Integrating diabetes self-management interventions for mexican-americans into the catholic church setting

Effectiveness of self-management interventions for long-term conditions in people experiencing socio-economic deprivation in high-income countries: a systematic review and meta-analysis

BACKGROUND

Long-term conditions (LTCs) are prevalent in socio-economically deprived populations. Self-management interventions can improve health outcomes, but socio-economically deprived groups have lower participation in them, with potentially lower effectiveness. This review explored whether self-management interventions delivered to people experiencing socio-economic deprivation improve outcomes.

METHODS

We searched databases up to November 2022 for randomized trials. We screened, extracted data and assessed the quality of these studies using Cochrane Risk of Bias 2 (RoB2). We narratively synthesized all studies and performed a meta-analysis on eligible articles. We assessed the certainty of evidence using GRADE for articles included in the meta-analysis.

RESULTS

The 51 studies included in this review had mixed findings. For the diabetes meta-analysis, there was a statistically significant pooled reduction in haemoglobin A1c (-0.29%). We had moderate certainty in the evidence. Thirty-eight of the study interventions had specific tailoring for socio-economically deprived populations, including adaptions for low literacy and financial incentives. Each intervention had an average of four self-management components.

CONCLUSIONS

Self-management interventions for socio-economically deprived populations show promise, though more evidence is needed. Our review suggests that the number of self-management components may not be important. With the increasing emphasis on self-management, to avoid exacerbating health inequalities, interventions should include tailoring for socio-economically deprived individuals.

Participant Perspectives on the Effects of an African American Faith-Based Health Promotion Educational Intervention: a Qualitative Study

Background

In the USA, African Americans (AAs) experience a greater burden of mortality and morbidity from chronic health conditions including obesity, diabetes, and heart disease. Faith-based programs are a culturally sensitive approach that potentially can address the burden of chronic health conditions in the AA community.

Objective

The primary objective was to assess (i) the perceptions of participants of Live Well by Faith (LWBF)—a government supported faith-based program to promote healthy living across several AA churches—on the effectiveness of the program in promoting overall wellness among AAs. A secondary objective was to explore the role of the church as an intervention unit for health promotion among AAs.

Methods

Guided by the socio-ecological model, data were collected through 21 in-depth interviews (71% women) with six AA church leaders, 10 LWBF lifestyle coaches, and five LWBF program participants. Interviews were audio-recorded, transcribed verbatim, and analyzed by three of the researchers.

Findings

Several themes emerged suggesting there was an effect of the program at multiple levels: the intrapersonal, interpersonal, organizational, and community levels. Most participants reported increased awareness about chronic health conditions, better social supports to facilitate behavior change, and creation of health networks within the community.

Conclusion

Our study suggests that one approach to address multilevel factors in a culturally sensitive manner could include developing government-community partnership to co-create interventions.

A nursing metaparadigm perspective of diabetic foot ulcer care

Diabetic foot ulcers (DFUs) are a serious complication of diabetes that impact on the patient, their social environment, overall health, and on nursing practice. Nursing scholars have integrated theories on practice to overcome these problems, but a lack of agreement in the available literature acts as a barrier to implementing these in practice. For that reason, using a nursing metaparadigm as a theoretical framework would assist nurses in managing care purposefully and proactively, thus possibly improving outcomes. There has been little discussion about the nursing metaparadigm in relation to DFU care. This article aims to identify why Fawcett's theory of the nursing metaparadigm is important as a fundamental part of DFU care. Understanding this will help to elucidate the phenomenon of DFUs. Moreover, identifying the elements of the DFU care framework is essential to improve reflective practice and intervention. This article discusses the concept of the nursing metaparadigm and its implications for practice in the care of patients with DFUs.

What Is Faith-Based Health Promotion? A Working Definition

Faith-based health promotion (FBHP) is a concept utilized across multiple disciplines, including nursing, public health, government, social work, and medicine. This article presents a hybrid concept analysis of FBHP and construction of a working definition for further investigative study. Defining FBHP is especially valuable for faith community nurses (FCNs), public health nurses, and other healthcare professionals who seek to study and offer FBHP. The relationship and application of FBHP to FCN practice is explored.

Advancing Nursing Science Through Community Advisory Boards: Working Effectively Across Diverse Communities

The movement toward community-engaged research is well aligned with nursing's strong tradition of engaging individuals, families, and communities in designing and evaluating nursing care. As such, nurse scientists should consider engaging the recipients of care in the research process. Community advisory boards are a common way in which communities are engaged in research. The purpose of this article is to provide a framework for effectively working with community advisory boards in diverse communities that is informed by evidence and experiences of the Robert Wood Johnson Foundation Nurse Faculty Scholars. Recommendations can serve as a blueprint for nurse scientists as they engage communities in research promoting health equity.

A Family-Based, Culturally Tailored Diabetes Intervention for Hispanics and Their Family Members

PURPOSE

The purpose of this study was to test efficacy of a family-based, culturally tailored intervention for Hispanics with type 2 diabetes and their family members.

METHODS

Hispanic patients with type 2 diabetes and their family members recruited from community clinics and ethnic churches were assigned to groups (N = 186). The intervention group received an 8-week culturally tailored diabetes educational program delivered in Spanish while the attention control group received 8 weekly sessions on general health information and 2 sessions on diabetes after completion of the study. Data were collected at baseline, after intervention, and at 1- and 6-month follow-ups for both patients and families. Comparisons of change over time were performed using growth curve analyses after propensity score adjustment.

RESULTS

Intervention patients improved in diabetes knowledge and diabetes self-efficacy over time (but did not sustain at 6-month follow-up). A1C was lower at 1-month follow-up. Family members had improvements in diabetes knowledge and physical health-related quality of life.

CONCLUSIONS

Including families in the interventions may improve glycemic control, diabetes knowledge, self-efficacy, and physical health-related quality of life. However, strategies for sustaining improvements are needed.

Picture Good Health: A Church-Based Self-Management Intervention Among Latino Adults with Diabetes

BACKGROUND

Churches may provide a familiar and accessible setting for chronic disease self-management education and social support for Latinos with diabetes.

OBJECTIVE

We assessed the impact of a multi-faceted church-based diabetes self-management intervention on diabetes outcomes among Latino adults.

DESIGN

This was a community-based, randomized controlled, pilot study.

SUBJECTS

One-hundred adults with self-reported diabetes from a Midwestern, urban, low-income Mexican-American neighborhood were included in the study.

INTERVENTIONS

Intervention participants were enrolled in a church-based diabetes self-management program that included eight weekly group classes led by trained lay leaders. Enhanced usual care participants attended one 90-minute lecture on diabetes self-management at a local church.

OUTCOME MEASURES

The primary outcome was change in glycosylated hemoglobin (A1C). Secondary outcomes included changes in low-density lipoproteins (LDL), blood pressure, weight, and diabetes self-care practices.

KEY RESULTS

Participants' mean age was 54 ± 12 years, 81 % were female, 98 % were Latino, and 51 % were uninsured. At 3 months, study participants in both arms decreased their A1C from baseline (-0.32 %, 95 % confidence interval [CI]: -0.62, -0.02 %). The difference in change in A1C, LDL, blood pressure and weight from baseline to 3-month and 6-month follow-up was not statistically significant between the intervention and enhanced usual care groups. Intervention participants reported fewer days of consuming high fat foods in the previous week (-1.34, 95 % CI: -2.22, -0.46) and more days of participating in exercise (1.58, 95 % CI: 0.24, 2.92) compared to enhanced usual care from baseline to 6 months.

CONCLUSIONS

A pilot church-based diabetes self-management intervention did not reduce A1C, but resulted in decreased high fat food consumption and increased participation in exercise among low-income Latino adults with diabetes. Future church-based interventions may need to strengthen linkages to the healthcare system and provide continued support to participants to impact clinical outcomes.

Family interventions to improve diabetes outcomes for adults

Diabetes self-care is a critical aspect of disease management for adults with diabetes. Since family members can play a vital role in a patient's disease management, involving them in self-care interventions may positively influence patients' diabetes outcomes. We systematically reviewed family-based interventions for adults with diabetes published from 1994 to 2014 and assessed their impact on patients' diabetes outcomes and the extent of family involvement. We found 26 studies describing family-based diabetes interventions for adults. Interventions were conducted across a range of patient populations and settings. The degree of family involvement varied across studies. We found evidence for improvement in patients' self-efficacy, perceived social support, diabetes knowledge, and diabetes self-care across the studies. Owing to the heterogeneity of the study designs, types of interventions, reporting of outcomes, and family involvement, it is difficult to determine how family participation in diabetes interventions may affect patients' clinical outcomes. Future studies should clearly describe the role of family in the intervention, assess quality and extent of family participation, and compare patient outcomes with and without family involvement.

"One Can Learn From Other People's Experiences": Latino adults' preferences for peer-based diabetes interventions

PURPOSE

To assess Latino adults' preferences for peer-based diabetes self-management interventions and the acceptability of the church setting for these interventions.

METHODS

The authors partnered with 2 predominantly Mexican American churches in Chicago and conducted 6 focus groups with 37 adults who had diabetes or had a family member with diabetes. They assessed participant preferences regarding group education and telephone-based one-to-one peer diabetes self-management interventions. Systematic qualitative methods were used to identify the types of programming preferred by participants in the church setting.

RESULTS

Participants had a mean (SD) age of 53 (11) years. All participants were Latino, and more than half were born in Mexico (60%). Most participants were female (78%), had finished high school (65%), and had health insurance (57%). Sixty-five percent reported having a diagnosis of diabetes. Many participants believed the group-based and telephone-based one-to-one peer support programs could provide opportunities to share diabetes knowledge. Yet, the majority stated the group education model would offer more opportunity for social interaction and access to people with a range of diabetes experience. Participants noted many concerns regarding the one-to-one intervention, mostly involving the impersonal nature of telephone calls and the inability to form a trusting bond with the telephone partner. However, the telephone-based intervention could be a supplement to the group educational sessions. Participants also stated the church would be a familiar and trusted setting for peer-based diabetes interventions.

CONCLUSIONS

Church-based Latinos with diabetes and their family members were interested in peer-based diabetes self-management interventions; however, they preferred group-based to telephone-based one-to-one peer programs.