Formative Evaluation of the Health Belief Model as a Valid Theoretical Framework for The Diabetes Garage

Background & Significance.b Recent studies estimate the prevalence of diabetes among Hispanics/Latinos (H/L) to be 16.9% and 18.7% among H/L men specifically. To address this disparity, the Diabetes Garage (DG), a culturally tailored Diabetes Self-Management Education and Support (DSME/S) program, was designed to engage H/L men in diabetes self-management. Because seriousness of diabetes best predicts men’s engagement in self-care, the Health Belief Model (HBM) was chosen as the central theoretical framework. The HBM hypothesizes that the cue to action (i.e. DG) increases men’s perceived diabetes risk/severity/threat, self-efficacy in self-care, and health outcomes. Aims & Objectives. This research was aimed to investigate the use of the HBM as a viable theoretical framework for changing men’s behaviors towards diabetes through their participation in the DG program. Specifically, this research sought to 1) determine if participating in the DG increases men’s diabetes knowledge, awareness of diabetes risk and severity, vulnerability, benefits and barriers, and self-efficacy and 2) examine the relationship between those variables. Methods. A mixed methods design was used. Quantitative descriptive non-parametric statistical analysis was conducted to examine pre- and post-survey data to determine if participation in the DG increases men’s diabetes knowledge, awareness of diabetes risk and severity, vulnerability, perceived benefits and barriers to treatment, and self-efficacy and to determine if there is a relationship between those variables. Second, qualitative analysis including coding focus group narratives for themes related to the HBM and to identify themes related to the quantitative findings. Results. Eleven men participated in both DG pilot classes and seven completed the program. Results are presented only for men who completed pre- and post-assessments. Quantitative findings showed an increase in diabetes knowledge (pre-mean=3.50 SD=0.55; post-mean=3.83, SD=0.75), risk knowledge (pre-mean=3.29 SD=1.70; post-mean=3.86, SD=1.35), and risk perception (pre-mean=1.53 SD=0.21; post-mean=1.15, SD=0.19). There were also improvements in weight (pre-mean=217.58 SD=40.58; post-mean=212.67, SD=34.01), systolic (pre-mean=145.40 SD=20.31; post-mean=129.60, SD=19.78) and diastolic (pre-mean=74.40 SD=9.45; post-mean=67.40, SD=10.67) blood pressure, and glycosylated hemoglobin A1c (HbA1c: pre-mean=7.62 SD=1.70; post-mean=7.34, SD=1.29). These findings were supported by the qualitative data, which shows men’s perceptions are in alignment with the HBM pathway for behavior change. For example, men stated: “a lot of this information…helped me out a lot” (diabetes knowledge); “diabetes can be more dangerous for individuals like myself with cardio problems” (risk knowledge); “…it can really happen to you down the road…“ (risk perception); “…I lost 14lbs just changing what I eat.” (weight). Conclusions. Results of the DG pilot study show that participation increased general diabetes knowledge and knowledge of the risk associated with the disease. In turn, participants’ risk perception decreased after participating in the program. Physical health markers and some self-care behaviors showed improvement after participation in the DG pilot. Although the sample size was small, the findings suggest that the HBM may be an appropriate theoretical framework to engage H/L men in diabetes self-management. These results also indicate that participation in the DG pilot had positive effects on the participants’ knowledge, behaviors, and physical health. Recommendations. Because of the nature of this study and the small sample size, paired sample analysis was limited, and pathway analysis could not be analyzed on the data to observe the relationship between the variables in relation to the pathway of the HBM. Recommendations include a larger sample size to further investigate the applicability of the HBM as a framework for engaging H/L men