Evaluating the Feasibility and Preliminary Effectiveness of a Tailored Diabetes Education Program for Rural Residents

Authors

• Brittany L. Smalls, University of Texas Medical BranchFollow
• Oluwatosin Leshi, University of Texas Medical BranchFollow
• Suraksha Khanal, University of Texas Medical BranchFollow
• Grejika E. Abram-Erby, University of KentuckyFollow

Corresponding Author

Brittany L. Smalls, PhD, MHSA, MSHPsych; blsmalls@UTMB.edu

Author Affiliations

1. Brittany L. Smalls, PhD, MHSA, MSHPsych: Vice Chair of Research, Department of Family and Community Medicine, University of Texas Medical Branch (Galveston TX); E-mail: blsmalls@UTMB.edu; ORCiD: https://orcid.org/0000-003-3727-346X
2. Oluwatosin Leshi, PhD, MS: Research Scientist, Department Family and Community Medicine, University of Texas Medical Branch 
3. Suraksha Khanal, BS, MPH: Research Associate, Department of Family and Community Medicine, University of Texas Medical Branch 
4. Grejika Abram-Erby, MS, MPH: Medical Student, College of Medicine, University of Kentucky (Lexington, KY)

Author Area of Expertise

Brittany Smalls

• Diabetes and metabolic syndromes
• Older adults
• Adolescent populations
• Rural communities
• Social determinants of health
• Feasibility studies
• Qualitative and quantitative methods

Oluwatosin Leshi

• Vulnerable populations
• Nutrition
• Social determinants of health
• Mothers
• Qualitative and quantitative methods
• Rural communities

Suraksha Khanal

• Quantitative data analysis
• Data management
• Nursing

Grejika Abram-Erby

• Public health
• Vulnerable populations
• Social determinants of health
• Qualitative methods
• Implementation science
• Program evaluation
• Military populations

Abstract

Introduction: Diabetes is a top ten Rural Healthy People 2030 priority for health improvement among rural Americans. Socioeconomic, environmental, geographic and political barriers contribute to the type 2 diabetes (T2D) prevalence and its disparate impact in rural communities. However, promoting proper self-care behaviors via self-management education can help people with diabetes better manage their condition.

Purpose: To account for the social environmental factors that affect rural residents, a tailored diabetes education program was developed, and the program’s effectiveness in improving diabetes knowledge and T2D-related health outcomes was assessed.

Methods: Using data collected from Appalachian Kentucky residents enrolled in a six-week, tailored educational intervention, this study used linear mixed models to assess the associations with clinical outcomes, knowledge, self-care, attitudes, and social support post intervention.

Results: Eighteen respondents consented to participate in the study (mean age: 58.3 years). Diabetes knowledge and attitudes improved significantly at six months post intervention. Positive changes in social support were also noted in that time frame. Self-care behaviors remained consistent post intervention, yet key metabolic outcomes (e.g., HbA1c, triglycerides, and BMI) decreased significantly.

Implications: Few studies have examined the effectiveness of a self-management intervention tailored for older, rural-dwelling Kentuckians living with T2D. With these promising results, tailored interventions that incorporate social support and social determinants of health hold the potential to improve the health and quality of life of adults with diabetes, paving the way for innovative and sustainable approaches to diabetes care.

DOI

https://doi.org/10.13023/jah.0801.06

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 License.

Recommended Citation

Smalls BL, Leshi O, Khanal S, Abram-Erby G. Evaluating the feasibility and preliminary effectiveness of a tailored diabetes education program for rural residents. J Appalach Health 2026; 8(1):69-84. DOI: https://doi.org/10.13023/jah.0801.06