Projects under CAIANDTR Auspices

Multilevel analysis of the translational effects of lifestyle intervention among American Indian and Alaska Natives

Luohua Jiang, PhD

Grant No.: ADA 7-12-CT-36

Recent landmark clinical trials showed that lifestyle interventions can prevent or delay the ‚Äčonset of diabetes for those at risk. However, substantial evidence exists that behavior change interventions are often less effective in the real-world of underserved populations, in part due to constrained resources these populations experience. Large-scale interventions in practice must translate findings from ideal settings in clinical trials to frequently less-than optimal and diverse situations that often face minority communities. The investigators of the proposed project will conduct secondary data analyses using data from the Special Diabetes Program for Indians Diabetes Prevention demonstration project (SDPI-DP), a translational effort implementing the lifestyle intervention, proven in previous diabetes prevention clinical trials, among 36 geographically and tribally diverse American Indian and Alaska Native (AI/AN) grantee sites.

The specific aims of this project are: 

  • Describe and delineate the differences in lifestyle intervention outcomes among a diverse group of AI/AN pre-diabetic patients with different individual level socioeconomic and sociocultural resources.
  • Investigate the impact of program level characteristics on the success of lifestyle intervention through the development of multilevel models.
  • Explore how potential social and behavioral mediators, assessed at both individual and program levels, explain the differential intervention effects among these AI/AN patients with pre-diabetes.
  • This work promises to provide important knowledge about how to successfully translate lifestyle intervention among minority communities with limited resources in the future and to reduce the diabetes disparities in AI/ANs and other underserved populations eventually.


Developing a diabetes numeracy intervention for American Indians/Alaska Natives

Angela Brega, PhD

Grant No.: R21DK093946

Patients with diabetes must engage in a variety of self-care behaviors, including appropriate dietary practices, blood glucose self-monitoring, and medication management. Important to each of these behaviors is the capacity to understand and use numbers (e.g., counting carbohydrates). Referred to as “numeracy,” such abilities are associated with a variety of diabetes self-care behaviors and outcomes (e.g., glycemic control).

Although the prevalence of diabetes has risen nationwide, American Indians and Alaska Natives (AI/ANs) are diagnosed with diabetes at 2-3 times the rate of non-Hispanic Whites. And, yet, Native people are at risk for limitations in the numerical skills that are critical for diabetes management.  Although deficits in numeracy are widespread, such limitations are particularly common among racial/ethnic minorities and individuals with limited income and education. As a result of restricted educational opportunities and high rates of poverty in many AI/AN communities, Native people with diabetes are at risk for limitations in diabetes-related numeracy.

Despite evidence of a link between numeracy and health, no interventions aimed at improving health-related numeracy have been published. The goal of the proposed project is to develop and pilot test an intervention to improve diabetes-related numerical skills among AI/ANs with diabetes. The aims of the project are the following:

  • To develop a culturally appropriate intervention to teach the numerical skills required for successful diabetes self-management;
    To assess change in numeracy skills following intervention; and
  • To explore change in diabetes self-efficacy, self-care behavior, and clinical outcomes following intervention and to assess whether change in numeracy predicts change in these secondary outcomes.

The INTervention to Enhance Numeracy in Diabetes (INTEND) will be adapted from two existing numeracy curricula – Extending Mathematical Power (EMPower) and Statistics for Action (SfA) – which were developed to teach adults the math skills needed to manage everyday numerical tasks.  The project team, which includes experts in AI/AN health and diabetes numeracy as well as the developers of EMPower and SfA, will adapt these curricula to address diabetes management among AI/ANs. The INTEND will be tested in a randomized controlled trial involving 130 AI/AN patients with diabetes from Yakama Indian Health Center in Toppenish, WA. Analyses will assess whether patients who participate in the INTEND show significantly greater improvement in numeracy, self-efficacy, self-care behavior, and clinical outcomes than do control patients.

As no interventions designed to improve health-related numeracy have been reported in the literature, this innovative project will advance science related to numeracy and highlight a new avenue for intervening with AI/ANs and other populations at risk for diabetes and its complications. As similar numerical skills are required in the management of other serious health problems, such as cardiovascular disease and hypertension, the results of this work may inform the development of effective interventions for other conditions as well.


Tribal Turning Point: Pilot study for prevention of T2D in American Indian youth

Mayer-Davis, Elizabeth J., PhD, Professor, School of Public Health, University of North Carolina