Importance of culture
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The importance of family involvement in diabetes self-management has been demonstrated across patients from various racial and ethnic minority populations.43–45 A systematic review of DSME interventions among older adults with diabetes from ethnic minorities found that characteristics of successful interventions included involvement of spouses and adult children.44 In another study among African-American women with diabetes, many women noted that support primarily came from family.27 In a study of Korean immigrants with type 2 diabetes, family support specific to diet was significantly associated with better glucose control.43 In American Indian populations, active family nutritional support was significantly associated with control of triglyceride, cholesterol, and A1c levels.46,47 Furthermore, among many Latinos, familismo, the importance of family and family-centeredness, is an important cultural value.8 Tailoring clinical care and developing novel educational approaches that include family and community is central to improving the health of Latinos with diabetes.8 Studies of Latinos with diabetes have found that including family members in educational interventions may promote patients’ diabetes self-management.21,48,49 Understanding a patient’s cultural and family environment is important in supporting diabetes self-care and in considering how to culturally tailor interventions for patients from racial/ethnic minority populations.
Including family members in diabetes interventions
Recognition of the important role that family members play has led increasingly to incorporating the index patient’s family members into diabetes self-management interventions.50 Family members play an especially significant role in managing diabetes for children and adolescents; thus, most family-based interventions to date have targeted children with diabetes.20,51,52 A review of family-based interventions for patients with diabetes mellitus conducted in 2005 found that most family interventions for diabetes in the previous 15 years were among youth and adolescents with type 1 diabetes, but few studies had focused on adult patients and their family members.20
Among adults, inclusion of a close family member in psychosocial interventions for chronic conditions may also be more efficacious than focusing solely on the patient.40 For example, including family members in educational interventions has been shown to improve rates of smoking cessation53,54 and weight loss.55,56 In a review of randomized controlled trials of chronic diseases, interventions using a family-oriented approach for adults were more beneficial than solely patient-oriented interventions.40 In a review of interventions for couples and families managing chronic health problems, including common neurological diseases, cardiovascular diseases, cancer, and diabetes, family interventions showed promise in helping patients and family members manage chronic illnesses.57
Among adults with diabetes, interventions including family or household members of people with diabetes may be more effective than usual care in improving diabetes-related knowledge and glycemic control.20,40,52,58–60 Family support has also been associated with improved medication adherence and blood sugar control in studies of adults with diabetes.18,44,61–62 Addressing a diabetes patient’s social–environmental support has been found to be positively associated with healthy diet and exercise.63 However, several interventions seeking to improve self-management behaviors by increasing social support from family and friends have shown varying results.