Culturally adapting an evidence-based diabetes self-management education program for black adults: a pilot mixed methods implementation study.

INTRODUCTION

Black adults in the United States disproportionately experience type 2 diabetes and related complications, yet participation in diabetes self-management education (DSME) is low. Culturally adapted approaches are needed to improve engagement and outcomes. This pilot study evaluated the implementation of a co-designed culturally adapted DSME program for Black adults using the RE-AIM framework and Proctor's implementation outcomes.

DESIGN

This pilot mixed-methods implementation study evaluated a culturally adapted 6-week group based DSME program delivered in community settings. Thirty-two Black adults with diabetes or prediabetes were enrolled. Implementation outcomes included attendance, retention, and satisfaction. Participant-reported outcomes were assessed at baseline and 6 months, and qualitative interviews explored participant experiences.

RESULTS

Retention was 100%, with high attendance (86%) and strong satisfaction, indicating high feasibility and acceptability. Participants reported improvements in engagement, empowerment, and self-care behaviors. Qualitative findings highlighted the role of culturally affirming facilitation, trust and group support in promoting participation in DSME. Participants' mean age was 57; 81% were female, and 75% had type 2 diabetes. Participants reported improvements in overall health (12.1%, p = 0.02), patient health engagement (82.8%, p < 0.01), and diabetes empowerment (19.7%, p < 0.01). Self-care behaviors, such as diet, blood glucose monitoring, and foot care, improved significantly. Retention was 100%, with average attendance of 86% and high satisfaction (mean 4.2/5). Qualitative findings highlighted empowerment, accountability, and trust, fostered by culturally affirming facilitation and group support. Participants recommended longer sessions and hybrid formats.

CONCLUSION

The program was feasible and acceptable, and was associated with improvements in self-reported self-care and empowerment among Black adults. Findings support further testing in larger trials to assess long-term effectiveness and implementation. Given the single-arm design, findings should be interpreted as exploratory.