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Nelson LA, Spieker AJ, Greevy RA, Roddy MK, LeStourgeon LM, Bergner EM, El-Rifai M, Aikens JE, Wolever RQ, Elasy TA, Mayberry LS. Glycemic outcomes of a family-focused intervention for adults with type 2 diabetes: Main, mediated, and subgroup effects from the FAMS 2.0 RCT. Diabetes Res Clin Pract 2023; 206:110991. [PMID: 37925077 PMCID: PMC10873034 DOI: 10.1016/j.diabres.2023.110991] [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: 08/21/2023] [Revised: 10/17/2023] [Accepted: 11/02/2023] [Indexed: 11/06/2023]
Abstract
AIMS Family/friend Activation to Motivate Self-care (FAMS) is a self-care support intervention delivered via mobile phones. We evaluated FAMS' effects on hemoglobin A1c (HbA1c) and intervention targets among adults with type 2 diabetes in a 15-month RCT. METHODS Persons with diabetes (PWDs) were randomized to FAMS or control with their support person (family/friend, optional). FAMS included monthly phone coaching and text messages for PWDs, and text messages for support persons over a 9-month intervention period. RESULTS PWDs (N = 329) were 52 % male, 39 % reported minoritized race or ethnicity, with mean HbA1c 8.6 ± 1.7 %. FAMS improved HbA1c among PWDs with a non-cohabitating support person (-0.64 %; 95 % CI [-1.22 %, -0.05 %]), but overall mean effects were not significant. FAMS improved intervention targets including self-efficacy, dietary behavior, and family/friend involvement during the intervention period; these improvements mediated post-intervention HbA1c improvements (total indirect effect -0.27 %; 95 % CI [-0.49 %, -0.09 %]) and sustained HbA1c improvements at 12 months (total indirect effect -0.19 %; 95 % CI [-0.40 %, -0.01 %]). CONCLUSIONS Despite improvements in most intervention targets, HbA1c improved only among PWDs engaging non-cohabitating support persons suggesting future family interventions should emphasize inclusion of these relationships. Future work should also seek to identify intervention targets that mediate improvements in HbA1c.
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Affiliation(s)
- Lyndsay A Nelson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Andrew J Spieker
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Robert A Greevy
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - McKenzie K Roddy
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lauren M LeStourgeon
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Erin M Bergner
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Merna El-Rifai
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James E Aikens
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Ruth Q Wolever
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA; Osher Center for Integrative Health at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tom A Elasy
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lindsay S Mayberry
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.
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Roddy MK, Spieker AJ, Nelson LA, Greevy RA, LeStourgeon LM, Bergner EM, El-Rifai M, Elasy TA, Aikens JE, Wolever RQ, Mayberry LS. Well-being outcomes of a family-focused intervention for persons with type 2 diabetes and support persons: Main, mediated, and subgroup effects from the FAMS 2.0 RCT. Diabetes Res Clin Pract 2023; 204:110921. [PMID: 37742801 PMCID: PMC10617415 DOI: 10.1016/j.diabres.2023.110921] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/12/2023] [Accepted: 09/20/2023] [Indexed: 09/26/2023]
Abstract
AIMS Type 2 diabetes self-management occurs within social contexts. We sought to test the effects of Family/friend Activation to Motivate Self-care (FAMS), a self-care support intervention delivered via mobile phones, on psychosocial outcomes for persons with diabetes (PWDs) and their support persons. METHODS PWDs had the option to enroll with a friend/family member as a support person in a 15-month RCT to evaluate FAMS versus enhanced usual care. FAMS included 9 months of monthly phone coaching and text message support for PWDs, and text message support for enrolled support persons. RESULTS PWDs (N = 329) were 52% male and 39% reported minoritized race or ethnicity ; 50% enrolled with elevated diabetes distress. Support persons (N = 294) were 26% male and 33% reported minoritized race or ethnicity. FAMS improved PWDs' diabetes distress (d = -0.19) and global well-being (d = 0.21) during the intervention, with patterns of larger effects among minoritized groups. Post-intervention (9-month) and sustained (15-month) improvements were driven by changes in PWDs' self-efficacy, self-care behaviors, and autonomy support. Among support persons, FAMS improved helpful involvement without increasing burden or harmful involvement. CONCLUSIONS FAMS improved PWDs' psychosocial well-being, with post-intervention and sustained improvements driven by improved self-efficacy, self-care, and autonomy support. Support persons increased helpful involvement without adverse effects.
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Affiliation(s)
- McKenzie K Roddy
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Andrew J Spieker
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Lyndsay A Nelson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Robert A Greevy
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Lauren M LeStourgeon
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Erin M Bergner
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Merna El-Rifai
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Tom A Elasy
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, United States
| | - James E Aikens
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Ruth Q Wolever
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, United States; Osher Center for Integrative Health at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Lindsay S Mayberry
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, United States; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States.
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Roddy MK, Spieker AJ, Nelson LA, Greevy RA, LeStourgeon LM, Bergner EM, El-Rifai M, Elasy TA, Aikens JE, Wolever RQ, Mayberry LS. Well-being outcomes of a family-focused intervention for persons with type 2 diabetes and support persons: Main, mediated, and subgroup effects from the FAMS 2.0 RCT. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.11.23295375. [PMID: 37745314 PMCID: PMC10516078 DOI: 10.1101/2023.09.11.23295375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Aims Type 2 diabetes self-management occurs within social contexts. We sought to test the effects of Family/friends Activation to Motivate Self-care (FAMS), a self-care support intervention delivered via mobile phones, on psychosocial outcomes for persons with diabetes (PWDs) and their support persons. Methods PWDs had the option to enroll with a friend/family member as a support person in a 15-month RCT to evaluate FAMS versus enhanced usual care. FAMS included 9-months of monthly phone coaching and text message support for PWDs, and text message support for enrolled support persons. Results PWDs (N=329) were 52% male and 39% from minoritized racial or ethnic groups; 50% enrolled with elevated diabetes distress. Support persons (N=294) were 26% male and 33% minoritized racial or ethnic groups. FAMS improved PWDs' diabetes distress ( d =-0.19) and global well-being ( d =0.21) during the intervention, with patterns of larger effects among minoritized groups. Post-intervention and sustained (15-month) improvements were driven by changes in PWDs' self-efficacy, self-care behaviors, and autonomy support. Among support persons, FAMS improved helpful involvement without increasing burden or harmful involvement. Conclusions FAMS improved PWDs' psychosocial well-being, with post-intervention and sustained improvements driven by improved self-efficacy, self-care, and autonomy support. Support persons increased helpful involvement without adverse effects.
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Affiliation(s)
- McKenzie K. Roddy
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN
| | - Andrew J. Spieker
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Lyndsay A Nelson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN
| | - Robert A. Greevy
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Lauren M. LeStourgeon
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN
| | - Erin M. Bergner
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN
| | - Merna El-Rifai
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN
| | - Tom A. Elasy
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - James E. Aikens
- Department of Family Medicine, University of Michigan, Ann Arbor, MI
| | - Ruth Q. Wolever
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN
- Osher Center for Integrative Health at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN
| | - Lindsay S. Mayberry
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
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Nelson LA, Spieker AJ, Greevy RA, Roddy MK, LeStourgeon LM, Bergner EM, El-Rifai M, Aikens JE, Wolever RQ, Elasy TA, Mayberry LS. Glycemic outcomes of a family-focused intervention for adults with type 2 diabetes: Main, mediated, and subgroup effects from the FAMS 2.0 RCT. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.11.23295374. [PMID: 37745473 PMCID: PMC10516064 DOI: 10.1101/2023.09.11.23295374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Aims Family/friends Activation to Motivate Self-care (FAMS) is a self-care support intervention delivered via mobile phones. We evaluated FAMS effects on hemoglobin A1c (HbA1c) and intervention targets among adults with type 2 diabetes in a 15-month RCT. Methods Persons with diabetes (PWDs) and their support persons (family/friend, optional) were randomized to FAMS or control. FAMS included monthly phone coaching and text messages for PWDs, and text messages for support persons over a 9-month intervention period. Results PWDs (N=329) were 52% male, 39% from minoritized racial or ethnic groups, with mean HbA1c 8.6±1.7%. FAMS improved HbA1c among PWDs with a non-cohabitating support person (-0.64%; 95% CI [-1.22%, -0.05%]), but overall effects were not significant. FAMS improved intervention targets including self-efficacy, dietary behavior, and family/friend involvement during the intervention period; these improvements mediated post-intervention HbA1c improvements (total indirect effect -0.27%; 95% CI [-0.49%, -0.09%]) and sustained HbA1c improvements at 12 months (total indirect effect -0.19%; 95% CI [-0.40%, -0.01%]). Conclusions Despite improvements in most intervention targets, HbA1c improved only among PWDs engaging non-cohabitating support persons suggesting future family interventions should emphasize inclusion of these relationships. Future work should also seek to identify intervention targets that mediate improvements in HbA1c.
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Affiliation(s)
- Lyndsay A. Nelson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Andrew J. Spieker
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Robert A. Greevy
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - McKenzie K. Roddy
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lauren M. LeStourgeon
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Erin M. Bergner
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Merna El-Rifai
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James E. Aikens
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Ruth Q. Wolever
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
- Osher Center for Integrative Health at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tom A. Elasy
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lindsay S. Mayberry
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
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Jiang T, Li A, Zhang M, Zhou Z, Wang L, Zhang X, Zhang Y, Zhang Q. Measuring Self-management Among People with Diabetes Mellitus: A Systematic Review of Patient-Reported Diabetes-Specific Instruments in English and Chinese. Adv Ther 2023; 40:769-813. [PMID: 36607543 DOI: 10.1007/s12325-022-02361-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/13/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Effective behavioral management is critical for people with diabetes to achieve glycemic control. Many instruments have been developed to measure diabetes-specific self-management. This review aimed to retrieve existing self-management-related instruments and identify well-validated instruments suitable for clinical research and practice. METHODS First, PubMed, Psych INFO, ERIC, and two Chinese databases (CNKI and Wanfang Data) were searched to identify existing instruments for self-management in diabetes systematically. Second, instruments were screened based on the pre-specified inclusion and exclusion criteria. Third, the psychometric property data of each included instrument were retrieved, and instruments with poor psychometric properties were excluded. Fourth, selected instruments were categorized into four categories: knowledge and health literacy, belief and self-efficacy, self-management behaviors, and composite scales. Finally, recommendations were made according to the application status and quality of the instruments. Instruments in English and Chinese were screened and summarized separately. RESULTS A total of 406 instruments (339 English instruments and 67 Chinese instruments) were identified. Forty-three English instruments were included. Five focused on knowledge and literacy, 12 on belief and self-management perception-related constructs, 21 on self-management and behaviors, and 5 on composite measures. We further recommended 19 English scales with relatively good quality and are frequently applied. Twenty-five Chinese instruments were included, but none were recommended because of a lack of sufficient psychometric property data. CONCLUSION Many English instruments measuring diabetes self-management have been developed and validated. Further research is warranted to validate instruments adapted or developed in the Chinese population.
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Affiliation(s)
- Tian Jiang
- Department of endocrinology, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Shushan District, Hefei, Anhui, China
| | - Aihua Li
- Sanofi China, 19F, Tower III, Kerry Center 1228 Middle Yan'an Road, Shanghai, China
| | - Minlu Zhang
- Sanofi China, 19F, Tower III, Kerry Center 1228 Middle Yan'an Road, Shanghai, China
| | - Zhou Zhou
- Sanofi China, 19F, Tower III, Kerry Center 1228 Middle Yan'an Road, Shanghai, China
| | - Lu Wang
- Sanofi China, 19F, Tower III, Kerry Center 1228 Middle Yan'an Road, Shanghai, China
| | - Xiaoqian Zhang
- Department of endocrinology, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Shushan District, Hefei, Anhui, China
| | - Yi Zhang
- Department of endocrinology, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Shushan District, Hefei, Anhui, China
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, China
| | - Qiu Zhang
- Department of endocrinology, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Shushan District, Hefei, Anhui, China.
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Miller ST, Akohoue SA, Murry VM, Tabatabai M, Wilus D, Foxx A. SISTER (Sisters Inspiring Sisters to Engage in Relevant Diabetes Self-Care) Diabetes Study: Protocol for diabetes medical nutrition therapy randomized clinical trial among African American women. Contemp Clin Trials 2023; 125:107052. [PMID: 36526256 DOI: 10.1016/j.cct.2022.107052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND African American (AA) women with type 2 diabetes (T2D) carry disproportionate diabetes-related morbidity and mortality burdens. Diabetes medical nutrition therapy (MNT) improves glycemic, blood pressure, and cholesterol control, all critical in preventing and reducing diabetes complications. Yet, MNT does not address low motivation for dietary intake management, which is frequently reported among AA women with T2D living in the Southeastern US. METHODS A randomized controlled trial will be used to test the central hypothesis that diabetes MNT plus culturally-tailored motivational interviewing (MI) (diabetes MNT plus MI) is more effective than diabetes MNT alone (diabetes MNT). Two hundred ninety-one Southeastern AA women who are at risk for development and/or progression of T2D complications will be randomized to diabetes MNT plus MI or diabetes MNT. Both groups will include: 1) a 3-month active intervention period, consisting of group-based, nutritionist-facilitated MNT sessions; 2) a 3-month maintenance intervention period, including one group-based, nutritionist-facilitated maintenance support session; and 3) a 6-month inactive period. Culturally-adapted MI exercises will be integrated into the diabetes MNT plus MI group only. Primary (HbA1c) and secondary (systolic blood pressure, LDL cholesterol) outcomes will be assessed at baseline and 3, 6, and 12 months following the active intervention period. DISCUSSION The results from this study, called the SISTER (Sisters Inspiring Sisters to Engage in Relevant Diabetes Self-Care) Diabetes Study, are vital to the adoption and uptake of rigorously-tested MNT interventions that address motivation among AA women with T2D as a way to reduce their risk and/or progression of diabetes-related complications.
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Affiliation(s)
- Stephania T Miller
- Department of Surgery, School of Medicine, Meharry Medical College, 1005 Dr. D.B. Todd, Jr. Blvd, Nashville, TN 37208-3599, USA.
| | - Sylvie A Akohoue
- Department of Family and Community Medicine, School of Medicine, Meharry Medical College, 1005 Dr. D.B. Todd, Jr. Blvd, Nashville, TN 37208-3599, USA
| | - Velma M Murry
- Departments of Health Policy & Human & Organizational Development, Vanderbilt University, 2525 West End, Ave., Nashville, TN 37203, USA
| | - Mohammad Tabatabai
- School of Graduate Studies and Research, Meharry Medical College, 1005 Dr. D.B. Todd, Jr. Blvd, Nashville, TN 37208-3599, USA
| | - Derek Wilus
- School of Graduate Studies and Research, Meharry Medical College, 1005 Dr. D.B. Todd, Jr. Blvd, Nashville, TN 37208-3599, USA
| | - Ardana Foxx
- Patient Advisory Group, SISTER Diabetes Study, Nashville, TN, USA
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Mayberry LS, Greevy RA, Huang LC, Zhao S, Berg CA. Development of a Typology of Diabetes-Specific Family Functioning Among Adults With Type 2. Ann Behav Med 2021; 55:956-969. [PMID: 33761527 DOI: 10.1093/abm/kaab009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Family members' responses to adults' diabetes and efforts to manage it vary widely. Multiple aspects of diabetes-specific family functioning have been identified as important for self-management and psychosocial well-being in theoretical (i.e., theories of social support and collaborative coping) and observational literature. PURPOSE Develop a typological framework of diabetes-specific family functioning and examine cross-sectional associations between type and diabetes outcomes. METHODS We used electronic health record (EHR) data to identify a cohort of 5,545 adults receiving outpatient care for type 2 diabetes and invited them to complete a survey assessing 10 dimensions of diabetes-specific family functioning. We used k-means cluster analysis to identify types. After type assignment, we used EHR data for the full cohort to generate sampling weights to correct for imbalance between participants and non-participants. We used weighted data to examine unadjusted associations between participant characteristics and type, and in regression models to examine associations between type and diabetes outcomes. Regression models were adjusted for sociodemographics, diabetes duration, and insulin status. RESULTS We identified and named four types: Collaborative and Helpful (33.8%), Satisfied with Low Involvement (22.2%), Want More Involvement (29.6%), and Critically Involved (14.5%; reflecting the highest levels of criticism and harmful involvement). Across these types, hemoglobin A1c, diabetes distress, depressive symptoms, diabetes medication adherence, and diabetes self-efficacy worsened. After covariate adjustment, type remained independently associated with each diabetes outcome (all p's < .05). CONCLUSIONS The typology extends theories of family support in diabetes and applications of the typology may lead to breakthroughs in intervention design, tailoring, and evaluation.
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Affiliation(s)
- Lindsay S Mayberry
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Center for Diabetes Translation Research, Nashville, TN, USA
| | - Robert A Greevy
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Li-Ching Huang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.,Center for Quantitative Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shilin Zhao
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.,Center for Quantitative Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Cynthia A Berg
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
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Wee PJL, Kwan YH, Loh DHF, Phang JK, Puar TH, Østbye T, Thumboo J, Yoon S, Low LL. Measurement Properties of Patient-Reported Outcome Measures for Diabetes: Systematic Review. J Med Internet Res 2021; 23:e25002. [PMID: 34397387 PMCID: PMC8398743 DOI: 10.2196/25002] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/18/2020] [Accepted: 06/14/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The management of diabetes is complex. There is growing recognition of the use of patient-reported outcome measures (PROMs) as a standardized method of obtaining an outlook on patients' functional status and well-being. However, no systematic reviews have summarized the studies that investigate the measurement properties of diabetes PROMs. OBJECTIVE Our aims were to conduct a systematic review of studies investigating the measurement properties of diabetes PROMs by evaluating the methodological quality and overall level of evidence of these PROMs and to categorize them based on the outcome measures assessed. METHODS This study was guided by the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. Relevant articles were retrieved from the Embase, PubMed, and PsychINFO databases. The PROMs were evaluated with the COSMIN (COnsensus-based Standards for the selection of health Measurement Instruments) guidelines. RESULTS A total of 363 articles evaluating the measurement properties of PROMs for diabetes in the adult population were identified, of which 238 unique PROMs from 248 studies reported in 209 articles were validated in the type 2 diabetes population. PROMs with at least a moderate level of evidence for ≥5 of 9 measurement properties include the Chinese version of the Personal Diabetes Questionnaire (C-PDQ), Diabetes Self-Management Instrument Short Form (DSMI-20), and Insulin Treatment Appraisal Scale in Hong Kong primary care patients (C-ITAS-HK), of which the C-PDQ has a "sufficient (+)" rating for >4 measurement properties. A total of 43 PROMs meet the COSMIN guidelines for recommendation for use. CONCLUSIONS This study identified and synthesized evidence for the measurement properties of 238 unique PROMs for patients with type 2 diabetes and categorized the PROMs according to their outcome measures. These findings may assist clinicians and researchers in selecting appropriate high-quality PROMs for clinical practice and research. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42020180978; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020180978.
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Affiliation(s)
| | - Yu Heng Kwan
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | | | - Jie Kie Phang
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
| | - Troy H Puar
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore
| | - Truls Østbye
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Julian Thumboo
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sungwon Yoon
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Lian Leng Low
- SingHealth Office of Regional Health, Singapore, Singapore
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Singapore
- Post Acute and Continuing Care, Outram Community Hospital, SingHealth Community Hospitals, Singapore, Singapore
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9
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Mayberry LS, Bergner EM, Harper KJ, Laing S, Berg CA. Text messaging to engage friends/family in diabetes self-management support: acceptability and potential to address disparities. J Am Med Inform Assoc 2021; 26:1099-1108. [PMID: 31403688 DOI: 10.1093/jamia/ocz091] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/19/2019] [Accepted: 05/22/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Explore acceptability of engaging family/friends in patients' type 2 diabetes (T2D) self-management using text messaging. MATERIALS AND METHODS Participants (N = 123) recruited from primary care clinics for a larger trial evaluating mobile phone support for T2D completed self-report measures and a hemoglobin A1c test and then had the option to invite an adult support person to receive text messages. We examined characteristics and reasons of participants who did/did not invite a support person, responses to the invitation, and feedback from patients and support persons. RESULTS Participants were 55.9 ± 10.1 years old, 55% female, 53% minority, and 54% disadvantaged (low income, less than high school degree/GED, uninsured, and/or homeless). Participants who invited a support person (48%) were slightly younger, more likely to be partnered, and reported more depressive symptoms and more emergency department visits in the year prior to study enrollment as compared to participants who did not (all p <.05). Participants' reasons for inviting a support person included needing help and seeing benefits of engaging others, while reasons for not inviting a support person included concerns about being a "burden" and support person's ability or desire to text. Support persons reported the texts increased awareness, created dialogue, and improved their own health behaviors. DISCUSSION Patients inviting a support person had higher need and thus may stand to benefit most. Most support persons were open to engagement via text messages. CONCLUSION Across race and socioeconomic status, text messaging may engage support persons to increase health-related support-particularly for patients with higher levels of need. TRIAL REGISTRATION Clinicaltrials.gov NCT02409329.
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Affiliation(s)
- Lindsay S Mayberry
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Erin M Bergner
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kryseana J Harper
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Simone Laing
- Meharry Medical College, Nashville, Tennessee, USA
| | - Cynthia A Berg
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
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10
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Nelson LA, Greevy RA, Spieker A, Wallston KA, Elasy TA, Kripalani S, Gentry C, Bergner EM, LeStourgeon LM, Williamson SE, Mayberry LS. Effects of a Tailored Text Messaging Intervention Among Diverse Adults With Type 2 Diabetes: Evidence From the 15-Month REACH Randomized Controlled Trial. Diabetes Care 2021; 44:26-34. [PMID: 33154039 PMCID: PMC7783936 DOI: 10.2337/dc20-0961] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 10/02/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Text messaging interventions have high potential for scalability and for reductions in health disparities. However, more rigorous, long-term trials are needed. We examined the long-term efficacy and mechanisms of a tailored text messaging intervention. RESEARCH DESIGN AND METHODS Adults with type 2 diabetes participated in a parallel-groups, 15-month randomized controlled trial and were assigned to receive Rapid Education/Encouragement and Communications for Health (REACH) for 12 months or control. REACH included interactive texts and tailored texts addressing medication adherence and nontailored texts supporting other self-care behaviors. Outcomes included hemoglobin A1c (HbA1c), diabetes medication adherence, self-care, and self-efficacy. RESULTS Participants (N = 506) were approximately half racial/ethnic minorities, and half were underinsured, had annual household incomes <$35,000, and had a high school education or less; 11% were homeless. Average baseline HbA1c was 8.6% ± 1.8%; 70.0 ± 19.7 mmol/mol) with n = 219 having HbA1c ≥8.5% (69 mmol/mol). Half were prescribed insulin. Retention was over 90%. Median response rate to interactive texts was 91% (interquartile range 75%, 97%). The treatment effect on HbA1c at 6 months (-0.31%; 95% CI -0.61%, -0.02%) was greater among those with baseline HbA1c ≥8.5% (-0.74%; 95% CI -1.26%, -0.23%), and there was no evidence of effect modification by race/ethnicity or socioeconomic disadvantage. REACH improved medication adherence and diet through 12 months and self-efficacy through 6 months. Treatment effects were not significant for any outcome at 15 months. REACH reduced barriers to adherence, but barrier reduction did not mediate outcome improvements. CONCLUSIONS REACH engaged at-risk patients in diabetes self-management and improved short-term HbA1c. More than texts alone may be needed to sustain the effects.
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Affiliation(s)
- Lyndsay A Nelson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN
| | - Robert A Greevy
- Department of Biostatistics, Vanderbilt University, Nashville, TN
| | - Andrew Spieker
- Department of Biostatistics, Vanderbilt University, Nashville, TN
| | - Kenneth A Wallston
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN
| | - Tom A Elasy
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Center for Diabetes Translation Research, Vanderbilt University Medical Center, Nashville, TN
| | - Sunil Kripalani
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Chad Gentry
- Department of Pharmacy, College of Pharmacy and Health Sciences, Lipscomb University, Nashville, TN
| | - Erin M Bergner
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN
| | - Lauren M LeStourgeon
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN
| | - Sarah E Williamson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN
| | - Lindsay S Mayberry
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN
- Center for Diabetes Translation Research, Vanderbilt University Medical Center, Nashville, TN
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
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11
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Jafari S, Ahmadipour H. Self-Management Barriers Perceived by Patients with Type 2 Diabetes: A Confirmatory Factor Analysis. Int J Prev Med 2020; 11:152. [PMID: 33209222 PMCID: PMC7643576 DOI: 10.4103/ijpvm.ijpvm_195_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 08/12/2019] [Indexed: 11/30/2022] Open
Abstract
Background: Self-management remains poor among most of the diabetic patients due to various individual and environmental barriers which affect it. These barriers should be identified and intervened promptly. The current study aimed to determine self-management barriers perceived by patients with type 2 diabetes. Methods: A cross-sectional study carried out on 681 patients with type 2 diabetes who referred to the diabetes center which is affiliated to Kerman University of Medical Sciences, Kerman, Iran during 2018. Through a structured interview, demographic and disease-related data were recorded and the Persian version of the modified Personal Diabetes Questionnaire (PDQ) was used to assess self-management barriers. The tool has four subscales including diet, medication, monitoring, and exercise barriers. The higher score in each subscale indicates a higher level of barriers in that section. Data analyzed by SPSS 20 using T-test, ANOVA, and multiple linear regressions. Results: The majority of the patients (62.8%) were female, married (78.3%) with monthly income 10 to 20 million IRRLs (78.4%) and the mean age of 55.65 ± 14.65 years. Body Mass Index, marital status, monthly income, and HbA1C significantly predicted the barriers' score. The instrument had excellent reliability (α = 0.95). In confirmatory factor analysis, the fit indices had approximately acceptable levels. Conclusions: The Persian version of modified PDQ had good psychometric properties and can be used as a valid and reliable instrument in the primary health care setting. The significant perceived barriers should be identified and intervened by health care providers through the comprehensive management of diabetic patients.
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Affiliation(s)
- Shohreh Jafari
- Department of Community and Family Medicine, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Habibeh Ahmadipour
- Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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12
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Estrella ML, Allen-Meares P. Tools to Measure Health Literacy among US African Americans and Hispanics/Latinos with Type 2 Diabetes: A Scoping Review of the Literature. PATIENT EDUCATION AND COUNSELING 2020; 103:2155-2165. [PMID: 32451221 PMCID: PMC7508870 DOI: 10.1016/j.pec.2020.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/27/2020] [Accepted: 04/10/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To provide an overview of the health literacy tools that have been validated in samples of African Americans and Hispanics/Latinos with type 2 diabetes, growing segments of the US population. METHODS Following PRISMA guidelines, three electronic databases were searched. The following inclusion criteria were used: peer-reviewed research; examined validity of a health literacy tool; and included US African American and/or Hispanic/Latino adults with type 2 diabetes. RESULTS Sixteen studies were selected; none exclusively included African Americans while 3 exclusively included Hispanics/Latinos in the sample. Seventeen health literacy tools were identified. Among African Americans, 2 health literacy screeners, 2 diabetes knowledge, and 3 numeracy tools have been validated. Among Hispanics/Latinos, 1 health literacy screener, 1 diabetes knowledge, and 1 numeracy tool have been validated. However, cross-cultural adaptation principles were rarely considered in the development and validation of these tools. CONCLUSION In those with type 2 diabetes, future studies should investigate the validity of health literacy screeners among English-speaking Hispanics/Latinos and general health literacy tools among African Americans and Hispanics/Latinos. Evidence on the validity of diabetes knowledge and numeracy tools was mixed across studies. PRACTICE IMPLICATIONS Findings can inform the selection of culturally-appropriate health literacy tools in clinical and research settings.
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Affiliation(s)
- Mayra L Estrella
- Institute for Minority Health Research, University of Illinois at Chicago, 1819 West Polk St., Chicago, IL 60612, USA.
| | - Paula Allen-Meares
- Institute for Minority Health Research, University of Illinois at Chicago, 1819 West Polk St., Chicago, IL 60612, USA; Office of Health Literacy, University of Illinois at Chicago, 808 S. Wood Street, Chicago, IL 60612, USA.
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13
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Mayberry LS, Berg CA, Greevy RA, Nelson LA, Bergner EM, Wallston KA, Harper KJ, Elasy TA. Mixed-Methods Randomized Evaluation of FAMS: A Mobile Phone-Delivered Intervention to Improve Family/Friend Involvement in Adults' Type 2 Diabetes Self-Care. Ann Behav Med 2020; 55:165-178. [PMID: 32706852 DOI: 10.1093/abm/kaaa041] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Family and friends have both helpful and harmful effects on adults' diabetes self-management. Family-focused Add-on to Motivate Self-care (FAMS) is a mobile phone-delivered intervention designed to improve family/friend involvement, self-efficacy, and self-care via monthly phone coaching, texts tailored to goals, and the option to invite a support person to receive texts. PURPOSE We sought to evaluate how FAMS was received by a diverse group of adults with Type 2 diabetes and if FAMS improved diabetes-specific family/friend involvement (increased helpful and reduced harmful), diabetes self-efficacy, and self-care (diet and physical activity). We also assessed if improvements in family/friend involvement mediated improvements in self-efficacy and self-care. METHODS Participants were prospectively assigned to enhanced treatment as usual (control), an individualized text messaging intervention alone, or the individualized text messaging intervention plus FAMS for 6 months. Participants completed surveys at baseline, 3 and 6 months, and postintervention interviews. Between-group and multiple mediator analyses followed intention-to-treat principles. RESULTS Retention, engagement, and fidelity were high. FAMS was well received and helped participants realize the value of involving family/friends in their care. Relative to control, FAMS participants had improved family/friend involvement, self-efficacy, and diet (but not physical activity) at 3 and 6 months (all ps < .05). Improvements in family/friend involvement mediated effects on self-efficacy and diet for FAMS participants but not for the individualized intervention group. CONCLUSIONS The promise of effectively engaging patients' family and friends lies in sustained long-term behavior change. This work represents a first step toward this goal by demonstrating how content targeting helpful and harmful family/friend involvement can drive short-term effects. TRIAL REGISTRATION NUMBER NCT02481596.
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Affiliation(s)
- Lindsay S Mayberry
- Department of Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN 37203, USA.,Vanderbilt Center for Diabetes Translation Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Cynthia A Berg
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Robert A Greevy
- Vanderbilt Center for Diabetes Translation Research, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Biostatistics, Vanderbilt University, Nashville, TN, USA
| | - Lyndsay A Nelson
- Department of Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN 37203, USA.,Vanderbilt Center for Diabetes Translation Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Erin M Bergner
- Department of Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN 37203, USA
| | - Kenneth A Wallston
- Vanderbilt Center for Diabetes Translation Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kryseana J Harper
- Department of Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN 37203, USA
| | - Tom A Elasy
- Department of Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN 37203, USA.,Vanderbilt Center for Diabetes Translation Research, Vanderbilt University Medical Center, Nashville, TN, USA
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14
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Metwally AM, Soliman M, Abdelmohsen AM, Kandeel WA, Saber M, Elmosalami DM, Asem N, Fathy AM. Effect of Counteracting Lifestyle Barriers through Health Education in Egyptian Type 2 Diabetic Patients. Open Access Maced J Med Sci 2019; 7:2886-2894. [PMID: 31844454 PMCID: PMC6901843 DOI: 10.3889/oamjms.2019.624] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Egypt is among the world top 10 countries in diabetes prevalence. It is the first country among the MENA region. Healthy lifestyle education and support help people with diabetes to improve health outcomes. Many physical and psychological barriers can hinder patients from following a healthy lifestyle. AIM This study aimed to examine the effect of lifestyle modification educational sessions in helping Egyptian patients to overcome main barriers of diabetes self-management through improving nutritional behaviours, physical activity, medication compliance, and blood glucose monitoring. METHODS A cohort study included 205 patients with type 2 diabetes. Baseline assessment of patients' lifestyle behaviours and barriers using personal diabetes questionnaire of Louisville University, with both anthropometric and blood glucose assessment. Interventional lifestyle health education was provided weekly through multiple integrated techniques, followed by a post-intervention assessment to evaluate the effect of the health education sessions. Statistical analysis was done to identify any statistically significant difference before and after the health education intervention. RESULTS There was a significant improvement of the post-education mean scores of the studied behaviours when compared with the pre-education scores of the participants' behaviours (p < 0.001). There was also a significant reduction in the barriers facing patients to diabetes self-management including nutritional barriers (P < 0.001), medication compliance barriers (P < 0.001) with a percent change (43%), physical activity barriers (p < 0.001), and blood glucose monitoring (p < 0.001) with a percent change (44%).There was a statistically significant positive correlation between improvement of medication compliance (P = 0.027), blood glucose monitoring(P = 0.045), and glycated haemoglobin of the study participants. CONCLUSION lifestyle modification education of type 2 diabetic patients can overcome the main barriers of following a healthy lifestyle and improve their anthropometric measures and blood glucose level.
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Affiliation(s)
- Ammal Mokhtar Metwally
- Department of Community Medicine Research, Medical Division, National Research Centre, Giza, Egypt
| | - Mona Soliman
- Department of Public Health & Community Medicine, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Aida M. Abdelmohsen
- Department of Community Medicine Research, Medical Division, National Research Centre, Giza, Egypt
| | - Wafaa A. Kandeel
- Biological Anthropology Department, Medical Division, National Research Centre, Giza, Egypt
- Theodor Bilharz Research Institute, Giza, Egypt
| | - Maha Saber
- Department of Complementary Medicine Research, Medical Division, National Research Centre, Giza, Egypt
- Medical Research Centre of Excellence (MRCE), Giza, Egypt
| | - Dalia Mohamed Elmosalami
- Department of Community Medicine Research, Medical Division, National Research Centre, Giza, Egypt
| | - Noha Asem
- Department of Public Health & Community Medicine, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Asmaa Mohamed Fathy
- Department of Community Medicine Research, Medical Division, National Research Centre, Giza, Egypt
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15
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Nelson LA, Ackerman MT, Greevy RA, Wallston KA, Mayberry LS. Beyond Race Disparities: Accounting for Socioeconomic Status in Diabetes Self-Care. Am J Prev Med 2019; 57:111-116. [PMID: 31130463 PMCID: PMC6589128 DOI: 10.1016/j.amepre.2019.02.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 02/11/2019] [Accepted: 02/12/2019] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Among patients with type 2 diabetes, racial disparities are prevalent across a variety of outcomes; however, inconsistent disparities in determinants of outcomes warrants exploring the impact of other, related factors. This study sought to examine whether disparities in health literacy, numeracy, self-care behaviors, and HbA1c persisted between non-Hispanic blacks and non-Hispanic whites after applying a robust adjustment for socioeconomic status (SES). METHODS From 2016 to 2018, adult patients with type 2 diabetes (N=444) were recruited from primary care clinics. Participants self-reported demographics; indicators of SES (i.e., income, education, health insurance, housing status, and financial strain); subjective health literacy and numeracy; and self-care behaviors. Participants also completed an HbA1c test. In 2018, differences were examined between non-Hispanic blacks and non-Hispanic whites in health literacy, numeracy, self-care, and HbA1c, first unadjusted and then adjusted using propensity score weighting. RESULTS In unadjusted analyses, compared with non-Hispanic whites, non-Hispanic blacks had lower health literacy (p=0.039) and numeracy (p<0.001); less medication adherence (p=0.009); use of information for dietary decisions (p=0.013); and problem eating behaviors (p<0.001; i.e., non-Hispanic blacks reported fewer problems); and higher HbA1c levels (p=0.005). After adjusting for all SES indicators, only the reverse disparity in problem eating behaviors (p=0.016) and the disparity in HbA1c (p=0.011) remained. CONCLUSIONS Findings highlight the importance of considering SES when examining disparities in health-related skills and behaviors. Moving beyond education and income to inclusion of more comprehensive markers of SES can improve understanding of how SES may contribute to disparities and the ability to appropriately target factors leading to inequality.
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Affiliation(s)
- Lyndsay A Nelson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michael T Ackerman
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert A Greevy
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kenneth A Wallston
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee; Center for Diabetes Translation Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lindsay S Mayberry
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, Tennessee; Center for Diabetes Translation Research, Vanderbilt University Medical Center, Nashville, Tennessee.
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16
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Mayberry LS, Berg CA, Greevy RA, Wallston KA. Assessing helpful and harmful family and friend involvement in adults' type 2 diabetes self-management. PATIENT EDUCATION AND COUNSELING 2019; 102:1380-1388. [PMID: 30922622 PMCID: PMC6546510 DOI: 10.1016/j.pec.2019.02.027] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 02/21/2019] [Accepted: 02/28/2019] [Indexed: 05/24/2023]
Abstract
OBJECTIVE Develop and evaluate a measure assessing helpful and harmful family/friends' involvement in adults' type 2 diabetes (T2D) self-management. METHODS Prior mixed-methods research, cognitive interviews, and expert input informed measure development. We administered the measure in two studies (N = 392 and N = 512) to evaluate its factor structure, internal consistency reliability, test-retest reliability, and construct, criterion and predictive validity. RESULTS Analyses supported a two-factor solution: helpful and harmful involvement with internal consistency reliability α = .86 and .72, respectively. Three-month test-retest reliability was rho = 0.64 for helpful and rho = 0.61 for harmful (both p < 0.001). Over 90% reported at least one instance of family/friend involvement in the past month. Associations with other measures of diabetes involvement were as anticipated (all p < .01). Helpful and harmful involvement were independently associated with diabetes self-efficacy, diet, blood glucose testing and medication adherence cross-sectionally [βs 0.13-0.39 helpful, -0.12--0.33 harmful; all p < .05]. Harmful involvement independently predicted worse HbA1c (β = 0.08), and worsening HbA1c over three months (β = 0.12, both p < 0.05). CONCLUSION The Family and Friend Involvement in Adults' Diabetes (FIAD) is a reliable and valid measure assessing family/friend involvement in adults' T2D. PRACTICE IMPLICATIONS FIAD use can inform interventions to improve social contexts in which adults manage diabetes.
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Affiliation(s)
- Lindsay S Mayberry
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Diabetes Translation Research, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Cynthia A Berg
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Robert A Greevy
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kenneth A Wallston
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA; School of Nursing, Vanderbilt University, Nashville, TN, USA
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