The DIALBEST curriculum was built upon extensive community-based participatory research work in the target community (27 (link),28 (link)) and was designed to provide culturally and health literacy appropriate counseling, including informational and instrumental education, skills, and support in the areas of nutrition and food access, physical activity, blood glucose monitoring, medication adherence, and compliance with medical appointments. The DIALBEST curriculum was organized into 17 home-visit sessions delivered by two well-trained and supervised bilingual/bicultural CHWs. Each participant in the intervention group was randomly assigned to and only seen by one of the CHWs. The CHW delivered a comprehensive set of well-structured curriculum modules that exceeded the American Diabetes Association medical nutrition therapy standards (29 (link)). The modules focused on T2D and its complications, nutrition, physical activity, blood glucose self-monitoring, adherence to medications and medical appointments, and mental health (Supplementary Table 1 ). Each module included educational materials with graphics to illustrate key concepts and hands-on activities to improve instrumental knowledge for T2D self-management (e.g., onsite supermarket education on comparative shopping guided by food label reading).
DIALBEST was patient centered and grounded in principles of behavioral change theory, including stages of change, problem-solving theory, and motivational interviewing. As recommended (29 (link),30 (link)), the intervention was individually tailored, taking heavily into account the language preference and specific socioeconomic circumstances of each participant. At each visit, the CHW and patient jointly developed a T2D self-management plan based on the individual patient’s clinical history and previous challenges experienced with T2D self-management. Further individual tailoring was determined based on the patient’s stage of change, level of motivation, health literacy, and social support. Home visits were scheduled only during weekdays. If endorsed by the patient, family members present at home during home sessions were allowed to participate.
DIALBEST was patient centered and grounded in principles of behavioral change theory, including stages of change, problem-solving theory, and motivational interviewing. As recommended (29 (link),30 (link)), the intervention was individually tailored, taking heavily into account the language preference and specific socioeconomic circumstances of each participant. At each visit, the CHW and patient jointly developed a T2D self-management plan based on the individual patient’s clinical history and previous challenges experienced with T2D self-management. Further individual tailoring was determined based on the patient’s stage of change, level of motivation, health literacy, and social support. Home visits were scheduled only during weekdays. If endorsed by the patient, family members present at home during home sessions were allowed to participate.
