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Hawley NL, Rivara AC, Naseri J, Faumuina K, Potoa’e-Solaita N, Iopu F, Faiai M, Naveno E, Tasele S, Lefale T, Lantini R, Carlson JC, Rabin TL, Semaia P, Mugadza P, Rosen RK. Protocol: Implementation and evaluation of an adolescent-mediated intervention to improve glycemic control and diabetes self-management among Samoan adults. PLoS One 2023; 18:e0279084. [PMID: 36795707 PMCID: PMC9934313 DOI: 10.1371/journal.pone.0279084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 11/25/2022] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Diagnoses of Type 2 Diabetes in the United States have more than doubled in the last two decades. One minority group at disproportionate risk are Pacific Islanders who face numerous barriers to prevention and self-care. To address the need for prevention and treatment in this group, and building on the family-centered culture, we will pilot test an adolescent-mediated intervention designed to improve the glycemic control and self-care practices of a paired adult family member with diagnosed diabetes. METHODS We will conduct a randomized controlled trial in American Samoa among n = 160 dyads (adolescent without diabetes, adult with diabetes). Adolescents will receive either a six-month diabetes intervention or a leadership and life skills-focused control curriculum. Aside from research assessments we will have no contact with the adults in the dyad who will proceed with their usual care. To test our hypothesis that adolescents will be effective conduits of diabetes knowledge and will support their paired adult in the adoption of self-care strategies, our primary efficacy outcomes will be adult glycemic control and cardiovascular risk factors (BMI, blood pressure, waist circumference). Secondarily, since we believe exposure to the intervention may encourage positive behavior change in the adolescent themselves, we will measure the same outcomes in adolescents. Outcomes will be measured at baseline, after active intervention (six months post-randomization) and at 12-months post-randomization to examine maintenance effects. To determine potential for sustainability and scale up, we will examine intervention acceptability, feasibility, fidelity, reach, and cost. DISCUSSION This study will explore Samoan adolescents' ability to act as agents of familial health behavior change. Intervention success would produce a scalable program with potential for replication in other family-centered ethnic minority groups across the US who are the ideal beneficiaries of innovations to reduce chronic disease risk and eliminate health disparities.
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Affiliation(s)
- Nicola L. Hawley
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America
- * E-mail:
| | - Anna C. Rivara
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America
| | - Joshua Naseri
- Obesity, Lifestyle and Genetic Adaptations Study Group, Pago Pago, American Samoa
| | - Kitiona Faumuina
- Obesity, Lifestyle and Genetic Adaptations Study Group, Pago Pago, American Samoa
| | | | - Francine Iopu
- Department of Public Health, Portland State University, Portland, OR, United States of America
| | - Mata’uitafa Faiai
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America
| | | | - Susie Tasele
- Obesity, Lifestyle and Genetic Adaptations Study Group, Pago Pago, American Samoa
| | - Temukisa Lefale
- Obesity, Lifestyle and Genetic Adaptations Study Group, Pago Pago, American Samoa
| | - Ryan Lantini
- Center for Behavioral and Preventative Medicine, The Miriam Hospital, Providence, RI, United States of America
| | - Jenna C. Carlson
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Tracy L. Rabin
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States of America
| | - Penny Semaia
- Athletic Department, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Phyllis Mugadza
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America
| | - Rochelle K. Rosen
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
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Gallegos ML, Segrin C. Family Connections and the Latino Health Paradox: Exploring the Mediating Role of Loneliness in the Relationships Between the Latina/o Cultural Value of Familism and Health. HEALTH COMMUNICATION 2022; 37:1204-1214. [PMID: 33853460 DOI: 10.1080/10410236.2021.1909244] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This study aims to understand Latina/o health from a social relationships perspective. Specifically, a major goal of the study is to explain how despite disadvantages (e.g., lower income and less education), Latinas/os in some cases have superior health compared to non-Latina/o whites, a phenomenon known as the Latino Health Paradox. Based on the central role of familial relationships in Latina/o culture, and utilizing Hawkley and Cacioppo's theoretical model of loneliness and health as a foundation for the study, the premise underlying this research is that the Latina/o cultural value of familism has a beneficial impact on health via reduced loneliness. Participants were 255 adults who identified as Latina/o (N = 139) or non-Latina/o white (N = 116), ranging in age from 19-88. Results indicate that being Latina/o predicted strong endorsement of familism, that predicted lower loneliness, and lower loneliness subsequently predicted better overall health, mental health, and health practices. These results suggest that the cultural value of familism provides health-related benefits for Latinas/os, which contributes to understanding the Latino health paradox. Results also underscore the value of including loneliness in studies examining the impact of cultural values on health, as only loneliness had statistically significant direct associations with all three health outcomes.
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Affiliation(s)
- Monica L Gallegos
- Department of Communication Studies, California State University, Northridge
| | - Chris Segrin
- Department of Communication, University of Arizona
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Laroche HH, Park-Mroch J, O'Shea A, Rice S, Cintron Y, Engebretsen B. Resource mobilization combined with motivational interviewing to promote healthy behaviors and healthy weight in low-income families: An intervention feasibility study. SAGE Open Med 2022; 10:20503121221102706. [PMID: 35707344 PMCID: PMC9189556 DOI: 10.1177/20503121221102706] [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: 05/14/2021] [Accepted: 05/05/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives: This non-randomized pilot trial examined the feasibility and acceptability of an intervention for low-income families with one parent with obesity, glucose intolerance and/or diabetes. Methods: The 12-month intervention combined health coaching using motivational interviewing to promote lifestyle behavior change and community resource mobilization to assist with basic needs plus diet quality and physical activity. Outcome measures included process measures, open-ended questions, and the Family Nutrition and Physical Activity scale. Results: Forty-five families completed an average of 2.1 health coach in-person visits, including 15 families lost to follow-up. Parents who stayed in the intervention reported the intervention was helpful. Some families and the health coach had difficulties contacting one another, and some of these families reported they would have liked more sessions with the coach. The Family Nutrition and Physical Activity scores improved significantly for all children (6 months: 2.9; p < .01; 12 months: 3.2; p < .05) and at 6 months for index children (6 months: 3.5; p < .01; 12 months: 2.9; p = .09). There was variation in the FNPA and other outcome changes between families. Conclusion: This intervention was feasible in terms of recruitment and delivery of family sessions and community referrals and acceptable to participants, but maintaining contact with participants was difficult. Findings warrant improvements to help retention and logistical aspects of communication between families and coaches and testing in a randomized, controlled trial.
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Affiliation(s)
- Helena H Laroche
- Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO, USA.,Children's Mercy Hospital and Clinics, Kansas City, MO, USA.,Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA.,Department of Internal Medicine, The University of Iowa, Iowa City, IA, USA
| | - Jennifer Park-Mroch
- Department of Internal Medicine, The University of Iowa, Iowa City, IA, USA.,Health & Well-Being, University of Wisconsin-Extension, Madison, WI, USA
| | - Amy O'Shea
- Department of Internal Medicine, The University of Iowa, Iowa City, IA, USA.,Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA, USA
| | - Sarai Rice
- Des Moines Area Religious Council (DMARC), Des Moines, IA, USA
| | - Yolanda Cintron
- Department of Internal Medicine, The University of Iowa, Iowa City, IA, USA
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All in the Family: A Qualitative Study of the Early Experiences of Adults with Younger Onset Type 2 Diabetes. J Am Board Fam Med 2022; 35:341-351. [PMID: 35379721 PMCID: PMC9605685 DOI: 10.3122/jabfm.2022.02.210223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/19/2021] [Accepted: 10/05/2021] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Adults with type 2 diabetes diagnosed at a younger age are at increased risk for poor outcomes. We examined life stage-related facilitators and barriers to early self-management among younger adults with newly diagnosed type 2 diabetes. RESEARCH DESIGN AND METHODS We conducted 6 focus groups that each met twice between November 2017 and May 2018. Participants (n = 41) were aged 21 to 44 years and diagnosed with type 2 diabetes during the prior 2 years. Transcripts were coded using thematic analysis and themes were mapped to the Capability-Opportunity-Motivation-Behavior framework. RESULTS Participants were 38.4 (±5.8) years old; 10 self-identified as Latinx, 12 as Black, 12 as White, and 7 as multiple or other races. We identified 9 themes that fell into 2 categories: (1) the impact of having an adult family member with diabetes, and (2) the role of nonadult children. Family members with diabetes served as both positive and negative role models, and, for some, personal familiarity with the disease made adjusting to the diagnosis easier. Children facilitated their parents' self-management by supporting self-management activities and motivating their parents to remain healthy. However, the stress and time demands resulting from parental responsibilities and the tendency to prioritize children's needs were perceived as barriers to self-management. CONCLUSIONS Our results highlight how the life position of younger-onset individuals with type 2 diabetes influences their early experiences. Proactively addressing perceived barriers to and facilitators of self-management in the context of family history and parenthood may aid in efforts to support these high-risk, younger patients.
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A randomized controlled trial of a community-based obesity intervention utilizing motivational interviewing and community resource mobilization for low-income families: Study protocol and baseline characteristics. Contemp Clin Trials 2022; 112:106626. [PMID: 34801731 PMCID: PMC8805455 DOI: 10.1016/j.cct.2021.106626] [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: 05/09/2021] [Revised: 10/21/2021] [Accepted: 11/11/2021] [Indexed: 01/03/2023]
Abstract
Low-income, racially diverse families with one parent with obesity are at high risk for child obesity. Effective approaches to promote healthy behaviors and prevent additional weight gain in family members are needed. Motivational interviewing (MI) may assist families to engage, identify motivations for change and establish goals. However, families with limited resources face other barriers to goal achievement that may be addressed through connection with community organizations. This paper describes a unique protocol combining MI and community connection. This randomized controlled trial includes low-income families with one parent with obesity and at least one child aged 6 to 12 years. Families in the intervention group receive an innovative, 12-month intervention combining health coaching using MI to promote lifestyle behavior change goals and community resource mobilization to assist with basic needs and resources to aid goals. The study protocol is modeled on community-based participatory research principles. Data is collected at baseline, 6 months, 12 months, and 18 months include questionnaires, body measurements, and accelerometer data. For adults, primary outcomes are Body Mass Index (BMI), minutes of moderate to vigorous physical activity (MVPA), and hours of sedentary time per day. For children, primary outcomes are sedentary time, MVPA, and the Family Nutrition and Physical Activity Score. From this hard-to-reach population, 236 diverse families were recruited. If the study is deemed effective, it has the potential to demonstrate that the combination of MI, resource mobilization, and utilization of existing community organizations is a sustainable model to assist families at risk for obesity.
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Vaccaro JA, Gaillard TR, Marsilli RL. Review and Implications of Intergenerational Communication and Social Support in Chronic Disease Care and Participation in Health Research of Low-Income, Minority Older Adults in the United States. Front Public Health 2021; 9:769731. [PMID: 35004581 PMCID: PMC8728749 DOI: 10.3389/fpubh.2021.769731] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/15/2021] [Indexed: 12/15/2022] Open
Abstract
Background: Health disparities disproportionally affect Black and Hispanic older US adults. Health research is needed to understand and eliminate these disparities; however, older adults, and particularly Black and Hispanic/Latino older adults are underrepresented in health research. Adult children have influenced health behavior and health outcomes of their older parents in several demographics in the US. Analysis of these studies can lead to a model for the development of interventions aimed at improving health and healthcare participation of older Black and Hispanic US adults. Objectives: To review the role of intergenerational communication and social support in health behavior, health research, and health outcomes for older adults and to apply these findings toward a model for health interventions for Black and Hispanic US older adults. Methods: An analytical narrative review and application toward an intervention model. Results: Key topic areas were reviewed and analyzed by examining studies that applied forms of intergenerational communication and/or intergenerational social support with the goal of either improving health, disease management and/or participation in health research in populations world-wide. Next, a model for providing health interventions in older Black and Hispanic US adults was developed using strategies gleaned from the findings. Conclusion: A model for health intervention for Black and Hispanic/Latino US older adults was presented based on an analytical review and intergenerational communication and/or social support. Qualitative data are necessary to understand the enablers and barriers of intergenerational communication and social support to improve health outcomes in these populations.
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Affiliation(s)
- Joan A. Vaccaro
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, United States
| | - Trudy R. Gaillard
- Nichole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, FL, United States,*Correspondence: Trudy R. Gaillard
| | - Ramces L. Marsilli
- Information and Research Service, Library Operations, Florida International University, Miami, FL, United States
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Smith-Miller CA, Berry DC, Miller CT. Gender Differences and Their Influences on T2DM Self-Management Among Spanish-Speaking Latinx Immigrants. HISPANIC HEALTH CARE INTERNATIONAL 2021; 20:44-55. [PMID: 33906459 DOI: 10.1177/15404153211011727] [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: 11/16/2022]
Abstract
INTRODUCTION Evidence suggests that gender may influence many aspects of type 2 diabetes (T2DM) self-management (SM) and we posit that limited English language-proficient Latinx immigrants face additional challenges. METHODS Instruments and semi-structured interviews were used to examine gender differences on health literacy, diabetes knowledge, health-promoting behaviors, diabetes, eating and exercise self-efficacy (SE), and T2DM SM practices among a cohort of limited English language-proficient Latinx immigrants. Statistical and qualitative analysis procedures were performed comparing males and females. RESULTS Thirty persons participated. Males tended to be older, have higher educational achievement, and more financial security than females. Physiologic measures tended worse among female participants. Health literacy and exercise SE scores were similar, but females scored lower on Eating and Diabetes SE. Forty-seven percent (n= 9) of the women reported a history of gestational diabetes mellitus and a majority of men (n = 7) cited difficulty with excessive alcohol. CONSUMPTION Males appeared to receive more SM support compared to females. Females more frequently noted how family obligations and a lack of support impeded their SM. Work environments negatively influenced SM practices. CONCLUSION Men and women have unique SM challenges and as such require individualized strategies and support to improve T2DM management.
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Affiliation(s)
- Cheryl A Smith-Miller
- UNC Medical Center, Nursing Quality and Research, Chapel Hill, NC, USA.,Office of Human Research Ethics, University of North Carolina-Chapel Hill, NC, USA.,School of Nursing, University of North Carolina-Chapel Hill, NC, USA
| | - Diane C Berry
- Co-Director Interventions for Preventing and Managing Chronic Illness (T32-NIH/NINR); Optimizing Outcomes in Women with Gestational Diabetes and their Infants (NIH/NIDDK); Diabetes Group Visits (Kate B. Reynolds), School of Nursing, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Cass T Miller
- Environmental Sciences and Engineering, UNC Gillings School of Global Public Health, University of North Carolina-Chapel Hill, NC, USA
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Krall J, Helgeson VS, Tracy EL, Campbell MS, Korytkowski M, Berg CA. Perspectives of Parents With Type 1 Diabetes: Role of Children in Self-Management and Support. DIABETES EDUCATOR 2020; 46:552-558. [PMID: 33063626 DOI: 10.1177/0145721720964598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE The purpose of this study was to examine parents' perceptions of the role children play in their type 1 diabetes (T1DM) care. Family members are a resource to support T1DM self-management, but how children are involved in their parents' diabetes has not been well explored. METHODS Parents with T1DM (n = 85) and a subset of their romantic partners (n = 55) participated in interviews during which they described their children's knowledge of and involvement in diabetes care. Interviews were transcribed, responses coded/tallied, and themes identified. RESULTS All parents reported that children knew of their diabetes, which they learned about progressively from a young age. Most parents reported children to be accepting and understanding of the ways that diabetes affected their family experiences (eg, pause to treat low blood glucose). When asked about specific support, parents rated "making parent feel better about diabetes" as the most frequently occurring behavior. Some parents felt that children, particularly younger ones, occasionally detracted from T1DM management, but this was usually expected and considered transient. Regardless of child age, many parents did not want diabetes to burden children and limited their involvement. Both parents with T1DM and partners requested resources to enhance child awareness and preparedness to support diabetes. Respondents, particularly partners, were also interested in learning how to communicate better as a family and share perspectives on how diabetes affects individual family members. CONCLUSIONS Diabetes care and education specialists should consider developmentally and relationally appropriate ways to engage children of parents with T1DM in education and self-management.
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Affiliation(s)
- Jodi Krall
- University of Pittsburgh Diabetes Institute, Pittsburgh, Pennsylvania
| | - Vicki S Helgeson
- Psychology Department, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - Eunjin Lee Tracy
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Mary Korytkowski
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Cynthia A Berg
- Department of Psychology, University of Utah, Salt Lake City, Utah
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Bramante CT, Thornton RLJ, Pilla SJ, Maruthur NM, Venkataramani M, Clark JM. Parents lose less weight than nonparents in an intensive lifestyle intervention. Obes Sci Pract 2020; 6:494-506. [PMID: 33082991 PMCID: PMC7556428 DOI: 10.1002/osp4.436] [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] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 05/19/2020] [Accepted: 05/24/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Understand whether parents lose less weight than nonparents in behavioural weight interventions. METHODS The Look AHEAD (Action for Health in Diabetes) trial randomized adults with Type 2 diabetes and overweight to an intensive lifestyle intervention (ILI) or control (diabetes support and education [DSE]). Participants who reported living with a child under age 18 were designated as 'parents' for this analysis. Intention to treat analysis was performed of the effect of the ILI on change in weight at 1 year by parental status. Adherence to attending intervention visits was compared between parents and nonparents. Subgroup analyses were done based on previous subgroup findings in the Look AHEAD study. RESULTS Among 4,547 participants, 15% were parents. Parents were younger and more likely to have self-identified as African American or Hispanic/Latino. Comparing ILI with DSE, parents lost less weight than nonparents (-7.1% vs. -8.3%, p = 0.021). African American female parents lost 4% body weight compared with 7% in African American female nonparents (p = 0.01). CONCLUSIONS In a randomized trial, parents lost less weight than nonparents, and this difference was largest for African American women. These findings suggest parents face unique challenges achieving weight loss; more research is needed to understand and optimize interventions for parents.
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Affiliation(s)
- Carolyn T. Bramante
- Division of General Internal Medicine, Department of MedicineUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Rachel L. J. Thornton
- Division of General Pediatrics and Adolescent Medicine, Department of PediatricsJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Department of Health, Behavior, and SocietyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Johns Hopkins School of Public Health, Center for Health EquityBaltimoreMarylandUSA
- Welch Center for Prevention, Epidemiology, and Clinical ResearchJohns Hopkins Medical InstitutionsBaltimoreMarylandUSA
| | - Scott J. Pilla
- Division of General Internal Medicine, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Nisa M. Maruthur
- Welch Center for Prevention, Epidemiology, and Clinical ResearchJohns Hopkins Medical InstitutionsBaltimoreMarylandUSA
- Division of General Internal Medicine, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Maya Venkataramani
- Division of General Internal Medicine, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Jeanne M. Clark
- Welch Center for Prevention, Epidemiology, and Clinical ResearchJohns Hopkins Medical InstitutionsBaltimoreMarylandUSA
- Division of General Internal Medicine, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
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Landi G, Andreozzi MS, Pakenham KI, Grandi S, Tossani E. Psychosocial adjustment of young offspring in the context of parental type 1 and type 2 diabetes: a systematic review. Diabet Med 2020; 37:1103-1113. [PMID: 32043620 DOI: 10.1111/dme.14271] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/08/2020] [Indexed: 12/26/2022]
Abstract
AIMS To identify all available research on psychosocial outcomes in young people who have a parent with type 1 or type 2 diabetes. METHODS Embase, PsychInfo, Scopus, Web of Science, PubMed and ProQuest Social Sciences databases were searched according to a registered study protocol (PROSPERO CRD42019125301). Quality assessment, data extraction and data synthesis were carried out. RESULTS The initial search yielded 11 599 articles, 10 of which met the criteria for this review: six for type 1 diabetes and four for type 2 diabetes. Through thematic analysis, five categories emerged related to offspring psychosocial adjustment: offspring mental health, offspring physical health, offspring personal resources, parental illness characteristics and offspring caregiving. Overall, there were few studies focusing solely on the effects of parental type 1 and type 2 diabetes on young people. From the limited available research, there is weak evidence suggesting both parental types of diabetes can adversely impact young offspring. Illness-related variables were only explored in parental type 1 diabetes studies, while offspring caregiving was only examined in parental type 2 diabetes studies. CONCLUSIONS Research on the effects of parental diabetes on young people is scarce; however, there was weak evidence to suggest some young people are at risk of adverse psychosocial impacts. Given the rise in the incidence of diabetes globally, there is a pressing public health need to conduct more rigorously designed studies to ascertain the extent to which young people are at risk of mental and physical health problems and to identify risk and protective factors associated with youth adjustment in the context of parental diabetes.
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Affiliation(s)
- G Landi
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy
| | - M S Andreozzi
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy
| | - K I Pakenham
- School of Psychology, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - S Grandi
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy
| | - E Tossani
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy
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Zhen-Duan J, Engebretsen B, Laroche HH. Diet and physical activity changes among low-income families: perspectives of mothers and their children. Int J Qual Stud Health Well-being 2019; 14:1658700. [PMID: 31452465 PMCID: PMC6720015 DOI: 10.1080/17482631.2019.1658700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2019] [Indexed: 10/28/2022] Open
Abstract
Purpose: The current study explored how mothers and their children influence each other's diet and physical activity. Methods: We conducted semi-structured interviews with women with diabetes and their children (N = 18) from eight low-income families. Results: Two approaches to changes emerged: collaborative and non-collaborative. Families using collaborative approaches believed they could sustain positive changes through accepting family changes, encouragement, abstaining from buying certain foods, modelling and compromise. Within families using non-collaborative approaches, some challenges included using more individualistic approaches and poor communication. Lack of information and resource constraints challenged all families. Conclusion: Interventions should reinforce family collaborative approaches and teach skills for families to work together towards a healthier lifestyle.
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Affiliation(s)
- Jenny Zhen-Duan
- Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
| | | | - Helena H. Laroche
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
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12
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Kiryu I, Sato Y. Does health guidance concerning lifestyle disease prevention spread to spouses? A qualitative study. J Clin Nurs 2019; 28:4332-4341. [PMID: 31325333 DOI: 10.1111/jocn.15000] [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: 03/13/2019] [Revised: 06/18/2019] [Accepted: 06/30/2019] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To describe how a health guidance programme provided to one person influences change in their spouse's health behaviours. BACKGROUND Individuals are indirectly affected by the health behaviours of those close to them; therefore, it is likely that guidance on the prevention of lifestyle disease modifies the behaviour of targeted individuals and their family members. In a previous study, approximately 30% of families displayed positive health changes because one individual family member received health guidance. DESIGN This study used an inductive, exploratory, qualitative design. METHODS Semi-structured interviews were conducted with spouses of persons who participated in a health guidance programme for lifestyle-related disease prevention. Data were analysed from 11 spouses (all women; Mage = 61.0 ± 9.1 years) using a modified grounded theory approach. This study was conducted according to the consolidated criteria for reporting qualitative research (COREQ; see Appendix S1). RESULTS The process of change in each spouse was a result of their partner's influence, which changed from a stage of assisting, where the spouse contemplated {I am just a supporter} to the partner, to a stage where the spouse thought {I am also a player}, and she engaged in her own health improvement practices. CONCLUSIONS For a spouse to change from assisting their partner to becoming a practitioner of their own health improvement, the spouse needed to experience a sense of surprise at the changes in her partner, through calm observation of the partner's attitude. Through the spreading effect of health guidance utilisation, indirect encouragement could be expected, even when people have difficulty accessing healthcare services. RELEVANCE TO CLINICAL PRACTICE This type of spreading effect from one participant to a family member could perhaps assist health guidance provisions so that disease prevention becomes more efficient.
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Affiliation(s)
- Ikue Kiryu
- Graduate School of Health Sciences, Gunma University, Gunma, Japan
| | - Yumi Sato
- Graduate School of Health Sciences, Gunma University, Gunma, Japan
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Harrison BL, Ogara C, Gladstone M, Carrol ED, Dusabe-Richards J, Medina-Lara A, Ditai J, Weeks AD. "We have to clean ourselves to ensure that our children are healthy and beautiful": findings from a qualitative assessment of a hand hygiene poster in rural Uganda. BMC Public Health 2019; 19:1. [PMID: 30606151 PMCID: PMC6318918 DOI: 10.1186/s12889-018-6343-3] [Citation(s) in RCA: 317] [Impact Index Per Article: 63.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 12/19/2018] [Indexed: 11/10/2022] Open
Abstract
Background Neonatal sepsis is a major cause of mortality worldwide, with most deaths occurring in low-income countries. The World Health Organisation (WHO) ‘5 Moments for Hand Hygiene’ poster has been used to reduce hospital-acquired infections, but there is no similar tool to prevent community-acquired newborn infections in low-resource settings. This assessment, part of the BabyGel Pilot study, evaluated the acceptability of the ‘Newborn Moments for Hand Hygiene in the Home’ poster. This was an educational tool which aimed to remind mothers in rural Uganda to clean their hands to prevent neonatal infection. Methods The BabyGel pilot was a cluster randomised trial that assessed the post-partum use of alcohol-based hand rub (ABHR) to prevent neonatal infections in Mbale, Uganda. Fifty-five women in 5 village clusters received the ABHR and used it from birth to 3 months postnatally, with use guided by the new poster. Following the study, 5 focus group discussions (FGDs) were conducted consisting of 6–8 purposively sampled participants from intervention villages. FGDs were audio-recorded, transcribed then translated into English. Transcripts were inductively coded using ATLAS.ti® and qualitatively analysed using thematic content analysis. Results Most mothers reported that they understood the message in the poster (“The picture shows me you must use these drugs to keep your baby healthy”) and that they could adhere to the moments from the poster. Some participants used the information from the poster to encourage other caregivers to use the ABHR (“after explaining to them, they liked it”). Other potential moments for hand hygiene were introduced by participants, such as after tending to domestic animals and gardening. Conclusion The poster was well-received, and participants reported compliance with the moments for hand hygiene (although the full body wipe of the baby has since been removed). The poster will be adapted into a sticker format on the ABHR bottle. More focus could be put into an education tool for other caregivers who wish to hold the baby. Overall, the study demonstrated the acceptability of an adapted version of the WHO Moments for Hand Hygiene poster in the introduction of an intervention in the community. Trial registration ISRCTN67852437, registered 02/03/2015. Trial funding Medical Research Council/ Wellcome Trust/ DfID (Global Health Trials Scheme).
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Affiliation(s)
- B L Harrison
- Sanyu Research Unit, Department of Women's and Children's Health, University of Liverpool, Liverpool, UK.
| | - C Ogara
- Sanyu Africa Research Institute (SAfRI), Mbale, Uganda
| | - M Gladstone
- Sanyu Research Unit, Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - E D Carrol
- Institute of Infection and Global Health, University of Liverpool, Mbale, Uganda
| | | | | | - J Ditai
- Sanyu Research Unit, Department of Women's and Children's Health, University of Liverpool, Liverpool, UK.,Sanyu Africa Research Institute (SAfRI), Mbale, Uganda.,Busitema University Faculty of Health Sciences, Tororo, Uganda
| | - A D Weeks
- Sanyu Research Unit, Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
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Thornton RLJ, Yang TJ, Ephraim PL, Boulware LE, Cooper LA. Understanding Family-Level Effects of Adult Chronic Disease Management Programs: Perceived Influences of Behavior Change on Adolescent Family Members' Health Behaviors Among Low-Income African Americans With Uncontrolled Hypertensions. Front Pediatr 2018; 6:386. [PMID: 30687684 PMCID: PMC6335327 DOI: 10.3389/fped.2018.00386] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 11/21/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Despite improvements in cardiovascular disease (CVD) prevention and treatment, low-income African Americans experience disparities in CVD-related morbidity and mortality. Childhood obesity disparities and poor diet and physical activity behaviors contribute to CVD disparities throughout the life course. Given the potential for intergenerational transmission of CVD risk, it is important to determine whether adult disease management interventions could be modified to achieve family-level benefits and improve primary prevention among high-risk youth. Objective: To explore mechanisms by which African-American adults' (referred to as index patients) participation in a hypertension disease management trial influences adolescent family members' (referred to as adolescents) lifestyle behaviors. Design/Methods: The study recruited index patients from the Achieving blood pressure Control Together (ACT) study who reported living with an adolescent ages 12-17 years old. Index patients and adolescents were recruited for in-depth interviews and were asked about any family-level changes to diet and physical activity behaviors during or after participation in the ACT study. If family-level changes were described, index patients and adolescents were asked whether role modeling, changes in the home food environment, meal preparation, and family functioning contributed to these changes. These mechanisms were hypothesize to be important based on existing research suggesting that parental involvement in childhood obesity interventions influences child and adolescent weight status. Thematic content analysis of transcribed interviews identified both a priori and emergent themes. Results: Eleven index patients and their adolescents participated in in-depth interviews. Index patients and adolescents both described changes to the home food environment and meal preparation. Role modeling was salient to index patients, particularly regarding healthy eating behaviors. Changes in family functioning due to study participation were not endorsed by index patients or adolescents. Emergent themes included adolescent care-taking of index patients and varying perceptions by index patients of their influence on adolescents' health behaviors. Conclusions: Our findings suggest that disease management interventions directed at high-risk adult populations may influence adolescent family members' health behaviors. We find support for the hypotheses that role modeling and changes to the home food environment are mechanisms by which family-level health behavior change occurs. Adolescents' roles as caretakers for index patients emerged as another potential mechanism. Future research should explore these mechanisms and ways to leverage disease management to support both adult and adolescent health behavior change.
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Affiliation(s)
- Rachel L J Thornton
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, United States.,Johns Hopkins Center for Health Equity, Baltimore, MD, United States.,Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.,Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD, United States
| | - Tracy J Yang
- New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY, United States
| | - Patti L Ephraim
- Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.,Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - L Ebony Boulware
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Lisa A Cooper
- Johns Hopkins Center for Health Equity, Baltimore, MD, United States.,Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.,Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD, United States.,Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
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15
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Reyes J, Tripp-Reimer T, Parker E, Muller B, Laroche H. Factors Influencing Diabetes Self-Management Among Medically Underserved Patients With Type II Diabetes. Glob Qual Nurs Res 2017; 4:2333393617713097. [PMID: 28660239 PMCID: PMC5476324 DOI: 10.1177/2333393617713097] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 04/24/2017] [Accepted: 05/01/2017] [Indexed: 11/26/2022] Open
Abstract
In this study, researchers compare and contrast issues regarding diabetes self-management between persons in good versus poor glycemic control. The sample comprises low-income racially diverse adults with diabetes from four mid-western community health centers; 44 patients participated in eight focus groups divided by control status (HbA1c of > 9 [uncontrolled] or < 7 [controlled]). Themes common to both groups included the impact of dietary restrictions on social interactions, food cravings, the impact of mental health on self-management, and the importance of formal and informal (friends and family) support. Those in the uncontrolled groups described fear about being able to control their diabetes, confusion about self-management, and difficulty managing their diabetes while caring for family members. Although those in the controlled groups acknowledged difficulties, they discussed resisting cravings, making improvements with small changes, positive feelings about their ability to control their diabetes, and enjoying new foods and exercise. Interventions should include mental health support, incorporate formal and informal patient support structures, and address literacy issues. Health care providers and intervention personnel should be very concrete about how to do self-management tasks and guide patients on how to alter their diabetes regimens for social and other important life events.
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Affiliation(s)
- Jimmy Reyes
- Iowa Board of Nursing, Des Moines, Iowa, USA
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16
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Gittelsohn J, Jock B, Redmond L, Fleischhacker S, Eckmann T, Bleich SN, Loh H, Ogburn E, Gadhoke P, Swartz J, Pardilla M, Caballero B. OPREVENT2: Design of a multi-institutional intervention for obesity control and prevention for American Indian adults. BMC Public Health 2017; 17:105. [PMID: 28114926 PMCID: PMC5260044 DOI: 10.1186/s12889-017-4018-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 01/07/2017] [Indexed: 11/25/2022] Open
Abstract
Background Obesity and other nutrition-related chronic disease rates are high in American Indian (AI) populations, and an urgent need exists to identify evidence-based strategies for prevention and treatment. Multi-level, multi-component (MLMC) interventions are needed, but there are significant knowledge gaps on how to deliver these types of interventions in low-income rural AI communities. Methods OPREVENT2 is a MLMC intervention targeting AI adults living in six rural reservations in New Mexico and Wisconsin. Aiming to prevent and reduce obesity in adults by working at multiple levels of the food and physical activity (PA) environments, OPREVENT2 focuses on evidence-based strategies known to increase access to, demand for, and consumption of healthier foods and beverages, and increase worksite and home-based opportunities for PA. OPREVENT2 works to create systems-level change by partnering with tribal stakeholders, multiple levels of the food and PA environment (food stores, worksites, schools), and the social environment (children as change agents, families, social media). Extensive evaluation will be conducted at each level of the intervention to assess effectiveness via process and impact measures. Discussion Novel aspects of OPREVENT2 include: active engagement with stakeholders at many levels (policy, institutional, and at multiple levels of the food and PA system); use of community-based strategies to engage policymakers and other key stakeholders (community workshops, action committees); emphasis on both the built environment (intervening with retail food sources) and the social environment. This paper describes the design of the intervention and the evaluation plan of the OPREVENT2. Trial registration Clinical Trial Registration: NCT02803853 (June 10, 2016)
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Affiliation(s)
- Joel Gittelsohn
- Johns Hopkins University, Bloomberg School of Public Health, 615 N. Wolfe St. Suite W2041, Baltimore, MD, 21205, USA.
| | - Brittany Jock
- Johns Hopkins University, Bloomberg School of Public Health, 615 N. Wolfe St. Suite W2041, Baltimore, MD, 21205, USA
| | - Leslie Redmond
- Johns Hopkins University, Bloomberg School of Public Health, 615 N. Wolfe St. Suite W2041, Baltimore, MD, 21205, USA
| | - Sheila Fleischhacker
- National Institute of Diabetes, Digestive and Kidney Diseases Office of Nutrition Research, Bethesda, USA
| | - Thomas Eckmann
- Johns Hopkins University, Bloomberg School of Public Health, 615 N. Wolfe St. Suite W2041, Baltimore, MD, 21205, USA
| | - Sara N Bleich
- Harvard T.H. Chan School of Public Health, Boston, USA
| | - Hong Loh
- Johns Hopkins University, Bloomberg School of Public Health, 615 N. Wolfe St. Suite W2041, Baltimore, MD, 21205, USA
| | - Elizabeth Ogburn
- Johns Hopkins University, Bloomberg School of Public Health, 615 N. Wolfe St. Suite W2041, Baltimore, MD, 21205, USA
| | | | - Jacqueline Swartz
- Johns Hopkins University, Bloomberg School of Public Health, 615 N. Wolfe St. Suite W2041, Baltimore, MD, 21205, USA
| | - Marla Pardilla
- Johns Hopkins University, Bloomberg School of Public Health, 615 N. Wolfe St. Suite W2041, Baltimore, MD, 21205, USA
| | - Benjamin Caballero
- Johns Hopkins University, Bloomberg School of Public Health, 615 N. Wolfe St. Suite W2041, Baltimore, MD, 21205, USA
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17
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Sadeghian HA, Madhu SV, Agrawal K, Kannan AT, Agrawal K. Effects of a self-management educational program on metabolic control in type 2 diabetes. Turk J Med Sci 2016; 46:719-26. [PMID: 27513247 DOI: 10.3906/sag-1501-115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 07/27/2015] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM India has 63 million diabetic people and the overall prevalence of diabetes in this country is 8.37%. Lifestyle modification by education is the most cost-effective strategy to have better metabolic control. The aim of this study was to investigate the effects of a self-management educational program on control of type 2 diabetes. MATERIALS AND METHODS It was a randomized controlled interventional study conducted among 306 patients with type 2 diabetes mellitus attending the Diabetic Clinic at G.T.B. Hospital, Delhi, from March 2010 to May 2013. The intervention was in the form of group education based on a self-management program, which was earlier developed in the pilot study. RESULTS The baseline characteristics were comparable in the two groups. After 6 months, there was a significant improvement in the HbA1c levels (P = 0.0001), physical activity level (P = 0.001), and BMI (P = 0.001) in the study group as compared to the control group and this difference persisted even when analysis was done using generalized estimation equations. CONCLUSION The findings of this study proved that a self-management educational program is an essential component in the management of diabetes and provided concrete evidence that this is an effective instrument in the control of body weight, blood pressure, and glycated Hb levels in type 2 diabetes.
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Affiliation(s)
| | | | - Kamal Agrawal
- Department of Community Medicine, UCMS & GTB Hospital, Delhi, India
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18
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Smit E, Leenaars KEF, Wagemakers MAE, Molleman GRM, Koelen MA, van der Velden J. Evaluation of the role of Care Sport Connectors in connecting primary care, sport, and physical activity, and residents' participation in the Netherlands: study protocol for a longitudinal multiple case study design. BMC Public Health 2015; 15:510. [PMID: 26597675 PMCID: PMC4657375 DOI: 10.1186/s12889-015-1841-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 05/14/2015] [Indexed: 11/10/2022] Open
Abstract
Background The number of people with one or more chronic diseases is increasing, but this trend could be reduced by promoting physical activity. Therefore, in 2012, the Dutch Ministry of Health, Welfare, and Sport introduced Care Sport Connectors (CSCs), to whom a broker role has been ascribed. The defined outcome of CSCs role is an increased number of residents participating in local sports facilities and being physically active in their own neighbourhood. To realize this, primary care and sports professionals need to collaborate, and local sports facilities and neighbourhoods need to offer accessible physical activities for people in the locality, including people with one or more chronic diseases or at increased risk of chronic disease(s). Adequate scientific research is needed to assess CSCs’ impact on: 1) connecting primary care, sport, and physical activity and 2) increasing the number of residents who engage in physical activity to promote their health. Methods and design To study the role and the impact of CSCs, a longitudinal multiple case study will be conducted, in nine municipalities spread over the Netherlands, from 2014 until 2017. A mixed methodology will be used to perform action research and process evaluation. Study I focuses on the expected alliances of CSCs and the preconditions that facilitate or hinder CSCs in the formation of these alliances. The study population will consist of intermediary target groups. A literature review, interviews, focus groups, and document analysis will be undertaken. Study II will concentrate on lifestyle program participants to identify health and physical activity behavior changes. For this purpose, interviews, literature studies, a Delphi study, fitness tests, and questionnaires will be used. Discussion Linking and integrating results gained by multiple methods, at different levels, will provide a validated assessment of CSCs’ impact on connecting the primary care and sports sectors. This will reveal changes in residents’ physical activity behavior, and also the circumstances under which this will happen. The assessment in combination with general lessons learned from the different case studies will make it possible to determine whether CSCs are able to fulfill the policy aspiration and whether it would be beneficial to extend this function. Trial registration Nederlands Trialregister NTR4986. Registered 14 December 2014.
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Affiliation(s)
- E Smit
- Academic Collaborative Centre AMPHI, Primary Health Care, Radboud university medical center, P.O. Box 9101, , 6500 HB, Nijmegen, The Netherlands.
| | - K E F Leenaars
- Department of Social Sciences, Health and Society Group, Wageningen University & Research Centre, P.O. Box 8130, Wageningen, The Netherlands.
| | - M A E Wagemakers
- Department of Social Sciences, Health and Society Group, Wageningen University & Research Centre, P.O. Box 8130, Wageningen, The Netherlands.
| | - G R M Molleman
- Academic Collaborative Centre AMPHI, Primary Health Care, Radboud university medical center, P.O. Box 9101, , 6500 HB, Nijmegen, The Netherlands.
| | - M A Koelen
- Department of Social Sciences, Health and Society Group, Wageningen University & Research Centre, P.O. Box 8130, Wageningen, The Netherlands.
| | - J van der Velden
- Academic Collaborative Centre AMPHI, Primary Health Care, Radboud university medical center, P.O. Box 9101, , 6500 HB, Nijmegen, The Netherlands.
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19
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Wilkin HA, Katz VS, Ball-Rokeach SJ, Hether HJ. Communication resources for obesity prevention among African American and Latino residents in an urban neighborhood. JOURNAL OF HEALTH COMMUNICATION 2015; 20:710-719. [PMID: 25928242 DOI: 10.1080/10810730.2015.1018559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
African Americans and Latinos are at disproportionately high risk for obesity and for the chronic conditions and diseases associated with it. This study uses communication infrastructure theory to explore how connections to neighborhood communication resources and communication with family members can affect residents' regular exercise and healthy eating behaviors-two of the most direct strategies for achieving or maintaining a healthy weight. Regression analyses revealed that connections to the neighborhood storytelling network and family interaction predicted residents' regular exercise and that family interaction had the strongest effect on the likelihood of exercising regularly. Family interaction was the only independent variable that predicted residents' daily intake of fruits and vegetables. Implications of these findings for community health programs and theory development are discussed.
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Affiliation(s)
- Holley A Wilkin
- a Department of Communication and School of Public Health , Georgia State University , Atlanta , Georgia , USA
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20
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Rintala TM, Paavilainen E, Åstedt-Kurki P. Everyday life of a family with diabetes as described by adults with type 1 diabetes. ACTA ACUST UNITED AC 2015. [DOI: 10.1002/edn.234] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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21
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Kennedy A, Rogers A, Vassilev I, Todorova E, Roukova P, Foss C, Knutsen I, Portillo MC, Mujika A, Serrano-Gil M, Lionis C, Angelaki A, Ratsika N, Koetsenruijter J, Wensing M. Dynamics and nature of support in the personal networks of people with type 2 diabetes living in Europe: qualitative analysis of network properties. Health Expect 2014; 18:3172-85. [PMID: 25393694 DOI: 10.1111/hex.12306] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Living with and self-managing a long-term condition implicates a diversity of networked relationships. This qualitative study examines the personal communities of support of people with type 2 diabetes. METHODS We conducted 170 biographical interviews in six European countries (Bulgaria, Greece, the Netherlands, Norway, Spain and UK) to explore social support and networks. Analysis was framed with reference to three predetermined social support mechanisms: the negotiation of support enabling engagement with healthy practices, navigation to sources of support and collective efficacy. Each interview was summarized to describe navigation and negotiation of participants' networks and the degree of collective efficacy. RESULTS Analysis highlighted the similarities and differences between countries and provided insights into capacities of networks to support self-management. The network support mechanisms were identified in all interviews, and losses and gains in networks impacted on diabetes management. There were contextual differences between countries, most notably the impact of financial austerity on network dynamics. Four types of network are suggested: generative, diverse and beneficial to individuals; proxy, network members undertook diabetes management work; avoidant, support not engaged with; and struggling, diabetes management a struggle or not prioritized. CONCLUSIONS It is possible to differentiate types of network input to living with and managing diabetes. Recognizing the nature of active, generative aspects of networks support is likely to have relevance for self-management support interventions either through encouraging continuing development and maintenance of these contacts or intervening to address struggling networks through introducing the means to connect people to additional sources of support.
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Affiliation(s)
- Anne Kennedy
- Health Sciences, University of Southampton, Southampton, UK
| | - Anne Rogers
- Health Sciences, University of Southampton, Southampton, UK
| | | | - Elka Todorova
- University of National and World Economy, Sofia, Bulgaria
| | | | - Christina Foss
- Department of Nursing Sciences, Institute of Health and Society, University of Oslo, Norway
| | - Ingrid Knutsen
- Department of Nursing Sciences, Institute of Health and Society, University of Oslo, Norway
| | | | | | | | - Christos Lionis
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Iraklion, Crete, Greece
| | - Agapi Angelaki
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Iraklion, Crete, Greece
| | - Nikoleta Ratsika
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Iraklion, Crete, Greece
| | - Jan Koetsenruijter
- Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Michel Wensing
- Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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22
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Gefter L, Rosas LG, Rodriguez E, Morioka-Douglas N. Training At-Risk Youth to Become Diabetes Self-management Coaches for Family Members. DIABETES EDUCATOR 2014; 40:786-96. [DOI: 10.1177/0145721714549676] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this study is to evaluate the impact of a school-based health program in which family medicine residents trained healthy at-risk adolescents to become diabetes self-management coaches for family members with diabetes. Methods A mixed methods study included 97 adolescents from 3 San Francisco Bay Area high schools serving primarily ethnic minority youth of low socioeconomic status. Physicians came to schools once a week for 8 weeks and trained 49 adolescents to become coaches. Student coaches and 48 nonparticipant students completed pre- and posttest intervention questionnaires, and 15 student coaches and 9 family members with diabetes gave in-depth interviews after participation. Linear regression was used to determine differences in knowledge and psychosocial assets on pre- and posttests between student coaches and nonparticipant students, and NVIVO was used to analyze interview transcripts. Results After controlling for initial score, sex, grade, and ethnicity, student coaches improved from pre- to posttest significantly compared to nonparticipants on knowledge, belonging, and worth scales. Student coaches reported high satisfaction with the program. Articulated program benefits included improvement in diet, increased physical activity, and improved relationship between student coach and family member. Conclusions Overall, this program can increase diabetes knowledge and psychosocial assets of at-risk youth, and it holds promise to promote positive health behaviors among at-risk youth and their families.
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Affiliation(s)
- Liana Gefter
- Center for Education and Research in Family and Community Medicine, Stanford University School of Medicine, Stanford, CA (Dr Gefter, Dr Morioka-Douglas)
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA (Dr Rosas)
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA (Dr Rodriguez)
| | - Lisa G. Rosas
- Center for Education and Research in Family and Community Medicine, Stanford University School of Medicine, Stanford, CA (Dr Gefter, Dr Morioka-Douglas)
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA (Dr Rosas)
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA (Dr Rodriguez)
| | - Eunice Rodriguez
- Center for Education and Research in Family and Community Medicine, Stanford University School of Medicine, Stanford, CA (Dr Gefter, Dr Morioka-Douglas)
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA (Dr Rosas)
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA (Dr Rodriguez)
| | - Nancy Morioka-Douglas
- Center for Education and Research in Family and Community Medicine, Stanford University School of Medicine, Stanford, CA (Dr Gefter, Dr Morioka-Douglas)
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA (Dr Rosas)
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA (Dr Rodriguez)
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23
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Vassilev I, Rogers A, Kennedy A, Koetsenruijter J. The influence of social networks on self-management support: a metasynthesis. BMC Public Health 2014; 14:719. [PMID: 25023948 PMCID: PMC4223639 DOI: 10.1186/1471-2458-14-719] [Citation(s) in RCA: 139] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 07/01/2014] [Indexed: 11/24/2022] Open
Abstract
Background There is increasing recognition that chronic illness management (CIM) is not just an individual but a collective process where social networks can potentially make a considerable contribution to improving health outcomes for people with chronic illness. However, the mechanisms (processes, activities) taking place within social networks are insufficiently understood. The aim of this review was to focus on identifying the mechanisms linking social networks with CIM. Here we consider network mechanisms as located within a broader social context that shapes practices, behaviours, and the multiplicity of functions and roles that network members fulfil. Methods A systematic search of qualitative studies was undertaken on Medline, Embase, and Web for papers published between 1st January 2002 and 1st December 2013. Eligible for inclusion were studies dealing with diabetes, and with conditions or health behaviours relevant for diabetes management; and studies exploring the relationship between social networks, self-management, and deprivation. 25 papers met the inclusion criteria. A qualitative metasynthesis was undertaken and the review followed a line of argument synthesis. Results The main themes identified were: 1) sharing knowledge and experiences in a personal community; 2) accessing and mediation of resources; 3) self-management support requires awareness of and ability to deal with network relationships. These translated into line of argument synthesis in which three network mechanisms were identified. These were network navigation (identifying and connecting with relevant existing resources in a network), negotiation within networks (re-shaping relationships, roles, expectations, means of engagement and communication between network members), and collective efficacy (developing a shared perception and capacity to successfully perform behaviour through shared effort, beliefs, influence, perseverance, and objectives). These network mechanisms bring to the fore the close interdependence between social and psychological processes in CIM, and the intertwining of practical and moral dilemmas in identifying, offering, accepting, and rejecting support. Conclusions CIM policy and interventions could be extended towards: raising awareness about the structure and organisation of personal communities; building individual and network capacity for navigating and negotiating relationships and CIM environments; maximising the possibilities for social engagement as a way of increasing the effectiveness of individual and network efforts for CIM.
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Affiliation(s)
- Ivaylo Vassilev
- NIHR CLAHRC Wessex, Faculty of Health Sciences, University of Southampton, Southampton SO17 1BJ, UK.
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de la Haye K, de Heer HD, Wilkinson AV, Koehly LM. Predictors of parent-child relationships that support physical activity in Mexican-American families. J Behav Med 2012. [PMID: 23203139 DOI: 10.1007/s10865-012-9471-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Family-based physical activity (PA) interventions would benefit from research that identifies how to build support for PA among family members. This study examined the extent to which relationships of encouragement to do PA, and co-engagement in PA, exist among Mexican-American parents and children, and sought to identify individual, relational, and household factors associated with these dimensions of support. Participants were 224 Mexican-origin adults, with at least one child aged 5-20 years, participating in a larger study conducted between 2008 and 2010. In baseline surveys, adult participants enumerated the names and attributes of their family and kin; this study focuses on 455 parent-child dyads, nested in 118 households. Parental encouragement of PA in their children was found in about half of dyads, and in 20 % of dyads children encouraged parents. Encouragement relationships were highly reciprocal. Reciprocal parent-child encouragement was also positively associated with co-participation in PA; the latter found in just 17 % of dyads. Results indicated that relational, individual, and socio-cultural attributes were associated with PA support among parents and children, and provide insights into how these relationships might be fostered within Mexican-American families.
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Affiliation(s)
- Kayla de la Haye
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA,
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Katiria Perez G, Cruess D. The impact of familism on physical and mental health among Hispanics in the United States. Health Psychol Rev 2011; 8:95-127. [PMID: 25053010 DOI: 10.1080/17437199.2011.569936] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The rapidly expanding number of Hispanics living in USA has increased the need for their inclusion in research on physical and mental health. Current studies that have explored health outcomes among Hispanics have often noted an 'epidemiological paradox', in which there is a discrepancy between their minority status and positive health outcomes when compared with other racial/ethnic groups. Certain socio-cultural variables, in particular the value placed on family, have been largely implicated in these findings. This review will provide a summary of the literature exploring familism within the structure of the Hispanic family and its potential impact on health. We will focus on research exploring the plausible impact that family and familism values may have on the physical health (particularly within the HIV, diabetes, and breast cancer literature) and also on health behaviours of Hispanics, as well as its effect on mental health (particularly related to acculturative stress and caregiver stress). Throughout the review, we highlight some of the potential mechanisms by which familism may impact on the health status of Hispanics. We conclude the review by noting some of the clinical and ethical implications of this research, and by offering suggestions for future work in this area.
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Affiliation(s)
- Giselle Katiria Perez
- a Department of Psychology , University of Connecticut , 406 Babbidge Road, Unit 1020, Storrs , CT 06269 , USA
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Berge JM, Larson N, Bauer KW, Neumark-Sztainer D. Are parents of young children practicing healthy nutrition and physical activity behaviors? Pediatrics 2011; 127:881-7. [PMID: 21482603 PMCID: PMC3081185 DOI: 10.1542/peds.2010-3218] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Although parenthood is a common life event in early adulthood, little is known about whether parenthood is associated with weight and weight-related health behaviors, including dietary intake and physical activity. OBJECTIVE In this article we examine whether parents of young children (aged ≤5 years) report different dietary intake, physical activity, and BMIs compared with young adults without children. METHODS Data for this analysis were drawn from the second and third waves of Project EAT (Eating and Activity in Teens and Young Adults), a longitudinal population-based cohort study. Young adults (838 women, 682 men) from diverse ethnic and socioeconomic backgrounds were included. Gender-stratified linear regression models were used to examine associations between parental status and dietary intake, hours of physical activity, and BMI. Results were adjusted for each health behavior outcome level 5 years earlier (time 2). RESULTS Results indicate that although many dietary behaviors were the same between parents and nonparents, mothers reported greater consumption of sugar-sweetened beverages, total energy, and percent saturated fat compared with women without children. Both mothers and fathers had lower amounts of physical activity compared with nonparents. Mothers had higher mean BMIs than women without children. No difference was observed in BMIs between fathers and men without children. CONCLUSIONS Our findings suggest that pediatricians and health care providers may want to consider discussing dietary intake and physical activity with new parents to identify ways to engage in healthful behaviors given the daily demands of parenthood, both to improve parents' own health and to help them model healthful behavior for their children.
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Affiliation(s)
- Jerica M. Berge
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota; and
| | - Nicole Larson
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Katherine W. Bauer
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Dianne Neumark-Sztainer
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
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Green LW, Glasgow RE, Atkins D, Stange K. Making evidence from research more relevant, useful, and actionable in policy, program planning, and practice slips "twixt cup and lip". Am J Prev Med 2009; 37:S187-91. [PMID: 19896017 DOI: 10.1016/j.amepre.2009.08.017] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Revised: 08/15/2009] [Accepted: 08/15/2009] [Indexed: 11/18/2022]
Affiliation(s)
- Lawrence W Green
- Department of Epidemiology and Biostatistics, Schoolof Medicine, University of California at San Francisco, 185 Berry Street, San Francisco, CA 94107-1728, USA.
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