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Orellano-Colón EM, Fernández-Torres A, Figueroa-Alvira N, Ortiz-Vélez B, Rivera-Rivera NL, Torres-Ferrer GA, Martín-Payo R. Empowering Potential of the My Assistive Technology Guide: Exploring Experiences and User Perspectives. DISABILITIES (BASEL, SWITZERLAND) 2024; 4:303-320. [PMID: 38962656 PMCID: PMC11221796 DOI: 10.3390/disabilities4020020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
The use of assistive technology (AT) devices enhances older adults' function in daily activities. However, the lack of awareness of AT among potential AT users has been identified as a major barrier to its adoption. This study aimed to assess the quality of the Mi Guía de Asistencia Tecnológica (MGAT) web app, which provides information on AT, from the perspective of older Latinos with physical disabilities, and to explore their experience using the MGAT. We employed a convergent parallel mixed-method design involving 12 older Latinos living in Puerto Rico. In Phase I, the researchers trained the participants in the use of the MGAT. In Phase II, participants were encouraged to use it for 30 days. In Phase III, the participants completed the User Mobile Application Rating Scale and individual interviews, analyzed with descriptive statistics and a directed thematic content analysis. The quality of the MGAT was rated high in both the objective (mean = 3.99; SD = 0.7) and subjective (mean = 4.13; SD = 1.1) domains. Qualitative data revealed the MGAT was accessible, usable, desirable, credible, useful, and valuable to increasing older Latinos' AT knowledge, function, and autonomy. The MGAT has the potential to increase AT awareness and adoption among older adults.
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Affiliation(s)
- Elsa M. Orellano-Colón
- Occupational Therapy Program, School of Health Professions, University of Puerto Rico Medical Sciences Campus, P.O. Box 365067, San Juan 00936-5067, Puerto Rico
| | - Angelis Fernández-Torres
- Occupational Therapy Program, School of Health Professions, University of Puerto Rico Medical Sciences Campus, P.O. Box 365067, San Juan 00936-5067, Puerto Rico
| | - Nixmarie Figueroa-Alvira
- Occupational Therapy Program, School of Health Professions, University of Puerto Rico Medical Sciences Campus, P.O. Box 365067, San Juan 00936-5067, Puerto Rico
| | - Bernice Ortiz-Vélez
- Occupational Therapy Program, School of Health Professions, University of Puerto Rico Medical Sciences Campus, P.O. Box 365067, San Juan 00936-5067, Puerto Rico
| | - Nina L. Rivera-Rivera
- Occupational Therapy Program, School of Health Professions, University of Puerto Rico Medical Sciences Campus, P.O. Box 365067, San Juan 00936-5067, Puerto Rico
| | - Gabriela A. Torres-Ferrer
- Occupational Therapy Program, School of Health Professions, University of Puerto Rico Medical Sciences Campus, P.O. Box 365067, San Juan 00936-5067, Puerto Rico
| | - Rubén Martín-Payo
- Faculty of Medicine and Health Sciences, University of Oviedo, Calle de Valentín Andrés Alvarez, 33006 Oviedo, Spain
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Hoog M, Maldonado JM, Wangia-Dixon R, Halpern R, Buysman E, Gremel GW, Huang A, Konig M. Glycemic and Cost Outcomes among Hispanic/Latino People with Type 2 Diabetes in the USA Initiating Dulaglutide versus Basal Insulin: a Real-World Study. Diabetes Ther 2024; 15:855-867. [PMID: 38427164 PMCID: PMC10951167 DOI: 10.1007/s13300-024-01542-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/01/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Optimal glycemic management after diabetes onset remains a challenge in Hispanic/Latino adults with type 2 diabetes (T2D), often resulting in poor health outcomes and higher rates of diabetes-related complications. The aim of this study was to examine and compare demographic and clinical characteristics, glycemic outcomes, health care resource utilization (HCRU), and costs among injection-naïve Hispanic/Latino adults with T2D initiating dulaglutide or basal insulin. METHODS This retrospective, observational study used administrative claims data from the Optum Research Database. Hispanic/Latino adults with T2D were assigned to dulaglutide or basal insulin cohorts on the basis of pharmacy claims and were propensity-score matched on demographic and baseline characteristics. Measures of glycemic management included 12 month follow-up glycated hemoglobin (HbA1c) and change in HbA1c from baseline. Follow-up all-cause and diabetes-related HCRU and costs, including costs per 1% change in HbA1c, were compared between cohorts. RESULTS The final propensity-score matched sample included 2872 patients: 1436 patients in each cohort. Mean (SD) reduction in HbA1c from baseline to 12 month follow-up was greater in the dulaglutide cohort compared with the basal insulin cohort [-1.40% (1.88) versus -0.92% (2.07); p < 0.001]. The dulaglutide cohort had significantly lower proportions of patients with ≥ 1 all-cause and diabetes-related outpatient visits, emergency room visits, and inpatient stays compared with the basal insulin cohort (p < 0.05). The dulaglutide cohort had significantly lower all-cause total costs per 1% HbA1c reduction than the basal insulin cohort ($13,768 versus $19,128; p < 0.001). Diabetes-related costs per 1% reduction were numerically lower for the dulaglutide cohort, but the difference was not statistically significant ($9737 versus $11,403; p = 0.081). CONCLUSIONS Dulaglutide demonstrated better glycemic outcomes and lower all-cause costs per 1% HbA1c reduction among Hispanic/Latino adults compared with those initiating basal insulin. Our real-world findings in the Hispanic/Latino population were consistent with results obtained from the overall population and confirm the glycemic benefits of dulaglutide observed in clinical settings.
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Affiliation(s)
- Meredith Hoog
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA.
| | | | | | | | | | | | | | - Manige Konig
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
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Cruz S, Holland H, Chi DL. Validating a Conceptual Model on Topical Fluoride Hesitancy With Latino Parents. HEALTH EDUCATION & BEHAVIOR 2024:10901981241231500. [PMID: 38372277 DOI: 10.1177/10901981241231500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Fluoride hesitancy is a growing public health challenge and interventions to address it may need to be tailored for minoritized subgroups to address oral health inequities. The goals of this qualitative study were to investigate the extent to which an existing conceptual model on topical fluoride hesitancy is applicable to Latino parents and whether applicability differed between Spanish-speaking Latino (SL) and English-speaking Latino (EL) parents. We conducted semi-structured one-on-one interviews with non-Latino English-speaking parents (N = 50), SL parents (n = 8), and EL parents (n = 8). We coded the transcripts deductively and compared our findings both qualitatively and quantitatively to an existing model on topical fluoride hesitancy comprising 21 categories classified into six domains. We compared frequencies across model domains and categories for Latino versus non-Latino parents as well as for SL versus EL parents. Latino parents were represented across all six domains and 21 categories of the conceptual model. Comparing Latino and non-Latino parents, representation was similar across Domains 1 to 3 (necessity, chemicals, and harm); Latino parents were more highly represented in Domains 4 to 6 (uncertainty, pressure, and choice) compared with non-Latino parents. A larger proportion of EL parents thought a healthy diet was more important than fluoride (Category 1d) and a larger proportion of SL parents felt they did not know enough about fluoride (Category 4a). An existing conceptual model on topical fluoride hesitancy was generally a good fit for SL and EL parents. However, differential representation across model categories suggests that fluoride-related communication and intervention approaches may need to be tailored to Latino parents based on language preference.
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L’Engle K, Trejo E, Landeros A, Zúñiga Sandoval E, Jauregui J, Yang S. Brief peer coaching complements daily digital messages for chronic disease prevention among young adult Latinas. Transl Behav Med 2024; 14:80-88. [PMID: 37339885 PMCID: PMC10849174 DOI: 10.1093/tbm/ibad036] [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] [Indexed: 06/22/2023] Open
Abstract
Young Latinas face multiple health challenges that place them at high risk for chronic diseases. Digital health promotion interventions can offer education and support to activate self-care and preventive behaviors. This pilot study evaluated a brief, theory-informed, culturally tailored intervention, Examen Tu Salud, that provided daily text and multimedia messages and weekly peer coaching via videoconference to improve health behaviors among young adult Latina women. Thirty-four participants who self-identified as Latina, female, and 18-29 years old were recruited from an urban college in Northern California to participate in a brief pilot test of the new intervention. Paired sample T-tests assessed health behavior and health activation changes from baseline to 1 month follow-up. Program participation and satisfaction were analyzed to assess feasibility of the intervention. Among 31 participants (91% completion), there were medium to large improvements in health outcomes. Confidence in preventing and managing one's health (t[30] = 5.18, p < .001, d = 0.93), days of moderate-intensity physical activity (t[30] = 3.50, p < .001, d = 0.63), and fruit (t[30] = 3.32, p = .001, d = 0.60) and vegetable (t[30] = 2.04, p = .025, d = 0.37) consumption in a typical day increased. Intervention satisfaction and engagement with health coaches was high. We found that a brief digital coaching intervention designed for young adult Latinas has the potential to improve health activation and behaviors. More attention is needed to prevent chronic conditions among a growing number of Latinos in the USA.
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Affiliation(s)
- Kelly L’Engle
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
| | - Evelin Trejo
- Department of Hematology Oncology, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, USA
| | - Adam Landeros
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
| | - Erika Zúñiga Sandoval
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
| | - Jazmin Jauregui
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
| | - Susan Yang
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
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Hall K, Barry F, Thompson LR, Ravandi B, Hall JE, Chang TP, Halterman JS, Szilagyi PG, Okelo SO. Feasibility of text message follow-up for pediatric asthma care after an emergency department visit. J Asthma 2024; 61:140-147. [PMID: 37610221 DOI: 10.1080/02770903.2023.2248507] [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: 05/24/2023] [Revised: 08/03/2023] [Accepted: 08/11/2023] [Indexed: 08/24/2023]
Abstract
Background: Many children seen in the Emergency Department (ED) for asthma do not follow-up with their primary care provider. Text messaging via short message service (SMS) is a ubiquitous, but untested means of providing post-ED asthma follow-up care.Objective: To evaluate responses to an asthma assessment survey via SMS following an ED visit and estimate the likelihood of response by sociodemographic and clinical characteristics. Methods: We recruited 173 parents of children 2-17 years-old presenting for ED asthma care to receive a follow-up text (participation rate: 85%). One month later, parents received via SMS a 22-item survey that assessed asthma morbidity. We assessed response rates overall and by various sociodemographic and clinical characteristics, including age, parental education, and indicators of asthma severity.Results: Overall, 55% of parents (n = 95) responded to the SMS survey. In multivariable logistic regression (MLR), parents who graduated high school had a four-fold higher response rate compared to parents with less than a high school degree (OR: 4.05 (1.62, 10.13)). More parents of children with oral steroid use in the prior 12 months responded to survey items (OR: 2.53 (1.2, 5.31)). Reported asthma characteristics included: 48% uncontrolled, 22% unimproved/worse, 21% with sleep disruption, and 10% who were hospitalized for asthma.Conclusions: Text messaging may be a viable strategy to improve post-ED asthma assessment and to identify children with persistent symptoms in need of enhanced care or modification of care plans.
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Affiliation(s)
- Kaitlin Hall
- Department of Pediatrics, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Frances Barry
- Frances Barry Psychotherapy Practice, Santa Monica, CA, USA
| | - Lindsey R Thompson
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Bahareh Ravandi
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern CA, Los Angeles, CA, USA
| | - Jeanine E Hall
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern CA, Los Angeles, CA, USA
| | - Todd P Chang
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern CA, Los Angeles, CA, USA
| | - Jill S Halterman
- Department of Pediatrics, University of Rochester School of Medicine, Rochester, NY, USA
| | - Peter G Szilagyi
- Department of Pediatrics, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Sande O Okelo
- Department of Pediatrics, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
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Smith C, Cristello Sarteau A, Qu X, Noe V, Young LA, Hassmiller Lich K, Kahkoska AR. A conceptual model of the continuous glucose monitoring integration process for older adults with diabetes developed using participatory systems science methods. Diabetes Res Clin Pract 2024; 207:111053. [PMID: 38097112 PMCID: PMC10958737 DOI: 10.1016/j.diabres.2023.111053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/21/2023] [Accepted: 12/09/2023] [Indexed: 01/13/2024]
Abstract
AIMS Continuous glucose monitoring (CGM) use remains low in older adults. We aimed to develop a conceptual model of CGM integration among older adults with type 1 and type 2 diabetes. METHODS We previously engaged older adults with type 1 diabetes using participatory system science methods to develop a model of the system of factors that shape CGM integration. To validate and expand the model, we conducted semi-structured interviews with 17 older adults with type 1 and type 2 diabetes and 3 caregivers. Vignettes representing each integration phase were used to elicit outcomes and strategies to support CGM use. Data were analyzed using team-based causal loop diagraming. RESULTS The model includes six phases spanning (1) CGM uptake; (2) device set-up; acquisition of (3) belief in oneself to use CGM effectively; (4) belief that CGM is preferable to blood glucose monitoring; (5) belief in future CGM benefits CGM; and (6) development of a sense of reliance on CGM. Causal loop diagrams visualize factors and feedback loops shaping outcomes at each phase. Participants proposed support strategies spanning clinical, educational, and behavioral interventions. CONCLUSIONS The model underscores the complex transition of learning new technology and provides opportunities for tailored support for older adults.
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Affiliation(s)
- Cambray Smith
- University of North Carolina at Chapel Hill, Department of Health Policy and Management, United States
| | | | - Xiaorui Qu
- University of North Carolina at Chapel Hill, Department of Nutrition, United States
| | - Violet Noe
- University of North Carolina at Chapel Hill, Department of Nutrition, United States
| | - Laura A Young
- University of North Carolina at Chapel Hill, School of Medicine Division of Endocrinology and Metabolism, United States
| | - Kristen Hassmiller Lich
- University of North Carolina at Chapel Hill, Department of Health Policy and Management, United States
| | - Anna R Kahkoska
- University of North Carolina at Chapel Hill, Department of Nutrition, United States; University of North Carolina at Chapel Hill, School of Medicine Division of Endocrinology and Metabolism, United States; Center for Aging and Health, University of North Carolina at Chapel Hill, United States.
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DeCamp LR, Williams L, Palmer C, Gorman C, Olson C, Thompson DA. Mixed methods evaluation of pediatric telehealth equity for patients/families who communicate in languages other than English. Mhealth 2023; 9:24. [PMID: 37492119 PMCID: PMC10364007 DOI: 10.21037/mhealth-22-43] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/15/2023] [Indexed: 07/27/2023] Open
Abstract
Background Emerging research demonstrates telehealth disparities for patients who communicate in languages other than English. A better understanding of pediatric telehealth use with families who communicate in languages other than English is needed to inform interventions to promote telehealth equity. Methods We conducted a mixed methods study of telehealth care in a children's hospital health system using electronic health record data for outpatient video telehealth encounters from April 2020 to July 2021 and qualitative interviews with clinical staff and Spanish-speaking parents of telehealth patients. Results The 16-month study period included 102,387 telehealth encounters; 5% of which were encounters in languages other than English. 83% of languages other than English encounters were with patients/families with a preferred healthcare language of Spanish. 11% of providers conducted ≥10 languages other than English telehealth encounters. This subset of providers conducted 71% of all languages other than English encounters. We conducted 25 interviews with clinical staff (n=13) and parents (n=12). Common themes identified across interviews were: (I) technology barriers affect access to and quality of telehealth; (II) clinical staff and parents are uncertain about the future role of telehealth for patients/families who communicate in languages other than English; (III) the well-known impact of language barriers on in-person healthcare access and quality for patients who communicate in languages other than English is also evident in telehealth. Conclusions Patients who communicate in languages other than English were underrepresented among telehealth encounters and encounters were concentrated among few providers. Promoting equitable telehealth care requires investment to address technology barriers, increase the readiness of providers and clinics to provide telehealth care in languages other than English, and continued attention to reducing the healthcare impact of language barriers.
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Affiliation(s)
- Lisa Ross DeCamp
- Children’s Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
- Adult and Child Center for Outcomes Research and Delivery Science, Aurora, CO, USA
| | - Leah Williams
- Children’s Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Claire Palmer
- Children’s Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Carol Gorman
- Adult and Child Center for Outcomes Research and Delivery Science, Aurora, CO, USA
| | - Christina Olson
- Children’s Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Darcy A. Thompson
- Children’s Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
- Adult and Child Center for Outcomes Research and Delivery Science, Aurora, CO, USA
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Rodriguez JA, Seiglie JA, Caballero AE. What Does a New Health Technology Landscape Mean for Hispanic/Latino People With Diabetes? Clin Diabetes 2023; 41:289-291. [PMID: 37092153 PMCID: PMC10115760 DOI: 10.2337/cd22-0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- Jorge A. Rodriguez
- Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Jacqueline Anne Seiglie
- Harvard Medical School, Boston, MA
- Diabetes Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Augusto Enrique Caballero
- Harvard Medical School, Boston, MA
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Boston, MA
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Torres HA, Schmidt VA. Maximizing diabetes education efforts in vulnerable populations - newer delivery concepts. Curr Opin Endocrinol Diabetes Obes 2022; 29:23-28. [PMID: 34864758 DOI: 10.1097/med.0000000000000688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Patients from ethnic/minority backgrounds or low socioeconomic status face numerous barriers to achieving ideal diabetes care goals. The purpose of this review is to describe the burden of diabetes in vulnerable populations; discuss the etiologic factors leading to health disparities in diabetes; and present challenges and solutions to improving diabetes care through novel diabetes self-management education and support interventions. RECENT FINDINGS Recent interventions to alleviate health disparities utilize a combination of community health workers, peer leaders and technology-based approaches to provide diabetes self-management education and support and overcome barriers to diabetes control such as low literacy, difficulty with transportation, and cultural beliefs. These interventions achieve clinically meaningful improvements in blood glucose control as measured by haemoglobin A1C and are effective in addressing psychosocial outcomes such as diabetes distress. Research is underway to address food insecurity through food delivery and use behavioural economics principles to provide financial incentives to diabetes control. SUMMARY Combining human interaction through peer or community health worker led diabetes educational efforts and support with technology-based interventions shows promise in improving diabetes outcomes for vulnerable populations.
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Affiliation(s)
- Hugo A Torres
- Division of Endocrinology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Philis-Tsimikas A, Fortmann AL, Godino JG, Schultz J, Roesch SC, Gilmer TP, Farcas E, Sandoval H, Savin KL, Clark T, Chichmarenko M, Jones JA, Gallo LC. Dulce Digital-Me: protocol for a randomized controlled trial of an adaptive mHealth intervention for underserved Hispanics with diabetes. Trials 2022; 23:80. [PMID: 35090520 PMCID: PMC8796443 DOI: 10.1186/s13063-021-05899-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/30/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND By 2034, the number of US individuals with diabetes is predicted to increase from 23.7 to 44.1 million, and annual diabetes-related spending is expected to grow from $113 to $336 billion. Up to 55% of US Hispanics born in the year 2000 are expected to develop diabetes during their lifetime. Poor healthcare access and cultural barriers prevent optimal care, adherence, and clinical benefit, placing Hispanics at disproportionate risk for costly diabetes complications. Mobile technology is increasingly prevalent in all populations and can circumvent such barriers. Our group developed Dulce Digital, an educational text messaging program that improved glycemic control relative to usual care. Dulce Digital-Me (DD-Me) has been tailored to a participant's individual needs with a greater focus on health behavior change. METHODS This is a three-arm, parallel group, randomized trial with equal allocation ratio enrolling Hispanic adults with low income and poorly managed type 2 diabetes (N = 414) from a San Diego County Federally Qualified Health Center. Participants are randomized to receive Dulce Digital, Dulce Digital-Me-Automated, or Dulce Digital-Me-Telephonic. The DD-Me groups include Dulce Digital components plus personalized goal-setting and feedback delivered via algorithm-driven automated text messaging (DD-Me-Automated) or by the care team health coach (DD-Me-Telephonic) over a 12-month follow-up period. The study will examine the comparative effectiveness of the three groups in improving diabetes clinical control [HbA1c, primary outcome; low-density lipoprotein cholesterol (LDL-C), and systolic blood pressure (SBP)] and patient-provider communication and patient adherence (i.e., medication, self-management tasks) over 12 months and will examine cost-effectiveness of the three interventions. DISCUSSION Our comparative evaluation of three mHealth approaches will elucidate how technology can be integrated most effectively and efficiently within primary care-based chronic care model approaches to reduce diabetes disparities in Hispanics and will assess two modes of personalized messaging delivery (i.e., automated messaging vs. telephonic by health coach) to inform cost and acceptability. TRIAL REGISTRATION NCT03130699-All items from the WHO Trial Registration data set are available in https://clinicaltrials.gov/ct2/show/study/NCT03130699 .
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Affiliation(s)
- Athena Philis-Tsimikas
- grid.288434.10000 0001 1541 3236Scripps Whittier Diabetes Institute, Scripps Health, San Diego, USA
| | - Addie L. Fortmann
- grid.288434.10000 0001 1541 3236Scripps Whittier Diabetes Institute, Scripps Health, San Diego, USA
| | - Job G. Godino
- grid.421317.20000 0004 0497 8794Laura Rodriguez Research Institute, Family Health Centers of San Diego, San Diego, USA ,grid.266100.30000 0001 2107 4242Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, USA
| | | | - Scott C. Roesch
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, USA ,grid.263081.e0000 0001 0790 1491Department of Psychology, San Diego State University, San Diego, USA
| | - Todd P. Gilmer
- grid.266100.30000 0001 2107 4242Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, USA
| | - Emilia Farcas
- grid.266100.30000 0001 2107 4242Qualcomm Institute, University of California, San Diego, USA
| | - Haley Sandoval
- grid.288434.10000 0001 1541 3236Scripps Whittier Diabetes Institute, Scripps Health, San Diego, USA
| | - Kimberly L. Savin
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, USA
| | - Taylor Clark
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, USA
| | - Mariya Chichmarenko
- grid.288434.10000 0001 1541 3236Scripps Whittier Diabetes Institute, Scripps Health, San Diego, USA
| | - Jennifer A. Jones
- grid.288434.10000 0001 1541 3236Scripps Whittier Diabetes Institute, Scripps Health, San Diego, USA
| | - Linda C. Gallo
- grid.263081.e0000 0001 0790 1491Department of Psychology, San Diego State University, San Diego, USA
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Joseph JJ, Ortiz R, Acharya T, Golden SH, López L, Deedwania P. Cardiovascular Impact of Race and Ethnicity in Patients With Diabetes and Obesity: JACC Focus Seminar 2/9. J Am Coll Cardiol 2021; 78:2471-2482. [PMID: 34886969 DOI: 10.1016/j.jacc.2021.06.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/26/2021] [Accepted: 06/01/2021] [Indexed: 01/02/2023]
Abstract
Obesity and type 2 diabetes mellitus are highly prevalent and increasing in the United States among racial/ethnic minority groups. Type 2 diabetes mellitus, which is driven by many factors including elevated levels of adiposity, is an exemplar health disparities disease. Pervasive disparities exist at every level from risk factors through outcomes for U.S. racial/ethnic minority groups, including African American, Hispanic/LatinX American, and Asian American populations. Disparities in clinical care exist including hemoglobin A1c control, lower prescription rates of newer antihyperglycemic medications, along with greater rates of complications postbariatric surgery. Underpinning these disparities are the social determinants of health affecting provider-patient interactions, access to resources, and healthy built environments. We review the best practices to address cardiometabolic disparities in the current cardiovascular guidelines and describe recommendations for cross-cutting strategies to advance equity in obesity and type 2 diabetes across U.S. racial/ethnic groups.
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Affiliation(s)
- Joshua J Joseph
- Division of Endocrinology, Diabetes and Metabolism, The Ohio State University College of Medicine, Columbus, Ohio, USA. https://twitter.com/joshuajosephmd
| | - Robin Ortiz
- Departments of Pediatrics and Population Health, Institute for Excellence in Health Equity, New York University Grossman School of Medicine, New York, New York, USA
| | - Tushar Acharya
- Division of Cardiology, Sarver Heart Center, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Sherita H Golden
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lenny López
- San Francisco VA Medical Center, Department of Medicine, University of California, San Francisco, California, USA
| | - Prakash Deedwania
- Department of Medicine, University of California, San Francisco, California, USA.
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Chin MH. New Horizons-Addressing Healthcare Disparities in Endocrine Disease: Bias, Science, and Patient Care. J Clin Endocrinol Metab 2021; 106:e4887-e4902. [PMID: 33837415 PMCID: PMC8083316 DOI: 10.1210/clinem/dgab229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Indexed: 02/06/2023]
Abstract
Unacceptable healthcare disparities in endocrine disease have persisted for decades, and 2021 presents a difficult evolving environment. The COVID-19 pandemic has highlighted the gross structural inequities that drive health disparities, and antiracism demonstrations remind us that the struggle for human rights continues. Increased public awareness and discussion of disparities present an urgent opportunity to advance health equity. However, it is more complicated to change the behavior of individuals and reform systems because societies are polarized into different factions that increasingly believe, accept, and live different realities. To reduce health disparities, clinicians must (1) truly commit to advancing health equity and intentionally act to reduce health disparities; (2) create a culture of equity by looking inwards for personal bias and outwards for the systemic biases built into their everyday work processes; (3) implement practical individual, organizational, and community interventions that address the root causes of the disparities; and (4) consider their roles in addressing social determinants of health and influencing healthcare payment policy to advance health equity. To care for diverse populations in 2021, clinicians must have self-insight and true understanding of heterogeneous patients, knowledge of evidence-based interventions, ability to adapt messaging and approaches, and facility with systems change and advocacy. Advancing health equity requires both science and art; evidence-based roadmaps and stories that guide the journey to better outcomes, judgment that informs how to change the behavior of patients, providers, communities, organizations, and policymakers, and passion and a moral mission to serve humanity.
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Affiliation(s)
- Marshall H Chin
- Section of General Internal Medicine, Department of Medicine, University of Chicago
- Corresponding author contact information: Marshall H. Chin, MD, MPH, University of Chicago, Section of General Internal Medicine, 5841 South Maryland Avenue, MC2007, Chicago, Illinois 60637 USA, (773) 702-4769 (telephone), (773) 834-2238 (fax), (e-mail)
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13
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Information and Communication Technology Access and Use Among Low-Income Latino Immigrant Parents. Matern Child Health J 2021; 25:1807-1813. [PMID: 34687401 DOI: 10.1007/s10995-021-03265-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Development of mHealth interventions to address health disparities for Latino children in immigrant families requires understanding access to and use of information and communication technology. METHODS We examined access to information and communication technology and use of common applications/programs by low-income immigrant Latino parents of infants to inform development of mHealth interventions for this population. Latino immigrant parents reported technology use and access of common applications/software via survey. RESULTS Of the 157 participants, we found nearly all parents owned a smartphone and that 60% accessed the internet only via their smartphone. Around one-quarter of participants had access to unlimited data. Frequent use of text messaging was common, but frequent email use was less common. Less than 10% of participants frequently used health-oriented applications. DISCUSSION Our findings suggest that mHealth interventions that use data, email, or an application interface may not have the intended reach or effectiveness among low-income immigrant Latino parents. Consideration of these findings is important in guiding the development of future mHealth programs for the low-income Latino population. This study was registered at clinicaltrials.gov (NCT02647814).
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14
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Jimenez N, Fuentes M, Virtue A, Alonso-Gonzalez L, Lopez E, Zhou C, Crawley D, Apkon S, Johnston B, Rivara F. Feasibility and Acceptability of a Telephone-Based Intervention for Hispanic Children to Promote Treatment Adherence After Traumatic Brain Injury: A Pilot Study. J Head Trauma Rehabil 2021; 36:274-281. [PMID: 33656480 PMCID: PMC8249323 DOI: 10.1097/htr.0000000000000658] [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] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the feasibility and acceptability of a telephone-based education and navigation program for Hispanic parents of children hospitalized with traumatic brain injury (TBI). SETTING Level I trauma hospital and pediatric inpatient rehabilitation unit in the Northwestern United States. PARTICIPANTS Fourteen Hispanic parent-child dyads. Parents were 85% female, with a mean age of 35 years. Children were 58% male, with a mean age of 9.7 years, and had been hospitalized for complicated mild/moderate (n = 5) or severe (n = 9) TBI. DESIGN Pilot prospective cohort design. MAIN MEASURES Feasibility measures include recruitment, retention, and intervention adherence rates. Acceptability of intervention was measured by parents' use of educational materials and satisfaction with navigation program. We also evaluated study processes, including completion of baseline, 3, 6, and 12 months functional assessments of the child; assessment of parental health literacy and self-efficacy; and adherence to follow-up rehabilitation appointments. RESULTS Eighty-two percent of approached potential participants were recruited into the study. One hundred percent of participants completed the intervention, and 85% had 1-year follow-up. Intervention acceptability was high: 90% reported satisfaction with navigator, and 92% used the educational manual. Assessments demonstrated significant improvement in parents' TBI caregiving and community self-efficacy; 92% attendance to follow-up rehabilitation appointments; and improvement in the child's functional measures, except communication skills. CONCLUSIONS Findings support feasibility and acceptability of a culturally relevant program to facilitate transitions of care for Hispanic children with TBI. A future randomized trial is warranted to determine the efficacy of the intervention on long-term treatment adherence and the child's post-TBI function.
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Affiliation(s)
- Nathalia Jimenez
- Departments of Anesthesiology and Pain Medicine (Dr Jimenez), Rehabilitation Medicine (Drs Fuentes and Apkon), Pediatrics (Drs Johnston and Rivara), Epidemiology (Dr Rivara), and Harborview Injury Prevention and Research Center (Drs Jimenez, Fuentes, and Rivara, Ms Virtue, and Mr Lopez), University of Washington, Seattle; Brain Injury Alliance of Washington, Seattle (Ms Crawley); and Center for Child Health, Behavior and Development, Seattle Children's Research Center, Seattle, Washington (Drs Jimenez, Fuentes, Zhou, and Rivara and Ms Alonso-Gonzalez)
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15
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Marrast L, Conigliaro J, Chan C, Kim EJ, Duer-Hefele J, Diefenbach MA, Davidson KW. Racial and ethnic minority patient participation in N-of-1 trials: perspectives of healthcare providers and patients. Per Med 2021; 18:347-359. [PMID: 34047197 DOI: 10.2217/pme-2020-0166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Aim: Patients from racial and ethnic minority backgrounds in the USA have historically been under-represented in research trials. Understanding their viewpoints regarding participation in N-of-1 trials is imperative as we design and implement these studies. Materials & methods: We conducted six focus groups of racial and ethnic minority patients (n = 25) and providers (n = 9). We used content analysis to identify themes. Results: Our results noted the importance of considering family members in N-of-1 trial recruitment and participation, patients' desire for education as a design feature, for 'lifestyle' changes as a treatment option and for use of nonevidence-based treatments in the design of future N-of-1 trials. Conclusion: Personalized trials have the potential to change the way we deliver primary care and improve disparities for minorities.
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Affiliation(s)
- Lyndonna Marrast
- Department of Medicine, Division of General Internal Medicine, The Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY 11042, USA.,Institute for Health System Science, Center for Health Innovations & Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, NY 11030, USA
| | - Joseph Conigliaro
- Department of Medicine, Division of General Internal Medicine, The Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY 11042, USA.,Institute for Health System Science, Center for Health Innovations & Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, NY 11030, USA
| | - Camille Chan
- Institute for Health System Science, Center for Health Innovations & Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, NY 11030, USA
| | - Eun Ji Kim
- Department of Medicine, Division of General Internal Medicine, The Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY 11042, USA.,Institute for Health System Science, Center for Health Innovations & Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, NY 11030, USA
| | - Joan Duer-Hefele
- Institute for Health System Science, Center for Personalized Health, Feinstein Institutes for Medical Research, Manhasset, NY 11030, USA
| | - Michael A Diefenbach
- Institute for Health System Science, Center for Health Innovations & Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, NY 11030, USA
| | - Karina W Davidson
- Institute for Health System Science, Center for Personalized Health, Feinstein Institutes for Medical Research, Manhasset, NY 11030, USA
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16
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King AC, Campero MI, Sheats JL, Castro Sweet CM, Hauser ME, Garcia D, Chazaro A, Blanco G, Banda J, Ahn DK, Fernandez J, Bickmore T. Effects of Counseling by Peer Human Advisors vs Computers to Increase Walking in Underserved Populations: The COMPASS Randomized Clinical Trial. JAMA Intern Med 2020; 180:1481-1490. [PMID: 32986075 PMCID: PMC7522781 DOI: 10.1001/jamainternmed.2020.4143] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Effective and practical treatments are needed to increase physical activity among those at heightened risk from inactivity. Walking represents a popular physical activity that can produce a range of desirable health effects, particularly as people age. OBJECTIVE To test the hypothesis that counseling by a computer-based virtual advisor is no worse than (ie, noninferior to) counseling by trained human advisors for increasing 12-month walking levels among inactive adults. DESIGN, SETTING, AND PARTICIPANTS A cluster-randomized, noninferiority parallel trial enrolled 245 adults between July 21, 2014, and July 29, 2016, with follow-up through September 15, 2017. Data analysis was performed from March 15 to December 20, 2018. The evidence-derived noninferiority margin was 30 minutes of walking per week. Participants included inactive adults aged 50 years and older, primarily of Latin American descent and capable of walking without significant limitations, from 10 community centers in Santa Clara and San Mateo counties, California. INTERVENTIONS All participants received similar evidence-based, 12-month physical activity counseling at their local community center, with the 10 centers randomized to a computerized virtual advisor program (virtual) or a previously validated peer advisor program (human). MAIN OUTCOMES AND MEASURES The primary outcome was change in walking minutes per week over 12 months using validated interview assessment corroborated with accelerometry. Both per-protocol and intention-to-treat analysis was performed. RESULTS Among the 245 participants randomized, 193 were women (78.8%) and 241 participants (98.4%) were Latino. Mean (SD) age was 62.3 (8.4) years (range, 50-87 years), 107 individuals (43.7%) had high school or less educational level, mean BMI was 32.8 (6.8), and mean years residence in the US was 47.4 (17.0) years. A total of 231 participants (94.3%) completed the study. Mean 12-month change in walking was 153.9 min/wk (95% CI, 126.3 min/wk to infinity) for the virtual cohort (n = 123) and 131.9 min/wk (95% CI, 101.4 min/wk to infinity) for the human cohort (n = 122) (difference, 22.0, with lower limit of 1-sided 95% CI, -20.6 to infinity; P = .02); this finding supports noninferiority. Improvements emerged in both arms for relevant clinical risk factors, sedentary behavior, and well-being measures. CONCLUSIONS AND RELEVANCE The findings of this study indicate that a virtual advisor using evidence-based strategies produces significant 12-month walking increases for older, lower-income Latino adults that are no worse than the significant improvements achieved by human advisors. Changes produced by both programs are commensurate with those reported in previous investigations of these behavioral interventions and provide support for broadening the range of light-touch physical activity programs that can be offered to a diverse population. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02111213.
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Affiliation(s)
- Abby C King
- Department of Epidemiology & Population Health, Stanford University School of Medicine, Stanford, California.,Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Maria Ines Campero
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Jylana L Sheats
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California.,Now with Global Community Health and Behavioral Science Department, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Cynthia M Castro Sweet
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California.,Now with Omada Health, Inc, San Francisco, California
| | - Michelle E Hauser
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California.,Now with Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, California.,Now with Primary Care, Veterans Affairs Palo Alto Health Care System, Livermore, California.,Now with Fair Oaks Health Center, San Mateo County Health System, Redwood City, California
| | - Dulce Garcia
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Aldo Chazaro
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - German Blanco
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Jorge Banda
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California.,Now with Department of Health and Kinesiology, Purdue University, West Lafayette, Indiana
| | - David K Ahn
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Juan Fernandez
- Khoury College of Computer Sciences, Northeastern University, Boston, Massachusetts
| | - Timothy Bickmore
- Khoury College of Computer Sciences, Northeastern University, Boston, Massachusetts
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17
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DeCamp LR, Godage SK, Valenzuela Araujo D, Dominguez Cortez J, Wu L, Psoter KJ, Quintanilla K, Rivera Rodríguez T, Polk S. A Texting Intervention in Latino Families to Reduce ED Use: A Randomized Trial. Pediatrics 2020; 145:peds.2019-1405. [PMID: 31879276 DOI: 10.1542/peds.2019-1405] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/16/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Latino children in immigrant families experience health care disparities. Text messaging interventions for this population may address disparities. The objective of this study was to evaluate the impact of a Spanish-language text messaging intervention on infant emergency department use and well care and vaccine adherence. METHODS The Salud al Día intervention, an educational video and interactive text messages throughout the child's first year of life, was evaluated via randomized controlled trial conducted in an urban, academic pediatric primary care practice from February 2016 to December 2017. Inclusion criteria were publicly insured singleton infant <2 months of age; parent age >18, with Spanish as the preferred health care language; and at least 1 household cellular phone. Primary outcomes were abstracted from the electronic medical record at age 15 months. Intention-to-treat analyses were used. RESULTS A total of 157 parent-child dyads were randomly assigned to Salud al Día (n = 79) or control groups (n = 78). Among all participants, mean parent age was 29.3 years (SD: 6.2 years), mean years in the United States was 7.3 (SD: 5.3 years), and 87% of parents had limited or marginal health literacy. The incidence rate ratio for emergency department use for the control versus intervention group was 1.48 (95% confidence interval: 1.04-2.12). A greater proportion of intervention infants received 2 flu vaccine doses compared with controls (81% vs 67%; P = .04). CONCLUSIONS This Spanish-language text messaging intervention reduced emergency department use and increased flu vaccine receipt among a population at high risk for health care disparities. Tailored text message interventions are a promising method for addressing disparities.
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Affiliation(s)
- Lisa Ross DeCamp
- Center for Salud/Health and Opportunity for Latinos and .,Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Sashini K Godage
- Harvard Medical School, Harvard University, Boston, Massachusetts
| | | | | | - Linxuan Wu
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Kevin J Psoter
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | | | - Sarah Polk
- Center for Salud/Health and Opportunity for Latinos and.,Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland
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Fortmann AL, Savin KL, Clark TL, Philis-Tsimikas A, Gallo LC. Innovative Diabetes Interventions in the U.S. Hispanic Population. Diabetes Spectr 2019; 32:295-301. [PMID: 31798285 PMCID: PMC6858072 DOI: 10.2337/ds19-0006] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
IN BRIEF In the United States, Hispanics have a 66% greater risk of developing type 2 diabetes and, once diagnosed, exhibit worse outcomes than non-Hispanic whites. It is therefore imperative to ensure that interventions meet the specific needs of this at-risk group. This article provides a selective review of the evidence on innovative, real-world approaches (both live and technology-based) to improving behavioral, psychosocial, and clinical outcomes in underserved Hispanics with type 2 diabetes. Key aspects of successful live interventions have included multimodal delivery, greater dosage/attendance, and at least some in-person delivery; effective technology-based approaches involved frequent but intermittent communication, bi-directional messaging, tailored feedback, multimodal delivery, and some human interaction. Across modalities, cultural tailoring also improved outcomes. Additional research is needed to address methodological limitations of studies to date and pinpoint the most efficacious components and optimal duration of interventions. Future efforts should also attend to variability within the U.S. Hispanic population to ensure acceptability and sustainability of interventions in this diverse group.
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Affiliation(s)
| | - Kimberly L. Savin
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA
| | - Taylor L. Clark
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA
| | | | - Linda C. Gallo
- Department of Psychology, San Diego State University, San Diego, CA
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19
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Yingling L, Allen NA, Litchman ML, Colicchio V, Gibson BS. An Evaluation of Digital Health Tools for Diabetes Self-Management in Hispanic Adults: Exploratory Study. JMIR Diabetes 2019; 4:e12936. [PMID: 31313657 PMCID: PMC6664655 DOI: 10.2196/12936] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 05/16/2019] [Accepted: 05/21/2019] [Indexed: 11/17/2022] Open
Abstract
Background Although multiple self-monitoring technologies for type 2 diabetes mellitus (T2DM) show promise for improving T2DM self-care behaviors and clinical outcomes, they have been understudied in Hispanic adult populations who suffer disproportionately from T2DM. Objective The objective of this study was to evaluate the acceptability, feasibility, and potential integration of wearable sensors for diabetes self-monitoring among Hispanic adults with self-reported T2DM. Methods We conducted a pilot study of T2DM self-monitoring technologies among Hispanic adults with self-reported T2DM. Participants (n=21) received a real-time continuous glucose monitor (RT-CGM), a wrist-worn physical activity (PA) tracker, and a tablet-based digital food diary to self-monitor blood glucose, PA, and food intake, respectively, for 1 week. The RT-CGM captured viewable blood glucose concentration (mg/dL) and PA trackers collected accelerometer-based data, viewable on the device or an associated tablet app. After 1 week of use, we conducted a semistructured interview with each participant to understand experiences and thoughts on integration of the data from the devices into a technology-facilitated T2DM self-management intervention. We also conducted a brief written questionnaire to understand participants’ self-reported T2DM history and past experience using digital health tools for T2DM self-management. Feasibility was measured by device utilization and objective RT-CGM, PA tracker, and diet logging data. Acceptability and potential integration were evaluated through thematic analysis of verbatim interview transcripts. Results Participants (n=21, 76% female, 50.4 [SD 11] years) had a mean self-reported hemoglobin A1c of 7.4 [SD 1.8] mg/dL and had been diagnosed with T2DM for 7.4 [SD 5.2] years (range: 1-16 years). Most (89%) were treated with oral medications, whereas the others self-managed through diet and exercise. Nearly all participants (n=20) used both the RT-CGM and PA tracker, and 52% (11/21) logged at least one meal, with 33% (7/21) logging meals for 4 or more days. Of the 8 possible days, PA data were recorded for 7.1 [SD 1.8] days (range: 2-8), and participants averaged 7822 [SD 3984] steps per day. Interview transcripts revealed that participants felt most positive about the RT-CGM as it unveiled previously unknown relationships between lifestyle and health and contributed to changes in T2DM-related thoughts and behaviors. Participants felt generally positive about incorporating the wearable sensors and mobile apps into a future intervention if support were provided by a health coach or health care provider, device training were provided, apps were tailored to their language and culture, and content were both actionable and delivered on a single platform. Conclusions Sensor-based tools for facilitating T2DM self-monitoring appear to be a feasible and acceptable technology among low-income Hispanic adults. We identified barriers to acceptability and highlighted preferences for wearable sensor integration in a community-based intervention. These findings have implications for the design of T2DM interventions targeting Hispanic adults.
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Affiliation(s)
- Leah Yingling
- Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Nancy A Allen
- College of Nursing, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Michelle L Litchman
- College of Nursing, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Vanessa Colicchio
- College of Nursing, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Bryan S Gibson
- Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT, United States
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20
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Greder K, Reina AS. Procuring Health: Experiences of Mexican Immigrant Women in Rural Midwestern Communities. QUALITATIVE HEALTH RESEARCH 2019; 29:1334-1344. [PMID: 30556481 DOI: 10.1177/1049732318816676] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Thematic analysis was used to analyze interview data from 15 first-generation Mexican immigrant women who resided in two rural Midwestern communities. Ten themes were identified and aligned with four thematic areas of interest ( meaning of being healthy, strategies to promote health, challenges to health, and supports for health). This study provides insights into the complexities and realities faced by Mexican immigrant women, as they strove to obtain optimal health in rural America, and contributes to the growing literature focused on health disparities among ethnic and racial minorities. Implications for research, professional practice, and public policy are discussed. Ethnographic and longitudinal studies that include the perspectives of populations that are difficult to reach such as first-generation Latino immigrant families are needed to further explore the nuances of achieving health in growing, diverse areas of rural America.
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21
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Caballero AE. The "A to Z" of Managing Type 2 Diabetes in Culturally Diverse Populations. Front Endocrinol (Lausanne) 2018; 9:479. [PMID: 30233490 PMCID: PMC6127640 DOI: 10.3389/fendo.2018.00479] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 08/02/2018] [Indexed: 12/15/2022] Open
Abstract
Type 2 diabetes affects racial/ethnic minorities at an alarming rate in the US and in many countries around the world. The quality of health care provided to these groups is often suboptimal, resulting in worse patient-related outcomes when compared to those in mainstream populations. Understanding the complex biological elements that influence the development and course of the disease in high-risk populations is extremely important but often insufficient to implement effective prevention and treatment plans. Multiple factors must be addressed in routine diabetes clinical care. This paper discusses various key factors, organized in alphabetical order. These are acculturation, biology, clinician's cultural awareness, depression and diabetes-specific emotional distress, educational level, fears, group integration, health literacy, intimacy and sexual dysfunction, judging, knowledge of the disease, language, medication adherence, nutritional preferences, other forms of medicine (alternative), perception of body image, quality of life, religion and faith, socio-economic status, technology, unconscious bias, vulnerable groups, asking why?, exercise, "you are in charge" and zip it! Considering these factors in the development of type 2 diabetes prevention and treatment programs will help improve diabetes-related outcomes in culturally diverse populations and reduce health care disparities.
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Affiliation(s)
- A. Enrique Caballero
- Office for External Education, Harvard Medical School, Boston, MA, United States
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22
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Abstract
BACKGROUND There is growing evidence supporting the use of mobile health apps for the management of diabetes. Given the disproportionate impact of diabetes on Latinos, especially those with limited English proficiency (LEP) and low literacy, diabetes apps have the potential to address existing health disparities. Our study aimed to understand the current accessibility of diabetes apps for these populations. METHODS We searched the Android and iOS stores for the term "diabetes" to identify patient-facing diabetes apps. We reviewed the app store descriptions and user interfaces for Spanish availability. We assessed the readability of the descriptions in English and Spanish using the Lexile Analyzer and the Flesch-Kincaid Reading Grade Level. RESULTS Overall, in reviewing both app stores, 30% (28/92) of apps had descriptions available in Spanish, of which 41% (18/44) of Android apps were available in Spanish and 21% (10/48) iOS apps were available in Spanish. In addition, the readability of 94% (90/96) for the app store descriptions was above the recommended reading level for patient education material in English and Spanish. The overall kappa coefficient for app translation quality assessment was .72, reflecting moderate interrater agreement. CONCLUSIONS Despite the evidence supporting the use of diabetes apps, they do not cater to the language needs of LEP Latino patients.
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Affiliation(s)
- Jorge A. Rodriguez
- Division of Clinical Informatics, Beth
Israel Medical Center, Boston, MA, USA
- Jorge A. Rodriguez, MD, Division of Clinical
Informatics, Beth Israel Deaconess Medical Center, 1330 Beacon St, Ste 400,
Brookline, MA 02446, USA.
| | - Karandeep Singh
- Departments of Learning Health Sciences
and Internal Medicine, University of Michigan Medical School, Ann Arbor, MI,
USA
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23
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Hincapie AL, Gupta V, Brown SA, Metzger AH. Exploring Perceived Barriers to Medication Adherence and the Use of Mobile Technology in Underserved Patients With Chronic Conditions. J Pharm Pract 2017; 32:147-153. [PMID: 29212410 DOI: 10.1177/0897190017744953] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Evidence suggests that the prevalence of medication nonadherence is greater in medically underserved, low-income communities. There is paucity of qualitative data examining the potential use of mobile health (mHealth) in underserved patients. This study aimed to explore barriers to medication adherence and identify opportunities and challenges for the potential use of mHealth adherence interventions in an underserved population. METHODS A qualitative cross-sectional focus group was conducted. Focus groups were conducted with underserved patients recruited at a federally qualified health center. The Health Belief Model was used as theoretical framework to develop the focus group guide. Audio-recorded data were transcribed and thematically analyzed to identify common themes across the data set. RESULTS Seventeen patients participated in 4 focus groups. Findings were organized by the following themes: (1) perceived barriers to medication adherence, (2) everyday practices used to improve medication adherence, and (3) perceived benefits and barriers to technology use. Use of text messages seemed beneficial; however, not carrying a phone always was a significant barrier for patients. Some patients expressed willingness to try smartphone applications but stated that they would not be able to afford them. Changes in daily routine and complexity of medication regimens were seen as barriers to medication adherence. CONCLUSIONS Findings underscore the importance of considering diverse experiences when engaging patients in mHealth for medication adherence. Providing patient-centered approaches to assist patients construct their individualized medication adherence strategies may lead to better outcomes.
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Affiliation(s)
- Ana L Hincapie
- 1 James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH, USA
| | - Vasudha Gupta
- 2 College of Pharmacy, Roseman University of Health Sciences, Henderson, NV, USA
| | | | - Anne H Metzger
- 1 James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH, USA
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