Alliance to Reduce Disparities in Diabetes

Evaluation: Reducing Diabetes Disparities in American Indian Communities (Wind River Reservation)

Research Questions and Measures

Research Questions Measures
Can an effective community-clinical diabetes care transition process be implemented with data sharing and collaborative management of diabetes supports and care?
  • Key informant interviews
  • Monthly Coalition Meeting Minutes
  • Quarterly Program Progress and Activities Reports
Are community-provided diabetes self-management education (DSME), structured fitness/exercise programs, and follow-up support systems effective in improving individual patient outcomes?
  • Individual client DSME and follow-up records
  • Individual client physical activity participation reports
  • Clinical pre- and post-intervention measures including HbA1c, blood pressure, LDL/HDL/total cholesterol, triglycerides, and BMI for participants (n=247) and a comparison group
    • Participant pre- and post-measures collected at baseline and at 3 to 9 months post-intervention
    • Comparison pre- and post-measures collected in 2009-2010 and in 2012, respectively
What are the impacts of the community-clinical collaboration and interventions on patient attitudes toward self-management and satisfaction with diabetes care?
  • Pre- and post-intervention surveys of patient attitudes and satisfaction with clinical and support services administered at baseline and within 3 months of DSME program completion:
    • Veterans Rand 12 Item Health Survey1
    • Summary of Diabetes Self-Care Activities Measure2
    • Resources and Supports for Self-Management3
    • Perceived Competence for Diabetes Scale4
What are the lessons learned and processes developed that may support replication in other Tribal communities?
  • Focus groups with individual DSME clients
  • Key informant interviews
  • Monthly Coalition Meeting Minutes
  • Quarterly Program Progress and Activities Reports


  1. Kazis, L.E., Miller, D.R., Skinner, K.M., Lee, A., Ren, X.S., Clark, J.A., Rogers, W.H., Spiro III, A., Selim, A., Linzer, M., Payne, S.M., Mansell, D., & Fincke, B.G. (2006). Applications of methodologies of the Veterans Health Study in the VA Health Care System: Conclusions and summary. Ambulatory Care Management, 29, 2182-2188.
  2. Toobert, D.J., Hampson, S.E., & Glasgow, R.E. (2000). The summary of Diabetes Self-Care Activities Measure: Results from 7 studies and a revised scale. Diabetes Care, 23(7), 943-950.
  3. McCormack, L.A., Williams-Piehota, P.A., Bann, C.M., Burton, J., Kamerow, D.B., Squire, C., et al. (2008). Development and validation of an instrument to measure resources and support for chronic illness self-management: A model using diabetes. Diabetes Educator, 34(4), 707-718.
  4. Williams, G.C., McGregor, H.A., Zeldman, A., Freedman, Z.R., & Deci, E.L. (2004). Testing a self-determination theory process model for promoting glycemic control through diabetes self-management. Health Psychology, 23(1), 58-66.


Presentations and Publications

2014 Publications

Langwell, K., Keene, C., Zullo, M., & Ogu, L.C. (2014). An American Indian community implements the chronic care model: Evolution and lessons learnedHealth Promotion Practice, 15(2S), 23S-28S.

2014 Presentations

Langwell, K., Keene, C.,  Le Beaux, K., Ogu, L.C., & Zullo, M. (2014, November). Implementation of a Tribal Participatory Chronic Care Model (TP-CCM): Integrating primary and community-based care to coordinate diabetes management on Wind River Indian Reservation, Wyoming USA. Oral presentation at the Second World Congress on Integrated Care, Sydney, Australia.

Langwell, K., Rogers, M., & Zullo, M. (2014, August). Improving diabetes outcomes through tribal community health workers. Poster presented at Spectrum Health Healthier Communities 7th Annual Community Health Worker Conference, Grand Rapids, MI.

Langwell, K., Keene, C., Zullo, M., and Ogu, L. (2014, June). A community-clinical partnership for improving diabetes management and outcomes for American Indians. Poster presented at the American Diabetes Association's 74th Scientific Sessions, San Francisco, CA.