Culturally adapting diabetes self-management education: a community engaged co-design approach

BACKGROUND: Black adults are disproportionately burdened by diabetes as they face systemic, cultural, and historical barriers to participating in and engaging in diabetes self-management education (DSME). Adapting DSME to address lived experiences and cultural values of Black adults may improve its effectiveness and relevance. PURPOSE: This study describes the co-design process of collaborating with a Stakeholder Advisory Board (SAB) to develop a culturally adapted supplemental guide for facilitators to use alongside an evidence-based DSME curriculum, titled Healthy Living with Diabetes (HLWD). METHODS: We actively engaged a SAB consisting of Black adults with diabetes, previous HLWD facilitators, community health workers, and community leaders. To guide the adaptation of the DSME curriculum for Black adults, we held five structured co-design SAB meetings with the focus of tailoring the content and implementation strategies. Qualitative meeting notes including feedback from the SAB were analyzed to inform the development of the supplemental guide. RESULTS: The SAB emphasized the importance of including the addressing of social and historical context, mistrust, family influence, stigma, and emotional challenges within Black communities. The co-developed supplemental guide included culturally relevant visuals, analogies, and facilitation strategies. The implementation strategies focused on relationship development, trauma-informed facilitation, and the use of affirming language. CONCLUSIONS: A culturally rooted codesign approach along with Stakeholder Advisory Board engagement led to the creation of a culturally adapted DSME supplemental guide that may enhance the engagement and cultural relevance of DSME programs for Black adults.