Project Summary/Abstract
African Americans (AAs) with Type 2 diabetes (T2D) have worse glycemic control and a 50% higher mortality
rate of diabetes compared to non-Hispanic Whites (NHWs). AAs with T2D have 3.2 times more hospital
admissions for uncontrolled diabetes compared to NHWs. Multiple, intertwined factors at the individual,
interpersonal, community, societal, and healthcare system levels contribute to lower adherence to diabetes self-
management, greater difficulty achieving glycemic control, and higher rates of microvascular and macrovascular
complications. The NIH Science of Behavior Change identifies interpersonal and social processes as one of the
three key mechanisms for behavior change, providing greater support for this strategy. Family is a critical social
context in which interdependence, collectivism, and extended family network is central to their way of life among
AAs. Indeed, focusing on the individual-level demonstrated only limited improvements in glycemic control for
AAs with T2D. Thus, effective multi-level interventions that promote adherence to diabetes self-management in
this vulnerable population are sorely needed. Our proposed phase I/II randomized controlled trial will not only
improve glycemic control for participants with T2D, but also engage family members in physical activity and
healthy eating strategies. The specific aims are: 1. to examine the feasibility and acceptability of a family-dyad-
focused diabetes intervention in AA adults with T2D and their designated family members; 2. to examine the
preliminary efficacy of the family-dyad-focused diabetes self-management intervention compared to a waitlist
control arm on: (1) glycemic control (hemoglobin A1c) and health-related quality of life (HRQOL) (primary
outcomes); and (2) blood pressure control (secondary outcome) in participants with T2D; and 3. to explore the
dyadic relationship (quality and support) and its association with a) changes in dyadic stress, physical activity
and dietary intake, and b) health outcomes (glycemic control, HRQOL and blood pressure control) over time in
participants with T2D. We will conduct a two-arm RCT. We will enroll 104 AAs with T2D and one family member
of each patient (104 dyads), randomized 1:1 to intervention or wait list control arm (n=52/arm). All participants
will undergo the standard usual care held at the pharmacy clinic. Patient-family-member dyads in the intervention
arm will receive 1) 14 session over 20 weeks of family dyad-focused, in-person group sessions on diabetes self-
management and family support; 2) family dyad-focused support component in each group session; and 3)
individual family feedback telephone sessions. All participants will be assessed at baseline, post-intervention
and six months after intervention. Our goals of the intervention are to encourage participants to (1) daily self-
manage diabetes and stress; (2) establish a healthy eating pattern reducing overall calorie and carbohydrate
intake; (3) engage in brisk walking of 150 or more minutes a week; and (4) use solution-focused problem-solving
strategy and supportive family communication skills. Our approach will add to the scientific knowledge and
identify interpersonal and social mechanisms in adherence to diabetes self-management among AAs.