Culturally Appropriate Strategies for Chinese Americans With Diabetes (CASCADe)

Implementation and Evaluation of A Culturally Tailored Diabetes Self-Management Program for Chinese Americans

The project aimed to evaluate the implementation process and efficacy of a culturally tailored Diabetes Self-Management and Education (DSME) program with mobile health (mHealth) technology integration, entitled Culturally Appropriate Strategies for Chinese Americans with Diabetes (CASCADe), among Chinese American adults with Type 2 diabetes.

The CASCADe program includes 1) a home visit for training of monitoring devices use, WeChat app and acquiring family support, 2) 8 weekly education sessions with a combined format of group class, games, food demonstration, group exercise, video and discussion, 3) WeChat follow-up on education tips, monitoring data summary, and group discussion. The monitoring system used a smartphone to coordinate cloud data transmission from a set of wireless devices to capture daily monitoring data on physical activity, body weight, blood pressure and blood glucose levels. WeChat app was used to facilitate behavioral self-monitoring by providing daily messages related to diabetes education curriculum, weekly summary reports on monitoring data as well as reinforcement messages and group discussion on readings and monitoring results implication. A single group pre-post-test design was adopted to evaluate changes of primary (HbA1c) and secondary (Self-efficacy, quality of life and stress coping) outcomes assessed at pre and post of intervention. Engagement and adherence in education sessions and self-monitoring system, and satisfaction with the content and delivery of intervention were also evaluated at the end of the study.

Inclusion Criteria:

• have been diagnosed with Type 2 diabetes
• having been managing diabetes with diet, oral hypoglycemic agents or insulin, or both
• confirmed HbA1c level >=6.5% and <10%
• 21-75 years old
• residents of San Gabriel Valley
• speak and understand of Mandarin
• willing to use the smartphone-based monitoring devices provided by the project.

Exclusion Criteria:

• unable or unwilling to give informed consent
• plan to move out of the area within the 1-year participation study period
• are or plan to be pregnant or breastfeeding in the next 12 months
• have a condition that inhibits movement (e.g., unable to walk unaided, or cannot walk 1/4 mile without stopping)
• have major physical disability or condition that prevents them from participating in person.