community's insights that include the entire family may improve T2D-PM outcomes for this population.