Natalie May, PhD
There are numerous limitations to the usual care of patients with chronic diseases, especially those with diabetes. As these have been recognized, a number of exciting innovations have been developed to improve this care, including telephone counseling, empowerment education, group education, behavioral goal setting, and culturally appropriate self-management education, to name a few.
This project will evaluate whether a comprehensive clinic- and community-based self-management support program, Call2Health, can improve the outcomes of care for rural and underserved African-American women with diabetes. In addition to providing elements of self-management support that have demonstrated effectiveness in this population, Call2Health will also examine usual care versus the effect of automated, daily text message reminders and affirmations both in conjunction with usual care and with the more comprehensive Call2Health intervention.
The question becomes, “How do we deliver these programs in the context of a busy primary care practice?” “How can we make these interventions more cost effective?” And, “How can we take the empowerment concept beyond the individual to empowering the entire family, even the community?”
The University of Virginia Division of General Medicine, Geriatrics, and Palliative Care and the Charlottesville-Albemarle Community Obesity Task Force will join together to implement the proposed program, Call2Health (C2H). C2H takes a strengths-based, four-pronged approach to empowering rural and underserved African-American women to manage their diabetes self-care. These four activities include
- Daily personalized text message reminders and affirmations reflecting each woman’s chosen health care behavior goals;
- A C2H retreat and monthly group visits in both the clinic and community-based settings where women and their female friends and family members learn about diabetes self-management; develop individualized self-care goals using an appreciative practice, strengths-based approach; and identify a buddy for support between group visits;
- Peer support prompted by provider text messages; and
- A partnership with the Charlottesville-Albemarle Community Obesity Task Force to leverage community resources and provide avenues for our program participants to engage with others to improve the healthfulness of their communities.
Building on our recent work using mobile phone based technology with HIV patients, Call2Health will provide 150 women cared for in our adult general medicine clinic with daily text message support. Numerous studies have shown the efficacy of telephone-delivered interventions, most of which are “healthcare personnel dependent.” C2H will be individually tailored for each patient, yet will be automated and therefore more replicable in other settings. Daily text messages will also prompt conversations (either by text or telephone) between the buddy pairs, an exciting innovation that has shown promise in patients with diabetes in South Africa.
Our project team also has directed the Alliance of Black Churches Health Project; Pippin, a Web-based support program which patients accessed through their televisions to improve self-management; several diabetes and chronic illness care interventions in the proposed clinical setting; the appreciative inquiry culture change project at our institution and extensive development of a community infrastructure to support obesity prevention in children and adults. We are eager to bring these collective strengths and experiences to bear on improving diabetes care for African-American women.
We are comprehensively monitoring and evaluating participants’ glycemic control, BMI, and other factors relevant to successful self-care, including locus of control, social support, quality of life, well being, diabetes distress, and stages of change. Exit interviews will examine more in-depth aspects of the intervention as well as satisfaction with Call2Health.