@article{5f6cc91e598b491fad2df2eff372f451,
title = "Comparative effectiveness and maintenance of diabetes self-management education interventions for Marshallese patients with type 2 diabetes: A randomized controlled trial",
abstract = "OBJECTIVE Marshallese adults experience high rates of type 2 diabetes. Previous diabetes self-management education (DSME) interventions among Marshallese were unsuccessful. This study compared the extent to which two DSME interventions improved glycemic control, measured on the basis of change in glycated hemoglobin (HbA1c). RESEARCH DESIGN AND METHODS A two-arm randomized controlled trial compared a standard-model DSME (standard DSME) with a culturally adapted family-model DSME (adapted DSME). Marshallese adults with type 2 diabetes (n = 221) received either standard DSME in a community setting (n = 111) or adapted DSME in a home setting (n = 110). Outcome measures were assessed at baseline, immediately after the intervention, and at 6 and 12 months after the intervention and were examined with adjusted linear mixed-effects regression models. RESULTS Participants in the adapted DSME arm showed significantly greater declines in mean HbA1c immediately (20.61% [95% CI 21.19, 20.03]; P = 0.038) and 12 months (20.77% [95% CI 21.38, 20.17]; P = 0.013) after the intervention than those in the standard DSME arm. Within the adapted DSME arm, participants had significant reductions in mean HbA1c from baseline to immediately after the intervention (21.18% [95% CI 21.55, 20.81]), to 6 months (20.67% [95% CI 21.06, 20.28]), and to 12 months (20.87% [95% CI 21.28, 20.46]) (P < 0.001 for all). Participants in the standard DSME arm had significant reductions in mean HbA1c from baseline to immediately after the intervention (20.55% [95% CI 20.93, 20.17]; P = 0.005). CONCLUSIONS Participants receiving the adapted DSME showed significantly greater reductions in mean HbA1c immediately after and 12 months after the intervention than the reductions among those receiving standard DSME. This study adds to the body of research that shows the potential effectiveness of culturally adapted DSME that includes participants{\textquoteright} family members.",
author = "McElfish, {Pearl A.} and Long, {Christopher R.} and Kohler, {Peter O.} and Yeary, {Karen H.K.} and Zoran Bursac and Narcisse, {Marie Rachelle} and Felix, {Holly C.} and Brett Rowland and Hudson, {Jonell S.} and Goulden, {Peter A.}",
note = "Funding Information: Acknowledgments. The authors thank the participants who made this study possible, local Mar-shallese faith leaders, the Arkansas Coalition of Marshallese, the Gaps in Services to Marshallese Task Force, and the Marshallese Consulate General in Springdale, Arkansas. The authors also thank members of the study team and community advisory board who are not authors here but whose work contributed to the success of the study: Sheldon Riklon, Lisa Smith, Gwen Wiley, Wana Bing, Kejjo Clarence, Krista Langston, Morda Net-won, Mandy Ritok-Lakien, Tori Rowe, Jellesen Rubon-Chutaro, Karra Sparks, Melissa Wann, Ralph Wilmoth, Tracy Canant (all from University of Arkansas for Medical Sciences Northwest, Fayetteville, AR), Nia Aitaoto (University of Utah, Salt Lake City, UT), Melisa Laelan (Arkansas Coalition of Marshallese, Springdale, AR), Erica Powell (North-west Medical Center, Lowell, AR), Melissa Brown (Medical Arts Pharmacy, Fayetteville, AR), Charles Heam (Seventh Day Adventist Church, Springdale, AR), Sandy Joel (Jouj Jesus Church, Springdale, AR), Sadie Briand Kabua (Community Clinic, Springdale, AR), Primrose Jones (Community Clinic, Springdale, AR), and Joe Kaminaga (Arkansas Department of Health, Springdale, AR). Funding. Financial support for the study was provided by the Patient-Centered Outcomes Research Institute (grant no. AD-1310-07159). Initial funding for a pilot project of the study was provided by a University of Arkansas for Medical Sciences College of Medicine Intramural Sturgis Grant for Diabetes Research from the Sturgis Foundation. Additional support for the community-based participatory research team was provided by the Translational Research Institute at the National Center for Advancing Translational Sciences, National Institutes of Health (grant no. 1U54TR001629-01A1).",
year = "2019",
month = may,
day = "1",
doi = "10.2337/dc18-1985",
language = "English (US)",
volume = "42",
pages = "849--858",
journal = "Diabetes Care",
issn = "1935-5548",
publisher = "American Diabetes Association Inc.",
number = "5",
}