Background: At West Side Community Health Services in St. Paul, MN, Hmong adults with diabetes mellitus type 2 had worse glycemic control than non-Hmong patients (A1C 9.4% versus 7.0%), a significant health disparity. In 2004, diabetes group visits were instituted, which provided excellent health care services and resulted in improved mental health, but did not improve diabetes management. Analysis of the group visit discussions revealed a Hmong diabetes model that stressed the importance of balance: balancing diet, exercise, medications, and mental health so that people felt healthy, and in balance. This study aimed to develop culturally appropriate group visit strategies to support self-efficacy for effective diabetes self-management. Methods: 17 Hmong adults with diabetes participated in monthly 2.5-3.0 hour group visits for 6 months, attending a mean of 3.88 visits. Culturally appropriate group visits meant: healthcare professionals were Hmong or spoke Hmong; professionals understood the Hmong diabetes model of balance; natural leaders were identified prior to the sessions and encouraged to take leadership roles; educational resources were verbal, in Hmung language and featured Hmung people; and discussions were aimed at helping patients set goals to change behaviors to gain healthy balance. Results: Pre-post data analyses revealed no significant improvement in biological variables (A1C, BP, BMI), self-reported behaviors of diet and exercise, or self-efficacy measures. Mental health did improve, as measured by Hmong Hopkins Symptom 25 checklist. Challenges included: identified natural leaders not taking leadership roles; members not instituting behavior change strategies and not sharing personal struggles with behavior change; poor mental health impairing behavior change; and healthcare professionals facing institutional changes that decreased their attention on the group. Significance: While Hmong diabetes group visits were culturally appropriate, the group visits did not translate into improved self-efficacy, improved diabetes management, or improved disease outcomes. The challenge remains of how to help Hmong patients institute behavior changes, when those changes upset their sense of healthy balance. [ABSTRACT FROM AUTHOR]