Non-Pharmacological Interventions for Diabetes Management Report

This report examines the effectiveness of non-pharmacological interventions for managing type 2 diabetes, particularly among African American adults. It analyzes four key studies that explore interventions such as culturally tailored diabetes self-management education, text-message-based programs, and positive psychology interventions. The report applies the Integrated Behavioral Model (IBM) to understand the determinants of behavioral intentions in promoting health changes, focusing on constructs like attitudes, perceived norms, and personal agency. The studies reviewed include randomized controlled trials and qualitative research, highlighting the impact of interventions on A1c levels, self-management skills, and psychological well-being. The report also discusses the strengths and limitations of each study, providing insights into the development and implementation of effective diabetes management strategies. The analysis considers the role of socio-economic factors, health disparities, and the importance of tailoring interventions to specific populations to improve diabetes outcomes.

Running head: DIABETES
Diabetes Prevention and Control: Interventions and Integrated Behavioral Model
Name of the Student
Name of the University
Author Note

1
DIABETES
Background of the study
Diabetes
According to the American Diabetes Association (ADA) (2019), diabetes is a
metabolic disorder that results in increase in the level of glucose in the blood. Diabetes can be
classified under two categories. Type 1 Diabetes mellitus (T1DM) is a metabolic disorder that
occurs due to the destruction of the beta cells leading to deficiency of absolute insulin and
thus hampering glucose uptake from blood, promoting hyperglycemia. Type 2 Diabetes
Mellitus (T2DM) create a progressive loss of bet-cells of the Islet of Langerhans, pancreas
and thus hampering the secretion of insulin and increasing the glucose level in blood. In
certain cases, the body develop insulin resistance in T2DM and thus increasing the blood
glucose level (GBL) or causing hyperglycemia. There is another type of diabetes known as
gestational diabetes (GD). This is common among the pregnant women who are in second or
third trimester of pregnancy (ABA, 2019). Centers for Disease Prevention and Control (CDC)
(2019) stated that more than 34 million people or one out of ten people in the USA have
diabetes. Approximately 90 to 95% of them have T2DM. T2DM is adult diabetes that
develops in people who are over 45 years of age. T2DM is popularly known as lifestyle
disease and at present it is becoming increasing popular among the children, teen and young
adults due to poor lifestyle habits.
Type 2 diabetes among African American
U.S Department of Health and Human Services Office of Minority Health (2019)
highlighted in their report that African American Adults are 60% more likely in comparison
to the non-Hispanic white adults to be diagnosed with T2DM. Socio-economic determinant
of health (SDH) is associated with the higher prevalence of the cardio-vascular risk factors
including diabetes among the African American adults. Diabetes is two times more prevalent

2
DIABETES
among the lo-income population in comparison to the wealthy population. Patients with
T2DM from low income countries are more likely to get hospitalized due to the management
of the micro and macro-vascular complications of diabetes. The link between the diabetes
vulnerability and financial status is complex. It has been seen that increased diabetes risk is
popular among the low-income groups and this is further associated with increased
prevalence of obesity within this group. (Bijlsma-Rutte, Rutters, Elders, Bot & Nijpels,
2018). In the USA the rate of occurrence of Diabetes is significantly higher among the black
adults in comparison to the while adults and the greatest difference is observed between the
black women and white women. The biological risk factors accounted for the significant
health disparities among the white and black population of the USA. The biological factors
include high body mass index (BMI), fasting glucose, waist measurement, lung function,
blood pressure and lipids. The differences between the whites and blacks in psychosocial,
behavioral and socio-economic factors are also linked with the diabetes development
(Schwartz, 2016).

3
DIABETES
(CDC, 2019)
Interventions for Diabetes management
According to the American Family Physician (2019), stated that insulin resistance
among the T2DM population occurs due to defective insulin-mediated glucose uptake and
glucose utilization within the body and this in turn reflects the inhibition of glucose transport.
Both the pharmacological and non-pharmacological interventions are used in order to reduce
the insulin resistance. However, non-pharmacological medication is found to promote long-
term result of diabetes management in comparison to the pharmacological interventions.
Common non-pharmacological intervention that is used for the management of T2DM
include low-calories diet, strict weight loss regime and conduction of mild to moderate
physical activity (American Family Physician, 2019).
Scope of the research
In my research into type 2 diabetes, I have identified four different studies to analyze
the effectiveness of the non-pharmacological interventions for the management of type 2
diabetes among the African American adults in the USA. I used multiple databases (PubMed,
JSTOR and Google Scholar) in order to retrieved those four selected articles. The keywords,
that were used for the search of the articles in those databases include: diabetes or Type 2
diabetes AND interventions OR non-pharmacological interventions AND self-management
and African American. The articles that were published within the last 10 years were
included in the study. The inclusion of the articles that are published within the last 10 years
helped in the generation of the evidence-based interventions that are relevant yet authentic. In
all the included studies, the authors included non-pharmacological interventions for the
promotion of the effective management of diabetes.

4
DIABETES
Integrated Behavioral Model (IBM)
Martin Fishbein and his colleagues developed the IBM. The model mainly outlines
the determinants of the behavioral intention in order to promote change in the health status.
The model posits that any intension to someone to conduct healthy behavior is constructed
and is influenced by the perceived norms, attitudes and other personal agency and ability to
practice that healthy behavior. The predictors of the behavior influence its rate of observance
in order to maintain healthy lifestyle (Fishbein, 2008). These three difference constructs
provide a clear entryways towards the health promotion in the domain of T2DM
management.

5
DIABETES
O
T
H
E
R
F
A
C
T
O
R
S
Instrumenta
l attitude
Behavioral beliefs
Normative beliefs
and other’s
expectations
Control Beliefs
Efficacy beliefs
Feelings about
behavior
Experiential
attitude
Injunction
norm
Descriptive
norm
Perceived
control
Habit
Salience of the behavior
Knowledge and skills of
perform the behavior
Environmental constraints
Self
efficacy
Intension of Decision to
Perform the Behavior
Change
Normative beliefs
and other’s
behaviors
B
E
H
A
V
I
O
R
Integrated Behavior Model
Source: Created by author

6
DIABETES
Branscum and Lora (2017) are of the opinion that IBM was first conceptualized in
order to promote community and public health and at the same time helps to promote public
health-behavior. Branscum and Lora (2017) further highlighted that the IBM is focused
towards predicting the sexual behavior and is limited towards change in the dietary or
nutritional behaviors. Thus, while using the IBM and other similar theories like the Theory of
Planned Behavior, more focus must be given to the indirect measures rather than focusing in
the direct measures. Direct measures can be highly predictive towards intentions and health
behaviors. Direct measures fail to provide substantive information about what drives the
attitudes and the perceived norms towards the behaviors.
I analyzed each of the four studies in relation to the three constructs generated from
the IBM. The three constructs of IBM includes: attitudes, perceived norms and personal
agency. This analysis will help me to study how well the healthcare policy developers make
use of the constructs and how the upcoming public health designers and policy developers
might attempt to improve the high susceptibility of T2DM among African Americans.
Overview of Studies
Lynch et al. (2019) conducted a randomized control trial over 211 African Amercians
in order to study change in the hemoglobin concentration (A1c) during the interval of 6, 12
and 18 months under the action of the novel and culturally tailored diabetes self-management
education. 211 African Americans (AA) were divided into two groups (experimental and
control groups). Control group received standard care and the experimental group received
Lifestyle Improvement through Food and Exercise (LIFE) intervention in a culturally tailored
manner. Cluster-adjusted ANCOVA modeling was used in order to access change in the A1c
levels from baseline during the tenure of 6, 12 and 18 months in between both the arms. The
results showed that Ac1 decreased significantly in the experimental group in comparison to

7
DIABETES
the control group at 6 months interval. However, during 12 and 18 months interval, the
difference was not significant. There was decrease in the A1c value in both the arms after 18
months of interval. However, the experimental group showed greater knowledge in healthy
lifestyle habits and high level of adherence to therapy. Lunch et al. (2019) concluded that
LIFE intervention helps in increasing nutritional knowledge and quality of diet in
intervention group, in comparison to control group. However, no significant difference is
found in the level of A1c post 18 months of interval. The principal strength of the study is its
large sample size and the use of the randomized control trial for the selection of the sample
and thus helping to eliminate the chances of biased selection of target population.
Nundy, Dick, Solomon and Peek (2013) conducted their study in order to explore the
potential mechanism through which text-message-based diabetes program help in the
promotion of the DSME skills among the AA. The main tool that was used for the collection
of data was in-depth interview over 18 AA with type 2 diabetes. The mode of data collection
can be regarded as one of the strength of the study. In-depth interview helps in detailed
exploration of the live -experience of the people and at the same time helps to highlight the
underlying behavioral thoughts of the participants and thus increasing the provision for
generating person-centered care plan in nursing research (Kallio, Pietilä, Johnson &
Kangasniemi, 2016). However, small sample size can be regarded as one of the prime
limitations of the study as it limits the generalization of the research results (Boddy, 2016).
The interview result based on the thematic analysis showed that effects of text message based
program is more useful in comparison to the automated reminders. Text message create a
scope of constant exchange of messages and this helps in facilitating daily communication
among the patient or the T2DM service users and thereby helping to reduce the denial of
diabetes care. The text messages also help in reinforcing the importance of the self-
management skills of diabetes as proposed by the Rosenstock Health Belief Model.

8
DIABETES
Responding to the questions about the DSME in a positive manner helps to increase the level
of proficiency in the disease self-management (Bandura Self Efficacy Model). The use of the
mobile-based education and awareness for the DSME also coincide with the Barrera Social
Support. Social support is received from the perceived automated program as friend or
support group sending the message for disease self-management. Overall, the authors
concluded that mobile-based technology must be designed in such a way to leverage the pre-
existing models of change in behavior for the disease management and thus helping to reduce
the health disparities (Nundy, Dick, Solomon & Peek, 2013)
Huffman, DuBois, Millstein, Celano and Wexler (2015) stated that the patients who
are suffering from T2DM have sub-optimal level of adherence to the diabetic diet plan,
physical activity and other diabetes related medication. The aim of the study conducted by
Huffman, DuBois, Millstein, Celano and Wexler (2015) is to promote simple yet well-
accepted interventions for the diabetes management in order to crater the need of the people
who are suffering from diabetes One of the approach include boosting positive psychological
state of mind like optimism and positive health behavior. The authors are of the opinion that
spreading positive psychology for the management of the diabetes helps in the utilization of
the positive healthcare interventions like exercise and diet and thus promoting comprehensive
health and well-being. The study mainly explored the theoretical model of the positive
psychology (PP) for the promotion of the effective management of diabetes mellitus. A toral
of 15 AA were included in the study with or without depression. Small sample size can be
considered as one of the limitation of the study. The single-arm proof-of-concept intervention
based study showed that motivational interviewing helps to provide a blended psychological-
behavioral approach for improving the overall health-related quality of life of the patient
suffering from diabetes. The conceptual model highlighted in the study showed few of the
important parameters of the positive psychological constructs include optimism, resilience,

9
DIABETES
happiness, well-being and self-esteem. These positive psychological factor, promotes
increased level of social support, influence self-motivation, and at the same time helps in
increasing coping or resilience power and cognitive processing. All these factors further
promote in the development of the health behaviors for the T2DM management like physical
activity, diet and medication adherence.
Peek, Ferguson, Roberson and Chin (2014) conducted a case study in order to analyze
the diabetes-related behavioral change interventions under the backdrop of the Chicago's
south Side. South Side Diabetes Project is officially known as "Improving Diabetes Care and
Outcomes on the South Side of Chicago". The aim of this project is to improve the health-
related outcomes of the people suffering from T2DM and at the same time reduce the health-
related disparities among the working class AA communities residing in the Chicago's South
side. The authors also described the down-stream program elements of this health promotion
program in order to provide additional support in the domain of patients' health-related
behavior. The main program components include promotion of patient education through
patient education class, encouraging the patient to take part in the food and exercise activity
and skill-based training of the patient in order to cook health food and shop for healthy food.
The health promotion program also aimed towards increasing the community-based
participation along with physical activity classes for the effective reduction of the T2DM.
This health promotion program also involves mobile-based intervention implementation
along with the inclusion of the family members in the care process. At the end, the authors
concluded that promotion of the behavioral interventions help in improving health-related
outcome among the people suffering from T2DM and thus helping to improve the overall
outcome of care (Peek, Ferguson, Roberson & Chin, 2014). This study however is not a
primary study unlike the previous one. It is a secondary study that examines the features and

10
DIABETES
the outcomes of the public health promotion in the domain of increasing positive psychology
for the disease management.
Analysis through IBM
Construct: Attitudes
In the IBM, the attitude construct signifies the experimental attitude and instrumental
attitude. Experimental attitude mainly refers to one’s personal feelings in the domain of
executing certain behavior. In this case, it would be studying the personal feelings and
experience of the AA who are suffering from diabetes about executing positive lifestyle
interventions for the reduction in the severity of T2DM. Instrumental attitude generally deals
with ones personal thoughts and beliefs about the overall outcome of the behavior (like
include believing that the intervention will help in preventing disease progression) (Glanz,
2015).
All the four studies that has been analyzed in this assignment, gave importance of the
attitudes (experimental and instrumental attitude). Lynch et al. (2019) stated that the AA
suffer from poor level of knowledge in the domain of diabetes management. Lynch et al.
(2019) also showed that the AA suffers from significant health inequalities due lack of
knowledge about the disease management and this further increase the level of inequalities
further. In the domain of the instrumental attitude, Lynch et al. (2019) study showed that
promotion of the DSME about the diet and physical activity helps in increasing the positive
hope among the individuals (AA). This positive hope deals with positive confidence in
effective self-management of diabetes and thus helping to increase the positive belief about
the effectiveness of the diabetes management interventions. This concept in turn coincides
with the health-behavioral management. Nundy et al. (2013) study highlighted that the using
mobile-based intervention for the diabetes management help in the generation of the

11
DIABETES
psychological connection with the patient by sending constant reminders and this setting
periodic text messages. This constant reminders and messages help to reduce the denial for
the diabetes while helping to increase a ray of hope towards the success of the interventions
and thus increasing the effective execution of the good lifestyle interventions and diabetes
self-management skills. Automated program through mobile-based technology provides
social support and friendship in order to increase the belief in diabetes self-management
skills. Huffman, DuBois, Millstein, Celano and Wexler (2015). showed that the promotion of
positive psychology help to increase the belief about the overall therapy and this positive ray
of hope helps to increase the therapy adherence (instrumental attitude) and thus helping to
increase the health-related outcome of care.
Constructs: Perceived Norms
Perceived norms refer to the social pressure and whether that pressure encourages or
sub subsequently discourages someone to get engage in the specific health-related behavior
or health improvement behavior (Glanz, 2015). Researcher have also highlighted that the
perceived norms do not have any significant influence on any one’s intention in order to
perform behavior as is depicted through the law of I BM (Lewis, 2013). In the IBM model,
Fishbein mainly separates the perceived norms into two different types namely injunctive
norms and descriptive norms. Injunctive norms are one’s normative belief about what others
are thinking or should do (Glanz, 2015). In case of the intervention for the effective
prevention of the T2DM management among the AA, it can be stated that social pressure
prevalent among the society or over the people who hails from the poor socio-economic
background, restricts them from taking pro-active approach for conducting successful health
promotion. Racial discrimination experienced by the AA in the society of White of the USA,
increase the level of social, depression and anxiety and thus decreasing their pro-active
approach to deliver effective self-management skills for diabetes management. Lack of

12
DIABETES
support and proper health-awareness coming from the society further reduces their level of
confidence in effective self-management of the disease (Peek, Ferguson, Roberson and Chin,
2014). Descriptive norms deals with the perceptions of one about what their peers or the
members of their social groups are doing (in other words, it can be said that if I believe my
peers would participate health lifestyle intervention in a proactive manner, then I might end-
up doing the same by getting motivated or influenced from them). Under this aspect it can be
stated that the modification of the IBM theory for the promotion and the effective
management of the T2DM must be done peers or under the community-based placement as
proposed by Peek, Ferguson, Roberson and Chin (2014). This would help in influencing the
descriptive norms and thereby helping in the adherence of the healthy lifestyle intervention.
Under this context, following healthy lifestyle intervention for the T2DM management under
the influence of others coincide with the concept of the Barrera Social support Group a
highlighted in the study of Nundy, Dick, Solomon and Peek (2013). In order to influence the
healthy-lifestyle interventions among the AA, internet-based support groups can act as an
excellent mutual aid. AA are always socially discriminated from the White population of the
USA and suffer from compassion fatigue and depression. Thus from them online exchanges
of health lifestyle tricks and tricks coming from the social support members or other peers
help to increase a ray of hope or faith and thereby helping to uptake healthy lifestyle
intervention and reducing T2DM related health-inequalities. Mazzoni et al. (2020) further
highlighted that Mediterranean Lifestyle Program (MLP) is successful in changing the level
of social embeddedness and social-ecological resources. Thus, the health promotion program
through MLP helps to improve the healthy lifestyle interventions and self-care for diabetes
and results are mainly prominent among the women in comparison to men. Nguyen, Chatters,
Taylor and Mouzon (2016) highlighted that the people who are from the AA origin mainly
suffer from racial and social discrimination. They also reside under the poor socio-economic

13
DIABETES
determinants of health. The lack of support coming from the society and from their other
white peers increase their disease vulnerability and thus under such circumstances. Social
support can prove to be helpful.
Construct: Personal agency
The final IBM construct is personal agency. This is comprised of self-efficacy and
control. Perceived control is defined as one’s perceptions about various elements that make it
either easy of difficult to conduct any particular behavior and other self-efficacy. This
approach coincide with the concept of the Social Cognitive theory. Alternatively, personal
agency can be defined as a measure of one’s level of confidence in conducting any particular
behavior despite the presence of numerous obstacles (Glanz, 2015). No researcher is
successful in making use of the perceived norms. However, perceived norm is associated to
perceiving of peers who are likely to support an intervention. Thus, personal agency mainly
focuses on the level of self-efficacy. Sai Ambati, El-Gayar and Nawar (2019) stated that
increase in the level of self-efficacy helps in overcoming the environmental constraints and
thereby helping to in comprehensive disease promotion. The main environmental threats in
the domain of diabetes management include lack of financial support, poor sanitation under
which the person resides. In such cases, the social or the peer support and other non-
governmental organizations must come forward in order to uplift the socio-economic status
of the people (AA) and thus helping to increase their will power for the promotion of the
effective management of diabetes.
Use of the IBM in Diabetes Prevention and Control
One of the principal strength of the IBM in the domain of the diabetes prevention and
management by the implementation of the non-pharmacological interventions include, it
provides clear targets. These clear targets are constructs of attitudes, perceived norms and

14
DIABETES
personal agency and all these targets are effective in implementing comprehensive health
behaviors for effective health prevention. Researchers have also focused that that perceive
norms along with the personal agency act in unison in order to promote self-management
skills for diabetes prevention. Thus, diabetes prevention and management programs that
incorporates both the perceived norms and personal agency help in increasing the overall
outcome of care and effective prevention of type 2 diabetes. The social support on the self-
care for the diabetes management is moderate however, its overall strength differed by the
level of ethnic majority and the overall nature of the social support (Song, Nam, Park, Shin &
Ku, 2017).
Because the IBM mainly focus on changing ones intention to perform health-related
behavior change, the ethical aspect regarding the researcher’s application of this principle
towards the implementation of the of diabetes prevention plan include taking informed
consent from the patients. Heisler, Choi, Mase, Long and Reeves (2019) are of the opinion
that taking informed consent and respecting the autonomy of the people helps in increasing
the level of participation of the care plan and thus helping t increase the level of therapy
adherence and at the same time increasing the pro-activeness to execute the disease self-
management skills. Heisler, Choi, Mase, Long and Reeves (2019) further highlighted that
people who are from the ethnic minorities like the African American suffer from racial
discrimination and abuse, under such circumstances, respecting their autonomy and informed
consent helps to increase the level of self-esteem and thereby helping to increase the overall
participation in the diabetes management.
Epistemology deals with theory of knowledge and the application of the overall
knowledge of the healthcare professionals in order to promote the disease prevention.
However, under the aspect of the IBM for the diabetes prevention and control, the role and
the knowledge of the healthcare professionals is limited as it mostly depends on the self-

15
DIABETES
efficacy and the will of the patients and the social support received by the patients in order to
promote positive motivation for the diabetes prevention. This can be considered as one of the
drawback of the theory as lack of proper incorporation of the knowledge of the healthcare
professionals limit the scope of designing of the person-centered care approach for diabetes
prevention (Motamed, 2019).
The main policy concerns for the application of the IBM for the effective prevention
and management of diabetes include increase in the provision for designing of the
community-based approach for the promotion of the self-efficacy in the diabetes
management. Office of Disease Prevention and Health Promotion (2019) stated that main
policy concerns for the community level health promotion activity for increasing the level of
social support self-management skill must be done at schools, worksites, at the healthcare
facilities and other social communities.
Conclusion
Thus from the above discussion, I would like to highlight overall performance of the
IBM theory is effective in promoting diabetes self-management skills among the people from
the ethnic minorities like AA and thereby helping to reduce the overall rate of diabetes
occurrence and decrease in the level of disease severity. Focus must be given in the social
support and promotion of self-motivation. Furthermore, NGO’s must come forward in
helping the AA to overcome their poor SDH ad thereby helping to increase the strength of
their personal agency in promotion of the effective diabetes management.

16
DIABETES
References
American Diabetes Association (ADA) (2019). Classification and Diagnosis of
Diabetes: Standards of Medical Care in Diabetes—2019. Retrieved from: 13th April
2020: https://care.diabetesjournals.org/content/42/Supplement_1/S13
American Family Physician. (2019). Treatment of Type 2 Diabetes Mellitus. Retrieved from:
13th April 2020: https://www.aafp.org/afp/1999/0515/p2835.html
Bijlsma-Rutte, A., Rutters, F., Elders, P. J., Bot, S. D., & Nijpels, G. (2018). Socio‐economic
status and HbA1c in type 2 diabetes: A systematic review and meta‐
analysis. Diabetes/metabolism research and reviews, 34(6), e3008.
https://doi.org/10.1002/dmrr.3008
Boddy, C. R. (2016). Sample size for qualitative research. Qualitative Market Research: An
International Journal. https://doi.org/10.1108/QMR-06-2016-0053
Branscum, P., & Lora, K. (2017). Using the Integrated Behavioral Model of Prediction to
Predict Maternal Monitoring of Fruit and Vegetable Consumption among Hispanic
Mothers. Family & community health, 40(1), 32.
doi: 10.1097/FCH.0000000000000130
Centers for Disease Prevention and Control (CDC) (2019). Type 2 Diabetes. Retrieved from:
13th April 2020: https://www.cdc.gov/diabetes/basics/type2.html
Glanz, K., Rimer, B. K., & Viswanath, K. (Eds.). (2015). Health behavior: Theory, research,
and practice. John Wiley & Sons.
Heisler, M., Choi, H., Mase, R., Long, J. A., & Reeves, P. J. (2019). Effectiveness of
Technologically Enhanced Peer Support in Improving Glycemic Management Among

17
DIABETES
Predominantly African American, Low-Income Adults With Diabetes. The Diabetes
Educator, 45(3), 260-271. https://doi.org/10.1177/0145721719844547
Huffman, J. C., DuBois, C. M., Millstein, R. A., Celano, C. M., & Wexler, D. (2015).
Positive psychological interventions for patients with type 2 diabetes: rationale,
theoretical model, and intervention development. Journal of diabetes research, 2015.
http://dx.doi.org/10.1155/2015/428349
Kallio, H., Pietilä, A. M., Johnson, M., & Kangasniemi, M. (2016). Systematic
methodological review: Developing a framework for a qualitative semi‐structured
interview guide. Journal of advanced nursing, 72(12), 2954-2965.
https://doi.org/10.1111/jan.13031
Kong, L. N., Zhu, W. F., He, S., Yao, Y., & Yang, L. (2019). Relationships among social
support, coping strategy, and depressive symptoms in older adults with
diabetes. Journal of gerontological nursing, 45(4), 40-46.
https://doi.org/10.3928/00989134-20190305-03
Lewis, N. (2013). The effects of perceived normative pressure and observability of behavior
on intention to perform sun protection and nutrition behaviors on behalf of young
children among parents. Journal of applied social psychology, 43(Suppl 1), E97.
doi: 10.1111/jasp.12038
Lynch, E. B., Mack, L., Avery, E., Wang, Y., Dawar, R., Richardson, D., ... & Fogelfeld, L.
(2019). Randomized trial of a lifestyle intervention for urban low-income African
Americans with type 2 diabetes. Journal of general internal medicine, 34(7), 1174-
1183. DOI: 10.1007/s11606-019-04894-y

18
DIABETES
Mazzoni, S., Hill, P., Briggs, A., Barbier, K., Cahill, A., Macones, G., ... & Carter, E. (2020).
The effect of group prenatal care for women with diabetes on social support and
depressive symptoms: a pilot randomized trial. The Journal of Maternal-Fetal &
Neonatal Medicine, 33(9), 1505-1510.
https://doi.org/10.1080/14767058.2018.1520832
Motamed, S. (2019). Health promotion, community-campus-local authorities partnership and
new health professional profile: Sandrine Motamed. European Journal of Public
Health, 29(Supplement_4), ckz186-428. https://doi.org/10.1093/eurpub/ckz186.428
Nguyen, A. W., Chatters, L. M., Taylor, R. J., & Mouzon, D. M. (2016). Social support from
family and friends and subjective well-being of older African Americans. Journal of
happiness studies, 17(3), 959-979. https://doi.org/10.1007/s10902-015-9626-8
Nundy, S., Dick, J. J., Solomon, M. C., & Peek, M. E. (2013). Developing a behavioral
model for mobile phone-based diabetes interventions. Patient education and
counseling, 90(1), 125-132. http://dx.doi.org/10.1016/j.pec.2012.09.008
Office of Disease Prevention and Health Promotion. (2019). Educational and community-
Based Programs. Retrieved from: 13th April 2020:
https://www.healthypeople.gov/2020/topics-objectives/topic/educational-and-
community-based-programs
Peek, M. E., Ferguson, M. J., Roberson, T. P., & Chin, M. H. (2014). Putting theory into
practice: a case study of diabetes-related behavioral change interventions on
Chicago’s south side. Health promotion practice, 15(2_suppl), 40S-50S. DOI:
10.1177/1524839914532292

19
DIABETES
Sai Ambati, L., El-Gayar, O., & Nawar, N. (2019). Understanding the Influence of Digital
Divide and Socio-Economic Factors on the Prevalence of Diabetes.
https://scholar.dsu.edu/cgi/viewcontent.cgi?article=1010&context=research-
symposium
Schwartz, A. V. (2016). Epidemiology of fractures in type 2 diabetes. Bone, 82, 2-8.
https://doi.org/10.1016/j.bone.2015.05.032
Song, Y., Nam, S., Park, S., Shin, I. S., & Ku, B. J. (2017). The impact of social support on
self-care of patients with diabetes: What is the effect of diabetes type? Systematic
review and meta-analysis. The Diabetes Educator, 43(4), 396-412.
https://doi.org/10.1177/0145721717712457
U.S Department of Health and Human Services Office of Minority Health. (2019). Diabetes
and African Americans. Retrieved from: 13th April 2020:
https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=18