title: The DISC (Diabetes in Social Context) Study-evaluation of a culturally sensitive social network intervention for diabetic patients in lower socioeconomic groups: a study protocol.
abstract: BACKGROUND
  Compared to those in higher socioeconomic groups, diabetic patients in lower socioeconomic groups have less favourable metabolic control and experience more diabetes-related complications. They encounter specific barriers that hinder optimal diabetes self-management, including a lack of social support and other psychosocial mechanisms in their immediate social environments. Powerful Together with Diabetes is a culturally sensitive social network intervention specifically targeted to ethnic Dutch, Moroccan, Turkish, and Surinamese diabetic patients in lower socioeconomic groups. For ten months, patients will participate in peer support groups in which they will share experiences, support each other in maintaining healthy lifestyles, and learn skills to resist social pressure. At the same time, their significant others will also receive an intervention, aimed at maximizing support for and minimizing the negative social influences on diabetes self-management. This study aims to test the effectiveness of Powerful Together with Diabetes.
  
  
  METHODS
  We will use a quasi-experimental design with an intervention group (Group 1) and two comparison groups (Groups 2 and 3), N = 128 in each group. Group 1 will receive Powerful Together with Diabetes. Group 2 will receive Know your Sugar, a six-week group intervention that does not focus on the participants' social environments. Group 3 receives standard care only. Participants in Groups 1 and 2 will be interviewed and physically examined at baseline, 3, 10, and 16 months. We will compare their haemoglobin A1C levels with the haemoglobin A1C levels of Group 3. Main outcome measures are haemoglobin A1C, diabetes-related quality of life, diabetes self-management, health-related, and intermediate outcome measures. We will conduct a process evaluation and a qualitative study to gain more insights into the intervention fidelity, feasibility, and changes in the psychosocial mechanism in the participants' immediate social environments.
  
  
  CONCLUSIONS
  With this study, we will assess the feasibility and effectiveness of a culturally sensitive social network intervention for lower socioeconomic groups. Furthermore, we will study how to enable these patients to optimally manage their diabetes.
authors.affiliation: Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. c.vissenberg@amc.uva.nl
authors.forename: Charlotte
authors.initials: C
authors.lastname: Vissenberg
authors.forename: Vera
authors.initials: V
authors.lastname: Nierkens
authors.forename: Paul J M
authors.initials: PJ
authors.lastname: Uitewaal
authors.forename: Diana
authors.initials: D
authors.lastname: Geraci
authors.forename: Barend J C
authors.initials: BJ
authors.lastname: Middelkoop
authors.forename: Giel
authors.initials: G
authors.lastname: Nijpels
authors.forename: Karien
authors.initials: K
authors.lastname: Stronks
mesh_terms: D001294:Attitude to Health / Q000208:ethnology*; D002985:Clinical Protocols; D003469:Culture; D003920:Diabetes Mellitus / Q000208:ethnology / Q000523:psychology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D009018:Morocco; D020380:Needs Assessment; D009426:Netherlands; D012923:Social Class; D012931:Social Environment; D060756:Social Networking; D012944:Social Support; D012959:Socioeconomic Factors; D013532:Suriname; D014421:Turkey