How Video Storytelling Interventions Can Improve Glycemic Control in T2D
In a recent randomized clinical trial published in JAMA Network Open, a digital storytelling intervention for type 2 diabetes (T2D) self-management for Hispanic patients showed promising results.
Mark L Wieland, MD, MPH, and colleagues evaluated the intervention’s acceptability, feasibility, and impact within diverse primary care settings.
“Narrative-based (storytelling) interventions are a series of promising approaches that incorporate culture-centric health messaging to promote behavior change,” Dr. Wieland and colleagues explained. “Storytelling interventions use narratives that resonate with target populations either through direct quotes from representative members or through story compositions inspired by culturally embedded informants.”
Culturally Tailored Video Intervention
The researchers recruited 451 participants from two primary care networks in Arizona and Minnesota, then randomly assigned patients to either the intervention group, which viewed a 12-minute culturally tailored storytelling video in addition to receiving usual clinical care, or the control group, which received only usual care. Both groups also received culturally tailored T2D self-management education materials.
Participants in the intervention group viewed a video featuring stories from Hispanic people to enhance their self-efficacy and motivation in managing T2D. They also received access to the video and educational materials via various platforms, with follow-up support through automated text messages to encourage ongoing engagement.
The researchers collected data at baseline and after 3 months, then conducted statistical analyses to compare changes in hemoglobin A1C and other health indicators, adjusting for baseline differences and demographic factors.
The intervention led to a modest improvement in glycemic control after 3 months in the adjusted model, but the unadjusted model did not show statistically significant results. Despite this, according to the study authors, the intervention’s high narrative quality and potential for broad implementation make it a noteworthy contribution to T2D management strategies.
“This intervention may be clinically relevant due to its high scalability,” the researchers explained. “It had high narrative quality, and participants felt more confident about managing their T2D and felt activated to make specific health-related changes as a result of viewing the intervention, all while achieving a potentially modest improvement on hemoglobin A1C levels.”
Dr. Wieland and colleagues went on to say that “while this brief intervention at a single point in time did not have a robust effect on glycemic control, its characteristics and outcomes suggest that it may be most impactful when combined with a longitudinal, interactive intervention that is culturally and linguistically tailored to Hispanic communities.”
The digital storytelling intervention is freely accessible via a web-based link or software application. The researchers noted that it is a highly scalable and portable intervention component and may be an attractive option for Hispanic patients, a population that is disproportionately affected by T2D.
Other Education Videos & Ongoing Research
In an unrelated systematic review published in Diabetes/Metabolism Research and Reviews, authors assessed the effectiveness of educational videos for people with diabetes.
Educational videos tended to run 10 minutes or less. Of 12 studies examining A1C, 7 found a significant decrease, ranging from -0.1% to -2.1%. One study reported that participants experienced greater declines in A1C when they consistently watched the videos. In another study, participants who had high A1C at baseline (9% or greater) experienced more significant decreases in A1C after receiving the video intervention.
“The length of studies that examined the effect of video education on A1C ranged from 3 to 12 months. Only one study examined the effect of video intervention on fasting blood sugar and post-prandial blood sugar, which showed statistically significant improvements. One study showed that intervention reduces the incidence of severe hypoglycemia,” the review authors wrote.
Additional studies demonstrated improved health literacy, medication adherence, and other outcomes.
Authors noted the promise of video education in supporting patients with T2D, adding that considerations for effective educational videos include incorporating participant feedback and tailoring content to the target audience’s cultural, linguistic, and knowledge backgrounds.
However, the review had limitations, including the exclusion of non-English language articles, abstract-only publications, and grey literature, which may have led to missing relevant studies.
“This review found some evidence that diabetes video education has the potential to improve clinical outcomes for people with diabetes, such as A1C, as well as health literacy, self-efficacy, and self-care behaviors. In addition, the included studies point to the importance of cultural adaptation and creating short, clear, and relatable videos for patients,” the researchers reported.
“Further research is needed, using more rigorous study designs, to understand the length of the effects of video interventions and how they compare to in-person or more resource-intensive diabetes education.”