Examining the Impact of Stories for Change - Diabetes
Hispanic/Latinx Americans are disproportionately impacted by type 2 diabetes (T2D) due, in part, to structural factors that lead to lower physical activity levels, dietary quality, medication adherence, and glucose self-monitoring than non-Hispanic White populations. To eliminate these disparities, culturally tailored interventions that enhance acceptance of healthy behaviors and improve T2D outcomes are needed. One intervention that has the potential to be successful is digital storytelling (DST).
Hispanic/Latinx Americans are disproportionately impacted by type 2 diabetes (T2D) due, in part, to structural factors that lead to lower physical activity levels, dietary quality, medication adherence, and glucose self-monitoring than non-Hispanic White populations. To eliminate these disparities, culturally tailored interventions that enhance acceptance of healthy behaviors and improve T2D outcomes are needed. One intervention that has the potential to be successful is digital storytelling (DST) (see Stories for Change - Diabetes). Through DST interventions, participants gain knowledge that informs behavior change which in turn enhances their healthcare outcomes and reduces illness. It is not known whether and how individual characteristics or disease type may influence how individuals respond to a tailored digital story. This project builds on Stories for Change (S4C) by evaluating how the impact of a DST intervention is influenced by sociodemographic factors such as age, gender, social support, knowledge, and T2D disease characteristics among Hispanic/Latinx populations.
We performed a secondary analysis to identify sociodemographic and disease status characteristics that influenced how participants respond to S4C. We analyzed results from S4C intervention participants (n=228), stratified by whether they experienced a clinically meaningful decrease (>0.5%) in hemoglobin A1c between baseline and three-month follow-up, and then identified factors associated with hemoglobin A1c. Participants with diabetes duration less than five years and/or whose diabetes self-efficacy improved between baseline and three-month follow-up were more likely to experience a meaningful decrease in hemoglobin A1c at three months (compared to participants without those characteristics). Next, we will interview S4C participants to further explain the results by asking participants how the factors identified did or did not contribute to their T2D-related behavior change. Finally, we will integrate our mixed methods findings to derive and visually display new insights beyond the information attained separately from the quantitative and qualitative results. These findings will allow DST interventions for Hispanic/Latinx patients with T2D to be more effectively tailored to those most likely to benefit.
Funding
National Institute of Diabetes and Digestive and Kidney Diseases (F32 DK135200)
Stories for Change (S4C) Diabetes
Racial and ethnic minorities in the United States, including immigrants and refugees, have higher rates of diabetes, and worse outcomes than the general population. Stories told by people who live successfully with diabetes may improve the health of people who are having difficulty living with diabetes.
Racial and ethnic minorities in the United States, including immigrants and refugees, have higher rates of diabetes, and worse outcomes than the general population. Stories told by people who live successfully with diabetes may improve the health of people who are having difficulty living with diabetes.
Stories for Change Diabetes is multi-phase project using a digital storytelling intervention aimed at improving diabetes management among Hispanic and Somali immigrants and refugees with type 2 diabetes. Phase 1 included development and deployment of a culturally and linguistically appropriate interview-based survey, in order to understand diabetes-related attitudes, knowledge and health-seeking behaviors among Hispanic and Somali adults with diabetes. Results from the survey were used to develop a focus group facilitation guide which was used in Phase 2. Focus group attendees included a subset of survey participants who were invited in order to learn more about their lived experiences with diabetes management. Transcripts from the focus groups were analyzed and emergent themes were used to inform the next phase. During Phase 3, a storytelling guide was developed. Eight participants were invited to share stories that centered on themes related to successful culturally relevant strategies for medication management, glucose self-monitoring, physical activity, and nutrition for diabetes. The study team worked with the Center for Digital Storytelling to develop and record eight digital stories during a multiday workshop. Phase 4 was a pilot feasibility project to test screening and enrollment processes and examine the potential effectiveness of these digital stories among 25 participants in five different clinical sites (four in Minnesota and one in Arizona). Participants found the stories to be interesting, attention-getting and useful. Implementation processes of this intervention in the clinical settings were streamlined. The intervention resulted in self-rated improvement in psychosocial constructs associated with healthy diabetes self-management behaviors, and some evidence of improvement in glycemic control.
In the current phase, RHCP is evaluating the effectiveness of these digitally recorded stories in improving health outcomes among Hispanic adults with diabetes, through a multi-site randomized clinical trial with partners at Mountain Park Health Center in Phoenix, AZ and Hennepin Healthcare in Minneapolis, MN. The study has enrolled and completed measurements on 455 participants. Data analysis is currently ongoing.
In addition, RHCP is evaluating the effectiveness of these digitally recorded stories in improving health outcomes among Somali adults with diabetes, through a randomized clinical trial in Rochester, MN.
Publications
Diabetes Knowledge, attitudes and Behaviors Among Somali and Latino Immigrants
Experiences of Hispanic Safety Net Clinic Patients with Diabetes During the COVID-19 Pandemic
Funding
Mayo Clinic: Values Council, Office of Health Disparities Research, and Center for Clinical and Translational Science
George Family Foundation: Catalyst Award
National Institutes of Health: National Institute of Diabetes and Digestive and Kidney Diseases (R01 DK 113999)
Materials
Stories for Change - Spanish
Stories for Change - Somali