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Randomized Controlled Trial
. 2024 Aug 1;7(8):e2424781.
doi: 10.1001/jamanetworkopen.2024.24781.

Digital Storytelling Intervention for Hemoglobin A1c Control Among Hispanic Adults With Type 2 Diabetes: A Randomized Clinical Trial

Mark L Wieland  1 , Katherine Diaz Vickery  2 , Valentina Hernandez  3 , Becky R Ford  2 , Crystal Gonzalez  3 , Silvio Kavistan  3 , Sheila Iteghete  4 , Christi A Patten  5 , Jane W Njeru  1 , Abby M Lohr  6 , Jamie O'Byrne  7 , Paul J Novotny  7 , Davinder P Singh  3 , Linda K Larkey  8 , Miriam Goodson  9 , Graciela Porraz Capetillo  4 , Irene G Sia  10
Affiliations
Randomized Controlled Trial

Digital Storytelling Intervention for Hemoglobin A1c Control Among Hispanic Adults With Type 2 Diabetes: A Randomized Clinical Trial

Mark L Wieland et al. JAMA Netw Open. .

Abstract

Importance: Hispanic adults with type 2 diabetes (T2D) are more likely to develop complications and die from the disease than the US general population. Digital storytelling interventions are narrative-based videos elicited through a community-based participatory research approach to surface the authentic voices of participants overcoming obstacles to health-promoting behaviors that perpetuate health inequities; research on the effect of digital storytelling on T2D outcomes among Hispanic adults is lacking.

Objective: To assess the impact of a digital storytelling intervention on glycemic control and its acceptability among Hispanic patients with poorly controlled T2D.

Design, setting, and participants: This was a multicenter, randomized clinical trial conducted within 2 primary care networks in Minnesota and Arizona among Hispanic adults with poorly controlled T2D (hemoglobin A1c level ≥8%). Enrollment and follow-up were conducted between February 14, 2019, and November 1, 2023.

Intervention: The intervention group viewed a 12-minute digital storytelling video. The video included 4 Spanish-language stories that reinforced 4 diabetes self-management behavioral goals (healthful diet for diabetes, physical activity, medication adherence, and glucose self-monitoring). The control group received printed, culturally tailored T2D education materials.

Main outcomes and measures: The primary outcome was the mean change from baseline to 3 months for hemoglobin A1c levels, adjusting for baseline hemoglobin A1c, age, gender, education, and income. Acceptability and narrative quality of the intervention were assessed through questionnaires.

Results: There were 451 study participants, with 227 (mean [SD] age, 54.3 [9.3] years; 158 [69.3%] women) randomized to the intervention group and 224 (mean [SD] age, 54.5 [9.1] years; 156 [69.3%] women) to the control group. Of these, 390 completed 3-month follow-up of the primary outcome (86% retention). There was a small improvement in the mean (SD) hemoglobin A1c level in the intervention group compared with the control group in the adjusted model (9.1% [1.7] to 8.4% [1.6] vs 9.4% [1.8] to 8.8% [2.0]; P = .04] but not in the unadjusted model. Acceptability and narrative quality of the intervention were high.

Conclusions and relevance: In this randomized clinical trial, a digital storytelling intervention developed with and for Hispanic adults with T2D was highly acceptable and feasibly implemented within primary care settings and resulted in a modest improvement of glycemic control. This was a highly scalable intervention that may be integrated into clinical practice as part of a longitudinal diabetes self-management program for Hispanic adults.

Trial registration: ClinicalTrials.gov Identifier: NCT03766438.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Wieland reported receiving grants from the National Institutes of Health during the conduct of the study. Dr Vickery reported receiving grants from National Institute of Diabetes and Digestive and Kidney Diseases during the conduct of the study. Ms Iteghete reported receiving grants from National Institutes of Health during the conduct of the study. Dr Lohr reported receiving an honorarium for speaking at the NYU School of Medicine outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Recruitment, Randomization, and Follow-Up
HbA1c indicates hemoglobin A1c.
See this image and copyright information in PMC

Comment in

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