1. African American (AA) women and men have an increased risk of type 2 diabetes (T2DM) that is estimated to be 77% more compared to their non-Hispanic White counterparts (Chow et al., 2012). At 18.7%, the prevalence of T2DM is also higher among adult AA women and men (Chow et al., 2012). Moreover, AA women share a greater burden of risk for T2DM given the higher likelihood that they also have hypertension, obesity, and cardiovascular disease (CDC, 2012). For this reason, T2DM screening and health education are urgent needs of this population. The American Diabetes Association (ADA) (2014) recommends screening in asymptomatic and low-risk individuals beginning age 45 years and at any age in adults who are overweight or obese and are at-risk. However, there is low AA women participation in screening and health education programs which contribute to the disparity. Factors hindering participation are culture-based beliefs about health and health care, inadequate proficiency in the English language, low literacy, and inability to access care (Ricci-Cabello et al., 2013). Community-based programs have the potential to overcome these barriers. In a study of community-based screening, 7113 African Americans in Detroit, Michigan participated enabling the determination of the prevalence of high random glucose levels which was 9% (Saffar et al., 2011). Meanwhile, a community-based diabetes prevention education program in a rural AA community which employed community health workers (CHWs) as educators was associated with increased knowledge and performance of healthy behaviors among participants. There is a need to survey the evidence pertaining to community-based screening and diabetes prevention education to inform improvements in current practice.
5. P = Asymptomatic African American women ≥ 30 years who have at least one of the following T2DM risk factors should be screened: overweight, obesity, sedentariness, family history of T2DM, hypertension, previous pre-diabetes HbA1c, abnormal cholesterol and/or triglycerides (ADA, 2014).
I = Community-based T2DM screening and health education
C = Facility-based T2DM screening and health education
O = AA women participation rate, HbA1c, and T2DM risk level using the ADA (2015) risk test
T = 6 months
7. PICOT Question = Among asymptomatic African American women with T2DM risk factors, is community-based T2DM screening and health education more effective than a facility-based intervention in improving participation rate, HbA1c, and T2DM risk after 6 months?
American Diabetes Association (ADA) (2014). Standards of medical care in diabetes – 2014. Diabetes Care, 37(Suppl 1), S14-S80. doi: 10.2337/dc14-S014
Center for Disease Control and Prevention (CDC) (2012). Women at high risk for diabetes: Physical activity, healthy eating, and weight loss. Retrieved from http://www.cdc.gov/diabetes/pubs/pdf/womenHighRiskDiabetes.pdf
Chow, E.A., Foster, H., Gonzalez, V., & McIver, L. (2012). The disparate impact of diabetes on racial/ethnic minority populations. Clinical Diabetes, 30(3), 130-133. doi: 10.2337/diaclin.30.3.130
Ricci-Cabello, I., Ruiz-Perez, I., Nevot-Cordero, A., Rodriguez-Barranco, M., Sordo, L., & Goncalves, D.C. (2013). Health care interventions to improve the quality of diabetes care in African Americans: A systematic review and meta-analysis. Diabetes Care, 36, 760-768. doi: 10.2337/dc12-1057.
Saffar, D., Perkins, D.W., Williams, V., Kapke, A., & Mahan, M. (2011). Screening for diabetes in an African American community: Identifying characteristics associated with abnormal blood glucose readings. Journal of the National Medical Association, 103(3), 190-193. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21671522