Abstract
OBJECTIVES: Type 2 diabetes disproportionally affects Hispanics, calling for effective diabetes self-management education and support (DSMES) strategies. Churches are promising settings for DSMES delivery in predominately Hispanic communities. Health programs are “faith-placed” (FP) if churches are used as a place for intervention delivery and “faith-based” (FB) if spirituality is incorporated. BHT DSMES integrates spirituality with DSMES in Hispanic churches for diabetic participants in Texas. The study aimed to compare impacts of a FB vs FP approach on diabetes outcomes. METHODS: This cluster-randomized controlled trial, conducted between 2017 and 2020, consisted of 271 participants from 16 churches randomly assigned to the FB Group (church = 9, n = 146) or FP Group (church = 7, n = 125). The FB Group, led by trained church lay leaders, received a Health Sermon, 6-session DSMES, and 7-session Healthy Bible Study. The FP Group, led by outside health professionals, received a 6-session DSMES and 7-session partial attention control curriculum. Key outcome measures included glycated hemoglobin (HbA1c), waist circumference (WC), diabetes self-efficacy, diabetes self-care activities, and diabetes distress. Data were collected at baseline, 6, 9, and 12 months (mo). Following an intent-to-treat principle, linear mixed-effect models were used to determine intervention effect on key outcomes. Models controlled for age, gender, and baseline measure. RESULTS: The FB Group had a significantly lower HbA1c at 6 mo (−0.3%, p < 0.05), and a lower WC at 12 mo (−2.9 cm, p = 0.05) than the FP Group. Within-group analysis shows that the FB intervention led to a decreased HbA1c at 6 mo, and WC reductions at 9 and 12 mo. Although no between group differences were observed, compared to baseline, both the FB and FP Groups significantly increased diabetes self-efficacy and diabetes self-care activity score and decreased diabetes distress score post-intervention. CONCLUSIONS: Both the FB and FP interventions had favorable changes in diabetes self-efficacy, diabetes self-care behavior, and diabetes distress. Integrating spirituality with DSMES led to a reduced WC and better blood glucose control among predominately Hispanic churchgoers with diabetes. FUNDING SOURCES: This study is funded by the American Diabetes Association Innovative Clinical or Translational Science Award.