Association Between Limited English Proficiency, Glycemic Control, and Diabetes Education Service Utilization Among U.S. Adults With Diagnosed Type 2 Diabetes: NHANES 2017–2018. 

Among U.S. adults aged 20 years and older with diagnosed type 2 diabetes, is limited English proficiency (LEP) associated with glycemic control (HbA1c) and utilization of diabetes education services compared with English-proficient adults?

The secondary analysis found that adults with LEP had significantly higher HbA1c levels than English-proficient adults in the crude analysis. 

However, after adjusting for demographic and socioeconomic factors, the association was no longer statistically significant. 

There was also no statistically significant association between LEP and utilization of diabetes education services, measured by the time since seeing a diabetes nurse educator, registered dietitian, or nutritionist. 

A possible qualitative research question would be: "How do adults with limited English proficiency describe the barriers to utilizing diabetes education and nutrition services; and how do these experiences influence diabetes self-management?"  Interview questions could include:

• "Please describe your experiences accessing diabetes education or nutrition services? Tell us about anything that has made it easier or more difficult for you to receive the information or support you need to manage your diabetes?"  or "Have communication challenges ever made it difficult for you to understand information about your diabetes? Please describe your experience."

• "How has your preferred language affected your experiences participating in diabetes education?

• "Can you tell me about your experiences using interpreter services during your healthcare visits? What worked well, and what could have been better?"

• "Have you received diabetes education materials in your preferred language? If so, how helpful were they?"

• "Who would you prefer to receive diabetes education from—a registered dietitian, diabetes nurse educator, nutritionist, or another healthcare professional? Why?

• "Would you prefer to receive diabetes education in person, through telehealth, or a combination of both? Why?

• "Would you rather participate in individual counseling sessions or group education classes? What makes that option work best for you?"

A qualitative descriptive study design would be appropriate because it allows participants to describe their experiences in their own words.1-3 Semi-structured, one-on-one interviews would provide the flexibility to ask follow-up questions while allowing participants to tell their stories.1-3 The study population would remain adults aged 20 years and older with diagnosed type 2 diabetes who receive care at hospitals, diabetes clinics, health centers, or referred by their health care provider. Purposeful sampling would help recruit participants who can provide rich descriptions of their experiences. Interview transcripts would be analyzed using thematic analysis.1-3 Themes may include barriers to utilizing diabetes education, language impact, cultural influences, and preferences for diabetes education delivery.

I believe this qualitative study would complement my quantitative findings by providing the experiences behind the numbers. It could also identify practical ways to improve culturally and language appropriate diabetes education services for adults with limited English proficiency. Understanding both the barriers people face and the types of diabetes education they prefer could help in designing patient-centered programs that support better diabetes self-management and ultimately improve glycemic control.4-5

REFERENCES

1. Jacobsen KH. Introduction to Health Research Methods. 3rd ed. Burlington, MA: Jones & Bartlett Learning; 2020

2. Drummond KE, Murphy-Reyes A. Nutrition research: Concepts and applications. Jones & Bartlett Learning; 2018.

3. Doyle L, McCabe C, Keogh B, Brady A, McCann M. An overview of the qualitative descriptive design within nursing research. J Res Nurs. 2020;25(5):443-455. doi:10.1177/1744987120927204

4. Alsaedi R, McKeirnan K. Literature Review of Type 2 Diabetes Management and Health Literacy. Diabetes Spectr. 2021;34(4):399-406. doi:10.2337/ds21-0014.

5. Al Shamsi H, Almutairi AG, Al Mashrafi S, Al Kalbani T. Implications of Language Barriers for Healthcare: A Systematic Review. Oman Med J. 2020;35(2):e122. doi:10.5001/omj.2020.40