The intervention described here is similar to others that have reported HbA1c values
in Hispanic groups. Like our intervention, successful interventions have included oneto-
There are several study limitations that should be acknowledged. First, we relied on
self-reported measures of behavior. Although HbA1c outcomes corroborated self-reported
improvements in behavior, it is important to note that the four-item food label measure
was developed to overlap with intervention content. Although this measure demonstrated
high internal consistency, additional psychometric evaluation is needed. Third, a larger
sample size would generate greater confidence in the results, allowing for targeted exploration
of retention and/or attrition effects, and meditational analyses can indicate if
changes in levels of information, motivation, and behavioral skills produced changes in
behavior. In addition, follow-up data were limited to a 3-month time period. Although
other brief interventions have shown continued improvement on multiple measures of
diet behavior at 12 months (Clark et al., 2004), longer follow-up periods are needed to
explore the sustainability of an intervention’s effect on diabetes self-care behaviors and
glycemic control. Last, we did not address diabetes comorbidities (e.g., depression,
hypertension, dyslipidemia, and obesity) or other diabetes self-care behaviors in the
design, content, or assessment of the intervention. Future IMB model-based diabetes
self-care interventions for ethnic minority groups should include both content to address
and assessments to monitor the impact of educational material on depressive symptoms,
blood pressure, lipids, and changes in weight and other self-care behaviors. Despite these
limitations, this study provides preliminary data necessary to begin to assess the potential
usefulness of the IMB model in designing culturally tailored diabetes self-care
interventions.