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Schepens Niemiec SL, Blanchard J, Vigen CLP, Martínez J, Guzmán L, Fluke M, Carlson M. A Pilot Study of the ¡Vivir Mi Vida! Lifestyle Intervention for Rural-Dwelling, Late-Midlife Latinos: Study Design and Protocol. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2018. [PMID: 29514544 DOI: 10.1177/1539449218762728] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Older, rural-dwelling Latinos face multiple health disparities. We describe the protocol of a pilot study of a community health worker-occupational therapist-led lifestyle program, ¡Vivir Mi Vida! ( ¡VMV!), designed for delivery in primary care and adapted for late-midlife, Latino rural-living patients. Using mixed methods, we collected feasibility, acceptability, and preliminary efficacy data on ¡VMV!. Forty 50- to 64-year-old Latinos participated in a 16-week lifestyle intervention led by a community health worker-occupational therapist team. We conducted pre- and post-intervention assessments to evaluate the efficacy of ¡VMV! in improving psychosocial and clinical health outcomes. Focus groups and interviews were held post-intervention with participants and key stakeholders to assess feasibility and acceptability. This is the first trial designed to evaluate a lifestyle intervention that includes collaboration between occupational therapists and community health workers within primary care. The detailed description of methodology promotes research transparency and reproducibility of a community health worker-occupational therapist-led lifestyle intervention.
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Affiliation(s)
| | | | | | | | - Laura Guzmán
- 1 University of Southern California, Los Angeles, USA
| | - Michelle Fluke
- 2 Antelope Valley Partners for Health, Lancaster, CA, USA
| | - Mike Carlson
- 1 University of Southern California, Los Angeles, USA
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Perales J, Reininger BM, Lee M, Linder SH. Participants' perceptions of interactions with community health workers who promote behavior change: a qualitative characterization from participants with normal, depressive and anxious mood states. Int J Equity Health 2018; 17:19. [PMID: 29402278 PMCID: PMC5800056 DOI: 10.1186/s12939-018-0729-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 01/16/2018] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Interventions that promote healthier lifestyles among Latinos often involve community health workers (CHWs). CHWs can effectively advocate for healthier lifestyles and may be pivotal in addressing such mental health conditions as depression and anxiety. The goal of this study was to characterize the relationship dynamics between Latino participants and CHWs, from the participant's perspective. We aimed to determine if CHW-delivered community interventions effected behavior change, especially among participants who reported anxiety and depression. METHODS Semi-structured interviews were conducted with a purposive sample of 28 Latino participants that was based on a mental health scoring strata. Participants completed a lifestyle intervention that included multiple home visits from CHWs to promote physical activity and healthful food choice. Interviews were conducted in the participant's preferred language (English or Spanish). Transcribed interviews were analyzed using a grounded theory approach until concept saturation was achieved. RESULTS The sample was primarily female (82%), lower socioeconomic status (64%), and mean age of 50 years. Participants discussed the rapport building and professionalism of CHWs as a feature that facilitated strong, positive relationships and lifestyle behavior changes. Participants described how CHWs patterned their change approaches, which were similar to commonly used therapeutic techniques in the treatment of anxiety and depression. While anxiety and depression were described as having an impact on behavior change, most, but not all, participants who reported negative mood states said that the CHW relationship helped in changing that state to some extent. CONCLUSIONS Participants' perceptions indicated that positive personal changes were influenced by CHWs. Only participants who reported consistently poor scores for depression, anxiety or both reported negative or neutral experiences with the CHWs. This study lends qualitative support to the use of CHWs as extenders of care, particularly in areas that have a shortage of primary and mental health care providers.
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Affiliation(s)
- Joseph Perales
- La Clínica - Casa del Sol, 1501 Fruitvale Ave, Oakland, California, 94601, USA
| | - Belinda M Reininger
- UT Health School of Public Health in Brownsville, Division of Health Promotion & Behavioral Sciences and Hispanic Health Research Center, One West University Blvd, Brownsville, TX, 78520, USA. .,Michael & Susan Dell Center for Healthy Living, UT School of Public Health, Austin Regional Campus, University of Texas Administration Building (UTA), 1616 Guadalupe Street, Suite 6.300, Austin, Texas, 78701, USA. .,University of Texas Health Science Center at Houston, Center for Clinical and Translational Sciences, 7000 Fannin, Suite 1800, Houston, Texas, 77030, USA.
| | - MinJae Lee
- University of Texas Health Science Center at Houston, Center for Clinical and Translational Sciences, 7000 Fannin, Suite 1800, Houston, Texas, 77030, USA.,University of Texas Health Science Center at Houston, Biostatistics/Epidemiology/Research Design (BERD) Core, Center for Clinical and Translational Sciences, 7000 Fannin, Suite 1800, Houston, Texas, 77030, USA
| | - Stephen H Linder
- UT Health School of Public Health, Institute for Health Policy, Division of Management, Policy and Community Health, 6410 Fannin, Houston, TX, 77030, USA
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53
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Erves JC, Mayo-Gamble TL, Malin-Fair A, Boyer A, Joosten Y, Vaughn YC, Sherden L, Luther P, Miller S, Wilkins CH. Needs, Priorities, and Recommendations for Engaging Underrepresented Populations in Clinical Research: A Community Perspective. J Community Health 2018; 42:472-480. [PMID: 27812847 PMCID: PMC5408035 DOI: 10.1007/s10900-016-0279-2] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Engaging underrepresented groups in outcomes research is a public health priority for reducing health and health care disparities; yet, engaging these groups is challenging. Failure to involve these underrepresented populations in research further exacerbates these disparities. This article presents the health and research priorities of diverse groups of underrepresented populations in biomedical research, their concerns for participating in research, and strategies to engage them in their healthcare and research studies. Eleven community listening sessions, ranging from 7 to 13 community members each (N = 117), representing racial/ethnic minority, economically disadvantaged (e.g., uninsured), and hearing impaired communities. We used an inductive, qualitative content analysis approach to analyze the data for emerging themes. We identified the following themes: Uncertainties of underrepresented populations regarding research participation; Ineffective communication about research opportunities and research findings; Research on primary care and prevention are priorities for underrepresented populations in research; and Research teams need training in cultural competence and humility. Underrepresented groups provided research priorities, concerns, and strategies to engage them in their healthcare and in research studies. Findings from this study could facilitate improvement of research participation among underrepresented groups, ultimately reducing health disparities and improving quality of life among groups commonly omitted from research recruitment and participation.
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Affiliation(s)
| | - Tilicia L Mayo-Gamble
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN, 37208, USA
| | - Alecia Malin-Fair
- Vanderbilt Institute for Clinical Translational Research (VICTR), Vanderbilt University Medical Center, Nashville, TN, 37203, USA
| | - Alaina Boyer
- National Health Care for the Homeless Council, Nashville, TN, USA
| | - Yvonne Joosten
- Vanderbilt University School of Medicine and Vanderbilt Institute for Medicine and Public Health, Nashville, TN, 37203, USA
| | - Yolanda C Vaughn
- Meharry-Vanderbilt Alliance and Vanderbilt University, Nashville, TN, 37208, USA
| | - Lisa Sherden
- Johns Hopkins Center to Reduce Cancer Disparities, Baltimore, MD, 21287, USA
| | | | - Stephania Miller
- Department of Surgery, Meharry Medical College, Nashville, TN, 37208, USA
| | - Consuelo H Wilkins
- Meharry-Vanderbilt Alliance, Vanderbilt University Medical Center, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Blvd., BioMedical Building, Nashville, TN, 37208, USA.
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54
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Garcia DS. A review of healthy weight behavior maintenance in Hispanic women. Health Care Women Int 2018; 40:407-432. [PMID: 29308977 DOI: 10.1080/07399332.2017.1421197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Healthy weight behavior maintenance is key to prevent overweight and obesity in Hispanic/Latino women, particularly for those who are more likely to be sedentary. In this paper, I review the intervention components used by various researchers for successful healthy weight behavior maintenance for Hispanic women. Randomized and experimental studies were located (N = 9) through computer and manual searches in identified articles dated between 1992 and 2015. The methodological characteristics and components of the intervention studies were analyzed systematically. Maintenance of behavior was determined by the statistical significant behavior change and by the effective magnitude of the intervention effect report, favoring the experimental groups in the follow-up periods. Intervention components supporting Hispanic women's weight-related behavior changes and maintenance included interpersonal contact, intervention duration, and the use of cultural motivation and social support strategies. Seven studies were found to be successful in maintaining behavior change, although their retention rates at follow-up completion had either wide-ranging variations or were not specified. The findings are discussed, and recommendations are made so future efforts may successfully employ weight-related intervention strategies for behavior maintenance in Hispanic women.
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Affiliation(s)
- Daisy S Garcia
- a Nursing Faculty, Seattle University , Seattle , Washington , USA
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55
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Hill J, Peer N, Oldenburg B, Kengne AP. Roles, responsibilities and characteristics of lay community health workers involved in diabetes prevention programmes: A systematic review. PLoS One 2017; 12:e0189069. [PMID: 29216263 PMCID: PMC5720739 DOI: 10.1371/journal.pone.0189069] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 11/17/2017] [Indexed: 01/16/2023] Open
Abstract
AIM To examine the characteristics of community health workers (CHWs) involved in diabetes prevention programmes (DPPs) and their contributions to expected outcomes. METHODS Electronic databases including PubMed-MEDLINE, EBSCOHost, and SCOPUS/EMBASE were searched for studies published between January 2000 and March 2016. All studies that used CHWs to implement DPP in ≥18-year-old participants without diabetes but at high risk for developing the condition, irrespective of the study design, setting or outcomes measured, were included. Results were synthesized narratively. RESULTS Forty papers of 30 studies were identified. Studies were mainly community-based and conducted in minority populations in USA. Sample sizes ranged from 20 participants in a single community to 2369 participants in 46 communities. Although CHWs were generally from the local community, their qualifications, work experience and training received differed across studies. Overall the training was culturally sensitive and/or appropriate, covering topics such as the importance of good nutrition and the benefits of increased physical activity, communication and leadership. CHWs delivered a variety of interventions and also screened or recruited participants. The shared culture and language between CHWs and participants likely contributed to better programme implementation and successful outcomes. CONCLUSIONS The complexity of DPPs and the diverse CHW roles preclude attributing specific outcomes to CHW involvement. Nevertheless, documenting potential CHW roles and the relevant training required may optimise CHW contributions and facilitate their involvement in DPPs in the future.
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Affiliation(s)
- Jillian Hill
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- * E-mail:
| | - Nasheeta Peer
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Brian Oldenburg
- Melbourne School of Public Health and Global Health, University of Melbourne, Melbourne, Australia
| | - Andre Pascale Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
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56
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Kritsotakis G, Konstantinidis T, Androulaki Z, Rizou E, Asprogeraka EM, Pitsouni V. The relationship between smoking and convivial, intimate and negative coping alcohol consumption in young adults. J Clin Nurs 2017; 27:2710-2718. [DOI: 10.1111/jocn.13889] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2017] [Indexed: 02/04/2023]
Affiliation(s)
- George Kritsotakis
- Laboratory of Epidemiology, Prevention & Management of Diseases Nursing Department Technological Educational Institute (TEI) of Crete Heraklion Greece
| | - Theocharis Konstantinidis
- Laboratory of Epidemiology, Prevention & Management of Diseases Nursing Department Technological Educational Institute (TEI) of Crete Heraklion Greece
| | - Zacharenia Androulaki
- Laboratory of Epidemiology, Prevention & Management of Diseases Nursing Department Technological Educational Institute (TEI) of Crete Heraklion Greece
| | - Efthymia Rizou
- Laboratory of Epidemiology, Prevention & Management of Diseases Nursing Department Technological Educational Institute (TEI) of Crete Heraklion Greece
| | - Eleni Maria Asprogeraka
- Laboratory of Epidemiology, Prevention & Management of Diseases Nursing Department Technological Educational Institute (TEI) of Crete Heraklion Greece
| | - Vasiliki Pitsouni
- Laboratory of Epidemiology, Prevention & Management of Diseases Nursing Department Technological Educational Institute (TEI) of Crete Heraklion Greece
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Venditti EM. Behavioral lifestyle interventions for the primary prevention of type 2 diabetes and translation to Hispanic/Latino communities in the United States and Mexico. Nutr Rev 2017; 75:85-93. [PMID: 28049753 DOI: 10.1093/nutrit/nuw041] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Lifestyle behaviors in overweight and obese individuals are closely linked to the development, course, and outcomes of type 2 diabetes and multiple comorbid health conditions. Behavior change theory and many randomized controlled studies offer strong support for screening and identifying adults at increased cardiometabolic risk and for providing early intervention to mitigate risk factors to prevent or delay the onset of disease. The current article reviews key lifestyle intervention efficacy and dissemination trials conducted with individuals deemed to be at increased risk for diabetes and describes the rationale for training teams of professionals and community health workers (e.g., promotores [in Spanish]) to implement comprehensive programs, with fidelity, in a variety of medical care and community settings. This evidence-based road map may be used to facilitate the design and implementation of strategies for structured behavioral diabetes risk reduction programs in the public and private healthcare sectors and other relevant community-based platforms serving individuals of Hispanic/Latino origin in the United States and Mexico.
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Affiliation(s)
- Elizabeth M Venditti
- E.M. Venditti is with the Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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58
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Sanee A, Somrongthong R, Plianbangchang S. The positive effects of a peer-led intervention system for individuals with a risk of metabolic syndrome. J Multidiscip Healthc 2017; 10:293-300. [PMID: 28860796 PMCID: PMC5565256 DOI: 10.2147/jmdh.s142272] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) is a major health risk in Thailand. Although it is reported that females have a higher rate of MetS than males, very few peer-led intervention studies have been conducted on specific groups, such as seamstresses, at risk of MetS. This study aimed to evaluate the effect of a peer-led intervention program on reducing MetS risk factors in individuals working in Thai Uniform Sewing Military Factories. METHODS A quasiexperimental program was introduced using a pre- and posttest design that was applied to female sewing factory workers selected for this research. All participants had at least one of the key MetS symptoms. The experimental group (N=50 participants) received 12 weekly peer-led individual support discussion sessions that included both dietary and physical activity (PA) advice and the control group (N=50 participants) followed their usual daily routines. The Student's t-test and the Pearson's chi-squared test were used to compare the differences of baseline data and analysis of variance was used for analysis of the data after intervention. RESULTS The results showed that after 3 months of participation, when compared to the control group, the experimental group had significantly improved systolic blood pressure (BP) (P=0.04), diastolic BP (P<0.001), PA (P=0.05), knowledge scores of MetS, perception of MetS and risk factors (P<0.001), and stress assessment (P=0.002). Waist circumference, body mass index, and Food Frequency Questionnaire score were not significantly different but still improved. CONCLUSION Findings from this study suggest that a peer-led support program can be introduced as an effective means of improving the behaviors of mostly sedentary factory workers at risk of MetS caused by working habits that are detrimental to health.
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Affiliation(s)
- Aree Sanee
- College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Ratana Somrongthong
- College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand
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59
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Hsu HC, Chuang SH, Hsu SW, Tung HJ, Chang SC, Lee MM, Wang JY, Kuo LT, Tseng FY, Po AT. Evaluation of a successful aging promotion intervention program for middle-aged adults in Taiwan. Glob Health Promot 2017; 26:81-90. [PMID: 28704138 DOI: 10.1177/1757975917702087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE This study was to implement and evaluate a successful aging intervention program for middle-aged private insurance beneficiaries. METHODS The participants were recruited from the staff and middle-aged clients for the experimental and control groups of a private insurance company. The two client (experimental and control) groups were matched by comparable age groups, gender, education, and purchased insurance types. The intervention program provided for the staff and the experimental group consisted of a series of educational courses on the topics about successful aging and preparation for 4 months. In total, there were 40 staff members, in addition to the 74 members of the experimental group and 60 members of the control group participating in the study. RESULTS After the intervention, the rate of physical activity and exercise significantly improved for the staff and for the intervention group. There were significant improvements in behaviors associated with doing exercise and living a less sedentary lifestyle and in the utilization of health examinations, and improvements in fitness and blood pressure. CONCLUSION The successful aging intervention program significantly improved awareness of successful aging, exercise behavior and fitness.
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Affiliation(s)
- Hui-Chuan Hsu
- 1. Department of Health Care Administration, Asia University, Taichung, Taiwan
- 2. Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Shu-Hui Chuang
- 1. Department of Health Care Administration, Asia University, Taichung, Taiwan
| | - Shang-Wei Hsu
- 1. Department of Health Care Administration, Asia University, Taichung, Taiwan
| | - Ho-Jui Tung
- 1. Department of Health Care Administration, Asia University, Taichung, Taiwan
| | - Shu-Ching Chang
- 3. Department of Health and Welfare, University of Taipei, Taipei, Taiwan
| | - Ming-Ming Lee
- 4. Department of Health and Nutrition Biotechnology, Asia University, Taichung, Taiwan
| | - Jiun-Yi Wang
- 1. Department of Health Care Administration, Asia University, Taichung, Taiwan
| | - Li-Ting Kuo
- 1. Department of Health Care Administration, Asia University, Taichung, Taiwan
| | - Fang-Ya Tseng
- 1. Department of Health Care Administration, Asia University, Taichung, Taiwan
| | - An-Ting Po
- 1. Department of Health Care Administration, Asia University, Taichung, Taiwan
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A Systematic Review of Obesity Disparities Research. Am J Prev Med 2017; 53:113-122. [PMID: 28341221 DOI: 10.1016/j.amepre.2017.01.041] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 12/22/2016] [Accepted: 01/23/2017] [Indexed: 11/22/2022]
Abstract
CONTEXT A review of interventions addressing obesity disparities could reveal gaps in the literature and provide guidance on future research, particularly for populations with a high prevalence of obesity and obesity-related cardiometabolic risk. EVIDENCE ACQUISITION A systematic review of clinical trials in obesity disparities research that were published in 2011-2016 in PubMed/MEDLINE resulted in 328 peer-reviewed articles. Articles were excluded if they had no BMI, weight, or body composition measure as primary outcome or were foreign (n=201); were epidemiologic or secondary data analyses of clinical trials (n=12); design or protocol papers (n=54); systematic reviews (n=3); or retracted or duplicates (n=9). Forty-nine published trials were summarized and supplemented with a review of ongoing obesity disparities grants being funded by the National, Heart, Lung and Blood Institute. EVIDENCE SYNTHESIS Of the 49 peer-reviewed trials, 27 targeted adults and 22 children only or parent-child dyads (5 of 22). Interventions were individually focused; mostly in single settings (e.g., school or community); of short duration (mostly ≤12 months); and primarily used behavioral modification (e.g., self-monitoring) strategies. Many of the trials had small sample sizes and moderate to high attrition rates. A meta-analysis of 13 adult trials obtained a pooled intervention effect of BMI -1.31 (95% CI=-2.11, -0.52, p=0.0012). Institutional review identified 140 ongoing obesity-related health disparities grants, but only 19% (n=27) were clinical trials. CONCLUSIONS The reviews call for cardiovascular-related obesity disparities research that is long term and includes population research, and multilevel, policy, and environmental, or "whole of community," interventions.
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Lai YJ, Hu HY, Lee YL, Ku PW, Yen YF, Chu D. A retrospective cohort study on the risk of stroke in relation to a priori health knowledge level among people with type 2 diabetes mellitus in Taiwan. BMC Cardiovasc Disord 2017; 17:130. [PMID: 28532430 PMCID: PMC5440939 DOI: 10.1186/s12872-017-0568-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 05/14/2017] [Indexed: 12/15/2022] Open
Abstract
Background Intervention of diabetes care education with regular laboratory check-up in outpatient visits showed long-term benefits to reduce the risk of macrovascular complications among people with type 2 diabetes. However, research on the level of a priori health knowledge to the prevention of diabetic complications in community settings has been scarce. We therefore aimed to investigate the association of health knowledge and stroke incidence in patients with type 2 diabetes in Taiwan. Methods A nationally representative sample of general Taiwanese population was selected using a multistage systematic sampling process from Taiwan National Health Interview Survey (NHIS) in 2005. Subjects were interviewed by a standardized face-to-face questionnaire in the survey, obtaining information of demographics, socioeconomic status, family medical history, obesity, health behaviors, and 15-item health knowledge assessment. The NHIS dataset was linked to Taiwan National Health Insurance claims data to retrieve the diagnosis of type 2 diabetes in NHIS participants at baseline and identify follow-up incidence of stroke from 2005 to 2013. Univariate and multivariate Cox regressions were used to estimate the effect of baseline health knowledge level to the risk of stroke incidence among this group of people with type 2 diabetes. Results A total of 597 diabetic patients with a mean age of 51.28 years old and nearly half of males were analyzed. During the 9-year follow-up period, 65 new stroke cases were identified among them. Kaplan–Meier curves comparing the three groups of low/moderate/high knowledge levels revealed a statistical significance (p-value of log-rank test <0.01). After controlling for potential confounders, comparing to the group of low health knowledge level, the relative risk of stroke was significantly lower for those with moderate (adjusted hazard ratio [AHR] = 0.63; 95% CI, 0.33–1.19; p-value = 0.15) and high level of health knowledge (AHR = 0.43; 95% CI, 0.22–0.86; p-value = 0.02), with a significant linear trend (p-value = 0.02). Conclusions An exposure-response gradient of moderate to high health knowledge levels to the prevention of stroke incidence among people with type 2 diabetes in community was found with 9 years of follow-up in Taiwan. Development and delivery of health education on stroke prevention to people with type 2 diabetes are warranted.
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Affiliation(s)
- Yun-Ju Lai
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Puli Branch of Taichung Veterans General Hospital, Nantou, Taiwan.,Department of Exercise Health Science, National Taiwan University of Sport, Taichung, Taiwan
| | - Hsiao-Yun Hu
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan.,Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Ya-Ling Lee
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan.,Department of Dentistry, Taipei City Hospital, Taipei, Taiwan.,Department of Dentistry, School of Dentistry, National Yang-Ming University, Taipei, Taiwan
| | - Po-Wen Ku
- Graduate Institute of Sports and Health, National Changhua University of Education, Changhua, Taiwan
| | - Yung-Feng Yen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Section of Infectious Diseases, Taipei City Hospital, Taipei City Government, No.145, Zhengzhou Rd., Datong Dist., Taipei, 10341, Taiwan. .,Department of Health and Welfare, College of City Management, University of Taipei, Taipei, Taiwan. .,Center for Infectious Disease and Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Dachen Chu
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan. .,Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan. .,Department of Neurosurgery, Taipei City Hospital, Taiwan, No.145, Zhengzhou Rd., Datong Dist., Taipei, 10341, Taiwan. .,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Portillo MC, Kennedy A, Todorova E, Regaira E, Wensing M, Foss C, Lionis C, Vassilev I, Goev V, Rogers A. Interventions and working relationships of voluntary organisations for diabetes self-management: A cross-national study. Int J Nurs Stud 2017; 70:58-70. [PMID: 28236688 PMCID: PMC5754322 DOI: 10.1016/j.ijnurstu.2017.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 01/29/2017] [Accepted: 02/01/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Diabetes has become a challenging health priority globally. Given the tensions of financially burdened health systems in Europe the mobilisation of community resources like voluntary organisations and community groups is seen as a health policy strategy to sustain the management of long-term conditions like diabetes. However, little is known about how this is happening in practice in Europe. OBJECTIVES To explore diabetes self-management interventions undertaken or promoted by voluntary organisations and community groups in Europe; and describe the types of working relationships between these organisations, European health systems and users when implementing diabetes self-management programmes in different areas. DESIGN A mixed method study (survey/qualitative interviews) was undertaken. This research formed part of a European project (7th Framework programme of the European Commission) exploring the link between resources, like community organisations, and peoples' capacities to manage long-term conditions. SETTINGS Six European countries (Bulgaria, Greece, Norway, Spain, the Netherlands and the United Kingdom) participated in the study. Three areas: deprived urban area, a relatively affluent urban area and a deprived rural area were purposefully selected. PARTICIPANTS Through a purposeful sample and bottom up strategies 749 representatives of voluntary organisations and community groups were recruited from the geographical areas above. Organisations with at least three members, existing for at least one year that could provide information or other type of support directly or indirectly relevant to patients with diabetes were included. METHODS Participants completed a 15 item questionnaire for the survey (n=749) and a voice recorded semi structured interview (n=300). Data collection focused on the type of activities and roles developed to promote health, and relationships and communication channels between organisations, health services and users. Descriptive and comparative statistical and qualitative content analyses were used. RESULTS Participants perceived they had better reach of people with health needs than health providers, filled the administration gaps left in their capacity to deal with basic diabetes practical needs, humanized care, and acted as mediators between services and communities. There were significant differences between countries in relation to the types of activities (p-value<0.001), roles (p-value<0.001) and funding sources (p-value<0.001) of organisations concerning diabetes self-management. In non-affluent countries organisations tend to promote social activities twice more often. CONCLUSIONS Community and voluntary organisations provide complimentary and on-going support in diabetes management. This involves a shift from focusing on the illness to also longing for social cohesion, sense of community and wellbeing in diabetes health practices and policies.
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Affiliation(s)
- Mari Carmen Portillo
- Faculty of Health Sciences, NIHR Wessex CLAHRC, University of Southampton, Hampshire, UK.
| | - Anne Kennedy
- Faculty of Health Sciences, NIHR Wessex CLAHRC, University of Southampton, Hampshire, UK
| | - Elka Todorova
- Department of Sociology, University of National and World Economy, Sofia, Bulgaria
| | - Elena Regaira
- Quality Department, University Clinic of Navarra, Pamplona, Spain
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Christina Foss
- Institute of Health and Society, University of Oslo, Norway
| | - Christos Lionis
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Crete, Greece
| | - Ivaylo Vassilev
- Faculty of Health Sciences, NIHR Wessex CLAHRC, University of Southampton, Hampshire, UK
| | - Valentin Goev
- Department of Statistics, University of National and World Economy, Sofia, Bulgaria
| | - Anne Rogers
- Faculty of Health Sciences, NIHR Wessex CLAHRC, University of Southampton, Hampshire, UK
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Khodaveisi M, Omidi A, Farokhi S, Soltanian AR. The Effect of Pender's Health Promotion Model in Improving the Nutritional Behavior of Overweight and Obese Women. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2017; 5:165-174. [PMID: 28409170 PMCID: PMC5385239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Changes in lifestyle and eating habits have put women at risk of obesity and overweight more than ever. This aim of this study was to investigate the effect of Pender's Health Promotion Model (HPM) to improve the nutritional behavior of overweight and obese women admitted to Fatemiyeh Hospital clinics in Hamadan, west Iran in 2015. METHODS In this quasi-experimental study, 108 eligible women were selected and randomly assigned to two groups: one experimental and one control. Data were gathered using three questionnaires: demographics, Pender's HPM constructs, and nutritional behavior. The questionnaires were filled out by both groups as pre-test and two months later. A Pender's HPM-based intervention was conducted for the experimental group. The data were analyzed by paired and independent t-tests, ANCOVA, and Spearmans' correlation coefficient in SPSS/16. The level of significance was considered to be <0.05. RESULTS The mean score of nutritional behavior was 41.75±3.28 and 42.36±3.69 before the intervention and 79.09±5.27 and 49.72±9.49 after it in the experimental and control groups, respectively. The difference was significant only between before and after the intervention in the experimental group (P<0.001). Furthermore, the mean scores of the following variables were significantly different between before and after the intervention in the experimental group: nutritional behavior, perceived benefits, perceived self-efficacy, commitment to action, interpersonal and situational influences, behavior-related affect, and perceived barriers (P<0.001). CONCLUSION The results showed that Pender's HPM-based training improved nutritional behavior and some constructs of the model. Therefore, this educative model can be used by healthcare providers to improve the nutritional and other health promoting behaviors.
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Affiliation(s)
- Masoud Khodaveisi
- Chronic Diseases (Home Care) Research Center, Department of Community Health Nursing, Hamadan University of Medical Sciences, Hamadan, Iran;
| | - Afsar Omidi
- Chronic Diseases (Home Care) Research Center, Department of Community Health Nursing, Hamadan University of Medical Sciences, Hamadan, Iran;
| | - Shima Farokhi
- Department of Community Health Nursing, Hamadan University of Medical Sciences, Hamadan, Iran;
| | - Ali Reza Soltanian
- Modeling of Noncommunicable Disease Research Center, School of Public Heath, Hamadan University of Medical Sciences, Hamadan, Iran
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Arab A, Askari G, Golshiri P, Feizi A, Hekmatnia A, Iraj B, Nourian M. The Effect of a Lifestyle Modification Education on Adiposity Measures in Overweight and Obese Nonalcoholic Fatty Liver Disease Patients. Int J Prev Med 2017; 8:10. [PMID: 28299034 PMCID: PMC5343609 DOI: 10.4103/2008-7802.200854] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 01/03/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Obesity is increasingly associated with nonalcoholic fatty liver disease (NAFLD) and weight loss through a combination of dietary modifications and increased physical activity is a primary goal of therapy in this disease. Therefore, this study was conducted to evaluate the effects of a lifestyle modification education on adiposity measures, physical activity, and total calorie intake in overweight and obese NAFLD patients. METHODS During 8 weeks, 82 obese patients were randomly assigned into either an intervention group (n = 41) receiving a lifestyle modification education or to a control group (n = 41) receiving usual care. Total calorie intake, physical activity, and body composition indices were measured before and after the intervention. RESULTS Thirty-six patients in intervention group and 33 in control group completed the study. The analysis of body composition variables did not show any significant reduction for percent of body fat, abdominal circumference, waist to hip ratio, visceral fat area, age matched of body, and soft lean mass (SLM) of the trunk (P > 0.05). On the other hand, a significant reduction in weight, body mass index, mass of body fat (MBF), SLM, and MBF of the trunk was observed after 2 months of intervention compared to the controls (P < 0.05). A significant reduction was observed in total calorie intake of intervention group as compared to the control group. Physical activity status did not show any significant improvements after 2 months of intervention. CONCLUSIONS Our lifestyle modification education and its guidelines could be used in obese patients with NAFLD to improve their body composition measurements and to lose weight. This could result in significant long-term benefits in NAFLD patients.
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Affiliation(s)
- Arman Arab
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Community Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gholamreza Askari
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Community Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parastoo Golshiri
- Department of Community Medicine and Family Physician, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Awat Feizi
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran; Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Hekmatnia
- Department of Radiology, Image Processing and Signal Research Center, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bijan Iraj
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mojgan Nourian
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Community Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
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Hilfinger Messias DK, Sharpe PA, Del Castillo-González L, Treviño L, Parra-Medina D. Living in Limbo: Latinas' Assessment of Lower Rio Grande Valley Colonias Communities. Public Health Nurs 2016; 34:267-275. [PMID: 27921331 DOI: 10.1111/phn.12307] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Community asset mapping (CAM) is the collective process of identifying local assets and strategizing processes to address public health issues and concerns and improve quality of life. Prior to implementing a community-based physical activity intervention with Latinas in the Texas Lower Rio Grande Valley, promotoras [community health workers] conducted 16 interactive sessions in 8 colonias. The analysis of the transcribed CAM recordings and on-site observational data resulted in the construction of Living in Limbo as the thematic representation of these Latinas' social isolation and marginalization associated with pervasive poverty, undocumented immigration status or lack of citizenship, their fears emanating from threats to physical and emotional safety, and the barriers created by lack of availability and access to resources.
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Affiliation(s)
| | - Patricia A Sharpe
- College of Social Work, University of South Carolina, Columbia, South Carolina
| | | | - Laura Treviño
- Texas A&M University Lower Rio Grande Colonias Program, Weslaco, Texas
| | - Deborah Parra-Medina
- Latino Research Initiative, Mexican American and Latina/o Studies, University of Texas at Austin, Austin, Texas
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Schwingel A, Wiley AR, Teran-Garcia M, McCaffrey J, Gálvez P, Vizcarra M. Promotoras and the Semantic Gap Between Latino Community Health Researchers and Latino Communities. Health Promot Pract 2016; 18:444-453. [PMID: 27760810 DOI: 10.1177/1524839916670576] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Promotoras are identified as a unique group of community health workers adept at reducing health disparities. This qualitative study was conducted to better understand perceptions of the term promotora, broadly used in research but not well documented in everyday Latina vocabulary. Six focus groups to better understand perceptions of the term promotora were conducted with 36 Latina women living in three nonmetropolitan areas in Illinois. Results suggest that Latina participants in the study do not understand the meaning of "promotora" in the same way as it is used in the literature. Latina participants understood "promotoras" as referring to people who sell or deliver information, or organize events in the community that are not necessarily related to health events or community health work. Furthermore, they usually understood the term to refer to paid work rather than volunteering. Results underscore the importance of being sensitive to Latinas' perceptions of community health terminology by assessing their context, needs, and expectations. These findings call researchers' attention to the need to educate certain Latino communities about the concept of promotoras, with implications for the implementation and dissemination of promotora-led community health programs, as the semantic discrepancy could affect the recruitment of promotoras as well as community participation in the programs they deliver.
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Affiliation(s)
| | - Angela R Wiley
- 1 University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | | | | | - Patricia Gálvez
- 1 University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Marcela Vizcarra
- 1 University of Illinois at Urbana-Champaign, Champaign, IL, USA
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Hoeft KS, Barker JC, Shiboski S, Pantoja-Guzman E, Hiatt RA. Effectiveness evaluation of Contra Caries Oral Health Education Program for improving Spanish-speaking parents' preventive oral health knowledge and behaviors for their young children. Community Dent Oral Epidemiol 2016; 44:564-576. [PMID: 27517458 DOI: 10.1111/cdoe.12250] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 06/30/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine the effectiveness of the Contra Caries Oral Health Education Program (CCOHEP) for improving low-income, Spanish-speaking parents' oral health knowledge and behaviors for their young children. Mexican American children in the United States suffer disproportionately high prevalence and severity of early childhood caries, yet few evaluated, theory-based behavioral interventions exist for this population. CCOHEP is a theory-based curriculum consisting of four 2-h interactive classes designed for and by Spanish speakers and led by designated community health educators (promotoras). Topics included children's oral hygiene, caries etiology, dental procedures, nutrition, child behavior management, and parent skill-building activities. METHODS Low-income Spanish-speaking parents/caregivers of children aged 0-5 years were recruited through community services in an agricultural city in California. Survey questions from the Oral Health Basic Research Facts Questionnaire measuring oral health-related behaviors and knowledge were verbally administered before, immediately after, and 3 months after attendance at CCOHEP. Five questions measured aspects of parental toothbrushing for their children (frequency, using fluoridated toothpaste, brushing before bed, not drinking or eating after nighttime brushing, adult assistance), three questions measured other oral health behaviors, and 16 questions measured oral health-related knowledge. Analyses of within-person changes between pre- and post-tests and again between post-test and 3-month follow-up consisted of McNemar's test for binary outcomes and sign tests for ordinal outcomes. RESULTS Overall, 105 caregivers participated in CCOHEP (n = 105 pretest, n = 95 post-test, n = 79 second post-test). At baseline, all parents self-reported doing at least one aspect of toothbrushing correctly, but only 13% reported performing all five aspects according to professional guidelines. At post-test, 44% of parents reported completing all aspects of toothbrushing according to professional guidelines (P < .001). Statistically significant improvements were seen in 4 aspects of toothbrushing (P ≤ .008) between pretest and post-test (all but adult assistance). The second post-test showed 3 of these improvements were maintained, while adult assistance and the other reported behaviors improved (P ≤ .008). Between pretest and post-test, checking child's teeth monthly and frequency of sweet drinks consumption improved (P ≤ .008), while frequency of eating sweet foods did not change. Knowledge was high at baseline (mean 12.8 of 16), but 6 knowledge items improved significantly between pretest and post-test. Improvements were maintained at second post-test. CONCLUSIONS Contra Caries Oral Health Education Program improved low-income Spanish-speaking parents' oral hygiene knowledge and self-reported behaviors for their young children, and change was sustained 3 months after the end of the intervention. Future, more rigorous evaluation of the intervention is recommended.
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Affiliation(s)
- K S Hoeft
- Department of Epidemiology & Biostatistics, Center to Address Disparities in Children's Oral Health (CAN DO), University of California, San Francisco, San Francisco, CA, USA.
| | - J C Barker
- Department of Anthropology, History & Social Medicine, Center to Address Disparities in Children's Oral Health (CAN DO), University of California, San Francisco, San Francisco, CA, USA
| | - S Shiboski
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - E Pantoja-Guzman
- Department of Anthropology, History & Social Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - R A Hiatt
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA
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Mattei J, Mendez J, Falcon LM, Tucker KL. Perceptions and Motivations to Prevent Heart Disease among Puerto Ricans. Am J Health Behav 2016; 40:322-31. [PMID: 27103411 DOI: 10.5993/ajhb.40.3.4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVES We performed a qualitative assessment of Puerto Ricans' knowledge and perceptions of cardiovascular disease (CVD), and motivations/barriers and preferences to participate in community/ clinical programs for CVD-prevention. METHODS Four guided focus group discussions were conducted on a total of 24 Puerto Ricans, aged 40-60 years in Boston, MA. RESULTS Participants were aware of CVD, but less knowledgeable about its prevention. They perceived it as serious, and either had CVD or knew someone who had it. They favored education and activities on nutrition, exercise, clinical advice, and social interaction, in weekly/ biweekly small-group sessions with other Latinos, led in Spanish by a familiar health professional, in a convenient community location. Age- and culture-specific program content and educational materials were preferred. A theme emerged on 'personal or family motivations' such as to become healthier and live longer so they would feel better and support their families, or to learn about CVD-prevention. Main barriers included family obligations, weather, safety concerns, transportation, and depressive mood. CONCLUSIONS Culturally-tailored CVD-prevention programs for Puerto Ricans should include multiple behavioral and social approaches, and draw on intrinsic motivators while reducing barriers to help enhance efficacy and sustainability.
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Affiliation(s)
- Josiemer Mattei
- Harvard T.H. Chan School of Public Health, Department of Nutrition, Boston MA, USA.
| | | | - Luis M Falcon
- College of Fine Arts, Humanities and Social Services, University of Massachusetts, Lowell, MA, USA
| | - Katherine L Tucker
- Department of Clinical Laboratory and Nutritional Sciences, University of Massachusetts, Lowell, MA, USA
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Kritsotakis G, Psarrou M, Vassilaki M, Androulaki Z, Philalithis AE. Gender differences in the prevalence and clustering of multiple health risk behaviours in young adults. J Adv Nurs 2016; 72:2098-113. [PMID: 27102085 DOI: 10.1111/jan.12981] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2016] [Indexed: 12/24/2022]
Abstract
AIMS To estimate the sex-stratified prevalence and clustering of 14 behavioural and metabolic health risk factors in emerging adulthood. BACKGROUND The high prevalence and the clustering of risk factors multiply health consequences and increase the threat to the future health and quality of life of young adults. DESIGN Descriptive cross-sectional study. METHODS During November-December 2012, we assessed 14 lifestyle characteristics of 1058 1st year university students' that were classified as: healthy (score = 0), unhealthy (score = 1) and high-risk unhealthy (score = 2). We subsequently created a Multiple Health Risk Behaviours Index by summing the score of each behaviour adjusted to 0-100. RESULTS Only 0·3% of the students had one risk behaviour and 21·3% (male: 31·5%; female: 12·6%) had ≥10 of 14. Male students had higher risk index score. In adjusted regression analyses, female students had higher odds of reporting healthier behaviours in oral hygiene (tooth brushing), red meat and junk food consumption, binge drinking, cannabis/hashish/marijuana use and lower number of sexual partners and Body Mass Index. Male students reported higher physical activity. No statistically significant gender differences were noted for screen time/sedentary behaviours, condom use, smoking, sunburns, breakfast and fruit and vegetable consumption. CONCLUSION Although health-compromising behaviours are highly prevalent in both men and women, they are gender-related, with males engaging in more health risk behaviours than females. Preventive interventions may need to focus on gender-informed approaches when targeting multiple health risk behaviours.
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Affiliation(s)
- George Kritsotakis
- Laboratory of Epidemiology, Prevention and Management of Diseases, Nursing Department, Technological Educational Institute (TEI) of Crete, Heraklion, Greece
| | - Maria Psarrou
- Laboratory of Epidemiology, Prevention and Management of Diseases, Nursing Department, Technological Educational Institute (TEI) of Crete, Heraklion, Greece
| | - Maria Vassilaki
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA.,Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Zacharenia Androulaki
- Laboratory of Epidemiology, Prevention and Management of Diseases, Nursing Department, Technological Educational Institute (TEI) of Crete, Heraklion, Greece
| | - Anastas E Philalithis
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
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Schwingel A, Gálvez P, Linares D, Sebastião E. Using a Mixed-Methods RE-AIM Framework to Evaluate Community Health Programs for Older Latinas. J Aging Health 2016; 29:551-593. [PMID: 27079919 DOI: 10.1177/0898264316641075] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This study used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to evaluate a promotora-led community health program designed for Latinas ages 50 and older that sought to improve physical activity, nutrition, and stress management. METHOD A mixed-methods evaluation approach was administered at participant and organizational levels with a focus on the efficacy, adoption, implementation, and maintenance components of the RE-AIM theoretical model. RESULTS The program was shown to be effective at improving participants' eating behaviors, increasing their physical activity levels, and lowering their depressive symptoms. Promotoras felt motivated and sufficiently prepared to deliver the program. Some implementation challenges were reported. More child care opportunities and an increased focus on mental well-being were suggested. DISCUSSION The promotora delivery model has promise for program sustainability with both promotoras and participants alike expressing interest in leading future programs.
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Serrata JV, Hernandez-Martinez M, Macias RL. Self-Empowerment of Immigrant Latina Survivors of Domestic Violence. HISPANIC HEALTH CARE INTERNATIONAL 2016; 14:37-46. [DOI: 10.1177/1540415316629681] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article presents the results of a self-empowerment leadership intervention program for Latina immigrant survivors of domestic violence in Atlanta, Georgia. It builds on the literature base of the Promotora model, a public health model using peer information sharing as a tool for health promotion. This study used an embedded mixed-methods design with quantitative and qualitative components to evaluate the impact of a peer community leadership program called Líderes. Results of single-subject analyses show that the participants experienced change in three components of self-empowerment: intrapersonal, interactional, and behavioral. The qualitative findings revealed that they overcame fear and gained knowledge as well as a sense that they could promote change in their community. These findings add support to a growing literature base that demonstrates how peer model programs can not only positively influence the well-being of the communities they serve but also have transformative effects on peer leaders themselves. Study findings can also inform future efforts to empower survivors through promotora approaches specifically in the context of domestic violence prevention.
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Shommu NS, Ahmed S, Rumana N, Barron GRS, McBrien KA, Turin TC. What is the scope of improving immigrant and ethnic minority healthcare using community navigators: A systematic scoping review. Int J Equity Health 2016; 15:6. [PMID: 26768130 PMCID: PMC4714538 DOI: 10.1186/s12939-016-0298-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 01/07/2016] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Immigrants are among the most vulnerable population groups in North America; they face multidimensional hurdles to obtain proper healthcare. Such barriers result in increased risk of developing acute and chronic conditions. Subsequently a great deal of burden is placed on the healthcare system. Community navigator programs are designed to provide culturally sensitive guidance to vulnerable populations in order to overcome barriers to accessing healthcare. Navigators are healthcare workers who support patients to obtain appropriate healthcare. This scoping review systematically searches and summarizes the literature on community navigators to help immigrant and ethnic minority groups in Canada and the United States overcome barriers to healthcare. METHODS We systematically searched electronic databases for primary articles and grey literature. Study selection was performed following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. Articles were selected based on four criteria: (1) the study population was comprised of immigrants or ethnic minorities living in Canada or the United States; (2) study outcomes were related to chronic disease management or primary care access; (3) the study reported effects of community navigator intervention; (4) the study was published in English. Relevant information from the articles was extracted and reported in the review. RESULT Only one study was found in the literature that focused on navigators for immigrants in Canada. In contrast, 29 articles were found that reported navigator intervention programs for immigrant minorities in the United States. In these studies navigators trained and guided members of several ethnic communities for chronic disease prevention and management, to undertake cancer screening as well as accessing primary healthcare. The studies reported substantial improvement in the immigrant and ethnic minority health outcomes in the United States. The single Canadian study also reported positive outcome of navigators among immigrant women. CONCLUSION Navigator interventions have not been fully explored in Canada, where as, there have been many studies in the United States and these demonstrated significant improvements in immigrant health outcomes. With many immigrants arriving in Canada each year, community navigators may provide a solution to reduce the existing healthcare barriers and support better health outcomes for new comers.
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Affiliation(s)
- Nusrat Sharmeen Shommu
- Department of Family Medicine, Room G012F, Health Sciences Center, University of Calgary, 3330 Hospital Drive Northwest, Calgary, AB, T2N 4N1, Canada.
| | - Salim Ahmed
- Department of Family Medicine, Room G012F, Health Sciences Center, University of Calgary, 3330 Hospital Drive Northwest, Calgary, AB, T2N 4N1, Canada.
| | - Nahid Rumana
- Sleep Center, Foothills Medical Center, University of Calgary, 1403 29 Street NW, Calgary, AB, Canada.
| | - Gary R S Barron
- Department of Family Medicine, Room G012F, Health Sciences Center, University of Calgary, 3330 Hospital Drive Northwest, Calgary, AB, T2N 4N1, Canada.
| | - Kerry Alison McBrien
- Department of Family Medicine, Room G012F, Health Sciences Center, University of Calgary, 3330 Hospital Drive Northwest, Calgary, AB, T2N 4N1, Canada. .,Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive Northwest, Calgary, AB, T2N 4Z6, Canada.
| | - Tanvir Chowdhury Turin
- Department of Family Medicine, Room G012F, Health Sciences Center, University of Calgary, 3330 Hospital Drive Northwest, Calgary, AB, T2N 4N1, Canada. .,Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive Northwest, Calgary, AB, T2N 4Z6, Canada.
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A Multidisciplinary Intervention Utilizing Virtual Communication Tools to Reduce Health Disparities: A Pilot Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 13:ijerph13010031. [PMID: 26703661 PMCID: PMC4730422 DOI: 10.3390/ijerph13010031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 10/27/2015] [Accepted: 11/17/2015] [Indexed: 01/17/2023]
Abstract
Advances in technology are likely to provide new approaches to address healthcare disparities for high-risk populations. This study explores the feasibility of a new approach to health disparities research using a multidisciplinary intervention and advanced communication technology to improve patient access to care and chronic disease management. A high-risk cohort of uninsured, poorly-controlled diabetic patients was identified then randomized pre-consent with stratification by geographic region to receive either the intervention or usual care. Prior to enrollment, participants were screened for readiness to make a behavioral change. The primary outcome was the feasibility of protocol implementation, and secondary outcomes included the use of patient-centered medical home (PCMH) services and markers of chronic disease control. The intervention included a standardized needs assessment, individualized care plan, intensive management by a multidisciplinary team, including health coach-facilitated virtual visits, and the use of a cloud-based glucose monitoring system. One-hundred twenty-seven high-risk, potentially eligible participants were randomized. Sixty-one met eligibility criteria after an in-depth review. Due to limited resources and time for the pilot, we only attempted to contact 36 participants. Of these, we successfully reached 20 (32%) by phone and conducted a readiness to change screen. Ten participants screened in as ready to change and were enrolled, while the remaining 10 were not ready to change. Eight enrolled participants completed the final three-month follow-up. Intervention feasibility was demonstrated through successful implementation of 13 out of 14 health coach-facilitated virtual visits, and 100% of participants indicated that they would recommend the intervention to a friend. Protocol feasibility was demonstrated as eight of 10 participants completed the entire study protocol. At the end of the three-month intervention, participants had a median of nine total documented contacts with PCMH providers compared to four in the control group. Three intervention and two control participants had controlled diabetes (hemoglobin A1C <9%). Multidisciplinary care that utilizes health coach-facilitated virtual visits is an intervention that could increase access to intensive primary care services in a vulnerable population. The methods tested are feasible and should be tested in a pragmatic randomized controlled trial to evaluate the impact on patient-relevant outcomes across multiple chronic diseases.
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Martinez M, Prabhakar N, Drake K, Coull B, Chong J, Ritter L, Kidwell C. Identification of Barriers to Stroke Awareness and Risk Factor Management Unique to Hispanics. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 13:ijerph13010023. [PMID: 26703690 PMCID: PMC4730414 DOI: 10.3390/ijerph13010023] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 09/26/2015] [Accepted: 09/29/2015] [Indexed: 11/26/2022]
Abstract
Barriers to risk factor control may differ by race/ethnicity. The goal of this study was to identify barriers to stroke awareness and risk factor management unique to Hispanics as compared to non-Hispanic whites (NHWs). We performed a prospective study of stroke patients from an academic Stroke Center in Arizona and surveyed members of the general community. Questionnaires included: the Duke Social Support Index (DSSI), the Multidimensional Health Locus of Control (MHLC) Scale, a stroke barriers questionnaire, and a Stroke Awareness Test. Of 145 stroke patients surveyed (72 Hispanic; 73 NHW), Hispanics scored lower on the Stroke Awareness Test compared to NHWs (72.5% vs. 79.1%, p = 0.029). Hispanic stroke patients also reported greater barriers related to medical knowledge, medication adherence, and healthcare access (p < 0.05 for all). Hispanics scored higher on the "powerful others" sub-scale (11.3 vs. 10, p < 0.05) of the MHLC. Of 177 members of the general public surveyed, Hispanics had lower stroke awareness compared to NHWs and tended to have lower awareness than Hispanic stroke patients. These results suggest that Hispanic stroke patients perceive less control over their health, experience more healthcare barriers, and demonstrate lower rates of stroke literacy. Interventions for stroke prevention and education in Hispanics should address these racial/ethnic differences in stroke awareness and barriers to risk factor control.
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Affiliation(s)
- Marina Martinez
- Department of Neurology, University of Arizona College of Medicine, 1501 N. Campbell Avenue Tucson, AZ 85724, USA.
| | - Nitin Prabhakar
- Department of Neurology, University of Arizona College of Medicine, 1501 N. Campbell Avenue Tucson, AZ 85724, USA.
| | - Kendra Drake
- Department of Neurology, University of Arizona College of Medicine, 1501 N. Campbell Avenue Tucson, AZ 85724, USA.
| | - Bruce Coull
- Department of Neurology, University of Arizona College of Medicine, 1501 N. Campbell Avenue Tucson, AZ 85724, USA.
| | - Jenny Chong
- Department of Neurology, University of Arizona College of Medicine, 1501 N. Campbell Avenue Tucson, AZ 85724, USA.
| | - Leslie Ritter
- Department of Neurology, University of Arizona College of Medicine, 1501 N. Campbell Avenue Tucson, AZ 85724, USA.
| | - Chelsea Kidwell
- Department of Neurology, University of Arizona College of Medicine, 1501 N. Campbell Avenue Tucson, AZ 85724, USA.
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Haughton J, Ayala GX, Burke KH, Elder JP, Montañez J, Arredondo EM. Community Health Workers Promoting Physical Activity: Targeting Multiple Levels of the Social Ecological Model. J Ambul Care Manage 2015; 38:309-20. [PMID: 26280587 PMCID: PMC4565764 DOI: 10.1097/jac.0000000000000108] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The effectiveness of community health workers (CHWs) as health educators and health promoters among Latino populations is widely recognized. The Affordable Care Act created important opportunities to increase the role of CHWs in preventive health. This article describes the implementation of CHW-led, culturally specific, faith-based program to increase physical activity among churchgoing Latinas. This study augments previous research by describing the recruitment, selection, training, and evaluation of CHWs for a physical activity intervention targeting multiple levels of the Social Ecological Model.
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Affiliation(s)
- Jessica Haughton
- College of Health and Human Services (Dr Ayala) and Graduate School of Public Health (Drs Elder and Arredondo), Institute for Behavioral and Community Health (Mss Haughton and Montañez), San Diego State University, San Diego, California; and Upstate University Hospital, SUNY Upstate Medical University, Syracuse, New York (Ms Burke)
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Hoeft KS, Rios SM, Pantoja Guzman E, Barker JC. Using community participation to assess acceptability of "Contra Caries", a theory-based, promotora-led oral health education program for rural Latino parents: a mixed methods study. BMC Oral Health 2015; 15:103. [PMID: 26335081 PMCID: PMC4558913 DOI: 10.1186/s12903-015-0089-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 08/25/2015] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Latino children experience more prevalent and severe tooth decay than non-Hispanic white and non-Hispanic black children. Few theory-based, evaluated and culturally appropriate interventions target parents of this vulnerable population. To fill this gap, the Contra Caries Oral Health Education Program, a theory-based, promotora-led education program for low-income, Spanish-speaking parents of children aged 1-5 years, was developed. This article describes qualitative findings of the acceptability of curriculum content and activities, presents the process of refinement of the curriculum through engaging the target population and promotoras, and presents results from the evaluation assessing the acceptability of the curriculum once implemented. METHODS Focus groups were conducted with low-income Spanish-speaking parents of children 1-5 years living in a city in an agricultural area of California. Interviews were digitally recorded, translated and transcribed, checked for accuracy and the resulting data was thematically coded and analyzed using a social constructionist approach. The Contra Caries Oral Health Education Program was then implemented with a separate but similar sample, and after completing the program, participants were administered surveys asking about acceptability and favorite activities of the education program. Data were entered into a database, checked for accuracy, open-ended questions were categorized, and responses to close-ended questions counted. RESULTS Twelve focus groups were conducted (N = 51), 105 parents attended the Contra Caries Oral Health Education Program, and 83 parents filled out surveys. Complete attendance and retention was high (89% and 90%, respectively). This study found that their children's oral health is a high priority. Parents were not only interested in, but actually attended classes focused on increasing their knowledge and skills with respect to early childhood oral health. The Contra Caries content and format was perceived as acceptable by parents. Strong opinions about curriculum content were expressed for including information on how caries starts and progresses, weaning from the bottle, oral health care for children and adults, motivational strategies for children's tooth brushing, dental visits and cavity restorations. CONCLUSIONS The Contra Caries Oral Health Education Program was acceptable to low-income, Spanish-speaking parents of children 1-5 years. Participating in the curriculum development and revision process likely played an important role in the parents' high acceptability of the program.
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Affiliation(s)
- Kristin S Hoeft
- Department of Epidemiology and Biostatistics, Center to Address Disparities in Children's Oral Health (CAN DO), 3333 California Street, Suite 485, San Francisco, CA, 94143, USA.
| | - Sarah M Rios
- Department of Epidemiology and Biostatistics, Center to Address Disparities in Children's Oral Health (CAN DO), 3333 California Street, Suite 485, San Francisco, CA, 94143, USA.
| | - Estela Pantoja Guzman
- Department of Epidemiology and Biostatistics, Center to Address Disparities in Children's Oral Health (CAN DO), 3333 California Street, Suite 485, San Francisco, CA, 94143, USA.
| | - Judith C Barker
- Department of Anthropology, History & Social Medicine, Center to Address Children's Oral health Disparities (CAN DO), University of California San Francisco, 3333 California Street, Suite 485, San Francisco, CA, 94143-0850, USA.
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Allen C, Brownstein JN, Jayapaul-Philip B, Matos S, Mirambeau A. Strengthening the Effectiveness of State-Level Community Health Worker Initiatives Through Ambulatory Care Partnerships. J Ambul Care Manage 2015; 38:254-62. [PMID: 26049655 PMCID: PMC5304911 DOI: 10.1097/jac.0000000000000085] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The transformation of the US health care system and the recognition of the effectiveness of community health workers (CHWs) have accelerated national, state, and local efforts to engage CHWs in the support of vulnerable populations. Much can be learned about how to successfully integrate CHWs into health care teams, how to maximize their impact on chronic disease self-management, and how to strengthen their role as emissaries between clinical services and community resources; we share examples of effective strategies. Ambulatory care staff members are key partners in statewide initiatives to build and sustain the CHW workforce and reduce health disparities.
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Affiliation(s)
- Caitlin Allen
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia (Ms Allen and Drs Brownstein, Jayapaul-Philip, and Mirambeau); and Community Health Worker Network of New York City, New York (Mr Matos)
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