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

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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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References

  1. Mokdad AH, Ballestros K, Echko M, Glenn S, Olsen HE, Mullany E, ... Kasaeian A. The state of US health, 1990-2016: burden of diseases, injuries, and risk factors among US states. JAMA, 2018;319:1444–72.

  2. Xu J, Murphy SL, Kochanek KD, Bastian B, Arias E. Deaths: final data for 2016. Natl Center Health Stat Div Vital Stat. 2018;67(5):1–176.

    Google Scholar 

  3. American Diabetes Association. Economic costs of diabetes in the U.S. in 2017. Diabetes Care. 2018;41:917–28.

    Article  PubMed Central  Google Scholar 

  4. Menke A, Casagrande S, Geiss L, Cowie CC. Prevalence of and trends in diabetes among adults in the United States, 1988-2012. JAMA. 2015;314:1021–9.

    CAS  PubMed  Google Scholar 

  5. Centers for Disease Control and Prevention. National diabetes statistics report, 2017: Estimates of diabetes and its burden in the United States. Atlanta: National Center for Chronic Disease Prevention and Health Promotion, Division of Diabetes Translation; 2017.

    Google Scholar 

  6. Spanakis EK, Golden SH. Race/ethnic difference in diabetes and diabetic complications. Curr Diab Rep. 2013;13:814–23.

    PubMed  Google Scholar 

  7. National Institutes of Health. NIH-wide strategic plan: Fiscal years 2016–2020. Turning discovery into health. Washington, DC: US Government Printing Office; 2016.

    Google Scholar 

  8. World Health Organization. Strengthening Resilience: a Priority Shared by Health 2020 and the Sustainable Development Goals. Copenhagen: World Health Organization Regional Office for Europe; 2017.

  9. Czajkowski SM, Powell LH, Adler N, Naar-King S, Reynolds KD, Hunter CM, et al. From ideas to efficacy: the ORBIT model for developing behavioral treatments for chronic diseases. Health Psychol. 2015;34:971–82.

  10. Mayberry LS, Bergner EM, Chakkalakal RJ, Elasy TA, Osborn CY. Self-care disparities among adults with type 2 diabetes in the USA. Curr Diab Rep. 2016;16:113.

    PubMed  PubMed Central  Google Scholar 

  11. Storey M, Anderson P. Income and race/ethnicity influence dietary fiber intake and vegetable consumption. Nutr Res. 2014;34:844–50.

    CAS  PubMed  Google Scholar 

  12. Hackett RA, Steptoe A. Type 2 diabetes mellitus and psychological stress—a modifiable risk factor. Nat Rev Endocrinol. 2017;13:547–60.

    PubMed  Google Scholar 

  13. Lloyd C, Smith J, Weinger K. Stress and diabetes: a review of the links. Diabetes Spectr. 2005;18:121–7.

    Google Scholar 

  14. Wiernik E, Nabi H, Thomas F, Pannier B, Hanon O, Simon T, et al. Association between current perceived stress and incident diabetes is dependent on occupational status: evidence from the IPC cohort study. Diabetes Metab. 2016;42(5):328–35.

  15. Marcy TR, Britton ML, Harrison D. Identification of barriers to appropriate dietary behavior in low-income patients with type 2 diabetes mellitus. Diab Ther. 2011;2:9–19.

    Google Scholar 

  16. Black AR, Peacock N. Pleasing the masses: messages for daily life management in African American women's popular media sources. Am J Public Health. 2011;101:144–50.

    PubMed  PubMed Central  Google Scholar 

  17. Lin EH, Katon W, Von Korff M, et al. Relationship of depression and diabetes self-care, medication adherence, and preventive care. Diabetes Care. 2004;27:2154–60.

    PubMed  Google Scholar 

  18. Juster RP, McEwen BS, Lupien SJ. Allostatic load biomarkers of chronic stress and impact on health and cognition. Neurosci Biobehav Res. 2010;35:2–16.

    Google Scholar 

  19. Adler NE. Health disparities through a psychological lens. Am Psychol. 2009;64:663–73.

    PubMed  Google Scholar 

  20. Lehrer HM, Dubois SK, Maslowsky J, Laudenslager ML, Steinhardt MA. Hair cortisol concentration and glycated hemoglobin in African American adults. PNE. 2016;72:212–8.

    CAS  Google Scholar 

  21. Schneiderman N, Ironson G, Siegel SD. Stress and health: psychological, behavioral, and biological determinants. Annu Rev Clin Psychol. 2005;1:607–28.

    PubMed  PubMed Central  Google Scholar 

  22. Slavich GM, Irwin MR. From stress to inflammation and major depressive disorder: a social signal transduction theory of depression. Psychol Bull. 2014;140:774–815.

    PubMed  PubMed Central  Google Scholar 

  23. Ali S, Stone MA, Peters JL, Davies MJ, Khunti K. The prevalence of co-morbid depression in adults with type 2 diabetes: a systematic review and meta-analysis. Diabet Med. 2006;23:1165–73.

    CAS  PubMed  Google Scholar 

  24. Schetter CD, Dolbier C. Resilience in the context of chronic stress and health in adults. Soc Personal Psychol Compass. 2011;5:634–52.

    PubMed  PubMed Central  Google Scholar 

  25. Southwick SM, Charney DS. The science of resilience: implications for the prevention and treatment of depression. Science. 2012;338:79–82.

    CAS  PubMed  Google Scholar 

  26. Connor KM, Davidson JRT. Development of a new resilience scale: the Connor-Davidson resilience scale (CD-RISC). Depress Anxiety. 2003;18:76–82.

    PubMed  Google Scholar 

  27. Masten AS. Ordinary magic: resilience processes in development. Am Psychol. 2001;56:227–38.

    CAS  PubMed  Google Scholar 

  28. Brooks R, Goldstein S. The power of resilience. New York: McGraw-Hill; 2003.

    Google Scholar 

  29. O'Leary VE, Ickovics JR. Resilience and thriving in response to challenge: an opportunity for a paradigm shift in women's health. Women Health. 1995;1:121–42.

    CAS  Google Scholar 

  30. Carver CS. Resilience and thriving: issues, models, and linkages. J Soc Issues. 1998;54:245–66.

    Google Scholar 

  31. Fredrickson BL, Branigan C. Positive emotions broaden the scope of attention and thought-action repertoires. Cognit Emot. 2005;19:313–32.

    Google Scholar 

  32. Troy AS, Mauss IB. Resilience in the face of stress: emotion regulation as a protective factor. In: Southwick SM, Litz BT, Charney D, Friedman MJ, editors. Resilience and mental health: challenges across the lifespan. Cambridge: Cambridge University Press; 2011. p. 30–44.

    Google Scholar 

  33. Kok BE, Coffey KA, Cohn MA, et al. How positive emotions build physical health: perceived positive social connections account for the upward spiral between positive emotions and vagal tone. Psychol Sci. 2014;24:1123–32.

    Google Scholar 

  34. King DK, Glasgow RE, Toobert DJ, Strycker LA, Estabrooks PA, Osuna D, et al. Self-efficacy, problem solving, and social-environmental support are associated with diabetes self-management behaviors. Diabetes Care. 2010;33:751–3.

  35. Moskowitz JT, Epel ES, Acree M. Positive affect uniquely predicts lower risk of mortality in people with diabetes. Health Psychol. 2008;27(1):S73–82.

    PubMed  Google Scholar 

  36. DeNisco S. Exploring the relationship between resilience and diabetes outcomes in African Americans. J Am Assoc Nurse Pract. 2011;23:602–10.

    Google Scholar 

  37. Cohen S, Williamson G. Perceived stress in a probability sample of the United States. In: Spacapan S, Oskamp S, editors. The social psychology of health: Claremont symposium on applied social psychology. Newbury Park: Sage; 1988.

    Google Scholar 

  38. Hajat A, Diez-Roux A, Franklin TG, Seeman T, Shrager S, Ranjit N, et al. Socioeconomic and race/ethnic differences in daily salivary cortisol profiles: the multi-ethnic study of atherosclerosis. Psychoneuroendocrinology. 2010;35:932–43.

  39. Mayberry LS, Bergner EM, Chakkalakal RJ, Elasy TA, Osborn CY. Self-care disparities among adults with type 2 diabetes in the USA. Curr Diab Rep. 2010;16:113.

    Google Scholar 

  40. Patel MR, Piette JD, Resnicow K, Kowalski-Dobson T, Heisler M. Social determinants of health, cost-related non-adherence, and cost-reducing behaviors among adults with diabetes: findings from the National Health Interview Survey. Med Car. 2016;54:796–803.

  41. Steinhardt MA, Brown SA, Dubois SK, Harrison L Jr, Lehrer HM, Jaggars SS. A resilience intervention in African-American adults with type 2 diabetes. Am J Health Behav. 2015;39:507–18.

    PubMed  PubMed Central  Google Scholar 

  42. Lehrer HM, Dubois SK, Brown SA, Steinhardt MA. Resilience-based diabetes self-management education: perspectives from African American participants, community leaders, and healthcare providers. Diabetes Educ. 2017;43:367–77.

    PubMed  Google Scholar 

  43. Smith BW, Dalen J, Wiggins K, Tooley E, Christopher P, Bernard J. The brief resilience scale: assessing the ability to bounce back. Int J Behav Med. 2008;15:194–200.

    PubMed  Google Scholar 

  44. Carver CS. You want to measure coping but your protocol’s too long: consider the brief COPE. Int J Behav Med. 1997;4:92–100.

    CAS  PubMed  Google Scholar 

  45. Zeidner M, Saklofske D. Adaptive and maladaptive coping. In: Zeidner M, Endler NS, editors. Handbook of coping: Theory, research, applications. Oxford: Wiley; 1996. p. 505–31.

    Google Scholar 

  46. Yi-Frazier JP, Smith RE, Vitaliano PP, Yi JC, Mai S, Hillman M, et al. A person-focused analysis of resilience resources and coping in patients with diabetes. Stress Health. 2010;26(1):51–60.

  47. Miles SR, Khambaty T, Petersen NJ, Naik AD, Cully JA. The role of affect and coping in diabetes self-management in rural adults with uncontrolled diabetes and depressive symptoms. J Clin Psychol Med Settings. 2018;25(1):55–65.

    PubMed  Google Scholar 

  48. Frederickson BL, Tugade MM, Waugh CE, Larkin GR. What good are positive emotions in crises? A prospective study of resilience and emotions following the terrorist attacks on the United States on September 11th, 2001. J Pers Soc Psychol. 2003;84:365–76.

    Google Scholar 

  49. Anderson RM, Fitzgerald JT, Gruppen LD, Funnell MM, Oh MS. The diabetes empowerment scale-short form (DES-SF). Diabetes Care. 2003;26:1641–2.

    PubMed  Google Scholar 

  50. Weinger K, Butler HA, Welch GW, La Greca AM. Measuring diabetes self-care: a psychometric analysis of the self-care inventory-revised with adults. Diabetes Care. 2005;28:1346–52.

    PubMed  Google Scholar 

  51. Lenters-Westra E, Slingerland RJ. Six of eight hemoglobin A1C point-of-care instruments do not meet the general accepted analytical performance criteria. Clin Chem. 2010;56:44–52.

    CAS  PubMed  Google Scholar 

  52. Fisher L, Glasgow RE, Mullan JT, Skaff MM, Polonsky WH. Development of a brief diabetes distress screening instrument. Ann Fam Med. 2008;6:246–52.

    PubMed  PubMed Central  Google Scholar 

  53. Cohen S, Kamarck T, Mermelstein R. Perceived stress scale. In: Measuring stress: A guide for health and social scientists; 1994. p. 10.

    Google Scholar 

  54. Kroenke K, Spitzer RL, Williams JBW. The PHQ-9. J Gen Intern Med. 2001;16:606–13.

    CAS  PubMed  PubMed Central  Google Scholar 

  55. Beck J, Greenwood DA, Blanton L, Bollinger ST, Butcher MK, Condon JE, et al. 2017 National standards for diabetes self-management education and support. Diabetes Educ. 2018;44:35–50.

  56. Dweck CS. Mindset: the new psychology of success. New York: Random House; 2006.

    Google Scholar 

  57. Oinas-Kukkonen H. A foundation for the study of behavior change support systems. Pers Ubiquit Comput. 2013;17:1223–35.

    Google Scholar 

  58. Kok BE, Coffey KA, Cohn MA, Catalino LI, Vacharkulksemsuk T, Algoe SB, et al. How positive emotions build physical health: perceived positive social connections account for the upward spiral between positive emotions and vagal tone. Psychol Sci. 2013;24:1123–32.

  59. Story M, Kaphingst KM, Robinson-O'Brien R, Glanz K. Creating healthy food and eating environments: policy and environmental approaches. Annu Rev Public Health. 2008;29:253–72.

    PubMed  Google Scholar 

  60. Grossman P, Niemann L, Schmidt S, Walach H. Mindfulness-based stress reduction and health benefits: a meta-analysis. J Psychosom Res. 2004;57:35–43.

    PubMed  Google Scholar 

  61. Benjamini Y, Yekutieli D. The control of the false discovery rate in multiple testing under dependency. Ann Stat. 2001;29:1165–88.

    Google Scholar 

  62. Efron B, Tibshirani R. Bootstrap methods for standard errors, confidence intervals, and other measures of statistical accuracy. Stat Sci. 1986;Feb:54–75.

    Google Scholar 

  63. Cohen J. Statistical power analysis for the behavioral sciences. 2nd. New York: Lawrence Erlbaum Associates; 1988.

    Google Scholar 

  64. Luthar SS, Cicchetti D. The construct of resilience: implications for interventions and social policies. Dev Psychopathol. 2000;12:857–85.

    PubMed Central  PubMed  Google Scholar 

  65. Steinhardt MA, Dubois SK, Brown SA, Harrison L Jr, Dolphin KE, Park W, et al. Positivity and indicators of health among African Americans with diabetes. Am J Health Behav. 2015;39:43–50.

  66. Park CL, Chmielewski J, Blank TO. Post-traumatic growth: finding positive meaning in cancer survivorship moderates the impact of intrusive thoughts on adjustment in younger adults. Psycho-Oncology. 2010;19:1139–47.

    PubMed  Google Scholar 

  67. Robertson SM, Stanley MA, Cully JA, Naik AD. Positive emotional health and diabetes care: concepts, measurement, and clinical implications. Psychosomatics. 2012;53(1):1–12.

    PubMed  Google Scholar 

  68. Macrodimitris SD, Endler NS. Coping, control, and adjustment in type 2 diabetes. Health Psychol. 2001;20:208–16.

    CAS  PubMed  Google Scholar 

  69. Betancourt JR, Duong JV, Bondaryk MR. Strategies to reduce diabetes disparities: an update. Curr Diab Rep. 2012;12:762–8.

    PubMed  Google Scholar 

  70. Peek ME, Wilkes AE, Roberson TS, Goddu AP, Nocon RS, Tang H, et al. Early lessons from an initiative on Chicago’s South Side to reduce disparities in diabetes care and outcomes. Health Aff. 2012;31:177–86.

  71. Chew BH, Shariff-Ghazali S, Fernandez A. Psychological aspects of diabetes care: effecting behavioral change in patients. World J Diabetes. 2014;5:796–808.

    PubMed  PubMed Central  Google Scholar 

  72. Steinhardt MA, Mamerow MM, Brown SA, Jolly CA. A resilience intervention in African American adults with type 2 diabetes: a pilot study of efficacy. Diabetes Educ. 2009;35:274–84.

    PubMed  PubMed Central  Google Scholar 

  73. Ricci-Cabello I, Ruiz-Pérez I, Rojas-García A, Pastor G, Rodríguez-Barranco M, Gonçalves DC. Characteristics and effectiveness of diabetes self-management educational programs targeted to racial/ethnic minority groups: a systematic review, meta-analysis and meta-regression. BMC Endocr Disord. 2014;14(1):60.

    PubMed  PubMed Central  Google Scholar 

  74. Yi JP, Vitaliano PP, Smith RE, Yi JC, Weinger K. The role of resilience on psychological adjustment and physical health in patients with diabetes. Br J Health Psychol. 2008;13:311–25.

    PubMed  Google Scholar 

  75. Katon WJ, Rutter C, Simon G, Lin EHB, Ludman E, Ciechanowski P, et al. The association of comorbid depression with mortality in patients with type 2 diabetes. Diabetes Care. 2005;28:2668–72.

  76. Housden L, Browne AJ, Wong ST, Dawes M. Attending to power differentials: how NP-led group medical visits can influence the management of chronic conditions. Health Expect. 2017;20:862–70.

    PubMed  PubMed Central  Google Scholar 

  77. Housden L, Wong ST, Dawes M. Effectiveness of group medical visits for improving diabetes care: a systematic review and meta-analysis. CMAJ. 2013;185:E635–44.

    PubMed  PubMed Central  Google Scholar 

  78. Housden L, Wong ST. Using group medical visits with those who have type 2 diabetes: examining the evidence. Curr Diabetes Rep. 2016;16:134.

    Google Scholar 

  79. Scholz N. Addressing health inequalities in the European Union: concepts, action, state of play. Brussels: European Union; 2020. p. 1–37.

    Google Scholar 

  80. Spencer MS, Kieffer EC, Sinco B, Piatt G, Palmisano G, Hawkins J, et al. Outcomes at 18 months from a community health worker and peer leader diabetes self-management program for Latino adults. Diabetes Care. 2018;41:1414–22.

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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. 27, 565–575 (2020). https://doi.org/10.1007/s12529-020-09894-5

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