Project DECIDE Yields Positive Results in African American Population

Developing and implementing a combined educational and problem-solving technique for diabetes is feasible and acceptable in the African American population, said Felicia Hill-Briggs, PhD, ABPP, an associate professor in the Department of Medicine at Johns Hopkins University, during a presentation at the American Diabetes Association’s 70th Scientific Sessions.

In the session, “Problem-Solving Training among Urban African Americans with Type 2 Diabetes—Project DECIDE,” Hill-Briggs discussed details of the study, which was conducted in Baltimore. She explained that diabetes education and teaching problem-solving techniques are paramount in lower socioeconomic groups, which suffer excess disease burden from type 2 diabetes. Because the risk factors for this disease are modifiable, it is important that these lower socioeconomic groups be taught the right way to either manage their disease or avoid it.

Although problem-solving skill training is an established method, Hill-Briggs said that precise methods and tools for patient problem-solving skill training within diabetes education and counseling needed to be established. To that end, Project DECIDE (Decision Making Education for Choices in Diabetes Everyday) was created to develop combined educational and problem-solving training for diabetes patients.

The educational component of Project DECIDE is composed of a single 90-minute booster session to reeducate diabetes patients about the important aspects of managing the disease. It promotes awareness of the cardiovascular risk factors associated with diabetes, along with knowledge of clinical targets for A1C, blood pressure and cholesterol, and provides recommendations for self-management behavior using sources such as the ADA’s Clinical Practice Recommendations. Project DECIDE is also designed to teach problem-solving training using modules modeled after D’Zurilla and Nezu problem solving therapy, and is an adapted version of this standard problem-solving training.

To establish the efficacy of DECIDE, researchers pre-tested it for suitability in vulnerable populations using two studies (Hill Briggs concluded that it was indeed suitable). The pilot aimed to assess the feasibility, acceptability, and effectiveness of the technique; a sample size of 50 people was used to detect a clinically significant change in A1C.

After the appropriate sample was recruited for the study, biweekly 90-minute group sessions were conducted with 8-10 people per group (29 people were placed in the comprehensive group and 27 in the enhanced brief group). After DECIDE was implemented, it was found among the sample group that as problem solving improved, A1C levels dropped. In the comprehensive group, the number of days in which patients ate healthy increased from 3.5 to 6 days. The project was also very well received among participants, who ranked it highly in nearly all categories assessed, including the helpfulness of the classes and how much they learned.

Hill-Briggs concluded that this type of intervention is feasible and acceptable in an African American population, and the problem-solving findings can be extended to patients with diabetes, proving that comprehensive problem-solving training is effective for quality outcomes.