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Berg KA, Bharmal N, Tereshchenko LG, Le P, Payne JY, Misra-Hebert AD, Rothberg MB. Racial and ethnic differences in uncontrolled diabetes mellitus among adults taking antidiabetic medication. Prim Care Diabetes 2024; 18:368-373. [PMID: 38423828 DOI: 10.1016/j.pcd.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 01/14/2024] [Accepted: 02/14/2024] [Indexed: 03/02/2024]
Abstract
AIM To examine whether racial and ethnic disparities in uncontrolled type 2 diabetes mellitus (T2DM) persist among those taking medication and after accounting for other demographic, socioeconomic, and health indicators. METHODS Adults aged ≥20 years with T2DM using prescription diabetes medication were among participants assessed in a retrospective cohort study of the National Health and Nutrition Examination Survey 2007-2018. We estimated weighted sequential multivariable logistic regression models to predict odds of uncontrolled T2DM (HbA1c ≥ 8%) from racial and ethnic identity, adjusting for demographic, socioeconomic, and health indicators. RESULTS Of 3649 individuals with T2DM who reported taking medication, 27.4% had uncontrolled T2DM (mean HgA1c 9.6%). Those with uncontrolled diabetes had a mean BMI of 33.8, age of 57.3, and most were non-Hispanic white (54%), followed by 17% non-Hispanic Black, and 20% Hispanic identity. In multivariable analyses, odds of uncontrolled T2DM among those with Black or Hispanic identities lessened, but persisted, after accounting for other indicators (Black OR 1.38, 97.5% CI: 1.04, 1.83; Hispanic OR 1.79, 97.5% CI 1.25, 2.57). CONCLUSIONS Racial and ethnic disparities in T2DM control persisted among individuals taking medication. Future research might focus on developmental and epigenetic pathways of disparate T2DM control across racially and ethnically minoritized populations.
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Affiliation(s)
- Kristen A Berg
- Center for Health Care Research and Policy, Population Health Research Institute, The MetroHealth System at Case Western Reserve University, Cleveland, OH, USA.
| | - Nazleen Bharmal
- Community Health & Partnerships, Cleveland Clinic Community Care, Cleveland, OH, USA
| | | | - Phuc Le
- Center for Value-Based Care Research, Cleveland Clinic Community Care, Cleveland, OH, USA
| | - Julia Y Payne
- Center for Value-Based Care Research, Cleveland Clinic Community Care, Cleveland, OH, USA; Department of Population and Quantitative Health Sciences, Case Western Reserve University, School of Medicine, Cleveland, OH, USA
| | - Anita D Misra-Hebert
- Center for Value-Based Care Research, Cleveland Clinic Community Care, Cleveland, OH, USA; Healthcare Delivery & Implementation Science Center, Cleveland Clinic, Cleveland, OH, USA
| | - Michael B Rothberg
- Center for Value-Based Care Research, Cleveland Clinic Community Care, Cleveland, OH, USA
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2
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Ajrouche S, Louis L, Esvan M, Chapron A, Garlantezec R, Allory E. HbA1c changes in a deprived population who followed or not a diabetes self-management programme, organised in a multi-professional primary care practice: a historical cohort study on 207 patients between 2017 and 2019. BMC Endocr Disord 2024; 24:72. [PMID: 38769550 PMCID: PMC11103828 DOI: 10.1186/s12902-024-01601-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 05/07/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Diabetes self-management (DSM) helps people with diabetes to become actors in their disease. Deprived populations are particularly affected by diabetes and are less likely to have access to these programmes. DSM implementation in primary care, particularly in a multi-professional primary care practice (MPCP), is a valuable strategy to promote care access for these populations. In Rennes (Western France), a DSM programme was designed by a MPCP in a socio-economically deprived area. The study objective was to compare diabetes control in people who followed or not this DSM programme. METHOD The historical cohort of patients who participated in the DSM programme at the MPCP between 2017 and 2019 (n = 69) was compared with patients who did not participate in the programme, matched on sex, age, diabetes type and place of the general practitioner's practice (n = 138). The primary outcome was glycated haemoglobin (HbA1c) change between 12 months before and 12 months after the DSM programme. Secondary outcomes included modifications in diabetes treatment, body mass index, blood pressure, dyslipidaemia, presence of microalbuminuria, and diabetes retinopathy screening participation. RESULTS HbA1c was significantly improved in the exposed group after the programme (p < 0.01). The analysis did not find any significant between-group difference in socio-demographic data, medical history, comorbidities, and treatment adaptation. CONCLUSIONS These results, consistent with the international literature, promote the development of DSM programmes in primary care settings in deprived areas. The results of this real-life study need to be confirmed on the long-term and in different contexts (rural area, healthcare organisation).
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Affiliation(s)
- Sarah Ajrouche
- Department of General Practice, Univ Rennes, 2, Avenue du Pr Léon Bernard, RENNES Cedex, 35043, France
| | - Lisa Louis
- Department of General Practice, Univ Rennes, 2, Avenue du Pr Léon Bernard, RENNES Cedex, 35043, France
| | - Maxime Esvan
- CHU Rennes, Inserm CIC 1414 (Centre d'Investigation Clinique), Rennes, 35000, France
| | - Anthony Chapron
- Department of General Practice, Univ Rennes, 2, Avenue du Pr Léon Bernard, RENNES Cedex, 35043, France
- CHU Rennes, Inserm CIC 1414 (Centre d'Investigation Clinique), Rennes, 35000, France
| | - Ronan Garlantezec
- CHU de Rennes, Univ Rennes, Inserm, EHESP (Ecole des Hautes Etudes en Santé Publique), Irset - UMR_S 1085, Rennes, 35000, France
| | - Emmanuel Allory
- Department of General Practice, Univ Rennes, 2, Avenue du Pr Léon Bernard, RENNES Cedex, 35043, France.
- CHU Rennes, Inserm CIC 1414 (Centre d'Investigation Clinique), Rennes, 35000, France.
- LEPS (Laboratoire Educations et Promotion de la Santé), University of Sorbonne Paris Nord, UR 3412, Villetaneuse, F-93430, France.
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3
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Choo JWS, Moosa AS, Koh JWM, Ng CJ, Tan NC. Empowering patients in primary care: a qualitative exploration of the usability and utility of an online diabetes self-management tool. BMC PRIMARY CARE 2024; 25:111. [PMID: 38605357 PMCID: PMC11010383 DOI: 10.1186/s12875-024-02358-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/30/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Despite the potential advantages of Internet-based diabetes self-management education, its adoption was not widespread among Singapore's public primary care clinics (polyclinics). An interactive online tool was thus developed to help educate patients with Type 2 diabetes mellitus (T2DM), and was now ready for user testing before implementation. AIM To explore the perceived utility and usability of the educational tool in patients with suboptimally-controlled T2DM in a Singapore primary care setting. METHODS In-depth interviews were used to gather qualitative data from multi-ethnic Asian adults who had suboptimally-controlled T2DM. A total of 17 IDIs were conducted between April 2022 to March 2023, audio-recorded, transcribed, and analyzed to identify emergent themes via thematic analysis. RESULTS Regarding utility, users found the educational tool useful because it provided them with information that was comprehensive, accessible, reliable, and manageable. Regarding usability, the majority of users reported that the educational tool was easy to use, and suggested ways to improve navigational cues, visual clarity, readability and user engagement. CONCLUSION Participants generally found the educational tool useful and easy to use. A revised educational tool will be developed based on their feedback and implemented in clinical practice.
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Affiliation(s)
| | - Aminath Shiwaza Moosa
- SingHealth Polyclinics, Singapore, Singapore
- SingHealth-Duke NUS Family Medicine Academic Clinical Programme, Singapore, Singapore
| | | | - Chirk Jenn Ng
- SingHealth Polyclinics, Singapore, Singapore
- SingHealth-Duke NUS Family Medicine Academic Clinical Programme, Singapore, Singapore
| | - Ngiap Chuan Tan
- SingHealth Polyclinics, Singapore, Singapore
- SingHealth-Duke NUS Family Medicine Academic Clinical Programme, Singapore, Singapore
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4
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Ricci L, Minary L, Kivits J, Ayav C, Rat AC. Use of qualitative methods to optimize collaborative practices by highlighting differences in perceptions between professionals: an example of patient education. J Interprof Care 2024; 38:264-272. [PMID: 38375794 DOI: 10.1080/13561820.2023.2289509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/27/2023] [Indexed: 02/21/2024]
Abstract
Interprofessional working must be approached within health promotion interventions using systematic methods to identify areas of suboptimal collaboration. We designed a qualitative study with a purposive sample of seven French therapeutic patient education programs. Semi-structured individual interviews were conducted with 14 healthcare providers and seven clinician leaders (coordinators) involved in patient education. We used the same interview guide and thematic grid regardless of the professional's profile to compare their perceptions on elements affecting outcome, participation and sustainability of programs. Healthcare providers and coordinators addressed non-convergent issues at both ends of a continuum from a micro-level nested in the program delivery to a macro-level corresponding to the structured implementation and sustainability of the program. Meso-level issues featured convergent perspectives. Our methodology could be used at the level of health services in a health system to provide a complete recovery of stakeholders' perspectives (without "blind spots" from one stakeholder or another). In our study, we focused on patient education in the French health system and pointed out possible considerations to optimize the functioning of programs. Such considerations include specific training plan development, encouraging reflection on the content and use of initial assessment, leading sessions in pairs to save on work time, and communication on the ins and outs of organizational imperatives that require healthcare providers' contributions.
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Affiliation(s)
- Laetitia Ricci
- Epidémiologie Clinique, CHRU-Nancy, INSERM, Université de Lorraine, CIC, Nancy, France
- Université de Lorraine, Inserm, INSPIIRE, Nancy, France
| | | | - Joëlle Kivits
- APEMAC, équipe MICS, Université de Lorraine, Nancy, France
| | - Carole Ayav
- Epidémiologie Clinique, CHRU-Nancy, INSERM, Université de Lorraine, CIC, Nancy, France
| | - Anne-Christine Rat
- APEMAC, équipe MICS, Université de Lorraine, Nancy, France
- UMR-S 1075-Mobilités: Vieillissement, Pathologie, Santé COMETE, Caen, France, Rheumatology Department, CHU Caen, Caen Normandie University, Caen, France
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5
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Gharacheh L, Amini-Rarani M, Torabipour A, Karimi S. A Scoping Review of Possible Solutions for Decreasing Socioeconomic Inequalities in Type 2 Diabetes Mellitus. Int J Prev Med 2024; 15:5. [PMID: 38487697 PMCID: PMC10935579 DOI: 10.4103/ijpvm.ijpvm_374_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 05/17/2023] [Indexed: 03/17/2024] Open
Abstract
Background As socioeconomic inequalities are key factors in access and utilization of type 2 diabetes (T2D) services, the purpose of this scoping review was to identify solutions for decreasing socioeconomic inequalities in T2D. Methods A scoping review of scientific articles from 2000 and later was conducted using PubMed, Web of Science (WOS), Scopus, Embase, and ProQuest databases. Using the Arksey and O'Malley framework for scoping review, articles were extracted, meticulously read, and thematically analyzed. Results A total of 7204 articles were identified from the reviewed databases. After removing duplicate and nonrelevant articles, 117 articles were finally included and analyzed. A number of solutions and passways were extracted from the final articles. Solutions for decreasing socioeconomic inequalities in T2D were categorized into 12 main solutions and 63 passways. Conclusions Applying identified solutions in diabetes policies and interventions would be recommended for decreasing socioeconomic inequalities in T2D. Also, the passways could be addressed as entry points to help better implementation of diabetic policies.
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Affiliation(s)
- Laleh Gharacheh
- Student Research Committee, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mostafa Amini-Rarani
- Social Determinants of Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amin Torabipour
- Social Determinants of Health Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Saeed Karimi
- Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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6
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Stepanian N, Larsen MH, Mendelsohn JB, Mariussen KL, Heggdal K. Empowerment interventions designed for persons living with chronic disease - a systematic review and meta-analysis of the components and efficacy of format on patient-reported outcomes. BMC Health Serv Res 2023; 23:911. [PMID: 37626346 PMCID: PMC10463815 DOI: 10.1186/s12913-023-09895-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Empowerment approaches are essential for building the capacity of individuals with chronic disease to be in control of their health. Reviews of empowerment interventions have been focused on specific chronic diseases, thereby limiting the scope of findings. This study had three aims: 1) to describe the characteristics of empowerment interventions covering a broad range of chronic diseases, 2) to clarify consistency with the World Health Organization`s (WHO) definition of empowerment as a process composed of four fundamental components and 3) to summarize outcome measures and estimate the effects in group and individual intervention formats. METHODS Systematic literature review and meta-analysis. CINAHL, Medline, Embase, PsycINFO, Web of Science, COCHRANE and Central Register of Controlled Trials were searched using Chronic Disease, NCD, Empowerment, as MeSH terms. Eligible randomized and quasi randomized controlled trials were included. Review Manager 5.4 was used to conduct the meta-analysis. Risk of bias was assessed with the Cochrane risk-of-bias tool (ROB 2). RESULTS Thirty-nine articles representing 8,011 participants were included in the review. A majority (82%) of studies reported robust evidence for changes on study-defined outcome measures in favor of interventions. Intervention content was assessed against WHO's four fundamental components of empowerment, showing that all studies incorporated one component, but none targeted all components. Components reflecting knowledge acquisition, patient engagement with their health care providers and facilitating environment were scarcely reported. Meta-analyses found evidence for positive effects of group-format interventions measuring empowerment, HbA1c, and self-efficacy. Effects on empowerment were also found in some individual-format interventions. High levels of heterogeneity and variability among the conceptual frameworks were identified. CONCLUSION Empowerment interventions in group-format were most efficient, however, considerable conceptual inconsistencies were identified. Future studies should consolidate conceptual understandings by using WHO's empowerment framework to ensure that fundamental components of empowerment are explicitly included in intervention design. Furthermore, there is a need to clarify the role of empowerment through pathways that include patient activation, self- management, and clinical outcomes. This systematic review will inform the clinicians and researchers who aim to develop novel empowerment interventions to assist patients in the process of gaining control of their health. TRIAL REGISTRATION PROSPERO: International Prospective register of systematic reviews ID=CRD42020178286.
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Affiliation(s)
- Natalie Stepanian
- College of Health Professions, Pace University, One Pace Plaza, New York, NY, 10038, USA
| | | | - Joshua B Mendelsohn
- College of Health Professions, Pace University, One Pace Plaza, New York, NY, 10038, USA
| | - Kari L Mariussen
- Lovisenberg Diaconal University College, Lovisenberggaten 15, 0456, Oslo, Norway
| | - Kristin Heggdal
- Faculty of Health, VID Specialized University, Theodor Dahls Vei 10, 0370, Oslo, Norway.
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7
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Allen LP, Ellis L, Engleton C, Valerio VL, Hatala AR. Voices of those living with type 2 diabetes in Belize: barriers to care before and during the COVID-19 pandemic. Int J Equity Health 2023; 22:163. [PMID: 37620814 PMCID: PMC10463824 DOI: 10.1186/s12939-023-01987-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/14/2023] [Indexed: 08/26/2023] Open
Abstract
Belize has the highest national prevalence of type 2 diabetes (T2D) of Central and South America, and fifth direst in the world. T2D is the leading cause of death in Belize, a country facing burdens of increasing prevalence with few resources. Since March of 2020, the COVID-19 pandemic has exacerbated the difficulties of those living with T2D in Belize. To address T2D issues in Belize, our interdisciplinary research team explored the barriers to care and self-management for adult patients with T2D in Belize prior to and during the COVID-19 pandemic.Research relationships between Canadian (ARH) and Belizean (LE) authors have been ongoing since 2016. Together we used a qualitative Constructivist Grounded Theory design generating knowledge through 35 semi-structured patient interviews, 25 key informant discussions, and participant observation with field notes between February 2020 to September 2021. We used Dedoose analysis software for a systematized thematic coding process, as well as iterative verification activities. Findings revealed several barriers to care and self-management, including: 1) the tiered health and social care system with major gaps in coverage; 2) the unfulfilled demand for accurate health information and innovative dissemination methods; and 3) the compounding of loss of community supports, physical exercise, and health services due to COVID-19 restrictions. In the post-pandemic period, it is necessary to invest in physical, nutritional, economic, and psychosocial health through organized activities adaptable to changeable public health restrictions. Recommendations for activities include sending patients informational and motivational text messages, providing recipes with accessibly sourced T2D foods, televising educational workshops, making online tools more accessible, and mobilising community and peer support networks.
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Affiliation(s)
- Lindsay P Allen
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, 221 Human Ecology Bldg, Winnipeg, MB, R3T 2N2, Canada
| | - Lucia Ellis
- Belize Diabetes Association, Belize City, Belize
| | | | | | - Andrew R Hatala
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, 221 Human Ecology Bldg, Winnipeg, MB, R3T 2N2, Canada.
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8
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Alawode O, Humble S, Herrick CJ. Food insecurity, SNAP participation and glycemic control in low-income adults with predominantly type 2 diabetes: a cross-sectional analysis using NHANES 2007-2018 data. BMJ Open Diabetes Res Care 2023; 11:e003205. [PMID: 37220963 PMCID: PMC10230897 DOI: 10.1136/bmjdrc-2022-003205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/25/2023] [Indexed: 05/25/2023] Open
Abstract
INTRODUCTION Diabetes, characterized by elevated blood glucose levels, affects 13% of US adults, 95% of whom have type 2 diabetes (T2D). Social determinants of health (SDoH), such as food insecurity, are integral to glycemic control. The Supplemental Nutrition Assistance Program (SNAP) aims to reduce food insecurity, but it is not clear how this affects glycemic control in T2D. This study investigated the associations between food insecurity and other SDoH and glycemic control and the role of SNAP participation in a national socioeconomically disadvantaged sample. RESEARCH DESIGN AND METHODS Adults with likely T2D and income <185% of the federal poverty level (FPL) were identified using cross-sectional National Health and Nutrition Examination Survey (NHANES) data (2007-2018). Multivariable logistic regression assessed the association between food insecurity, SNAP participation and glycemic control (defined by HbA1c 7.0%-8.5% depending on age and comorbidities). Covariates included demographic factors, clinical comorbidities, diabetes management strategies, and healthcare access and utilization. RESULTS The study population included 2084 individuals (90% >40 years of age, 55% female, 18% non-Hispanic black, 25% Hispanic, 41% SNAP participants, 36% low or very low food security). Food insecurity was not associated with glycemic control in the adjusted model (adjusted OR (aOR) 1.181 (0.877-1.589)), and SNAP participation did not modify the effect of food insecurity on glycemic control. Insulin use, lack of health insurance, and Hispanic or another race and ethnicity were among the strongest associations with poor glycemic control in the adjusted model. CONCLUSIONS For low-income individuals with T2D in the USA, health insurance may be among the most critical predictors of glycemic control. Additionally, SDoH associated with race and ethnicity plays an important role. SNAP participation may not affect glycemic control because of inadequate benefit amounts or lack of incentives for healthy purchases. These findings have implications for community engaged interventions and healthcare and food policy.
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Affiliation(s)
- Oluwatobi Alawode
- Department of Obstetrics and Gynecology, Meharry Medical College, Nashville, Tennessee, USA
| | - Sarah Humble
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Cynthia J Herrick
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
- Department of Medicine, Division of Endocrinology, Metabolism, and Lipid Research, Washington University in St Louis, St Louis, Missouri, USA
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Loyal D, Ricci L, Villegente J, Ayav C, Kivits J, Rat AC. Healthcare providers perception of therapeutic patient education efficacy according to patient and healthcare provider characteristics. Chronic Illn 2023; 19:233-249. [PMID: 34894789 DOI: 10.1177/17423953211058411] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Therapeutic patient education improves numerous health and psychological outcomes in patients with chronic diseases. However, little is known about what makes a therapeutic patient education intervention more effective than another one. This study aims to identify in healthcare professionals the perceived determinants of therapeutic patient education efficacy at the individual level. METHODS Semi-structured individual interviews have been conducted with healthcare professionals (HCP, n=28, including 20 nurses) involved in therapeutic patient education programs (n=14) covering various chronic conditions (kidney and cardiovascular diseases, chronic pain, diabetes, etc.). A thematic content analysis following an inductive approach was used (Nvivo.11 software). RESULTS Five themes were retrieved for patient characteristics: understanding and education, personality, readiness and motivation, social environment, and misinformation and beliefs. Four themes were retrieved for healthcare professionals' characteristics: medical knowledge, appropriate attitude and relational skills, pedagogical skills, and training. DISCUSSION Patient personality is rarely discussed in the literature. Patients who are introverted, lack curiosity, or are not compliant might benefit from specific therapeutic patient education practices or formats. All these potential determinants regarding patients and healthcare professionals should be routinely assessed in future studies about therapeutic patient education efficacy to understand precisely what makes an intervention successful.
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Affiliation(s)
| | - Laetitia Ricci
- CIC 1433 Clinical Epidemiology, 26920CHRU-Nancy, INSERM, 137665University of Lorraine, France
| | - Julie Villegente
- CIC 1433 Clinical Epidemiology, 26920CHRU-Nancy, INSERM, 137665University of Lorraine, France.,27078University of Reims Champagne-Ardenne, France
| | - Carole Ayav
- CIC 1433 Clinical Epidemiology, 26920CHRU-Nancy, INSERM, 137665University of Lorraine, France
| | | | - Anne-Christine Rat
- 137665University of Lorraine, APEMAC EA4360, France.,27003University of Caen Normandie, UMR-S 1075 - COMETE, France.,Rheumatology Department, 26962University Hospital Center Caen, France
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Improving Health and Diabetes Self-Management in Immigrants with Type 2 Diabetes Through a Co-Created Diabetes Self-Management Education and Support Intervention. J Community Health 2023; 48:141-151. [PMID: 36326989 PMCID: PMC9632564 DOI: 10.1007/s10900-022-01151-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2022] [Indexed: 11/06/2022]
Abstract
To examine the impact of a co-created culturally sensitive diabetes self-management education and support (DSMES) intervention on the physical and mental health of immigrants with type 2 diabetes (T2D). Pre- and post-test among people with T2D whose primary language was Urdu, Arabic or Turkish (n = 97). Participants were offered a six-week intervention based on a person-centred approach using research-based dialogue tools to facilitate learning and reflection, which was developed in co-creation with immigrants and healthcare professionals. Data were collected at baseline, post-intervention and after 6 months and analysed using paired t-tests, Wilcoxon signed-rank tests, chi-square tests and regression models when appropriate. Several clinical outcomes were improved post-intervention, including HbA1c (P < 0.001), body fat percentage (P = 0.002), self-rated general health (P = 0.05), well-being (P = 0.004) and several self-management behaviours, e.g., physical activity (P < 0.001). Most outcomes remained improved after 6 months, but the effect on HbA1c was no longer statistically significant. Some outcomes were improved only at 6 months, including waist circumference (P < 0.001) and diabetes-related emotional distress (P < 0.001). Fatigue did not change. Attendance at more programme sessions was associated with better outcomes. The DSMES intervention developed in a co-creation process was highly effective in improving the health of immigrants with T2D.
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11
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Iregbu S, Spiers J, Duggleby W, Salami B, Schick-Makaroff K. Nigerian Health Care Providers and Diabetes Self-Management Support: Their Perspectives and Practices. QUALITATIVE HEALTH RESEARCH 2023; 33:92-105. [PMID: 36519805 PMCID: PMC9827480 DOI: 10.1177/10497323221143889] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Nigeria struggles to reframe its traditional acute-care disease approach to health care to accommodate rising needs for chronic disease care. This interpretive descriptive study explored Nigerian healthcare providers' (HCPs) perspectives, experiences, and practices related to self-management support (SMS). Observational and experiential data were gathered from 19 HCPs at two urban hospitals in Southeastern Nigeria (seven physicians, four nurses, five dietitians/nutritionists, and three health educators). There were four themes: (a) compliance-oriented medical model, (b) SMS as advice, informal counseling, and education, (c) navigating the sociocultural terrain, and (d) workarounds. Nigerian HCPs perspectives and SMS practices were characterized by attempts to foster compliance with healthcare instructions within a traditional biomedical model. Participants enhanced patient support using specific strategies to bypass structural system obstacles. These findings demonstrate the need to reevaluate the current understanding of SMS in Nigeria and its practice.
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Affiliation(s)
- Sandra Iregbu
- Faculty of Nursing,
University
of Alberta, Ave Edmonton, AB,
Canada
| | - Jude Spiers
- Faculty of Nursing,
University
of Alberta, Ave Edmonton, AB,
Canada
| | - Wendy Duggleby
- Faculty of Nursing,
University
of Alberta, Ave Edmonton, AB,
Canada
| | - Bukola Salami
- Faculty of Nursing,
University
of Alberta, Ave Edmonton, AB,
Canada
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Fradelos EC, Barisone M, Lora E, Valiakos E, Papathanasiou IV. COMPETENCIES AND SKILLS NEEDED IN THE MANAGEMENT OF CHRONIC PATIENTS' NEEDS THROUGH TELECARE. POLSKI MERKURIUSZ LEKARSKI : ORGAN POLSKIEGO TOWARZYSTWA LEKARSKIEGO 2023; 51:403-416. [PMID: 37756462 DOI: 10.36740/merkur202304116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
OBJECTIVE Aim: To identify the necessary competencies that future professionals must obtain in order to effectively manage patients with chronic conditions. We employed a multilayer review in PubMed, Scopus and Cochrane. PATIENTS AND METHODS Materials and Methods: We applied three searches in PubMed, Scopus, and Cochrane using various terms in order to identify the necessary skills and competences needed for healthcare professionals to provide distance care in patients with chronic conditions. From the initial search, a total of 1008 studies were identified while 54 met the inclusion criteria and were retained for data extraction. After the review of the 54 studies, we grouped the proposed skills and competencies in eight major categories. Those groups were Clinical Knowledge, Critical Thinking Skills, Technological Skills, Clinical skills, Communication skills, Implementation skills, Professionalism and professional ethics, Evidence based Practice. CONCLUSION Conclusions: Although telehealth is gaining ground in healthcare practice and healthcare professionals possess the necessary knowledge and skills to provide safe, effective, and personalized care, additional specialized training is nevertheless required to provide telecare. Therefore, the integration of telehealth into various healthcare professions curricula - both at undergraduate and postgraduate levels - is required for the development of education and the dynamic development of healthcare.
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Wang Y, Yu Q, Zeng Z, Yuan R, Wang R, Chen J, Zhou H, Tang J. Predictors of fear of diabetes progression: A multi-center cross-sectional study for patients self-management and healthcare professions education. Front Public Health 2022; 10:910145. [PMID: 36600932 PMCID: PMC9806215 DOI: 10.3389/fpubh.2022.910145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022] Open
Abstract
Objective Excessive fear of progression can affect the mental health, social function, and wellbeing of patients with chronic diseases. This study investigated the fear of progression (FoP) and the socio-demographic and clinical predictors among patients with type 2 diabetes mellitus (T2DM). Method The present study is a multi-center cross-sectional study. Inpatients with T2DM were recruited by a multi-stage convenience sampling method from the department of endocrinology in 5 tertiary hospitals in Southwest China. 459 T2DM patients were consecutively enrolled. Socio-demographic, clinical data, and answers to the fear of progression questionnaire (FoP-Q) were collected. Results 385 patients with complete data were eligible. The average score of FoP-Q-SF was 26.84 and 23.1% of patients reached the dysfunctional fear of progression criterion. The greatest fears were worrying about "disease progression," "the adverse reactions of medication," and "relying on strangers for activities of daily living." Health education (P < 0.001), age (P = 0.002), hypoglycemia history (P = 0.006), employment status (P = 0.025) and duration since being diagnosed with type 2 diabetes mellitus (P = 0.032) were the related factors of fear of progression. Conclusion Early assessment of the fear of progression was imperative to identify dysfunctional fear of progression in patients with type 2 diabetes mellitus. Meanwhile, the meaning of these predictors for strengthening healthcare professions education and patients self-management might help healthcare givers timely perform related interventions and help patients reduce their fear of progression thus actively cooperate with T2DM treatments.
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Affiliation(s)
- Yanhao Wang
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi, China,Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, College of Stomatology, Chongqing Medical University, Chongqing, China,Department of Orthodontics, School of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Qiuhua Yu
- Department of Breast Surgery, Peking Union Medical College Hospital (Xidan Campus), Beijing, China
| | - Zihuan Zeng
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China,Department of Plastic Surgery, State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Ruizhu Yuan
- School of Nursing, Chongqing Medical University, Chongqing, China
| | - Ruiding Wang
- Department of Critical Care Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jianli Chen
- Guangzhou Women and Children Medical Center, Guangzhou Medical University Affiliated Women and Children Medical Center, Guangzhou, China
| | - Hengyu Zhou
- School of Nursing, Chongqing Medical University, Chongqing, China,*Correspondence: Hengyu Zhou
| | - Jiao Tang
- School of Nursing, Chongqing Medical University, Chongqing, China,Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China,Jiao Tang
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14
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Love O, Peter D, Julie S. Systematic review: Perceptions of type 2 diabetes of people of African descent living in high-income countries. J Adv Nurs 2022; 78:2277-2289. [PMID: 35441727 PMCID: PMC9546182 DOI: 10.1111/jan.15266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/04/2022] [Accepted: 04/05/2022] [Indexed: 11/29/2022]
Abstract
AIMS To describe how people of African descent perceive and understand type 2 diabetes, and to examine the impact of their perceptions and beliefs on the uptake of diet, exercise, weight control and adherence to medication recommendations. DESIGN Systematic literature review of quantitative and qualitative studies. DATA SOURCES We searched MEDLINE, CINAHL Complete, Psych INFO, Academic Search Premier, Education Research Complete, Web of Science and Scopus, World Health Organization (WHO), Diabetes UK and American Diabetes Association for articles published from January 1999 to December 2019. REVIEW METHODS Informed by the PRISMA guidelines, we independently reviewed titles and abstracts, identified articles for full-text review that met inclusion criteria, conducted a quality assessment and extracted data. Findings were synthesized using a thematic approach. RESULTS Twenty-six studies met the inclusion criteria. Knowledge and understanding of diabetes were poor. Beliefs and behaviours about diet, exercise, weight and health care were erroneous. Most diabetic participants could not recognize diabetes symptoms, failed to take their diagnosis seriously and did not adhere to medication recommendations. The resultant effect was an increased risk of complications with undesirable outcomes. CONCLUSION Poor diabetes perceptions are linked to negative consequences and may be responsible for poorer outcomes among people of African descent. This review highlights the need to consider this population's beliefs and practices in structuring culturally sensitive programmes for diabetes management. IMPACT This systematic literature review is the first to exclusively explore perceptions of people of African descent in relation to diabetes. It is important to consider people of African descents' diabetes perceptions and practices before formulating interventions for their diabetes management.
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15
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Unnikrishnan AG, Viswanathan V, Zhou FL, Hao L, Kamath P, Bertolini M, Botero JF, Mancillas-Adame L. Impact of My Dose Coach App Frequency of Use on Clinical Outcomes in Type 2 Diabetes. Diabetes Ther 2022; 13:983-993. [PMID: 35316509 PMCID: PMC8938735 DOI: 10.1007/s13300-022-01245-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/28/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION My Dose Coach (MDC) is a US Food and Drug Administration-approved digital smartphone application designed to help users with type 2 diabetes (T2D) titrate their basal insulin (BI) according to a clinician-prescribed individualized titration plan. The aim of this analysis was to assess the impact of the frequency of MDC use on clinical outcomes. METHODS This retrospective observational analysis included people with T2D who were registered for MDC (August 1st, 2018-April 30th, 2020) and received BI. Users with an activated care plan and ≥2 fasting blood glucose (FBG) observations spanning ≥2 weeks were defined as active. Outcomes included percentage achieving their individual FBG target, time to FBG target, change in FBG, change in insulin dose and hypoglycemia. Users were stratified into high (>3 days per week), moderate (>1- ≤3 days per week), and low (≤1 day per week) MDC usage groups. RESULTS The analysis included 2517 active MDC users. Approximately 49% of users had high MDC usage. Overall, 44% of users across all usage frequencies achieved their individual FBG target. High MDC use was associated with significantly better FBG target achievement and less time to FBG target versus moderate- and low-usage groups (p≤0.01 for all). Insulin dose change was significantly greater in the high- versus moderate-usage group (p=0.01). There was no significant difference in hypoglycemia incidence among MDC usage groups (12%-16% of users in any usage group). CONCLUSIONS More frequent MDC usage was associated with better FBG outcomes without increased hypoglycemia risk.
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Affiliation(s)
| | | | | | | | | | | | | | - Leonardo Mancillas-Adame
- Endocrinology Division, Medical School and University Hospital, Universidad Autonoma de Nuevo Leon, Nuevo Leon, Mexico
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16
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Abstract
Providers and health systems should use ethnic differences in risk of harm from healthcare to reimagine their role in reducing health inequalities, write Cian Wade and colleagues
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Affiliation(s)
- Cian Wade
- NHS England and NHS Improvement, London, UK
- Harvard T H Chan School of Public Health, Boston, MA, USA
| | | | | | - Charles Vincent
- Department of Experimental Psychology, University of Oxford, UK
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17
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Ng AH, Greenwood DA, Iacob E, Allen NA, Ferrer M, Rodriguez B, Litchman ML. Examining a Continuous Glucose Monitoring Plus Online Peer Support Community Intervention to Support Hispanic Adults With Type 2 Diabetes: Protocol for a Mixed Methods Feasibility Study. JMIR Res Protoc 2022; 11:e31595. [PMID: 35200153 PMCID: PMC8914754 DOI: 10.2196/31595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 12/13/2021] [Accepted: 12/22/2021] [Indexed: 11/17/2022] Open
Abstract
Background Type 2 diabetes is twice as likely to affect Hispanic people than their White counterparts. Technology and social support may be an important part of behavior change. In this study, we address gaps in diabetes care for Hispanic Spanish-speaking people with diabetes through an online peer support community (OPSC) pilot intervention using Hispanic Spanish-speaking peer facilitators with diabetes to enhance the use of continuous glucose monitoring (CGM) for diabetes management. Objective This study aims to address gaps in diabetes care for Hispanic Spanish-speaking people with diabetes through an OPSC pilot intervention using Hispanic Spanish-speaking peer facilitators with diabetes to enhance the use of CGM for diabetes management. Methods A mixed-methods, pre-post test design will be used in this feasibility study. A total of 50 Hispanic participants with type 2 diabetes willing to wear a continuous glucose monitor for 13 weeks will be recruited. Hispanic Spanish-speaking peer facilitators with diabetes and experience wearing a continuous glucose monitor will be employed and undergo training. Peer facilitators will help participants learn how CGM data can inform behavior changes via an OPSC. Participants will interact with the private OPSC at least three times a week. Weekly questions and prompts derived from the Association of Diabetes Care and Education Specialists, previously American Association of Diabetes Educators, and seven self-care behaviors will be delivered by peer facilitators to engage participants. Measures of feasibility and acceptability will be determined by the percentage of participants who enroll, complete the study, and use CGM (number of scans) and objective metrics from the OPSC. Efficacy potential outcomes include change in time in range of 70 to 180 mg/dL from baseline to 12 weeks, A1c, diabetes online community engagement, self-efficacy, and quality of life. Additionally, semistructured exit interviews will be conducted. Results Funding for this project was secured in November 2018 and approved by the institutional review board in April 2019. Peer facilitator recruitment and training were undertaken in the second half of 2019, with participant recruitment and data collection conducted in January and April 2020. The study has now concluded. Conclusions This study will generate new evidence about the use of an OPSC for Hispanic Spanish-speaking patients with diabetes to make behavior changes incorporating feedback from CGM. Trial Registration ClinicalTrials.gov NCT03799796; https://clinicaltrials.gov/ct2/show/NCT03799796 International Registered Report Identifier (IRRID) RR1-10.2196/31595
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Affiliation(s)
- Ashley H Ng
- Department of Dietetics, Human Nutrition and Sport, La Trobe University, Bundoora, Australia
| | | | - Eli Iacob
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Nancy A Allen
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Mila Ferrer
- Beyond Type 1, California, CA, United States
| | - Bruno Rodriguez
- College of Nursing, University of Utah, Salt Lake City, UT, United States
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18
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Khurshid A, Oliveira E, Nordquist E, Lakshminarayanan V, Abrol V. FHIRedApp: a LEAP in health information technology for promoting patient access to their medical information. JAMIA Open 2022; 4:ooab109. [PMID: 35155997 PMCID: PMC8826978 DOI: 10.1093/jamiaopen/ooab109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/28/2021] [Accepted: 12/10/2021] [Indexed: 11/13/2022] Open
Abstract
Objective Our aim is to develop a patient engagement technology that makes it easy for patients to access their own medical information and share it with others. Materials and Methods This paper describes our design through an adapted Community Engagement Studio methodology to identify the needs and preferences of a diverse group of Latinx, African–American, and Asian–American individuals in the community. We use Human-Centered Design to interpret these needs and preferences to build a digital app platform, using national data standards, clinical data aggregators, and privacy-preserving solutions while maintaining the security and confidentiality of patients. Results We designed and developed FHIRedApp, an app platform, that allows patients to access their data and to share that access as HL7® FHIR® application programming interfaces with third-party app developers. We accomplished 2 major tasks: first, to demonstrate the use of interoperability and authentication standards, such as HL7® FHIR and OAuth2, to help develop patient engagement technologies, and second, to co-develop and co-design FHIRedApp with active involvement of African–American, Latinx, and Asian–American community members. Usability results show high satisfaction rates for FHIRedApp. Conclusion The development of FHIRedApp demonstrates how technology innovations using national interoperability standards can be informed through a methodology of community engagement and human-centered design that involves local racial and ethnic groups. Our aim is to develop a patient engagement technology (PET) that makes it easy for patients to access their own medical information and share it with others. We adapted a methodology to identify the needs and preferences of a diverse group of Latinx, African–American, and Asian–American patients. We used Human-Centered Design to interpret these needs and preferences to build a digital app platform, using national data standards, clinical data aggregators, and privacy-preserving solutions while maintaining the security and confidentiality of patients. We designed and developed FHIRedApp, a platform that allows other applications to work on it. Patients showed high satisfaction with the use of FHIRedApp. The development of FHIRedApp demonstrates how technology innovations using national standards for exchanging data can be informed through a methodology of community engagement and human-centered design.
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Affiliation(s)
- Anjum Khurshid
- Department of Population Health, Dell Medical School, The University of Texas at Austin, Texas, USA
| | - Eliel Oliveira
- Department of Population Health, Dell Medical School, The University of Texas at Austin, Texas, USA
| | - Eric Nordquist
- School of Information, The University of Texas at Austin, Texas, USA
| | - Vidya Lakshminarayanan
- Department of Population Health, Dell Medical School, The University of Texas at Austin, Texas, USA
| | - Vishal Abrol
- Department of Population Health, Dell Medical School, The University of Texas at Austin, Texas, USA
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19
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Davis J, Fischl AH, Beck J, Browning L, Carter A, Condon JE, Dennison M, Francis T, Hughes PJ, Jaime S, Lau KHK, McArthur T, McAvoy K, Magee M, Newby O, Ponder SW, Quraishi U, Rawlings K, Socke J, Stancil M, Uelmen S, Villalobos S. 2022 National Standards for Diabetes Self-Management Education and Support. Sci Diabetes Self Manag Care 2022; 48:44-59. [PMID: 35049403 DOI: 10.1177/26350106211072203] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The National Standards for Diabetes Self-Management Education and Support (DSMES) provide guidance and evidence-based, quality practice for all DSMES services. Due to the dynamic nature of health care and diabetes research, the National Standards are reviewed and revised approximately every 5 years by key stakeholders and experts within the diabetes care and education community. For each revision, the Task Force is charged with reviewing the current National Standards for appropriateness, relevance, and scientific basis and making updates based on current evidence and expert consensus. In 2021, the group was tasked with reducing administrative burden related to DSMES implementation across diverse care settings. CONCLUSION The evidence supporting the 2022 National Standards clearly identifies the need to provide person-centered services that embrace cultural differences, social determinants of health, and the ever-increasing technological engagement platforms and systems. Payers are invited to review the National Standards as a tool to inform and modernize DSMES reimbursement requirements and to align with the evolving needs of people with diabetes (PWD) and physicians/other qualified health care professionals. The American Diabetes Association and the Association of Diabetes Care & Education Specialists strongly advocate for health equity to ensure all PWD have access to this critical service proven to improve outcomes both related to and beyond diabetes. The 2022 National Standards update is meant to be a universal document that is easy to understand and can be implemented by the entire health care community. DSMES teams in collaboration with primary care have been shown to be the most effective approach to overcome therapeutic inertia.
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Affiliation(s)
| | | | - Joni Beck
- The University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
| | | | | | - Jo Ellen Condon
- Anne Arundel Medical Center, Annapolis, Maryland, and Diabetes Alliance Network, Naples, Florida
| | | | | | | | - Stephen Jaime
- El Centro Regional Medical Center, El Centro, California
| | | | | | - Karen McAvoy
- Yale New Haven Health System, New Haven, Connecticut
| | - Michelle Magee
- MedStar Diabetes and Research Institutes, Georgetown University School of Medicine, Washington, DC
| | - Olivia Newby
- The Healthy Living Center Diabetes Education Program, Norfolk, Virginia
| | | | | | | | | | | | - Sacha Uelmen
- Association of Diabetes Care & Education Specialists, Chicago, Illinois
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20
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Paguio JA, Golbin JM, Yao JS, Eala MA, Dee EC, Yu MG. Self-reported cultural competency measures among patients with diabetes: A nationwide cross-sectional study in the United States. LANCET REGIONAL HEALTH. AMERICAS 2021; 7:100158. [PMID: 36777658 PMCID: PMC9904095 DOI: 10.1016/j.lana.2021.100158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background Culturally tailored interventions may reduce disparities in diabetes care. We conducted a nationally representative assessment of self-reported cultural competency measures of care among patients with diabetes in the United States. Methods The 2017 National Health Interview Survey was queried for adults with self-reported diabetes. Sample weight-adjusted multivariable logistic regressions defined adjusted odds ratios and 95% confidence intervals of a positive response to each of the cultural competency measures while controlling for relevant sociodemographic variables. Findings 2,448 adults were included in the analyses. Black, Latinx, and Asian respondents had greater odds of and individuals with the highest income level had lower odds of placing greater importance in sharing cultures with their provider. Black and Latinx individuals had lower odds of reporting encountering providers who shared or understood their cultures. Asians had lower odds of and respondents aged 40-64 and 65 years and older had greater odds of reporting frequently being treated with respect by their providers. Non-English speakers had lower odds of and individuals from higher income brackets had greater odds of reporting frequently receiving easy-to-understand information about their care. Blacks and respondents not part of the workforce had greater odds of reporting frequently being asked about their opinions or beliefs in care. Interpretation Disparities in self-reported provider cultural competency measures exist among cultural minorities in the United States. Our findings may inform efforts to reduce disparities and improve care among minorities with diabetes. Funding No funding was used in the preparation of this work.
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Affiliation(s)
| | - Jem Marie Golbin
- University of the Philippines College of Medicine, Manila, Philippines
| | | | - Michelle Ann Eala
- University of the Philippines College of Medicine, Manila, Philippines
| | - Edward Christopher Dee
- Memorial Sloan Kettering Cancer Center, NY, USA,Harvard Medical School, Boston, MA, USA
| | - Marc Gregory Yu
- Harvard Medical School, Boston, MA, USA,Joslin Diabetes Center, Boston, MA, USA
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21
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Alvarez-Perez Y, Perestelo-Perez L, Rivero-Santana A, Wagner AM, Torres-Castaño A, Toledo-Chávarri A, Duarte-Díaz A, Alvarado-Martel D, Piccini B, Van den Broucke S, Vandenbosch J, González-González C, Perello M, Serrano-Aguilar P. Cocreation of Massive Open Online Courses to Improve Digital Health Literacy in Diabetes: Pilot Mixed Methods Study. JMIR Diabetes 2021; 6:e30603. [PMID: 34898453 PMCID: PMC8713090 DOI: 10.2196/30603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/12/2021] [Accepted: 09/19/2021] [Indexed: 12/19/2022] Open
Abstract
Background Self-management education is a fundamental aspect in the health care of people with diabetes to develop the necessary skills for the improvement of health outcomes. Patients are required to have the competencies to manage electronic information resources—that is, an appropriate level of digital health literacy. The European project IC-Health aimed to improve digital health literacy among people with diabetes through the cocreation of massive open online courses (MOOCs). Objective We report the preliminary results obtained in 3 participating countries in the IC-Health project (Italy, Spain, and Sweden) regarding (1) experience of the participants during the cocreation process of MOOCs, (2) perceived changes in their digital health literacy level after using MOOCs, and (3) a preliminary assessment of the acceptability of MOOCs. Methods The cocreation of the MOOCs included focus groups with adults and adolescents with diabetes and the creation of independent communities of practice for type 1 diabetes and type 2 diabetes participants aimed to co-design the MOOCs. Quantitative measures of the acceptability of MOOCs, experience in the cocreation process, and increase in digital health literacy (dimensions of finding, understanding, and appraisal) were assessed. Results A total of 28 participants with diabetes participated in focus groups. Adults and adolescents agreed that the internet is a secondary source of health-related information. A total of 149 participants comprised the diabetes communities of practice. A total of 9 MOOCs were developed. Acceptability of the MOOCs and the cocreation experience were positively valued. There was a significant improvement in digital health literacy in both adults and adolescents after using MOOCs (P<.001). Conclusions Although the results presented on self-perceived digital health literacy are preliminary and exploratory, this pilot study suggests that IC-Health MOOCs represent a promising tool for the medical care of diabetes, being able to help reduce the limitations associated with low digital health literacy and other communication barriers in the diabetes population.
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Affiliation(s)
| | - Lilisbeth Perestelo-Perez
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Tenerife, Spain.,Center for Biomedical Research of the Canary Islands (CIBICAN), Tenerife, Spain
| | - Amado Rivero-Santana
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Tenerife, Spain
| | - Ana M Wagner
- Department of Endocrinology and Nutrition, University Hospital Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain.,Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | | | - Ana Toledo-Chávarri
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Tenerife, Spain
| | - Andrea Duarte-Díaz
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
| | - Dácil Alvarado-Martel
- Department of Endocrinology and Nutrition, University Hospital Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain.,Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Barbara Piccini
- Diabetology Unit, Meyer University Children's Hospital, Florence, Italy
| | | | | | - Carina González-González
- Interaction, Technology, and Education Research Group, Department of Computer Science and Engineering, University of La Laguna, La Laguna, Spain
| | - Michelle Perello
- Consulta Europa Projects and Innovation, Las Palmas de Gran Canaria, Spain
| | - Pedro Serrano-Aguilar
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Tenerife, Spain.,Center for Biomedical Research of the Canary Islands (CIBICAN), Tenerife, Spain
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22
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Tschida S, Flood D, Guarchaj M, Milian J, Aguilar A, Fort MP, Guetterman T, Montano CM, Miller A, Morales L, Rohloff P. Implementation of a Diabetes Self-Management Education and Support Intervention in Rural Guatemala: A Mixed-Methods Evaluation Using the RE-AIM Framework. Prev Chronic Dis 2021; 18:E100. [PMID: 34882536 PMCID: PMC8673946 DOI: 10.5888/pcd18.210259] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION To address the global diabetes epidemic, lifestyle counseling on diet, physical activity, and weight loss is essential. This study assessed the implementation of a diabetes self-management education and support (DSMES) intervention using a mixed-methods evaluation framework. METHODS We implemented a culturally adapted, home-based DSMES intervention in rural Indigenous Maya towns in Guatemala from 2018 through 2020. We used a pretest-posttest design and a mixed-methods evaluation approach guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Quantitative data included baseline characteristics, implementation metrics, effectiveness outcomes, and costs. Qualitative data consisted of semistructured interviews with 3 groups of stakeholders. RESULTS Of 738 participants screened, 627 participants were enrolled, and 478 participants completed the study. Adjusted mean change in glycated hemoglobin A1c was -0.4% (95% CI, -0.6% to -0.3%; P < .001), change in systolic blood pressure was -5.0 mm Hg (95% CI, -6.4 to -3.7 mm Hg; P < .001), change in diastolic blood pressure was -2.6 mm Hg (95% CI, -3.4 to -1.9 mm Hg; P < .001), and change in body mass index was 0.5 (95% CI, 0.3 to 0.6; P < .001). We observed improvements in diabetes knowledge, distress, and most self-care activities. Key implementation factors included 1) recruitment barriers for men, 2) importance of patient-centered care, 3) role of research staff in catalyzing health worker involvement, 4) tradeoffs between home and telephone visits, and 5) sustainability challenges. CONCLUSION A community health worker-led DSMES intervention was successfully implemented in the public health system in rural Guatemala and resulted in significant improvements in most clinical and psychometric outcomes. Scaling up sustainable DSMES in health systems in rural settings requires careful consideration of local barriers and facilitators.
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Affiliation(s)
- Scott Tschida
- Center for Research in Indigenous Health, Wuqu' Kawoq, Tecpán, Chimaltenango, Guatemala
- Wuqu' Kawoq, 2da Avenida 3-48 Zona 3, Barrio Patacabaj, Tecpán, Chimaltenango, Guatemala.
| | - David Flood
- Center for Research in Indigenous Health, Wuqu' Kawoq, Tecpán, Chimaltenango, Guatemala
- Department of Internal Medicine, National Clinician Scholars Program, University of Michigan, Ann Arbor, Michigan
| | - Magdalena Guarchaj
- Center for Research in Indigenous Health, Wuqu' Kawoq, Tecpán, Chimaltenango, Guatemala
| | - Juanita Milian
- Instituto de Salud Incluyente, San Lucas Sacatepéquez, Sacatepéquez, Guatemala
| | - Andrea Aguilar
- Center for Research in Indigenous Health, Wuqu' Kawoq, Tecpán, Chimaltenango, Guatemala
| | - Meredith P Fort
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Timothy Guetterman
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | - Carlos Mendoza Montano
- Centro de Investigación para la Prevención de las Enfermedades Crónicas, Instituto de Nutrición de Centro América y Panamá, Guatemala City, Guatemala
| | - Ann Miller
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Lidia Morales
- Instituto de Salud Incluyente, San Lucas Sacatepéquez, Sacatepéquez, Guatemala
| | - Peter Rohloff
- Center for Research in Indigenous Health, Wuqu' Kawoq, Tecpán, Chimaltenango, Guatemala
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts
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23
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Alzubaidi H, Sulieman H, Mc Namara K, Samorinha C, Browning C. The relationship between diabetes distress, medication taking, glycaemic control and self-management. Int J Clin Pharm 2021; 44:127-137. [PMID: 34586556 DOI: 10.1007/s11096-021-01322-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/20/2021] [Indexed: 11/30/2022]
Abstract
Background Diabetes distress (DD) has broad-ranging effects on type 2 diabetes (T2DM) management and outcomes. DD research is scarce among ethnic minority groups, particularly Arabic-speaking immigrant communities. To improve outcomes for these vulnerable groups, healthcare providers, including pharmacists, need to understand modifiable predictors of DD. Aim To assess and compare DD and its association with medication-taking behaviours, glycaemic control, self-management, and psychosocial factors among first-generation Arabic-speaking immigrants and English-speaking patients of Anglo-Celtic background with diabetes, and determine DD predictors. Setting Various healthcare settings in Australia. Method A multicentre cross-sectional study was conducted. Adults with T2DM completed a survey comprised of validated tools. Glycated haemoglobin, blood pressure, and lipid profile were gathered from medical records. Multiple linear regression models were computed to assess the DD predictors. Main outcome measure Diabetes distress level. Results Data was analysed for 696 participants: 56.3% Arabic-speaking immigrants and 43.7% English-speaking patients. Compared with English-speaking patients, Arabic-speaking immigrants had higher DD, lower medication adherence, worse self-management and glycaemic control, and poorer health and clinical profile. The regression analysis demonstrated that higher DD in Arabic-speaking immigrants was associated with cost-related medication underuse and lower adherence to exercise, younger age, lower education level, unemployment, lower self-efficacy, and inadequate glycaemic control. Whereas among English-speaking patients, higher DD was associated with both cost- and non-cost-related underuse of medication and lower dietary adherence. Conclusion Results provided new insights to guide healthcare providers on reducing the apparent excess burden of DD among Arabic-speaking immigrants and potentially improve medication adherence, glycaemic control, and self-management.
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Affiliation(s)
- Hamzah Alzubaidi
- Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates. .,Sharjah Institute for Medical Research, University of Sharjah, Sharjah, United Arab Emirates.
| | - Hana Sulieman
- Department of Mathematics and Statistics, American University of Sharjah, Sharjah, United Arab Emirates
| | - Kevin Mc Namara
- School of Medicine, Deakin University, Victoria, Australia.,Centre for Population Health Research, Deakin University, Burwood, VIC, Australia
| | - Catarina Samorinha
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah, United Arab Emirates
| | - Colette Browning
- School of Nursing and Healthcare Professions, Federation University, Ballarat, VIC, Australia.,Australian National University, Australian Capital Territory, Canberra, Australia
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Roth P, Tang CY, Rumbold B, Gupta S. Knowledge and perceptions around self-management of type 2 diabetes among a Sudanese community in Australia: A qualitative study. Health Promot J Austr 2021; 33:869-879. [PMID: 34460974 DOI: 10.1002/hpja.535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 07/11/2021] [Accepted: 08/27/2021] [Indexed: 11/11/2022] Open
Abstract
ISSUE ADDRESSED People from Sudanese background are more likely to be diagnosed with type 2 diabetes (T2D) as compared to the general population. In recent years, there has been an increase in the number of migrants from Sudan to Australia. However, there is a dearth of research exploring the perceptions and experiences of self-management strategies for diabetes among this migrant Sudanese population residing in Australia. This study aims to explore these experiences and perceptions as well as to identify cultural aspects related to T2D self-management strategies for people from this migrant group. METHODS A qualitative study using semi-structured in-depth interviews with Sudanese participants (n = 12) living with T2D was conducted in Melbourne, Australia. RESULTS The thematic analysis found barriers to self-management of diabetes to include language differences, the burden of self-management, difficulties in accommodating traditional dietary practices in self-management, as well as the expectations of familial and social obligations. Enablers included positive relationships with health professionals, support networks, involvement in religion and adopting traditional remedies. CONCLUSIONS This study found cultural considerations, such as incorporating traditional dietary practices and familial obligations into self-management, to be the most significant influence for this group of Sudanese participants in the way they managed their diabetes. SO WHAT This study highlights the need for culturally appropriate provision of health services and resources for Sudanese people with T2D while recognising the value placed on traditional food choices. Importantly, the collectivist Sudanese culture must be considered for any future development and implementation of health promotion strategies.
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Affiliation(s)
- Phoebe Roth
- Department of Public Health, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia.,Level 1, 715 Swanston Street, Parkville, Victoria, Australia
| | - Clarice Y Tang
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia.,Department of Physiotherapy, School of Health Sciences, Western Sydney University, Sydney, Australia
| | - Bruce Rumbold
- Department of Public Health, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Sabrina Gupta
- Department of Public Health, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
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25
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Schwaab B, Bjarnason-Wehrens B, Meng K, Albus C, Salzwedel A, Schmid JP, Benzer W, Metz M, Jensen K, Rauch B, Bönner G, Brzoska P, Buhr-Schinner H, Charrier A, Cordes C, Dörr G, Eichler S, Exner AK, Fromm B, Gielen S, Glatz J, Gohlke H, Grilli M, Gysan D, Härtel U, Hahmann H, Herrmann-Lingen C, Karger G, Karoff M, Kiwus U, Knoglinger E, Krusch CW, Langheim E, Mann J, Max R, Metzendorf MI, Nebel R, Niebauer J, Predel HG, Preßler A, Razum O, Reiss N, Saure D, von Schacky C, Schütt M, Schultz K, Skoda EM, Steube D, Streibelt M, Stüttgen M, Stüttgen M, Teufel M, Tschanz H, Völler H, Vogel H, Westphal R. Cardiac Rehabilitation in German Speaking Countries of Europe-Evidence-Based Guidelines from Germany, Austria and Switzerland LLKardReha-DACH-Part 2. J Clin Med 2021; 10:jcm10143071. [PMID: 34300237 PMCID: PMC8306118 DOI: 10.3390/jcm10143071] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/29/2021] [Accepted: 07/05/2021] [Indexed: 02/08/2023] Open
Abstract
Background: Scientific guidelines have been developed to update and harmonize exercise based cardiac rehabilitation (ebCR) in German speaking countries. Key recommendations for ebCR indications have recently been published in part 1 of this journal. The present part 2 updates the evidence with respect to contents and delivery of ebCR in clinical practice, focusing on exercise training (ET), psychological interventions (PI), patient education (PE). In addition, special patients’ groups and new developments, such as telemedical (Tele) or home-based ebCR, are discussed as well. Methods: Generation of evidence and search of literature have been described in part 1. Results: Well documented evidence confirms the prognostic significance of ET in patients with coronary artery disease. Positive clinical effects of ET are described in patients with congestive heart failure, heart valve surgery or intervention, adults with congenital heart disease, and peripheral arterial disease. Specific recommendations for risk stratification and adequate exercise prescription for continuous-, interval-, and strength training are given in detail. PI when added to ebCR did not show significant positive effects in general. There was a positive trend towards reduction in depressive symptoms for “distress management” and “lifestyle changes”. PE is able to increase patients’ knowledge and motivation, as well as behavior changes, regarding physical activity, dietary habits, and smoking cessation. The evidence for distinct ebCR programs in special patients’ groups is less clear. Studies on Tele-CR predominantly included low-risk patients. Hence, it is questionable, whether clinical results derived from studies in conventional ebCR may be transferred to Tele-CR. Conclusions: ET is the cornerstone of ebCR. Additional PI should be included, adjusted to the needs of the individual patient. PE is able to promote patients self-management, empowerment, and motivation. Diversity-sensitive structures should be established to interact with the needs of special patient groups and gender issues. Tele-CR should be further investigated as a valuable tool to implement ebCR more widely and effectively.
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Affiliation(s)
- Bernhard Schwaab
- Curschmann Klinik, D-23669 Timmendorfer Strand, Germany
- Medizinische Fakultät, Universität zu Lübeck, D-23562 Lübeck, Germany
- Correspondence:
| | - Birna Bjarnason-Wehrens
- Institute for Cardiology and Sports Medicine, Department of Preventive and Rehabilitative Sport- and Exercise Medicine, German Sportuniversity Cologne, D-50933 Köln, Germany; (B.B.-W.); (H.-G.P.)
| | - Karin Meng
- Institute for Clinical Epidemiology and Biometry (ICE-B), University of Würzburg, D-97080 Würzburg, Germany;
| | - Christian Albus
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine, University Hospital, D-50937 Köln, Germany;
| | - Annett Salzwedel
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany; (A.S.); (S.E.); or (H.V.)
| | | | | | - Matthes Metz
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany; (M.M.); (K.J.); (D.S.)
| | - Katrin Jensen
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany; (M.M.); (K.J.); (D.S.)
| | - Bernhard Rauch
- Institut für Herzinfarktforschung Ludwigshafen, IHF, D-67063 Ludwigshafen am Rhein, Germany;
- Zentrum für ambulante Rehabilitation, ZAR Trier GmbH, D-54292 Trier, Germany
| | - Gerd Bönner
- Medizinische Fakultät, Albert-Ludwigs-Universität zu Freiburg, D-79104 Freiburg, Germany;
| | - Patrick Brzoska
- Fakultät für Gesundheit, Universität Witten/Herdecke, Lehrstuhl für Versorgungsforschung, D-58448 Witten, Germany;
| | | | | | - Carsten Cordes
- Gollwitzer-Meier-Klinik, D-32545 Bad Oeynhausen, Germany;
| | - Gesine Dörr
- Alexianer St. Josefs-Krankenhaus Potsdam, D-14472 Potsdam, Germany;
| | - Sarah Eichler
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany; (A.S.); (S.E.); or (H.V.)
| | - Anne-Kathrin Exner
- Klinikum Lippe GmbH, Standort Detmold, D-32756 Detmold, Germany; (A.-K.E.); (S.G.)
| | - Bernd Fromm
- REHA-Klinik Sigmund Weil, D-76669 Bad Schönborn, Germany;
| | - Stephan Gielen
- Klinikum Lippe GmbH, Standort Detmold, D-32756 Detmold, Germany; (A.-K.E.); (S.G.)
| | - Johannes Glatz
- Reha-Zentrum Seehof der Deutschen Rentenversicherung Bund, D-14513 Teltow, Germany; (J.G.); (E.L.)
| | - Helmut Gohlke
- Private Practice, D-79282 Ballrechten-Dottingen, Germany;
| | - Maurizio Grilli
- Library Department, University Medical Centre Mannheim, D-68167 Mannheim, Germany;
| | - Detlef Gysan
- Department für Humanmedizin, Private Universität Witten/Herdecke GmbH, D-58455 Witten, Germany;
| | - Ursula Härtel
- LMU München, Institut für Medizinische Psychologie, D-80336 München, Germany;
| | | | - Christoph Herrmann-Lingen
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center and German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, D-37075 Göttingen, Germany;
| | | | | | | | | | | | - Eike Langheim
- Reha-Zentrum Seehof der Deutschen Rentenversicherung Bund, D-14513 Teltow, Germany; (J.G.); (E.L.)
| | | | - Regina Max
- Zentrum für Rheumatologie, Drs. Dornacher/Schmitt/Max/Lutz, D-69115 Heidelberg, Germany;
| | - Maria-Inti Metzendorf
- Cochrane Metabolic and Endocrine Disorders Group, Institute of General Practice, Medical Faculty of the Heinrich-Heine University, D-40225 Düsseldorf, Germany;
| | - Roland Nebel
- Hermann-Albrecht-Klinik METTNAU, Reha-Einrichtungen der Stadt Radolfzell, D-7385 Radolfzell, Germany;
| | - Josef Niebauer
- Universitätsinstitut für Präventive und Rehabilitative Sportmedizin, Uniklinikum Salzburg, Paracelsus Medizinische Privatuniversität, A-5020 Salzburg, Austria;
| | - Hans-Georg Predel
- Institute for Cardiology and Sports Medicine, Department of Preventive and Rehabilitative Sport- and Exercise Medicine, German Sportuniversity Cologne, D-50933 Köln, Germany; (B.B.-W.); (H.-G.P.)
| | - Axel Preßler
- Privatpraxis für Kardiologie, Sportmedizin, Prävention, Rehabilitation, D-81675 München, Germany;
| | - Oliver Razum
- Epidemiologie und International Public Health, Fakultät für Gesundheitswissenschaften, Universität Bielefeld, D-33615 Bielefeld, Germany;
| | - Nils Reiss
- Schüchtermann-Schiller’sche Kliniken, D-49214 Bad Rothenfelde, Germany;
| | - Daniel Saure
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany; (M.M.); (K.J.); (D.S.)
| | | | - Morten Schütt
- Diabetologische Schwerpunktpraxis, D-23552 Lübeck, Germany;
| | - Konrad Schultz
- Klinik Bad Reichenhall, Zentrum für Rehabilitation, Pneumologie und Orthopädie, D-83435 Bad Reichenhall, Germany;
| | - Eva-Maria Skoda
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR University Hospital, University of Duisburg-Essen, D-45147 Essen, Germany; (E.-M.S.); (M.T.)
| | | | - Marco Streibelt
- Department for Rehabilitation Research, German Federal Pension Insurance, D-10704 Berlin, Germany;
| | | | | | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR University Hospital, University of Duisburg-Essen, D-45147 Essen, Germany; (E.-M.S.); (M.T.)
| | | | - Heinz Völler
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany; (A.S.); (S.E.); or (H.V.)
- Klinik am See, D-15562 Rüdersdorf, Germany
| | - Heiner Vogel
- Abteilung für Medizinische Psychologie und Psychotherapie, Medizinische Soziologie und Rehabilitationswissenschaften, Universität Würzburg, D-97070 Würzburg, Germany;
| | - Ronja Westphal
- Herzzentrum Segeberger Kliniken, D-23795 Bad Segeberg, Germany;
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Archundia Herrera MC, Campbell-Scherer DL, Bell RC, Chan CB. Contextually Appropriate Tools and Solutions to Facilitate Healthy Eating Identified by People with Type 2 Diabetes. Nutrients 2021; 13:2301. [PMID: 34371811 PMCID: PMC8308352 DOI: 10.3390/nu13072301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/28/2021] [Accepted: 07/01/2021] [Indexed: 12/22/2022] Open
Abstract
Type 2 diabetes (T2D) is a complex, multifaceted disease and its treatment involves lifestyle intervention (LI) programs that participants may find difficult to adopt and maintain. The objective of this study is to understand the lived experiences of participants with T2D regarding healthy eating behavior change, in order to identify and incorporate relevant information, skills, and educational approaches into LI programs. An explorative qualitative study was undertaken. Purposeful sampling was used to recruit 15 participants. One-on-one, semi-structured, open-ended, and in-depth interviews were conducted. An essentialist paradigm was adopted to accurately report the experiences, meaning, and reality of participants. An inductive approach was used to analyze the data. Participants reported that being diagnosed and living with T2D could be overwhelming, and their ability to manage was influenced by health care providers (HCP), family, and individual context. Many experienced a loop of "good-bad" eating behaviors. Participants expressed desires for future diabetes management that would include program content (nutrition, physical activity, mental health, foot care, and consequences of T2D), program features (understand context, explicit information, individualized, hands-on learning, applicable, realistic, incremental, and practical), program components (access to multidisciplinary team, set goals, track progress and be held accountable, one-on-one sessions, group support, maintenance/follow-up), and policy change. In conclusion, the results of this study indicate that T2D management requires more extensive, comprehensive, and ongoing support, guided by the individual participant.
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Affiliation(s)
- M. Carolina Archundia Herrera
- 4-102 Li Ka Shing Centre for Health Innovation Research, Department of Agriculture, Food and Nutritional Science, Alberta Diabetes Institute, University of Alberta, Edmonton, AB T6G 2E1, Canada; (M.C.A.H.); (R.C.B.)
| | - Denise L. Campbell-Scherer
- Office of Lifelong Learning & the Physician Learning Program, Department of Family Medicine, Alberta Diabetes Institute, University of Alberta, 2-590 ECHA, Edmonton, AB T6G 1C9, Canada;
| | - Rhonda C. Bell
- 4-102 Li Ka Shing Centre for Health Innovation Research, Department of Agriculture, Food and Nutritional Science, Alberta Diabetes Institute, University of Alberta, Edmonton, AB T6G 2E1, Canada; (M.C.A.H.); (R.C.B.)
| | - Catherine B. Chan
- 4-102 Li Ka Shing Centre for Health Innovation Research, Department of Agriculture, Food and Nutritional Science, Alberta Diabetes Institute, University of Alberta, Edmonton, AB T6G 2E1, Canada; (M.C.A.H.); (R.C.B.)
- 6-002 Li Ka Shing Centre for Health Innovation Research, Department of Physiology, Alberta Diabetes Institute, University of Alberta, Edmonton, AB T6G 2E1, Canada
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Eyler AA, Schmidt L, Kepper M, Mazzucca S, Gilbert A, Beck A. Parent Perceptions of Changes in Child Physical Activity During COVID-19 Stay-At-Home Orders. Front Public Health 2021; 9:637151. [PMID: 34164363 PMCID: PMC8215440 DOI: 10.3389/fpubh.2021.637151] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 05/11/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose: The purpose of this study was to explore parent perceptions of changes in child physical activity during COVID-19 stay-at-home orders. Design: A cross-sectional study. Setting: The research team used social media, relevant organizations, and neighborhood groups to distribute the survey link in May and June of 2020. Subjects: A convenience sample of parents of children aged 5-12. Measures: Survey to assess parental perceptions of changes in children's physical activity before and during stay-at-home orders, and environmental and social barriers to physical activity. Analysis: Results were analyzed using descriptive statistics, bivariate comparisons, and multinomial-logistic regression models with covariates of environmental factors, social factors, and frequency of factors as barriers on association with perceived physical activity change. Results: Data from 245 parents were analyzed. A majority (63.7%) of parents reported a decrease in children's physical activity during stay-at-home orders. More parents indicated social barriers (e.g., lack of access to playmates) than environmental barriers (e.g., lack of access to neighborhood play spaces) to children's physical activity. In multivariate analyses, the odds of parents reporting decreased physical activity was greater for those reporting lack of playmates (OR = 4.72; 95% CI: 1.99-11.17) and lack of adult supervision (OR = 11.82; 95% CI: 2.48-56.28) as barriers. No environmental barriers were significantly associated with decreased children's physical activity. Conclusion: The unique aspects of the COVID-19 pandemic provide a natural experiment for developing social and environmental strategies to improve children's overall physical activity. Assessing parental perceptions is a way to inform these future efforts.
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Affiliation(s)
- Amy A. Eyler
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, United States
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Roman YM, Lor K, Xiong T, Culhane-Pera K, Straka RJ. Gout prevalence in the Hmong: a prime example of health disparity and the role of community-based genetic research. Per Med 2021; 18:311-327. [PMID: 33787318 DOI: 10.2217/pme-2020-0107] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Individuals of distinct Asian backgrounds are commonly aggregated as Asian, which could mask the differences in the etiology and prevalence of health conditions in the different Asian subgroups. The Hmong are a growing Asian subgroup in the United States with a higher prevalence of gout and gout-related comorbidities than non-Hmong. Genetic explorations in the Hmong suggest a higher prevalence of genetic polymorphisms associated with an increased risk of hyperuricemia and gout. History of immigration, acculturation, lifestyle factors, including dietary and social behavioral patterns, and the use of traditional medicines in the Hmong community may also increase the risk of developing gout and lead to poor gout management outcomes. Engaging minorities such as the Hmong population in biomedical research is a needed step to reduce the burden of health disparities within their respective communities, increase diversity in genomic studies, and accelerate the adoption of precision medicine to clinical practice.
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Affiliation(s)
- Youssef M Roman
- Assistant Professor, Virginia Commonwealth University, School of Pharmacy, Richmond, Virginia 23298, USA
| | - Kajua Lor
- Associate Professor & Chair, Medical College of Wisconsin, School of Pharmacy, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, USA
| | - Txia Xiong
- Clinical Pharmacist, West Side Community Health Services, St. Paul, MN 55106, USA
| | | | - Robert J Straka
- Professor & Department Head, University of Minnesota College of Pharmacy, Minneapolis, Minnesota 55455, USA
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Hasan M, Singh H, Haffizulla F. Culturally Sensitive Health Education in the Caribbean Diaspora: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041476. [PMID: 33557252 PMCID: PMC7913987 DOI: 10.3390/ijerph18041476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/26/2021] [Accepted: 02/01/2021] [Indexed: 11/17/2022]
Abstract
Context: The Caribbean diaspora in the United States is a diverse community that is afflicted with high morbidity and mortality due to preventable chronic diseases. Objective: Our goal is to determine which culturally sensitive health and nutrition educational modalities have the highest efficacy for improving general health in the Caribbean diaspora. Methods: A scoping literature review was performed on the MEDLINE, CINAHL, and Web of Science databases using terms related to health and nutrition in the Caribbean population. Original, peer-reviewed research published from 2010 to 2020, which took place in the U.S. and Caribbean countries, were included in our review. Results: We identified a total of nine articles that met our inclusion criteria. Rate differences for individual education program features were calculated to assess the likelihood of a positive impact on diet, physical activity, and diabetes. Conclusion: Our review helps to identify key educational modalities targeting diabetes, diet, and physical activity levels that can be used to meet the health and nutritional needs of the Caribbean diaspora population.
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Affiliation(s)
- Mashtura Hasan
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA;
- Correspondence: (M.H.); (F.H.)
| | - Harmandip Singh
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA;
| | - Farzanna Haffizulla
- Department of Internal Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA
- Correspondence: (M.H.); (F.H.)
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Eyler AA, Gachupin FC, Johnston SL, Kapp JM, Parra DC, Popescu M. Disparities in Text Messaging Interventions to Improve Diabetes Management in the United States. Diabetes Spectr 2021; 34:34-41. [PMID: 33627992 PMCID: PMC7887528 DOI: 10.2337/ds19-0071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Substantial progress has been made in the development of evidence-based interventions to facilitate the management of type 2 diabetes. The increase in ownership of mobile phones has made short messaging services (SMS, or text messaging) a feasible way to enhance information delivery. The goals of this study were to 1) summarize characteristics of diabetes SMS interventions implemented in the United States and 2) identify the extent to which disadvantaged populations are represented in SMS-based diabetes management intervention studies. We conducted a literature search to identify published studies of type 2 diabetes self-management SMS interventions conducted with adults in the United States. Of the 792 articles retrieved, only 9 met inclusion criteria. We systematically extracted data on the theoretical basis, recruitment, incentives, inclusion/exclusion criteria, strategies toward ensuring a racially/ethnically or income-diverse sample, text message delivery, and study duration. Sixty-three percent of the participants across the nine studies were non-white. Only two studies reported participants' education level, and four captured non-English-speaking status. Interventions varied in offering one-way, two-way, or a combination of messaging strategies. Five studies did not describe cultural adaptations or report results separately for different cultural groups. None of the studies provided cell phones, and not having texting capability was an exclusion criterion for six studies. There is a dearth of published research on type 2 diabetes management interventions using text messaging among racially/ethnically or income-diverse populations. Future interventions should be better tailored to these target populations and include the collection of complete sociodemographic data and cell phone/smartphone availability, thereby ensuring cultural appropriateness.
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Affiliation(s)
- Amy A. Eyler
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, MO
| | - Francine C. Gachupin
- Department of Family and Community Medicine, University of Arizona College of Medicine, Tucson, AZ
| | - Shelly L. Johnston
- Center for Diabetes Translation Research, Brown School at Washington University in St. Louis, St. Louis, MO
- Corresponding author: Shelly L. Johnston,
| | - Julie M. Kapp
- Department of Health Management and Informatics, School of Medicine, University of Missouri, Columbia, MO
| | - Diana C. Parra
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, MO
| | - Mihail Popescu
- Medical Intelligent System Laboratory, School of Medicine, University of Missouri, Columbia, MO
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Development of a group-based diabetes education model for migrants with type 2 diabetes, living in Sweden. Prim Health Care Res Dev 2020; 21:e50. [PMID: 33161939 PMCID: PMC7681170 DOI: 10.1017/s1463423620000493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Aim: To develop a diabetes education model based on individual beliefs, knowledge and risk awareness, aimed at migrants with type 2 diabetes, living in Sweden. Background: Type 2 diabetes is rapidly increasing globally, particularly affecting migrants living in developed countries. There is ongoing debate about what kind of teaching method gives the best result, but few studies have evaluated different methods for teaching migrants. Previous studies lack a theoretical base and do not proceed from the individuals’ own beliefs about health and illness, underpinned by their knowledge, guiding their health-related behaviour. Methods: A diabetes education model was developed to increase knowledge about diabetes and to influence self-care among migrants with type 2 diabetes. The model was based on literature review, on results from a previous study investigating knowledge about diabetes, on experience from studies of beliefs about health and illness, and on collaboration between researchers in diabetes care and migration and health and staff working in a multi-professional diabetes team. Findings: This is a culturally appropriate diabetes education model proceeding from individual beliefs about health and illness and knowledge, conducted in focus-group discussions in five sessions, led by a diabetes specialist nurse in collaboration with a multi-professional team, and completed within three months. The focus groups should include 4–5 persons and last for about 90 min, in the presence of an interpreter. A thematic interview guide should be used, with broad open-ended questions and descriptions of critical situations/health problems. Discussions of individual beliefs based on knowledge are encouraged. When needed, healthcare staff present at the session answer questions, add information and ensure that basic principles for diabetes care are covered. The diabetes education model is tailored to both individual and cultural aspects and can improve knowledge about type 2 diabetes, among migrants and thus increase self-care behaviour and improve health.
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Muñoz-Torres AV, Medina-Bravo P, Valerio-Pérez BE, Mendoza-Salmeron G, Escobedo-de la Peña J, Velázquez-López L. Positive health beliefs are associated with improvement of glycated hemoglobin and lipid profiles in Mexican patients with type 2 diabetes mellitus: a cross-sectional study. BMC Public Health 2020; 20:761. [PMID: 32448139 PMCID: PMC7245761 DOI: 10.1186/s12889-020-08866-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 05/07/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Health beliefs are relevant to consider in patients with type 2 diabetes since disease control depends mainly on the patient's behaviour. The aim of this study was to assess the association between health beliefs and glycated hemoglobin levels in Mexican patients with type 2 diabetes. METHODS An analytical cross-sectional study was conducted, and 336 patients were included. Fasting blood levels of glycated hemoglobin, glucose, cholesterol; triglycerides, high-density lipoprotein cholesterol (HDL-c), and low-density lipoprotein cholesterol (LDL-c) were measured. Body fat percentage, weight, height; waist circumference, and systolic and diastolic blood pressures were also obtained. A previously validated self-administered questionnaire was used to assess the health beliefs with regards to non-pharmacological treatment. Health beliefs were classified as positive, neutral, and negative. RESULTS The average age of patients was 54.7 ± 8.5 years, with a higher proportion of females (69%). The questionnaire had a good internal consistency with a Cronbach's alpha score of 0.83. More than 90% of patients attributed a health benefit to diet and exercise, 30 to 40% experienced barriers, and more than 80% had a perception of complications associated to uncontrolled diabetes. Patients with positive health beliefs had lower HbA1c levels (8.2 ± 1.7%) compared to those with neutral (9.0 ± 2.3%), or negative (8.8 ± 1.8%; p = 0.042). The LDL-c levels were lower (p = 0.03), and HDL-c levels were higher (0.002) in patients with positive heath beliefs. CONCLUSIONS Positive health beliefs are associated with better metabolic control indicators in patients with type 2 diabetes.
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Affiliation(s)
- Abril Violeta Muñoz-Torres
- Department of Public Health, School of Medicine, National Autonomous University (Universidad Nacional Autónoma de Mexico, UNAM), Mexico City, Mexico
| | - Patricia Medina-Bravo
- Department of Endocrinology, “Federico Gómez” Children’s Hospital of Mexico, Ministry of Health (SSA), Mexico City, Mexico
| | | | - Grecia Mendoza-Salmeron
- Clinical Epidemiology Research Unit, “Carlos Mac Gregor Sánchez Navarro” Hospital, Mexican Social Security Institute (Instituto Mexicano del Seguro Social, IMSS), Mexico City, Mexico
| | - Jorge Escobedo-de la Peña
- Clinical Epidemiology Research Unit, “Carlos Mac Gregor Sánchez Navarro” Hospital, Mexican Social Security Institute (Instituto Mexicano del Seguro Social, IMSS), Mexico City, Mexico
| | - Lubia Velázquez-López
- Clinical Epidemiology Research Unit, “Carlos Mac Gregor Sánchez Navarro” Hospital, Mexican Social Security Institute (Instituto Mexicano del Seguro Social, IMSS), Mexico City, Mexico
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Tang L, Zhao Q, Han W, Li K, Li J. Association of cardiovascular risk factor clustering and prehypertension among adults:Results from the China health and retirement longitudinal study baseline. Clin Exp Hypertens 2020; 42:315-321. [PMID: 31394956 DOI: 10.1080/10641963.2019.1652633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Prehypertension is common in China, but its causes and associated factors have not been well studied. This study aimed to examine the age and gender-specific associations between CVD risk factor clustering and prehypertension among adults in China.Methods: This cross-sectional study used data from participants (n = 8735) aged over 45 in the China Health and Retirement Longitudinal Study (CHARLS) Baseline conducted from 2011-2012. The participants' data were collected using standard questionnaires, anthropometric, and biochemical tests. Logistic regression analyses were used to examine the associations between cardiovascular risk factors, their clustering and prehypertension.Results: Overall, 21.1%, 39.5%, 27.6% and 11.8% participants had 0, 1, 2, ≥ 3 CVD risk factors in prehypertension group, respectively. Diabetes and overweight/obesity were significantly associated with prehypertension (OR, 1.24; 95% confidence interval [CI], 1.06-1.44; OR, 1.55; 95% CI, 1.38-1.75) in the overall population, and diabetes was associated with prehypertension only in men (OR, 1.26; 95% CI, 1.00-1.58) and older adults (OR, 1.32; 95% CI, 1.03-1.69). Moreover, participants with 1, 2 and ≥3 risk factors had increased odds of having prehypertension (OR, 1.29; 95% CI, 1.12-1.49; OR, 1.59; 95% CI, 1.31-1.78; OR, 2.05; 95% CI, 1.66-2.53, respectively) and existed dose-response relationship, regardless of age and gender.Conclusions: This study indicated that CVD risk factor clustering was significantly associated with prehypertension and hypertension. These results provide valuable information for health professionals to better understand the impact of CVD risk factor clustering on prehypertension and hypertension.
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Affiliation(s)
- Liya Tang
- School of Nursing, Jilin University, Changchun, China
| | - Qiheng Zhao
- Department of orthopedics, China-Japan Union Hospital, Jilin University, Changchun, China
| | - Wenwen Han
- School of Nursing, Jilin University, Changchun, China
| | - Kun Li
- School of Nursing, Jilin University, Changchun, China
| | - Junxin Li
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
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Tan NC, Koong Ying Leng A, Phoon Kwong Yun I, Wang Zhen S, Paulpandi M, Lee YK, Furler J, Car J, Ng CJ. Cultural adaptation of a patient decision-aid for insulin therapy. BMJ Open 2020; 10:e033791. [PMID: 32152165 PMCID: PMC7064126 DOI: 10.1136/bmjopen-2019-033791] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Patient decision-aids (PDAs) support patients in selecting evidence-based treatment options. PDA is useful only if the user understands the content to make personalised decisions. Cultural adaptation is a process of adjusting health messages so that the information is accurate, relevant and understandable to users from a different population. A PDA has been developed to assist Malaysian patients with secondary drug failure to initiate insulin therapy to control their type 2 diabetes mellitus (T2DM). Likewise, patients with T2DM in neighbouring Singapore face similar barriers in commencing insulin treatment, which a PDA may facilitate decision-making in selecting personalised therapy. OBJECTIVE The study aimed to explore the views and perceptions of Singaporean primary care providers on the Malaysia PDA to initiate insulin therapy and described the cultural adaptation process used in the design and development of a new PDA, which would be trialled in a Singapore primary healthcare institution. METHOD Qualitative research method was deployed to conduct one-to-one in-depth interviews of the healthcare providers at the trial site (SingHealth Polyclinics-SHP), including six primary care physicians and four nurses to gather their views and feedbacks on the Malaysian PDA. The interviews were transcribed, audited and analysed (standard content analysis) to identify themes relating to the content, layout, concerns of the original PDA and suggestions to the design of the new SHP PDA. RESULTS Cultural adaptation of the new PDA includes change to the overall design, graphics (including pictograms), presentation styles, additional contextualised content (personalisation, subheadings, cost and treatment option), modified phrasing of the subtitles and concerns (choice of words) relevant to the new users. CONCLUSION A PDA on insulin therapy underwent cultural adaptation before its implementation in another population in a neighbouring country. Its relevance and effectiveness will be evaluated in future research.
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Affiliation(s)
- Ngiap Chuan Tan
- Department of Research, SingHealth Polyclinics, Singapore, Singapore
- Duke-NUS, Singapore, Singapore
| | | | | | | | | | - Yew Kong Lee
- Department of Primary Care Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - John Furler
- Department of General Practice and Primary Health Care, University of Melbourne, Carlton, Victoria, Australia
| | - Josip Car
- Health Services and Outcomes Research Programme, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Christensen NI, Drejer S, Burns K, Lundstrøm SL, Hempler NF. A Qualitative Exploration of Facilitators and Barriers for Diabetes Self-Management Behaviors Among Persons with Type 2 Diabetes from a Socially Disadvantaged Area. Patient Prefer Adherence 2020; 14:569-580. [PMID: 32210542 PMCID: PMC7073429 DOI: 10.2147/ppa.s237631] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 01/30/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Enhancing diabetes self-management (DSM) in patients with type 2 diabetes (T2D) can reduce the risk of complications, enhance healthier lifestyles, and improve quality of life. Furthermore, vulnerable groups struggle more with DSM. AIM To explore barriers and facilitators related to DSM in vulnerable groups through the perspectives of patients with T2D and healthcare professionals (HCPs). METHODS Data were collected through three interactive workshops with Danish-speaking patients with T2D (n=6), Urdu-speaking patients with T2D (n=6), and HCPs (n=16) and analyzed using systematic text condensation. RESULTS The following barriers to DSM were found among members of vulnerable groups with T2D: 1) lack of access to DSM support, 2) interference and judgment from one's social environment, and 3) feeling powerless or helpless. The following factors facilitated DSM among vulnerable persons with T2D: 1) a person-centered approach, 2) peer support, and 3) practical and concrete knowledge about DSM. Several barriers and facilitators expressed by persons with T2D, particularly those who spoke Danish, were also expressed by HCPs. CONCLUSION Vulnerable patients with T2D preferred individualized and practice-based education tailored to their needs. More attention should be paid to training HCPs to handle feelings of helplessness and lack of motivation among vulnerable groups, particularly among ethnic minority patients, and to tailor care to ethnic minorities.
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Affiliation(s)
| | - Sabina Drejer
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Karin Burns
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
- Department of Endocrinology and Cardiology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Sanne Lykke Lundstrøm
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Nana Folmann Hempler
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Correspondence: Nana Folmann Hempler Tel +45 40 732 591 Email
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Beck J, Greenwood DA, Blanton L, Bollinger ST, Butcher MK, Condon JE, Cypress M, Faulkner P, Fischl AH, Francis T, Kolb LE, Lavin-Tompkins JM, MacLeod J, Maryniuk M, Mensing C, Orzeck EA, Pope DD, Pulizzi JL, Reed AA, Rhinehart AS, Siminerio L, Wang J. 2017 National Standards for Diabetes Self-Management Education and Support. DIABETES EDUCATOR 2019; 46:46-61. [PMID: 31874594 DOI: 10.1177/0145721719897952] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE The purpose of this study is to review the literature for Diabetes Self-Management Education and Support (DSMES) to ensure the National Standards for DSMES (Standards) align with current evidence-based practices and utilization trends. METHODS The 10 Standards were divided among 20 interdisciplinary workgroup members. Members searched the current research for diabetes education and support, behavioral health, clinical, health care environment, technical, reimbursement, and business practice for the strongest evidence that guided the Standards revision. RESULTS Diabetes Self-Management Education and Support facilitates the knowledge, skills, and ability necessary for diabetes self-care as well as activities that assist a person in implementing and sustaining the behaviors needed to manage their condition on an ongoing basis. The evidence indicates that health care providers and people affected by diabetes are embracing technology, and this is having a positive impact of DSMES access, utilization, and outcomes. CONCLUSION Quality DSMES continues to be a critical element of care for all people with diabetes. The DSMES services must be individualized and guided by the concerns, preferences, and needs of the person affected by diabetes. Even with the abundance of evidence supporting the benefits of DSMES, it continues to be underutilized, but as with other health care services, technology is changing the way DSMES is delivered and utilized with positive outcomes.
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Affiliation(s)
- Joni Beck
- University of Oklahoma Health Sciences Center, College of Medicine, Oklahoma City, Oklahoma
| | | | | | | | | | | | | | | | | | | | - Leslie E Kolb
- American Association of Diabetes Educators, Chicago, Illinois
| | | | | | | | - Carolé Mensing
- National Certification Board for Diabetes Educators, Arlington Heights, Illinois
| | | | | | | | | | | | - Linda Siminerio
- University of Pittsburgh Diabetes Institute, Pittsburgh, Pennsylvania
| | - Jing Wang
- University of Texas Health Science Center at Houston, Houston, Texas.,Technical Writer, Washington, DC
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Joo JY, Liu MF. Experience of Culturally-Tailored Diabetes Interventions for Ethnic Minorities: A Qualitative Systematic Review. Clin Nurs Res 2019; 30:253-262. [PMID: 31690114 DOI: 10.1177/1054773819885952] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
This qualitative systematic review synthesizes recent qualitative studies of culturally tailored interventions to better understand the experiences that individuals who are members of ethnic minorities have when undergoing type 2 diabetes treatment in the United States. Such interventions have been shown to be effective among ethnic minority populations; however, no qualitative synthesis has reported on recent findings from studies of these interventions. This systematic review identified seven relevant qualitative studies from five electronic databases-CINAHL, PsycINFO, PubMed, Ovid, and Web of Science-published from 2009 to 2019, and used a thematic synthesis review methodology. Methodological rigor was assessed for an appraisal of study quality. Five themes were identified as experiences of culturally tailored diabetes interventions: culturally appropriate healthy lifestyle behaviors, knowledge about diabetes care, emotional supports, access to the healthcare system, and family involvement. The findings of this review can be utilized as resources for improving diabetes care for ethnic minorities.
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Affiliation(s)
- Jee Young Joo
- Associate Professor, College of Nursing, Gachon University, Incheon, Korea
| | - Megan F Liu
- Associate Professor, School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei
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Abu-Saad K, Murad H, Barid R, Olmer L, Ziv A, Younis-Zeidan N, Kaufman-Shriqui V, Gillon-Keren M, Rigler S, Berchenko Y, Kalter-Leibovici O. Development and Efficacy of an Electronic, Culturally Adapted Lifestyle Counseling Tool for Improving Diabetes-Related Dietary Knowledge: Randomized Controlled Trial Among Ethnic Minority Adults With Type 2 Diabetes Mellitus. J Med Internet Res 2019; 21:e13674. [PMID: 31621640 PMCID: PMC6913526 DOI: 10.2196/13674] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 07/10/2019] [Accepted: 08/19/2019] [Indexed: 12/25/2022] Open
Abstract
Background Ethnic minority populations exhibit disproportionately high rates of type 2 diabetes mellitus (T2DM). Electronic health tools have the potential to facilitate the cultural adaptation and tailoring of T2DM education to improve the knowledge and management of diabetes mellitus (DM). Objective This study aimed (1) to develop an adaptable Interactive Lifestyle Assessment, Counseling, and Education (I-ACE) software to support dietitian-delivered lifestyle counseling among low-socioeconomic status (SES) ethnic minority patients with T2DM and (2) to evaluate its effect on DM-related dietary knowledge and management compared with standard lifestyle advice (SLA) in a randomized controlled trial (RCT). Methods The I-ACE software, developed in consultation with clinical dieticians, incorporates evidence-based dietary and physical activity (PA) recommendations and educational materials. The features and behavioral change techniques include quantitative lifestyle (dietary intake and PA) assessment and simulation, individually tailored education and recommendations, motivational interviewing, and goal setting. For the unblinded pilot RCT, 50 overweight or obese Arab adults (aged 40-62 years) with poorly controlled T2DM were recruited from primary care clinics and randomly assigned to receive 4 in-person, dietician-delivered counseling sessions over 6 months using either (1) the I-ACE tool (experimental arm) or (2) the SLA methods (comparison arm). All outcome assessments were face-to-face. DM-related dietary knowledge (primary outcome) was measured at baseline, 3, 6, and 12 months. Lifestyle and other parameters were measured before, during, and after the intervention. Multiple linear regression and repeated measures linear mixed models were used to compare the changes in study outcomes and explore time trends in between-group and within-group changes. Results A total of 25 participants were enrolled in each arm, of whom 24 and 21 completed the final assessment of the primary outcome in the I-ACE and SLA arms, respectively. DM-related lifestyle knowledge increased more rapidly in the I-ACE arm than in the SLA arm (P value for study arm×time interaction=.02). Within the I-ACE arm, the mean (SE) differences in added sugar and dietary fiber intakes from baseline to 12 months were −2.6% (SE 1.0%) of total energy (P=.03) and 2.7 (SE 0.0) g/1000 kcal (P=.003), respectively. The odds of engaging in any leisure PA at 12 months tended to be higher in the I-ACE arm versus SLA arm, but did not reach statistical significance (odds ratio 2.8; 95% CI 0.7-11.6; P=.16). Both arms exhibited significant reductions in HbA1c (P value for change over time <.001). Conclusions The use of the I-ACE software in a 6-month, 4-session dietician-delivered lifestyle counseling intervention improved the efficiency of lifestyle education, compared with SLA, among low-SES, ethnic minority patients with T2DM. This pilot trial provides justification for conducting a large-scale trial to evaluate its effectiveness and applicability in routine clinical care among ethnically diverse populations. Trial Registration ClinicalTrials.gov NCT01858506; https://clinicaltrials.gov/ct2/show/NCT01858506.
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Affiliation(s)
- Kathleen Abu-Saad
- Cardiovascular Epidemiology Unit, Gertner Institute for Epidemiology and Health Policy Research, Ramat Gan, Israel
| | - Havi Murad
- Biostatistics and Biomathematics Unit, Gertner Institute for Epidemiology and Health Policy Research, Ramat Gan, Israel
| | - Rivka Barid
- Biostatistics and Biomathematics Unit, Gertner Institute for Epidemiology and Health Policy Research, Ramat Gan, Israel.,Israel Central Bureau of Statistics, Jerusalem, Israel
| | - Liraz Olmer
- Biostatistics and Biomathematics Unit, Gertner Institute for Epidemiology and Health Policy Research, Ramat Gan, Israel
| | - Arnona Ziv
- Information and Computerization Unit, Gertner Institute for Epidemiology and Health Policy Research, Ramat Gan, Israel
| | - Nuha Younis-Zeidan
- Diet and Nutrition Service Unit for the Arab population in Sharon-Shomron District, Clalit Health Services, Arara, Israel
| | | | - Michal Gillon-Keren
- Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Shmuel Rigler
- Sharon-Shomron District, Clalit Health Services, Hadera, Israel
| | - Yakir Berchenko
- Biostatistics and Biomathematics Unit, Gertner Institute for Epidemiology and Health Policy Research, Ramat Gan, Israel.,Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Ofra Kalter-Leibovici
- Cardiovascular Epidemiology Unit, Gertner Institute for Epidemiology and Health Policy Research, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Jager MJ, van der Sande R, Essink-Bot ML, van den Muijsenbergh METC. Views and experiences of ethnic minority diabetes patients on dietetic care in the Netherlands - a qualitative study. Eur J Public Health 2019; 29:208-213. [PMID: 30204883 PMCID: PMC6426026 DOI: 10.1093/eurpub/cky186] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Diabetes type 2 is more prevalent in people from ethnic minorities in the Netherlands, and outcomes of care are worse compared with other Dutch people. Dieticians experience difficulties in managing these groups in self-management and adherence to dietary advice. The aim of this study was to explore the views regarding a healthy diet and dietetic care among ethnic minority type 2 diabetes patients. Methods Semi-structured interviews were held with 12 migrants with diabetes from Turkey, Morocco, Iraq and Curacao, who visited a dietician. Inclusion went on until saturation was reached. The interview guide was based on the Attitudes, Social influence and self-Efficacy (ASE) model and Kleinman’s explanatory model of illness. Interviews were held in the language preferred by the respondent. Transcripts were coded and thematically analyzed. Results Several respondents expected a more rigorous, directive and technical approach of the dietician. All respondents acknowledged the importance of a healthy diet. What they considered healthy was determined by culturally influenced ideas about health benefits of specific foods. Important hindrances for dietary change were lack of self-efficacy and social support. Social influences were experienced both as supportive and a hindrance. Conclusions Migrant diabetic patients’ opinions about healthy food are determined by culturally influenced ideas rather than by dietary guidelines. Dutch dietary care is not tailored to the needs of these patients and should take into account migrants’ expectations, cultural differences in dietary habits and specifically address the role of family.
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Affiliation(s)
- Mirjam J Jager
- Nutrition and Dietetics, HAN University of Applied Sciences, Nijmegen, The Netherlands.,Department of Public Health, Academic Medical Centre, Amsterdam, The Netherlands
| | - Rob van der Sande
- Primary and Community Care, HAN University of Applied Sciences, Nijmegen, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Maria E T C van den Muijsenbergh
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands.,Prevention and care programme, Pharos, National Centre of Expertise on Health Disparities, Utrecht, The Netherlands
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Zhang Z, Monro J, Venn BJ. Development and Evaluation of an Internet-Based Diabetes Nutrition Education Resource. Nutrients 2019; 11:E1217. [PMID: 31142056 PMCID: PMC6627433 DOI: 10.3390/nu11061217] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 01/19/2023] Open
Abstract
Nutritional education for pre- and type 2 diabetes empowers individuals to make positive dietary and lifestyle choices. As the world migrates to digital devices, opportunities arise for education resources to reach a broad spectrum of society. This study aimed to develop and test the effectiveness of an electronic nutritional education resource for people with pre- and type 2 diabetes within the multi-ethnic New Zealand population. A needs assessment was conducted via ethnic-specific discussion groups (n = 29), followed by a population-based online survey (n = 448). An educational resource, including an educational video and pre- and post-questionnaires, was developed and tested online among 156 participants (17 with pre- and type 2 diabetes, 118 interested lay public and 21 health professionals). There was a strong desire to learn nutrition through simple, visual, practical, and culturally appropriate online educational resources. After interacting with the educational resource, the accuracy of identifying foods that increase blood glucose concentration improved by 17.4% (p = 0.013) in people with pre- and type 2 diabetes, 12.8% (p = 0.003) in health professionals, and 16.3% (p < 0.001) in interested lay public. There was an improvement among ethnic minority participants of 14.1% (p = 0.003). Most participants expressed intentions to make positive dietary and lifestyle choices. The electronic nutrition education resource was found to be an effective means for delivering education. It has potential to bridge the gap between the limited supply of healthcare resources and the increasing demand for diabetes nutrition education.
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Affiliation(s)
- Zhuoshi Zhang
- Department of Human Nutrition, University of Otago, PO Box 56, 9054 Dunedin, New Zealand.
| | - John Monro
- New Zealand Institute for Plant & Food Research Ltd, 11600 Private Bag, Palmerston North, New Zealand.
| | - Bernard J Venn
- Department of Human Nutrition, University of Otago, PO Box 56, 9054 Dunedin, New Zealand.
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41
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Han P, Nicholson W, Norton A, Graffeo K, Singerman R, King S, Sundaresan A, Bennett W. DiabetesSistersVoices: Virtual Patient Community to Identify Research Priorities for Women Living With Diabetes. J Med Internet Res 2019; 21:e13312. [PMID: 31094360 PMCID: PMC6533875 DOI: 10.2196/13312] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/29/2019] [Accepted: 03/30/2019] [Indexed: 01/16/2023] Open
Abstract
Background Women with or at high risk of diabetes have unique health concerns across their life course. Effective methods are needed to engage women living with diabetes to develop and carry out a patient-centered research agenda. Objective This study aimed to (1) describe the creation of DiabetesSistersVoices, a virtual patient community for women living with and at risk for diabetes and (2) assess the feasibility and acceptability of DiabetesSistersVoices for engaging women in talking about their experiences, health care, and research priorities. Methods We partnered with a national advocacy organization to create DiabetesSistersVoices and to develop recruitment strategies, which included use of social media, Web-based newsletters, and weblinks through partnering organizations. Study inclusion criteria were as follows: Being a woman aged ≥18 years, residing in the United States, and self-reporting a diagnosis of diabetes or risk of diabetes. Eligible participants were given access to DiabetesSistersVoices and completed online surveys at enrollment and 6 months. We assessed trends in participants’ activities, including posting questions, sharing experiences about living with diabetes, and searching for posted resources. Results We enrolled 332 women (white: 86.5%; type 1 diabetes: 76.2%; median age: 51 years [interquartile range: 31 to 59 years]) over 8 months. Most (41.6%, 138/332) were classified as being active users (ie, posting) of the virtual community, 36.1% (120/332) as observers (ie, logged in but no posts), and 22.3% (74/332) as never users (ie, completed baseline surveys but then never logged in). Online activities were constant during the study, although participants had the highest website usage during the first 10 weeks after their enrollment. Conclusions We demonstrated the feasibility and acceptability of an online patient community for women living with diabetes by showing durability of recruitment and online usage over 6 months of testing. Next steps are to address barriers to joining a virtual patient community for women of color and women with type 2 diabetes to enhance inclusiveness and gain diverse perspectives to inform diabetes research.
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Affiliation(s)
- Peijin Han
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Wanda Nicholson
- Center for Women's Health Research, Department of Obstetrics and Gynecology, Chapel Hill, NC, United States.,Public Health Leadership Program, The University of North Carolina School of Medicine and, Gillings Global School of Public Health, Chapel Hill, NC, United States
| | - Anna Norton
- DiabetesSisters, #180, 1112 W Boughton Road, Bolingbrook, IL, United States
| | - Karen Graffeo
- DiabetesSisters, #180, 1112 W Boughton Road, Bolingbrook, IL, United States
| | | | | | - Aditi Sundaresan
- Center for Women's Health Research, Department of Obstetrics and Gynecology, Chapel Hill, NC, United States
| | - Wendy Bennett
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.,Johns Hopkins University School of Medicin, Division of General Internal Medicine, Baltimore, MD, United States
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Murdoch-Flowers J, Tremblay MC, Hovey R, Delormier T, Gray-Donald K, Delaronde E, Macaulay AC. Understanding how Indigenous culturally-based interventions can improve participants' health in Canada. Health Promot Int 2019; 34:154-165. [PMID: 28973378 DOI: 10.1093/heapro/dax059] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
There is increasing recognition that culturally-based diabetes prevention programs can facilitate the adoption and maintenance of healthy behaviours in the communities in which they are implemented. The Kahnawake School Diabetes Prevention Project (KSDPP) is a health promotion, community-based participatory research project aiming to reduce the incidence of Type 2 diabetes in the community of Kahnawake (Mohawk territory, Canada), with a large range of interventions integrating a Haudenosaunee perspective of health. Building on a qualitative, naturalistic and interpretative inquiry, this study aimed to assess the outcomes of a suite of culturally-based interventions on participants' life and experience of health. Data were collected through semi-structured qualitative interviews of 1 key informant and 17 adult, female Kahnawake community members who participated in KSDPP's suite of interventions from 2007 to 2010. Grounded theory was chosen as an analytical strategy. A theoretical framework that covered the experiences of all study participants was developed from the grounded theory analysis. KSDPP's suite of interventions provided opportunities for participants to experience five different change processes: (i) Learning traditional cooking and healthy eating; (ii) Learning physical activity; (iii) Learning mind focusing and breathing techniques; (iv) Learning cultural traditions and spirituality; (v) Socializing and interacting with other participants during activities. These processes improved participants' health in four aspects: mental, physical, spiritual and social. Results of this study show how culturally-based health promotion can bring about healthy changes addressing the mental, physical, spiritual and social dimensions of a holistic concept of health, relevant to the Indigenous perspective of well-being.
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Affiliation(s)
- Jayne Murdoch-Flowers
- Kahnawake Schools Diabetes Prevention Project, Kahnawake Territory, Kanien'keha, Mohawk Nation, QC, Canada.,School of Dietetics and Human Nutrition, McGill University, Montréal, QC, Canada
| | - Marie-Claude Tremblay
- Department of Family Medicine and Emergency Medicine, Office of Education and Continuing Professional Development, Université Laval, QC, Canada
| | - Richard Hovey
- Kahnawake Schools Diabetes Prevention Project, Kahnawake Territory, Kanien'keha, Mohawk Nation, QC, Canada.,Division of Oral Health and Society, Faculty of Dentistry, McGill University, Montréal, QC, Canada
| | - Treena Delormier
- Kahnawake Schools Diabetes Prevention Project, Kahnawake Territory, Kanien'keha, Mohawk Nation, QC, Canada.,Office of Public Health Studies, University of Hawai'i, Honolulu, HI, USA
| | - Katherine Gray-Donald
- Kahnawake Schools Diabetes Prevention Project, Kahnawake Territory, Kanien'keha, Mohawk Nation, QC, Canada.,School of Dietetics and Human Nutrition, McGill University, Montréal, QC, Canada
| | - Elaine Delaronde
- Kahnawake Schools Diabetes Prevention Project, Kahnawake Territory, Kanien'keha, Mohawk Nation, QC, Canada
| | - Ann C Macaulay
- Kahnawake Schools Diabetes Prevention Project, Kahnawake Territory, Kanien'keha, Mohawk Nation, QC, Canada.,Participatory Research at McGill, Department of Family Medicine, McGill University, Montréal, QC, Canada
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Rowland M, Coombs T, Connor M. A Study of Traveller Horse Owners' Attitudes to Horse Care and Welfare Using an Equine Body Condition Scoring System. Animals (Basel) 2019; 9:E162. [PMID: 31013846 PMCID: PMC6523149 DOI: 10.3390/ani9040162] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 03/21/2019] [Accepted: 03/28/2019] [Indexed: 11/16/2022] Open
Abstract
Traveller horses are often perceived to be exposed to poor welfare due to Travellers' traditional way of horsemanship. However, few studies have investigated Traveller horse welfare. Hence, the present study aims to explore Traveller horse owners' attitudes to horse care and welfare. Semi-structured interviews and discussion groups examined 14 Irish Traveller horse owners' attitudes and approach to horse ownership. Additionally, a body condition scoring (BCS) instrument was assessed for its accuracy and ease of use when applied by Traveller horse owners. Additionally, the BCS system was used to assess 18 horses. Results show that Travellers have a good understanding of horses' natural behaviours and environment, which is reflected in their management practices. However, barriers to improved welfare are land availability, since landowners are often reluctant to lease to Travellers, and the impoundment of horses as a consequence of fly grazing, under the Control of Horses Act 1996 (Ireland). Furthermore, Travellers regarded the BCS as a useful tool, but would require training to apply the scoring successfully. The results suggest that attitudes and management practices are favourable, but Travellers have limited means to overcome barriers. Therefore, it is necessary to increase capacity building and assist with the acquisition of land.
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Affiliation(s)
- Marie Rowland
- Royal (Dick) School of Veterinary Studies, Easter Bush, Midlothian EH25 9RG, UK.
| | - Tamsin Coombs
- SRUC, Roslin Institute, Easter Bush, Midlothian EH25 9RG, UK.
| | - Melanie Connor
- Royal (Dick) School of Veterinary Studies, Easter Bush, Midlothian EH25 9RG, UK.
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44
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Drago MJ, Guillén U, Schiaratura M, Batza J, Zygmunt A, Mowes A, Munson D, Lorenz JM, Farkouh-Karoleski C, Kirpalani H. Constructing a Culturally Informed Spanish Decision-Aid to Counsel Latino Parents Facing Imminent Extreme Premature Delivery. Matern Child Health J 2019. [PMID: 29520727 DOI: 10.1007/s10995-018-2471-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective How Latino parents perceive and understand antenatal counseling for extreme prematurity, < 26 weeks of gestational age (GA), is not clear. We aim to characterize Latino parental perceptions of antenatal counseling in order to construct and validate a Spanish decision-aid (SDA) to improve parental knowledge of prematurity after antenatal consults. Methods This is a three-phased, prospective, multicenter study. First, interviews of 22 Latino parents with a history of birth < 26 weeks GA were conducted. Thematic analysis identified themes valued during antenatal counseling for decisions regarding neonatal resuscitation. Next, we incorporated these themes into the SDA. Finally, improvement in knowledge of prematurity in two Spanish-speaking groups, 'experienced' parents with a history of extremely premature birth and 'naïve' adult Latino volunteers, was measured using a multiple choice test before and after simulated counseling with the SDA. Result Twenty-two interviews generated seven unique themes. An SDA was constructed that preserved six themes paralleled by those found in a previously studied English population, and addressed a novel theme of "intercultural linguistic barriers" unique to our population. Knowledge scores rose in "naive" volunteers, 41 ± 12% to 71 ± 15% (P < 0.001), after simulated counseling with the SDA. 'Experienced' parents had a ceiling effect in knowledge scores, 62 ± 9% to 65 ± 11% (P = 0.22). The SDA was well received by participants. Conclusions for Practice Interviews of Latino parents with a history of premature birth generated similar themes to English-speaking parents, with intercultural linguistic barriers as a novel theme. An SDA for Latino parents facing extremely premature birth may improve comprehension of antenatal counseling.
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Affiliation(s)
- Matthew J Drago
- Columbia University, New York, NY, USA. .,Yale University School of Medicine, 333 Cedar Street, Neonatal-Perinatal Medicine, New Haven, CT, 06520, USA.
| | | | | | | | | | - Anja Mowes
- Drexel University, Philadelphia, PA, USA
| | - David Munson
- University of Pennsylvania, Philadelphia, PA, USA
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Guérin E, Jaafar H, Amrani L, Prud'homme D, Aguer C. Intervention Strategies for Prevention of Comorbid Depression Among Individuals With Type 2 Diabetes: A Scoping Review. Front Public Health 2019; 7:35. [PMID: 30891439 PMCID: PMC6411710 DOI: 10.3389/fpubh.2019.00035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 02/12/2019] [Indexed: 01/04/2023] Open
Abstract
Background: Type 2 diabetes (T2D)-related depression has a significant impact on quality of life and leads to greater morbidity and mortality. Current educational and treatment programs for T2D rarely include a specific depression-prevention component, focusing largely on remediating depressive symptoms that have reached clinical levels. Objective: Given the vast field of research on the association between T2D and depression, and the unknown status of prevention efforts for the latter, the goal of this scoping review was to conduct a synopsis of intervention strategies specifically targeting the prevention of depression among adults with T2D. Eligibility Criteria: (1) participants aged 18 and over with T2D; (2) experimental and quasi-experimental designs (3) intervention strategies seeking to prevent the onset or worsening of (non-clinical) depressive symptoms; (4) a valid measure of depressive symptoms; (5) full-text articles available in English or French. Sources of Evidence: Databases including Medline, PubMed, and SCOPUS were searched between 2000 and 2018 resulting in 4,219 potential articles. Charting Methods: This review was conducted in-line with the current methodological framework for scoping reviews. Titles, abstract and full text articles were screened independently and in duplicate. A narrative analysis was conducted to synthesize study characteristics and the nature of intervention strategies and components. Results: Twelve studies were identified with the primary aim of preventing the incidence of depressive symptoms or improving non-clinical depression levels. Individual and group-based approaches included educational interventions incorporating diabetes self-management, problem-solving, and resilience-focused approaches, emotion-targeted techniques as well as alternative interventions. Self-monitoring, home practices, and motivational interviewing were common elements. Conclusions: This review lays the groundwork for future studies seeking to develop, validate, and improve prevention strategies targeting the diabetes-depression comorbidity. More studies over longer periods and with larger samples are needed to capture the effects of prevention efforts.
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Affiliation(s)
- Eva Guérin
- Institut du Savoir Montfort-Recherche, Ottawa, ON, Canada
| | - Hamdi Jaafar
- Institut du Savoir Montfort-Recherche, Ottawa, ON, Canada
- Department of Biochemistry, Microbiology, and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Lisa Amrani
- Institut du Savoir Montfort-Recherche, Ottawa, ON, Canada
| | - Denis Prud'homme
- Institut du Savoir Montfort-Recherche, Ottawa, ON, Canada
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
| | - Céline Aguer
- Institut du Savoir Montfort-Recherche, Ottawa, ON, Canada
- Department of Biochemistry, Microbiology, and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Goff LM, Moore AP, Rivas C, Harding S. Healthy Eating and Active Lifestyles for Diabetes (HEAL-D): study protocol for the design and feasibility trial, with process evaluation, of a culturally tailored diabetes self-management programme for African-Caribbean communities. BMJ Open 2019; 9:e023733. [PMID: 30826792 PMCID: PMC6398623 DOI: 10.1136/bmjopen-2018-023733] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 12/18/2018] [Accepted: 01/08/2019] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Black British communities are disproportionately burdened by type 2 diabetes (T2D) and its complications. Tackling these inequalities is a priority for healthcare providers and patients. Culturally tailored diabetes education provides long-term benefits superior to standard care, but to date, such programmes have only been developed in the USA. The current programme of research aims to develop the Healthy Eating and Active Lifestyles for Diabetes (HEAL-D) culturally tailored T2D self-management programme for black British communities and to evaluate its delivery, acceptability and the feasibility of conducting a future effectiveness trial of HEAL-D. METHODS AND ANALYSIS Informed by Medical Research Council Complex Interventions guidance, this research will rigorously develop and evaluate the implementation of the HEAL-D intervention to understand the feasibility of conducting a full-scale effectiveness trial. In phase 1, the intervention will be developed. The intervention curriculum will be based on existing evidence-based T2D guidelines for diet and lifestyle management; codesign methods will be used to foster community engagement, identify the intervention's underpinning theory, identify the optimal structure, format and delivery methods, ascertain adaptations that are needed to ensure cultural sensitivity and understand issues of implementation. In phase 2, the intervention will be delivered and compared with usual care in a feasibility trial. Process evaluation methods will evaluate the delivery and acceptability of HEAL-D. The effect size of potential primary outcomes, such as HbA1c and body weight, will be estimated. The feasibility of conducting a future effectiveness trial will also be evaluated, particularly feasibility of randomisation, recruitment, retention and contamination. ETHICS AND DISSEMINATION This study is funded by a National Institute of Health Research Fellowship (CDF-2015-08-006) and approved by National Health Service Research Ethics Committee (17-LO-1954). Dissemination will be through national and international conferences, peer-reviewed publications and local and national clinical diabetes networks. TRIAL REGISTRATION NUMBER NCT03531177; Pre-results.
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Affiliation(s)
- Louise M Goff
- Diabetes and Nutritional Sciences, Kings College London, London, UK
| | - Amanda P Moore
- Diabetes and Nutritional Sciences, Kings College London, London, UK
| | - Carol Rivas
- Faculty of Health Sciences, University of Southamptom, Southamptom, UK
| | - Seeromanie Harding
- Diabetes & Nutritional Sciences Division, King's College London, London, UK
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Miranda JJ, Lazo-Porras M, Bernabe-Ortiz A, Pesantes MA, Diez-Canseco F, Cornejo SDP, Trujillo AJ. The effect of individual and mixed rewards on diabetes management: A feasibility randomized controlled trial. Wellcome Open Res 2019; 3:139. [PMID: 30662958 PMCID: PMC6325609 DOI: 10.12688/wellcomeopenres.14824.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2019] [Indexed: 11/20/2022] Open
Abstract
Background: Incentives play a role in introducing health-related benefits, but no interventions using mixed incentives, i.e. a combination of individual and group incentives, have been tested in individuals with type 2 diabetes mellitus (T2DM). We evaluated the feasibility of implementing individual- and mixed-incentives, with and without a supportive partner, on glycated haemoglobin (HbA1c) control and weight loss among patients with T2DM. Methods: This is a feasibility, sex-stratified, single-blinded, randomized controlled study in individuals with T2DM. All participants received diabetes education and tailored goal setting for weight and glycated haemoglobin (HbA1c). Participants were randomly assigned into three arms: individual incentives (Arm 1), mixed incentives-altruism (Arm 2), and mixed incentives-cooperation (Arm 3). Participants were accompanied by a diabetes educator every other week to monitor targets, and the intervention period lasted 3 months. The primary outcome was the change in HbA1c at 3 months from baseline. Weight and change body mass index (BMI) were considered as secondary outcomes. Results: Out of 783 patients screened, a total of 54 participants, 18 per study arm, were enrolled and 44 (82%) completed the 3-month follow-up. Mean baseline HbA1c values were 8.5%, 7.9% and 8.2% in Arm 1, Arm 2, and Arm 3, respectively. At 3 months, participants in all three study arms showed reductions in HbA1c ranging from -0.9% in Arm 2 to -1.4% in Arm 1. Weight and BMI also showed reductions. Conclusions: Individual and mixed cash incentives show important reductions in HbA1c, weight and BMI in patients with type 2 diabetes mellitus after 3 months. Recruitment and uptake of the intervention were successfully accomplished demonstrating feasibility to conduct larger effectiveness studies to test individual and mixed economic incentives for diabetes management. Registration: ClinicalTrials.gov Identifier NCT02891382.
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Affiliation(s)
- J. Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - María Lazo-Porras
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Antonio Bernabe-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - M. Amalia Pesantes
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Francisco Diez-Canseco
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Antonio J. Trujillo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Systematic Review of the Effect of Lifestyle Interventions on the Components of the Metabolic Syndrome in South Asian Migrants. J Immigr Minor Health 2019; 20:231-244. [PMID: 27766507 DOI: 10.1007/s10903-016-0515-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
A systematic review was undertaken to identify lifestyle intervention studies in South Asian migrant populations to determine the effect on the components of the metabolic syndrome. A total of seven studies were identified, of which six focused on educational advice and the seventh on intensive exercise intervention. Four studies were Randomised Controlled Trials of which two studies reported significant reductions in waist circumference. One of these studies focused on home based education with cooperation of the home cook (adjusted waist reduction of 1.9 cm, 95 % CI 0.52-3.3 cm; p = 0.007) and the other entailed an intensive physical activity program (adjusted waist reduction 3.4 cm, 95 % CI 2.0-4.7 cm). The evidence whether lifestyle intervention studies in South Asians can improve components of the metabolic system is not clear. Further lifestyle interventions for South Asians should be culturally adapted, involve friends and family, especially those with cooking responsibilities.
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Beck J, Greenwood DA, Blanton L, Bollinger ST, Butcher MK, Condon JE, Cypress M, Faulkner P, Fischl AH, Francis T, Kolb LE, Lavin-Tompkins JM, MacLeod J, Maryniuk M, Mensing C, Orzeck EA, Pope DD, Pulizzi JL, Reed AA, Rhinehart AS, Siminerio L, Wang J. 2017 National Standards for Diabetes Self-Management Education and Support. DIABETES EDUCATOR 2018; 45:34-49. [PMID: 30558523 DOI: 10.1177/0145721718820941] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of this study is to review the literature for Diabetes Self-Management Education and Support (DSMES) to ensure the National Standards for DSMES (Standards) align with current evidence-based practices and utilization trends. METHODS The 10 Standards were divided among 20 interdisciplinary workgroup members. Members searched the current research for diabetes education and support, behavioral health, clinical, health care environment, technical, reimbursement, and business practice for the strongest evidence that guided the Standards revision. RESULTS Diabetes Self-Management Education and Support facilitates the knowledge, skills, and ability necessary for diabetes self-care as well as activities that assist a person in implementing and sustaining the behaviors needed to manage their condition on an ongoing basis. The evidence indicates that health care providers and people affected by diabetes are embracing technology, and this is having a positive impact of DSMES access, utilization, and outcomes. CONCLUSION Quality DSMES continues to be a critical element of care for all people with diabetes. The DSMES services must be individualized and guided by the concerns, preferences, and needs of the person affected by diabetes. Even with the abundance of evidence supporting the benefits of DSMES, it continues to be underutilized, but as with other health care services, technology is changing the way DSMES is delivered and utilized with positive outcomes.
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Affiliation(s)
- Joni Beck
- University of Oklahoma Health Sciences Center, College of Medicine, Oklahoma City, Oklahoma
| | | | | | | | | | | | | | | | | | | | - Leslie E Kolb
- American Association of Diabetes Educators, Chicago, Illinois
| | | | | | | | - Carolé Mensing
- National Certification Board for Diabetes Educators, Arlington Heights, Illinois
| | | | | | | | | | | | - Linda Siminerio
- University of Pittsburgh Diabetes Institute, Pittsburgh, Pennsylvania
| | - Jing Wang
- The University of Texas Health Science Center at Houston, Houston, Texas
- Technical Writer, Washington, DC
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Captieux M, Pearce G, Parke HL, Epiphaniou E, Wild S, Taylor SJC, Pinnock H. Supported self-management for people with type 2 diabetes: a meta-review of quantitative systematic reviews. BMJ Open 2018; 8:e024262. [PMID: 30552277 PMCID: PMC6303627 DOI: 10.1136/bmjopen-2018-024262] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/31/2018] [Accepted: 09/12/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Self-management support aims to give people with chronic disease confidence to actively manage their disease, in partnership with their healthcare provider. A meta-review can inform policy-makers and healthcare managers about the effectiveness of self-management support strategies for people with type 2 diabetes, and which interventions work best and for whom. DESIGN A meta-review of systematic reviews of randomised controlled trials (RCTs) was performed adapting Cochrane methodology. SETTING AND PARTICIPANTS Eight databases were searched for systematic reviews of RCTs from January 1993 to October 2016, with a pre-publication update in April 2017. Forward citation was performed on included reviews in Institute for Scientific Information (ISI) Proceedings. We extracted data and assessed quality with the Revised-Assessment of Multiple Systematic Reviews (R-AMSTAR). PRIMARY AND SECONDARY OUTCOME MEASURES Glycaemic control as measured by glycated haemoglobin (HbA1c) was the primary outcome. Body mass Index, lipid profiles, blood pressure and quality of life scoring were secondary outcomes. Meta-analyses reporting HbA1c were summarised in meta-forest plots; other outcomes were synthesised narratively. RESULTS 41 systematic reviews incorporating data from 459 unique RCTs in diverse socio-economic and ethnic communities across 33 countries were included. R-AMSTAR quality score ranged from 20 to 42 (maximum 44). Apart from one outlier, the majority of reviews found an HbA1c improvement between 0.2% and 0.6% (2.2-6.5 mmol/mol) at 6 months post-intervention, but attenuated at 12 and 24 months. Impact on secondary outcomes was inconsistent and generally non-significant. Diverse self-management support strategies were employed; no single approach appeared optimally effective (or ineffective). Effective programmes tended to be multi-component and provide adequate contact time (>10 hours). Technology-facilitated self-management support showed a similar impact as traditional approaches (HbA1c MD -0.21% to -0.6%). CONCLUSIONS Self-management interventions using a range of approaches improve short-term glycaemic control in people with type 2 diabetes including culturally diverse populations. These findings can inform researchers, policy-makers and healthcare professionals re-evaluating the provision of self-management support in routine care. Further research should consider implementation and sustainability.
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Affiliation(s)
- Mireille Captieux
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Gemma Pearce
- Coventry University, Centre for Advances in Behavioural Science, Coventry, UK
| | - Hannah L Parke
- University of Exeter Biomedical Informatics Hub, Exeter, Devon, UK
| | - Eleni Epiphaniou
- University of Nicosia, Department of Social Sciences, Nicosia, Cyprus
| | - Sarah Wild
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Stephanie J C Taylor
- Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Hilary Pinnock
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
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