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Maruo Y, Irie Y, Obata Y, Takayama K, Yamaguchi H, Kosugi M, Hazama Y, Yasuda T. Medium-term Influence of the Coronavirus Disease 2019 Pandemic on Patients with Diabetes: A Single-center Cross-sectional Study. Intern Med 2022; 61:303-311. [PMID: 34803093 PMCID: PMC8866774 DOI: 10.2169/internalmedicine.8010-21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective This study evaluated the lifestyle changes in patients with diabetes and their independent associations with glycemic and body weight control. In addition, the correlation between changes in mental health and lifestyles was evaluated. Methods This single-center cross-sectional study included 340 patients with diabetes who periodically visited our department. Changes in dietary habits, activities of daily living, and mental health before and during approximately six months after the onset of the coronavirus disease 2019 (COVID-19) pandemic were evaluated using a questionnaire, including the International Physical Activity Questionnaire-Short Form. Results Approximately 20%, 30%, and over 50% of patients had worsened dietary habits, decreased activities of daily living, and deteriorated mental health, respectively. A multiple regression analysis showed that irregular meal timing was significantly associated with change in HbA1c (β=0.328, p=0.001), and decreased walking time was significantly associated with changes in body weight (β=-0.245, p=0.025). The change in fear and anxiety was positively associated with changes in meal timing regularity (r=0.129, p=0.019) and carbohydrate consumption (r=0.127, p=0.021). Subsequently, the change in depressed mood was positively associated with changes in carbohydrate (r=0.142, p=0.010) and alcohol (r=0.161, p=0.037) consumption, and the change in psychological stress was positively associated with changes in carbohydrates (r=0.183, p=0.001) and snack (r=0.151, p=0.008) consumption as well as sedentary time (r=0.158, p=0.004). Conclusion The COVID-19 pandemic has had a considerable medium-term impact on the lifestyle and mental health of patients with diabetes. Lifestyle changes were associated with glycemic and body weight control, and mental health changes were associated with lifestyle changes. These findings may provide important information on diabetes care during the pandemic.
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Affiliation(s)
- Yumiko Maruo
- Department of Diabetes, Metabolism and Endocrinology, Osaka Police Hospital, Japan
| | - Yoko Irie
- Department of Diabetes, Metabolism and Endocrinology, Osaka Police Hospital, Japan
| | - Yoshinari Obata
- Department of Diabetes, Metabolism and Endocrinology, Osaka Police Hospital, Japan
| | - Kana Takayama
- Department of Diabetes, Metabolism and Endocrinology, Osaka Police Hospital, Japan
| | - Hiroki Yamaguchi
- Department of Diabetes, Metabolism and Endocrinology, Osaka Police Hospital, Japan
| | - Motohiro Kosugi
- Department of Diabetes, Metabolism and Endocrinology, Osaka Police Hospital, Japan
| | - Yoji Hazama
- Department of Diabetes, Metabolism and Endocrinology, Osaka Police Hospital, Japan
| | - Tetsuyuki Yasuda
- Department of Diabetes, Metabolism and Endocrinology, Osaka Police Hospital, Japan
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2
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Butler AM, Brown SD, Carreon SA, Smalls BL, Terry A. Equity in Psychosocial Outcomes and Care for Racial and Ethnic Minorities and Socioeconomically Disadvantaged People With Diabetes. Diabetes Spectr 2022; 35:276-283. [PMID: 36082019 PMCID: PMC9396713 DOI: 10.2337/dsi22-0006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The role of social determinants of health (SDOH) in promoting equity in diabetes prevalence, incidence, and outcomes continues to be documented in the literature. Less attention has focused on disparities in psychosocial aspects of living with diabetes and the role of SDOH in promoting equity in psychosocial outcomes and care. In this review, the authors describe racial/ethnic and socioeconomic disparities in psychosocial aspects of living with diabetes, discuss promising approaches to promote equity in psychosocial care, and provide future research directions.
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Affiliation(s)
- Ashley M. Butler
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
- Corresponding author: Ashley M. Butler,
| | - Susan D. Brown
- Department of Internal Medicine, School of Medicine, University of California, Davis, Sacramento, CA
| | | | - Brittany L. Smalls
- Department of Family and Community Medicine, University of Kentucky College of Medicine, Lexington, KY
| | - Amanda Terry
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
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3
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Garcia JF, Fogel J, Reid M, Bisno DI, Raymond JK. Telehealth for Young Adults With Diabetes: Addressing Social Determinants of Health. Diabetes Spectr 2021; 34:357-362. [PMID: 34866868 PMCID: PMC8603121 DOI: 10.2337/dsi21-0011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Type 1 diabetes is a challenging chronic condition and can lead to diabetes-related distress and disengagement. Historically disadvantaged, racially and ethnically diverse young adults (YAs) with type 1 diabetes experience higher blood glucose levels and encounter more barriers to care than their White counterparts. Current research shows that telehealth may provide a route for improving psychosocial issues and diabetes care among YAs.
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Affiliation(s)
- Jaquelin Flores Garcia
- Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA
- Corresponding author: Jaquelin Flores Garcia,
| | - Jennifer Fogel
- Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA
| | - Mark Reid
- Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA
| | - Daniel I. Bisno
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Jennifer K. Raymond
- Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA
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Helgeson VS, Naqvi JB, Korytkowski MT, Gary-Webb TL. A Closer Look at Racial Differences in Diabetes Outcomes Among a Community Sample: Diabetes Distress, Self-care, and HbA 1c. Diabetes Care 2021; 44:2487-2492. [PMID: 34475029 PMCID: PMC8546284 DOI: 10.2337/dc21-0734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 08/16/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Approximately 34 million people in the U.S. have diabetes. With this illness come substantial changes to psychological and physical health. However, type 2 diabetes disproportionately affects non-Hispanic Black compared with non-Hispanic White populations. The purpose of this study was to examine racial differences in psychological, behavioral, and physical health over time among individuals recently diagnosed with type 2 diabetes. RESEARCH DESIGN AND METHODS Data were collected from a community sample of 193 adults recently diagnosed with type 2 diabetes (44% female; 45% Black). Measures of distress, self-care behaviors, and HbA1c were taken at an initial interview (time 1) and 6 months later (time 2). Individuals wore an Actical accelerometer to assess physical activity and participated in three 24-h dietary recall interviews to assess dietary intake within 2 weeks of the initial interview. RESULTS From time 1 to time 2, Black women showed the highest increase in depressive symptoms. There was a greater increase in regimen and physician distress among White compared with Black participants. White men and Black women reported a decline in medication adherence over time. There were no racial differences in changes in physical activity across 6 months. However, Black individuals had higher overall calorie consumption with greater protein, saturated fat, and cholesterol intake than White individuals. There were no race or sex differences in changes in glycemic stability. CONCLUSIONS Initial adjustment to a diagnosis of type 2 diabetes differentially influences Black and White men and women in terms of depressive symptoms, diabetes distress, and self-care.
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Sadlon P, Charron-Prochownik D, Sullivan-Bolyai S. "Together We Can Return to Balance"-Eastern Woodlands Native Perspectives and Type 2 Diabetes: A Qualitative Study. DIABETES EDUCATOR 2020; 46:597-606. [PMID: 33126843 DOI: 10.1177/0145721720967631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To explore the perspectives of Eastern Woodlands Native people with type 2 diabetes (T2DM) in the context of health beliefs, T2DM disease self-management, and family and community connections. METHODS A qualitative descriptive method using face-to-face or telephonic semistructured interviews was employed with Native people ages 18 years or older who have a diagnosis of T2DM (N = 12) from an unidentified Eastern Woodlands tribe. The PEN-3 Cultural Model guided the study initially. RESULTS The overarching theme "together we can return to balance" corresponded to 5 subthemes: coming to know life paths with T2DM, acknowledging the imbalance, negotiating my way forward, making important connections, and sticking closer to Mother Earth. Dimensions within the subthemes suggest why Native people may not be reaching T2DM treatment goals. Reasons include incomplete diabetes knowledge, difficulty accessing resources, and contextual variations in adoption of conventional diabetes treatments. CONCLUSION This study identified themes from Native perspectives about T2DM self-management and about prospects that may mitigate incomplete knowledge and support. Integrating indigenous health and wellness knowledge with conventional principles of diabetes care presents several opportunities for nurses to advance diabetes self-management (DSM) education and support. Including Native health concepts when educating patients about DSM should be viewed as desirable for holistic family and community involvement that is central toward preventing disease progression.
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Affiliation(s)
- Penni Sadlon
- University of Massachusetts Medical School, Graduate School of Nursing, Worcester, Massachusetts
| | | | - Susan Sullivan-Bolyai
- University of Massachusetts Medical School, Graduate School of Nursing, Worcester, Massachusetts
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Fox LA, Pfeffer E, Stockman J, Shapiro S, Dully K. Medical Neglect in Children and Adolescents with Diabetes Mellitus. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2020; 13:259-269. [PMID: 33088382 PMCID: PMC7561625 DOI: 10.1007/s40653-018-0215-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Diabetes mellitus was a fatal disease for thousands of years, but the discovery of insulin in 1921 and major substantial improvements in care have made living with diabetes a chronic rather than fatal disease for many people, including children and adolescents. Diabetes mellitus is a lifestyle-altering diagnosis for the entire family. In some families, children and adolescents do not get the daily care they depend upon. This article reviews the consequences of medical neglect of children with diabetes and the optimal community response to concerns of medical neglect of diabetes. Criteria for placement in foster or substitute care are suggested.
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Affiliation(s)
- Larry A. Fox
- Northeast Florida Pediatric Diabetes Center, Jacksonville, FL USA
- Division of Endocrinology, Metabolism and Diabetes, Nemours Children’s Health System, Jacksonville, FL USA
| | - Erin Pfeffer
- Division of Endocrinology, Metabolism and Diabetes, Nemours Children’s Health System, Jacksonville, FL USA
| | | | - Sandra Shapiro
- Division of Forensic Pediatrics, First Coast Child Protection Team, University of Florida College of Medicine, 4539 Beach Boulevard, Jacksonville, FL 32207 USA
| | - Kathleen Dully
- Division of Forensic Pediatrics, First Coast Child Protection Team, University of Florida College of Medicine, 4539 Beach Boulevard, Jacksonville, FL 32207 USA
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7
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Abstract
OBJECTIVE The importance of physician training in communication skills for motivating patients to adopt a healthy life-style and optimize clinical outcomes is increasingly recognized. This study inventoried and systematically reviewed the psychometric properties of, and the skills assessed by, existing assessment tools used to evaluate communication skills among physicians. METHODS This review was conducted in accordance with the PRISMA guidelines (PROSPERO: CRD42018091932). Four databases (PUBMED, EMBASE, PsychINFO, and SCOPUS) were searched up to December 2018, generating 3902 unique articles, which were screened by two authors. A total of 57 articles met the inclusion criteria and underwent full data extraction. RESULTS Forty-five different assessment tools were identified. Only 47% of the studies mentioned underlying theories or models for designing the tool. Fifteen communication skills were assessed across the tools, the five most prevalent were information giving (46%) or gathering (40%), eliciting patients' perspectives (44%), planning/goal setting (37%), and closing the session (32%). Most tools (93%) assessed communication skills using in-person role play exercises with standardized (61%) or real (32%) patients, but only 54% described the expertise of the raters who performed the evaluations. Overall, reporting of the psychometric properties of the assessment tools was poor-moderate (4.5 ± 1.3 out of 9). CONCLUSIONS Despite identifying several existing physician communication assessment tools, a high degree of heterogeneity between these tools, in terms of skills assessed and study quality, was observed, and most have been poorly validated. Research is needed to rigorously develop and validate accessible, convenient, "user-friendly," and easy to administer and score communication assessment tools.
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Thornton PL, Kumanyika SK, Gregg EW, Araneta MR, Baskin ML, Chin MH, Crespo CJ, de Groot M, Garcia DO, Haire-Joshu D, Heisler M, Hill-Briggs F, Ladapo JA, Lindberg NM, Manson SM, Marrero DG, Peek ME, Shields AE, Tate DF, Mangione CM. New research directions on disparities in obesity and type 2 diabetes. Ann N Y Acad Sci 2019; 1461:5-24. [PMID: 31793006 DOI: 10.1111/nyas.14270] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 10/18/2019] [Indexed: 12/12/2022]
Abstract
Obesity and type 2 diabetes disproportionately impact U.S. racial and ethnic minority communities and low-income populations. Improvements in implementing efficacious interventions to reduce the incidence of type 2 diabetes are underway (i.e., the National Diabetes Prevention Program), but challenges in effectively scaling-up successful interventions and reaching at-risk populations remain. In October 2017, the National Institutes of Health convened a workshop to understand how to (1) address socioeconomic and other environmental conditions that perpetuate disparities in the burden of obesity and type 2 diabetes; (2) design effective prevention and treatment strategies that are accessible, feasible, culturally relevant, and acceptable to diverse population groups; and (3) achieve sustainable health improvement approaches in communities with the greatest burden of these diseases. Common features of guiding frameworks to understand and address disparities and promote health equity were described. Promising research directions were identified in numerous areas, including study design, methodology, and core metrics; program implementation and scalability; the integration of medical care and social services; strategies to enhance patient empowerment; and understanding and addressing the impact of psychosocial stress on disease onset and progression in addition to factors that support resiliency and health.
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Affiliation(s)
- Pamela L Thornton
- Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, Maryland
| | - Shiriki K Kumanyika
- Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Edward W Gregg
- Epidemiology and Statistics Branch, Division of Diabetes Translation, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Maria R Araneta
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Monica L Baskin
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Carlos J Crespo
- Oregon Health and Science University and Portland State University Joint School of Public Health, Portland, Oregon
| | - Mary de Groot
- Indiana University School of Medicine, Indianapolis, Indiana
| | - David O Garcia
- Department of Health Promotion Sciences, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona
| | - Debra Haire-Joshu
- Washington University in St. Louis, School of Medicine and the Brown School, St. Louis, Missouri
| | | | - Felicia Hill-Briggs
- Johns Hopkins School of Medicine and Welch Center for Prevention, Epidemiology & Clinical Research, Baltimore, Maryland
| | - Joseph A Ladapo
- David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California
| | | | | | | | | | - Alexandra E Shields
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute, Massachusetts General Hospital and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Deborah F Tate
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Carol M Mangione
- David Geffen School of Medicine at the University of California, and UCLA Fielding School of Public Health, Los Angeles, Los Angeles, California
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9
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Peña-Purcell N, Han G, Lee Smith M, Peterson R, Ory MG. Impact of Diabetes Self-Management Education on Psychological Distress and Health Outcomes Among African Americans and Hispanics/Latinos With Diabetes. Diabetes Spectr 2019; 32:368-377. [PMID: 31798295 PMCID: PMC6858074 DOI: 10.2337/ds18-0081] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Diabetes self-management education and support (DSME/S) is an effective strategy to improve health outcomes. However, little is known about the impact of formal DSME/S on psychological distress among minority populations. The study purposes were to 1) explore the impact of a culturally tailored DSME/S intervention on psychological distress and diabetes-related outcomes among African-American and Hispanic/Latino participants and 2) examine differences across groups in self-care, self-efficacy, diabetes knowledge, and psychological distress. METHODS Using a pre- and post-test research design, baseline and post-test assessments were conducted at weeks 1 and 7 of the intervention, respectively. Statistical analyses included descriptive statistics for demographic variables and four outcomes (self-care, self-efficacy, knowledge, and psychological distress score), general linear regression analysis of the post-test outcomes, and the Spearman correlation between psychological distress score and the outcomes. RESULTS Compared to African-American participants (n = 122), Hispanic/Latino participants (n = 137) were significantly younger and less educated. The two groups were comparable in sex, income, and health status. Significant pre- to post-test improvements were seen in each group for self-care, self-efficacy, and psychological distress. Diabetes knowledge had moderate improvement. Hispanics/Latinos had significantly greater post-test self-efficacy and self-care scores compared to African Americans. For both African-American and Hispanic/Latino participants, lower psychological distress scores were generally associated with greater self-efficacy and self-care. Psychological distress scores were not significantly associated with knowledge in African-Amerian or Hispanic/Latino participants. For African Americans only, better health status was significantly associated with less psychological distress. CONCLUSION DSME/S programs have the potential to improve psychological health among African Americans and Hispanics/Latinos, which can lead to better diabetes outcomes.
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Affiliation(s)
| | - Gang Han
- Texas A&M University, School of Public Health, College Station, TX
| | | | - Rick Peterson
- Texas A&M AgriLife Extension Service, College Station, TX
| | - Marcia G. Ory
- Texas A&M University, School of Public Health, College Station, TX
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10
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Hoogendoorn CJ, Shapira A, Roy JF, Walker EA, Cohen HW, Gonzalez JS. Depressive symptom dimensions and medication non-adherence in suboptimally controlled type 2 diabetes. J Diabetes Complications 2019; 33:217-222. [PMID: 30598369 PMCID: PMC6662178 DOI: 10.1016/j.jdiacomp.2018.12.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 11/02/2018] [Accepted: 12/01/2018] [Indexed: 11/25/2022]
Abstract
AIMS Research suggests differential effects for somatic and cognitive-affective depressive symptoms in predicting health outcomes. This study evaluated differential relations with medication non-adherence among disadvantaged, and predominantly immigrant adults with sub-optimally controlled type 2 diabetes (T2D). METHODS Health plan members taking oral diabetes medication and who had A1c ≥ 7.5% were recruited for a trial of telephonic self-management support. A subset (n = 376; age, M = 55.6 ± 7.2 years; A1c M = 9.1% ± 1.6) completed the Patient Health Questionnaire-8 (PHQ-8). Diabetes medication adherence was measured by self-report and claims-based records. Multivariable logistic regression modeled depressive symptoms and odds of non-adherence using pre-intervention data. RESULTS A positive PHQ-8 screen (OR = 2.72 [95%CI: 1.56-4.73]) and each standard deviation increase in PHQ-8 score (OR = 1.40 [95%CI: 1.11-1.75]) were associated with non-adherence, with no independent effects for somatic versus cognitive-affective symptoms. Exploration of individual symptoms identified three significantly associated with non-adherence in covariate-adjusted models; after adjustment for likely presence of clinical depression, only fatigue was independently associated with non-adherence (OR = 1.71 [95%CI: 1.06-2.77]). CONCLUSIONS Findings support depression symptom severity as a significant correlate of medication non-adherence among disadvantaged adults with T2D. Support was limited for differential associations for symptom dimensions, but findings suggest that fatigue may be associated with non-adherence independent of the likely presence of depression.
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Affiliation(s)
| | - Amit Shapira
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Juan F Roy
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Elizabeth A Walker
- Department of Medicine (Endocrinology), Albert Einstein College of Medicine, Bronx, NY, USA
| | - Hillel W Cohen
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jeffrey S Gonzalez
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA; Department of Medicine (Endocrinology), Albert Einstein College of Medicine, Bronx, NY, USA; The Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine, Bronx, NY, USA
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11
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Coser A, Sittner KJ, Walls ML, Handeland T. Caregiving Stress Among American Indians With Type 2 Diabetes: The Importance of Awareness of Connectedness and Family Support. JOURNAL OF FAMILY NURSING 2018; 24:621-639. [PMID: 30497320 PMCID: PMC6510027 DOI: 10.1177/1074840718810550] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
American Indian (AI) communities experience a disproportionate rate of Type 2 diabetes (T2D) and cumulative exposure to stress. Although this link is well researched among various populations, it has not been examined among AI communities. Path analysis was used to examine a multiple-mediator model to explain how caregiver stress influences self-reported mental and physical health among 100 AI participants with T2D. Caregiver stress was negatively associated with physical and mental health. Physical health was positively associated with family/community connectedness and mental health was positively associated with both family support and connectedness. The relationship between caregiver stress and mental health was partially mediated by family/community connectedness; caregiver stress had no indirect effects on physical health via either hypothesized mediator. Findings demonstrate the importance of integrating individuals' connection to family and community and its influence on caregiver stress and mental health in intervention programs targeting diabetes management and care among AI communities.
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Abstract
PURPOSE OF REVIEW This review summarizes the literature on care and outcome disparities in young adults (YA) with type 1 and type 2 diabetes, and outlines remaining needs and suggestions to reduce disparities and improve care. RECENT FINDINGS Despite well-documented disparities and data from large national and international diabetes populations, the role that social determinants of health play in disease management is largely unstudied. Further, mechanisms of how these risk factors interact with the unique developmental needs of racial-ethnic minority and economically vulnerable young adults with diabetes remain unknown. Little intervention research has focused on improving outcomes in this vulnerable population. More research needs to focus on identifying and addressing risk factors in racial-ethnic minority and economically vulnerable young adults with diabetes. Interventions need to be adapted and developed to meet the unique needs of this high-risk population. Clinicians and healthcare systems must recognize the inequity in care and outcomes for this group and structure clinical programs and policies to promote their optimal care.
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Affiliation(s)
- Shivani Agarwal
- Endocrinology, Diabetes, and Metabolism, University of Pennsylvania, Smilow Translational Research Center Room 12-142 3400 Civic Center Blvd., Philadelphia, PA, USA.
| | - Marisa Hilliard
- Baylor College of Medicine and Texas Children's Hospital, Feigin Tower 1102 Bates Ave., Suite 940, Houston, TX, 77030, USA
| | - Ashley Butler
- Baylor College of Medicine and Texas Children's Hospital, Feigin Tower 1102 Bates Ave., Suite 940, Houston, TX, 77030, USA
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13
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Emotional abilities and HbA1c levels in patients with type 1 diabetes. Psychoneuroendocrinology 2018; 93:118-123. [PMID: 29723781 DOI: 10.1016/j.psyneuen.2018.04.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 04/12/2018] [Accepted: 04/13/2018] [Indexed: 02/01/2023]
Abstract
In recent years a growing body of research is focused on the relationships between emotions and health. When it comes to diabetes, findings suggest that distress might play a key role in the acquisition and maintenance of health habits associated with diabetic management. This report describes two studies examining the roles of emotional abilities in diabetic management from two different conceptual points of view using two culturally different samples. In study 1, we examined the relationship between emotional intelligence and HbA1c levels in a sample of eighty-five patients with type 1 diabetes mellitus (DM1) in Israel. In study 2, we examined the relationship between specific emotional regulation strategies and HbA1c in sixty-seven adolescents with DM1, while examining the mediating role of distress in this association. The results showed a negative association between emotional intelligence and HbA1c levels, even after controlling for potential intervening factors. We found that the relationship between difficulties in emotion regulation and HbA1c seemed to be mediated by diabetes-related distress. These findings may aid in the design of psychological models for future research as well as interventions aimed at improving emotional abilities in people with DM1.
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Whitebird RR, Kreitzer MJ, Vazquez-Benitez G, Enstad CJ. Reducing diabetes distress and improving self-management with mindfulness. SOCIAL WORK IN HEALTH CARE 2018; 57:48-65. [PMID: 29064772 PMCID: PMC9083374 DOI: 10.1080/00981389.2017.1388898] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Stress associated with diabetes makes managing diabetes harder. We investigated whether mindfulness-based stress reduction (MBSR) could reduce diabetes distress and improve management. We recruited 38 participants to complete an MBSR program. Surveys and lab values were completed at baseline and post-intervention. Participants showed significant improvement in diabetes-related distress (Cohen's d -.71, p < .002), psychosocial self-efficacy (Cohen's d .80, p < .001), and glucose control (Cohen's d -.79, p < .001). Significant improvements in depression, anxiety, stress, coping, self-compassion, and social support were also found. These results suggest that MBSR may offer an effective method for helping people better self-manage their diabetes and improve mental health.
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Affiliation(s)
- Robin R. Whitebird
- School of Social Work, University of St Thomas, 2115 Summit Ave SCB #106, St Paul, MN 55105, 651-962-5867
| | - Mary Jo Kreitzer
- Center for Spiritualty & Healing, University of Minnesota, C510 Mayo Memorial Bldg., MMC 505, 420 Delaware Street SE, Minneapolis, MN 55455, 612-625-3977,
| | | | - Chris J. Enstad
- HealthPartners Institute, PO Box 1524, MS 21111R, Minneapolis, MN 55440-1524, 952-967-5007,
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15
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Gonzalez JS, Tanenbaum ML, Commissariat PV. Psychosocial factors in medication adherence and diabetes self-management: Implications for research and practice. ACTA ACUST UNITED AC 2017; 71:539-551. [PMID: 27690483 DOI: 10.1037/a0040388] [Citation(s) in RCA: 170] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Diabetes is a chronic illness that places a significant self-management burden on affected individuals and families. Given the importance of health behaviors-such as medication adherence, diet, physical activity, blood glucose self-monitoring-in achieving optimal glycemic control in diabetes, interventions designed and delivered by psychologists hold promise in assisting children, adolescents, and adults with diabetes in improving their health status and lowering their risk of serious complications. This article first provides an overview of diabetes self-management and associated challenges and burdens. Socioeconomic status factors that may influence diabetes management and outcomes are briefly highlighted. We then review the evidence base for select psychosocial factors that may be implicated in diabetes self-management. Modifiable targets of psychological intervention are presented across 3 overarching domains: (a) knowledge, beliefs, and related cognitive constructs; (b) emotional distress and well-being; and (c) behavioral skills and coping. Important methodological issues facing future research are discussed, along with opportunities for psychologists in improving the care and treatment outcomes of individuals and families living with diabetes. In conclusion, we advocate for continued research emphasis on improving psychosocial aspects of living with diabetes, with greater attention to the situational context in which the self-regulatory processes underlying self-management occur. Psychologists have important roles to play in reducing emotional distress, improving patient knowledge, and providing training in behavioral skills to promote successful self-management and to support patient-centered diabetes care. (PsycINFO Database Record
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Wagner JA, Bermudez-Millan A, Damio G, Segura-Perez S, Chhabra J, Vergara C, Feinn R, Perez-Escamilla R. A randomized, controlled trial of a stress management intervention for Latinos with type 2 diabetes delivered by community health workers: Outcomes for psychological wellbeing, glycemic control, and cortisol. Diabetes Res Clin Pract 2016; 120:162-70. [PMID: 27568646 PMCID: PMC5037043 DOI: 10.1016/j.diabres.2016.07.022] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 05/31/2016] [Accepted: 07/30/2016] [Indexed: 11/22/2022]
Abstract
AIMS To test the efficacy of a community health worker (CHW) delivered stress management (SM) intervention on psychosocial, glycemic, and cortisol outcomes among U.S. Latinos with type 2 diabetes. METHODS A randomized, controlled trial compared CHW-delivered diabetes education (DE; one group session) to DE plus CHW-delivered SM (DE+SM; 8 group sessions). Psychosocial variables and urinary cortisol were measured at baseline and posttreatment. HbA1c was measured at baseline, posttreatment, and 3-month follow-up. RESULTS In intent to treat analysis, compared to DE (n=46), DE+SM (n=61) showed significantly improved symptoms of depression, anxiety, and self-reported health status. There were no significant group effects for HbA1c, diabetes distress, or urinary cortisol. However, there was a dose response effect for HbA1c and diabetes distress; increasing attendance at SM sessions was associated with greater improvements in HbA1c and diabetes distress. CONCLUSIONS This is the first randomized, controlled trial demonstrating that CHWs can improve psychological symptoms and self-reported health among Latinos with type 2 diabetes. Efforts to increase intervention attendance may improve HbA1c and diabetes distress.
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Affiliation(s)
| | | | | | | | | | | | - Richard Feinn
- Quinnipiac University School of Medicine, Hamden, CT, USA
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Vallis M, Burns KK, Hollahan D, Ross S, Hahn J. Diabetes Attitudes, Wishes and Needs Second Study (DAWN2): Understanding Diabetes-Related Psychosocial Outcomes for Canadians with Diabetes. Can J Diabetes 2016; 40:234-41. [DOI: 10.1016/j.jcjd.2015.11.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/12/2015] [Accepted: 11/04/2015] [Indexed: 11/24/2022]
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White RO, Chakkalakal RJ, Presley CA, Bian A, Schildcrout JS, Wallston KA, Barto S, Kripalani S, Rothman R. Perceptions of Provider Communication Among Vulnerable Patients With Diabetes: Influences of Medical Mistrust and Health Literacy. JOURNAL OF HEALTH COMMUNICATION 2016; 21:127-134. [PMID: 27662442 PMCID: PMC5540358 DOI: 10.1080/10810730.2016.1207116] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Patient-provider communication is modifiable and is linked to diabetes outcomes. The association of communication quality with medical mistrust is unknown. We examined these factors within the context of a low-literacy/numeracy-focused intervention to improve diabetes care, using baseline data from diverse patients enrolled in a randomized trial of a health communication intervention. Demographics, measures of health communication (Communication Assessment Tool [CAT], Interpersonal Processes of Care survey [IPC-18]), health literacy (Short Test of Functional Health Literacy in Adults), depression, medical mistrust, and glycemic control were ascertained. Adjusted proportional odds models were used to test the association of mistrust with patient-reported communication quality. The interaction effect of health literacy on mistrust and communication quality was also assessed. A total of 410 patients were analyzed. High levels of mistrust were observed. In multivariable modeling, patients with higher mistrust had lower adjusted odds of reporting a higher CAT score (adjusted odds ratio [AOR] = 0.67, 95% confidence interval [CI] [0.52, 0.86], p = .003) and higher scores on the Communication (AOR = 0.69, 95% CI [0.55, 0.88], p = .008), Decided Together (AOR = 0.74, 95% CI [0.59, 0.93], p = .02), and Interpersonal Style (AOR = 0.69, 95% CI [0.53, 0.90], p = .015) subscales of the IPC-18. We observed evidence of an interaction effect of health literacy for the association between mistrust and the Decided Together subscale of the IPC-18 such that patients with higher mistrust and lower literacy perceived worse communication relative to mistrustful patients with higher literacy. In conclusion, medical mistrust was associated with poorer communication with providers in this public health setting. Patients' health literacy level may vary the effect of mistrust on interactional aspects of communication. Providers should consider the impact of mistrust on communication with vulnerable diabetes populations and focus efforts on mitigating its influence.
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Affiliation(s)
- Richard O. White
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Rosette J. Chakkalakal
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Caroline A. Presley
- School of Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Aihua Bian
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jonathan S. Schildcrout
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Shari Barto
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sunil Kripalani
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Russell Rothman
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Zeitler P, Hirst K, Copeland KC, El Ghormli L, Levitt Katz L, Levitsky LL, Linder B, McGuigan P, White NH, Wilfley D. HbA1c After a Short Period of Monotherapy With Metformin Identifies Durable Glycemic Control Among Adolescents With Type 2 Diabetes. Diabetes Care 2015; 38:2285-92. [PMID: 26537182 PMCID: PMC4657618 DOI: 10.2337/dc15-0848] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 09/07/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine whether clinically accessible parameters early in the course of youth-onset type 2 diabetes predict likelihood of durable control on oral therapy. RESEARCH DESIGN AND METHODS TODAY was a randomized clinical trial of adolescents with type 2 diabetes. Two groups, including participants from all three treatments, were defined for analysis: (1) those who remained in glycemic control for at least 48 months of follow-up and (2) those who lost glycemic control before 48 months. Outcome group was analyzed in univariate and multivariate models as a function of baseline characteristics (age, sex, race/ethnicity, socioeconomic status, BMI, waist circumference, Tanner stage, disease duration, depressive symptoms) and biochemical measures (HbA1c, C-peptide, lean and fat body mass, insulin inverse, insulinogenic index). Receiver operating characteristic curves were used to analyze HbA1c cut points. RESULTS In multivariate models including factors significant in univariate analysis, only HbA1c and insulinogenic index at randomization remained significant (P < 0.0001 and P = 0.0002, respectively). An HbA1c cutoff of 6.3% (45 mmol/mol) (positive likelihood ratio [PLR] 3.7) was identified that optimally distinguished the groups; sex-specific cutoffs were 6.3% (45 mmol/mol) for females (PLR 4.4) and 5.6% (38 mmol/mol) for males (PLR 2.1). CONCLUSIONS Identifying youth with type 2 diabetes at risk for rapid loss of glycemic control would allow more targeted therapy. HbA1c is a clinically accessible measure to identify high risk for loss of glycemic control on oral therapy. Adolescents with type 2 diabetes unable to attain a non-diabetes range HbA1c on metformin are at increased risk for rapid loss of glycemic control.
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Affiliation(s)
- Phil Zeitler
- Section of Endocrinology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Kathryn Hirst
- George Washington University Biostatistics Center, Rockville, MD
| | | | - Laure El Ghormli
- George Washington University Biostatistics Center, Rockville, MD
| | - Lorraine Levitt Katz
- Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Lynne L Levitsky
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Barbara Linder
- Division of Diabetes, Endocrinology and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Paul McGuigan
- Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH
| | - Neil H White
- Washington University School of Medicine, St. Louis, MO
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Chew BH, Mohd-Sidik S, Shariff-Ghazali S. Negative effects of diabetes-related distress on health-related quality of life: an evaluation among the adult patients with type 2 diabetes mellitus in three primary healthcare clinics in Malaysia. Health Qual Life Outcomes 2015; 13:187. [PMID: 26596372 PMCID: PMC4657278 DOI: 10.1186/s12955-015-0384-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 11/17/2015] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Patients with type 2 diabetes mellitus (T2D) often experienced change in life, altered self-esteem and increased feelings of uncertainty about the future that challenge their present existence and their perception of quality of life (QoL). There was a dearth of data on the association between diabetes-related distress (DRD) and health-related quality of life (HRQoL). This study examined the determinants of HRQoL, in particular the association between DRD and HRQoL by taking into account the socio-demographic-clinical variables, including depressive symptoms (DS) in adult patients with T2D. METHODS This cross-sectional study was conducted in 2012-2013 in three public health clinics in Malaysia. The World Health Organization Quality of Life-Brief (WHOQOL-BREF), 17-items Diabetes Distress Scale (DDS-17), and 9-items Patient Health Questionnaire (PHQ-9) were used to measure HRQoL, DRD and DS, respectively. The aim of this research was to examine the association between the socio-demographic-clinical variables and HRQoL as well as each of the WHOQOL-BREF domain score using multivariable regression analyses. RESULTS The response rate was 93.1% (700/752). The mean (SD) for age was 56.9 (10.18). The majority of the patients were female (52.8%), Malay (53.1%) and married (79.1%). About 60% of the patients had good overall HRQoL. The mean (SD) for Overall QoL, Physical QoL, Psychological QoL, Social Relationship QoL and Environmental QoL were 61.7 (9.86), 56.7 (10.64), 57.9 (11.73), 66.8 (15.01) and 65.3 (13.02), respectively. The mean (SD) for the total DDS-17 score was 37.1 (15.98), with 19.6% (136/694) had moderate distress. DDS-17 had a negative association with HRQoL but religiosity had a positive influence on HRQoL (B ranged between 3.07 and 4.76). Women, especially younger Malays, who had diabetes for a shorter period of time experienced better HRQoL. However, patients who were not married, had dyslipidaemia, higher levels of total cholesterol and higher PHQ-9 scores had lower HRQoL. Macrovascular complications showed the largest negative effect on the overall HRQoL (adjusted B = -4.98, 95% CI -8.56 to -1.40). CONCLUSION The majority of primary care adult with T2D had good overall HRQoL. Furthermore, the independent determinants for HRQoL had also concurred with many past studies. In addition, the researchers found that DRD had negative effects on HRQoL, but religiosity had positive influence on HRQoL. Appropriate support such as primary care is needed for adult patients with T2D to improve their life and their HRQoL. TRIAL REGISTRATION NMRR-12-1167-14158.
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Affiliation(s)
- Boon-How Chew
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia.
| | - Sherina Mohd-Sidik
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, 43400, Selangor, Malaysia.
| | - Sazlina Shariff-Ghazali
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia.
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Yilmaz-Aslan Y, Brzoska P, Bluhm M, Aslan A, Razum O. Illness perceptions in Turkish migrants with diabetes: a qualitative study. Chronic Illn 2014; 10:107-21. [PMID: 23986085 DOI: 10.1177/1742395313501207] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Illness perceptions are usually conceptualized using the self-regulatory model of illness. Although a few examinations of illness perceptions among Turkish language populations exist, the validity of the self-regulatory model of illness has never been confirmed for this population group. The aim of our study was to explore the validity of the self-regulatory model of illness in chronically ill Turkish migrants residing in Germany using diabetes mellitus type 2 as an example. METHODS Qualitative semi-structured interviews were conducted with 24 Turkish migrants with self-reported diabetes who were recruited through key persons. The core aspects of the qualitative data were extracted through a hermeneutic approach. Subsequently, a system of categories and sub-categories was developed by means of content analysis. RESULTS Seven distinct core dimensions of illness perceptions, each with a different number of sub-domains, could be identified in the sample. They comprised the perceived timeline of diabetes, its consequences, its causes, its controllability as well as the identity/coherence and the emotional response with respect to the condition. DISCUSSION As regards the conceptualization of illness perceptions, the dimensions identified are in line with the self-regulatory model of illness. Addressing illness perceptions through tailored interventions may contribute to improving health care and health outcomes in Turkish migrants.
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Affiliation(s)
- Yüce Yilmaz-Aslan
- 1Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
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Mitchell JA, Hawkins J. Current approaches to support the psychosocial care of African American adults with diabetes: a brief review. SOCIAL WORK IN PUBLIC HEALTH 2014; 29:518-527. [PMID: 25144694 PMCID: PMC4145410 DOI: 10.1080/19371918.2014.888533] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 01/24/2014] [Indexed: 06/03/2023]
Abstract
African Americans are disproportionately affected by Type 2 diabetes and experience significantly higher age-adjusted prevalence of the disease. Psychosocial support, material resources, and education can have a significant impact on successful diabetes management, particularly among populations with diabetes-related psychological distress such as African Americans. This brief review of the literature identifies and synthesizes current evidence on faith-based, community-based, empowerment-based, strength-based, and culturally competent strategies that may be particularly relevant for social work practitioners supporting African American adults at risk for or diagnosed with Type 2 diabetes. Discussion focuses on multiple influences on the self-determination of clients working to manage their condition.
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Affiliation(s)
- Jamie Ann Mitchell
- School of Social Work, Wayne State University, 337 Thompson Home, 4756 Cass Avenue, Detroit, MI 48202
| | - Jaclynn Hawkins
- School of Social Work, University of Michigan, 1080 S. University Avenue, Ann Arbor, MI 48109-1106
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Leiner M, Peinado J, Villanos MTM, Jimenez P. Assessment Disparities among Pediatric Patients: Advantages of Pictorial Descriptions. Front Pediatr 2013; 1:28. [PMID: 24400274 PMCID: PMC3864193 DOI: 10.3389/fped.2013.00028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 10/02/2013] [Indexed: 11/13/2022] Open
Affiliation(s)
- Marie Leiner
- Department of Pediatrics, Texas Tech University Health Sciences El Paso, TX, USA ; Department of Social Sciences and Administration, Universidad Autonoma de Ciudad Juarez, Ciudad Juarez Chihuahua, Mexico
| | - Jesus Peinado
- Department of Pediatrics, Texas Tech University Health Sciences El Paso, TX, USA
| | | | - Patricia Jimenez
- Department of Social Sciences and Administration, Universidad Autonoma de Ciudad Juarez, Ciudad Juarez Chihuahua, Mexico
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