Lessons learned from The Black Cosmetologists Promoting Health Program: A randomized controlled trial testing a diabetes education program

Purpose: Diabetes is reaching epidemic proportions in the United States and African Americans are at greater risk than most. Disparities in the incidence of diabetes place African American women at a much higher risk than their white counterparts. As such, the purpose of this study was to evaluate a community-based educational intervention program aimed at changing diabetes attitudes, knowledge, and screening behaviors of African American women via cosmetologists trained as community health educators. Methods: Twenty African American cosmetologists joined the Black Cosmetologist Promoting Health Program. Their salons were randomized to disseminate diabetes or breast cancer information and given educational materials to display in their salons and give to their clients. Their clients (n = 984 women) consented to help evaluate the program, completing a baseline and 6-month follow-up survey regarding their knowledge, attitudes, and behaviors related to diabetes and breast cancer. Results: At the 6-month follow-up, self-reported knowledge about diabetes increased across both groups. However, despite similar programmatic structure offered to the two groups, there were no significant differences in diabetes knowledge, attitudes, and screening at follow-up. Conclusion: This non-significant outcome contrasted with the positive outcomes achieved by the parallel breast cancer program. Gladwell’s Tipping Point theory could explain the different outcomes. The programs differed in message content, messaging tone, and the environment in which the messages were delivered. The diabetes program lacked a clear, memorable, and upbeat call-to-action and an environment that socially and financially supported the uptake of the recommended actions

Predictors of Sustained Walking among Diabetes Patients in Managed Care: The Translating Research into Action for Diabetes (TRIAD) Study

BackgroundAlthough patients with diabetes may benefit from physical activity, few studies have examined sustained walking in this population.ObjectiveTo examine the factors associated with sustained walking among managed care patients with diabetes.DesignLongitudinal, observational cohort study with questionnaires administered 2.5 years apart.ParticipantsFive thousand nine hundred thirty-five patients with diabetes walking at least 20 minutes/day at baseline.MeasurementsThe primary outcome was the likelihood of sustained walking, defined as walking at least 20 minutes/day at follow-up. We evaluated a logistic regression model that included demographic, clinical, and neighborhood variables as independent predictors of sustained walking, and expressed the results as predicted percentages.ResultsThe absence of pain was linked to walking behavior, as 62% of patients with new pain, 67% with ongoing pain, and 70% without pain were still walking at follow-up (p = .03). Obese patients were less likely (65%) to sustain walking than overweight (71%) or normal weight (70%) patients (p = .03). Patients > or =65 years (63%) were less likely to sustain walking than patients between 45 and 64 (70%) or < or =44 (73%) years (p = .04). Only 62% of patients with a new comorbidity sustained walking compared with 68% of those who did not (p < .001). We found no association between any neighborhood variables and sustained walking in this cohort of active walkers.ConclusionsPain, obesity, and new comorbidities were moderately associated with decreases in sustained walking. Whereas controlled intervention studies are needed, prevention, or treatment of these adverse conditions may help patients with diabetes sustain walking behavior