Remotely-delivered Mindfulness-Based Diabetes Education for rural adults with uncontrolled diabetes and elevated distress

Caroline Presley, MD

Assistant Professor, Preventive Medicine, University of Alabama at Birmingham

Rural, Black populations have a significant burden of diabetes, experience disparities in care and outcomes, and face substantial barriers to accessing health care. Diabetes distress, the emotional burden of living with diabetes, is common and closely linked to worse self-management behaviors, glycemic control, and outcomes. Interventions are lacking to simultaneously help adults with type 2 diabetes to improve their diabetes self- management and glycemic control, as well as to reduce diabetes distress. 

Current Intervention

Our team is currently pilot testing Mindfulness-Based Diabetes Education, which integrates Mindfulness-Based Stress Reduction and Diabetes Self-Management Education (DSME) in urban, safety-net healthcare systems.

Project Scope

In this project, we will expand the scope of our research to focus on Black adults living in rural areas in Alabama who have limited access to DSME or other programs to support self-management.

Objectives

• Partner with the Alabama Primary Health Care Association and Health Centers in the rural Black Belt region in Alabama.
• Conduct formative qualitative work to adapt the Mindfulness-Based Diabetes Education program to this population and context.
• Deliver the adapted intervention remotely by videoconference to reduce access barriers and enhance the program by including remote monitoring of self-monitoring of blood glucose (SMBG).

Methodology

We will conduct a pilot trial and evaluate key contextual factors related to intervention delivery and implementation. The project includes three specific aims:

• Aim 1: To conduct focus groups (N=4) with patients with type 2 diabetes from the Black Belt region to inform adaptations to the program.
• Aim 2: To conduct a pilot Randomized Controlled Trial (RCT) of the adapted Mindfulness-Based Diabetes Education program versus DSME among Black adults with uncontrolled type 2 diabetes (Hemoglobin A1c ≥8%) and elevated diabetes distress in rural Alabama.
• Aim 3: To characterize the contextual factors relevant to delivery and implementation of the intervention program using PRISM through mixed methods evaluation.

Primary aim of study: Test intervention of Integrated Mindfulness-Based Stress Reduction and Diabetes Self-Management Education program, Delivered remotely in group setting
Diseases or conditions being studied: Type 2 diabetes, Diabetes distress
Communities of focus: Rural Black adults living with Type 2 Diabetes
Study sites: Federally Qualified Health Centers in Black Belt region in Alabama
Study population: Rural Black adults with Type 2 Diabetes in Alabama (AL)
Community or non-academic partners: Alabama Primary Health Care Association
Primary outcome: Feasibility, acceptability
Outcome measures collected at: Baseline, 6 Months

Levels of action:
1) Individual-level (health behaviors)
2) Community-level (access to education, health care services)

Expected Outcomes

This study will provide key results to guide a larger, fully powered hybrid effectiveness-implementation RCT of remotely delivered adapted Mindfulness-Based Diabetes Education in rural safety-net healthcare settings statewide. This work is crucial as under-resourced rural populations need access to effective programs to support stress reduction and self-management to achieve glycemic control and reduce their risk of diabetes-related complications.

Alignment with Forge AHEAD

This project aligns with the Center’s theme of applying a precision public health approach across the care continuum to achieve health equity. It aims to test intervention strategies that address multiple levels of influence to improve cardiometabolic health across Black communities in the Deep South.