A Pilot Study to Improve Diabetes Management through Family-Based Health Care Navigation

About This Grant

Native Hawaiians and Pacific Islanders (NH/PI) are affected by diabetes with an estimated prevalence of 19.8% compared to non-Hispanic White adults at 8.0%. There are a number of barriers to NHPI engaging in diabetes clinical care, including the experience of health-related social needs. Most NHPI live in multigenerational homes and several activities are done as a family unit. Yet, family members are often not well-integrated into clinical care and lack the knowledge to fully support the family member(s) living with diabetes. The purpose of the Ho’okele (Hawaiian for Navigate) study is to test the feasibility and preliminary efficacy of a family-based Diabetes Self-Management Education and Support (DSMES) and social care navigation intervention to improve diabetes-related outcomes among NH/PI patients with poorly managed diabetes and social needs. Kaiser Permanente Hawaii NHPI patients (N = 80) age ≥ 18, recent A1C ≥ 8%, and who report >1 social needs will be recruited and randomized to one of two study arms: 1) family-based DSMES and social care navigation intervention; or 2) enhanced usual care. In the family-based intervention, participants and their family members will receive the 6-week NHPI culturally adapted DSMES program and 6 months of support and navigation to resources from a NH/PI CHW.  Participants in the enhanced usual care arm will receive standard diabetes clinical care and be provided with a tailored community-based resource list. Feasibility will be determined using mixed methods and based on recruitment, retention, attendance, social need resolution, and several implementation outcomes (i.e., practicality, acceptability, fidelity, cultural appropriateness, and sustainability). We will also examine preliminary effects of Ho’okele on diabetes distress, self-management, self-efficacy/empowerment, A1C, and healthcare utilization at 6 months.  Feasibility and preliminary data will be generated for a future R01 application that will test this intervention, refined by results of this pilot, in a large-scale, pragmatic trial. Findings from this pilot and a future larger trial will contribute critical knowledge on effective, culturally adapted approaches to improve diabetes management long-term among NH/PI.