Integrating Cultural Aspects Into Diabetes Education

Weight measured in pounds (lbs) via a standardized weight scale.

Weight measured in pounds (lbs) via a standardized weight scale.

8-item self-report questionnaire measuring dietary behaviors. Scores range from 0 to 16; lower scores indicate more healthful dietary behaviors. A decrease in scores indicates healthful dietary behaviors increased during the observation period.

8-item self-report questionnaire measuring dietary behaviors. Scores range from 0 to 16; lower scores indicate more healthful dietary behaviors. A decrease in scores indicates healthful dietary behaviors increased during the observation period.

7-item self-assessment providing an estimate of the number of minutes per week participants engage in three categories of physical activity: vigorous activity, moderate activity, and walking activity.

Scores are expressed in metabolic equivalent (MET) minutes per week. MET minutes represent the amount of energy expended carrying out physical activity. Higher scores indicate higher weekly levels of physical activity. An increase in scores indicates weekly levels of physical activity increased during the observation period.

7-item self-assessment providing an estimate of the number of minutes per week participants engage in three categories of physical activity: vigorous activity, moderate activity, and walking activity.

Scores are expressed in metabolic equivalent (MET) minutes per week. MET minutes represent the amount of energy expended carrying out physical activity. Higher scores indicate higher weekly levels of physical activity. An increase in scores indicates weekly levels of physical activity increased during the observation period.

18-item self-assessment measuring food access and insecurity among Chinese immigrants. Responses of "yes," "often," "sometimes," "almost every month," and "some months but not every month" are coded as affirmative. Food Security Status Levels are assigned based on the total number of affirmative responses.

Households with children: 0-2 affirmative responses = "Food Secure"; 3-7 = "Food Insecure without Hunger"; 8-12 = "Food Insecure with Hunger, Moderate"; 13-18 = "Food Insecure with Hunger, Severe."

Households without children: 0-2 affirmative responses = "Food Secure"; 3-5 = "Food Insecure without Hunger"; 6-8 = "Food Insecure with Hunger, Moderate"; 9-10 = "Food Insecure with Hunger, Severe."

A decrease in the number of affirmative responses indicates food security status improved during the observation period.

18-item self-assessment measuring food access and insecurity among Chinese immigrants. Responses of "yes," "often," "sometimes," "almost every month," and "some months but not every month" are coded as affirmative. Food Security Status Levels are assigned based on the total number of affirmative responses.

Households with children: 0-2 affirmative responses = "Food Secure"; 3-7 = "Food Insecure without Hunger"; 8-12 = "Food Insecure with Hunger, Moderate"; 13-18 = "Food Insecure with Hunger, Severe."

Households without children: 0-2 affirmative responses = "Food Secure"; 3-5 = "Food Insecure without Hunger"; 6-8 = "Food Insecure with Hunger, Moderate"; 9-10 = "Food Insecure with Hunger, Severe."

A decrease in the number of affirmative responses indicates food security status improved during the observation period.

20-item participant self-report of confidence level in resisting desire to eat. Assessed via 10-point Likert scale ranging from 0 (not confident) to 9 (very confident). Scores range from 0-180; higher scores indicate higher confidence level in resisting desire to eat. An increase in scores indicates confidence levels in resisting desire to eat increased during the observation period.

20-item participant self-report of confidence level in resisting desire to eat. Assessed via 10-point Likert scale ranging from 0 (not confident) to 9 (very confident). Scores range from 0-180; higher scores indicate higher confidence level in resisting desire to eat. An increase in scores indicates confidence levels in resisting desire to eat increased during the observation period.

The 14-item SDOH questionnaire assessed core health-related social needs and barriers across five domains: economic stability (e.g., food access and housing stability), education access and quality (e.g., need to improve English proficiency, reading skills, or educational attainment), health care access and quality (e.g., insurance coverage), neighborhood and built environment (e.g., housing conditions), and social and community context (e.g., racial discrimination; need for childcare; and need for assistance addressing tobacco, alcohol, or drug use). Items used dichotomous response options (1 = "Yes"; 0 = "No"). An overall SDOH score was calculated by summing responses across the 14 items (range: 0-14), with higher scores indicating greater SDOH-related barriers.

The 14-item SDOH questionnaire assessed core health-related social needs and barriers across five domains: economic stability (e.g., food access and housing stability), education access and quality (e.g., need to improve English proficiency, reading skills, or educational attainment), health care access and quality (e.g., insurance coverage), neighborhood and built environment (e.g., housing conditions), and social and community context (e.g., racial discrimination; need for childcare; and need for assistance addressing tobacco, alcohol, or drug use). Items used dichotomous response options (1 = "Yes"; 0 = "No"). An overall SDOH score was calculated by summing responses across the 14 items (range: 0-14), with higher scores indicating greater SDOH-related barriers.

Illness perceptions were measured using the 8-item Brief Illness Perception Questionnaire, adapted to assess participants' perceptions of prediabetes or risk for T2D. The instrument includes 8 scaled items rated from 0 to 10 that capture cognitive and emotional representations of diabetes or risk, including perceived consequences, timeline, personal control, treatment control, identity, illness coherence, concern, and emotional response. A ninth open-ended item asks participants to report perceived causes of their prediabetes or diabetes risk. Item scores were summed, ranging from 0 to 80, with higher scores indicating a more negative perception of prediabetes or diabetes risk. We expected the intervention to reduce Brief IPQ total scores, reflecting a shift toward a more manageable perception of diabetes risk.

Illness perceptions were measured using the 8-item Brief Illness Perception Questionnaire, adapted to assess participants' perceptions of prediabetes or risk for T2D. The instrument includes 8 scaled items rated from 0 to 10 that capture cognitive and emotional representations of diabetes or risk, including perceived consequences, timeline, personal control, treatment control, identity, illness coherence, concern, and emotional response. A ninth open-ended item asks participants to report perceived causes of their prediabetes or diabetes risk. Item scores were summed, ranging from 0 to 80, with higher scores indicating a more negative perception of prediabetes or diabetes risk. We expected the intervention to reduce Brief IPQ total scores, reflecting a shift toward a more manageable perception of diabetes risk.

Perceived stress was assessed using the 10-item Perceived Stress Scale, a widely used and validated measure of the extent to which individuals perceive situations in their lives as stressful, unpredictable, uncontrollable, and overwhelming. Items are rated on a 5-point scale from 0 ("never") to 4 ("very often"), yielding a total score ranging from 0 to 40. Higher scores indicate greater perceived stress.

Perceived stress was assessed using the 10-item Perceived Stress Scale, a widely used and validated measure of the extent to which individuals perceive situations in their lives as stressful, unpredictable, uncontrollable, and overwhelming. Items are rated on a 5-point scale from 0 ("never") to 4 ("very often"), yielding a total score ranging from 0 to 40. Higher scores indicate greater perceived stress.

Depressive symptoms were assessed using the Patient Health Questionnaire-2, a brief screening tool for patients with low literacy that measures the frequency of depressed mood and loss of interest or pleasure during the past 2 weeks. Each item is rated on a 4-point scale from 0 ("not at all") to 3 ("nearly every day"), yielding a total score ranging from 0 to 6. Higher scores indicate greater depressive symptom severity.

Depressive symptoms were assessed using the Patient Health Questionnaire-2, a brief screening tool for patients with low literacy that measures the frequency of depressed mood and loss of interest or pleasure during the past 2 weeks. Each item is rated on a 4-point scale from 0 ("not at all") to 3 ("nearly every day"), yielding a total score ranging from 0 to 6. Higher scores indicate greater depressive symptom severity.

Digital literacy was assessed using the 8-item eHealth Literacy Scale, a validated self-report measure of perceived ability to locate, evaluate, and apply health information from electronic sources. Each item is rated on a 5-point scale ranging from 1 ("strongly disagree") to 5 ("strongly agree"), yielding a total score from 8 to 40. Higher scores indicate better digital literacy.

Digital literacy was assessed using the 8-item eHealth Literacy Scale, a validated self-report measure of perceived ability to locate, evaluate, and apply health information from electronic sources. Each item is rated on a 5-point scale ranging from 1 ("strongly disagree") to 5 ("strongly agree"), yielding a total score from 8 to 40. Higher scores indicate better digital literacy.