CBPR with Immigrant Chinese with Diabetes

The epidemic of type 2 diabetes in the U.S. is particularly acute in ethnic minority groups. Disproportionately high rates of diabetes, 1.6 to 3 times those observed in European Americans are found in Chinese Americans, the largest group of Asian Americans and one of the most rapidly growing immigrant groups. Chinese Americans have cultural concerns about family obligation and well-being and are challenged by health prescriptions that assume a Western individualistic orientation. Few culturally appropriate interventions for immigrant Chinese with type 2 diabetes mellitus (T2DM) are available and none address the family context of self-management. The proposed project is part of a program of research to improve management of T2DM through a community-academic partnership that addresses cultural factors in disease management. Specific aims are to: 1. Strengthen a community-academic partnership with the immigrant Chinese community in San Francisco to improve diabetes management; 2. Adapt and test a behavioral diabetes intervention, Coping Skills Training, to addresses family and cultural issues in immigrant Chinese patients with T2DM; and 3. Disseminate the adapted Coping Skills Training Program findings via the community-academic partnership to the immigrant Chinese American community through service programs, ethnic media, and professional/scientific publications.

A mixed-methods CBPR approach is used to interpretively adapt a behavioral intervention to be culturally appropriate, and test its efficacy using a repeated measures design. Two historically significant social service and health agencies serving immigrant Chinese in San Francisco have previously collaborated with this nurse-led interdisciplinary research team to describe Chinese family processes of care of T2DM. This project enabled partners to co-develop a culturally appropriate intervention that strengthens patient skills to address personal and family dilemmas in managing disease. Twenty patients participated in the pilot phase to adapt the intervention. Using a repeated measure design, where participants served as their own control, 145 Chinese immigrants with T2DM were enrolled to test the efficacy of the adapted intervention. The intervention trial is complete (Summer, 2011) and data analysis is in process.

Significance: Although immigrant Chinese Americans demonstrate significant health disparities, services tailored to their cultural concerns are few, perhaps because of a ‘model minority’ stereotype that that mischaracterizes Asian Americans as free from health and social problems. The proposed project partners with the immigrant Chinese community to tailor an efficacious diabetes behavioral intervention to Chinese cultural concerns, focusing on family factors that support or impede disease management.