Biopsychosocial outcomes of a resilience and diabetes self-management education intervention in African American adults with type 2 diabetes
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Type 2 diabetes (T2DM) currently affects more than three million African American adults with double the number expected by 2025. The most effective and safest treatment for T2DM is lifestyle change therapy, including healthful eating, monitoring of blood glucose, and physical activity. However, current lifestyle change interventions are limited in their scope to alter the behaviors of individuals to more healthful ones. These limitations may be attributed, in part, to a lack of attention given to enhancing an individual’s psychosocial process variables, such as resilience, coping skills, selfleadership, and empowerment. Incorporating resilience education into lifestyle change therapies is a novel approach that addresses the behavior modification limitations of current interventions by aiming to enhance psychosocial process variables. Therefore, the purpose of this project was to conduct a six-month pilot study to determine the feasibility of our resilience and diabetes self-management intervention, The Diabetes Coaching Program: Transforming Lives Through Resilience Education, in a convenience sample of African American adults (n=16) with T2DM. The intervention included four weekly resilience and diabetes education classes and eight bi-weekly support group sessions. Survey data and blood samples were collected at baseline and at six months. Twelve participants completed the study (75% retention). Results indicated that higher perceived stress scores were associated with less resilience, fewer adaptive coping skills, lower selfleadership, lower diabetes empowerment and greater depressive symptoms. However, diabetes empowerment was the only psychosocial process variable to be significantly enhanced by the intervention at six months. Weight, BMI, HbA1c, total cholesterol, LDL cholesterol, blood pressure, and IGF-1 levels were significantly decreased at six months, whereas, lymphocyte proliferation and physical activity were significantly increased. These data indicate that our intervention has the potential to improve diabetes selfmanagement among African Americans with T2DM and increase positive health outcomes, though further studies are needed to confirm these findings. Additionally, several lessons were learned from conducting the pilot study that may be useful for improving the intervention for future studies, including: recruitment and retention strategies; cultural competency issues; the use of complementary and alternative medicine practices by African Americans with T2DM; and approaches for increasing participant self-assessment and goal-setting.