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Hu L, Shi Y, Wylie-Rosett J, Sevick MA, Xu X, Lieu R, Wang C, Li H, Bao H, Jiang Y, Zhu Z, Yeh MC, Islam N. Feasibility of a family-oriented mHealth intervention for Chinese Americans with type 2 diabetes: A pilot randomized control trial. PLoS One 2024; 19:e0299799. [PMID: 38466714 PMCID: PMC10927140 DOI: 10.1371/journal.pone.0299799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 01/30/2024] [Indexed: 03/13/2024] Open
Abstract
OBJECTIVES To test the feasibility, acceptability, and potential efficacy of a mHealth intervention tailored for Chinese immigrant families with type 2 diabetes (T2D). METHODS We conducted a pilot randomized controlled trial (RCT) with baseline, 3-, and 6-month measurements. Participating dyads, T2D patients and families/friends from NYC, were randomized into the intervention group (n = 11) or the wait-list control group (n = 12). Intervention includes 24 videos covering T2D self-management, behavioral techniques, and family-oriented sessions. Feasibility and acceptability were measured respectively by the retention rate and video watch rate, and a satisfaction survey. Patients' HbA1c, weight, and self-management were also assessed to test potential efficacy. RESULTS Most T2D patients (n = 23; mean age 56.2±9.4 years; 52.2% male) and families/friends (n = 23, mean age 54.6±11.2 years; 52.2% female) had high school education or less (69.6% and 69.6%), annual household income < $25,000 (65.2% and 52.2%), and limited English proficiency (95.7% and 95.7%). The retention rates were not significantly different between the intervention and the control groups for both the patients (90.91% vs 83.3%, p = 0.589); and their families/friends (3-month: 90.9% vs 75%, p = 0.313; 6-month: 90.9% vs 83.3%, p = 0.589). The mean video watch rate was 76.8% (7%). T2D patients and families/friends rated satisfaction as 9.4 and 10 out of 10, respectively. Despite no between-group differences, the intervention group had significantly lower HbA1c (p = 0.014) and better self-management (p = 0.009), and lost 12 lbs. on average at 6 months (p = 0.079), compared to their baseline levels. CONCLUSIONS A culturally-tailored, family-based mHealth intervention is feasible and acceptable among low-income, limited English-proficient Chinese families with T2D in NYC. Significant changes in HbA1c and self-management within the intervention group indicate this intervention may have potential efficacy. Given the small sample size of this study, a future RCT with adequate power is needed to test efficacy.
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Affiliation(s)
- Lu Hu
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, NYU Langone Health, New York, NY, United States of America
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - Yun Shi
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, NYU Langone Health, New York, NY, United States of America
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - Judith Wylie-Rosett
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, New York, NY, United States of America
- Department of Medicine, Albert Einstein College of Medicine, New York, NY, United States of America
| | - Mary Ann Sevick
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, NYU Langone Health, New York, NY, United States of America
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
- Department of Medicine, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - Xinyi Xu
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, NYU Langone Health, New York, NY, United States of America
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - Ricki Lieu
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, NYU Langone Health, New York, NY, United States of America
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - Chan Wang
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - Huilin Li
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - Han Bao
- Jacobi Medical Center, New York, NY, United States of America
| | - Yulin Jiang
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, NYU Langone Health, New York, NY, United States of America
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - Ziqiang Zhu
- Wellsure Medical Practice, New York, NY, United States of America
| | - Ming-Chin Yeh
- School of Urban Public Health, Hunter College, City University of New York, New York, NY, United States of America
| | - Nadia Islam
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
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Wan CS, Nankervis A, Teede H, Aroni R. Priorities to improve woman-centred gestational diabetes mellitus care: A qualitative study to compare views between clinical and consumer end-users. J Hum Nutr Diet 2023; 36:1636-1648. [PMID: 37282816 DOI: 10.1111/jhn.13191] [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: 04/18/2023] [Accepted: 05/22/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Immigrants worldwide have a two-fold higher risk of gestational diabetes mellitus (GDM) than women of the host country. Providing culturally appropriate woman-centred GDM care to attenuate adverse maternal and neonatal health outcomes is a persistent challenge for health services. Underpinned by the Knowledge to Action Framework, understanding and comparing the views of patients from different ethnic backgrounds and healthcare professionals (HCPs) about current and optimal GDM care can highlight priority areas to improve woman-centred care. This qualitative study aimed to compare the views of ethnic Chinese and Australian-born Caucasian women and their HCPs, including endocrinologists, obstetricians, midwives, diabetes nurse educators and dietitians, about what constitutes optimal GDM care and how to improve woman-centred GDM care. METHODS Purposive sampling was used to recruit 42 Chinese and 30 Caucasian women with GDM and 17 HCPs from two large Australian hospital maternity services to complete in-depth, semi-structured interviews. Patients' and HCPs' views were thematically analysed and compared. RESULTS Four out of nine themes showed misalignments between patients' and HCPs' views on GDM care, reflecting priority areas to improve woman-centred care by (i) reaching agreement on the attitudes towards different treatment targets between HCPs; (ii) enhancing inter-professional communication; (iii) improving GDM care transition to postpartum care; and (iv) providing detailed dietary advice tailored to Chinese patients' cultural diet. CONCLUSIONS Further research on reaching consensus on treatment targets, enhancing inter-professional communication, developing a perinatal care transition model from pregnancy to postpartum, and developing Chinese patient-oriented educational resources is required to improve woman-centred care.
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Affiliation(s)
- Ching Shan Wan
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Melbourne, VIC, Australia
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Clayton, VIC, Australia
| | - Alison Nankervis
- Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
- Departments of Diabetes and Endocrinology, The Royal Melbourne and Royal Women's Hospitals, Parkville, VIC, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Clayton, VIC, Australia
- Department of Endocrinology and Diabetes, Monash Health, Clayton, Victoria, Australia
| | - Rosalie Aroni
- Medical School, College of Health and Medicine, Canberra, ACT, Australia
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Huang LC, Lin CL, Chang YT, Chen RY, Bai CH. Gender Impact on Diabetes Distress Focus at Medical Communication Concerns, Life and Interpersonal Stress. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15678. [PMID: 36497755 PMCID: PMC9737495 DOI: 10.3390/ijerph192315678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION along with the rapidly aging population in many countries around the world, the global prevalence of diabetes and suffering from diabetes-related depression have risen in middle-aged and elderly adults. However, given that psychological stress is deeply influenced by culture, gender inequality in these statistics is often exhibited and increases with age. The aim of this study was to explore the gender difference in diabetes distress among middle-aged and elderly diabetic patients. METHODS 395 participants from four hospitals were recruited for a cross-sectional survey. The Taiwan Diabetes Distress Scale (TDDS) was used to measure diabetes distress. Linear regression was conducted to assess the gender difference in different types of diabetes distress. RESULTS there was significant gender difference in each diabetes distress domain. In particular, men who had received diabetes education in the past six months seemed to be more concerned about diabetes complications and felt pressured to communicate with doctors. In addition, women seemed to be more affected by diabetes distress because of their marital status, especially for married women. CONCLUSIONS diabetes distress seems to have significant gender differences; however, more longitudinal research is needed on the causal relationship between gender and diabetes distress.
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Affiliation(s)
- Li-Chi Huang
- Endocrinology & Metabolism, Cathay General Hospital, Taipei 106438, Taiwan
- School of Public Health, Taipei Medical University, Taipei 110301, Taiwan
| | - Ching-Ling Lin
- Endocrinology & Metabolism, Cathay General Hospital, Taipei 106438, Taiwan
- School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
- School of Medicine, National Tsing Hua University, Hsinchu 300044, Taiwan
| | - Yao-Tsung Chang
- School of Public Health, Taipei Medical University, Taipei 110301, Taiwan
| | - Ruey-Yu Chen
- School of Public Health, Taipei Medical University, Taipei 110301, Taiwan
| | - Chyi-Huey Bai
- School of Public Health, Taipei Medical University, Taipei 110301, Taiwan
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Huang YC, Zuñiga J, García A. Illness perceptions as a mediator between emotional distress and management self-efficacy among Chinese Americans with type 2 diabetes. ETHNICITY & HEALTH 2022; 27:672-686. [PMID: 32894684 DOI: 10.1080/13557858.2020.1817339] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 08/23/2020] [Indexed: 06/11/2023]
Abstract
Objectives: Emotional distress and illness perceptions have been linked to patients' self-efficacy for diabetes management. This study, guided by Leventhal's Self-Regulatory Model, explores the direct effects of emotional distress (diabetes distress and depressive symptoms) on diabetes management self-efficacy, and the indirect effects through illness perceptions among Chinese Americans with type 2 diabetes (T2DM).Design: Data were obtained from a cross-sectional study of Chinese Americans with T2DM recruited from health fairs and other community settings (N = 155, 47.1% male, mean age 69.07 years). Data analyses including descriptive statistics, correlation, and PROCESS mediation models were used to examine the mediation effects of illness perceptions.Results: Diabetes distress and depressive symptoms had direct negative effects on self-efficacy. Perceived treatment control mediated the association between diabetes distress and self-efficacy, while none of the illness perceptions dimensions impacted the relationship between depressive symptoms and self-efficacy.Conclusion: Improved perceptions of treatment control can ameliorate diabetes distress and improve diabetes management self-efficacy among Chinese Americans. Health providers should elicit patients' illness perceptions as a first step in evaluating their diabetes management self-efficacy and provide appropriate culturally-tailored interventions.
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Affiliation(s)
- Ya-Ching Huang
- Texas State University, St. David's School of Nursing, Round Rock, TX, USA
| | - Julie Zuñiga
- The University of Texas at Austin, School of Nursing
| | - Alexandra García
- The University of Texas at Austin, School of Nursing and Dell Medical School
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5
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Petrovic D, Marcus K, Sandoval J, Cullati S, Piumatti G, Bodenmann P, Jackson YL, Durosier Izart C, Wolff H, Guessous I, Stringhini S. Health-related biological and non-biological consequences of forgoing healthcare for economic reasons. Prev Med Rep 2021; 24:101602. [PMID: 34976659 PMCID: PMC8683898 DOI: 10.1016/j.pmedr.2021.101602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 10/07/2021] [Accepted: 10/17/2021] [Indexed: 12/14/2022] Open
Abstract
Forgoing healthcare for economic reasons has been previously associated with adverse health outcomes, including a higher risk of hospitalization, a lower quality of life, and worse self-reported health. However, the exact cause-to-effect relation between forgoing healthcare and health-related outcomes has been insufficiently described. Here, we investigate the prospective health consequences of forgoing healthcare for economic reasons using data from “ReBus” (N = 400), a prospective study examining the health consequences of forgoing healthcare (Baseline: 2008–2013, Follow-up: 2014–2016). Using regression models, we explored the baseline determinants of forgoing healthcare, including socioeconomic, demographic, and pre-existing health-risk factors, and examined the associations between forgoing healthcare at baseline and health deterioration at follow-up, using highly pertinent biomarkers (glucose, glycated hemoglobin, lipids, blood pressure) and SF-36 questionnaire data. Low income, low occupation, low education, and smoking were associated with higher odds of forgoing healthcare at baseline. Forgoing healthcare for economic reasons at baseline was subsequently related to detrimental changes in glucose, high-density lipoprotein cholesterol (HDL), and blood pressure (BP) at follow-up, independently of baseline socioeconomic factors (Glucose-β = 0.19, 95%CI[0.03;0.34], HDL-β = -0.07, 95%CI[-0.14;0.01], BP-β = 3.30, 95%CI[-0.01;6.60]). Moreover, we found strong associations between forgoing healthcare and adverse SF-36 health scores at follow-up, with individuals forgoing healthcare systematically displaying worse health scores (6%–11% lower scores). For the first time, we show that forgoing healthcare for economic reasons predicts adverse health-related consequences 2–8 years later. Our findings shall further encourage the implementation of public health measures aimed at identifying individuals who forgo healthcare and preventing the adverse health consequences of unmet medical needs.
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Affiliation(s)
- Dusan Petrovic
- Department and Division of Primary Care Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland.,Department of Epidemiology and Health Systems (DESS), University Center for General Medicine and Public Health (UNISANTE), Lausanne, Switzerland.,Centre for Environment and Health, School of Public Health, Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Kailing Marcus
- Department and Division of Primary Care Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - José Sandoval
- Department of Oncology, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Stéphane Cullati
- Population Health Laboratory (#PopHealthLab), Faculty of Science and Medicine, University of Fribourg, Switzerland.,Quality of Care Service, Department of Readaptation and Geriatrics, Faculty of Medicine, University of Geneva, Switzerland
| | | | - Patrick Bodenmann
- Department of Vulnerabilities and Social Medicine, University Center for General Medicine and Public Health (UNISANTE), Lausanne, Switzerland.,Faculty of Biology and Medicine, Deanship, University of Lausanne, Lausanne, Switzerland
| | - Yves-Laurent Jackson
- Department and Division of Primary Care Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Claire Durosier Izart
- Department and Division of Primary Care Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Hans Wolff
- Department and Division of Primary Care Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Idris Guessous
- Department and Division of Primary Care Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Silvia Stringhini
- Department and Division of Primary Care Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland.,Department of Epidemiology and Health Systems (DESS), University Center for General Medicine and Public Health (UNISANTE), Lausanne, Switzerland
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Huang YC, Zuñiga J, Hua Y, García A. Emotional Distress and Self-Rated Health Among Middle-Aged and Older Chinese Americans with Type 2 Diabetes. J Immigr Minor Health 2020; 23:487-493. [DOI: 10.1007/s10903-020-01062-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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7
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Xia A, Yau KW, Tang TS. When qualitative data contradict quantitative data: diabetes distress in the Chinese-Canadian community. Diabet Med 2020; 37:963-970. [PMID: 31498471 DOI: 10.1111/dme.14129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2019] [Indexed: 12/13/2022]
Abstract
AIMS To use both quantitative and qualitative approaches to characterize the diabetes distress profile of Chinese-Canadians with Type 2 diabetes and to better understand their experience of living with diabetes. METHODS We recruited 40 Chinese-Canadian adults with Type 2 diabetes who completed a Mandarin- or Cantonese-language diabetes education programme in Richmond, British Columbia. Using a mixed-methods sequential explanatory research design, participants first completed a 15-item Chinese version of the Diabetes Distress Scale, which included three subscales: emotional burden, regimen-related distress, and physician distress. The self-report survey was followed by a semi-structured interview that addressed the following diabetes-related topics: perspectives towards the healthcare team, emotional health, diabetes-related concerns and stressors, diabetes diagnosis experience, and sources of social support and diabetes education. RESULTS The mean (sd) scores for total distress 1.5 (0.5), emotional burden 1.7 (0.7), regimen-related distress 1.4 (0.5), and physician distress 1.4 (0.9), fell within the 'low distress' range (< 2.0). Qualitative analysis of semi-structured interviews showed that some participants were dissatisfied with diabetes care providers and experienced emotional challenges, particularly early in their diagnosis. Other themes that emerged included eating distress, fear of complications, language barriers, and medication concerns. CONCLUSIONS Not only did the qualitative findings from semi-structured interviews capture aspects of diabetes distress that were not included in the quantitative survey, it also uncovered inconsistencies between the two datasets. To more accurately understand the diabetes distress experience of any ethnic community, both quantitative and qualitative approaches contribute unique value.
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Affiliation(s)
- A Xia
- School of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - K W Yau
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - T S Tang
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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Beverly EA, Ritholz MD, Cook K, Johnson LK, Ruhil A, Singh RP, Berryman DE. Diabetes in Appalachia: providers' perspectives. Prim Health Care Res Dev 2020; 21:e11. [PMID: 32404218 PMCID: PMC7232122 DOI: 10.1017/s1463423620000134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/13/2020] [Accepted: 03/02/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Southeastern Appalachian Ohio has more than double the national average of diabetes and a critical shortage of healthcare providers. Paradoxically, there is limited research focused on primary care providers' experiences treating people with diabetes in this region. This study explored providers' perceived barriers to and facilitators for treating patients with diabetes in southeastern Appalachian Ohio. METHODS We conducted in-depth interviews with healthcare providers who treat people with diabetes in rural southeastern Ohio. Interviews were transcribed, coded, and analyzed via content and thematic analyses using NVivo 12 software (QSR International, Chadstone, VIC, Australia). RESULTS Qualitative analysis revealed four themes: (1) patients' diabetes fatalism and helplessness: providers recounted story after story of patients believing that their diabetes was inevitable and that they were helpless to prevent or delay diabetes complications. (2) Comorbid psychosocial issues: providers described high rates of depression, anxiety, incest, abuse, and post-traumatic stress disorder among people with diabetes in this region. (3) Inter-connected social determinants interfering with diabetes care: providers identified major barriers including lack of access to providers, lack of access to transportation, food insecurity, housing insecurity, and financial insecurity. (4) Providers' cultural understanding and recommendations: providers emphasized the importance of understanding of the values central to Appalachian culture and gave culturally attuned clinical suggestions for how to use these values when working with this population. CONCLUSIONS Evidence-based interventions tailored to Appalachian culture and training designed to increase the cultural competency and cultural humility of primary care providers may be effective approaches to reduce barriers to diabetes care in Appalachian Ohio.
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Affiliation(s)
- Elizabeth A. Beverly
- Department of Family Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH45701, USA
- The Diabetes Institute, Ohio University, Athens, OH45701, USA
| | - Marilyn D. Ritholz
- Department of Behavioral Health, Joslin Diabetes Center, Boston, MA02215, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA02215, USA
| | - Karie Cook
- The Diabetes Institute, Ohio University, Athens, OH45701, USA
| | - Lesli K. Johnson
- Voinovich School of Leadership and Public Affairs, Ohio University, Athens, OH45701, USA
| | - Anirudh Ruhil
- Voinovich School of Leadership and Public Affairs, Ohio University, Athens, OH45701, USA
| | - Rashmi P. Singh
- Department of Family Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH45701, USA
| | - Darlene E. Berryman
- The Diabetes Institute, Ohio University, Athens, OH45701, USA
- Department of Biomedical Sciences, Ohio University Heritage College of Osteopathic Medicine, Athens, OH45701, USA
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Huang YC, Garcia AA. Culturally-tailored interventions for chronic disease self-management among Chinese Americans: a systematic review. ETHNICITY & HEALTH 2020; 25:465-484. [PMID: 29385815 DOI: 10.1080/13557858.2018.1432752] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 12/21/2017] [Indexed: 06/07/2023]
Abstract
Objectives: Literature review evaluating the effectiveness and cultural surface and deep structures of interventions designed to improve Chinese Americans' chronic disease self-management.Method: PubMed, PsycINFO, CINAHL, and Health Source databases were searched for research conducted from 1990 to 2016 on self-management interventions for Chinese Americans with chronic disease.Results: Ten articles comprised eight interventions, which each addressed a dimension of cultural surface structure, all providing linguistically appropriate messages delivered via bilingual staff. Five interventions also addressed cultural deep structure dimensions by providing culturally congruent counsellors or educators, or incorporating Chinese cultural values and social customs. Six interventions resulted in significant improvements in major outcome variables. Participants also reported high satisfaction and retention rates were high.Conclusion: Culturally-tailored interventions that incorporate surface and deep structural elements of culture are sensitive and generally effective for Chinese Americans to improve access to health care, disease awareness, social environment, and participants' ability to practice self-management skills.
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Affiliation(s)
- Ya-Ching Huang
- The School of Nursing, The University of Texas at Austin, Austin, TX, USA
| | - Alexandra A Garcia
- Dell Medical School, The School of Nursing, The University of Texas at Austin, Austin, TX, USA
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10
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Kuo HJ, Huang YC, García AA. Fatigue, Pain, Sleep Difficulties, and Depressive Symptoms in Mexican Americans and Chinese Americans with Type 2 Diabetes. J Immigr Minor Health 2020; 22:895-902. [DOI: 10.1007/s10903-020-01001-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Tran L, Tran P, Tran L. A cross-sectional analysis of racial disparities in US diabetes screening at the national, regional, and state level. J Diabetes Complications 2020; 34:107478. [PMID: 31706806 DOI: 10.1016/j.jdiacomp.2019.107478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 11/02/2019] [Accepted: 11/03/2019] [Indexed: 10/25/2022]
Abstract
AIMS To determine US diabetes screening estimates in Whites, Blacks, Hispanics, Asians, Native Hawaiians/Pacific Islanders, American Indians/Alaska Natives, and Others at the national, regional, and state level. METHODS In this study of 2011, 2013, 2015, and 2017 Behavioral Risk Factor Surveillance System data, we used logistic regression results to generate national, regional, and state screening marginal probabilities (average adjusted predictions (AAPs)) for each race in the two American Diabetes Association recommended screening groups1: asymptomatic overweight/obese people <45y with ≥1 diabetes risk factor and2 people ≥45y. RESULTS Even after adjusting for sociodemographic and clinical factors, significant racial disparities in screening (p-value<.05) persist at all three geographic levels. Asians had the worst national, regional, and state level AAPs of all the races. Across all races, the Northeast had the highest regional screening levels (regional AAP: 48.4-78.58%) while the West had the lowest (regional AAP: 41.98-75.18%). CONCLUSIONS Study findings indicate that sociodemographic and clinical factors do not fully explain racial disparities in diabetes screening. Further research on clinician and patient attitudes towards diabetes screening are warranted in order to design and implement initiatives in US areas where certain racial groups have particularly low diabetes screening levels.
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Affiliation(s)
- Lam Tran
- Department of Biostatistics, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, United States of America.
| | - Phoebe Tran
- Department of Chronic Disease Epidemiology, Yale University, 60 College Street, New Haven, CT 06510, United States of America.
| | - Liem Tran
- Department of Geography, University of Tennessee, 1000 Phillip Fulmer Way, Knoxville, TN 37916, United States of America.
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Peyrot M, Egede L, Funnell M, Hsu W, Ruggiero L, Stuckey H. US Ethnic Group Differences in Family Member Support for People With Diabetes in the 2nd Diabetes Attitudes, Wishes and Needs (DAWN2) Study. DIABETES EDUCATOR 2018; 44:249-259. [PMID: 29787698 PMCID: PMC5967008 DOI: 10.1177/0145721718770767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Purpose The purpose of the study was to describe the perceptions of family members (FM) and people with diabetes (PWD) regarding the frequency and helpfulness of FM support for PWD, including differences among US ethnic groups. Methods The US 2nd Diabetes Attitudes, Wishes and Needs (DAWN2) substudy was a survey of independent samples of 238 adult FM and 540 adult PWD. Outcome measures included ratings by FM and PWD of the frequency and perceived helpfulness of 7 FM support behaviors and composite scores for frequency and helpfulness. Results Ratings of individual FM support behaviors were strongly correlated between FM and PWD but significantly different among behaviors. FM and PWD reported most frequent support for listening, assisting, and doing activities with PWD and reporting PWD was doing poorly least frequently. Both groups reported listening, assisting, and reporting PWD was doing well as most helpful; reporting PWD was doing poorly was least helpful. PWD rated support and helpfulness of most behaviors lower than FM. Composite measures of support frequency and helpfulness were strongly correlated for both FM and PWD. Ethnic minority PWD and FM reported most support behaviors as more frequent and more helpful than non-Hispanic white Americans. Conclusions FM more frequently engage in the support behaviors they view as most helpful, but PWD perceive support to be less frequent and less helpful than FM. FM support differs across ethnic groups, with ethnic minorities reporting higher support frequency and helpfulness. Diabetes care providers should consider ethnic group differences in FM support for PWD.
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Affiliation(s)
- Mark Peyrot
- Loyola University Maryland, Baltimore, Maryland
| | - Leonard Egede
- Medical College of Wisconsin, Division of General Internal Medicine, Milwaukee, Wisconsin
| | - Martha Funnell
- University of Michigan Medical School, Ann Arbor, Michigan
| | - William Hsu
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
| | - Laurie Ruggiero
- School of Public Health, University of Illinois at Chicago, Chicago, Illinois.,University of Delaware, School of Nursing, Newark, Delaware
| | - Heather Stuckey
- Penn State University, Department of Medicine, Hershey, Pennsylvania
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Wah YYE, McGill M, Wong J, Ross GP, Harding AJ, Krass I. Self-management of gestational diabetes among Chinese migrants: A qualitative study. Women Birth 2018; 32:e17-e23. [PMID: 29693546 DOI: 10.1016/j.wombi.2018.03.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 10/29/2017] [Accepted: 03/05/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Gestational diabetes mellitus is one of the most common complications of pregnancy. Women with Gestational diabetes are at increased risk of serious health outcomes, such as pre-eclampsia, obstructed labor, and the development of Type 2 diabetes later in life. Chinese migrants, the third largest cultural group in Australia, are more likely to develop Gestational diabetes than Australian-born women. However, to date, Gestational diabetes self-management has not been investigated in this population. AIM To explore the understanding and self-management experiences of Gestational diabetes among Chinese migrants. METHODS Data were collected through individual semi-structured face-to-face interviews. Participants were recruited from the antenatal clinic at the Royal Prince Alfred Hospital. Interviews were audio-recorded, transcribed verbatim and thematically analyzed. FINDINGS Although the majority of participants demonstrated a good understanding of Gestational diabetes, some did not understand the principles behind healthcare advice and faced challenges in self-management. Confusion about self-monitoring of blood glucose and fear of insulin were also evident. Participants relied on both formal and informal sources of information. Some had difficulty obtaining adequate support. Cultural influences on self-management included meeting family needs, Chinese diet and use of Chinese medicines. CONCLUSION To assist Chinese women with Gestational diabetes to better self-manage their condition, there is a need for clinicians to: (1) provide more effective diabetes education to ensure clear understanding of self-management principles; (2) actively elicit and respond to women's confusion and concerns; (3) provide women with adequate practical support; and (4) develop greater cultural awareness.
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Affiliation(s)
- Yat Yin Eric Wah
- Faculty of Pharmacy, The University of Sydney, Sydney, Australia.
| | - Margaret McGill
- Discipline of Medicine, The University of Sydney, Sydney, Australia; Royal Prince Alfred Hospital, Diabetes Centre, Sydney, Australia
| | - Jencia Wong
- Discipline of Medicine, The University of Sydney, Sydney, Australia; Royal Prince Alfred Hospital, Diabetes Centre, Sydney, Australia
| | - Glynis P Ross
- Discipline of Medicine, The University of Sydney, Sydney, Australia; Royal Prince Alfred Hospital, Diabetes Centre, Sydney, Australia
| | | | - Ines Krass
- Faculty of Pharmacy, The University of Sydney, Sydney, Australia
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Pan W, Ge S, Xu Y, Toobert D. Cross-Validating a Structural Model of Factors Influencing Diabetes Self-Management in Chinese Americans with Type 2 Diabetes. J Transcult Nurs 2018; 30:163-172. [DOI: 10.1177/1043659618790085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Introduction: The purpose of this study was to cross-validate a structural model depicting the effects of individual and environmental factors on diabetes self-management in Chinese Americans with type 2 diabetes. Methodology: A cross-sectional survey was administered to a convenience sample of 209 Chinese Americans with type 2 diabetes in the Midwest of the United States. Structural equation modeling was used to cross-validate the model fit. Results: Provider–patient communication indirectly influenced self-management via belief in treatment. Knowledge indirectly influenced self-management via belief in treatment and self-efficacy. Social support indirectly influenced self-management via belief in treatment and knowledge. Discussion: This study demonstrated that the structural model, previously tested with Chinese diabetes patients in China, also fits Chinese Americans in the United States with few modifications. The cross-validated model provides a theoretical basis for developing culturally relevant diabetes self-management interventions for Chinese Americans, which may lead to health improvements in this ethnic population.
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Affiliation(s)
- Wei Pan
- Duke University, Durham, NC, USA
| | | | - Yin Xu
- Innovative Spine and Orthopedic Clinic, San Antonio, TX, USA
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15
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Clari M, Matarese M, Ivziku D, De Marinis MG. Self-Care of People with Chronic Obstructive Pulmonary Disease: A Meta-Synthesis. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2017; 10:407-427. [DOI: 10.1007/s40271-017-0218-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Eh K, McGill M, Wong J, Krass I. Cultural issues and other factors that affect self-management of Type 2 Diabetes Mellitus (T2D) by Chinese immigrants in Australia. Diabetes Res Clin Pract 2016; 119:97-105. [PMID: 27497145 DOI: 10.1016/j.diabres.2016.07.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 06/22/2016] [Accepted: 07/16/2016] [Indexed: 12/01/2022]
Abstract
AIMS To investigate the influence of cultural and other factors on diabetes self-management behaviors among Australian Chinese immigrants with T2D. METHODS A cross-sectional survey was conducted between June and October 2015. The questionnaire comprised several validated scales examining aspects of self-management practice including medication adherence, acculturation and demographics. Participants were recruited from the community and Diabetes Center of the Royal Prince Alfred Hospital (RPAH), Sydney, Australia. RESULTS Of the 139 participants, a majority were female, from mainland China, with high school level education and a mean age of 64 (SD±12) years. Participants were found to have poor self-management practices generally but moderate medication adherence. 13.7% of participants reported incorporating TCM into their diabetes treatment and 24% reported a cultural shame surrounding a diabetes diagnosis. Higher levels of acculturation predicted better medication adherence, whereas stronger beliefs in TCM predicted poorer medication adherence. Gender, education level and duration of diabetes were also predictors of diabetes self-management behaviors. CONCLUSIONS This study provided insight into cultural influences on diabetes self-management and medication taking among Chinese immigrants in Australia. Health care providers should take these into account in delivering culturally sensitive care and advice to achieve better health outcomes.
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Affiliation(s)
- Kexin Eh
- Faculty of Pharmacy, The University of Sydney, Camperdown, NSW 2006, Australia.
| | - Margaret McGill
- Central Clinical School, Sydney Medical School, The University of Sydney, NSW 2006, Australia; The Diabetes Centre, Royal Prince Alfred Hospital, Sydney, NSW 2006, Australia.
| | - Jencia Wong
- The Diabetes Centre, Royal Prince Alfred Hospital, Sydney, NSW 2006, Australia; Sydney Medical School, The University of Sydney, NSW 2006, Australia.
| | - Ines Krass
- Faculty of Pharmacy, The University of Sydney, Camperdown, NSW 2006, Australia.
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Park C, Nam S, Whittemore R. Incorporating Cultural Perspectives into Diabetes Self-Management Programs for East Asian Immigrants: A Mixed-Study Review. J Immigr Minor Health 2015; 18:454-67. [DOI: 10.1007/s10903-015-0181-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Peyrot M, Egede LE, Funnell MM, Hsu WC, Ruggiero L, Siminerio LM, Stuckey HL. Ethnic differences in family member diabetes involvement and psychological outcomes: results from the second Diabetes Attitudes, Wishes and Needs (DAWN2) study in the USA. Curr Med Res Opin 2015; 31:1297-307. [PMID: 25907127 DOI: 10.1185/03007995.2015.1043251] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess differences among USA ethnic groups in psychological status of adult family members (FMs) and their involvement with the diabetes of another adult. RESEARCH METHODS Data are from the FM survey of the USA DAWN2 study, including 105 White non-Hispanics, 47 African Americans, 46 Hispanic Americans and 40 Chinese Americans. All FMs lived with and cared for an adult with diabetes. Analysis of covariance controlled for respondent and patient characteristics to assess ethnic group differences (P < 0.05). Multiple regression analyses identified significant (P < 0.05) independent correlates of psychological outcomes. MAIN OUTCOME MEASURES FM psychological outcomes measured include well-being, quality of life (QoL), impact of diabetes on life domains, diabetes distress, and burden. CLINICAL TRIAL REGISTRATION NCT01507116. RESULTS White non-Hispanics reported less diabetes burden and distress, more negative life impact, and lower well-being than FMs from ethnic minority groups. African Americans reported the highest well-being and lowest negative life impact, Chinese Americans reported the most diabetes burden, Hispanic Americans reported the highest distress. There were no ethnic group differences in QoL. Ethnic minority FMs reported having more involvement with diabetes, greater support success, and more access to a diabetes support network than White non-Hispanics. Higher FM diabetes involvement was associated with negative psychological outcomes, while diabetes education, support success and diabetes support network size were associated with better psychological outcomes. Potential limitations are the sample sizes and representativeness. CONCLUSIONS Minority ethnic FMs experienced both advantages and disadvantages in psychological outcomes relative to each other and to White non-Hispanics. Ethnic minority FMs had more involvement in diabetes care, support success and support from others, with the first associated with worse and the latter two with better psychological outcomes. Additional studies are needed with larger samples and broader representation of ethnic groups to better understand these associations and identify areas for intervention.
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Affiliation(s)
- Mark Peyrot
- Loyola University Maryland , Baltimore, MD , USA
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Peyrot M, Egede LE, Campos C, Cannon AJ, Funnell MM, Hsu WC, Ruggiero L, Siminerio LM, Stuckey HL. Ethnic differences in psychological outcomes among people with diabetes: USA results from the second Diabetes Attitudes, Wishes, and Needs (DAWN2) study. Curr Med Res Opin 2014; 30:2241-54. [PMID: 25079662 DOI: 10.1185/03007995.2014.947023] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess differences in psychological outcomes as well as risk and protective factors for these outcomes among several USA ethnic groups and identify correlates of these psychological outcomes among adults with diabetes in the second Diabetes Attitudes, Wishes and Needs (DAWN2 * ) study. RESEARCH DESIGN AND METHODS The core USA DAWN2 sample was supplemented by independent samples of specific ethnic minority groups, yielding a total of 447 White non-Hispanics, 241 African Americans, 194 Hispanics, and 173 Chinese Americans (n = 1055). Multivariate analysis examined ethnic differences in psychological outcomes and risk/protective factors (disease, demographic and socioeconomic factors, health status and healthcare access/utilization, subjective burden of diabetes and social support/burden). Separate analyses were performed on each group to determine whether risk/protective factors differed across ethnic groups. MAIN OUTCOME MEASURES Psychological outcomes include well-being, quality of life, impact of diabetes on life domains, diabetes distress, and diabetes empowerment. CLINICAL TRIAL REGISTRATION NCT01507116. RESULTS Ethnic minorities tended to have better psychological outcomes than White non-Hispanics, although their diabetes distress was higher. Levels of most risk and protective factors differed significantly across ethnic groups; adjustment for these factors reduced ethnic group differences in psychological outcomes. Health status and modifiable diabetes-specific risk/protective factors (healthcare access/utilization, subjective diabetes burden, social support/burden) had strong associations with psychological outcomes, especially diabetes distress and empowerment. Numerous interactions between ethnicity and other correlates of psychological outcomes suggest that ethnic groups are differentially sensitive to various risk/protective factors. Potential limitations are the sample sizes and representativeness. CONCLUSIONS Ethnic groups differ in their psychological outcomes. The risk/protective factors for psychological outcomes differ across ethnic groups and different ethnic groups are more/less sensitive to their influence. These findings can aid the development of strategies to overcome the most prominent and influential psychosocial barriers to optimal diabetes care within each ethnic group.
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Affiliation(s)
- Mark Peyrot
- Loyola University Maryland , Baltimore, MD , USA
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Towards a conceptual model of diabetes self-management among Chinese immigrants in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:6727-42. [PMID: 24978878 PMCID: PMC4113840 DOI: 10.3390/ijerph110706727] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 06/06/2014] [Accepted: 06/06/2014] [Indexed: 11/29/2022]
Abstract
Background: Chinese immigrants have been disproportionally affected by type 2 diabetes. This paper presents the state of science regarding the factors that may influence diabetes self-management among Chinese immigrants in the US and the potential health outcomes. Design: Using Walker and Avant’s techniques, a search of the literature was conducted from CINAHL, PubMed, OVID, and Web of Science. Findings: Factors most relevant to diabetes self-management were grouped under five categories: socio-demographic characteristics, behavioral and psychological characteristics, social support, linguistic barriers, and cultural characteristics. Potential outcomes derived from improved diabetes self-management include quality of life, glycosylated hemoglobin, and blood pressure and other cardiovascular risk factors. Discussion: A conceptual model was provided to guide future research. Based on the review of the literature, specific research topics that need to fill the gaps in the literature were provided, including family-focused interventions for Chinese immigrant patients with diabetes and the effectiveness of these interventions to improve family functioning.
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Chesla CA, Kwan CML, Chun KM, Stryker L. Gender differences in factors related to diabetes management in Chinese American immigrants. West J Nurs Res 2014; 36:1074-90. [PMID: 24558055 DOI: 10.1177/0193945914522718] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Chinese American women with type 2 diabetes (T2DM) are more vulnerable to poor diabetes outcomes than men because immigrant status, ethnicity, and economics intersect with gender to diminish disease management opportunities. We explored gender differences in factors associated with diabetes management at intake and after treatment with a behavioral intervention in first-generation Chinese American immigrants. A sample of 178 Chinese Americans with T2DM was enrolled in a single-cohort, repeated-measures delayed-treatment trial. Data were collected at baseline, 8, 16, 24, and 32 weeks with 6-week treatment provided after 16 weeks. Gender differences at baseline and gender by treatment interactions were noted. Women at baseline reported significantly worse depressive symptoms and general health. Significant gender by treatment interactions were observed for diabetes self-efficacy, bicultural efficacy, family instrumental support, and diabetes quality of life-satisfaction. Only women showed improvement, suggesting women benefited more from the intervention in psychosocial factors related to diabetes management.
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