Dosage Effects of Diabetes Self-Management Education for Mexican Americans

The Starr County Border Health Initiative

  1. Sharon A. Brown, RN, PHD1,
  2. Shelley A. Blozis, PHD2,
  3. Kamiar Kouzekanani, PHD3,
  4. Alexandra A. Garcia, RN, PHD1,
  5. Maria Winchell, MS1 and
  6. Craig L. Hanis, PHD4
  1. 1School of Nursing, University of Texas at Austin, Austin, Texas
  2. 2Department of Psychology, University of California, Davis, California
  3. 3College of Education, Texas A&M University, Corpus Christi, Texas
  4. 4Human Genetics Center, School of Public Health, University of Texas Health Science Center, Houston, Texas
  1. Address correspondence and reprint requests to Sharon A. Brown, RN, PhD, The University of Texas at Austin, P.O. Box 7426, Austin, Texas 78713. E-mail: sabrown{at}


OBJECTIVE—The objective of this study was to compare two diabetes self-management interventions designed for Mexican Americans: “extended” (24 h of education, 28 h of support groups) and “compressed” (16 h of education, 6 h of support groups). Both interventions were culturally competent regarding language, diet, social emphasis, family participation, and incorporating cultural beliefs.

RESEARCH DESIGN AND METHODS—We recruited 216 persons between 35 and 70 years of age diagnosed with type 2 diabetes ≥1 year. Intervention groups of eight participants and eight support persons were randomly assigned to the compressed or extended conditions. The interventions differed in total number of contact hours over the yearlong intervention period, with the major difference being the number of support group sessions held. The same information provided in the educational sessions of the extended intervention was compressed into fewer sessions, thus providing more information during each group meeting.

RESULTS—The interventions were not statistically different in reducing HbA1c; however, both were effective. A “dosage effect” of attendance was detected with the largest HbA1c reductions achieved by those who attended more of the extended intervention. For individuals who attended ≥50% of the intervention, baseline to 12-month HbA1c change was −0.6 percentage points for the compressed group and −1.7 percentage points for the extended group.

CONCLUSIONS—Both culturally competent diabetes self-management education interventions were effective in promoting improved metabolic control and diabetes knowledge. A dosage effect was evident; attending more sessions resulted in greater improvements in metabolic control.


  • A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    • Accepted November 15, 2004.
    • Received September 10, 2004.
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