Rural Federally Qualified Health Center Interventions Targeting Persons with Diabetes: A Systematic Review

Abstract: Diabetes and its complications are serious public health problems, disproportionately affecting rural Americans. Contributing to the literature, this systematic review examines intervention studies targeting people with diabetes (PWDs) receiving care in rural federally qualified health centers (FQHCs). The study (N=16) is informed by the Study Design, Data, Methods, Outcomes (SDMO) framework. Overall, findings revealed that rural FQHC interventions targeting PWDs were of serious or high risk of bias. Most studies (69%) used pre-experimental, pre-post intervention designs, often embedded within quality improvement initiatives or feasibility studies. Three studies (19%) employed quasi-experimental designs while only two studies (12%) employed randomized controlled trial designs. Most studies (63%) collected self-report (e.g., dietary intake, diabetes knowledge and behaviors) and objective (e.g., A1C, body mass index) data. Interventions largely focused on improving diabetes self-management or outcomes (56%), with fewer focused on hypertension management and food insecurity (44%). The intervention studies often reported improved A1C levels and other meaningful results. More rigorous research is needed to advance the science of rural FQHC interventions targeting PWDs.