Sugar, Heart, and Life: A Bilingual Diabetes Education Interactive Telenovela to Promote Diabetes Self-Care In Hispanic Primary Care Patients with Type 2 Diabetes

Theoretical Background and research questions/hypothesis: Hispanics exhibit worse glycemic control, compared to other racial/ethnic groups in the US. Moreover, it is estimated that only 7% of adults with Type 2 diabetes mellitus (T2DM) are able to follow diabetes guidelines delivered by their providers. A diabetes education program that engages patients in practicing skills and helping them to take action in their daily lives in managing their diabetes is likely to have an impact on patients’ ability to cope with their illness. We have developed a culturally appropriate web-based diabetes education program titled “Sugar, Heart and Life (SHL) to assist patients and their families with decision-making and coping skills related to diabetes management. This program incorporates concepts of entertainment education (interactive soap opera segments and games) to present the problem to the user in interesting, appealing, and engaging formats. We explored the effects of the SHL Diabetes Interactive Telenovela (DIT) on diabetes self-management knowledge, adherence and glycemic control in Hispanic patients with T2DM. We hypothesized that patients who interact with the DIT will exhibit improved diabetes self-care behaviors, leading to improved glycemic control.

Methods:  A total of 200 adult Hispanic men and women (aged 52.8 ± 10.1 years) with T2DM (mean HbA1c 9.5 ± 1.96) participated in a randomized controlled trial. Intervention patients (N=100) viewed and interacted with the DIT. They were also given a DVD version to take home. Usual care patients (N=100) attended diabetes education classes. Diabetes self-care management and HbA1c data were obtained at baseline and at 3 months post-randomization.

Results: Compared to usual care, intervention patients exhibited significant mean improvement in diabetes management knowledge (-0.74 ± 0.14; -0.36 ± 0.13, p = 0.04, respectively), and diet adherence approached significance (-0.56 ± 0.11;-0.28 ± 0.09, p = 0.06). Further improvement in diabetes management knowledge was observed with additional home viewing of the DIT (mean, -0.93 ± 0.17, p = 0.03). A larger proportion of intervention patients showed improvement in HbA1c compared to usual care (70.8% vs. 36.4%, p=0.02, respectively).

Conclusions: Findings indicate that this culturally and linguistically appropriate diabetes education program helped increase diabetes management knowledge and diet adherence among Hispanic patients with T2DM. However, longer HbA1c follow-up is needed to determine long term effectiveness of the DIT on glycemic control.

Implications for research and/or practice: The SHL program provides a timely and needed opportunity to explore an alternative strategy to assist Hispanic patients in coping with the often complex and bewildering issues associated with managing their diabetes. Furthermore, the popularity and accessibility of the telenovela in the Hispanic community makes it an ideal vehicle to engage viewers in learning the content and promote greater knowledge about managing and coping with diabetes.