Development, Implementation and Evaluation of a Culturally Grounded Diabetes Educational Tool for the Diné (Navajo)

Abstract

BACKGROUND: American Indian and Alaskan Native (AIAN) populations experience disproportionately higher rates of type 2 diabetes and diabetes-related complications compared to other racial and ethnic groups in the United States (US). Studies have demonstrated that diabetes education can effectively improve self-care practices and metabolic control, thereby preventing or delaying the onset of diabetes-related complications. Since culture plays a significant role in decision-making and health, cultural adaptation of diabetes education has been at the forefront of combating diabetes in tribal communities. PURPOSE: The purpose of this dissertation was to investigate how a culturally adapted diabetes intervention affects diabetes outcomes among Diné people with type 2 diabetes. The study included the development, implementation and evaluation of a tribe-specific diabetes education curriculum called Diné Health (DH). METHODS: The first stage of the study consisted of conducting key informant interviews with Diné (Navajo) cultural experts and collaborating with community partners to develop a culturally grounded diabetes curriculum and intervention. The second stage used a mixed-methods semi-quasi experimental design to pilot the feasibility, acceptability and satisfaction of the DH among intervention and control participants; and to determine whether intervention participants, compared to controls, would demonstrate greater improvement in A1C. RESULTS: Key themes that emerged from the key informant interviews included the importance of discipline, positivity and mindfulness in the context of Hózhó, a Diné wellness philosophy; and were included in the DH intervention and offered in a tribal community. Thirty-four participants were enrolled in the intervention group and received the intervention and 34 controls were retrospectively selected for comparison of results to the standard program condition. Eighty-two percent of intervention participants attended a diabetes education class and follow-up appointment, as did 82% of controls. Both groups showed statistically significant improvement in mean A1C levels. No difference in between group reductions in A1C were shown. There were no differences in satisfaction between intervention and control participants. Satisfaction and acceptability of the DH curriculum was high. CONCLUSION: Culturally enhanced diabetes education supported reductions in A1C levels equal to the standard programming, but with a slightly greater change in A1C. This study demonstrated how diabetes programs can work with local healers and cultural experts to develop and implement culturally appropriate educational tools into clinical practice to improve patient health outcomes.