The Multifamily Groups: Diabetes (MFG-D) program has been designed for adult Latinos with Type II diabetes who need to maintain adherence to the treatment regimen and lifestyle required for adequate control of their disease and its complications. MFG-D is an adaptation of the standard multifamily group program (MFG), a technique which has been shown effective in improving the course and outcome of several health and mental health conditions, by involving family members (or other caregivers) in helping patients deal with the challenges they face with their health condition.
Like standard MFG, MFG-D consists of three components: 1) three initial “joining” sessions conducted with each of a small group of families (patient and family member or other caregiver) separately; 2) a six-hour educational workshop for all the families; and, 3) six multifamily group problem-solving sessions every two weeks for three months. The multifamily sessions in MFG-D are organized around key constructs from the Summary of Diabetes Self-Care Activities measure, a conceptual framework useful for tracking adherence to treatment and behavior change aspects of effective management of Type II diabetes. There are seven behaviors associated with good glycemic control: 1) healthy eating, 2) being active, 3) monitoring, 4) taking medication, 5) problem solving, 6) healthy coping, and 7) reducing risks. Leaders for the MFG-D program may be either health professionals or promotoras – not medically trained but with practical knowledge of diabetes and of Latino culture.
Since 2007, Valley Nonprofit Resources has partnered with Dr. Alex Kopelowicz of Olive View-UCLA Medical Center on work to implement the MFG approach in nonprofit health and human service settings (see Raising the Bar section of this website), and to adapt the MFG with Spanish-speaking Latino populations (see Latino MFG section of this website). Both previous projects centered on the original target population of the MFG program – people with severe mental illnesses.
This website section provides information for nonprofit health and human service agencies interested in implementing MFG-D for adult Spanish-speaking Latinos with Type II diabetes. The information and resources presented here are based on a two-year pilot study VNR undertook with Dr. Kopelowicz, in which four San Fernando Valley agencies each implemented two MFG-D programs, using a Manual which has been refined and is now available to guide future implementations (see below to download a free copy; a free copy of a PowerPoint used for the MFG-D educational workshop also is available). A brief overview follows of results from this Pilot Study, supported by a grant from UniHealth Foundation.
Results from Pilot Study
Results from the two-year pilot study indicate that the MFG-D program can be effectively taught to promotoras, who then implement it. Fidelity measures for the first four groups conducted by community health and human service nonprofits showed 90% adherence to the program model.
The program was most effective in increasing patient self-efficacy (i.e., how confident someone is that they can manage their diabetes effectively). There were no significant changes on diabetes behaviors (e.g., eating healthy, exercise, testing glucose levels, medication adherence) or family factors (i.e., how much the family supports the patient’s efforts at controlling his/her diabetes). There was some improvement on diabetes knowledge. Individual interviews with MFG-D program promotoras and agency administrators, as well as a group session with these personnel held at the end of the project, identified several strengths and challenges of this program. For instance:
- There were difficulties in recruiting patients and family members to participate, and in retaining them to the end of the intervention. Various accommodations were made to remediate this problem, and some MFG-D program personnel suggested reducing the number of problem-solving sessions or providing more assistance with transportation, or greater incentives to participate (such as gift cards).
- Examples of success were sometimes dramatic. For instance, one participant, a wheelchair user, was very reluctant to participate and seemed to lack motivation. But the interviewee said: “Now he is making sure to take care of himself – progress is amazing!” Other examples were given of patients who were not engaged or enthusiastic at the beginning but became much more so as the problem-solving sessions continued.
- Implementation of the MFG-D also may have been more challenging because the patients and families recruited by the four agencies often had already received some type of diabetes education and had developed certain skills, so that the differences between their pre- and post-scores on both knowledge and behavior change may have been smaller. The increase in self-efficacy may well have happened in part because family members became more involved as a result of this intervention.
- There was substantial evidence that the success of the MFG-D program at one of the sites was due partly to the long-standing trustful relationships project personnel there had with not just the specific patients and their family members, but with the community at large from which these participants were drawn.
Results from this project also are being aligned with a National Institutes of Health-funded controlled research study Dr. Kopelowicz and colleagues at Olive View-UCLA Medical Center are conducting. It is focused on adult Mexican Americans with T2DM who are receiving their primary health care at Olive View.
PowerPoint for MFG-D Educational Workshop, 2017. Developed by Alex Kopelowicz, MD. (for a free copy of this PowerPoint Presentation, please contact Ashley Wright via email)
Roberto Zarate & Alex Kopelowicz. Multifamily Groups: Type II Diabetes for Adult Spanish-Speaking Latinos - Program Implementation Manual, 2018 (available soon)