A randomized trial of an intervention to improve self-care behaviors of African-American women with type 2 diabetes: impact on physical activity.
OBJECTIVE
To determine whether a culturally appropriate clinic- and community-based intervention for African-American women with type 2 diabetes will increase moderate-intensity physical activity (PA).


METHODS
In this randomized controlled trial conducted at seven practices in central North Carolina, 200 African-American women, > or =40 years of age with type 2 diabetes, were randomized to one of three treatment conditions: clinic and community (group A), clinic only (group B), or minimal intervention (group C). The clinic-based intervention (groups A and B) consisted of four monthly visits with a nutritionist who provided counseling to enhance PA and dietary intake that was tailored to baseline practices and attitudes; the community-based intervention (group A) consisted of three group sessions and 12 monthly phone calls from a peer counselor and was designed to provide social support and reinforce behavior change goals; and the minimal intervention (group C) consisted of educational pamphlets mailed to participants. The primary study outcome was the comparison of PA levels between groups assessed at 6 and 12 months by accelerometer, which was worn while awake for 7 days.


RESULTS
Totals of 175 (88%) and 167 (84%) participants completed PA assessment at 6 and 12 months, respectively. For comparison of PA, the P value for overall group effect was 0.014. Comparing group A with C, the difference in the average adjusted mean for PA was 44.1 kcal/day (95% CI 13.1-75.1, P = 0.0055). Comparing group B with C, the difference in the average adjusted mean was 33.1 kcal/day (95% CI 3.3-62.8, P = 0.029). The intervention was acceptable to participants: 88% were very satisfied with clinic-based counseling to enhance PA, and 86% indicated that the peer counselor's role in the program was important.


CONCLUSIONS
The intervention was associated with a modest enhancement of PA and was acceptable to participants.
Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA. thomas_keyserling@med.unc.edu
Thomas C
TC
Keyserling
Carmen D
CD
Samuel-Hodge
Alice S
AS
Ammerman
Barbara E
BE
Ainsworth
Carlos F
CF
Henríquez-Roldán
Tom A
TA
Elasy
Anne H
AH
Skelly
Larry F
LF
Johnston
Shrikant I
SI
Bangdiwala
D000328:Adult; D001741:Black or African American; D003469:Culture; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D010809:Physical Fitness; D015397:Program Evaluation; D012648:Self Care / Q000379:methods*; D012944:Social Support; D016896:Treatment Outcome