Diabetes prevention, puerto ricans, faith based, health threat messages


Diabetes is a serious health threat that disproportionately affects Hispanics of Puerto Rican heritage. Current evidence supports diabetes prevention programs to change health behaviors in people who are at risk and thus prevent the development of type 2 diabetes. However, few interventions exist for Hispanics, and even fewer have been designed for Puerto Rican adults. A literature review of community-based diabetes prevention programs involving at-risk Hispanics was conducted using a cultural sensitivity framework to determine the state of the science and identify gaps in knowledge regarding diabetes prevention for Puerto Ricans. An integrated theoretical framework was developed using constructs from the extended parallel process model (perceived severity and susceptibility) and social cognitive theory (self-efficacy) to design program components aimed to educate and motivate positive dietary behavior change in Puerto Rican adults. The two key components were a diabetes health threat message and dietary skill building exercises that incorporated spirituality and relevant faith practices, and were culturally-tailored for Puerto Ricans. A pretest-posttest, concurrent mixed methods design was used to test the impact and evaluate feasibility of a diabetes health threat message and skill-building exercises in a sample of Puerto Rican adults. A total of 24 participants enrolled in the study and attended six-weekly meetings that included baseline data collection, a health threat message, dietary skill building exercises, focus group interviews, posttest data collection, and an end-of-study potluck gathering. All of the study participants were Puerto Rican and a majority were female (70.8%), with a mean age of 55.5 years (SD 13.71). Most had a family history of diabetes (n = 21, 87.5%) and believed they were at-risk for the disease (n = 16, 66.7%). Using Wilcoxon matched-pairs signed rank test, significant increases or improvements were found in perceptions of diabetes severity (p < .01), dietary self-efficacy (p = .002), and dietary patterns (p = .02) at posttest in comparison to baseline. Spearman's rank correlations found moderate to strong relationships between the following variables: perceived severity and weight (rs = -.44, p = .03), dietary self-efficacy and dietary patterns (rs = .43, p = .04), dietary self-efficacy and fasting blood glucose levels (rs = - .45, p = .03), and American acculturation and weight (rs = .51, p = .02). The qualitative themes that emerged contributed to our understanding of participants' perspective relative to the health threat message, dietary skill building exercises, and the importance of cultural relevance and spirituality. The data support feasibility of this faith-based intervention that had an attendance rate of 58% and no loss of sample due to attrition. Diabetes prevention interventions for at-risk Puerto Ricans adults that incorporate a faith-based, culturally-tailored health threat message and dietary skill building exercises may help educate those who are at-risk and motivate lifestyle behavior change to prevent the development of diabetes. Further faith-based, culturally-tailored diabetes prevention research is indicated for Puerto Rican adults.


If this is your thesis or dissertation, and want to learn how to access it or for more information about readership statistics, contact us at

Graduation Date





Chase, Susan


Doctor of Philosophy (Ph.D.)


College of Nursing



Degree Program









Release Date

May 2018

Length of Campus-only Access

3 years

Access Status

Doctoral Dissertation (Open Access)

Included in

Nursing Commons