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Allory E, Scheer J, De Andrade V, Garlantézec R, Gagnayre R. Characteristics of self-management education and support programmes for people with chronic diseases delivered by primary care teams: a rapid review. BMC PRIMARY CARE 2024; 25:46. [PMID: 38297228 PMCID: PMC10829293 DOI: 10.1186/s12875-024-02262-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/02/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Primary care actors can play a major role in developing and promoting access to Self-Management Education and Support (SMES) programmes for people with chronic disease. We reviewed studies on SMES programmes in primary care by focusing on the following dimensions: models of SMES programmes in primary care, SMES team's composition, and participants' characteristics. METHODS For this mixed-methods rapid review, we searched the PubMed and Cochrane Library databases to identify articles in English and French that assessed a SMES programme in primary care for four main chronic diseases (diabetes, cancer, cardiovascular disease and/or respiratory chronic disease) and published between 1 January 2013 and 31 December 2021. We excluded articles on non-original research and reviews. We evaluated the quality of the selected studies using the Mixed Methods Appraisal Tool. We reported the study results following the PRISMA guidelines. RESULTS We included 68 studies in the analysis. In 46/68 studies, a SMES model was described by focusing mainly on the organisational dimension (n = 24). The Chronic Care Model was the most used organisational model (n = 9). Only three studies described a multi-dimension model. In general, the SMES team was composed of two healthcare providers (mainly nurses), and partnerships with community actors were rarely reported. Participants were mainly patients with only one chronic disease. Only 20% of the described programmes took into account multimorbidity. Our rapid review focused on two databases and did not identify the SMES programme outcomes. CONCLUSIONS Our findings highlight the limited implication of community actors and the infrequent inclusion of multimorbidity in the SMES programmes, despite the recommendations to develop a more interdisciplinary approach in SMES programmes. This rapid review identified areas of improvement for SMES programme development in primary care, especially the privileged place of nurses in their promotion. TRIAL REGISTRATION PROSPERO 2021 CRD42021268290 .
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Affiliation(s)
- Emmanuel Allory
- Department of General Practice, Univ Rennes, 2 Av. du Professeur Léon Bernard, Rennes, 35000, France.
- CHU Rennes, Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, 35000, France.
- LEPS (Laboratoire d'Education Et Promotion en Santé), University of Sorbonne Paris Nord, Villetaneuse, UR, 3412, F-93430, France.
| | - Jordan Scheer
- Department of General Practice, Univ Rennes, 2 Av. du Professeur Léon Bernard, Rennes, 35000, France
- CHU Rennes, Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, 35000, France
| | - Vincent De Andrade
- LEPS (Laboratoire d'Education Et Promotion en Santé), University of Sorbonne Paris Nord, Villetaneuse, UR, 3412, F-93430, France
| | - Ronan Garlantézec
- CHU de Rennes, Univ Rennes, Inserm, EHESP (Ecole Des Hautes Etudes en Santé Publique), Irset - UMR_S 1085, Rennes, 35000, France
| | - Rémi Gagnayre
- LEPS (Laboratoire d'Education Et Promotion en Santé), University of Sorbonne Paris Nord, Villetaneuse, UR, 3412, F-93430, France
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Fu Y, Yu G, Maulana N, Thomson K. Interventions to tackle health inequalities in cardiovascular risks for socioeconomically disadvantaged populations: a rapid review. Br Med Bull 2023; 148:22-41. [PMID: 37724711 PMCID: PMC10724464 DOI: 10.1093/bmb/ldad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 09/21/2023]
Abstract
INTRODUCTION Cardiovascular disease (CVD) has shown significant health inequalities for people with low socioeconomic status associated with more risk factors. This review was to synthesize interventions that targeted CVD risks and outcomes among socioeconomically disadvantaged populations and to understand the impact associated with these interventions. SOURCES OF DATA Cochrane CENTRAL, MEDLINE, Embase, PsycINFO and CINAHL were searched for records published in the last decade using a systematic search strategy, complemented by screening the reference lists and citation indexes. Nineteen studies were included and a narrative synthesis with the effect direction plot was undertaken in which studies, interventions, participants and outcomes were examined according to the intervention type focusing on behaviours, lifestyle, education, medication and monitoring. AREAS OF AGREEMENT No universal definition of disadvantaged socioeconomic status was used with common factors relating to racial/ethnic minorities, low income and low or no health insurance. Mixed effects of interventions were reported on clinical outcomes including weight, body mass index, blood pressure, glycated haemoglobin and cholesterol. AREAS OF CONTROVERSY Inconsistent effect was reported due to a large variety of settings, participants and intervention components although they are considered necessary to address the complex health needs of socioeconomically disadvantaged populations. GROWING POINTS There is inadequate evidence to determine whether any of the intervention types are effective in optimising lipids management for socioeconomically disadvantaged populations. AREAS TIMELY FOR DEVELOPING RESEARCH Research is needed with mixed evidence using real world evaluation and lived experience combined with health economic evaluation, on both mental and physical health outcomes.
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Affiliation(s)
- Yu Fu
- Department of Primary Care & Mental Health, Institute of Population Health, University of Liverpool, 1-3 Brownlow Street, Liverpool, L69 3GL, UK
| | - Ge Yu
- King’s Health Economics, Health Services and Population Research, Department of Psychiatry, Psychology & Neuroscience, King’s College London, David Goldberg Centre 18 De Crespigny Park, London, SE5 8AF, UK
| | - Naswa Maulana
- Population Health Sciences Institute, Faculty of Medical Sciences Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK
| | - Katie Thomson
- Population Health Sciences Institute, Faculty of Medical Sciences Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK
- National Institute for Health Research Applied Research Collaboration, North East and North Cumbria, Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust St Nicholas Hospital Gosforth, Newcastle Upon Tyne NE3 3XT, UK
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Lamptey R, Amoakoh-Coleman M, Djobalar B, Grobbee DE, Adjei GO, Klipstein-Grobusch K. Diabetes self-management education interventions and self-management in low-resource settings; a mixed methods study. PLoS One 2023; 18:e0286974. [PMID: 37450431 PMCID: PMC10348576 DOI: 10.1371/journal.pone.0286974] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 05/27/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION Diabetes is largely a self-managed disease; thus, care outcomes are closely linked to self-management behaviours. Structured self-management education (DSME) interventions are, however, largely unavailable in Africa. AIM We sought to characterise DSME interventions in two urban low-resource primary settings; and to explore diabetes self-management knowledge and behaviours, of persons living with diabetes (PLD). RESEARCH DESIGN AND METHODS A convergent parallel mixed-methods study was conducted between January and February 2021 in Accra, Ghana. The sampling methods used for selecting participants were total enumeration, consecutive sampling, purposive and judgemental sampling. Multivariable regression models were used to study the association between diabetes self-management knowledge and behaviours. We employed inductive content analysis of informants' experiences and context, to complement the quantitative findings. RESULTS In total, 425 PLD (70.1% (n = 298) females, mean age 58 years (SD 12), with a mean blood glucose of 9.4 mmol/l (SD 6.4)) participated in the quantitative study. Two managers, five professionals, two diabetes experts and 16 PLD participated in in-depth interviews. Finally, 24 PLD were involved in four focus group discussions. The median diabetes self-management knowledge score was 40% ((IQR 20-60). For every one unit increase in diabetes self-management knowledge, there were corresponding increases in the diet (5%;[95% CI: 2%-9%, p<0.05]), exercise (5%; [95% CI:2%-8%, p<0.05]) and glucose monitoring (4%;[95% CI:2%-5%, p<0.05]) domains of the diabetes self-care activities scale respectively. The DSME interventions studied, were unstructured and limited by resources. Financial constraints, conflicting messages, beliefs, and stigma were the themes underpinning self-management behaviour. CONCLUSIONS The DSME interventions studied were under-resourced, and unstructured. Diabetes self-management knowledge though limited, was associated with self-management behaviour. DSME interventions in low resource settings should be culturally tailored and should incorporate sessions on mitigating financial constraints. Future studies should focus on creating structured DSME interventions suited to resource-constrained settings.
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Affiliation(s)
- Roberta Lamptey
- Polyclinic/ Family Medicine Department, Korle Bu Teaching Hospital, Accra, Ghana
- Department of Community Health, University of Ghana Medical School, Accra, Ghana
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Mary Amoakoh-Coleman
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Babbel Djobalar
- Internal Medicine Department, Korle Bu Teaching Hospital, Accra, Ghana
| | - Diederick E. Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - George Obeng Adjei
- Centre for Tropical Clinical Pharmacology and Therapeutics, University of Ghana Medical School, Accra, Ghana
- Office of Research Innovation and Development, University of Ghana, Legon, Ghana
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Romero-Castillo R, Pabón-Carrasco M, Jiménez-Picón N, Ponce-Blandón JA. Effects of Nursing Diabetes Self-Management Education on Glycemic Control and Self-Care in Type 1 Diabetes: Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095079. [PMID: 35564474 PMCID: PMC9100266 DOI: 10.3390/ijerph19095079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/14/2022] [Accepted: 04/18/2022] [Indexed: 11/16/2022]
Abstract
(1) Background: Type 1 diabetes is a chronic disease that creates a high demand and responsibility for patient self-care. Patient education, self-care training and the management of derived complications are great challenges for nurses. The objective of this project is to evaluate the efficacy of a therapeutic education program for type 1 diabetes. (2) Methods: Participants recruited to the study will be adult patients with diagnosed type 1 diabetes attending the clinic at the study site. A nurse diabetes educator will deliver a four-session education program. A two-group randomized controlled trial will be used in this study, with an intervention group and a control group. The subjects included in the experimental group will attend some health education sessions, while control group participants will receive the existing standard care provided by the endocrinology and nutrition unit of the hospital. Measurements and evaluations will be conducted at the baseline prior to the intervention and at 1 and 3 months from the intervention. (3) Conclusions: The primary outcome is improving patients' knowledge about diet and treatment management. Secondary outcomes are improving patients' glycemic control and mood. The findings from this study will help to determine the effect of diabetes education about self-care and treatment in patients with diabetes, as well as helping to decrease short-term and long-term complications and reduce health care costs.
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Mendez I, Lundeen EA, Saunders M, Williams A, Saaddine J, Albright A. Diabetes Self-Management Education and Association With Diabetes Self-Care and Clinical Preventive Care Practices. Sci Diabetes Self Manag Care 2022; 48:23-34. [PMID: 35023406 PMCID: PMC10979825 DOI: 10.1177/26350106211065378] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of the study is to assess self-reported receipt of diabetes education among people with diabetes and its association with following recommended self-care and clinical preventive care practices. METHODS We analyzed data from the 2017 and 2018 Behavioral Risk Factor Surveillance System for 61 424 adults (≥18 years) with self-reported diabetes in 43 states and Washington, DC. Diabetes education was defined as ever taking a diabetes self-management class. The association of diabetes education with self-care practices (daily glucose testing, daily foot checks, smoking abstention, and engaging in leisure-time physical activity) and clinical practices (pneumococcal vaccination, biannual A1C test, and an annual dilated eye exam, influenza vaccination, health care visit for diabetes, and foot exam by a medical professional) was assessed. Multivariable logistic regression with predicted margins was used to predict the probability of following these practices, by diabetes education, controlling for sociodemographic factors. RESULTS Of adults with diabetes, only half reported receiving diabetes education. Results indicate that receipt of diabetes education is associated with following self-care and clinical preventive care practices. Those who did receive diabetes education had a higher predicted probability for following all 4 self-care practices (smoking abstention, daily glucose testing, daily foot check, and engaging in leisure-time physical activity) and all 6 clinical practices (pneumonia vaccination, biannual A1C test, and an annual eye exam, flu vaccination, health care visit, and medical foot exam). CONCLUSIONS The prevalence of adults with diabetes receiving diabetes education remains low. Increasing receipt of diabetes education may improve diabetes-related preventive care.
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Affiliation(s)
- Isabel Mendez
- Oak Ridge Institute for Science and Education (ORISE) fellow, Division of Diabetes Translation (DDT), National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
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Kardaş Kin Ö, Türeyen A. The effect of diabetes education based on learning modality in individuals with diabetes incompatible with treatment on compliance and metabolic goals: A randomized controlled trial. Prim Care Diabetes 2022; 16:150-155. [PMID: 34930689 DOI: 10.1016/j.pcd.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 11/23/2021] [Accepted: 12/04/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND The purpose of this study is to examine the effect of education based on learning modality in diabetic individuals who are incompatible with treatment, on treatment compliance and metabolic goals. METHODS This study is a randomized controlled trial. Among the individuals who applied to the outpatient clinic and were eligible for inclusion in the study, the odd numbers were assigned to the intervention group (n:30), and the even numbers to the control group (n:30). The practice group of 30 people and the control group were divided into 3 groups. Three groups in the intervention group was given according to the learning modality. The auditory group in the post-training practice group; calling by phone, to the visual group; by Short Messaging Servis, to the tactile group; reminder alerts were made by phone + Short Messaging Servise. Standard training was given to the control group. RESULT It was observed that the total scale score of the intervention group decreased significantly after the training, while the total scale score of the control group increased significantly after the training. As a result of the diabetes education given based on learning modality, significant decreases were observed in A1C, fasting blood glucose, post-prandial blood glucose, body mass index, high-density lipoprotein and blood pressure values of the intervention group compared to the control group. CONCLUSION Study findings show that the diabetes education given to the intervention group according to their learning modality positively affects the diabetes management and treatment compliance of the individuals.
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Affiliation(s)
- Özlem Kardaş Kin
- Pazarcik State Hospital, Surgery Service, Kahramanmaras, Turkey.
| | - Aynur Türeyen
- Ege University, Nursing Faculty, Internal Nursing Department, Izmir, Turkey
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Boakye MD, Miyamoto S, Greenwood D. What Individuals Want to Hear at the Point of Type 2 Diabetes Diagnosis. Clin Diabetes 2022; 41:110-119. [PMID: 36714250 PMCID: PMC9845082 DOI: 10.2337/cd21-0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Recent studies have shown that the time of diagnosis with type 2 diabetes is often not a teachable moment because of heightened emotions. Yet, research also shows that individuals who are newly diagnosed with type 2 diabetes need reassurance and a clear pathway to obtain the education and support needed to self-manage the condition. This article reports on qualitative research exploring the experiences of individuals with type 2 diabetes at the time of diagnosis, including information they wanted to hear and learn at diagnosis. The findings suggest that initial communication should offer reassurance and establish a partnership between the diagnosed individual and the health care provider to identify next steps toward self-management success.
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Affiliation(s)
- Michelle D.S. Boakye
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA
- Corresponding author: Michelle D.S. Boakye, or
| | - Sheridan Miyamoto
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA
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Ghisi GLDM, Seixas MB, Pereira DS, Cisneros LL, Ezequiel DGA, Aultman C, Sandison N, Oh P, da Silva LP. Patient education program for Brazilians living with diabetes and prediabetes: findings from a development study. BMC Public Health 2021; 21:1236. [PMID: 34174860 PMCID: PMC8236150 DOI: 10.1186/s12889-021-11300-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 06/15/2021] [Indexed: 11/16/2022] Open
Abstract
Background Globally, the incidence of diabetes is increasing and strategies to reach a comprehensive approach of care are needed, including education in self-management. This is particularly true in low and middle-income countries where the number of people living with diabetes is higher than in the high-income ones. This article describes the development of a structured patient education program for Brazilians living with diabetes or prediabetes. Methods These steps were undertaken: 1) a 4-phase needs assessment (literature search of local diabetes guidelines, environmental scan, evaluation of information needs of patients identified by diabetes experts, and patient focus groups); and, 2) the translation and cultural adaptation of the patient guide (preparation, translation, back-translation, back-translation review, harmonization, and proofreading). Results Four of the seven guidelines identified include educational aspects of diabetes management. No structured education program was reported from the environmental scan. Regarding the information needs, 15 diabetes experts identified their patients’ needs, who referred that they have high information needs for topics related to their health condition. Finally, results from six patient focus groups were clustered into six themes (self-management, physical activity, eating habits, diabetes medication, psychosocial being, and sleep), all embedded into the new education program. Constructive theory, adult learning principles, and the Health Action Process Approach model were used in program development and will be used in delivery. The developed program consists of 18 educational sessions strategically mapped and sequenced to support the program learning outcomes and a patient guide with 17 chapters organized into five sections, matched with weekly lectures. Conclusions This program is a sequential and theoretical strategic intervention that can reach programs in Brazil to support diabetes and prediabetes patient education. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11300-y.
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Affiliation(s)
- Gabriela Lima de Melo Ghisi
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, M4G 1R7, ON, Canada
| | - Mariana Balbi Seixas
- Faculty of Physical Therapy, Federal University of Juiz de Fora, Juiz de Fora, MG, 36038-330, Brazil
| | - Daniele Sirineu Pereira
- Department of Physiotherapy, Federal University of Minas Gerais, Belo Horizonte, 31270-901, MG, Brazil
| | - Ligia Loiola Cisneros
- Department of Physiotherapy, Federal University of Minas Gerais, Belo Horizonte, 31270-901, MG, Brazil
| | | | - Crystal Aultman
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, M4G 1R7, ON, Canada
| | - Nicole Sandison
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, M4G 1R7, ON, Canada
| | - Paul Oh
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, M4G 1R7, ON, Canada
| | - Lilian Pinto da Silva
- Faculty of Physical Therapy, Federal University of Juiz de Fora, Juiz de Fora, MG, 36038-330, Brazil.
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James TL. Improving Referrals to Diabetes Self-Management Education in Medically Underserved Adults. Diabetes Spectr 2021; 34:20-26. [PMID: 33627990 PMCID: PMC7887525 DOI: 10.2337/ds20-0001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Electronic health records (EHRs) and clinical decision-support algorithms improve diabetes care. This quality improvement (QI) project aimed to determine whether an electronic diabetes education referral protocol using the Diabetes Self-Management Education and Support for Adults With Type 2 Diabetes: Algorithm of Care (DSMES Algorithm) and protocol training would increase the proportion of adult patients with type 2 diabetes at a federally qualified health center electronically referred for diabetes self-management education and support (DSMES). DESIGN AND METHODS The EHR was modified to include the DSMES Algorithm and questions regarding prior participation in diabetes education. Protocol trainings were conducted. Data were obtained via retrospective chart review. A one-sample t test was used to evaluate the statistical difference between the electronic referral (e-referral) rates of the pre-intervention and intervention groups. RESULTS Completion of the DSMES Algorithm was positively associated with e-referrals to diabetes education (P <0.001). The intervention group had a higher rate of e-referral for DSMES than the pre-intervention group (31 vs. 0%, P <0.001). CONCLUSION E-referral protocols using the DSMES Algorithm and protocol training may aid in the identification and documentation of self-care needs of medically underserved patients with type 2 diabetes and improve e-referrals to DSMES. Of clinical importance, these findings translate into active patient engagement, team-based care, and information-sharing. Additional work is needed to determine whether the e-referral rate is sustained or increases over time. Further investigations should also be explored to evaluate the impact of e-referral protocols and algorithms on participation in DSMES.
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Affiliation(s)
- Tiffany L James
- University of Alabama at Birmingham, Birmingham, AL, and Valley Healthcare System, Columbus, GA
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Ghisi GLDM, Aultman C, Konidis R, Foster E, Tahsinul A, Sandison N, Sarin M, Oh P. Effectiveness of an education intervention associated with an exercise program in improving disease-related knowledge and health behaviours among diabetes patients. PATIENT EDUCATION AND COUNSELING 2020; 103:1790-1797. [PMID: 32362522 DOI: 10.1016/j.pec.2020.04.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/17/2020] [Accepted: 04/08/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE to assess the effectiveness of an education intervention associated with an exercise program in improving knowledge and health behaviours among diabetes patients. METHODS Diabetes and prediabetes patients were exposed to an evidence- and theoretically-based comprehensive education intervention over 24 weeks. Patients completed surveys assessing knowledge, physical activity, food intake, self-efficacy, and health literacy. Functional capacity was measured by oxygen uptake. All outcomes were assessed pre- and post-CR. Satisfaction about the education provided was assessed at post-CR. Paired t-tests, Pearson correlation coefficients, and linear regression models were computed to investigate the effectiveness of this intervention. RESULTS 84 patients consented to participate, of which 47(56.0%) completed post-CR assessments. There was a significant improvement in patients' overall knowledge pre- to post-CR, as well as in physical activity, food intake, self-efficacy, and health literacy (p < 0.05). Peak VO2 has clinically significant improved. Results showed a low significant positive correlation was between post-CR knowledge and food intake(r = 0.297;p = 0.04). Linear regression analysis revealed that age(B=-0.051; p = 0.01) was influential in changing post-CR knowledge. CONCLUSION The benefits of an education intervention designed for diabetes and prediabetes patients associated with an exercise program have been supported. PRACTICE IMPLICATIONS This work shows one effective education strategy taken in place that can be replicated in different settings.
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Affiliation(s)
- Gabriela Lima de Melo Ghisi
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute (TRI), University Health Network (UHN), Toronto, Canada.
| | - Crystal Aultman
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute (TRI), University Health Network (UHN), Toronto, Canada
| | - Renee Konidis
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute (TRI), University Health Network (UHN), Toronto, Canada
| | - Evelyn Foster
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute (TRI), University Health Network (UHN), Toronto, Canada
| | - Anam Tahsinul
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute (TRI), University Health Network (UHN), Toronto, Canada
| | - Nicole Sandison
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute (TRI), University Health Network (UHN), Toronto, Canada
| | - Michael Sarin
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute (TRI), University Health Network (UHN), Toronto, Canada
| | - Paul Oh
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute (TRI), University Health Network (UHN), Toronto, Canada
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Flores-Luevano S, Pacheco M, Shokar GS, Dwivedi AK, Shokar NK. Impact of a Culturally Tailored Diabetes Education and Empowerment Program in a Mexican American Population Along the US/Mexico Border: A Pragmatic Study. J Clin Med Res 2020; 12:517-529. [PMID: 32849940 PMCID: PMC7430876 DOI: 10.14740/jocmr4273] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 07/07/2020] [Indexed: 01/30/2023] Open
Abstract
Background The study purpose was to deliver a diabetes education program under real world conditions and evaluate its effect on diabetes-related clinical, self-management and psychosocial outcomes among Mexican Americans residing along the US/Mexico border. Methods A pragmatic study was conducted among adult patients with diabetes in three primary care clinics located along the US/Mexico border. A bilingual culturally tailored diabetes education program incorporating hands-on participatory techniques was delivered in 4 - 8 weekly group sessions. Clinical, self-management and psychosocial outcomes were evaluated pre- and post-intervention with surveys and medical record review. Results A total of 209 participants were enrolled; mean age was 58.9 years (range 23 - 94, standard deviation: 11.2); 68.4% were female; 91.1% were Hispanic. Significant improvements were observed in glycated hemoglobin (-1.1%, P < 0.001, n = 79), total cholesterol (-17.2 mg/dL, P = 0.041, n = 63), glucose self-monitoring (+1.3 times a week, P = 0.021, n = 115), exercise less than once a week (-18.2%, P < 0.001, n = 129), nutritional behavior (+2.23, P < 0.001, n = 115), knowledge (+1. 83, P < 0.001, n = 141) and diabetes-related emotional distress (-7.32, P = 0.002, n = 111). Benefits were observed with attendance rates as low as 50%. Conclusion A clinic-based culturally competent diabetes education/self-management program resulted in significant improvements in outcomes among Hispanic participants. Experimentally tested culturally appropriate interventions adapted for real world situations can benefit Mexican American diabetic patients even when attendance is imperfect.
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Affiliation(s)
- Silvia Flores-Luevano
- Department of Molecular and Translational Medicine and Family and Community Medicine, Texas Tech University Health Sciences Center, El Paso, TX 79924, USA
| | - Maricela Pacheco
- Christus Health TX A&M College of Medicine Spohn Hospital, Family Medicine Residency, 600 Elizabeth Street, Corpus Christi, TX 78404, USA
| | - Gurjeet S Shokar
- Department of Family and Community Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX 79924, USA
| | - Alok Kumar Dwivedi
- Division of Biostatistics and Epidemiology, Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, Biostatistics and Epidemiology Consulting Lab (BECL), Texas Tech University Health Sciences Center El Paso (TTUHSC EP), El Paso, TX 79905, USA
| | - Navkiran K Shokar
- Family & Community Medicine & Department of Molecular and Translational Medicine, Center of Emphasis for Cancer, El Paso, TX 79924, USA
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Jakoby MG, Schleder M, Luff V, Yergler C, Botchway A, Burns C. A 2-Hour Diabetes Self-Management Education Program for Patients With Low Socioeconomic Status Improves Short-Term Glycemic Control. J Patient Cent Res Rev 2020; 7:275-281. [PMID: 32760759 DOI: 10.17294/2330-0698.1745] [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: 11/04/2022] Open
Abstract
Diabetes self-management education (DSME) improves glycemic control, but patients with low socioeconomic status face institutional and personal barriers to receiving DSME. A retrospective single cohort study of a 2-hour group DSME program prioritizing accessibility and completion of a tightly focused curriculum was performed to determine if glycemic control improved and whether a longer, more comprehensive, prospective evaluation of the program is indicated. All patients who participated in the program from September 2017 to December 2018 were included in the analysis. The primary study endpoint was change in hemoglobin A1c (HbA1c) from baseline. A total of 58 out of 94 patients (61.7%) had paired measurements of HbA1c. Mean HbA1c improved from 9.8% ± 2.2% (83.5 ± 24.2 mmol/mol) to 8.3% ± 2.0% (67.7 ± 22.0 mmol/mol) at a median of 4 months after participation in the program (P<0.001). The proportion of patients with any improvement in HbA1c was 75.9% (44 of 58; P=0.003), and 65.5% of patients (38 of 58; P=0.066) had an improvement in HbA1c of ≥0.5%. These results demonstrate the benefit of highly targeted DSME for low-income patients and justify a longer-term and prospective evaluation of the program.
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Affiliation(s)
- Michael G Jakoby
- Division of Endocrinology, SIU School of Medicine, Springfield, IL
| | | | - Vickie Luff
- Central Counties Health Center, Springfield, IL
| | | | | | - Cheryl Burns
- Diabetes Education, SIU School of Medicine, Springfield, IL
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Allen JO, Concha JB, Mejía Ruiz MJ, Rapp A, Montgomery J, Smith J, Wolfson JA, Thornton W, Mezuk B. Engaging Underserved Community Members in Diabetes Self-Management: Evidence From the YMCA of Greater Richmond Diabetes Control Program. THE DIABETES EDUCATOR 2020; 46:169-180. [PMID: 32129157 PMCID: PMC7813155 DOI: 10.1177/0145721720907059] [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] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this study was to identify factors influencing participant engagement in a community-based diabetes self-management program (DSMP), with a focus on the needs of underserved groups (eg, racial/ethnic minorities, low income). METHODS Focus groups were conducted with participants (n = 22) from the YMCA of Greater Richmond's Diabetes Control Program, who were recruited using a purposeful sampling frame to capture a range of experiences. In-depth interviews were conducted with lay health coaches (n = 3). The RADaR qualitative analysis technique was used to identify themes related to factors across the continuum of engagement. RESULTS Fear affected program enrollment and retention in complex ways. Peers and coaches were important for social support and accountability. The length of the program (12 weeks), accessible information, practical skill building, and emphasis on making small, feasible improvements in pursuit of larger goals were identified as critical for engagement and improving diabetes self-management. Health and outside obligations were the major barriers to program attendance. CONCLUSIONS Participant and coach perspectives provide important insight into existing strengths of community-based DSMPs that can be expanded on to promote engagement as well as potential opportunities for improvement. Actionable recommendations for increasing engagement of underserved groups in community-based DSMPs are provided.
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Affiliation(s)
- Julie Ober Allen
- Population Studies Center, University of Michigan Institute for Social Research, Ann Arbor, Michigan
| | - Jeannie B Concha
- Department of Public Health Sciences, University of Texas, El Paso, Texas
| | | | - Ashley Rapp
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Joshua Montgomery
- Office of the Assistant Secretary for Health, U.S. Department of Health and Human Services, Washington, District of Columbia
| | - Jana Smith
- YMCA of Greater Richmond, Richmond, Virginia
| | - Julia A Wolfson
- Departments of Health Management and Policy and Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan
| | | | - Briana Mezuk
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
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McElfish PA, Rowland B, Riklon S, Aitaoto N, Sinclair KA, Ima S, Kadlubar SA, Goulden PA, Hudson JS, Mamis S, Long CR. Development and Evaluation of a Blood Glucose Monitoring YouTube Video for Marshallese Patients Using a Community-Based Participatory Research Approach. Policy Polit Nurs Pract 2019; 20:205-215. [PMID: 31537196 PMCID: PMC9524581 DOI: 10.1177/1527154419872834] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to (a) describe the development of a culturally appropriate glucose monitoring video using a community-based participatory research approach and (b) assess the cultural appropriateness and effectiveness of the video. The topic of the video-using a glucometer and the importance of performing blood glucose checks-was chosen by Marshallese community stakeholders. The video was produced in Marshallese with English subtitles and disseminated through YouTube. Participants were recruited from August 16, 2016 to September 12, 2016 in a diabetes clinic that serves Marshallese patients in northwest Arkansas. Fifty participants completed a survey at pre- and postintervention, with questions capturing demographic information and questions on glucose monitoring self-efficacy using an adapted version of the Stanford Patient Education Research Center's Diabetes Self-Efficacy Scale. Twenty of those participants who completed the survey also completed semistructured interviews that assessed cultural appropriateness and effectiveness of the video. Participants reported significant increases in self-efficacy related to glucometer use and the importance of performing blood glucose checks (p < .001) and a 1.45% reduction in A1C between preintervention and 12 weeks postintervention (p = .006). Qualitative results indicated the video was both culturally appropriate and effective. The findings of this study were consistent with evidence in the literature, which shows health education videos can be effective at improving health behaviors. Using a community-based participatory research approach to prioritize video topics, and including members of the community in the creation and dissemination of the videos, could aid in ensuring the videos are effective and culturally appropriate.
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Affiliation(s)
- Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Sheldon Riklon
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Nia Aitaoto
- Nutrition & Integrative Physiology, University of Utah, Salt Lake City, UT, USA
| | | | - Shumona Ima
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Susan A Kadlubar
- Division of Medical Genetics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Peter A Goulden
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jonell S Hudson
- College of Pharmacy, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Sammie Mamis
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Christopher R Long
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
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Wetherill MS, Williams MB, White KC, Seligman HK. Characteristics of Households of People With Diabetes Accessing US Food Pantries: Implications for Diabetes Self-Management Education and Support. DIABETES EDUCATOR 2019; 45:397-407. [PMID: 31204590 DOI: 10.1177/0145721719857547] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study is to explore the associations between food insecurity (FI) and coping strategies of relevance to diabetes self-management among households of people with diabetes (HHDM) who access US food pantry programs. METHODS The authors conducted a secondary data analysis of HHDM accessing US food pantry programs from the Hunger in America 2014 study (n = 16 826). Weighted analyses included descriptive statistics for household sociodemographics, food pantry service utilization, FI, and coping behaviors. The authors used chi-square and logistic regression to estimate the relationship between FI and coping behaviors. RESULTS Nearly one-half of HHDM reported visiting food pantries at least 6 times in the past year. Most HHDM were FI, with the majority experiencing the most severe form of FI. Over one-fifth of households reported lacking health insurance. The majority of HHDM reported purchasing inexpensive unhealthy foods to ensure household food adequacy, and many reported watering down food and beverages. The odds of reporting these behaviors significantly increased as FI worsened. CONCLUSION Food pantries represent an opportunity for the delivery of community-based diabetes self-management education and support programs. These programs should be adapted to address population barriers to self-management and to support access to healthful foods and medical care.
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Affiliation(s)
- Marianna S Wetherill
- Department of Health Promotion Sciences, Hudson College of Public Health and Department of Family and Community Medicine, OU-TU School of Community Medicine, University of Oklahoma-Tulsa Schusterman Center, Tulsa, Oklahoma
| | - Mary B Williams
- Department of Biostatistics and Epidemiology, Hudson College of Public Health and Department of Family and Community Medicine, OU-TU School of Community Medicine, University of Oklahoma-Tulsa Schusterman Center, Tulsa, Oklahoma
| | - Kayla C White
- Hudson College of Public Health, University of Oklahoma-Tulsa Schusterman Center, Tulsa, Oklahoma
| | - Hilary K Seligman
- Department of Medicine, University of California San Francisco, San Francisco, California and Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, California
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Diabetes Self-Management Education and Medical Nutrition Therapy: A Multisite Study Documenting the Efficacy of Registered Dietitian Nutritionist Interventions in the Management of Glycemic Control and Diabetic Dyslipidemia through Retrospective Chart Review. J Acad Nutr Diet 2019; 119:449-463. [DOI: 10.1016/j.jand.2018.06.303] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 06/25/2018] [Indexed: 11/22/2022]
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17
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Rolnitsky A, Kirtsman M, Goldberg HR, Dunn M, Bell CM. The representation of vulnerable populations in quality improvement studies. Int J Qual Health Care 2018; 30:244-249. [DOI: 10.1093/intqhc/mzy016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 01/23/2018] [Indexed: 12/13/2022] Open
Affiliation(s)
- Asaph Rolnitsky
- Department of Paediatrics, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada
| | - Maksim Kirtsman
- Department of Paediatrics, Neonatology Division, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada
| | - Hanna R Goldberg
- Faculty of Medicine, University of Toronto, 190 Elizabeth Street, R. Fraser Elliott Building, 3-805Toronto, ON M5G 2C4, Canada
| | - Michael Dunn
- Department of Paediatrics, Neonatology Division, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada
| | - Chaim M Bell
- Internal Medicine division, University of Toronto, 190 Elizabeth Street, R. Fraser Elliott Building, 3-805Toronto, ON M5G 2C4, Canada
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Marincic PZ, Hardin A, Salazar MV, Scott S, Fan SX, Gaillard PR. Diabetes Self-Management Education and Medical Nutrition Therapy Improve Patient Outcomes: A Pilot Study Documenting the Efficacy of Registered Dietitian Nutritionist Interventions through Retrospective Chart Review. J Acad Nutr Diet 2017; 117:1254-1264. [DOI: 10.1016/j.jand.2017.01.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 01/20/2017] [Indexed: 10/19/2022]
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Bivins BL. Integrative Review on Adherence in Haitians With Diabetes. Nurs Forum 2017; 52:165-172. [PMID: 27454836 DOI: 10.1111/nuf.12176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 02/07/2016] [Accepted: 02/27/2016] [Indexed: 06/06/2023]
Abstract
In light of a marked increase in the incidence and prevalence of diabetes in the United States in recent years with associated health costs totaling $245 billion for 2012, diabetes has become a major health and fiscal concern. Haitian Americans as a cultural group have unique obstacles to effective treatment and management of diabetes. This paper analyzes recent studies relevant to these challenges in anticipation of new research pertaining to this population. Although medication compliance is generally referred to as adherence, it is a complex concept and key challenge in diabetes care. Accordingly, this paper will further define adherence by describing its relevance in effective treatment and management. It will also analyze key theoretical perspectives in diabetes care, summarize recent research, and make recommendations for effective future research on the impact of diabetes education in Haitian Americans.
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Affiliation(s)
- Balkys L Bivins
- Adjunct Professor, APRN Program, Department of Nursing, Nova Southeastern University, Palm Beach Garden, FL
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Miller JM, Phalen AG, Crawford A, Frisby A, Ziring BS. Text Messaging in the Patient-Centered Medical Home to Improve Glucose Control and Retinopathy Screening. Health Equity 2017; 1:2-6. [PMID: 30283829 PMCID: PMC6071875 DOI: 10.1089/heq.2016.0003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Purpose: To evaluate the effectiveness of a text messaging program (TMP) to improve glucose control, retinopathy screening (RS) rates, and self-care behaviors in patients with uncontrolled type 2 diabetes. Methods: A single-group design with a quasi-systematic random sample (n=20) received educational/exhortational text messages on their cellular phones for 3 months. Subjects, 12 of whom identified as a minority ethnicity, were mostly male, aged 27-73 years. Results: Glucose control and RS rates improved significantly. Subjects (>70%) reported changes in self-care behaviors. Conclusion: Leveraging ubiquitous technology, a TMP for patients with limited access to healthcare education, holds promise.
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Affiliation(s)
- Janice M Miller
- Jefferson College of Nursing, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ann G Phalen
- Jefferson College of Nursing, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Albert Crawford
- College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Anthony Frisby
- Center for Teaching and Learning, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Barry S Ziring
- Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
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Chrvala CA, Sherr D, Lipman RD. Diabetes self-management education for adults with type 2 diabetes mellitus: A systematic review of the effect on glycemic control. PATIENT EDUCATION AND COUNSELING 2016; 99:926-43. [PMID: 26658704 DOI: 10.1016/j.pec.2015.11.003] [Citation(s) in RCA: 499] [Impact Index Per Article: 62.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 10/16/2015] [Accepted: 11/05/2015] [Indexed: 05/25/2023]
Abstract
OBJECTIVE Assess effect of diabetes self-management education and support methods, providers, duration, and contact time on glycemic control in adults with type 2 diabetes. METHOD We searched MEDLINE, CINAHL, EMBASE, ERIC, and PsycINFO to December 2013 for interventions which included elements to improve participants' knowledge, skills, and ability to perform self-management activities as well as informed decision-making around goal setting. RESULTS This review included 118 unique interventions, with 61.9% reporting significant changes in A1C. Overall mean reduction in A1C was 0.74 and 0.17 for intervention and control groups; an average absolute reduction in A1C of 0.57. A combination of group and individual engagement results in the largest decreases in A1C (0.88). Contact hours ≥10 were associated with a greater proportion of interventions with significant reduction in A1C (70.3%). In patients with persistently elevated glycemic values (A1C>9), a greater proportion of studies reported statistically significant reduction in A1C (83.9%). CONCLUSIONS This systematic review found robust data demonstrating that engagement in diabetes self-management education results in a statistically significant decrease in A1C levels. PRACTICE IMPLICATIONS The data suggest mode of delivery, hours of engagement, and baseline A1C can affect the likelihood of achieving statistically significant and clinically meaningful improvement in A1C.
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Affiliation(s)
| | - Dawn Sherr
- American Association of Diabetes Educators, 200 W. Madison Street, Chicago, IL 60606, USA.
| | - Ruth D Lipman
- American Association of Diabetes Educators, 200 W. Madison Street, Chicago, IL 60606, USA.
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Gala S, Wu W. The effect of receiving diabetes self-management education on preventive care practices and health-related quality of life among type II diabetes adults. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2015. [DOI: 10.1111/jphs.12112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Abstract
Objectives
To assess the effect of diabetes self-management education (DSME) on preventive care practices and the health-related quality of life (HRQOL) measures among type II diabetes adults.
Methods
A retrospective database analysis was conducted using the Behavioral Risk Factor Surveillance System survey. Bivariate analyses were conducted to compare the utilization of preventive care practices among those receiving and not receiving DSME; and to determine the association between DSME status and HRQOL measures. Multiple logistic regression was employed to determine the likelihood of obtaining preventive care practices among those receiving DSME. Data analysis was performed using SAS version 9.2.
Key findings
Only 54% of type II diabetes adults received DSME. All preventive care practices except bi-annual HbA1c testing were utilized higher in adults receiving DSME. Adults receiving DSME were more likely to get an annual comprehensive foot examination (OR = 2.19, P < 0.0001), annual dilated eye examination (OR = 1.63, P = 0.0007), annual doctor visit (OR = 1.60, P = 0.0244), pneumococcal vaccine (OR = 1.48, P = 0.0042) and daily self-monitoring of blood glucose (OR = 1.46, P = 0.0065) than adults not receiving DSME. Higher proportion of adults receiving DSME reported good general health, <13 days of physical and mental distress as compared to adults not receiving DSME.
Conclusions
Patient programmes are needed to increase DSME, which in turn may increase the uptake of preventive care measures and improve HRQOL of type II diabetes adults.
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Affiliation(s)
- Smeet Gala
- Department of Pharmacy Administration and Public Health, College of Pharmacy and Health Sciences, St. John's University, 8000 Utopia Parkway, Queens, NY 11439, USA
| | - Wenchen Wu
- Department of Pharmacy Administration and Public Health, College of Pharmacy and Health Sciences, St. John's University, 8000 Utopia Parkway, Queens, NY 11439, USA
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Association of copayment and socioeconomic status with hormonal contraceptive adherence in a female veteran population. Womens Health Issues 2014; 24:e237-41. [PMID: 24533983 DOI: 10.1016/j.whi.2013.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 11/16/2013] [Accepted: 12/10/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND There are limited studies available analyzing association between copayment and hormonal contraception adherence. The study was conducted to investigate the association between copayment status and hormonal contraceptive adherence in a female veteran population when stratified by socioeconomic status. METHODS This 4-year, retrospective, cohort study of women Veterans from the Veterans Integrated Service Network 22, a network of Veterans Affairs facilities that includes Southern California and Nevada, included patients who received a new hormonal contraceptive prescription between October 1, 2008, and September 30, 2012. Patients were split into five quintiles (one having the lowest income and five the highest) dependent on zip code-based median annual household income from the 2007-2011 American Community Survey data. Medication possession ratio difference of copayment versus no copayment group for each respective quintile was the primary outcome. Analysis was done using multiple linear regression models. RESULTS A total of 3,622 patients met the inclusion criteria and were included in the analysis. Over the entire population, copayment was significantly associated with reduced adherence (-0.034; 95% confidence interval [CI], -0.06 to -0.008). Patients in the highest socioeconomic group, quintile five, had the largest reduction in adherence associated with having a copayment (-0.073; 95% CI, -0.129 to -0.017). Patients in the other four quintiles saw varying levels of decreased adherence respectively, although the differences did not achieve statistical significance. CONCLUSION The association between adherence and copayment status varied by socioeconomic status. Our findings suggest that even affluent patients may be discouraged from adherence when subject to a copayment. If larger studies substantiate these findings, consideration should be given to a policy that exempts women veterans from copayments for hormonal contraceptives.
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Diabetes Knowledge and its Importance Expands Rapidly: Diabetes Update in Clinical Therapeutics. Clin Ther 2013; 35:A1-2. [DOI: 10.1016/j.clinthera.2012.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 12/16/2012] [Indexed: 10/27/2022]
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