Felicia Hill-Briggs, PhD and Frederick Brancati, MD, MHS: Intensive Problem-Solving Training Improves Diabetes Self-Management in Low-Income Patients
By: Almas Eftekhari
Statistics show that people with low socioeconomic status are often ineffective at self-managing their diabetes and avoiding progression to complications. Populations stricken with poverty and low literacy rates face barriers in caring for their health, such as the inability to pay for medications, limited access to healthy foods, family caretaking demands, and even neighborhood violence.
Recently published results from an American Diabetes Association-funded study indicate that low-income patients may benefit from an intense, problem-solving training intervention in self-managing their diabetes. Lead researcher Felicia Hill-Briggs, Ph.D. and Frederick Brancati, MD, MHS., who is currently funded by the Association on a different project, collaborated to create a feasible and effective intervention that addresses competing life priorities, teaches problem solving skills, and facilitates commitment to a healthy lifestyle change.
The researchers motivated the patients using a supportive group model in combination with engaging, informative sessions. Participants underwent problem-solving training and were provided with educational materials adapted to a fifth-grade reading level, which included guidelines for taking medication, healthy eating choices, regular physical activity, and self-monitoring. Three months after completing the intense intervention, the patients showed significant improvements in cholesterol, better blood sugar levels, and enhanced knowledge, problem-solving ability, and improved self-management behaviors.
Currently-used diabetes intervention methods involve a more condensed approach with less problem-solving skill-building. Dr. Hill-Briggs and Dr. Brancati demonstrate that their intense, custom-delivered, and clinic-based program can be a more successful tool in improving self-care in these populations and in eliciting a sustained behavioral lifestyle change. The patients rated the program as easy to use and understand and helpful because it focused on the specific life challenges that had formerly prevented them from managing their diabetes.
“We helped people integrate diabetes care into everything else that was going on in their lives and in the context of how those things affected their health,” said Dr. Hill-Briggs. “We helped them understand that their diabetes can be a priority, and problem solving lets us meet them where they are.”
Results of the study are published online in the March 29, 2011 issue of the Journal of General Internal Medicine, and portions of the results were presented at the American Diabetes Association Scientific Sessions in Orlando, Florida during June 2010.
(Hill-Briggs F, Lazo M, Peyrot M, Doswell A, Chang YT, Hill MN, Levine D, Wang NY, Brancati FL. Effect of Problem-Solving-Based Diabetes Self-Management Training on Diabetes Control in a Low Income Patient Sample. J Gen Intern Med. 2011 Mar 29. [Epub ahead of print].)
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