Integrated Second Language Learning for Chronic Care

The purpose of this randomized controlled 2-group study is to test the effect of an
innovative educational intervention called Integrated Language Learning for Chronic Care
(IL2L) on successful self-management of diabetes. It pursues an integrated development of
second language and interpersonal communication skills that will facilitate productive
interactions between Spanish-speaking nurse practitioners (NP) and limited English
proficiency Hispanic patients with diabetes. The intervention targets the acquisition of
language skills that facilitate communicative functions known to be effective in engaging
chronically ill patients. It accelerates acquisition of these skills by adding a longitudinal
clinical instruction dimension. Further, the investigators propose that the efficacy of the
intervention can be demonstrated at the provider level through improved linguistic and
interpersonal performance and at the patient level through improved diabetes outcomes in
response to language concordance. In support of these claims, the investigators seek to
achieve the following specific aims:

Aim 1: To determine the efficacy of the IL2L for Chronic Care intervention on physical and
mental health outcomes for Spanish-speaking patients with diabetes. Our hypothesis is: H1:
Patients in the IL2L care group will report better physical health (HbA1C, lipids, and
weight), mental health (depression and anxiety) and satisfaction with their healthcare than
patients in the non-IL2L care group.

Aim 2: To determine the efficacy of the IL2L for Chronic Care intervention on provider
language proficiency and interpersonal communication skills. Our hypothesis is:H2: Providers
exposed to the IL2L intervention will demonstrate improved Spanish language skills and
interpersonal communication skills upon completion of the intervention.Specific Aim 3: To
assess the acceptability of the IL2L for Chronic Care model within a graduate level nurse
practitioner curriculum in a leading College of Nursing.

The study will employ a mixed-methods model to assess the efficacy and accessibility of the
IL2L for Chronic Care educational intervention in The Ohio State University's College of
Nursing nurse practitioner program. To achieve Aim 1, the investigators will use a randomized
control trial to demonstrate efficacy of the IL2L for Chronic Care model at the patient
level. The investigators will compare a group of patients exposed to providers who underwent
the IL2L intervention (intervention group) and a group of patients who are undergoing
standard care (comparison group). To achieve Aim 2, the investigators will use a qualitative
data interaction analysis system to demonstrate improvement in Spanish language proficiency
and interpersonal communication skills. To achieve Aim 3, the investigators will use a
combination of quantitative and qualitative measures within the RE-AIM model to assess the
acceptability of the IL2L for chronic care model at the program level in a nurse practitioner
program in a leading College of Nursing. The study has been approved by the institutional
review boards of both universities prior to implementation and patients and student providers
provide written informed consent.

INCLUSION CRITERIA

Students:

Enrolled in nurse practitioner programs at Ohio State University or University of Arizona
Minimum intermediate Spanish language fluency by Oral Proficiency testing Patients Self
identify as Hispanic/Latino Self identify preference for health care interaction in Spanish
Clinical diagnosis of Type 2 diabetes Hemoglobin A1C of 7 or higher 22 years or older Must
have access to land line or mobile phone

EXCLUSION CRITERIA

Students:

Distinguished Spanish language fluency by Oral Proficiency testing Received professional
training for a health-related profession in a Spanish-speaking country

Patients:

Clinic diagnosis of diabetic retinopathy, diabetic neuropathy, or diabetic nephropathy
Clinical diagnosis of major depression Clinical diagnosis of other psychiatric disorder