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. 2021 Feb 15;28(2):261-275.
doi: 10.1093/jamia/ocaa223.

Integrating family and friend support, information technology, and diabetes education in community-centric diabetes self-management

Christina Higa  1 , Elizabeth J Davidson  2 , Joanne R Loos  3
Affiliations

Integrating family and friend support, information technology, and diabetes education in community-centric diabetes self-management

Christina Higa et al. J Am Med Inform Assoc. .

Abstract

Objective: Diabetes self-management (DSM) education, social support, and information technology interventions can improve patient engagement and health. A major challenge is animating, integrating, and accessing resources in under-resourced, rural communities. Set in an island community in Hawai'i, this study piloted a program that integrated friend-and-family support, community health services, telehealth-enabled DSM education, and mobile technologies by activating the community's social capital to support the program.

Materials and methods: An action research approach informed the design and implementation of a community-based DSM program that included: friends and family support, telehealth classes, personalized consultations, Bluetooth-enabled blood glucose monitors, and text messaging support. Outcomes were evaluated using biometric data, surveys, interviews, and participant observations.

Results: The study spanned 9 months with 7 dyads, each with 1 individual with type 2 diabetes and a friend or family member. Six of the 7 participants with diabetes experienced reduced hemoglobin A1c percentages, with 3 reducing by more than 1%. The seventh participant maintained a hemoglobin A1c level within American Diabetes Association recommended ranges. DSM knowledge and self-care behaviors improved overall. Interviews and participant observations highlighted program strengths and social challenges associated with the interpersonal relationships between the members of the dyads.

Conclusions: A community-centric diabetes program can enhance understanding of diabetes etiology, DSM activities, and communication skills for effective disease management support in under-resourced rural communities. Social capital among community members, leveraged with health information technology, can catalyze and integrate limited health system resources for DSM and social support as a cost-effective strategy to develop community-centric chronic healthcare management initiatives.

Keywords: action research; diabetes self-management; health information technology intervention; social support; telehealth.

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Figures

Figure 1.
Figure 1.
Action research cycles in the Moloka‘i ‘Ohana Diabetes Program (MOD-P). A1c: hemoglobin A1c; DSM: diabetes self-management; F&F: family and friends; IT: information technology.
Figure 2.
Figure 2.
Demographic characteristics of participants with diabetes. DM: diabetes mellitus.
Figure 3.
Figure 3.
Diabetes Knowledge Test scores before, during, and after the Moloka‘i ‘Ohana Diabetes Program. Percent of correct answers from the Spoken Knowledge in Low Literacy in Diabetes Knowledge Assessment Scale; administered to patients with diabetes and family and friends support P: participant with diabetes; S: family and friends support.
Figure 4.
Figure 4.
Changes in diabetes self-management activities. P: participant with diabetes.
Figure 5.
Figure 5.
Pre and post hemoglobin A1c percentage levels. P: participant with diabetes.
See this image and copyright information in PMC

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