A Resilience Intervention for Adults with Type 2 Diabetes: Proof-of-Concept in Community Health Centers

Abstract

Background

Given the psychological stress associated with managing type 2 diabetes (T2D), resilience-promoting interventions may particularly benefit populations experiencing high levels of stress (e.g., racial/ethnic minority and lower-income individuals). Federally qualified Community Health Centers (CHCs) primarily serve these patients and are therefore ideal settings for resilience-promoting T2D programs. This proof-of-concept study tested the Resilience-Based Diabetes Self-Management Education (RB-DSME) intervention within a CHC.

Method

Thirty-five patients with T2D (M age = 51 years, 71% female, 60% Hispanic, 69% annual household income < $20,000) at two clinics within the CHC completed the RB-DSME, consisting of eight bi-weekly classes and two monthly support groups. In this treatment-only design, resilience resources, self-management behaviors, and physical and mental health outcomes were measured at baseline and 6 months.

Results

Attendance (M = 7.66/10) and program satisfaction (M = 6.79/7) were high. Participants improved adaption to stress (d = .67), adaptive coping (d = .60), diabetes empowerment (d = .57), and finding positive meaning (d = .85). Large increases in self-management behaviors (d = 1.38) and number of steps (d = 1.11) were also observed. Participants lowered A1C from baseline (M = 8.79%) to 6 months (M = 8.11%; d = .50), along with diabetes distress (d = 1.31), depressive symptoms (d = .80), and general perceived stress (d = .55).

Conclusion

This study demonstrated the ability of the RB-DSME to improve resilience resources, self-management behaviors, and health outcomes among racial/ethnic minority and lower-income patients with T2D at clinics within a CHC. A larger, randomized trial should more rigorously test the RB-DSME in this clinical setting.

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Funding

This study was funded by the Seton Healthcare Family Center for Health and Social Policy, Lyndon B. Johnson School of Public Affairs, The University of Texas at Austin. H. Matthew Lehrer was partially supported by NIH grant T32HL082610.

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Correspondence to Mary A. Steinhardt.

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Written informed consent was obtained from all participants, and the study protocol was approved by the Institutional Review Board of the sponsoring university.

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Dubois, S.K., Lehrer, H.M., Whyne, E.Z. et al. A Resilience Intervention for Adults with Type 2 Diabetes: Proof-of-Concept in Community Health Centers. Int.J. Behav. Med. (2020). https://doi.org/10.1007/s12529-020-09894-5

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Keywords

  • Resilience
  • Diabetes
  • Stress
  • Health disparities
  • Self-management