Implementing a Diabetes Education Program to Reduce Health Disparities in South Texas: Application of the RE-AIM Framework for Planning and Evaluation
Abstract
:1. Introduction
2. Materials and Methods
2.1. Population Setting and Targets
2.2. Recruitment
2.3. Intervention
2.4. Data Collection
2.5. Analyses
2.6. Research Ethics
3. Results
3.1. Reach
Retention
3.2. Effectiveness
3.3. Adoption
3.4. Implementation
3.5. Maintenance
4. Discussion
Study Limitations and Strengths
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Characteristics | Overall (n = 8664) | First Biennium (n = 3514) | Second Biennium (n = 5150) | p-Value a |
---|---|---|---|---|
Age | <0.001 ** | |||
18–44 years old | 1720 (20.0%) | 594 (17.1%) | 1126 (22.0%) | |
45–64 years old | 4757 (55.3%) | 2002 (57.5%) | 2755 (53.8%) | |
65 years or older | 2120 (24.7%) | 883 (25.4%) | 1237 (24.2%) | |
Sex | 0.030 | |||
Female | 5325 (61.6%) | 2204 (63.0%) | 3121 (60.6%) | |
Male | 3323 (38.4%) | 1297 (37.0%) | 2026 (39.4%) | |
Race/Ethnicity | 0.148 | |||
Non-Hispanic White | 2215 (25.9%) | 930 (26.7%) | 1285 (25.4%) | |
Non-Hispanic Black | 298 (3.5%) | 111 (3.2%) | 187 (3.7%) | |
Non-Hispanic Other races | 175 (2.0%) | 80 (2.3%) | 95 (1.9%) | |
Hispanic | 5859 (68.6%) | 2357 (67.8%) | 3502 (69.1%) | |
Education | 0.421 | |||
High school or less | 5553 (72.2%) | 2237 (71.7%) | 3316 (72.5%) | |
More than high school | 2141 (27.8%) | 884 (28.3%) | 1257 (27.5%) | |
Primary language | 0.277 b | |||
English | 7746 (89.5%) | 3153 (90.0%) | 4593 (89.2%) | |
Spanish | 904 (10.4%) | 351 (10.0%) | 553 (10.7%) | |
Other | 5 (0.1%) | 1 (0.03%) | 4 (0.1%) | |
BMI categories | 0.007 * | |||
Underweight | 432 (5.0%) | 198 (5.6%) | 234 (4.5%) | |
Normal | 777 (9.0%) | 285 (8.1%) | 492 (9.6%) | |
Overweight | 1928 (22.3%) | 755 (21.5%) | 1173 (22.8%) | |
Obese | 5527 (63.8%) | 2276 (64.8%) | 3251 (63.1%) | |
Diabetes type c | <0.001 ** | |||
Pre-diabetes | 999 (14.7%) | 425 (15.4%) | 574 (14.3%) | |
Type 1 | 221 (3.3%) | 81 (2.9%) | 140 (3.5%) | |
Type 2 | 5463 (80.5%) | 2238 (81.1%) | 3225 (80.1%) | |
Gestational | 12 (0.2%) | 5 (0.2%) | 7 (0.2%) | |
Do not know | 93 (1.4%) | 12 (0.4%) | 81 (2.0%) | |
Baseline A1c (%) (mean (standard deviation)) d | ||||
Pre-diabetes | 6.2 (0.97) | 6.1 (0.85) | 6.2 (1.05) | 0.024 |
Type 1 | 8.7 (2.17) | 8.4 (2.00) | 8.9 (2.25) | 0.120 |
Type 2 | 8.6 (2.25) | 8.5 (2.23) | 8.7 (2.27) | 0.616 |
Characteristics | 3 Months (n = 8664) | 6 Months (n = 8234) a | 9 Months (n = 7534) b | 12 Months (n = 6798) c | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Attended (n = 4147) | Not Attended (n = 4517) | p-Value d | Attended (n = 2509) | Did Not Attend (n = 5725) | p-Value d | Attended (n = 1736) | Did Not Attend (n = 5798) | p-Value d | Attended (n = 1252) | Did Not Attend (n = 5546) | p-Value d | |
Age | <0.001 ** | <0.001 ** | <0.001 ** | <0.001 ** | ||||||||
18–44 years old | 614 (35.7%) | 1106 (64.3%) | 296 (18.0%) | 1349 (82.0%) | 188 (12.5%) | 1318 (87.5%) | 120 (9.0%) | 1212 (91.0%) | ||||
45–64 years old | 2334 (49.1%) | 2423 (50.9%) | 1410 (31.2%) | 3113 (68.8%) | 962 (23.1%) | 3200 (76.9%) | 703 (18.6%) | 3085 (81.4%) | ||||
65 years or older | 1177 (55.5%) | 943 (44.5%) | 791 (39.6%) | 1208 (60.4%) | 575 (31.9%) | 1225 (68.1%) | 423 (25.9%) | 1210 (74.1%) | ||||
Sex | 0.005 * | 0.003 * | 0.006 * | 0.014 * | ||||||||
Female | 2611 (49.0%) | 2714 (51.0%) | 1598 (31.7%) | 3447 (68.3%) | 1119 (24.1%) | 3526 (75.9%) | 816 (19.3%) | 3408 (80.7%) | ||||
Male | 1527 (46.0%) | 1796 (54.0%) | 905 (28.5%) | 2268 (71.5%) | 613 (21.3%) | 2260 (78.7%) | 433 (16.9%) | 2125 (83.1%) | ||||
Race/Ethnicity | <0.001 ** | <0.001 ** | <0.001 ** | <0.001 ** | ||||||||
Non-Hispanic White | 1244 (56.2%) | 971 (43.8%) | 818 (38.9%) | 1284 (61.1%) | 594 (30.5%) | 1353 (69.5%) | 444 (25.3%) | 1309 (74.7%) | ||||
Non-Hispanic Black | 145 (48.7%) | 153 (51.3%) | 86 (30.4%) | 197 (69.6%) | 58 (22.7%) | 197 (77.3%) | 42 (18.5%) | 185 (81.5%) | ||||
Non-Hispanic Other races | 81 (46.3%) | 94 (53.7%) | 47 (28.7%) | 117 (71.3%) | 40 (26.0%) | 114 (74.0%) | 33 (23.2%) | 109 (76.8%) | ||||
Hispanic | 2629 (44.9%) | 3230 (55.1%) | 1532 (27.5%) | 4043 (72.5%) | 1027 (20.2%) | 4046 (79.8%) | 716 (15.7%) | 3859 (84.3%) | ||||
Education | <0.001 ** | <0.001 ** | <0.001 ** | <0.001 ** | ||||||||
High school or less | 2467 (44.4%) | 3086 (55.6%) | 1413 (26.6%) | 3892 (73.4%) | 944 (19.5%) | 3889 (80.5%) | 684 (15.7%) | 3665 (84.3%) | ||||
More than high school | 1101 (51.4%) | 1040 (48.6%) | 710 (35.0%) | 1316 (65.0%) | 512 (27.6%) | 1343 (72.4%) | 363 (21.7%) | 1313 (78.3%) | ||||
Primary language e | <0.001 ** | <0.001 ** | <0.001 ** | <0.001 ** | ||||||||
English | 3625 (46.8%) | 4121 (53.2%) | 2166 (29.4%) | 5198 (70.6%) | 1505 (22.4%) | 5220 (77.6%) | 1082 (17.8%) | 5005 (82.2%) | ||||
Spanish | 519 (57.4%) | 385 (42.6%) | 339 (39.6%) | 517 (60.4%) | 228 (28.6%) | 568 (71.4%) | 168 (24.1%) | 530 (75.9%) | ||||
BMI categories | <0.001 ** | <0.001 ** | <0.001 ** | <0.001 ** | ||||||||
Underweight | 157 (36.3%) | 275 (63.7%) | 86 (21.2%) | 320 (78.8%) | 52 (13.6%) | 330 (86.4%) | 25 (7.9%) | 293 (92.1%) | ||||
Normal | 388 (49.9%) | 389 (50.1%) | 249 (33.3%) | 498 (66.7%) | 186 (27.6%) | 489 (72.4%) | 141 (23.2%) | 467 (76.8%) | ||||
Overweight | 975 (50.6%) | 953 (49.4%) | 600 (32.6%) | 1241 (67.4%) | 431 (25.7%) | 1244 (74.3%) | 310 (20.7%) | 1191 (79.3%) | ||||
Obese | 2627 (47.5%) | 2900 (52.5%) | 1574 (30.0%) | 3666 (70.0%) | 1067 (22.2%) | 3735 (77.8%) | 776 (17.8%) | 3595 (82.2%) | ||||
Diabetes type f,g | <0.001 ** | 0.012 | 0.212 | 0.116 | ||||||||
Pre-diabetes | 548 (54.9%) | 451 (45.1%) | 347 (37.3%) | 584 (62.7%) | 245 (28.6%) | 611 (71.4%) | 190 (24.3%) | 591 (75.7%) | ||||
Type 1 | 98 (44.3%) | 123 (55.7%) | 62 (29.7%) | 147 (70.3%) | 46 (24.2%) | 144 (75.8%) | 33 (19.2%) | 139 (80.8%) | ||||
Type 2 | 2801 (51.3%) | 2662 (48.7%) | 1750 (33.6%) | 3456 (66.4%) | 1235 (25.9%) | 3528 (74.1%) | 893 (20.7%) | 3430 (79.3%) | ||||
Do not know | 33 (35.5%) | 60 (64.5%) | 11 (20.4%) | 43 (79.6%) | 4 (16.0%) | 21 (84.0%) | 2 (16.7%) | 10 (83.3%) | ||||
Baseline A1c (%) (mean (standard deviation)) h | ||||||||||||
Pre-diabetes | 6.2 (1.00) | 6.1 (0.94) | 0.231 | 6.1 (0.74) | 6.2 (1.05) | 0.374 | 6.1 (0.73) | 6.2 (1.01) | 0.299 | 6.1 (0.82) | 6.1 (0.94) | 0.775 |
Type 1 | 8.5 (1.96) | 8.9 (2.32) | 0.146 | 8.4 (2.11) | 8.8 (2.17) | 0.277 | 8.5 (2.24) | 8.7 (2.13) | 0.539 | 9.00 (2.52) | 8.55 (2.05) | 0.284 |
Type 2 | 8.3 (2.19) | 8.8 (2.30) | <0.001 ** | 8.2 (2.13) | 8.7 (2.29) | <0.001 ** | 8.2 (2.16) | 8.7 (2.28) | <0.001 ** | 8.1 (2.12) | 8.71 (2.29) | <0.001 ** |
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Ory, M.G.; Lee, S.; Towne, S.D., Jr.; Flores, S.; Gabriel, O.; Smith, M.L. Implementing a Diabetes Education Program to Reduce Health Disparities in South Texas: Application of the RE-AIM Framework for Planning and Evaluation. Int. J. Environ. Res. Public Health 2020, 17, 6312. https://doi.org/10.3390/ijerph17176312
Ory MG, Lee S, Towne SD Jr., Flores S, Gabriel O, Smith ML. Implementing a Diabetes Education Program to Reduce Health Disparities in South Texas: Application of the RE-AIM Framework for Planning and Evaluation. International Journal of Environmental Research and Public Health. 2020; 17(17):6312. https://doi.org/10.3390/ijerph17176312
Chicago/Turabian StyleOry, Marcia G., Shinduk Lee, Samuel D. Towne, Jr., Starr Flores, Olga Gabriel, and Matthew Lee Smith. 2020. "Implementing a Diabetes Education Program to Reduce Health Disparities in South Texas: Application of the RE-AIM Framework for Planning and Evaluation" International Journal of Environmental Research and Public Health 17, no. 17: 6312. https://doi.org/10.3390/ijerph17176312