Date of Award

5-13-2016

Degree Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

Public Health

First Advisor

Dr. Ike S. Okosun, PhD

Second Advisor

Dr. Priscilla E. Pemu, MD

Third Advisor

Dr. Ernest Alema-Mensah, PhD

Abstract

INTRODUCTION: Diabetes is one of the leading causes of morbidity and mortality in the United States and has a great economic impact as well. Despite pharmacological advancement in its treatment, diabetes care still remains suboptimal at best. Diabetes self-management education (DSME) has been recognized as a key element to improved diabetes self-care and better patient health outcome. However, attendance to traditional DSME classes has been reported to be low due to several factors like accessibility, The internet has great potential for bridging several of the challenges of the formal DSME classes. Many studies have looked at internet-based programs in the management of chronic diseases like diabetes but just a few have studied specifically the black American population.

AIM: The study sets out to assess the effectiveness of e-HealthyStrides tool in the management of diabetes in a minority African American population. We also aimed to compare the health outcomes of this tool across the two settings where it was administered, a community faith-based setting and clinic setting.

METHODS: The study analyzed 135 participants from a total of 3 physician practices in the Morehouse Community Physicians’ network (CPN), and 110 participants from a black American church in the downtown Atlanta region, all of whom were diabetes patients. Participants from the three CPN practices were merged into one group coded as clinic while the other group was coded as church. Descriptive analysis at baseline was done and used to obtain frequencies and percentages of the study population with chi-square test used to determine the differences between the groups. The outcome variables of blood pressure, blood glucose and distance walked by the participants were analyzed within each group and between the groups. T-tests were used to compare differences in the outcomes from baseline to the 12th week of the e-HealthyStrides program. The level of significance was set at a P-value of <0.05.

RESULTS: The study population was 97.6% black, 73.7% female, with about 15% having high school education or less. Overall e-HealthyStrides proved more beneficial in blood glucose control with an increase in proportion of people with well-controlled sugar levels, from 48.4% at baseline to 72.9% at 12 weeks (P <0.0001). Clinic participants showed statistically significant improvement in glycemic control (baseline mean 142.0mg/dl Vs 12th week 122.7mg/dl, P=0.0152) and distance walked (1.0mile Vs 1.8miles, P<.0001). Though there was improvement in glucose levels noticed in the church participants (164.1mg/dl Vs 143.8mg/dl), this however was not statistically significant. There was little to no effect noticed on blood pressure management.

DISCUSSION: In general, e-HealthyStrides showed beneficial effects in glycemic control and behavioral pattern like physical activity judged by distance walked by the participants. Its effect on blood pressure control was however not clear. The findings from this study agree with most other studies that have found variable beneficial effects of online or internet-based interventions in chronic disease management. e-Health interventions should be encouraged, with future studies continuing to find out ways to make the people more engaged and reduce attrition which is one of the major problems with these interventions.

DOI

https://doi.org/10.57709/8545041

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