title: Integrating education, group support, and case management for diabetic Hispanics.
abstract: OBJECTIVE
  Culturally tailored diabetes self-management education (DSME) improves glycemic control and other health outcomes in Mexican Americans but sociocultural barriers to health improvements remain. This study explored the feasibility of adding a nurse case manager (NCM) to DSME to foster DSME attendance and increase utilization of other available health care services.
  
  
  METHODS
  The setting was a rural community on the Texas-Mexico border in one of the poorest counties in the United States. Using a repeated measures pretest, post-test control group design, we enrolled 165 Mexican American adults into: 1) an experimental group that received a DSME intervention plus access to a NCM; or 2) a control group that received DSME only.
  
  
  RESULTS
  Both experimental and control groups received the DSME intervention, reported positive changes in diet and physical activity, and showed improved clinical outcomes; there were no significant group differences. A statistically significant reduction in body mass index was seen in women compared to men, regardless of group or number of NCM contacts. For individuals having the most NCM contacts, DSME attendance rates were greater. Participants expressed acceptance of the NCM; they preferred face-to-face contact rather than by telephone.
  
  
  CONCLUSIONS
  Our previously tested, culturally tailored DSME continues to be an effective strategy for improving glycemic control in Mexican Americans. This feasibility study provided partial support for the NCM model for underserved border communities, but additional research is needed on resource utilization and the nature of NCM contacts.
authors.affiliation: The University of Texas at Austin School of Nursing, 1700 Red River Street, Austin, Texas 78701, USA. sabrown@mail.utexas.edu
authors.forename: Sharon A
authors.initials: SA
authors.lastname: Brown
authors.forename: Alexandra A
authors.initials: AA
authors.lastname: García
authors.forename: Mary
authors.initials: M
authors.lastname: Winter
authors.forename: Lita
authors.initials: L
authors.lastname: Silva
authors.forename: Adama
authors.initials: A
authors.lastname: Brown
authors.forename: Craig L
authors.initials: CL
authors.lastname: Hanis
mesh_terms: D000328:Adult; D000368:Aged; D019090:Case Management; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology / Q000451:nursing* / Q000628:therapy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D017058:Mexican Americans; D008800:Mexico / Q000208:ethnology; D008875:Middle Aged; D010349:Patient Compliance; D010353:Patient Education as Topic / Q000458:organization & administration*; D019035:Rural Health Services; D012648:Self Care; D012944:Social Support; D013781:Texas