Mindfulness-Based Stress Reduction Intervention With Type 2 Diabetic Patients at Beaufort Jasper Hampton Comprehensive Health Services, Inc.

Issue or Challenge Addressed and Why Diabetes Mellitus Type 2 (DMT2) continues to be the 7th leading cause of death in the United States affecting an estimated 30.3 million people. It is well recognized that socioeconomic stressors can worsen effects of disease states and increase poor health outcomes among more socially disadvantaged patients with DMT2. Research also shows a connection between high stress levels, high amounts of cortisol, and decreased insulin sensitivity with higher blood sugar/HA1C levels. This project aimed to improve stress levels and regimen compliance in DMT2 patients by providing a daily meditation program as a supplement to their medical treatment. Population Targeted Our population were patients of Beaufort Jasper Hampton Comprehensive Health Services (BJHCHS) in coastal (Low Country) South Carolina with DMT2. Description of Innovation/Methodology The project team created a six minute recorded meditative/mindfulness breathing exercise composed of guided meditation and Native American Flute music designed to help patients enter a state of mindful relaxation. This program was stored in an audio file that patients could listen to digitally or by using a CD. It was designed to improve the accessibility of daily mindful meditation practice and to help DMT2 patients develop a sense of control over their lives and disease management. Medical students of A.T. Still University of Osteopathic Medicine, Arizona (ATSU-SOMA) met directly with patients, shared the research-backed benefits of mindful meditation, and described how to use the recording during an in clinic educational session. A baseline survey measuring stress and anxiety levels, perception of their disease, and familiarity with mindfulness was administered. Patients then completed their first six minute session in the exam room. After, patients were given a copy of the recording and were asked to complete a post-interventional survey covering their experience with the program after 4 weeks. Staff Involved and Their Roles ATSU-SOMA students comprised the main agents in our innovation and directly administered the program to eligible patients during clinical exam time as an adjunct to their current pharmacologic treatment. The role of the students was to describe the program, enroll patients, and demonstrate use of the media during the patients’ first session. Students had the responsibility of measuring and recording survey data as patients used and evaluated the meditation program. Primary care providers of BJHCHS worked with students to facilitate patient referrals for the study and to support/reinforce the program with their patients to ensure participation and compliance with the recorded meditation regimen. The program was also made available to the Nutrition department and Diabetes Outreach staff affiliated with the clinic to introduce the innovation to a wider array of patients. External Partners Involved and Their Roles This innovation was a partnership between the BJHCHS and ATSU-SOMA. Coordinating staff for ATSU-SOMA played a role in assisting student participation in developing this project. Resources or Levers Used The spoken portion of the recorded meditation used by this study was originally created by the ATSU-SOMA Chicago Community Health Center (CHC) class of 2018. Patients were enticed to enroll in the study by being offered entry into a raffle for a FitBit Versa smartwatch. Patients who received the recording but were not part of the study were not offered any incentives to use the program. Impact or Result A study to document the effect of the innovation is ongoing. Preliminary feedback from patients has been very positive. There is significant interest among providers in implementing this innovation into their practice as well. We do not have data from a statistically large enough sample size at this time to make final conclusions. However, we have observed that the recording has subjective benefits for patients based on patient feedback and the completed surveys we have so far. When our study is completed, we expect the data to support our hypothesis that practicing daily mindfulness has beneficial impacts on patient compliance and self-empowerment with their diabetes management. We also expect to see improvements in stress levels, and a decrease in symptoms of anxiety and depression based on answers to completion surveys after 4 weeks of using the recording. Challenges Faced and Overcoming Those Challenges Our most significant challenge was the time consuming and restrictive nature of the measurement tools used in our study. Completing our baseline survey took an average of 20-30 minutes, slowing down primary care providers too much to allow them to participate. Because of this, only medical students were able to recruit patients or administer the innovation. Students were only at clinic once a week, which greatly reduced patient recruitment opportunities. During the study, we decided to hand out the recording to any patient with abnormal blood sugar that expressed concern about stress management, even if they were not able to participate in the study. To date, we have handed out over 30 copies of the recording within a 4 week period and are currently producing more. When it could be prescribed in less than 5 minutes, providers were also able to give the recording to patients and help distribute the program further. Replicating This Innovation in Other Organizations This innovation has minimal material/start-up costs and can easily be replicated at any institution. We adapted this innovation based on several studies in similar patient populations. Our most significant accomplishment has been to standardize the meditation/mindfulness component with a uniform, self-contained recorded 6 minute breathing session that can be easily distributed and accessed by patients, rather than referring patients to YouTube or an external resource. Tips for Sustaining this Innovation Based on conversations with patients and our experience administering the study, we observed the most important asset in the success of this innovation is cooperation and advocacy from primary care providers. A successful adaptation of this innovation will need to facilitate the providers’ ability to introduce this tool and use their provider-patient relationship to encourage patients to use the program consistently by discussing it at regular checkups. For example, the audio file/CD could be given with brief written instructions, like a prescription. This would allow providers to integrate the innovation into their practice in a consistent and accessible way initially designed. Other Information or Lessons Learned Our innovation is expected to positively impact the long-term wellbeing of the community by helping to reduce the impact of daily stressors on DMT2 patients. Use of the meditation program is generalizable to just about any DMT2 patient in an outpatient setting due to the recognized biochemical connection between stress and increased blood sugar. We hope to create an easy to use, cost-free, non-pharmaceutical lifestyle intervention program that can be effectively utilized by socioeconomically disadvantaged DMT2 patients to help control their blood sugar. Ideally, this program could also be expanded to other chronic disease patients and any condition which is worsened by high stress levels, which will reduce healthcare costs and foster patient wellbeing.