Type 2 Diabetes Self-management Among Spanish-Speaking Hispanic Immigrants

mHealth Intervention for Vietnamese Living With Diabetes: Protocol for a Stepped Wedge Pilot Study

BACKGROUND

Evidence indicates participation in a diabetes self-management education and support program improves self-care behaviors and hemoglobin A1c. Language and cultural differences may be barriers to program participation resulting in ineffective self-management, but these factors can be addressed with appropriate interventions. Given the high health care costs associated with diabetes complications, we developed a multicomponent, culturally tailored Self-Management Mobile Health Intervention for US Vietnamese With Diabetes (SMart-D).

OBJECTIVE

This study aims to evaluate the SMart-D intervention's feasibility, acceptability, and effectiveness with intentions to scale up the intervention in the future. This mixed methods study incorporates the Reach, Effectiveness, Adoption, Implementation, Maintenance framework to evaluate the intervention.

METHODS

This stepped wedge randomized controlled pilot study will be conducted over 2 years in collaboration with primary care clinics. Eligible participants are patients with type 2 diabetes who are receiving health care from participating clinics. Clinics will be randomly assigned to an implementation date and will begin with patients enrolling in the control period while receiving standard care, then cross over to the intervention period where patients receive standard care plus the SMart-D intervention for over 12 weeks. Focus groups or interviews will be conducted with clinicians and patients after study completion. Qualitative data will be analyzed using NVivo. Outcomes on self-care behavior changes will be measured with the Summary of Diabetes Self-Care Activities scale and clinical changes will be measured using laboratory tests. A generalized linear mixed-effect model will be used to compute time effect, clustering effect, and the interaction of the control and intervention periods using SAS (version 9.4; SAS Institute).

RESULTS

We hypothesize that (1) at least 50% (n=5) of eligible clinics and 50% (n=40) of eligible patients who are invited will participate, and at least 70% (n=56) of patients will complete the program, and (2) patients who receive the intervention will have improved self-care behaviors and clinical test results with at least 75% (n=60) of the patients maintaining improved outcomes at follow-up visits compared with baseline, and participants will verbalize that the intervention is feasible and acceptable. As of August 2023, we enrolled 10 clinics and 60 patients. Baseline data results will be available by the end of 2023 and outcome data will be published in 2025.

CONCLUSIONS

This is the first Vietnamese diabetes self-management education and support intervention that leverages mobile health technology to address the barriers of language and culture differences through collaboration with primary care clinics. This study will provide a better understanding of the implementation process, demonstrate the potential effectiveness of the intervention, accelerate the pace of moving evidence-based interventions to practice among the US Vietnamese population, and potentially provide a replicable implementation model that can be culturally adapted to other non-English speaking ethnic minorities.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/48585.

Psychometric properties of the Diabetes Empowerment Scale Modified Version-Spanish, tested in an at-risk Latino immigrant population

BACKGROUND

Latino populations are at high risk of developing diabetes; however, few scales measure self-efficacy to change health behaviours in at-risk Latino individuals. The Diabetes Empowerment Scale was translated into Spanish, and its psychometric properties were tested.

METHODS

This descriptive investigation was conducted with adults in a predominately Latino Midwest community. Participants (N = 141) completed a modified version of the Diabetes Empowerment Scale, which measures self-efficacy in exercising and healthy eating. Factor analysis was performed on completed surveys. Recruitment in Latino cultural centres and parishes took place from June 2016 to May 2017.

RESULTS

Three factors emerged: self-efficacy to exercise, emotional eating and social eating. Three scale questions had low scores during analysis; however, overall, the tool demonstrated adequate validity.

CONCLUSIONS

The Diabetes Empowerment Scale Modified Version-Spanish demonstrated adequate reliability and validity. Healthy dietary preferences and physical activity in populations at-risk for diabetes should be assessed by nurses to ascertain level of self-efficacy in individuals by assessing confidence to engage in specific healthy behaviours.

Efficacy of a language-concordant health coaching intervention for latinx with diabetes

OBJECTIVE

To describe the effect of a language-concordant health coaching intervention for Spanish-speaking patients with limited English proficiency (LEP) and uncontrolled Type 2 Diabetes (T2D) on glycemic control, anxiety, depression, and diabetes self-efficacy.

METHODS

64 patients with T2D were randomly assigned to a control or intervention group. Outcomes were assessed by blood work and surveys pre and post intervention.

RESULTS

The mean sample age was 47.8 years (SD=11.3) and 81% were female. HbA1c was not significantly different between groups at baseline. The intervention group's HbA1c was significantly lower at times 2 and 3 than in the control arm (p < .01 and p < .001). There were significant reductions in the intervention group's mean HbA1c levels from baseline 10.37 to midpoint 9.20, p < .001; and from baseline 10.42 to study end 8.14, p < .001. Depression and anxiety scores significantly decreased (p < .05 and p < .001), and diabetes self-efficacy significantly increased (p < .001).

CONCLUSION

Health coaching led to statistically significant and clinically meaningful decreases in HbA1c, depression, and anxiety scores among LEP Latinx adults with uncontrolled T2D.

PRACTICE IMPLICATIONS

Heath coaching can be conducted in primary care clinics by nurses or advanced practice nurses. The short-term intervention tested here could be adapted to the clinical setting.

Type 2 diabetes mellitus patients' lived experience at a tertiary hospital in Ekiti State, Nigeria

Diabetes mellitus is a complex and chronic metabolic disorder that is associated with multiple complications and disabilities. This contributes to increased mortality and poor quality of life among affected individuals. The study explored the lived experience of patients with type 2 diabetes mellitus at a Teaching Hospital in Ekiti State, Nigeria. A mixed method of qualitative and quantitative design was adopted. For the quantitative aspect, a convenience sampling technique was employed while the instrument used was an adapted questionnaire. For the qualitative aspect, focus-group discussion involving twenty-four participants was conducted, and the sample size was determined by data saturation. Qualitative data was analyzed using thematic transcription. Findings revealed that 55.6% of the participants were females while 63.5% had tertiary education. Majority (18 of 24) of the respondents experienced body weakness, frequent urination and excessive thirst when diagnosed of diabetes mellitus and later experienced occasional body weakness, burning sensation, tingling and numbness of the feet, fatigue, loss of libido, and occasional visual disturbance. Two-third of the participants reported being indifferent when they were informed about their condition. However, majority of the participants perceived that the cause of diabetes mellitus was heredity. More than two-third of the participants did not experience reduction in their normal daily activities but rather experienced occasional emotional disturbances, anxiety and challenges with self-management of diabetes and this was associated with maintaining a normo-glycemic state due to the financial implications of drugs and dietary modifications.

Feasibility and Acceptability of a Language Concordant Health Coaching Intervention Delivered by Nurses for Latinx With Type 2 Diabetes

BACKGROUND

Latinx immigrants have high rates of type 2 diabetes (T2D), exhibit out-of-range glycemic control, and have higher rates of diabetes-related complications than non-Latinx whites, with limited English proficiency (LEP) being a major barrier to care.

AIMS

We tested the feasibility and acceptability of a language concordant (provider that is proficient in the patient's preferred language) health coaching intervention delivered by nurse and nurse practitioner students in a pilot study of Latinx immigrants with T2D and LEP.

METHODS

A sample of 17 Latinx immigrants with T2D and LEP were split into intervention and control groups. The control group received basic diabetes care and written educational materials on diabetes self-management in Spanish. Individuals in the intervention group received the standard diabetes care offered by the clinic and six biweekly health coaching sessions (intervention) with a trained language concordant health coach.

RESULTS

The language concordant health coaching intervention was both feasible (delivery) and acceptable (satisfactory) to Latinx immigrants with T2D and LEP and resulted in clinically meaningful differences in key diabetes-related outcomes.

LINKING EVIDENCE TO ACTION

Our findings suggest that lack of language concordance between provider and patient has an important and meaningful impact on the ability of an LEP Latinx patient to receive, and perhaps act upon, adequate education for T2D management. Receiving biweekly coaching calls could have offered further emotional support for participants to discuss living with T2D, which may have helped to alleviate symptoms of depression and anxiety that individuals with T2D frequently endure.

The Space Between: Transformative Learning and Type 2 Diabetes Self-Management

INTRODUCTION

Immigrant populations experience higher type 2 diabetes mellitus (T2DM) prevalence rates and worse health outcomes secondary to T2DM than native-born populations. But as the largest immigrant population in the United States, the experience of T2DM diagnosis and self-management among Spanish-speaking, limited English-language proficient Latinx immigrants remains largely unexamined. This study used semistructured interviews to explore these phenomena among a cohort of 30 recent Latinx immigrants.

METHOD

All aspects of data collection were conducted in Spanish. Quantitative and qualitative data were collected. Data analysis included descriptive statistical procedures. Qualitative data analysis was conducted using a grounded theory approach.

RESULTS

Patterns in the data analysis of 30 interviews identified accepting T2DM as a common transitional process that required significant changes in individuals' self-perspective and ways of being. Accepting T2DM was identified by the participants as a precursor to treatment initiation. And while for most participants this transition period was brief, for some it took months to years. Distinct transitional stages were identified, categorized, and considered within the context of several theoretical orientations and were observed to align with those in transformative learning.

CONCLUSION

Understanding differing responses and processing of a T2DM diagnosis could be leveraged to better support patients' acceptance and transition into treatment.

Health Literacy and Cardiovascular Disease: Fundamental Relevance to Primary and Secondary Prevention: A Scientific Statement From the American Heart Association

Health literacy is the degree to which individuals are able to access and process basic health information and services and thereby participate in health-related decisions. Limited health literacy is highly prevalent in the United States and is strongly associated with patient morbidity, mortality, healthcare use, and costs. The objectives of this American Heart Association scientific statement are (1) to summarize the relevance of health literacy to cardiovascular health; (2) to present the adverse associations of health literacy with cardiovascular risk factors, conditions, and treatments; (3) to suggest strategies that address barriers imposed by limited health literacy on the management and prevention of cardiovascular disease; (4) to demonstrate the contributions of health literacy to health disparities, given its association with social determinants of health; and (5) to propose future directions for how health literacy can be integrated into the American Heart Association's mandate to advance cardiovascular treatment and research, thereby improving patient care and public health. Inadequate health literacy is a barrier to the American Heart Association meeting its 2020 Impact Goals, and this statement articulates the rationale to anticipate and address the adverse cardiovascular effects associated with health literacy.

Health-promoting behaviors benefit the mental health of cirrhotic outpatients

PURPOSE

The objectives of this study were to survey the frequency of engaging in a health-promoting lifestyle in patients with liver cirrhosis, and examine the mediating effects of a health-promoting lifestyle on relationships of symptoms and psychological distress with the quality of life (QOL).

METHODS

A cross-sectional study was conducted to recruit 148 cirrhotic outpatients from the gastroenterology outpatient department of one medical university hospital. All study participants completed self-administered questionnaires comprising a multidimensional symptoms scale, Hospital Anxiety and Depression Scale, short-form Chinese health-promoting lifestyle profile, and the Taiwanese version of the Short-Form 36. Hierarchical linear regression and mediation models were used to evaluate the effect of a health-promoting lifestyle on the QOL.

RESULTS

Results showed these cirrhotic outpatients reported low frequencies of health-promoting behaviors in their daily activities and had poor mental health but superior physical health. The hierarchical linear regression model found that depression, anxiety, and a health-promoting lifestyle were significant determinants of mental health. The mediation analysis further identified that a health-promoting lifestyle acted as a significant mediator which ameliorated the effects of depression and anxiety on the mental health aspect of the QOL.

CONCLUSIONS

A health-promoting lifestyle can improve the mental health of the QOL. Healthcare professionals can develop effective health-promoting interventions to manage and improve the mental health of cirrhotic patients.

Impact of Demographic, Socioeconomic, and Psychological Factors on Glycemic Self-Management in Adults with Type 2 Diabetes Mellitus

Diabetes mellitus (DM) is reported as one of the most complex chronic diseases worldwide. In the United States, Type 2 DM (T2DM) is the seventh leading cause of morbidity and mortality. Individuals with diabetes require lifelong personal care to reduce the possibility of developing long-term complications. A good knowledge of diabetes risk factors, including obesity, dyslipidemia, hypertension, family history of DM, and sedentary lifestyle, play an essential role in prevention and treatment. Also, sociodemographic, economic, psychological, and environmental factors are directly and indirectly associated with diabetes control and health outcomes. Our review intends to analyze the interaction between demographics, knowledge, environment, and other diabetes-related factors based on an extended literature search, and to provide insight for improving glycemic control and reducing the incidence of chronic complications.