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Martínez-Tofé J, Ausili D, Soto-Ruiz N, Santolalla-Arnedo I, Durante A, di Nitto M, Lysanets Y, de Viñaspre-Hernández RR, Tejada-Garrido CI, Sánchez Barba M, Gea-Caballero V, Juárez-Vela R. Transcultural adaptation and theoretical models validation of the Spanish version of the Self-Care of Diabetes Inventory. Front Med (Lausanne) 2024; 11:1423948. [PMID: 39318591 PMCID: PMC11420126 DOI: 10.3389/fmed.2024.1423948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 08/30/2024] [Indexed: 09/26/2024] Open
Abstract
Background For patients with diabetes mellitus, self-care is crucial because it prevents complications and helps preserve quality of life. Clinicians and researchers require effective tools for assessing self-care behaviors across various dimensions to identify individual needs and maximize resource allocation. The aim of this study was to evaluate the validity and reliability of the Spanish version of the Self-Care of Diabetes Inventory (SCODI). Methods Two hundred eighteen participants with DMT1 and DMT2 who were recruited through convenience sampling from a university hospital participated in our cross-sectional study. After translation and cultural adaptation, the enrolled patients answered the questions. We performed an exploratory factor analysis (EFA) on each of the SCODI scales and Confirmatory factor analysis (CFA) was performed using our models which appropriate fit indices. Results The original structure of the four-dimensions tool was confirmed. The overall consistency across the four scales was assessed by Cronbach's alpha: self-care maintenance (0.766), self-care monitoring (0.790), self-care management (0.771), and self-care confidence (0.936). The model fit yielded a chi-square index of 1.028 with 773 degrees of freedom. Confirmatory factor analysis showed a good fit, thereby affirming the reliability of the model. Conclusion The internal consistency and reliability of the SCODI Spanish version are deemed adequate. This tool is appropriate when it is desired to evaluate the self-care practices of Spanish persons suffering from diabetes due to its good psychometric qualities.
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Affiliation(s)
- Jesús Martínez-Tofé
- Doctoral Program in Health Sciences, Public University of Navarra, Pamplona, Spain
- Faculty of Health Sciences, Research Group in Care, University of La Rioja, Logroño, Spain
| | - Davide Ausili
- Department of Medicine and Sugery, Università degli Studi di Milano-Bicocca, Milan, Italy
| | - Nelia Soto-Ruiz
- Department of Health Sciences, Public University of Navarra (UPNA), Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Iván Santolalla-Arnedo
- Faculty of Health Sciences, Research Group in Care, University of La Rioja, Logroño, Spain
| | - Angela Durante
- Sant’Anna School of Advanced Studies, Health Science Interdisciplinary Center, Pisa, Italy
- Fondazione Toscana “Gabriele Monasterio”, Pisa, Italy
| | - Marco di Nitto
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Yuliia Lysanets
- Department of Foreign Languages with Latin and Medical Terminology, Poltava State Medical University, Poltava, Ukraine
| | | | | | | | - Vicente Gea-Caballero
- Faculty of Health Sciences, Research Group Community and Health SALCOM, International University of Valencia, Valencia, Spain
| | - Raúl Juárez-Vela
- Faculty of Health Sciences, Research Group in Care, University of La Rioja, Logroño, Spain
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Hackl CM, Lee WC, Sallam HS, Jneid H, Campbell KM, Serag H. Racial Disparities in Selected Complications and Comorbidities among People with Type 2 Diabetes. Healthcare (Basel) 2024; 12:846. [PMID: 38667608 PMCID: PMC11050140 DOI: 10.3390/healthcare12080846] [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: 03/26/2024] [Revised: 04/10/2024] [Accepted: 04/13/2024] [Indexed: 04/28/2024] Open
Abstract
Type 2 diabetes (T2D) is a growing public health concern, disproportionately impacting racial and ethnic minorities. Assessing disparities is the first step towards achieving the translation goal to reduce disparities in diabetes outcomes, according to the Centers for Disease Control and Prevention (CDC)'s Division of Diabetes. We analyzed the data of patients (18+ years) diagnosed with T2D between 1 January 2012 and 31 March 2017, using the electronic health records of the University of Texas Medical Branch at Galveston. We compared the crude rate and age-standardized rate (using direct method) of selected micro- and macrovascular complication rates, associated obesity, and insulin dependence among racial and ethnic groups. Our sample included 20,680 patients who made 394,106 visits (9922 non-Hispanic White patients, 4698 non-Hispanic Black patients, and 6060 Hispanic patients). Our results suggest a higher risk of acquiring macrovascular (hypertension, ischemic disease, and stroke) and microvascular (renal, ophthalmic, and neurological) complications in Black patients compared to non-Hispanic White and Hispanic patients. The rates of stage I or II obesity were higher in Black patients compared with White and Hispanic patients. The rates of insulin use rather than oral hypoglycemics were also higher in Black patients than White and Hispanic patients. The disparities in terms of the higher susceptibility to complications among Black patients are possibly linked to the socioeconomic disadvantages of this population, leading to poorer management. Prevention strategies are warranted to reduce the incidence of T2D complications in racial minorities.
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Affiliation(s)
- Caitlin M. Hackl
- John Sealy School of Medicine (JSSM), University of Texas Medical Branch (UTMB), Galveston, TX 77555, USA;
| | - Wei-Chen Lee
- Department of Family Medicine, John Sealy School of Medicine (JSSM), University of Texas Medical Branch (UTMB), Galveston, TX 77555, USA; (W.-C.L.); (K.M.C.)
| | - Hanaa S. Sallam
- Department of Internal Medicine, Division of Endocrinology, John Sealy School of Medicine (JSSM), University of Texas Medical Branch (UTMB), Galveston, TX 77555, USA;
- Department of Medical Physiology, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
| | - Hani Jneid
- Department of Internal Medicine, Division of Cardiology, John Sealy School of Medicine (JSSM), University of Texas Medical Branch (UTMB), Galveston, TX 77555, USA;
| | - Kendall M. Campbell
- Department of Family Medicine, John Sealy School of Medicine (JSSM), University of Texas Medical Branch (UTMB), Galveston, TX 77555, USA; (W.-C.L.); (K.M.C.)
| | - Hani Serag
- Department of Internal Medicine, Division of Endocrinology, John Sealy School of Medicine (JSSM), University of Texas Medical Branch (UTMB), Galveston, TX 77555, USA;
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Agurs-Collins T, Alvidrez J, ElShourbagy Ferreira S, Evans M, Gibbs K, Kowtha B, Pratt C, Reedy J, Shams-White M, Brown AG. Perspective: Nutrition Health Disparities Framework: A Model to Advance Health Equity. Adv Nutr 2024; 15:100194. [PMID: 38616067 PMCID: PMC11031378 DOI: 10.1016/j.advnut.2024.100194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 04/16/2024] Open
Abstract
Disparities in nutrition, such as poor diet quality and inadequate nutrient intake, arise from multiple factors and are related to adverse health outcomes such as obesity, diabetes, cardiovascular disease, and some cancers. The aim of the current perspective is to present a nutrition-centric socioecological framework that delineates determinants and factors that contribute to diet and nutrition-related disparities among disadvantaged populations. The Nutrition Health Disparities Framework (NHDF) describes the domains (biological, behavioral, physical/built environment, sociocultural environment, and healthcare system) that influence nutrition-related health disparities through the lens of each level of influence (that is, individual, interpersonal, community, and societal). On the basis of the scientific literature, the authors engaged in consensus decision making in selecting nutrition-related determinants of health within each domain and socioecological level when creating the NHDF. The framework identifies how neighborhood food availability and access (individual/built environment) intersect with cultural norms and practices (interpersonal/sociocultural environment) to influence dietary behaviors, exposures, and risk of diet-related diseases. In addition, the NHDF shows how factors such as genetic predisposition (individual/biology), family dietary practices (interpersonal/behavioral), and food marketing policies (societal) may impact the consumption of unhealthy foods and beverages and increase chronic disease risk. Family and peer norms (interpersonal/behavior) related to breastfeeding and early childhood nutrition interact with resource-poor environments such as lack of access to preventive healthcare settings (societal/healthcare system) and low usage of federal nutrition programs (societal/behavioral), which may increase risk of poor nutrition during childhood and food insecurity. The NHDF describes the synergistic interrelationships among factors at different levels of the socioecological model that influence nutrition-related outcomes and exacerbate health disparities. The framework is a useful resource for nutrition researchers, practitioners, food industry leaders, and policymakers interested in improving diet-related health outcomes and promoting health equity in diverse populations.
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Affiliation(s)
- Tanya Agurs-Collins
- National Cancer Institute, Division of Cancer Control and Population Sciences, Bethesda, MD, United States.
| | | | - Sanae ElShourbagy Ferreira
- National Center for Advancing Translational Sciences, Division of Clinical Innovation, Bethesda, MD, United States
| | - Mary Evans
- National Institute of Diabetes and Digestive and Kidney Diseases, Division of Digestive Diseases and Nutrition, Bethesda, MD, United States
| | - Kimberlea Gibbs
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Division of Extramural Research, Pediatric Growth and Nutrition Branch, Bethesda, MD, United States
| | | | - Charlotte Pratt
- National Heart, Lung, and Blood Institute, Division of Cardiovascular Sciences, Bethesda, MD, United States
| | - Jill Reedy
- National Cancer Institute, Division of Cancer Control and Population Sciences, Bethesda, MD, United States
| | - Marissa Shams-White
- National Cancer Institute, Division of Cancer Control and Population Sciences, Bethesda, MD, United States
| | - Alison Gm Brown
- National Heart, Lung, and Blood Institute, Division of Cardiovascular Sciences, Bethesda, MD, United States
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Studer CM, Linder M, Pazzagli L. A global systematic overview of socioeconomic factors associated with antidiabetic medication adherence in individuals with type 2 diabetes. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:122. [PMID: 37936205 PMCID: PMC10631092 DOI: 10.1186/s41043-023-00459-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/21/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Antidiabetic medication adherence is a key aspect for successful control of type 2 diabetes mellitus (T2DM). This systematic review aims to provide an overview of the associations between socioeconomic factors and antidiabetic medication adherence in individuals with T2DM. METHODS A study protocol was established using the PRISMA checklist. A primary literature search was conducted during March 2022, searching PubMed, Embase, Web of Science, as well as WorldCat and the Bielefeld Academic Search Engine. Studies were included if published between 1990 and 2022 and included individuals with T2DM. During primary screening, one reviewer screened titles and abstracts for eligibility, while in the secondary screening, two reviewers worked independently to extract the relevant data from the full-text articles. RESULTS A total of 15,128 studies were found in the primary search, and 102 were finally included in the review. Most studies found were cross-sectional (72) and many investigated multiple socioeconomic factors. Four subcategories of socioeconomic factors were identified: economic (70), social (74), ethnical/racial (19) and geographical (18). The majority of studies found an association with antidiabetic medication adherence for two specific factors, namely individuals' insurance status (10) and ethnicity or race (18). Other important factors were income and education. CONCLUSIONS A large heterogeneity between studies was observed, with many studies relying on subjective data from interviewed individuals with a potential for recall bias. Several socioeconomic groups influencing medication adherence were identified, suggesting potential areas of intervention for the improvement of diabetes treatment adherence and individuals' long-term well-being.
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Affiliation(s)
- Christian Ming Studer
- Department of Chemistry and Applied Biosciences, Institute for Pharmaceutical Sciences, ETH Zurich, Zurich, Switzerland
| | - Marie Linder
- Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Laura Pazzagli
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
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Tam B, Lin M, Castellanos C, Ulloa R, Kokot N, Hur K. Head and Neck Cancer Online Support Groups: Disparities in Participation and Impact on Patients. OTO Open 2023; 7:e87. [PMID: 37933274 PMCID: PMC10625668 DOI: 10.1002/oto2.87] [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: 05/14/2023] [Revised: 08/13/2023] [Accepted: 10/07/2023] [Indexed: 11/08/2023] Open
Abstract
Objective To characterize the users of the head and neck cancer (HNC) online support group (OSG) and describe the perceived benefits of membership. Study Design Cross-sectional. Setting Online. Methods An administered survey with questions asking about demographics, cancer history, treatment choices, and feelings about OSGs was posted on the 5 largest HNC OSGs on Facebook. Results A total of 97 participants completed the survey. Mean age was 57.8 years old (standard deviation = 10.7 years). Most participants were female (50.5%) and Caucasian (92.8%). This cohort was well educated with 65.5% holding at least a college degree. Annual income was high with 41.8% reporting annual income of $100,000 or greater. The most common treatment modality was radiation (88.7%). The most common surgery was neck dissection (46.4%). Most participants preferred OSGs (70.8%) over other support group types. OSGs were heavily utilized with our cohort reporting using the OSG at least several times a week (80.0%). The top reasons for joining the OSG were sharing one's experience of HNC (76.3%) and gaining support from others with HNC (85.6%). OSGs were ranked as the #3 source of medical information for HNC behind otolaryngologists and oncologists. Membership in a HNC OSG had a minimal impact on decision-making. Conclusion HNC OSGs appear to provide a beneficial community for HNC patients. Otolaryngologists should consider incorporating HNC OSG as a possible supplemental resource for their HNC patients.
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Affiliation(s)
- Benjamin Tam
- Caruso Department of Otolaryngology‐Head and Neck SurgeryKeck School of Medicine of the University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Matthew Lin
- Caruso Department of Otolaryngology‐Head and Neck SurgeryKeck School of Medicine of the University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Carlos Castellanos
- Caruso Department of Otolaryngology‐Head and Neck SurgeryKeck School of Medicine of the University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Ruben Ulloa
- Caruso Department of Otolaryngology‐Head and Neck SurgeryKeck School of Medicine of the University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Niels Kokot
- Caruso Department of Otolaryngology‐Head and Neck SurgeryKeck School of Medicine of the University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Kevin Hur
- Caruso Department of Otolaryngology‐Head and Neck SurgeryKeck School of Medicine of the University of Southern CaliforniaLos AngelesCaliforniaUSA
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Presley CA, Khodneva Y, Juarez LD, Howell CR, Agne AA, Riggs KR, Huang L, Pisu M, Levitan EB, Cherrington AL. Trends and Predictors of Glycemic Control Among Adults With Type 2 Diabetes Covered by Alabama Medicaid, 2011-2019. Prev Chronic Dis 2023; 20:E81. [PMID: 37708338 PMCID: PMC10516203 DOI: 10.5888/pcd20.220332] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION Despite advances in diabetes management, only one-quarter of people with diabetes in the US achieve optimal targets for glycated hemoglobin A1c (HbA1c), blood pressure, and cholesterol. We sought to evaluate temporal trends and predictors of achieving glycemic control among adults with type 2 diabetes covered by Alabama Medicaid from 2011 through 2019. METHODS We completed a retrospective analysis of Medicaid claims and laboratory data, using person-years as the unit of analysis. Inclusion criteria were being aged 19 to 64 years, having a diabetes diagnosis, being continuously enrolled in Medicaid for a calendar year and preceding 12 months, and having at least 1 HbA1c result during the study year. Primary outcomes were HbA1c thresholds of <7% and <8%. Primary exposure was study year. We conducted separate multivariable-adjusted logistic regressions to evaluate relationships between study year and HbA1c thresholds. RESULTS We included 43,997 person-year observations. Mean (SD) age was 51.0 (9.9) years; 69.4% were women; 48.1% were Black, 42.9% White, and 0.4% Hispanic. Overall, 49.1% had an HbA1c level of <7% and 64.6% <8%. Later study years and poverty-based eligibility were associated with lower probability of reaching target HbA1c levels of <7% or <8%. Sex, race, ethnicity, and geography were not associated with likelihood of reaching HbA1c <7% or <8% in any model. CONCLUSION Later study years were associated with lower likelihood of meeting target HbA1c levels compared with 2011, after adjusting for covariates. With approximately 35% not meeting an HbA1c target of <8%, more work is needed to improve outcomes of low-income adults with type 2 diabetes.
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Affiliation(s)
- Caroline A Presley
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine
- Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Ave South, MT-616, Birmingham, AL 35205
| | - Yulia Khodneva
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine
| | - Lucia D Juarez
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine
| | - Carrie R Howell
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine
| | - April A Agne
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine
| | - Kevin R Riggs
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine
| | - Lei Huang
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham
| | - Maria Pisu
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine
| | - Emily B Levitan
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham
| | - Andrea L Cherrington
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine
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Odai-Afotey A, Lederman RI, Ko NY, Gagnon H, Fikre T, Gundersen DA, Revette AC, Hershman DL, Crew KD, Keating NL, Freedman RA. Breast cancer treatment receipt and the role of financial stress, health literacy, and numeracy among diverse breast cancer survivors. Breast Cancer Res Treat 2023; 200:127-137. [PMID: 37178432 PMCID: PMC10182756 DOI: 10.1007/s10549-023-06960-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 04/26/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE Disparities in breast cancer treatment for low-income and minority women are well documented. We examined economic hardship, health literacy, and numeracy and whether these factors were associated with differences in receipt of recommended treatment among breast cancer survivors. METHODS During 2018-2020, we surveyed adult women diagnosed with stage I-III breast cancer between 2013 and 2017 and received care at three centers in Boston and New York. We inquired about treatment receipt and treatment decision-making. We used Chi-squared and Fisher's exact tests to examine associations between financial strain, health literacy, numeracy (using validated measures), and treatment receipt by race and ethnicity. RESULTS The 296 participants studied were 60.1% Non-Hispanic (NH) White, 25.0% NH Black, and 14.9% Hispanic; NH Black and Hispanic women had lower health literacy and numeracy and reported more financial concerns. Overall, 21 (7.1%) women declined at least one component of recommended therapy, without differences by race and ethnicity. Those not initiating recommended treatment(s) reported more worry about paying large medical bills (52.4% vs. 27.1%), worse household finances since diagnosis (42.9% vs. 22.2%), and more uninsurance before diagnosis (9.5% vs. 1.5%); all P < .05. No differences in treatment receipt by health literacy or numeracy were observed. CONCLUSION In this diverse population of breast cancer survivors, rates of treatment initiation were high. Worry about paying medical bills and financial strain were frequent, especially among non-White participants. Although we observed associations of financial strain with treatment initiation, because few women declined treatments, understanding the scope of impact is limited. Our results highlight the importance of assessments of resource needs and allocation of support for breast cancer survivors. Novelty of this work includes the granular measures of financial strain and inclusion of health literacy and numeracy.
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Affiliation(s)
- Ashley Odai-Afotey
- Department of Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Ruth I Lederman
- Survey and Qualitative Methods Core, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Naomi Y Ko
- Section of Hematology and Medical Oncology, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Haley Gagnon
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Tsion Fikre
- Section of Hematology and Medical Oncology, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Daniel A Gundersen
- Survey and Qualitative Methods Core, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Anna C Revette
- Survey and Qualitative Methods Core, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Dawn L Hershman
- Department of Medicine and Epidemiology, Columbia University Irving Medical Center, Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Katherine D Crew
- Department of Medicine and Epidemiology, Columbia University Irving Medical Center, Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Nancy L Keating
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Rachel A Freedman
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.
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Alsayed Hassan D, Helaluddin F, Chahestani OH, Mohamed O, Islam N. Diabetes Self-Management and Health-Related Quality of Life among Primary Care Patients with Diabetes in Qatar: A Cross-Sectional Study. Healthcare (Basel) 2022; 10:2124. [PMID: 36360465 PMCID: PMC9691062 DOI: 10.3390/healthcare10112124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/02/2022] [Accepted: 10/12/2022] [Indexed: 08/13/2023] Open
Abstract
Diabetes self-management (DSM) practices are an important determinant of health-related outcomes, including health-related quality of life (HRQOL). The purpose of this study is to explore DSM practices and their relationship with the HRQOL of patients with type 2 diabetes in primary health care centers (PHCCs) in Qatar. In this cross-sectional study, data were collected from PHCC patients with diabetes via interview-administered questionnaires by utilizing two instruments: the DSM questionnaire (DSMQ) and the HRQOL Short Form (SF-12). Frequencies were calculated for categorical variables and medians were calculated for continuous variables that were not normally distributed. A statistical comparison between groups was conducted using chi-square for categorical data. Binary logistic regression was utilized to examine the relationship between the significant independent factors and the dependent variables. A total of 105 patients completed the questionnaire, 51.4% of whom were male. Approximately half of the participants (48.6%) reported poor overall DSM practices, and 50.5% reported poor physical health quality of life (PC) and mental health quality of life (MC). Female participants showed significantly higher odds of reporting poor DSM than male participants (OR, 4.77; 95% CI, 1.92-11.86; p = 0.001). Participants with a secondary education (OR, 0.18; 95% CI, 0.04-0.81; p = 0.025) and university education (OR, 0.18; 95% CI, 0.04-0.84; p = 0.029) showed significantly lower odds of reporting poor DSM than participants with no/primary education. Older participants showed higher odds of reporting poor PC than younger participants (OR 11.04, 95% CI, 1.47-82.76 and OR 8.32; 95% CI, 1.10-62.86, respectively). Females also had higher odds for poor PC than males (OR 7.08; 95% CI, 2.21-22.67), while participants with a secondary (OR, 0.13; 95% CI, 0.03-0.62; p = 0.010) and university education (OR, 0.11; 95% CI, 0.02-0.57; p = 0.008) showed significantly lower odds of reporting poor MC. In conclusion, patients with diabetes reported poor overall DSM practices and poor HRQOL. Our findings suggest intensifying efforts to deliver culturally appropriate DSM education to patients and to empower patients to take charge of their health.
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Affiliation(s)
- Diana Alsayed Hassan
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha 2713, Qatar
| | - Fatema Helaluddin
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha 2713, Qatar
| | - Ozra Hajebi Chahestani
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha 2713, Qatar
| | - Omnia Mohamed
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha 2713, Qatar
| | - Nazmul Islam
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha 2713, Qatar
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON L8S 4K1, Canada
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9
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Garcia SP, Madalosso MM, Bottino LG, Monteiro LEC, Sparrenberger K, Schneiders J, Berlanda G, Blume C, Gossenheimer AN, Telo GH, Schaan BD. Optimization of care for outpatients with type 2 diabetes through the Diabetes Self-Management Multidisciplinary Program: A randomized clinical trial. Can J Diabetes 2022; 46:449-456.e3. [DOI: 10.1016/j.jcjd.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/20/2021] [Accepted: 01/20/2022] [Indexed: 10/19/2022]
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Lamb KE, Crawford D, Thornton LE, Shariful Islam SM, Maddison R, Ball K. Educational differences in diabetes and diabetes self-management behaviours in WHO SAGE countries. BMC Public Health 2021; 21:2108. [PMID: 34789208 PMCID: PMC8597224 DOI: 10.1186/s12889-021-12131-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 10/29/2021] [Indexed: 12/03/2022] Open
Abstract
Background Diabetes mellitus represents a substantial global health challenge, with prevalence rising in low- and middle-income countries (LMICs). Although diabetes is known to follow a socioeconomic gradient, patterns in LMICs are unclear. This study examined associations between education and diabetes, and diabetes self-management behaviours, in six LMICs. Methods Cross-sectional data for 31,780 participants from China, Ghana, India, Mexico, Russia, and South Africa from the World Health Organization Study on Global AGEing and adult health (SAGE) study were used. Participants aged ≥50 years completed face-to-face interviews between 2007 and 2010. Participants self-reported diabetes diagnosis, physical activity, sedentary time, fruit and vegetable consumption, any special diet/program for diabetes, whether they were taking insulin for diabetes and number of years of education. Height, weight, waist, and hip circumference were measured. Country-specific survey-weighted log-binomial regression models were fitted to examine associations between the number of years of education and self-reported diabetes diagnosis (primary analysis). In secondary analyses, among those with a self-reported diabetes diagnosis, generalised linear regression models were fitted to examine associations between education and i) physical activity, ii) sedentary time, iii) fruit and vegetable consumption, iv) special diet for diabetes, v) taking insulin, vi) BMI, vii) waist circumference and viii) hip circumference. Results There was strong evidence of an association between years of education and diabetes diagnosis in Ghana (RR = 1.09, 95% CI: 1.06–1.13) and India (RR = 1.09, 95% CI: 1.07–1.12) only. In India, greater years of education was associated with higher leisure physical activity, fruit and vegetable intake, rates following a special diet or taking insulin, but also higher mean BMI, waist and hip circumference. Relationships between education and self-management behaviours were rarely seen in the other countries. Conclusions Associations between education and diabetes, and behavioural self-management (India only) was more evident in the two least developed (Ghana and India) of the WHO SAGE countries, indicating increasing diabetes diagnosis with greater numbers of years of education. The lack of gradients elsewhere may reflect shifting risk from higher to lower educated populations. While there was some suggestion that self-management behaviours were greater with increased education in India, this was not observed in the other countries. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12131-7.
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Affiliation(s)
- Karen E Lamb
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Australia. .,Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia. .,Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia.
| | - David Crawford
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Australia
| | - Lukar E Thornton
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Australia
| | - Sheikh M Shariful Islam
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Australia
| | - Ralph Maddison
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Australia
| | - Kylie Ball
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Australia.
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11
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Brevidelli MM, Oliveira ABD, Rodrigues GVG, Gamba MA, De Domenico EBL. Factores sociodemográficos, clínicos y psicosociales relacionados con el autocuidado de la diabetes. REVISTA CUIDARTE 2021. [DOI: 10.15649/cuidarte.2057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introducción: Aunque la ciencia ha descubierto diversos factores que intervienen en el autocuidado de la diabetes, todavía quedan algunos vacíos sobre todo en lo que respecta a los comportamientos de autocuidado entre personas con diferentes características socioeconómicas. El objetivo del presente estudio fue identificar la adherencia al autocuidado de la diabetes y su correlación con factores sociodemográficos, clínicos y psicosociales entre los usuarios del sistema de salud suplementaria en Sao Paulo. Materiales y métodos: Se realizó un estudio transversal con 214 participantes que padecían diabetes tipo 2, en el que se utilizaron las versiones brasileñas del cuestionario de actividades de autocuidado en diabetes, el cuestionario de actitudes sobre diabetes y la escala de empoderamiento de la diabetes. Se empleó un modelo de regresión lineal múltiple (método regresión stepwise) para delinear las correlaciones entre las variables. Resultados: Los participantes mostraron una adherencia moderada al autocuidado global. Factores como ser mujer, estar casado/en unión libre estable, ser jubilado, tener más tiempo de diagnóstico y mostrar una actitud más positiva frente a la diabetes explicaron el 93.0% de la varianza en el autocuidado global. Discusión: El estudio es inédito en la caracterización del autocuidado de la diabetes entre los usuarios del sistema de salud complementaria en Brasil. Si bien los resultados son similares a los de estudios nacionales e internacionales, estos se sugieren que, dada la complejidad de la enfermedad, el autocuidado de la diabetes se descuida constantemente y se requiere una mayor formación entre los profesionales de la salud para tratar los aspectos psicosociales asociados. Conclusión: Los resultados sugieren que las intervenciones educativas para la promoción del autocuidado deben diseñarse teniendo en cuenta el perfil sociodemográfico y clínico de los participantes, así como la promoción de la autoeficacia para disminuir la actitud negativa hacia la diabetes.
Como citar este artículo: Brevidelli, Maria Meimei; Oliveira, Adriana Bueno de; Rodrigues, Gilcelli Vascom Girotto; Gamba, Monica Antar; DeDomenico, Edvane Birello Lopes. Fatores sociodemográficos, clínicos e psicossociais correlacionados ao autocuidado em diabetes. Revista Cuidarte. 2021;12(2):e2057 http://dx.doi.org/10.15649/cuidarte.2057
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12
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Kitson A, Feo R, Lawless M, Arciuli J, Clark R, Golley R, Lange B, Ratcliffe J, Robinson S. Towards a unifying caring life-course theory for better self-care and caring solutions: A discussion paper. J Adv Nurs 2021; 78:e6-e20. [PMID: 34002886 PMCID: PMC9292879 DOI: 10.1111/jan.14887] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/23/2021] [Accepted: 04/25/2021] [Indexed: 12/18/2022]
Abstract
Aim To present the first iteration of the caring life‐course theory. Background Despite requiring care from birth to death, a person's universal or fundamental care needs and the subsequent care provision, either by self or others, has yet to be presented within a life‐course perspective. Accurately describing the care people require across their lifespan enables us to identify who, what type, how and where this care should be provided. This novel perspective can help to legitimise a person's care needs and the support they require from wider care systems and contexts. Design Discussion paper outlines theory development. We adopted an inductive approach to theory development, drawing upon existing literature and the team's diverse experiences. Our theoretical insights were refined through a series of collaborative meetings to define the theory's constructs, until theoretical saturation was reached. Discussion Fourteen constructs are identified as essential to the theory. We propose it is possible, using these constructs, to generate caring life‐course trajectories and predict divergences in these trajectories. The novel contribution of the theory is the interplay between understanding a person's care needs and provision within the context of their lifespan and personal histories, termed their care biography, and understanding a person's care needs and provision at specific points in time within a given care network and socio‐political context. Impact for Nursing The caring life‐course theory can provide a roadmap to inform nursing and other care industry sectors, providing opportunities to integrate and deliver care from the perspective of the person and their care history, trajectories and networks, with those of professional care teams. It can help to shape health, social and economic policy and involve individuals, families and communities in more constructive ways of talking about the importance of care for improved quality of life and healthy societies.
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Affiliation(s)
- Alison Kitson
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia.,Caring Futures Institute, Flinders University, Bedford Park, SA, Australia
| | - Rebecca Feo
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia.,Caring Futures Institute, Flinders University, Bedford Park, SA, Australia
| | - Michael Lawless
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia.,Caring Futures Institute, Flinders University, Bedford Park, SA, Australia
| | - Joanne Arciuli
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia.,Caring Futures Institute, Flinders University, Bedford Park, SA, Australia
| | - Robyn Clark
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia.,Caring Futures Institute, Flinders University, Bedford Park, SA, Australia
| | - Rebecca Golley
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia.,Caring Futures Institute, Flinders University, Bedford Park, SA, Australia
| | - Belinda Lange
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia.,Caring Futures Institute, Flinders University, Bedford Park, SA, Australia
| | - Julie Ratcliffe
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia.,Caring Futures Institute, Flinders University, Bedford Park, SA, Australia
| | - Sally Robinson
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia.,Caring Futures Institute, Flinders University, Bedford Park, SA, Australia
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13
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Barankay I, Reese PP, Putt ME, Russell LB, Phillips C, Pagnotti D, Chadha S, Oyekanmi KO, Yan J, Zhu J, Volpp KG, Clapp JT. Qualitative Exploration of Barriers to Statin Adherence and Lipid Control: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2021; 4:e219211. [PMID: 33944923 PMCID: PMC8097500 DOI: 10.1001/jamanetworkopen.2021.9211] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/17/2021] [Indexed: 12/20/2022] Open
Abstract
Importance Financial incentives may improve health by rewarding patients for focusing on present actions-such as medication regimen adherence-that provide longer-term health benefits. Objective To identify barriers to improving statin therapy adherence and control of cholesterol levels with financial incentives and insights for the design of future interventions. Design, Setting, and Participants This qualitative study involved retrospective interviews with participants in a preplanned secondary analysis of a randomized clinical trial of financial incentives for statin therapy adherence. A total of 636 trial participants from several US insurer or employer populations and an academic health system were rank ordered by change in low-density lipoprotein cholesterol (LDLC) levels. Participants with the most LDLC level improvement (high-improvement group) and those with LDLC levels that did not improve (nonimprovement group) were purposively targeted, stratified across all trial groups, for semistructured telephone interviews that were performed from April 1 to June 30, 2018. Interviews were coded using a team-based, iterative approach. Data were analyzed from July 1, 2018, to October 31, 2020. Main Outcomes and Measures The primary outcome was mean change in LDLC level from baseline to 12 months; the secondary outcome, statin therapy adherence during the first 6 months. Results A total of 54 patients were interviewed, divided equally between high-improvement and nonimprovement groups, with a mean (SD) age of 43.5 (10.3) years; 36 (66.7%) were women, 28 (51.9%) had diabetes, and 18 (33.3%) had cardiovascular disease. Compared with the high-improvement group, the nonimprovement group had fewer interviewees with an annual income of greater than $50 000 (11 [40.7%] vs 22 [81.5%]), worse self-reported health (fair to poor, 13 [48.1%] vs 3 [11.1%]), more Black interviewees (16 [59.3%] vs 4 [14.8%]), and lower baseline LDLC levels (>160 mg/dL, 2 [7.4%] vs 25 [92.6%]). Participants in the nonimprovement group had a greater burden of chronic illness (≥2 chronic conditions, 13 [48.1%] vs 6 [22.2%]) and were less frequently employed (full-time, 6 [22.2%] vs 12 [44.4%]). In interviews, the nonimprovement group was less focused on risks of high LDLC levels, described less engagement in LDLC level management, articulated fewer specific nutritional choices for optimizing health, and recounted greater difficulty obtaining healthy food. Participants in both groups had difficulty describing the structure of the financial incentives but did recall features of the electronic pill containers used to track adherence and how those containers affected medication routines. Conclusions and Relevance Participants in a statin adherence trial whose LDLC levels did not improve found it more difficult to create medication routines and respond to financial incentives in the context of complex living conditions and a high burden of chronic illness. These findings suggest that future studies should be more attentive to socioeconomic circumstances of trial participants. Trial Registration ClinicalTrials.gov Identifier: NCT01798784.
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Affiliation(s)
- Iwan Barankay
- Department of Management, The Wharton School, University of Pennsylvania, Philadelphia
- Department of Business Economics and Public Policy, The Wharton School, University of Pennsylvania, Philadelphia
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
| | - Peter P. Reese
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Division of Renal Electrolyte and Hypertension, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Mary E. Putt
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Louise B. Russell
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Caitlin Phillips
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - David Pagnotti
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Sakshum Chadha
- currently a medical student at Rutgers New Jersey Medical School, Newark
| | - Kehinde O. Oyekanmi
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jiali Yan
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jingsan Zhu
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Kevin G. Volpp
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Center for Health Equity Research and Promotion, Cresencz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- Department of Health Care Management, The Wharton School, University of Pennsylvania, Philadelphia
| | - Justin T. Clapp
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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14
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Nelson LA, Williamson SE, LeStourgeon LM, Mayberry LS. Retaining diverse adults with diabetes in a long-term trial: Strategies, successes, and lessons learned. Contemp Clin Trials 2021; 105:106388. [PMID: 33812991 DOI: 10.1016/j.cct.2021.106388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/25/2021] [Accepted: 03/28/2021] [Indexed: 11/30/2022]
Abstract
Background Retention can be difficult in longitudinal trials, especially among minoritized groups and individuals with low socioeconomic status (SES) who may experience more barriers to research participation. Organized retention strategies may help; however, limited research has reported on this in detail. Methods We employed several strategies throughout a 15-month randomized controlled trial to encourage retention among a diverse sample of adults with type 2 diabetes. Participants were randomized to receive mobile health support for diabetes self-care for 12 months or an attention control. Participants completed assessments at 3, 6, 12, and 15 months post-baseline. We used three main categories of retention strategies: flexibility in participation (e.g., multiple methods for data collection), communication (e.g., tracking contacts), and community building (e.g., study branding, newsletters). We monitored participants' use of strategies and examined associations between participant characteristics and retention. Results Retention remained high (≥90%) at each follow-up assessment. Participants used various methods for survey completion: online (34%), in-person (31%), and mail (30%). Most (73%) used a mail-in A1c kit at least once. Multiple completion methods were important for retaining minoritized and lower SES participants who completed assessments in-person more frequently. Communication also facilitated retention; 39% of participants used a study Helpline and tracking systems helped maintain contact. Conclusions Retaining disadvantaged patients in clinical trials is necessary so findings generalize to and can benefit these populations. Retention strategies that reduce barriers to participation and engage participants and community partners can be successful. Future studies should assess the impact of retention strategies.
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Affiliation(s)
- Lyndsay A Nelson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Diabetes Translation Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarah E Williamson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA; DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Knoxville, TN, USA
| | - Lauren M LeStourgeon
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lindsay S Mayberry
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Diabetes Translation Research, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.
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15
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Sorber R, Abularrage CJ. Diabetic foot ulcers: Epidemiology and the role of multidisciplinary care teams. Semin Vasc Surg 2021; 34:47-53. [PMID: 33757635 DOI: 10.1053/j.semvascsurg.2021.02.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Diabetic foot ulcers (DFUs) are a common but highly morbid complication of long-standing diabetes, carrying high rates of associated major amputation and mortality. As the global incidence of diabetes has increased, along with the lifespan of the diabetic patient, the worldwide burden of DFUs has grown steadily. Outcomes in diabetes and DFUs are known to depend strongly on social determinants of health, with worse outcomes noted in minority and socioeconomically disadvantaged populations. Effective treatment of DFUs is complex, requiring considerable expenditure of resources and significant cost to the health care system. Comprehensive care models with multidisciplinary teams have proven effective in the treatment of DFUs by decreasing barriers to care and increasing access to the multiple specialists required to provide timely and effective DFU procedural intervention, surveillance, and preventative care. Vascular surgeons are an integral part throughout the cycle of care for DFUs and should be involved early in the course of such patients to maximize their contributions to a multidisciplinary care model.
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Affiliation(s)
- Rebecca Sorber
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins Medical Institutions, Halsted 671, 600 N Wolfe Street, Baltimore, MD 21287
| | - Christopher J Abularrage
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins Medical Institutions, Halsted 671, 600 N Wolfe Street, Baltimore, MD 21287.
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ZEIDI ISAMOHAMMADI, MORSHEDI HADI, ALIZADEH OTAGHVAR HAMIDREZA. A theory of planned behavior-enhanced intervention to promote health literacy and self-care behaviors of type 2 diabetic patients. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2021; 61:E601-E613. [PMID: 33628967 PMCID: PMC7888399 DOI: 10.15167/2421-4248/jpmh2020.61.4.1504] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 08/12/2020] [Indexed: 12/30/2022]
Abstract
Background Improved health literacy and awareness could help type 2 diabetic patients to control the disease complications. Objective The current study aimed to evaluate the impact of theory-based educational intervention on health literacy and self-care behaviors of type 2 diabetic patients in Tonekabon city. Methods This randomized controlled trial study was conducted at health care centers in Tonekabon city, Iran, from April 5, 2017, to October 22, 2018. Using multistage random sampling, 166 patients with type 2 diabetes divided into two groups: theory-based intervention (n = 83) and custom education (n = 83). The data collection tools consisted of demographic information, Theory of Planned Behavior (TPB) measures, health literacy for Iranian adults (HELIA) and summary of diabetes self-care activities (SDSCA). The five 45-minute group training sessions based on the baseline assessment and model constructs along with the targeted pamphlet and m-health strategy were designed for the experimental group. Data were analyzed using chi-square, independent and paired t-test and Analysis of covariance (ANCOVA). Results After controlling for pre-test effect, there was a significant difference between the two groups in terms of mean scores of attitudes, subjective norms, perceived behavior control and intention in post-test (P < 0.001). Also, after controlling for the pre-test effect, the results showed a significant difference in the self-care domain in the post-test (P < 0.001). Finally, after controlling for the pre-test variable effect, covariance analysis reflects significant difference in total health literacy score and its dimension at posttest (P < 0.001). Conclusions Applying TPB based education is suggested to maintain and improve self-care behaviors and health literacy in type 2 diabetic patients and other chronic diseases.
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Affiliation(s)
- ISA MOHAMMADI ZEIDI
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
- Correspondence: Isa Mohammadi Zeidi, Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran - Tel. +98 9124146500 - E-mail: ,
| | - HADI MORSHEDI
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
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Mayberry LS, Berg CA, Greevy RA, Nelson LA, Bergner EM, Wallston KA, Harper KJ, Elasy TA. Mixed-Methods Randomized Evaluation of FAMS: A Mobile Phone-Delivered Intervention to Improve Family/Friend Involvement in Adults' Type 2 Diabetes Self-Care. Ann Behav Med 2020; 55:165-178. [PMID: 32706852 DOI: 10.1093/abm/kaaa041] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Family and friends have both helpful and harmful effects on adults' diabetes self-management. Family-focused Add-on to Motivate Self-care (FAMS) is a mobile phone-delivered intervention designed to improve family/friend involvement, self-efficacy, and self-care via monthly phone coaching, texts tailored to goals, and the option to invite a support person to receive texts. PURPOSE We sought to evaluate how FAMS was received by a diverse group of adults with Type 2 diabetes and if FAMS improved diabetes-specific family/friend involvement (increased helpful and reduced harmful), diabetes self-efficacy, and self-care (diet and physical activity). We also assessed if improvements in family/friend involvement mediated improvements in self-efficacy and self-care. METHODS Participants were prospectively assigned to enhanced treatment as usual (control), an individualized text messaging intervention alone, or the individualized text messaging intervention plus FAMS for 6 months. Participants completed surveys at baseline, 3 and 6 months, and postintervention interviews. Between-group and multiple mediator analyses followed intention-to-treat principles. RESULTS Retention, engagement, and fidelity were high. FAMS was well received and helped participants realize the value of involving family/friends in their care. Relative to control, FAMS participants had improved family/friend involvement, self-efficacy, and diet (but not physical activity) at 3 and 6 months (all ps < .05). Improvements in family/friend involvement mediated effects on self-efficacy and diet for FAMS participants but not for the individualized intervention group. CONCLUSIONS The promise of effectively engaging patients' family and friends lies in sustained long-term behavior change. This work represents a first step toward this goal by demonstrating how content targeting helpful and harmful family/friend involvement can drive short-term effects. TRIAL REGISTRATION NUMBER NCT02481596.
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Affiliation(s)
- Lindsay S Mayberry
- Department of Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN 37203, USA.,Vanderbilt Center for Diabetes Translation Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Cynthia A Berg
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Robert A Greevy
- Vanderbilt Center for Diabetes Translation Research, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Biostatistics, Vanderbilt University, Nashville, TN, USA
| | - Lyndsay A Nelson
- Department of Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN 37203, USA.,Vanderbilt Center for Diabetes Translation Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Erin M Bergner
- Department of Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN 37203, USA
| | - Kenneth A Wallston
- Vanderbilt Center for Diabetes Translation Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kryseana J Harper
- Department of Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN 37203, USA
| | - Tom A Elasy
- Department of Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN 37203, USA.,Vanderbilt Center for Diabetes Translation Research, Vanderbilt University Medical Center, Nashville, TN, USA
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18
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Nelson LA, Spieker A, Greevy R, LeStourgeon LM, Wallston KA, Mayberry LS. User Engagement Among Diverse Adults in a 12-Month Text Message-Delivered Diabetes Support Intervention: Results from a Randomized Controlled Trial. JMIR Mhealth Uhealth 2020; 8:e17534. [PMID: 32706738 PMCID: PMC7404018 DOI: 10.2196/17534] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/06/2020] [Accepted: 06/03/2020] [Indexed: 01/17/2023] Open
Abstract
Background Text message–delivered interventions are a feasible and scalable approach for improving chronic disease self-care and reducing health disparities; however, information on long-term user engagement with these interventions is limited. Objective The aim of this study is to examine user engagement in a 12-month text message–delivered intervention supporting diabetes self-care, called REACH (Rapid Education/Encouragement And Communications for Health), among racially and socioeconomically diverse patients with type 2 diabetes (T2D). We explored time trends in engagement, associations between patient characteristics and engagement, and whether the addition of a human component or allowing patients to change their text frequency affected engagement. Qualitative data informed patients’ subjective experience of their engagement. Methods We recruited patients with T2D for a randomized trial evaluating mobile phone support relative to enhanced treatment as usual. This analysis was limited to participants assigned to the intervention. Participants completed a survey and hemoglobin A1c (HbA1c) test and received REACH text messages, including self-care promotion texts, interactive texts asking about medication adherence, and adherence feedback texts. For the first 6 months, texts were sent daily, and half of the participants also received monthly phone coaching. After 6 months, coaching stopped, and participants had the option to receive fewer texts for the subsequent 6 months. We defined engagement via responses to the interactive texts and responses to a follow-up interview. We used regression models to analyze associations with response rate and thematic and structural analysis to understand participants’ reasons for responding to the texts and their preferred text frequency. Results The participants were, on average, aged 55.8 (SD 9.8) years, 55.2% (137/248) female, and 52.0% (129/248) non-White; 40.7% (101/248) had ≤ a high school education, and 40.7% (101/248) had an annual household income <US $25,000. The median response rate to interactive texts was 91% (IQR 75%-97%) over 12 months. Engagement gradually declined throughout the intervention but remained high. Engagement did not differ by age, gender, education, income, diabetes duration, insulin status, health literacy, or numeracy. Black race and worse baseline medication adherence and HbA1c were each associated with lower engagement, although the effects were small. Nearly half of the participants chose to continue receiving daily texts for the last 6 months of the intervention. Participants who continued daily text messages said they wanted to continue experiencing benefits to their health, whereas those who chose fewer texts said that the daily texts had helped them create routines and they no longer needed them as often. Engagement was not impacted by receiving coaching or by participants’ chosen text frequency. Conclusions Well-designed interactive text messages can engage diverse patients in a self-care intervention for at least 1 year. Variation in and reasons for frequency preference suggest that offering a frequency choice may be important to users’ engagement.
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Affiliation(s)
- Lyndsay A Nelson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.,Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Andrew Spieker
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Robert Greevy
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Lauren M LeStourgeon
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.,Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Kenneth A Wallston
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Lindsay S Mayberry
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.,Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, United States.,Center for Diabetes Translation Research, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
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Tan X, Lee LK, Huynh S, Pawaskar M, Rajpathak S. Sociodemographic disparities in the management of type 2 diabetes in the United States. Curr Med Res Opin 2020; 36:967-976. [PMID: 32297530 DOI: 10.1080/03007995.2020.1756764] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Objective: To examine the potential sociodemographic disparities in type 2 diabetes (T2D) management and care among US adult individuals, after controlling for clinical and behavioral factors.Methods: This was a retrospective cohort study of individuals with T2D (N = 4552) from a linked database of the National Health and Wellness Survey and a large US ambulatory electronic health record (EHR) database. This study period was between 1 January 2015 and 31 December 2018 and individuals were followed up for at least 6 months through EHR after the completion of the survey. The sociodemographic characteristics included gender, race, ethnicity, marital status, education, employment status, household income, insurance status, and geographic region. The independent variables included testing and control of HbA1c, blood pressure (BP), and low-density lipoprotein-cholesterol (LDL-C); hypoglycemia, emergency room (ER) visits, and all-cause hospitalization. Multivariable analyses were conducted using generalized linear models.Results: The percentage of uncontrolled HbA1c was 38.6%. With clinical and behavioral characteristics adjusted, individuals living in the Northeast region had 30% higher odds of having HbA1c testing than those who lived in the South. Blacks and Asians were less likely to have HbA1c control than Whites. Uninsured individuals had a lower likelihood of receiving HbA1c, BP, or LDL-C testing compared with commercial insurers. Individuals with low income were more likely to have higher ER visits and hospitalizations.Conclusion: Potential sociodemographic disparities exist in T2D management and care in the US, indicating the needs for improvement in healthcare access, educational and behavioral programs, as well as disease and treatment management in these subgroups.
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Affiliation(s)
- Xi Tan
- Merck & Co., Inc, Kenilworth, NJ, USA
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20
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Rahman M, Nakamura K, Hasan SMM, Seino K, Mostofa G. Mediators of the association between low socioeconomic status and poor glycemic control among type 2 diabetics in Bangladesh. Sci Rep 2020; 10:6690. [PMID: 32317650 PMCID: PMC7174358 DOI: 10.1038/s41598-020-63253-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 03/26/2020] [Indexed: 12/19/2022] Open
Abstract
Although low socioeconomic status (SES) is related to poor glycemic control, the underlying mechanisms remain unclear. We examined potentially modifiable factors involved in the association between low SES and poor glycemic control using data from the baseline survey of a multicenter, prospective cohort study. Five hundred adult type 2 diabetes patients were recruited from three diabetes centers. Glycemic control was poorer in diabetic individuals with low SES than in those with higher SES. Adverse health-related behaviors, such as non-adherence to medication (adjusted odds ratio [AOR] = 1.07, 95% confidence interval [CI] 1.04–1.13) and diet (AOR = 1.04, 95% CI 1.02–1.06); existing comorbidities, such as depressive symptoms (AOR = 1.05, 95% CI 1.04–1.09); and non-adherence to essential health service-related practices concerning diabetes care, such as irregular scheduled clinic visits (AOR = 1.04, 95% CI 1.03–1.06) and not practicing self-monitoring of blood glucose (AOR = 1.05, 95% CI 1.03–1.07), mediated the relationship between social adversity and poor glycemic control specially in urban areas of Bangladesh. Those identified factors provide useful information for developing interventions to mitigate socioeconomic disparities in glycemic control.
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Affiliation(s)
- Mosiur Rahman
- Department of Global Health Entrepreneurship, Division of Public Health, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.,Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, 6205, Bangladesh
| | - Keiko Nakamura
- Department of Global Health Entrepreneurship, Division of Public Health, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
| | - S M Mahmudul Hasan
- Department of Global Health Entrepreneurship, Division of Public Health, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kaoruko Seino
- Department of Global Health Entrepreneurship, Division of Public Health, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.,Department of Environmental Health Sciences, School of Public Health, The University of Michigan, Michigan, USA
| | - Golam Mostofa
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, 6205, Bangladesh
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21
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Mayberry LS, Lyles CR, Oldenburg B, Osborn CY, Parks M, Peek ME. mHealth Interventions for Disadvantaged and Vulnerable People with Type 2 Diabetes. Curr Diab Rep 2019; 19:148. [PMID: 31768662 PMCID: PMC7232776 DOI: 10.1007/s11892-019-1280-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Mobile- and Internet-delivered (collectively, digital) interventions are widely used by persons with diabetes (PWD) to assist with self-management and improve/maintain glycemic control (hemoglobin A1c [A1c]). However, evidence concerning the acceptance and benefits of such interventions among disadvantaged/vulnerable PWD is still quite limited. PURPOSE OF REVIEW We reviewed studies published from 2011-April 2019 evaluating the impact of diabetes self-management interventions delivered via mobile device and/or Internet on glycemic control of disadvantaged/vulnerable adults with type 2 diabetes (T2D). Included studies reported ≥ 50% of the sample having a low socioeconomic status and/or being a racial/ethnic minority, or living in a rural setting or low-/middle-income country (LMIC). We identified 21 studies evaluating a digital intervention among disadvantaged/vulnerable PWD. RECENT FINDINGS Although many digital interventions found within-group A1c improvements (16 of 21 studies), only seven of the seventeen studies with a control group found between-group differences in A1c. Three studies found reductions in emergency room (ER) visits and hospitalizations. We synthesize this information, and provide recommendations for increasing access, and improving the design and usability of such interventions. We also discuss the role of human support in digital delivery, issues related to study design, reporting, economic value, and available research in LMICs. There is evidence suggesting that digital interventions can improve diabetes control, healthcare utilization, and healthcare costs. More research is needed to substantiate these early findings, and many issues remain in order to optimize the impact of digital interventions on the health outcomes of disadvantaged/vulnerable persons with diabetes.
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Affiliation(s)
| | | | | | | | - Makenzie Parks
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Monica E Peek
- Section of General Internal Medicine, Chicago Center for Diabetes Translation Research, The University of Chicago, 5841 S. Maryland Avenue, MC 2007, Chicago, IL, 60637, USA.
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Riegel B, Dunbar SB, Fitzsimons D, Freedland KE, Lee CS, Middleton S, Stromberg A, Vellone E, Webber DE, Jaarsma T. Self-care research: Where are we now? Where are we going? Int J Nurs Stud 2019; 116:103402. [PMID: 31630807 DOI: 10.1016/j.ijnurstu.2019.103402] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/04/2019] [Accepted: 08/10/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND OBJECTIVE The beneficial effects of self-care include improved well-being and lower morbidity, mortality, and healthcare costs. In this article we address the current state of self-care research and propose an agenda for future research based on the inaugural conference of the International Center for Self-Care Research held in Rome, Italy in June 2019. The vision of this Center is a world where self-care is prioritized by individuals, families, and communities and is the first line of approach in every health care encounter. The mission of the Center is to lead the self-care research endeavor, improving conceptual clarity and promoting interdisciplinary work informed by a shared vision addressing knowledge gaps. A focused research agenda can deepen our theoretical understanding of self-care and the mechanisms underlying self-care, which can contribute to the development of effective interventions that improve outcomes. METHODS During conference discussions, we identified seven major reasons why self-care is challenging, which can be grouped into the general categories of behavior change and illness related factors. We identified six specific knowledge gaps that, if addressed, may help to address these challenges: the influence of habit formation on behavior change, resilience in the face of stressful life events that interfere with self-care, the influence of culture on self-care behavioral choices, the difficulty performing self-care with multiple chronic conditions, self-care in persons with severe mental illness, and the influence of others (care partners, family, peer supporters, and healthcare professionals) on self-care. PLANS TO ACHIEVE RESULTS To achieve the vision and mission of the Center, we will lead a collaborative program of research that addresses self-care knowledge gaps and improves outcomes, create a supportive international network for knowledge transfer and support of innovations in self-care research, and support and train others in self-care research. Beyond these specific short-term goals, important policy implications of this work are discussed.
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Affiliation(s)
- Barbara Riegel
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, PA 19104-4217, USA; Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
| | | | | | | | | | - Sandy Middleton
- Nursing Research Institute, St Vincent's Health Australia & Australian Catholic University, Australia.
| | - Anna Stromberg
- Department of Medical and Health Sciences and Department of Cardiology, Linkoping University, Sweden.
| | | | | | - Tiny Jaarsma
- Julius Center, University Medical Center Utrecht, the Netherlands; Faculty of Medical and Health Sciences, Linkoping University, Sweden.
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