Using Multifamily Groups to Improve Self-Management of Type 2 Diabetes

The project evaluates four culturally adapted, family-based treatments designed to improve
health status, self-management behaviors and self-efficacy among Mexican-Americans with Type
2 diabetes using a Sequential, Multiple Assignment Randomized Trial in a public health
setting. In the first phase of the study, subjects will be randomly assigned to six 2.5 hour
sessions (three months) of either: 1) Tomando Control de su Diabetes (TC), a culturally
tailored, community-based, Diabetes Self-Management program delivered in a group format by
community health workers (promotoras) working with individual patients and families; or 2) TC
delivered by health professionals (licensed nurses). Evaluations will be made at baseline,
three months, six months and 12 months. After six weeks of treatment (at the midway point of
the intervention), subjects will be assessed for improvement in diabetes self-management
behaviors (the primary outcome). In the second phase of the study, those subjects who have
improved their diabetes self-management behaviors by 50% over baseline will be continued in
their assigned treatment for the duration of three months. Those subjects who do not meet
this target will be re-randomized to receive either: 1) an augmented version of TC that has a
specific focus on engaging family members; or 2) a multifamily group treatment led by nurses
specially trained in teaching diabetes self-management skills for an additional three months.

Inclusion Criteria:

1. Mexican origin and speaks Spanish fluently

2. age 18 years or older

3. medical chart diagnosis of Type 2 diabetes

4. living with at least one adult family member who is willing to participate.

Exclusion Criteria:

1. diagnosis of Type 1 diabetes

2. participation in another Diabetes Self-management education program within the past 12
months

3. pregnancy

4. significant cognitive impairment.