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Lababidi H, Lababidi G, Rifai MA, Nasir K, Al-Kindi S. Cardiovascular disease in Arab Americans: A literature review of prevalence, risk factors, and directions for future research. Am J Prev Cardiol 2024; 18:100665. [PMID: 38634110 PMCID: PMC11021916 DOI: 10.1016/j.ajpc.2024.100665] [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: 01/03/2024] [Revised: 03/26/2024] [Accepted: 04/04/2024] [Indexed: 04/19/2024] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of mortality worldwide. Recent evidence suggests Arab Americans, individuals with ancestry from Arabic-speaking countries, have an elevated risk for CVD compared to other ethnicities in the US. However, research focusing specifically on CVD in this population is limited. This literature review synthesizes studies investigating CVD prevalence, risk factors, and outcomes in Arab Americans. Multiple studies found higher rates of coronary heart disease, cerebrovascular disease, and hypertension compared to non-Hispanic White participants. The prevalence of type 2 diabetes, a major CVD risk factor, was also markedly higher, ranging from 16 % to 41 % in Arab Americans based on objective measures. Possible explanations include high rates of vitamin D deficiency, genetic factors, and poor diabetes control. Other metabolic factors like dyslipidemia and obesity did not consistently differ from general population estimates. Psychosocial factors may further increase CVD risk, including acculturative stress, discrimination, low health literacy, and barriers to healthcare access. Smoking, especially waterpipe use, was more prevalent in Arab American men. Though heterogenous, Arab Americans overall appear to have elevated CVD risk, warranting tailored screening and management. Culturally appropriate educational initiatives on CVD prevention are greatly needed. Future directions include better characterizing CVD prevalence across Arab American subgroups, delineating genetic and environmental factors underlying increased diabetes susceptibility, and testing culturally tailored interventions to mitigate CVD risks. In summary, this review highlights concerning CVD disparities in Arab Americans and underscores the need for group-specific research and preventive strategies.
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Affiliation(s)
- Hossam Lababidi
- Houston Methodist DeBakey Heart and Vascular Institute, Houston Methodist Hospital, 6550 Fannin St, Houston, TX 77030, United States
| | - Ghena Lababidi
- Medical program, American University of Beirut, United States
| | - Mahmoud Al Rifai
- Houston Methodist DeBakey Heart and Vascular Institute, Houston Methodist Hospital, 6550 Fannin St, Houston, TX 77030, United States
| | - Khurram Nasir
- Houston Methodist DeBakey Heart and Vascular Institute, Houston Methodist Hospital, 6550 Fannin St, Houston, TX 77030, United States
| | - Sadeer Al-Kindi
- Houston Methodist DeBakey Heart and Vascular Institute, Houston Methodist Hospital, 6550 Fannin St, Houston, TX 77030, United States
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Rodriguez SA, Tiro JA, Baldwin AS, Hamilton-Bevil H, Bowen M. Measurement of Perceived Risk of Developing Diabetes Mellitus: A Systematic Literature Review. J Gen Intern Med 2023; 38:1928-1954. [PMID: 37037984 PMCID: PMC10272015 DOI: 10.1007/s11606-023-08164-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 03/10/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND This systematic review describes approaches to measuring perceived risk of developing type 2 diabetes among individuals without diagnoses and describes the use of theories, models, and frameworks in studies assessing perceived risk. While a systematic review has synthesized perceived risk of complications among individuals with diabetes, no reviews have systematically assessed how perceived risk is measured among those without a diagnosis. METHODS Medline, PubMed, PsycINFO, and CINAHAL databases were searched for studies conducted through October 2022 with measures of perceived risk among adults ≥ 18 years without a diabetes diagnosis. Extracted data included study characteristics, measures, and health behavior theories, models, or frameworks used. RESULTS Eighty-six studies met inclusion criteria. Six examined perceived risk scales' psychometric properties. Eighty measured perceived risk using (1) a single item; (2) a composite score from multiple items or subconstructs; and (3) multiple subconstructs but no composite score. Studies used items measuring "comparative risk," "absolute or lifetime risk," and "perceived risk" without defining how each differed. Sixty-four studies used cross-sectional designs. Twenty-eight studies mentioned use of health behavior theories in study design or selection of measures. DISCUSSION There was heterogeneity in how studies operationalized perceived risk; only one third of studies referenced a theory, model, or framework as guiding design or scale and item selection. Use of perceived lifetime risk, absolute risk, or comparative risk limits comparisons across studies. Consideration of context, target population, and how data are utilized is important when selecting measures; we present a series of questions to ask when selecting measures for use in research and clinical settings. This review is the first to categorize how perceived risk is measured in the diabetes prevention domain; most literature focuses on perceived risk among those with diabetes diagnoses. Limitations include exclusion of non-English and gray literature and single reviewer screening and data extraction.
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Affiliation(s)
- Serena A. Rodriguez
- Department of Health Promotion & Behavioral Sciences, The University of Texas Health Science Center Houston (UTHealth Houston) School of Public Health, Trinity Towers, 2777 N Stemmons Fwy, Ste 8400, TX 75207 Dallas, USA
- UTHealth Houston School of Public Health, Center for Health Promotion & Prevention Research, 7000 Fannin Street, Houston, TX 77030 USA
| | - Jasmin A. Tiro
- Department of Public Health Sciences, University of Chicago, 5841 S. Maryland Ave., Chicago, IL 60637 USA
- University of Chicago Medicine Comprehensive Cancer Center, 5841 S. Maryland Avenue, Chicago, IL 60637 USA
| | - Austin S. Baldwin
- Department of Psychology, Southern Methodist University, Expressway Tower, PO Box 750442, Dallas, TX 75275 USA
| | - Hayley Hamilton-Bevil
- University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 75229 USA
| | - Michael Bowen
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390 USA
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Taskin Yilmaz F, Celik S, Anataca G. Perceived diabetes risk and actual risk level in relatives of individuals with type 2 diabetes: Its relationship with promotive and protective health behaviors. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2022. [DOI: 10.29333/ejgm/12300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Bandi K, Vargas MC, Lopez A, Cameron KA, Ackermann RT, Mohr L, Williams GC, Fagerlin A, Kirley K, Hodge H, Kandula NR, O'Brien MJ. Development and Evaluation of a Prediabetes Decision Aid in Primary Care: Examining Patient-Reported Outcomes by Language Preference and Educational Attainment. Sci Diabetes Self Manag Care 2021; 47:216-227. [PMID: 34000911 DOI: 10.1177/26350106211009189] [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: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to examine the development and preliminary effectiveness of a novel Prediabetes Decision Aid on adoption of intensive lifestyle interventions (ILIs) and metformin. Little research has focused on increasing uptake of these evidence-based treatments, especially among non-English speakers and those with low educational attainment. METHODS Investigators developed an English and Spanish decision aid displaying information about type 2 diabetes (T2DM) risk and treatments to prevent T2DM and prompting patients to identify next steps for management. This pilot study was a single-arm, pretest-posttest trial of 40 adult patients with prediabetes, obesity, and ≥1 office visit within the prior 12 months. Participants reviewed this tool briefly with a study team member, and data were collected on 3 coprimary outcomes: knowledge about T2DM risk, decisional conflict, and intention to adopt treatment. Exploratory outcomes included subsequent documentation of prediabetes in chart notes and adoption of ILIs or metformin. RESULTS Almost all participants were women, with nearly half expressing Spanish language preference and low educational attainment. A nonsignificant increase in knowledge was observed across all subgroups. Decisional conflict was significantly reduced from pretest to posttest and was similar between subgroups defined by language preference and educational attainment. While intention to adopt ILIs increased across all subgroups, this change was only significant among Spanish speakers and participants with low educational attainment. At 6 months, 17 participants had subsequent provider documentation of prediabetes, and 12 adopted ILIs or metformin. CONCLUSIONS The decision aid improved patient-reported outcomes and promoted treatment adoption in a diverse patient sample.
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Affiliation(s)
- Keerthi Bandi
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Maria C Vargas
- Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Azucena Lopez
- Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kenzie A Cameron
- Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ronald T Ackermann
- Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Geoffrey C Williams
- Collaborative Science and Innovation, Billings Clinic, Billings, Montana.,Center for Community Health and Prevention, University of Rochester, Rochester, New York
| | - Angela Fagerlin
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah.,Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS), Center for Innovation, Salt Lake City, Utah
| | - Kate Kirley
- American Medical Association, Chicago, Illinois
| | | | - Namratha R Kandula
- Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Matthew J O'Brien
- Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Alanazi M. Determinants of successful diabetes self-management behaviors among women of Arab descent with Type 2 Diabetes. Prim Care Diabetes 2021; 15:306-313. [PMID: 33176980 DOI: 10.1016/j.pcd.2020.10.009] [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: 08/23/2020] [Revised: 10/23/2020] [Accepted: 10/27/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Type 2 Diabetes (T2D) continues to be an escalating public health problem contributes to increased morbidity and mortality. Although the complications of T2D is a major threat to the health of women of Arab descent, there is lack of information about their health practices and diabetes self-management behaviors. AIMS The purpose is to examine the impact of diabetes knowledge, social/family support, acculturation, and diabetes-related emotional distress on DSM behaviors and glycemic control among women of Arab descent utilizing the Roy Adaptation Model. METHOD A non-experimental correlational descriptive design. RESULTS The BMI, Diabetes knowledge, diabetes-related emotional distress, and the level of HbA1C explained 28% of the variance in DSM behaviors. DSM behaviors were negatively related to diabetes-related emotional distress. DSM behaviors were positively related to diabetes knowledge and HbA1C. CONCLUSIONS The findings of this work provided a foundation for further advanced research design including experimental designs to expand the knowledge of this phenomenon and how to manage this disease successfully yet a culturally appropriate method.
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Affiliation(s)
- Mona Alanazi
- King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), 3660 Prince Muteb Street, Riyadh 11481, Saudi Arabia; Wayne State University, 5557 Cass Avenue, Detroit, MI 48202, United States.
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Yost O, DeJonckheere M, Stonebraker S, Ling G, Buis L, Pop-Busui R, Kim N, Mizokami-Stout K, Richardson C. Continuous Glucose Monitoring With Low-Carbohydrate Diet Coaching in Adults With Prediabetes: Mixed Methods Pilot Study. JMIR Diabetes 2020; 5:e21551. [PMID: 33325831 PMCID: PMC7773517 DOI: 10.2196/21551] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/21/2020] [Accepted: 10/26/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is preventable; however, few patients with prediabetes participate in prevention programs. The use of user-friendly continuous glucose monitors (CGMs) with low-carbohydrate diet coaching is a novel strategy to prevent T2DM. OBJECTIVE This study aims to determine the patient satisfaction and feasibility of an intervention combining CGM use and low-carbohydrate diet coaching in patients with prediabetes to drive dietary behavior change. METHODS We conducted a mixed methods, single-arm pilot and feasibility study at a suburban family medicine clinic. A total of 15 adults with prediabetes with hemoglobin A1c (HbA1c) levels between 5.7% and 6.4% and a BMI >30 kg/m2 were recruited to participate. The intervention and assessments took place during 3 in-person study visits and 2 qualitative phone interviews (3 weeks and 6 months after the intervention). During visit 1, participants were asked to wear a CGM and complete a food intake and craving log for 10 days. During visit 2, the food intake and craving log along with the CGM results of the participants were reviewed and the participants received low-carbohydrate diet coaching, including learning about carbohydrates and personalized feedback. A second CGM sensor, with the ability to scan and record glucose trends, was placed, and the participants logged their food intake and cravings as they attempted to reduce their total carbohydrate intake (<100 g/day). During visit 3, the participants reviewed their CGM and log data. The primary outcome was satisfaction with the use of CGM and low-carbohydrate diet. The secondary outcomes included feasibility, weight, and HbA1c change, and percentage of time spent in hyperglycemia. Changes in attitudes and risk perception of developing diabetes were also assessed. RESULTS The overall satisfaction rate of our intervention was 93%. The intervention induced a weight reduction of 1.4 lb (P=.02) and a reduction of HbA1c levels by 0.71% (P<.001) since enrollment. Although not significantly, the percentage of time above glucose goal and average daily glucose levels decreased slightly during the study period. Qualitative interview themes indicated no major barriers to CGM use; the acceptance of a low-carbohydrate diet; and that CGMs helped to visualize the impact of carbohydrates on the body, driving dietary changes. CONCLUSIONS The use of CGMs and low-carbohydrate diet coaching to drive dietary changes in patients with prediabetes is feasible and acceptable to patients. This novel method merits further exploration, as the preliminary data indicate that combining CGM use with low-carbohydrate diet coaching drives dietary changes, which may ultimately prevent T2DM.
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Affiliation(s)
- Olivia Yost
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Melissa DeJonckheere
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States
| | - Spring Stonebraker
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Grace Ling
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Lorraine Buis
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States
| | - Rodica Pop-Busui
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Noa Kim
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Kara Mizokami-Stout
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States.,Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Caroline Richardson
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States
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Abstract
BACKGROUND Cognitive risk perception has been linked to health behavior needed to reduce the risk of developing type 2 diabetes. The concept of risk perception of developing diabetes needed review due to: (a) frequent lack of congruency between perceived and actual risk of developing diabetes, and (b) inconsistent measures for calculating perceived diabetes risk. DESIGN The concept analysis was conducted using the Walker and Avant approach. DATA SOURCES Dictionary definitions, thesaurus synonyms and antonyms, theoretical sources, and seminal works related generally to risk perception were reviewed. Database searches for studies conducted in the United States measuring perceived risk of developing diabetes, were conducted in PubMed, Embase, and CINAHL; resulting in the selection and review of 23 research articles. RESULTS The identified dimensions of perceived diabetes risk were: perceived likelihood, personal risk, general risk, cognitive, emotional, comparative risk, and unrealistic optimism. Some antecedents of perceived diabetes risk were motivational factor, individual difference, contextual factor, cognitive factor, and affective factor. A consequence of perceived diabetes risk was health-promoting behaviors. CONCLUSIONS This concept analysis increases clarity of a multidimensional concept, providing a basis for validity for measurements. Consideration of antecedents for perceived diabetes risk will be important as related to diabetes prevention efforts.
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Affiliation(s)
- Angelina P Nguyen
- Louise Herrington School of Nursing, Baylor University, Dallas, Texas
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Badlishah-Sham SF, Ramli AS, Isa MR, Mohd-Zaki N, Whitford DL. Are Malaysian Type 2 Diabetes patients willing to be trained to speak to their offspring about risk of diabetes and preventive measures? BMC FAMILY PRACTICE 2020; 21:50. [PMID: 32160862 PMCID: PMC7066836 DOI: 10.1186/s12875-020-01121-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 03/03/2020] [Indexed: 11/24/2022]
Abstract
Background Offspring of type 2 diabetes patients have an absolute risk of 20–40% of developing the condition. Type 2 diabetes patients should be encouraged to speak to their offspring regarding diabetes risk and prevention strategies. The Health Belief Model conceptualises that the higher the perceived risk, the more likely an individual will modify their behaviour. The objectives of this study were to i) determine the distribution of type 2 diabetes patients regarding their willingness to accept training to speak to their offspring, ii) determine the distribution of type 2 diabetes patients regarding their willingness to accept training based on the HBM and iii) to determine the factors associated with their willingness to accept training. Methods This was a cross-sectional study amongst type 2 diabetes patients attending two primary care clinics in Malaysia. Sociodemographic data and knowledge of diabetes risk factors were collected. The adapted, translated and validated Diabetes Mellitus in the Offspring Questionnaire-Malay version (DMOQ-Malay) was self-administered. Statistical analysis included descriptive statistics, univariate and multiple logistic regression (MLogR). Results A total of 425 participants were recruited. Of these, 61.6% were willing to accept training. In MLogR, six variables were found to be significantly associated with willingness to accept training. These were i) positive family history [Adj. OR 2.06 (95% CI: 1.27, 3.35)], ii) having the correct knowledge that being overweight is a risk factor [Adj. OR 1.49 (95%CI: 1.01, 2.29)], iii) correctly identifying age ≥ 40 years old as a risk factor [Adj. OR 1.88 (95%CI: 1.22, 2.90)], iv) agreeing that speaking to their offspring would help them to prevent type 2 diabetes [Adj. OR 4.34 (95%: 1.07, 17.73)], v) being neutral with the statement ‘I do not have much contact with my offspring’ [Adj. OR: 0.31 (95% CI: 0.12, 0.810] and vi) being neutral with the statement ‘my offspring are not open to advice from me’ [Adj. OR: 0.63 (95% CI: 0.31, 0.84]. Conclusion The majority of type 2 diabetes patients were willing to accept training to speak to their offspring to prevent diabetes. A training module should be designed to enhance their knowledge, attitude and skills to become family health educators.
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Affiliation(s)
- Siti Fatimah Badlishah-Sham
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Selayang Campus, Jalan Prima Selayang 7, 68100, Batu Caves, Selangor, Malaysia
| | - Anis Safura Ramli
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Selayang Campus, Jalan Prima Selayang 7, 68100, Batu Caves, Selangor, Malaysia. .,Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA (UiTM), Sungai Buloh Campus, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia.
| | - Mohamad Rodi Isa
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
| | - Nurzakiah Mohd-Zaki
- Department of Medicine, Hospital Kuala Lumpur, Ministry of Health, Jalan Pahang, 50586, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - David Leonard Whitford
- RCSI & UCD Malaysia Campus, 4, Jalan Sepoy Lines, 10450, George Town, Pulau Pinang, Malaysia
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Rochefort C, Baldwin AS, Tiro J, Bowen ME. Evaluating the Validity of the Risk Perception Survey for Developing Diabetes Scale in a Safety-Net Clinic Population of English and Spanish Speakers. DIABETES EDUCATOR 2019; 46:73-82. [PMID: 31747830 DOI: 10.1177/0145721719889068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study is to examine the factor structure of the Risk Perception Survey for Developing Diabetes (RPS-DD) and test for factorial invariance by language (English, Spanish) and gender (males, females) in a clinically engaged, racially diverse, low-education population. METHODS Adult patients seen in a safety-net health system (N = 641) answered an interviewer-administered survey via telephone in their preferred language (English: 42%, Spanish: 58%). Three constructs in the RPS-DD were assessed-personal control (2 items for internal control and 2 for external control), optimistic bias (2 items), and worry (2 items). Single and multigroup confirmatory factor analyses (CFAs) were performed using maximum-likelihood estimation to determine the factor structure and test for invariance. RESULTS Contrary to previous psychometric analyses in white, educated populations, CFAs supported a 4-factor measurement model with internal and external control items loading onto separate factors. The 4-factor structure was equivalent between males and females. However, the structure varied by language, with the worry subscale items loading more strongly for English than Spanish speakers. CONCLUSIONS The RPS-DD can be used to investigate group differences across gender and language and to help understand if interventions have differential effects for subgroups at high risk for diabetes. Given the increasing prevalence of diabetes among Spanish speakers, researchers should continue to examine the psychometric properties of the RPS-DD, particularly the worry subscale, to improve its validity and clinical utility.
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Affiliation(s)
| | - Austin S Baldwin
- Department of Psychology, Southern Methodist University, Dallas, Texas
| | - Jasmin Tiro
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michael E Bowen
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
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Abuelezam NN, El-Sayed AM, Galea S. The Health of Arab Americans in the United States: An Updated Comprehensive Literature Review. Front Public Health 2018; 6:262. [PMID: 30255009 PMCID: PMC6141804 DOI: 10.3389/fpubh.2018.00262] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/22/2018] [Indexed: 01/09/2023] Open
Abstract
Background: Arab Americans are a historically understudied minority group in the United States and their health needs and risks have been poorly documented. We aim to provide an updated comprehensive review of the literature on Arab American physical and mental health and provide suggestions for future work in this field. Methods: A comprehensive review of the English language medical and public health literature published prior to 2017 identified through multiple database searches was conducted with search terms describing Arab Americans and health outcomes and behaviors. The literature was qualitatively summarized by health behavior (vaccination, tobacco use, drug and alcohol use, and physical activity), health outcome (diabetes, mental health, cardiovascular disease, cancer, women's, and child health), and populations at increased risk of poor health outcomes (adolescents and the elderly). Results: The majority of studies identified exploring Arab American health have been published since 2009 with an increase in the number of longitudinal and intervention studies done with this population. The majority of research is being undertaken among individuals living in ethnic enclaves due to the lack of an ethnic or racial identifier that may help identify Arab Americans from population-based studies. Studies highlight the conflicting evidence in the prevalence of diabetes and cardiovascular disease based on study sample, an increased understanding of cancer incidence and barriers to identification, and an increased level of knowledge regarding mental health and sexual health needs in the population. Information on health behaviors has also increased, with a better understanding of physical activity, alcohol and drug use, and vaccination. Conclusion: More research on Arab American health is needed to identify risks and needs of this marginalized population given the current social and political climate in the United States, especially with regard to acculturation status and immigrant generation status. We provide recommendations on approaches that may help improve our understanding of Arab American health.
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Affiliation(s)
- Nadia N Abuelezam
- Boston College, William F. Connell School of Nursing, Chestnut Hill, MA, United States
| | | | - Sandro Galea
- School of Public Health, Boston University, Boston, MA, United States
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Abstract
All racial/ethnic groups are at higher risk for type 2 diabetes compared to whites, but it is unknown if young adults recognize their risk. Risk knowledge and individual risk perception were examined in 1579 multiracial urban college students. Students have little knowledge of diabetes risk factors; identifying less than three of ten. Considerable variation exists in the understanding of risk; only .02 % of Asian, 14.0 % of Hispanic and 22.8 % of black students recognized that their race increased risk. Among those with ≥3 risk factors (n = 541) only 39 % perceived their risk. These under-estimators had lower knowledge scores (p = .03) than those who acknowledged their risk; indicating that the cause of under-estimating risk may be, at least, in part due to a lack of information. There is a pressing need to heighten understanding of type 2 diabetes risk among young adults to decrease the future burden of this disease.
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O'Brien MJ, Moran MR, Tang JW, Vargas MC, Talen M, Zimmermann LJ, Ackermann RT, Kandula NR. Patient Perceptions About Prediabetes and Preferences for Diabetes Prevention. DIABETES EDUCATOR 2016; 42:667-677. [PMID: 27621093 DOI: 10.1177/0145721716666678] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE The purpose of this study was to explore how adults with prediabetes perceive their risk of developing diabetes and examine their preferences for evidence-based treatment options to prevent diabetes. METHODS A qualitative study was conducted in 2 large Midwest primary care practices, involving in-depth semistructured interviews with 35 adult patients with prediabetes. RESULTS This ethnically diverse (77% nonwhite) sample of middle-aged primary care patients exhibited multiple diabetes risk factors. Knowledge gaps about prediabetes and its medical management were pervasive. Most patients overestimated the risk of developing diabetes and were not familiar with evidence-based treatment options for prediabetes. They suggested that receiving brief, yet specific information about these topics during the study interview motivated them to act. The majority of participants considered both intensive lifestyle intervention and metformin acceptable treatment options. Many preferred initial treatment with intensive lifestyle intervention but would take metformin if their efforts at lifestyle change failed and their primary care physician recommended it. Some participants expressed wanting to combine both treatments. CONCLUSIONS This qualitative study highlights potential opportunities to promote patient-centered dialogue about prediabetes in primary care settings. Providing patients specific information about the risk of developing diabetes and evidence-based treatment options to prevent or delay its onset may encourage action. Physicians' prediabetes counseling efforts should be informed by the finding that most patients consider both intensive lifestyle intervention and metformin acceptable treatment options.
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Affiliation(s)
- Matthew J O'Brien
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (Dr O'Brien, Ms Vargas, Dr Zimmermann, Dr Ackermann, Dr Kandula),Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (Dr O'Brien, Ms Moran, Ms Vargas, Dr Ackermann, Dr Kandula)
| | - Margaret R Moran
- Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (Dr O'Brien, Ms Moran, Ms Vargas, Dr Ackermann, Dr Kandula)
| | - Joyce W Tang
- Section of Hospital Medicine, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA (Dr Tang)
| | - Maria C Vargas
- Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (Dr O'Brien, Ms Moran, Ms Vargas, Dr Ackermann, Dr Kandula)
| | - Mary Talen
- Northwestern Family Medicine Residency Program, Erie Family Health Center, Chicago, Illinois, USA (Dr Talen)
| | - Laura J Zimmermann
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (Dr O'Brien, Ms Vargas, Dr Zimmermann, Dr Ackermann, Dr Kandula),Erie Family Health Center, Chicago, Illinois, USA (Dr Zimmermann)
| | - Ronald T Ackermann
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (Dr O'Brien, Ms Vargas, Dr Zimmermann, Dr Ackermann, Dr Kandula),Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (Dr O'Brien, Ms Moran, Ms Vargas, Dr Ackermann, Dr Kandula)
| | - Namratha R Kandula
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (Dr O'Brien, Ms Vargas, Dr Zimmermann, Dr Ackermann, Dr Kandula),Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (Dr O'Brien, Ms Moran, Ms Vargas, Dr Ackermann, Dr Kandula),Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (Dr Kandula)
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13
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Awareness of modifiable acute myocardial infarction risk factors has little impact on risk perception for heart attack among vulnerable patients. Heart Lung 2015; 44:183-8. [DOI: 10.1016/j.hrtlng.2015.02.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Revised: 02/24/2015] [Accepted: 02/27/2015] [Indexed: 11/17/2022]
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14
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Al-Amer R, Ramjan L, Glew P, Salamonson Y. Diagnosis of Type 2 Diabetes: The Experience of Jordanian Patients with Co-existing Depression. Issues Ment Health Nurs 2015; 36:231-8. [PMID: 25897571 DOI: 10.3109/01612840.2014.960627] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In Jordan, Type 2 diabetes mellitus (T2DM) is becoming a significant health problem, and a high concomitant rate of depression among this population complicates the situation. This qualitative study explored and described the emotional reactions of Jordanian patients with co-existing depression, on diagnosis of T2DM. Data were collected using semi-structured qualitative interviews from 15 patients with T2DM and depression in 2013. Interviews were audiotaped, translated and then analysed using thematic analysis. A major theme-'Initial reactions to the diagnosis'-emerged with four accompanying sub-themes (Devastation, Mixed Emotions, Denial and Acceptance). Although the majority of participants expressed negative emotional reactions on first diagnosis, a strong religious conviction allowed for acceptance of the diagnosis. Overall, the study findings support that in Arabic countries, spirituality and faith played a key role in promoting acceptance of concomitant comorbidities, and will often be useful in enhancing positive coping strategies among patients with T2DM and depression.
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Affiliation(s)
- Rasmieh Al-Amer
- School of Nursing and Midwifery, University of Western Sydney , Penrith, NSW , Australia
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15
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Screening for type 2 diabetes in a high-risk population: effects of a negative screening test after 4 years follow-up. Ann Behav Med 2014; 47:102-10. [PMID: 23818042 DOI: 10.1007/s12160-013-9525-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND A negative diabetes screening test may unintentionally provide reassurance, resulting in reduced incentive to follow a healthy lifestyle. PURPOSE The purpose of this study is to assess negative test result effects on lifestyle and risk perception at 4 years follow-up. METHODS Risk perception and changes in smoking, physical activity, body mass index (BMI), and waist circumference were compared between 706 high-risk participants with a negative test result and 706 high-risk participants not offered screening (controls) in a randomized controlled trial of diabetes screening. RESULTS Negative-screened individuals experienced a small but significant increase in BMI and waist circumference, but there was no significant difference with controls. The negative-screened group had significantly higher perception of risk of developing diabetes (p = 0.009) than controls, but no differences were observed in perceived personal control, worry, and optimistic bias. CONCLUSION Screening negative for diabetes did not lead to overt long-term changes in lifestyle, despite a high perception of risk of developing diabetes. (ISRCTN75983009.).
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16
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Saha S, Leijon M, Gerdtham U, Sundquist K, Sundquist J, Arvidsson D, Bennet L. A culturally adapted lifestyle intervention addressing a Middle Eastern immigrant population at risk of diabetes, the MEDIM (impact of Migration and Ethnicity on Diabetes In Malmö): study protocol for a randomized controlled trial. Trials 2013; 14:279. [PMID: 24006857 PMCID: PMC3844588 DOI: 10.1186/1745-6215-14-279] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 05/30/2013] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Studies have shown that lifestyle interventions are effective in preventing or delaying the onset of type 2 diabetes in high-risk patients. However, research on the effectiveness of lifestyle interventions in high-risk immigrant populations with different cultural and socioeconomic backgrounds is scarce. The aim was to design a culturally adapted lifestyle intervention for an immigrant population and to evaluate its effectiveness and cost-effectiveness. METHODS/DESIGN In this randomized controlled trial, 308 participants (born in Iraq, living in Malmö, Sweden and at high risk of type 2 diabetes) will be allocated to either a culturally adapted intervention or a control group. The intervention will consist of 10 group counseling sessions focusing on diet, physical activity and behavioral change over 6 months, and the offer of exercise sessions. Cultural adaptation includes gender-specific exercise sessions, and counseling by a health coach community member. The control group will receive the information about healthy lifestyle habits provided by the primary health care center. The primary outcome is change in fasting glucose level. Secondary outcomes are changes in body mass index, insulin sensitivity, physical activity, food habits and health-related quality of life. Measurements will be taken at baseline, after 3 and 6 months. Data will be analyzed by the intention-to-treat approach. The cost-effectiveness during the trial period and over the longer term will be assessed by simulation modeling from patient, health care and societal perspectives. DISCUSSION This study will provide a basis to measure the effectiveness of a lifestyle intervention designed for immigrants from the Middle East in terms of improvement in glucose metabolism, and will also assess its cost-effectiveness. Results from this trial may help health care providers and policy makers to adapt and implement lifestyle interventions suitable for this population group that can be conducted in the community. TRIAL REGISTRATION ClinicalTrials.gov, NCT01420198.
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Affiliation(s)
- Sanjib Saha
- Department of Clinical Sciences, Center for Primary Health Care Research, Lund University/Region Skåne, Skåne University Hospital, Building 60, floor 12 Jan Waldenströms gata 37, 205 02 Malmö, Sweden.
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17
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Al-Khawaldeh OA, Al-Jaradeen N. Diabetes awareness and diabetes risk reduction behaviors among attendance of primary healthcare centers. Diabetes Metab Syndr 2013; 7:172-178. [PMID: 23953184 DOI: 10.1016/j.dsx.2013.02.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
AIMS The aims of this study were to assess level of awareness about diabetes and the level of adoption of diabetes risk behaviors among adult attending primary healthcare centers. METHODS A cross-sectional descriptive study was conducted using a self-administrated questionnaire. In addition to demographic information, the questionnaire contained questions on diabetes awareness related to diabetes definition, symptoms, risk factors, complications and management of diabetes as well as questions on diabetes risk reduction behaviors and sources of information on diabetes. The data was analyzed with independent t-test, Pearson's correlation coefficient, and ANOVA test. RESULTS A total of 541 participants aged ≥ 18 years were recruited. The mean score of diabetes awareness was 27.5/40 [SD=5.7]. The participants performed best in symptoms section with a mean score of 6.3/8 [SD=1.6], and worst in the risk factors section with a mean score of 3.6/6 (SD=1.4). With respect to diabetes risk reduction behaviors the results showed that the highest mean score was for fat reduction 2.0/4 [SD=0.8]; and the lowest mean score was for weight control or losing 1.7/4 [SD=0.8]. CONCLUSIONS The current study demonstrated that substantial numbers of adult Jordanian lack the sufficient awareness about diabetes to prevent and cope with the increasing prevalence of diabetes in Jordan. Also, it demonstrated that adoption of diabetes risk reduction behaviors was suboptimal. Raising public awareness of diabetes and diabetes risk reduction behaviors through population-based programs and mass media should be planned and implemented.
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18
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Laws RA, Fanaian M, Jayasinghe UW, McKenzie S, Passey M, Davies GP, Lyle D, Harris MF. Factors influencing participation in a vascular disease prevention lifestyle program among participants in a cluster randomized trial. BMC Health Serv Res 2013; 13:201. [PMID: 23725521 PMCID: PMC3702446 DOI: 10.1186/1472-6963-13-201] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 05/20/2013] [Indexed: 11/30/2022] Open
Abstract
Background Previous research suggests that lifestyle intervention for the prevention of diabetes and cardiovascular disease (CVD) are effective, however little is known about factors affecting participation in such programs. This study aims to explore factors influencing levels of participation in a lifestyle modification program conducted as part of a cluster randomized controlled trial of CVD prevention in primary care. Methods This concurrent mixed methods study used data from the intervention arm of a cluster RCT which recruited 30 practices through two rural and three urban primary care organizations. Practices were randomly allocated to intervention (n = 16) and control (n = 14) groups. In each practice up to 160 eligible patients aged between 40 and 64 years old, were invited to participate. Intervention practice staff were trained in lifestyle assessment and counseling and referred high risk patients to a lifestyle modification program (LMP) consisting of two individual and six group sessions over a nine month period. Data included a patient survey, clinical audit, practice survey on capacity for preventive care, referral and attendance records at the LMP and qualitative interviews with Intervention Officers facilitating the LMP. Multi-level logistic regression modelling was used to examine independent predictors of attendance at the LMP, supplemented with qualitative data from interviews with Intervention Officers facilitating the program. Results A total of 197 individuals were referred to the LMP (63% of those eligible). Over a third of patients (36.5%) referred to the LMP did not attend any sessions, with 59.4% attending at least half of the planned sessions. The only independent predictors of attendance at the program were employment status - not working (OR: 2.39 95% CI 1.15-4.94) and having high psychological distress (OR: 2.17 95% CI: 1.10-4.30). Qualitative data revealed that physical access to the program was a barrier, while GP/practice endorsement of the program and flexibility in program delivery facilitated attendance. Conclusion Barriers to attendance at a LMP for CVD prevention related mainly to external factors including work commitments and poor physical access to the programs rather than an individuals’ health risk profile or readiness to change. Improving physical access and offering flexibility in program delivery may enhance future attendance. Finally, associations between psychological distress and attendance rates warrant further investigation. Trial registration ACTRN12607000423415
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Affiliation(s)
- Rachel A Laws
- Prevention Research Collaboration, School of Public Health, University of Sydney, Sydney, NSW 2006, Australia.
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19
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Salmela SM, Vähäsarja K, Villberg J, Vanhala M, Saaristo T, Lindström J, Oksa H, Korpi-Hyövälti E, Niskanen L, Keinänen-Kiukaanniemi S, Poskiparta M. The reporting of previous lifestyle counseling by persons at high risk of Type 2 diabetes. PATIENT EDUCATION AND COUNSELING 2012; 87:178-185. [PMID: 21943790 DOI: 10.1016/j.pec.2011.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Revised: 08/01/2011] [Accepted: 08/26/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To assess (i) whether the reporting of counseling previously received is associated with high-risk individuals' agreement to participate in lifestyle intervention, (ii) whether the reporting of previous counseling differed within such a high-risk group, and (iii) the associations between lifestyles and previous lifestyle counseling. METHODS Cross-sectional data were drawn from 10149 adults at high risk of Type 2 diabetes, who were participating in a Finnish national diabetes prevention project (FIN-D2D). Bivariate analysis and multivariate logistic regression were used. RESULTS In relation to the reporting of previous counseling, no difference was found between persons who had agreed and persons who had not agreed to participate in the lifestyle intervention. Persons who were more educated or who had dyslipidemia or diabetes were more likely than the others to report previous counseling. A generally healthy lifestyle, or certain health behaviors (being a non-smoker or eating large amounts of fruit and vegetables) may make the reporting of previous counseling more likely. CONCLUSION The results raise questions about the amount and quality of the previously received lifestyle counseling. PRACTICE IMPLICATIONS There is a need for sustainable lifestyle counseling structures, within vigorously implemented diabetes prevention projects, if long-lasting lifestyle changes are to be achieved.
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Affiliation(s)
- Sanna M Salmela
- Research Centre for Health Promotion, Faculty of Sport and Health Sciences, Department of Health Sciences, University of Jyväskylä, Finland.
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20
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Salmela SM, Vähäsarja KA, Villberg JJ, Vanhala MJ, Saaristo TE, Lindström J, Oksa HH, Korpi-Hyövälti EAL, Moilanen L, Keinänen-Kiukaanniemi S, Poskiparta ME. Perceiving need for lifestyle counseling: findings from Finnish individuals at high risk of type 2 diabetes. Diabetes Care 2012; 35:239-41. [PMID: 22190673 PMCID: PMC3263895 DOI: 10.2337/dc11-1116] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 11/05/2011] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate the proportion of individuals at high risk of type 2 diabetes who perceive the need for lifestyle counseling, factors associated with this perception, and whether the perceived need is associated with subsequent attendance in lifestyle intervention. RESEARCH DESIGN AND METHODS Baseline and intervention data were obtained from 10,149 participants in a Finnish National Diabetes Prevention Project. RESULTS In total, 36% of men and 52% of women perceived the need for counseling. Most of the risk factors did not increase the perceived need for counseling. Those agreeing to attend supervised lifestyle intervention were more likely to report a perceived need than those who agreed on a self-initiated lifestyle change or those who refused to attend lifestyle intervention. The perceived need was associated with actual attendance in the lifestyle intervention only among women. CONCLUSIONS It will be vital to find additional means to support lifestyle change.
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Affiliation(s)
- Sanna M Salmela
- Research Centre for Health Promotion, Faculty of Sport and Health Sciences, Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
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