Culturally Competent Diabetes Self-Management Education for Mexican Americans

The Starr County Border Health Initiative

  1. Sharon A. Brown, RN, PHD, FAAN1,
  2. Alexandra A. Garcia, RN, MSN1,
  3. Kamiar Kouzekanani, PHD1 and
  4. Craig L. Hanis, PHD2
  1. 1School of Nursing, The University of Texas at Austin, Austin, Texas
  2. 2School of Public Health, the University of Texas Health Science Center at Houston, Houston, Texas


    OBJECTIVE—To determine the effects of a culturally competent diabetes self-management intervention in Mexican Americans with type 2 diabetes.

    RESEARCH DESIGN AND METHODS—A prospective, randomized, repeated measures study was conducted on the Texas-Mexico border in Starr County. A total of 256 randomly selected individuals with type 2 diabetes between 35 and 70 years of age, diagnosed with type 2 diabetes after 35 years of age, and accompanied by a family member or friend were included. The intervention consisted of 52 contact hours over 12 months and was provided by bilingual Mexican American nurses, dietitians, and community workers. The intervention involved 3 months of weekly instructional sessions on nutrition, self-monitoring of blood glucose, exercise, and other self-care topics and 6 months of biweekly support group sessions to promote behavior changes. The approach was culturally competent in terms of language, diet, social emphasis, family participation, and incorporation of cultural health beliefs. Outcomes included indicators of metabolic control (HbA1c and fasting blood glucose), diabetes knowledge, and diabetes-related health beliefs.

    RESULTS—Experimental groups showed significantly lower levels of HbA1c and fasting blood glucose at 6 and 12 months and higher diabetes knowledge scores. At 6 months, the mean HbA1c of the experimental subjects was 1.4% below the mean of the control group; however, the mean level of the experimental subjects was still high (>10%).

    CONCLUSIONS—This study confirms the effectiveness of culturally competent diabetes self-management education on improving health outcomes of Mexican Americans, particularly for those individuals with HbA1c levels >10%.


    • Address correspondence and reprint requests to Sharon A. Brown, The University of Texas at Austin, P.O. Box 7996, Austin, TX 787012-1111. E-mail: sabrown{at}

      Received for publication 1 June 2001 and accepted in revised form 24 October 2001.

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