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Dunkel A, von Storch K, Hochheim M, Zank S, Polidori MC, Woopen C. Long-term effects of a telemedically-assisted lifestyle intervention on glycemic control in patients with type 2 diabetes - A two-armed randomised controlled trial in Germany. J Diabetes Metab Disord 2024; 23:519-532. [PMID: 38932898 PMCID: PMC11196553 DOI: 10.1007/s40200-023-01290-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 08/22/2023] [Indexed: 06/28/2024]
Abstract
Purpose Diabetes is considered one of the fastest growing diseases worldwide. Especially in the treatment of type 2 diabetes, lifestyle interventions have proven to be effective. However, long-term studies in real-world contexts are rare, which is why further research is needed. The aim of the present study is to investigate whether effects achieved in the context of a long-term lifestyle intervention can be sustained by patients in the long term. Methods In a two-arm randomized trial we compared diabetes care as usual to a lifestyle intervention combining telemedically support and individual needs-based telephone coaching. The study included 151 patients with type 2 diabetes randomized to either the intervention or control group. Intervention Group (IG; N = 86, 80.2% male, mean age: 59.7) received telemedical devices and telephone coaching over a period of 12 months, Control Group (CG; N = 65, 83.1% male, mean age: 58,8) received care as usual. The primary outcome was chance in HbA1c. A follow-up survey was conducted after 24 months. Results The intervention group showed significantly better HbA1c- values compared to the control group at both 12 and 24 months (12 M: - 0.52 (-0.73; - 0.32), p < .000; 24 M: - 0.38 (-0.61; - 0.15), p = .001). The strongest change was seen in the first three months, with the best value obtained at 6 months and stable thereafter. Conclusion Combined telephone coaching with telemedicine support could lead to better long-term glycemic control in people with type 2 diabetes. In the future, more long-term studies should be conducted in real-world settings and lifestyle interventions should be offered more widely.
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Affiliation(s)
- Annalena Dunkel
- NRW Graduate School GROW - Gerontological Research on Well-Being, Faculty of Medicine, Faculty of Human Sciences, University of Cologne, Albertus-Magnus-Platz, 50923 Cologne, DE Germany
| | - Katja von Storch
- NRW Graduate School GROW - Gerontological Research on Well-Being, Faculty of Medicine, Faculty of Human Sciences, University of Cologne, Albertus-Magnus-Platz, 50923 Cologne, DE Germany
| | | | - Susanne Zank
- Rehabilitative Gerontology, Faculty of Human Sciences, University of Cologne, Cologne, DE Germany
| | - M. Cristina Polidori
- Ageing Clinical Research, Department II of Internal Medicine, Center for Molecular Medicine Cologne, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, DE Germany
- Cologne Excellence Cluster on Cellular Stress- Responses in Aging- Associated Diseases (CECAD), Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, DE Germany
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Tincopa MA, Patel N, Shahab A, Asefa H, Lok AS. Implementation of a randomized mobile-technology lifestyle program in individuals with nonalcoholic fatty liver disease. Sci Rep 2024; 14:7452. [PMID: 38548875 PMCID: PMC10978851 DOI: 10.1038/s41598-024-57722-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 03/21/2024] [Indexed: 04/01/2024] Open
Abstract
Identifying effective, feasible, low-cost interventions that promote sustainable lifestyle changes in nonalcoholic fatty liver disease (NAFLD) is a key unmet need. The aim of this study was to assess predictors of lifestyle practice patterns of NAFLD patients and evaluate the implementation of a mobile technology-based intervention. We prospectively enrolled adults with NAFLD (diagnosed by imaging or biopsy). Individuals with additional liver diseases or decompensated cirrhosis were excluded. Patient were randomized to usual care or a FitBit based program for 6-months. We obtained anthropometrics, labs, vibration controlled transient elastography (VCTE), health-related quality of life (HRQOL), physical activity, diet and motivation to change data. 70 patients were enrolled, 33% with cirrhosis. Median age was 52.1 years, 47% males, 83% white, body mass index 32.3, liver stiffness 7.6 kPa, controlled attenuation parameter 319 db/m, and 50% had diabetes. Baseline HRQOL was 5.4/7 and independently negatively correlated with level of concern about their disease and positively with physical function. Younger age was independently associated with unhealthy diets whereas diabetes was independently associated with unhealthy diets and higher VCTE kPa. 6-month follow-up data available on 31 patients showed trends in improvement in weight. In a cohort of NAFLD patients, we identified independent correlates of lifestyle behaviors and HRQOL. Implementation of interventions that improve physical function may improve HRQOL in NAFLD. Younger patients and those with diabetes appeared to have the greatest need for dietary interventions. Structured mobile technology lifestyle interventions using Fitbit and personalized coaching showed promise but require further validation with a focus on sustainability of intervention and improvement in outcomes.
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Affiliation(s)
- Monica A Tincopa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of California San Diego, 9350 Campus Point Dr Ste 2B #0975, San Diego, CA, USA.
| | - Nik Patel
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Areesha Shahab
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Haila Asefa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Anna S Lok
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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Sanlier N, Kocaay F, Kocabas S, Ayyildiz P. The Effect of Sociodemographic and Anthropometric Variables on Nutritional Knowledge and Nutrition Literacy. Foods 2024; 13:346. [PMID: 38275713 PMCID: PMC10814858 DOI: 10.3390/foods13020346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/21/2023] [Accepted: 05/24/2023] [Indexed: 01/27/2024] Open
Abstract
Nutrition literacy, which is one of the important components of health literacy, includes basic nutritional information and understanding, interpreting and having the ability to make healthy decisions on nutrition-related issues. This study aims to dwell upon the relationship between sociodemographic and anthropometric variables and nutritional knowledge and nutrition literacy. A total of 1600 people aged 19-64 years, 934 women and 666 men, voluntarily participated in the research in the capital city of Turkey. The mean age is 28.2 ± 10.9 years. More than half of the participants (57.4%) have a university graduate/postgraduate education level, and 66.2% are unemployed. This cross-sectional study evaluated demographic information, anthropometric measurements, nutritional information and nutrition literacy. Nearly all the respondents (94.6%) were determined to have sufficient nutrition literacy. Body mass index (BMI) and age were negatively associated with nutrition literacy, whilst nutrition knowledge was positively associated. Respondents with nutrition education at school had the highest nutrition knowledge and nutrition literacy scores, and primary school graduates had the lowest. Participants who received nutrition education scored higher in all the subgroups of the GNKQ. Age, gender, marital status, education status, employment status, BMI and nutrition education were significantly associated with nutrition literacy. The results will be useful in developing food and nutrition policies that will pave the way for making decisions on the most useful themes of health and nutrition campaigns.
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Affiliation(s)
- Nevin Sanlier
- Department of Nutrition and Dietetics Ankara, Faculty of Health Sciences, Ankara Medipol University, Ankara 06050, Turkey
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Mori H, Taniguchi S, Tamaki Y, Tamaki M, Akehi Y, Kuroda A, Matsuhisa M. Telenutrition Education Is Effective for Glycemic Management in People with Type 2 Diabetes Mellitus: A Non-Inferiority Randomized Controlled Trial in Japan. Nutrients 2024; 16:268. [PMID: 38257162 PMCID: PMC10819819 DOI: 10.3390/nu16020268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/06/2024] [Accepted: 01/14/2024] [Indexed: 01/24/2024] Open
Abstract
This study examined the non-inferior efficacy of telenutrition education compared with face-to-face nutrition education in managing glycemic control in people with type 2 diabetes mellitus (T2DM). Participants had T2DM and a glycated hemoglobin (HbA1c) ranged 6.5-9.5%. Thirty participants were randomly assigned to either the telenutrition or face-to-face nutrition education group. During the 32-week intervention period, the participants received four sessions on nutrition education from a registered dietitian at the hospital. The telenutrition group received remote education via a videoconferencing platform. Face-to-face nutrition education was conducted using paper-based instructions. The main outcome measure was the non-inferiority of HbA1c levels in the telenutrition group compared to the face-to-face nutrition group. The non-inferiority of telenutrition education was considered valid if the intergroup difference in the mean values of the change in HbA1c had a bilateral 95% confidence interval (CI) upper limit below 0.40%. The intergroup difference in the mean HbA1c change from baseline to the fourth nutrition education session was -0.11 (95% CI -0.54-0.32) for both groups. The upper limit of the bilateral 95% CI was 0.32%, which was below the 0.40% non-inferiority margin (non-inferiority test; p = 0.011). Telenutrition education was not inferior to face-to-face nutrition education for glycemic management in people with T2DM.
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Affiliation(s)
- Hiroyasu Mori
- Diabetes Therapeutics and Research Center, Institute of Advanced Medical Sciences, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima 770-8503, Japan
| | - Satoshi Taniguchi
- Diabetes Therapeutics and Research Center, Institute of Advanced Medical Sciences, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima 770-8503, Japan
| | - Yu Tamaki
- Medical IT Center, Tokushima University Hospital, 2-50-1 Kuramoto-cho, Tokushima 770-8503, Japan
| | - Motoyuki Tamaki
- Diabetes Therapeutics and Research Center, Institute of Advanced Medical Sciences, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima 770-8503, Japan
| | - Yuko Akehi
- Diabetes Therapeutics and Research Center, Institute of Advanced Medical Sciences, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima 770-8503, Japan
| | - Akio Kuroda
- Diabetes Therapeutics and Research Center, Institute of Advanced Medical Sciences, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima 770-8503, Japan
| | - Munehide Matsuhisa
- Diabetes Therapeutics and Research Center, Institute of Advanced Medical Sciences, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima 770-8503, Japan
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Xu N, Han X, Chen S, Zhang J, Gu P. Self-reported barriers in self-management of women with gestational diabetes: A systematic review of qualitative studies. Nurs Open 2023; 10:7130-7143. [PMID: 37700604 PMCID: PMC10563407 DOI: 10.1002/nop2.1988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 08/10/2023] [Accepted: 08/14/2023] [Indexed: 09/14/2023] Open
Abstract
AIM To provide a systematic review of the qualitative literature on self-reported barriers to self-management in pregnant women with gestational diabetes mellitus (GDM). DESIGN Systematic review. METHODS This systematic review followed the Joanna Briggs Institute meta-aggregation approach and was evaluated using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. Qualitative studies on the barriers to self-management among GDM pregnancy survivors conducted until 17 May 2022, were searched. RESULTS A total of 30 studies were included, of which seven were in Chinese and 23 were in English, and 10 findings resulted in three themes: (a) Knowledge and belief, (b) Skills and abilities and (c) Environment and social support. By summarizing the self-reported barriers to self-management in patients with GDM and recommends precise interventions for these barriers, thereby saving health resources and helping to increase their willingness and ability to engage in self-management.
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Affiliation(s)
- Nuo Xu
- School of NursingNanjing Medical UniversityNanjingChina
| | - Xia Han
- School of NursingNanjing Medical UniversityNanjingChina
| | - Sijing Chen
- School of NursingNanjing Medical UniversityNanjingChina
| | - Jingjing Zhang
- Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital)NanjingChina
| | - Ping Gu
- School of NursingNanjing Medical UniversityNanjingChina
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Nakahata M, Tanaka-Mizuno S, Yamaguchi F, Takeuchi M, Kawakami K. Does nutritional guidance reduce cardiovascular events in patients with type 2 diabetes mellitus? A retrospective cohort study using a nationwide claims database. Acta Diabetol 2023; 60:1541-1549. [PMID: 37421440 DOI: 10.1007/s00592-023-02147-3] [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: 03/19/2023] [Accepted: 06/25/2023] [Indexed: 07/10/2023]
Abstract
AIM To examine the effect of nutritional guidance (NG) provided by a registered dietitian under the direction of a physician on the development of subsequent cardiovascular events in patients with early-stage type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS This retrospective cohort study used the JMDC claims database to explore patients aged 18 years or older who first met the diagnostic criteria for T2DM at a health checkup between January 2011 and January 2019. The last day of the observation period was set for 28 February, 2021. Exposure was defined as receiving NG within 180 days of diagnosis of T2DM. The primary outcome was a composite endpoint of coronary artery disease (CAD) and cerebrovascular disease, and the secondary outcomes were each event, and time to event was compared. The propensity score weighting method was used for adjusting the distribution of confounding variables. Cox regression was conducted to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS Overall, 31,378 patients met the eligibility criteria at an annual health checkup. 9.6% received NG (n = 3013). Patients who attended ≥ 1 NG after diagnosis had significantly reduced risk of cardiovascular composite (adjusted HR 0.75, 95% CI 0.58-0.97) and cerebrovascular disease (adjusted HR 0.65, 95% CI 0.47-0.90) during approximately 3.3 years of follow-up. In contrast, no difference was observed for CAD. CONCLUSIONS Receiving NG in early-stage diabetes may reduce the incidence of cardiovascular events, especially cerebrovascular events.
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Affiliation(s)
- Misaki Nakahata
- Department of Pharmacoepidemiology, Graduate School of Medicine, Kyoto University, Yoshidakonoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
| | - Sachiko Tanaka-Mizuno
- Department of Pharmacoepidemiology, Graduate School of Medicine, Kyoto University, Yoshidakonoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan.
- Department of Digital Health and Epidemiology, Graduate School of Medicine, Kyoto University, Yoshidakonoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan.
| | - Fumitaka Yamaguchi
- Department of Pharmacoepidemiology, Graduate School of Medicine, Kyoto University, Yoshidakonoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
| | - Masato Takeuchi
- Department of Pharmacoepidemiology, Graduate School of Medicine, Kyoto University, Yoshidakonoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine, Kyoto University, Yoshidakonoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
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Zima J, Jairath N. Enhancing Self-Management Skills of Patients With Existing Diabetic Foot Ulcerations: A Quality Improvement Project. J Wound Ostomy Continence Nurs 2023; 50:413-419. [PMID: 37713353 DOI: 10.1097/won.0000000000001009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
PURPOSE The purpose of this quality improvement initiative was to determine the impact of a nurse-administered foot care intervention bundle (NA-FCIB) upon self-management knowledge, skills, and outcomes in patients with diabetic foot ulcerations. PARTICIPANTS AND SETTING The sample comprised 39 patients being treated for diabetic foot ulceration at a wound care clinic in a tertiary care hospital in Arlington, Virginia. The project was conducted from August 2017 to February 2018. APPROACH This quality improvement project used the Johns Hopkins Plan-Do-Study-Act Method supplemented by self-regulation theory for diabetic patient education and evidence in clinical literature. The 12-week-long intervention included one-on-one teaching in the prevention of ulcerations and optimal care of the diabetic foot, blood glucose level tracking logs, patient "teach-back" and skills demonstration, and free foot care tools. OUTCOMES From baseline to post-NA-FCIB, the number of participants knowing the reasons for temperature foot protection increased by 92%, those knowing major factors leading to diabetic foot ulceration by 85%, those knowing what to look for in the foot self-exam by 85%, and those able to demonstrate correct foot self-exam by 84%. The number of participants understanding proper footwear increased by 74%, and those identifying ways to avoid/decrease the likelihood of diabetic foot ulcers by 72%. Mean serum hemoglobin A1c (HgbA1c) levels decreased from baseline to postintervention (8.27%; SD 2.05% vs 7.46%; SD 1.58%; P = .002). IMPLICATIONS FOR PRACTICE The NA-FCIB intervention was successfully incorporated into routine clinic care as the standard of care. Our experience suggests that the NA-FCIB may be feasible and effective for use at comparable wound care clinics and may have secondary benefits for HgbA1c regulation.
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Affiliation(s)
- Janice Zima
- Janice Zima, DNP, FNP-C, Wound Healing and Hyperbaric Center, Virginia Hospital Center, Arlington
- Nalini Jairath, PhD, RN, The Catholic University of America, Washington, District of Columbia
| | - Nalini Jairath
- Janice Zima, DNP, FNP-C, Wound Healing and Hyperbaric Center, Virginia Hospital Center, Arlington
- Nalini Jairath, PhD, RN, The Catholic University of America, Washington, District of Columbia
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Buchmann M, Jordan S, Loer AKM, Finger JD, Domanska OM. Motivational readiness for physical activity and health literacy: results of a cross-sectional survey of the adult population in Germany. BMC Public Health 2023; 23:331. [PMID: 36788515 PMCID: PMC9930360 DOI: 10.1186/s12889-023-15219-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 02/06/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Health literacy, defined as the knowledge, motivation, and competences to use health information to improve health and well-being, is associated with regular physical activity. However, there is limited evidence on whether health literacy is also related to the motivational readiness for physical activity in a general population. The aim of this study was to investigate whether motivational readiness for leisure-time physical activity is associated with health literacy. METHODS Analyses were based on data of 21,895 adults from the cross-sectional German Health Update and European Health Interview Survey 2014/2015 (GEDA 2014/2015-EHIS). Motivational readiness for leisure-time physical activity was assessed with stages of change for physical activity with a set of validated items. It was then classified, according to an established algorithm, into five stages: precontemplation, contemplation, preparation, action, and maintenance. Health literacy was measured with the short form of the European Health Literacy Survey Questionnaire (HLS-EU-Q16) and categorised as low, medium, and high. For bivariate and multinomial logistic regression analyses, the stages were categorised in three phases as: (1) no intention (precontemplation), (2) planning (contemplation or preparation), and (3) in activity (action or maintenance). The models were adjusted for sex, age, education, health consciousness, self-efficacy, and self-perceived general health status. RESULTS High compared to low health literacy was associated with a 1.65-times (95% CI = 1.39-1.96) greater probability of being in activity than planning. High compared to low health literacy was associated with a reduced risk of having no intention to change physical activity behaviour (relative risk ratio, RRR = 0.84, 95% CI = 0.75-0.95). The associations persisted after adjusting for covariates. CONCLUSION High health literacy was positively associated with more advanced phases of motivational readiness for leisure-time physical activity. Therefore, taking health literacy into account in interventions to promote motivational readiness for leisure-time physical activity could be a useful approach.
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Affiliation(s)
- Maike Buchmann
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany.
| | - Susanne Jordan
- grid.13652.330000 0001 0940 3744Department of Epidemiology and Health Monitoring, Robert Koch Institute, Nordufer 20, 13353 Berlin, Germany
| | - Anne-Kathrin Mareike Loer
- grid.13652.330000 0001 0940 3744Department of Epidemiology and Health Monitoring, Robert Koch Institute, Nordufer 20, 13353 Berlin, Germany
| | - Jonas David Finger
- Senate Department for Higher Education and Research, Long-Term Care and Gender Equality, Department of Health, Oranienstraße 106, 10969 Berlin, Germany
| | - Olga Maria Domanska
- grid.13652.330000 0001 0940 3744Department of Epidemiology and Health Monitoring, Robert Koch Institute, Nordufer 20, 13353 Berlin, Germany
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Hori S, Hori K, Yoshimura S, Uehara F, Sato N, Hasegawa Y, Akazawa K, Ono T. Masticatory Behavior Change with a Wearable Chewing Counter: A Randomized Controlled Trial. J Dent Res 2023; 102:21-27. [PMID: 36085580 DOI: 10.1177/00220345221118013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Because a relationship has been reported between masticatory behavior, obesity, and postprandial blood glucose, it is recommended to chew well and take a longer time to eat. The purpose of this study was to examine the possibility of changing masticatory behavior using a small ear-hung wearable chewing counter, which can monitor masticatory behavior without disturbing daily meals. In total, 235 healthy volunteers participated in a 4-wk randomized controlled trial and were divided into 3 groups. All participants were instructed about the importance of mastication at the first visit. During the intervention, group B used the chewing counter without an algorithm during each meal (notification of the number of chews after meal), and group C used the chewing counter with a masticatory behavior change algorithm (setting a target value and displaying the number of chews in real time). Group A was set as the control group. The number of chews and the meal time when consuming 1 rice ball (100 g) were measured before and after the intervention using the chewing counter, and the rate of change in these values was evaluated. Participants also provided a subjective evaluation of their changes in masticatory behavior. The number of chews and the meal time of 1 rice ball increased significantly in groups B and C compared with before the intervention, and the rate of change was significantly higher in group C than in group A and group B. In addition, the subjective evaluation of the change in the number of chews was highest in group C. Self-monitoring of masticatory behavior by providing a target value and the degree of achievement for the number of chews using a wearable chewing counter with a behavioral change algorithm could promote effective change in masticatory behavior and lead to an increased number of chews. (Trial ID: UMIN000034476).
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Affiliation(s)
- S Hori
- Division of Comprehensive Prosthodontics, Faculty of Dentistry and Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - K Hori
- Division of Comprehensive Prosthodontics, Faculty of Dentistry and Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - S Yoshimura
- Division of Comprehensive Prosthodontics, Faculty of Dentistry and Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - F Uehara
- Division of Comprehensive Prosthodontics, Faculty of Dentistry and Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - N Sato
- Division of Comprehensive Prosthodontics, Faculty of Dentistry and Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Y Hasegawa
- Division of Comprehensive Prosthodontics, Faculty of Dentistry and Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - K Akazawa
- Department of Medical Informatics, Niigata University Medical and Dental Hospital, Japan
| | - T Ono
- Division of Comprehensive Prosthodontics, Faculty of Dentistry and Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
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Wang H, Li D, Xiong Y, Huang H, Hu Q, Zhang W. Effect of Cross Theoretical Model of Behaviour Change and Motivation Interview on Self-Management Behaviour. JOURNAL OF ONCOLOGY 2022; 2022:3551167. [PMID: 36046367 PMCID: PMC9423961 DOI: 10.1155/2022/3551167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/27/2022] [Accepted: 07/08/2022] [Indexed: 11/18/2022]
Abstract
Objective To evaluate the effects of a trans-theoretical model (TTM) of behavioural change plus motivational interviewing on self-management behavior and quality of life (QoL) in patients with intracranial aneurysm. Methods A total of 94 patients with intracranial aneurysm treated in the First Affiliated Hospital of Wenzhou Medical University from 2019 to 04/2021-04 were retrospectively analyzed. Among them, 49 patients used TTM + motivational interview as the observation group (Obs group), and 45 patients used the traditional method as the control group (Con group). The Self-Management Behavior Scale for Patients with Intracranial Aneurysm was used for analyzing the changes in the self-management behavior of the two groups of patients, and the MOS 36-item Short Form Health Survey (SF-36) was used to analyze the changes in the QoL of the patients. The incidence of adverse events after 6 months of intervention was counted. In addition, the Barthel Index (BI) and Montreal Cognitive Assessment Scale (MOCA) were used to evaluate the recovery effects of patients. Logistic regression was conducted for analyzing the risk factors of adverse cerebrovascular events. Results After treatment, the Con group got lower self-management behavior score than the Obs group (P < 0.05), and also got lower SF-36 scores, BI, and MOCA scores than the Obs group (P < 0.05). Age and a history of hypertension were independent risk factors for adverse events. The Hosmer-Lemeshow test was adopted for testing the goodness of fit of the regression equation (P=0.903). With the established model, the area under the receiver operating characteristic curve for predicting adverse events in patients with intracranial aneurysm was determined to be 0.851, indicating that the model performed well as a risk prediction model. Conclusion TTM + motivational interviewing can help improve the self-management behavior and QoL of patients with intracranial aneurysm without increasing the occurrence of adverse events.
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Affiliation(s)
- Hongxia Wang
- Department of Nursing, The First Hospital Affiliated to Wenzhou Medical University, Ouhai District, Wenzhou 325000, Zhejiang Province, China
| | - Dongmei Li
- Department of Neurosurgery, The First Hospital of Wenzhou Medical University, Ouhai District, Wenzhou 325000, Zhejiang Province, China
| | - Ye Xiong
- Department of Neurosurgery, The First Hospital of Wenzhou Medical University, Ouhai District, Wenzhou 325000, Zhejiang Province, China
| | - Huijun Huang
- Department of Neurosurgery, The First Hospital of Wenzhou Medical University, Ouhai District, Wenzhou 325000, Zhejiang Province, China
| | - Qiongshuang Hu
- Department of Neurosurgery, The First Hospital of Wenzhou Medical University, Ouhai District, Wenzhou 325000, Zhejiang Province, China
| | - Weimei Zhang
- Interventional Surgery Centre, The First Hospital of Wenzhou Medical University, Ouhai District, Wenzhou 325000, Zhejiang Province, China
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Glass L, Asefa H, Volk M, Lok AS, Tincopa MA. Disease Knowledge, Health-Related Quality of Life, and Lifestyle Behavior Change in Patients with Nonalcoholic Fatty Liver Disease: Impact of an Educational Intervention. Dig Dis Sci 2022; 67:2123-2133. [PMID: 34043121 DOI: 10.1007/s10620-021-07052-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/11/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Lifestyle modification is currently the only treatment for nonalcoholic fatty liver disease (NAFLD). The most effective way to motivate behavior change in this population is not well understood. AIMS The aims of this study were to characterize the association between patient disease knowledge, attitudes, and behaviors and to determine the impact of an educational intervention. METHODS Adults with NAFLD had the following assessed before and after an educational intervention: (1) disease knowledge; (2) health-related quality of life (HRQOL); (3) physical activity; (4) diet; (5) stages of change; and (6) clinical variables. RESULTS Median age of the cohort (N = 248) was 53.5, 46% were male, 85% were white, and median body mass index was 33.9. Forty-eight percentage had nonalcoholic steatohepatitis, and 28% had cirrhosis. The median correct knowledge score was 73.6%, median Chronic Liver Disease Questionnaire-NAFLD was 5.2/7, and diet score was 7/16 (higher indicating unhealthy diets). The cohort was sedentary at baseline, with 46% and 60% in active phases of change for nutrition and physical activity, respectively. Fifty-six (22%) had all three high-risk behaviors (sedentary, poor diet scores, low stage of change), which was independently associated with depression. The educational intervention improved diet scores, HRQOL, stages of change, and weight. CONCLUSIONS Despite good disease knowledge, NAFLD participants were sedentary and 1/4 had high-risk lifestyle behaviors. An educational intervention had positive impacts on clinical outcomes, though effect size was small. Pairing educational interventions with targeted interventions to motivate behavior change can improve care for patients with NAFLD.
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Affiliation(s)
- Lisa Glass
- Department of Internal Medicine, John D. Dingell VA Medical Center, Detroit, MI, USA
| | - Haila Asefa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, 3912 Taubman Center, 1500 East Medical Center Drive, SPC 5362, Ann Arbor, MI, 48109, USA
| | - Michael Volk
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Anna S Lok
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, 3912 Taubman Center, 1500 East Medical Center Drive, SPC 5362, Ann Arbor, MI, 48109, USA
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12
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Schmidt K, Faerch K, Zoffmann V, Amadid H, Varming AR. The process of health behaviour change following participation in a randomised controlled trial targeting prediabetes: A qualitative study. Diabet Med 2022; 39:e14748. [PMID: 34806793 DOI: 10.1111/dme.14748] [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: 05/10/2021] [Revised: 10/20/2021] [Accepted: 11/18/2021] [Indexed: 11/29/2022]
Abstract
AIM To explore how participating in a randomised controlled trial affected motivation, barriers and strategies in the process of health behaviour change among individuals with prediabetes. METHODS An extension to the PRE-D trial, a qualitative study investigated the efficacy of glucose-lowering interventions (metformin, dapagliflozin or exercise) compared with a control group among individuals with prediabetes and overweight/obesity. Data were collected through separate focus group interviews with participants using semi-structured interview guides inspired by health behaviour change theories. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis with an inductive-deductive approach. RESULTS Four interrelated themes were generated from interviews: (1) 'self-construction of prediabetes', on how participants understood the term 'prediabetes', (2) 'altered health image', on how participants' health perceptions were affected, (3) 'personal strategies for health behaviour change', on different ways to attempt to implement behaviour changes and (4) 'the process of health behaviour change', on how participants progressed and relapsed while trying to change behaviour. Themes relate to the health belief model, self-determination theory, self-efficacy and the trans-theoretical model of change. Participants shared their experiences and thoughts during interviews and inspired each other, which led some participants to develop a new perspective on prediabetes severity and increased their motivation for behaviour change. CONCLUSIONS How participants perceived and accepted, rejected or neglected prediabetes appeared to affect their health images and whether they realised a need for behaviour change. Their achievements during interventions, health literacy, self-efficacy and perceived support from their social networks, professionals and technological aids influenced the maintenance of health behaviour changes.
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Affiliation(s)
- Kirstine Schmidt
- Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Kristine Faerch
- Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Vibeke Zoffmann
- Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Hanan Amadid
- Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Annemarie R Varming
- Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
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Pakpour AH, Fazeli S, Zeidi IM, Alimoradi Z, Georgsson M, Brostrom A, Potenza MN. Effectiveness of a mobile app-based educational intervention to treat internet gaming disorder among Iranian adolescents: study protocol for a randomized controlled trial. Trials 2022; 23:229. [PMID: 35313935 PMCID: PMC8935262 DOI: 10.1186/s13063-022-06131-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 02/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background The use of video games, a hobby for many teenagers in their leisure time, has brought with it a new potential for concerns. Internet gaming disorder (IGD) is a mental condition classified as a disorder due to addictive behaviors. It may include use of video games, both online and offline. Consequences of IGD may include introversion, social anxiety, mood swings, loneliness, sleep problems, behavioral problems, depression, low self-esteem, and increased violence. In order to design an app-based intervention for adolescents, a transtheoretical model (TTM) has been used. This widely used model in the field of behavioral change is also practical for health education programs. In addition, cognitive-behavioral therapy (CBT) has been used to make people more aware of their behaviors, feelings and thoughts and how to achieve behavioral change. The present study seeks to determine the effectiveness of this app-based intervention in in the treatment of IGD among adolescents. Method In this single-blinded, randomized, controlled trial, 206 high-school adolescents aged 13 to 18 years in Qazvin city will be recruited. Eligible adolescents will be randomly assigned into intervention and control groups. Eight consecutive sessions delivered over 2 months and based on the TTM and CBT will be delivered through the `app (named HAPPYTEEN) to the intervention group. The control group will receive a sleep hygiene intervention (8 consecutive sessions for 2 months) via the app. Data collection tools include the Internet Gaming Disorder Scale, Insomnia Severity Index, Depression, Anxiety, and Stress Scales, Stages of Change Questionnaire, Decision Balance, and Self-Efficacy. The study measures will be completed at baseline, post intervention, and 1 month and 3 months after the intervention. Discussion The results of this intervention could be used as adjunct therapy for adolescents with IGD. Trial registration Clinical Trial Registration Center of Iran (IRCT) IRCT20181226042140N1. Registered on June 9, 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06131-0.
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14
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Kato T, Nishimura A, Ohtsuki M, Wakasugi Y, Nagao-Nishiwaki R, Fukuda A, Kato K, Sudo A. Is musculoskeletal pain related to locomotive syndrome even in young and middle-aged adults? Mod Rheumatol 2022; 32:213-220. [PMID: 33769924 DOI: 10.1080/14397595.2021.1906512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 03/12/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Locomotive syndrome (LS) is the leading cause of persons needing long-term care in old age and is characterized by locomotive organ impairment including musculoskeletal pain. The aim was to examine the association between musculoskeletal pain and LS in young and middle-aged persons. METHODS A total of 836 participants (male 667, female 169; mean age 44.4 years) were examined in this cross-sectional study. The LS was evaluated by three screening tools: the two-step test, the stand-up test, and the 25-question Geriatric Locomotive Function Scale. Musculoskeletal pain, exercise habits, physical function (walkability and muscle strength), and physical activity were also assessed. RESULTS The LS was found in 22.8% of participants. The number with musculoskeletal pain was significantly higher in those with the LS. A significant correlation was found between the degree of musculoskeletal pain and exercise habits. Less regular exercise was significantly associated with higher LS prevalence. Physical activity and function were greater in participants with more regular exercise. CONCLUSION Musculoskeletal pain was significantly related to LS even in young and middle-aged persons. The present results suggest that control of musculoskeletal pain and improvement of exercise habits in young and middle-aged persons might help prevent the LS.
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Affiliation(s)
- Toshihiro Kato
- Department of Rehabilitation, Suzuka Kaisei Hospital, Suzuka, Japan
- Department of Orthopaedic and Sports Medicine, Mie University Graduate School of Medicine, Tsu City, Japan
| | - Akinobu Nishimura
- Department of Orthopaedic and Sports Medicine, Mie University Graduate School of Medicine, Tsu City, Japan
| | - Makoto Ohtsuki
- Faculty of Health Science, Department of Clinical Nutrition, Suzuka University of Medical Science, Suzuka, Japan
| | - Yusuke Wakasugi
- Faculty of Health Science, Department of Clinical Nutrition, Suzuka University of Medical Science, Suzuka, Japan
| | - Rie Nagao-Nishiwaki
- Faculty of Health Science, Department of Nursing, Suzuka University of Medical Science, Suzuka, Japan
| | - Aki Fukuda
- Department of Orthopaedic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan
| | - Ko Kato
- Department of Orthopaedic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu City, Japan
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Levic M, Bogavac-Stanojevic N, Krajnovic D. The Instruments Used to Assess Health Literacy and Pharmacotherapy Literacy of Diabetes Mellitus Type 2 Patients: A Scoping Review. Front Public Health 2021; 9:747807. [PMID: 34646807 PMCID: PMC8502961 DOI: 10.3389/fpubh.2021.747807] [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: 07/26/2021] [Accepted: 08/31/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Patients with chronic diseases, like diabetes need to continuously perform tasks associated with self-management especially with medications they use. It is shown that the patients with diabetes with limited HL and PTHL cannot read medication labels correctly, may misuse their medications, spend much more on therapy and generally have difficulties in understanding printed care instructions and perceiving health advice and warnings. There has been an increasing demand for valid and reliable instruments for HL and PTHL assessment in this population. This review aims to search and critically discuss instruments used to assess HL and PTHL in people with type 2 diabetes and propose their use in different settings. Methods: Authors conducted a comprehensive, electronic search of original studies using a structured approach of the Scopus and PubMed databases, during November and the first 2 weeks of December 2020 to find relevant papers. The review was conducted in accordance with the Cochrane guidelines and the reporting was based on the PRISMA-ScR. The comparison of instruments was made by utilizing a comparison model related to their structure, measurement scope, range, psychometric properties, validation, strengths, and limitations. Results: The final number of included studies was 24, extracting the following identified instruments: Korean Functional Test HL, NVS, FCCHL, HLS-EU-47, TOFLHA, S-TOFHLA, REALM-R, 3-brief SQ, REALM, HLQ and DNT-15. In all, FCCHL and 3-brief SQ are shown with the broadest measurement scopes. They are quick, easy, and inexpensive for administration. FCCHL can be considered the most useful and comprehensive instrument to screen for inadequate HL. The limitation is that the English version is not validated. Three-brief SQ has many advantages in comparison to other instruments, including that it is less likely to cause anxiety and shame. These instruments can be considered the best for measuring functional HL in patients with diabetes mellitus type 2 and other chronic diseases. PTHL instruments (REALM and DNT-15) did not find the best application in this population. Conclusions: The future research should be directed in validation of the FCCHL in English and establishing of the structural validity of this questionnaire. Developing a specific PTHL questionnaire for this population will be of great help in management of their disease.
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Affiliation(s)
- Marija Levic
- Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
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Pavão ALB, Werneck GL. [Health literacy in low- and middle-income countries: a systematic review]. CIENCIA & SAUDE COLETIVA 2021; 26:4101-4114. [PMID: 34586263 DOI: 10.1590/1413-81232021269.05782020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 07/19/2020] [Indexed: 11/21/2022] Open
Abstract
Health literacy (HL) is linked to individual capacities of access, understanding, assessment and application of health information to make decisions in everyday life, in order to maintain or improve health. The scope of this article is to review studies on HL conducted in low- and middle-income countries, with an emphasis on the definition used for HL. It involved a systematic search in the Medline, Embase, Scopus, LILACS and SciELO databases. It included studies that showed the definition of HL, studies in countries with low- and middle-income economies and Latin American studies. Initially, a selection of studies was made by reading the titles and/or abstracts. Two independent evaluators conducted the reading of the full text. Disagreements were discussed by consensus. A total of 6,025 references were located and 36 were selected for the final sample. Most studies (58.3%) were from countries on the Asian continent, followed by studies from South American countries (27.8%), including Brazil. Most studies (58.3%) evaluated the functional dimension of the HL (FHL). The most frequent definitions were from the Institute of Medicine and from the World Health Organization. Approximately 30% of the studies that evaluated FHL used broader definitions of HL as theoretical frameworks.
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Affiliation(s)
- Ana Luiza Braz Pavão
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz. Av. Brasil 4.365 Pavilhão Haity Moussatché, Manguinhos. 21040-900 Rio de Janeiro RJ Brasil.
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Quimby KR, Sobers N, George C, Greaves N, Browman-Jones F, Samuels TA. Implementation of a community-based low-calorie dietary intervention for the induction of type-2 diabetes and pre-diabetes remission: a feasibility study utilising a type 2 hybrid design. Implement Sci Commun 2021; 2:95. [PMID: 34454636 PMCID: PMC8399825 DOI: 10.1186/s43058-021-00196-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/05/2021] [Indexed: 12/14/2022] Open
Abstract
Objectives The aims of this feasibility study were to (1) examine the implementation of a community-based health advocate (CHA) training programme to develop the clinical skills needed to support a diabetes remission protocol based on a low-calorie diet (LCD) and (2) investigate if participant weight loss can be achieved and diabetes remission induced under these conditions. Methods This tripartite study followed a type 2 implementation-effectiveness design. Three faith-based organisations (FBOs) were purposively selected as study sites. Implementation outcomes were guided by the Consolidated Framework for Implementation Research. During the pre-implementation phase, site ‘readiness’ to facilitate the intervention was determined from a site visit and an interview with the FBOs’ leadership. During the implementation phase, congregants could volunteer for the 10-week CHA training which included practical exercises in weight, glucose and blood pressure (BP) measurement, and a summative practical assessment. Acceptability and implementation effectiveness were assessed via survey. During the intervention phase, other congregants and community members with T2DM or pre-diabetes and overweight were invited to participate in the 12-week LCD. Anti-diabetic medication was discontinued on day 1 of the intervention. Clinical effectiveness was determined from the change in weight, fasting blood glucose (FBG) and BP which were monitored weekly at the FBO by the CHA. HbA1C was performed at weeks 1 and 12. Results The FBOs were found to be ready as determined by their adequate resources and engagement in health-related matters. Twenty-nine CHAs completed the training; all attained a passing grade at ≥1 clinical station, indicating implementation effectiveness. CHA feedback indicated that the programme structure was acceptable and provided sufficient access to intervention-related material. Thirty-one persons participated in the LCD (11 T2DM:20 pre-diabetes). Mean (95%CI) weight loss was 6.0 kg (3.7 to 8.2), 7.9 kg in males vs 5.7 kg in females; A1C (%) decreased from 6.6 to 6.1, with a greater reduction in those with T2DM when compared to pre-diabetes. FBG decreased from 6.4 to 6.0mmol/L. T2DM remission rates were 60% and 90% by A1C<6.5% and FBG<7mmol/L respectively. Pre-diabetes remission was 18% and 40% by A1C<5.7% and FBG<5.6 respectively. Conclusion Implementation of a community-based diabetes remission protocol is both feasible and clinically effective. Its sustainability is to be determined. Adaptability to other disorders or other settings should be investigated. Trial registration NCT03536377 registered on 24 May 2018.
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Affiliation(s)
- Kim R Quimby
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Jemmott's Lane, St. Michael, Bridgetown, Barbados.
| | - Natasha Sobers
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Jemmott's Lane, St. Michael, Bridgetown, Barbados
| | - Colette George
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Natalie Greaves
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | | | - T Alafia Samuels
- Epidemiology Research Unit, Caribbean Institute for Health research, The University of the West Indies, Kingston, Jamaica
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Rivera Rivero B, Makarova A, Sidig D, Niazi S, Abddelgader R, Mirza S, Joud H, Urfi M, Ahmed A, Jureyda O, Khan F, Swanson J, Siddique M, Weare-Regales N, Mirza AS. Nutritional Literacy Among Uninsured Patients With Diabetes Mellitus: A Free Clinic Study. Cureus 2021; 13:e16355. [PMID: 34414041 PMCID: PMC8364779 DOI: 10.7759/cureus.16355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/15/2021] [Indexed: 11/05/2022] Open
Abstract
Objective Evaluate nutrition literacy in uninsured subjects with diabetes mellitus (DM) who presented to free diabetes management classes. Design This single-site, cross-sectional observational study recruited thirty subjects from a free clinic for uninsured patients to attend diabetes mellitus, self-management classes. Before starting the classes, DM care-related data were collected, and subjects were administered the Nutrition Literacy Assessment Instrument (NLit). The assessment covers six subscales in nutrition and categorizes results into three possible categories: the likelihood of poor nutrition literacy (NLit Score ≤ 44), the possibility of poor nutrition literacy (NLit Score- 45-57), and the likelihood of good nutrition literacy (NLit score ≥ 58). Results Median glycated haemoglobin (HbA1c) was 7.45% for study participants. The mean NLit score was 38.1 (SD ± 9.4), correlating with a likelihood of poor nutrition literacy. All participants had either likelihood or the possibility of poor nutrition literacy based on the NLit Assessment. There were no participants who scored in the range of likelihood of good nutrition literacy. Subjects who scored in the range of likelihood of poor nutrition literacy had a significantly higher mean HbA1c (8.6 %) than those who scored in the possibility of poor nutrition literacy (6.9 %, p=0.005). Conclusions Poor nutrition literacy is associated with worse glycemic control among uninsured subjects with diabetes mellitus.
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Affiliation(s)
| | - Alena Makarova
- Medicine, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Dina Sidig
- General Medicine, Red Crescent Clinic, Tampa , USA
| | - Saniya Niazi
- General Medicine, Red Crescent Clinic, Tampa, USA
| | | | - Sabbir Mirza
- Medicine, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Hadi Joud
- Medicine, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Mustafa Urfi
- Miscellaneous, University of South Florida College of Arts and Sciences, Tampa, USA
| | - Abdillahi Ahmed
- Medicine, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Omar Jureyda
- Miscellaneous, University of South Florida College of Arts and Sciences, Tampa, USA
| | - Firaas Khan
- Medicine, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Justin Swanson
- Miscellaneous, University of South Florida College of Public Health, Tampa, USA
| | - Maqsood Siddique
- Cardiology, James A. Hailey Veterans Affairs Medical Center, Tampa, USA
| | - Natalia Weare-Regales
- Endocrinology, Diabetes and Metabolism, James A. Hailey Veterans Affairs Medical Center, Tampa, USA
| | - Abu-Sayeef Mirza
- Internal Medicine, University of South Florida Morsani College of Medicine, Florida, USA
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Fu XJ, Hu SD, Peng YF, Zhou LY, Shu T, Song DD. Observation of the effect of one-to-one education on high-risk cases of diabetic foot. World J Clin Cases 2021; 9:3265-3272. [PMID: 34002135 PMCID: PMC8107901 DOI: 10.12998/wjcc.v9.i14.3265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/20/2021] [Accepted: 03/13/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Diabetes is a common chronic disease, and its global incidence is on the rise. The disease is directly attributed to insufficient insulin efficacy/secretion, and patients are often accompanied by multiple complications. Diabetic foot is one of the most common complications of diabetes. Diabetic feet have ulcers and infections, which can eventually lead to amputation. Basic nursing care, such as lowering blood pressure and preventing foot skin infections in clinical nursing work, has positive significance for the prevention and control of diabetic feet.
AIM To explore the positive significance of one-to-one education in high-risk cases of diabetic foot.
METHODS This observation included 98 high-risk cases of diabetic foot in our hospital during the period from August 2017 to October 2019, and these patients were randomly divided into the basic nursing group and the one-to-one education group with 49 patients per group. The basic nursing group only received routine basic nursing, while the one-to-one education group gave patients one-to-one education on the basis of basic nursing. After nursing, the self-care ability and compliance behavior of the two groups were evaluated and compared between these two groups. The knowledge mastery of the patient and the satisfaction of nursing were accounted.
RESULTS The assessment results of patients (self-care responsibility, self-care skills, self-concept and self-care knowledge) were significantly higher in the one-to-one education group than in the basic nursing group. The scores of compliance behaviors (foot bathing, shoes and socks selection, sports health care) in the one-to-one education group were significantly higher than those in the basic nursing group. Patients in the one-to-one education group had a significantly higher level of knowledge mastery and satisfaction of nursing than the basic nursing group.
CONCLUSION One-to-one education for high-risk cases of diabetic foot is helpful to improve the cognition and self-care ability of patients with diabetic foot, to ensure that patients follow the doctor’s advice of self-care and to improve their nursing satisfaction.
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Affiliation(s)
- Xia-Jun Fu
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital, Southern Medical University, Guangzhou 510630, Guangdong Province, China
| | - Shi-Di Hu
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital, Southern Medical University, Guangzhou 510630, Guangdong Province, China
| | - Yin-Fang Peng
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital, Southern Medical University, Guangzhou 510630, Guangdong Province, China
| | - Ling-Yan Zhou
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital, Southern Medical University, Guangzhou 510630, Guangdong Province, China
| | - Ting Shu
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital, Southern Medical University, Guangzhou 510630, Guangdong Province, China
| | - Dan-Dan Song
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital, Southern Medical University, Guangzhou 510630, Guangdong Province, China
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Medina LAC, Silva RA, de Sousa Lima MM, Barros LM, Lopes ROP, Melo GAA, Garcia Lira Neto JC, Caetano JÁ. Correlation Between Functional Health Literacy and Self-efficacy in People with Type 2 Diabetes Mellitus: Cross-sectional Study. Clin Nurs Res 2021; 31:20-28. [PMID: 33779351 DOI: 10.1177/10547738211006841] [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: 11/16/2022]
Abstract
To analyze the correlation between functional health literacy (FHL) and self-efficacy (SE) in people with type 2 Diabetes Mellitus. Cross-sectional study was conducted among September and October 2019, with 196 people with type 2 diabetes. Data were collected using the Functional Literacy in Health instrument (B-TOFHLA) and the Diabetes Management Self-Efficacy Scale for Patients with Type 2 Diabetes Mellitus (DMSES). Bivariate analysis was used to verify the relationship among the constructs. Most diabetics showed an average B-TOFHLA score of 74.75, considered adequate, and self-efficacy of 4.07, high. The association between SE and FHL in the bivariate analysis found no statistical significance (p > .05), in the same sense as the B-TOFHLA score and the DMSES domains (p > .05). Constructs were not related to each other in terms of skills arising from judgments and decisions with motivational confidence by the investigated audience.
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Affiliation(s)
| | | | | | - Lívia Moreira Barros
- University of International Integration of Afro-Brazilian Lusophony, Redenção, Ceará, Brazil
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Basile AJ, Renner MW, Hidaka BH, Sweazea KL. An evolutionary mismatch narrative to improve lifestyle medicine: a patient education hypothesis. EVOLUTION MEDICINE AND PUBLIC HEALTH 2021; 9:eoab010. [PMID: 33747517 PMCID: PMC7962761 DOI: 10.1093/emph/eoab010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 02/20/2021] [Indexed: 11/14/2022]
Abstract
An evolutionary perspective provides a unifying explanation for the modifiable risk factors and lifestyle-based interventions for the leading causes of morbidity and mortality globally. Non-communicable diseases develop from an evolutionary mismatch between the prior environment and modern patterns of behavior; however, it is unclear whether an evolutionary mismatch narrative could promote positive behavior change in patients. We hypothesize that educating patients about evolutionary mismatch could augment efforts to improve healthful behavior. Specifically, explaining the 'why' behind what is being recommended could promote health literacy and adherence. Furthermore, we offer suggestions of how clinicians could educate patients about evolutionary mismatch for key-lifestyle factors, diet and physical activity, as well as several specific modern diseases. We also consider how to sidestep patients' skepticism of evolutionary theory. Here, we lay the groundwork for research on how educating patients with an evolutionary mismatch narrative could impact health behaviors and improve outcomes.
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Affiliation(s)
- Anthony J Basile
- School of Life Sciences, Arizona State University, 427 E Tyler Mall, Tempe, AZ 85287, USA.,Center for Evolution and Medicine, Arizona State University, 427 E Tyler Mall, Tempe, AZ 85287, USA
| | - Michael W Renner
- School of Life Sciences, Arizona State University, 427 E Tyler Mall, Tempe, AZ 85287, USA
| | - Brandon H Hidaka
- Department of Family Medicine, Mayo Clinic Health System, 1400 Bellinger St., Eau Claire, WI 54703, USA
| | - Karen L Sweazea
- School of Life Sciences, Arizona State University, 427 E Tyler Mall, Tempe, AZ 85287, USA.,Center for Evolution and Medicine, Arizona State University, 427 E Tyler Mall, Tempe, AZ 85287, USA.,College of Health Solutions, Arizona State University, 550 N 3rd St, Phoenix, AZ 85004, USA
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Lipsey AF, Waterman AD, Wood EH, Balliet W. Evaluation of first-person storytelling on changing health-related attitudes, knowledge, behaviors, and outcomes: A scoping review. PATIENT EDUCATION AND COUNSELING 2020; 103:1922-1934. [PMID: 32359877 DOI: 10.1016/j.pec.2020.04.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 04/06/2020] [Accepted: 04/13/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES First-person storytelling (FPS) has the potential to engage patients in changing behavior differently than didactic education. We assessed the prevalence of FPS in health education interventions; whether published FPS research has shown improvements in attitudinal, knowledge, behavioral, or clinical outcomes; and whether randomized controlled trials (RCTs) including FPS have shown more effectiveness than non-FPS interventions. METHODS A scoping review of FPS studies published before October 2019 in five medical databases was conducted. RESULTS 22 out of 10,363 identified studies met eligibility criteria. FPS has been studied primarily in cancer, diabetes, and hypertension. Of the 12 RCTs, compared to controls, patients receiving FPS interventions improved attitudes (N = 6 studies) and knowledge (N = 1), improved health behaviors like quitting smoking (N = 6), and improved clinical outcomes like lowering A1C levels (N = 3). Of the 10 non-RCT studies, compared to baseline assessments, patients who received FPS interventions had improved knowledge (N = 1), attitudes (N = 3), clinical outcomes (N = 4), and improved health behaviors (N = 7). CONCLUSION While rarely used, FPS interventions can improve patient health attitudes and outcomes. Future research should expand FPS to new health areas and determine best practices for developing FPS interventions. PRACTICE IMPLICATIONS FPS may be particularly effective with low income patients and racial/ethnic minorities.
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Affiliation(s)
- Amanda Faye Lipsey
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, United States; Terasaki Institute for Biomedical Innovation, Los Angeles, United States.
| | - Amy D Waterman
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, United States; Terasaki Institute for Biomedical Innovation, Los Angeles, United States.
| | - Emily H Wood
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, United States.
| | - Wendy Balliet
- Medical University of South Carolina, Charleston, United States.
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Trevino A, Cardinal C, Douglas CC. Altered health knowledge and attitudes among health sciences students following media exposure. Nurs Health Sci 2020; 22:967-976. [PMID: 32623789 DOI: 10.1111/nhs.12754] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/10/2020] [Accepted: 07/03/2020] [Indexed: 11/27/2022]
Abstract
Communications media that fails to present information supported by evidence-based practice has the potential to adversely influence knowledge and, ultimately, behaviors. We assessed the immediate effect of a health science documentary on knowledge, attitude, and beliefs among collegiate health sciences students enrolled in an entry-level nutrition course using surveys administered online. Participants (n = 160) completed the pre-survey, watched the documentary What the Health, and immediately completed the post-survey in one setting. Compared with pre-survey scores, participants reported a significant decrease in knowledge, change in attitude to health toward regulation of animal products, and increased agreement with all seven, pre-selected contradictory health claims presented in the documentary. Post-documentary, most participants reported they were planning to make a change in their dietary habits to reflect a plant-based diet. Documentaries providing health information contradictory to the current body of scientific literature are persuasive and can potentially increase negative health behaviors. Inclusion of practices within the health curriculum that encourage, and ultimately, improve health literacy among students before entering the health care workforce is essential.
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Affiliation(s)
- Amanda Trevino
- Sam Houston State University, College of Health Sciences, Family and Consumer Sciences, Huntsville, Texas, USA
| | - Christine Cardinal
- Sam Houston State University, College of Health Sciences, Population Health, Huntsville, Texas, USA
| | - Crystal C Douglas
- Sam Houston State University, College of Health Sciences, Family and Consumer Sciences, Huntsville, Texas, USA.,The University of Texas Medical Branch, School of Health Professions, Nutrition & Metabolism, Galveston, Texas, USA
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He J, Wang Y, Du Z, Liao J, He N, Hao Y. Peer education for HIV prevention among high-risk groups: a systematic review and meta-analysis. BMC Infect Dis 2020; 20:338. [PMID: 32398032 PMCID: PMC7218508 DOI: 10.1186/s12879-020-05003-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 03/30/2020] [Indexed: 12/23/2022] Open
Abstract
Background Peer education has become a strategy for health promotion among high-risk groups for HIV infection worldwide. However, the extent to which peer education could have an impact on HIV prevention or the long-term effect of this impact is still unknown. This study thus quantifies the impact of peer education over time among high-risk HIV groups globally. Method Following the PRISMA guidelines, a systematic review and meta-analysis was used to assess the effects and duration of peer education. A thorough literature search of PubMed, Web of Science, Embase and Cochrane Library was performed, and studies about peer education on high-risk HIV groups were reviewed. Pooled effects were calculated and the sources of heterogeneity were explored using meta-regression and subgroup analysis. Results A total of 60 articles with 96,484 subjects were identified, and peer education was associated with 36% decreased rates of HIV infection among overall high risk groups (OR: 0.64; 95%CI: 0.47–0.87). Peer education can promote HIV testing (OR = 3.19; 95%CI:2.13,4.79) and condom use (OR = 2.66, 95% CI: 2.11–3.36) while reduce equipment sharing (OR = 0.50; 95%CI:0.33,0.75) and unprotected sex (OR = 0.82; 95%CI: 0.72–0.94). Time trend analysis revealed that peer education had a consistent effect on behavior change for over 24 months and the different follow-up times were a source of heterogeneity. Conclusion Our study shows that peer education is an effective tool with long-term impact for behavior change among high-risk HIV groups worldwide. Low and middle-income countries are encouraged to conduct large-scale peer education.
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Affiliation(s)
- Jiayu He
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China.,Department of Epidemiology, School of Public Health, Fudan University, Shanghai, 200032, China.,The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, 200032, China
| | - Ying Wang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China
| | - Zhicheng Du
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China
| | - Jing Liao
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China
| | - Na He
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, 200032, China.,The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, 200032, China
| | - Yuantao Hao
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China.
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Honda H, Igaki M, Tanaka SI, Ono K, Hirota Y. Impact of Self-Reported Sitting Time and Transtheoretical Model Based on Exercise Behavior Change on Glycemic and Weight Control in Japanese Adults with Type 1 Diabetes: A Cross-Sectional Study. Healthcare (Basel) 2020; 8:healthcare8020105. [PMID: 32331210 PMCID: PMC7348764 DOI: 10.3390/healthcare8020105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/11/2020] [Accepted: 04/20/2020] [Indexed: 12/04/2022] Open
Abstract
This cross-sectional study aimed to examine the associations among self-reported sitting time (ST), transtheoretical model (TTM) based on exercise behavior change, and glycemic and weight control in Japanese adults with type 1 diabetes (T1D). Forty-two adults (age, 44.0 (33.3–56.8) years) with uncomplicated T1D answered questions regarding their lifestyles, including ST per day, and TTM using self-administered questionnaires. The glycated hemoglobin (HbA1c) level correlated with age and ST (p < 0.05, p < 0.01, respectively), whereas body mass index correlated with duration of T1D and TTM (p < 0.05, p < 0.01, respectively). Logistic regression analysis showed that poor glycemic control (HbA1c, >7%) was associated with ST (odds ratio, 3.53 (95% confidence interval, 1.54–8.11), p < 0.01). In addition, the cut-off points for quartiles of ST were 4.6, 6.0, and 8.0 h/day, and the HbA1c level in the lowest quartile was 15% lower than that in the highest quartile (p < 0.01). Although further studies with larger samples are needed, these results implied that expanded self-reported ST might be related to poor glycemic control in Japanese T1D adults, most of whom were lean, young and middle-aged, regardless of TTM based on exercise behavior change.
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Affiliation(s)
- Hiroto Honda
- Department of Physical Therapy, Aino University, Ibaraki 567-0012, Japan
- Correspondence: ; Tel.: +81-72-627-1711
| | - Makoto Igaki
- Department of Rehabilitation, Toyooka Hospital Hidaka Medical Center, Toyooka 669-5392, Japan
| | - Shin-ichiro Tanaka
- Department of Internal Medicine, Toyooka Hospital Hidaka Medical Center, Toyooka 669-5392, Japan
| | - Kumiko Ono
- Graduate School of Health Sciences, Kobe University, Kobe 654-0142, Japan
| | - Yushi Hirota
- Division of Diabetes and Endocrinology, The Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
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Vasconcelos C, Almeida A, Sá C, Viana J, Cabral M, Ramos E, Mendes R. Nutrition-related knowledge and its determinants in middle-aged and older patients with type 2 diabetes. Prim Care Diabetes 2020; 14:119-125. [PMID: 31350159 DOI: 10.1016/j.pcd.2019.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 06/24/2019] [Accepted: 06/28/2019] [Indexed: 11/29/2022]
Abstract
AIMS To analyse nutrition-related knowledge and its determinants in middle-aged and older patients with T2D. METHODS In a cross sectional study, a total of 116 participants with T2D, aged 50-80 years, were recruited in primary health care. Data was collected by a self-reported questionnaire - the modified version of General Nutrition Knowledge Questionnaire (0-56 points). Sociodemographic data was also collected: gender, age, personal monthly income, living situation, education level, and marital status. One-way analysis of variance (ANOVA) was performed to assess differences in nutrition-related knowledge score among the different levels of sociodemographic characteristics. RESULTS Questions on general dietary recommendations, dietary behaviors to reduce cardiovascular disease and cancer are the items with higher proportion of correct answers. On the other hand, health problems related with lower intake of fruit, vegetables and fiber and knowledge about antioxidants vitamins presented the lower proportion of correct answers. Higher scores were found among those with lower age, higher personal monthly income, and higher education. CONCLUSIONS Middle-aged and older patients with T2D showed alarming deficits on nutrition-related knowledge. Age, personal monthly income, and education level were observed as major determinants of nutrition-related knowledge. TRIAL REGISTRATION NCT02631902.
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Affiliation(s)
- Carlos Vasconcelos
- University of Trás-os-Montes e Alto Douro, School of Education of Viseu, Polytechnic Institute of Viseu, Portugal.
| | | | - Carla Sá
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, University Institute of Maia, Portugal
| | - João Viana
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, University Institute of Maia, Portugal
| | - Maria Cabral
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Portugal
| | - Elisabete Ramos
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Faculdade de Medicina, Universidade do Porto, Portugal
| | - Romeu Mendes
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, University of Trás-os-Montes e Alto Douro, Public Health Unit, ACES Douro I - Marão e Douro Norte, Northern Region Health Administration, Portugal
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The association of diabetes literacy with self-management among older people with type 2 diabetes mellitus: a cross-sectional study. BMC Nurs 2019; 18:34. [PMID: 31427896 PMCID: PMC6696697 DOI: 10.1186/s12912-019-0354-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Diabetes has become one of public health problem up until now. As the disease progressed, it might lead to increasing complication as well as death related to them. Diabetes as chronic disease in older people can lead to more vulnerable conditions if they fail to carry out a proper diabetes self-management. Diabetes literacy is an internal factor affecting how the older people go about their diabetes management routines. This study aimed to describe diabetes literacy of the older people and identify the relation of diabetes literacy to diabetes self-management of the older people with T2DM in selected areas of Depok City, West Java, Indonesia. Method A cross-sectional observational study was utilized and used 106 samples of older people individuals with T2DM, all of whom were chosen via cluster sampling. This research took place in five selected areas under the supervision of three public health center in Depok City. The data were analyzed using a bivariate t-independent test, the Pearson product-moment correlation, and logistic regression for multivariate analysis to determine the relationship of independent and dependent variable. Result This research shows a significant correlation between diabetes literacy and diabetes self-management (p = 0,011). Conclusion Diabetes self management is associated with diabetes literacy in older people with type 2 diabetes mellitus. Diabetes literacy should be considered when assessing and addressing diabetes-specific health education needs.
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Wang RH, Hsu HC, Chen SY, Hsieh CH, Lee YJ. Modeling patient empowerment and health literacy to glycemic control in insulin-treated patients: A prospective study. PATIENT EDUCATION AND COUNSELING 2019; 102:1336-1341. [PMID: 30773291 DOI: 10.1016/j.pec.2019.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 01/28/2019] [Accepted: 02/05/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To model the pathways of patient empowerment (PE) and health literacy (HL) to glycemic control specific to insulin-treated patients by prospective design. METHODS Insulin-treated patients with type 2 diabetes (T2DM) (N = 185) were recruited by convenience sampling. Data of personal characteristics, PE, and HL were collected by questionnaires at baseline and 9 months later. The 9-month glycosylated hemoglobin (HbA1c) levels of each participant were collected from medical records. Structural equation modeling was used to test a hypothesized model. RESULTS Baseline and 9-month communicative HL and critical HL significantly and negatively correlated with 9-month HbA1c levels. Structural equation modeling supported that baseline and 9-month PE significantly affected HL at corresponding time points. Baseline PE indirectly affected 9-month HL through 9-month PE. The 9-month HL directly affected 9-month HbA1c. Baseline HL indirectly affected 9-month HbA1c through 9-month HL. CONCLUSION Communicative HL and critical HL rather than functional HL were crucial in improving glycemic control. PE is essential to improve HL in insulin-treated patients. PRACTICE IMPLICATIONS Healthcare providers could apply the empowerment approach to educate insulin-treated patients. Through reciprocal dynamic process of PE, insulin-treated patients with T2DM might improve their communicative and critical HL; and finally, glycemic control could be improved.
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Affiliation(s)
- Ruey-Hsia Wang
- College of Nursing, Kaohsiung Medical University, Department of Medical Research, Kaohsiung Medical University Hospital, No. 100, Shih-Chuan 1st Road, Kaohsiung City, 807, Taiwan, ROC.
| | - Hui-Chun Hsu
- Lee's Endocrinology Clinic, No. 396, Guangdong Road, Pingtung City, 900, Taiwan, ROC.
| | - Shi-Yu Chen
- Tri-Service General Hospital, No. 325, Sec. 2, Chenggong Road, Taipei City, 114, Taiwan, ROC.
| | - Chang-Hsun Hsieh
- Tri-Service General Hospital, No. 325, Sec. 2, Chenggong Road, Taipei City, 114, Taiwan, ROC.
| | - Yau-Jiunn Lee
- Lee's Endocrinology Clinic, No. 396, Guangdong Road, Pingtung City, 900, Taiwan, ROC.
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Li Y, Zhang S, Zhang T, Cao Y, Liu W, Jiang H, Ren D, Ren J, Liu H, Hua Z. Chinese health literacy scale for tuberculosis patients: a study on development and psychometric testing. BMC Infect Dis 2019; 19:545. [PMID: 31221099 PMCID: PMC6587253 DOI: 10.1186/s12879-019-4168-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 06/05/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The role of health literacy on tuberculosis patients has not been evaluated in China, in part because few special health literacy measurements exist. METHODS A three-step design process was used: (1) Scale construction: Based on the model of revised Bloom's taxonomy, the item-pool was drafted from a literature review, focus group discussion, and in-depth interviews. In addition, a Delphi survey was used in order to select items for inclusion in the scales; (2) Pilot study: Acceptability and clarity were tested with 60 tuberculosis patients; and (3) Psychometric testing: Validity analysis includes content validity, construct validity, and discriminative validity. The Cronbach's alpha coefficient, split-half reliability, and test-retest method were used to assess reliability. Finally, a receiver operating characteristic analysis was conducted to generate a cut-off point. RESULTS The final scale had 29 items with four domains. The item level Content Validity Index ranged from 0.70 to 1.0, and the scale level Content Validity Index was 0.95. The mean score among the lowest 27% group was significantly lower than that those of the highest 27% group (p < 0.01), which supports adequate discriminant validity. Explanatory factor analysis produced a clear four-factor construct, explaining 47.254% of the total variance. Factor 1 and Factor 2 were consistent with read and memorize TB-related words; Factor 3 was associated with understand the meaning of the health education leaflets and examine if TB patients can apply the correct approach to correct context; Factor 4 was related to the ability of TB patient to calculate and identify what unspecified assumptions are included in known conditions. The confirmatory factory analysis results confirmed that a four-factor model was an acceptable fit to the data, with a goodness-of-fit index = 0.930, adjusted goodness of fit index = 0.970, root mean square error of approximation = 0.069, and χ2/df = 2.153. The scale had good internal consistency and test-retest reliability. Additionally, the receiver operating characteristic analysis indicated that the cut-off point for the instrument was set at 45 and 35. CONCLUSIONS The Chinese Health Literacy scale for Tuberculosis has good reliability and validity, and it could be used for measuring the health literacy of Chinese patients with tuberculosis.
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Affiliation(s)
- Yan Li
- Department of Nursing, Xi'an Jiaotong University, Xian, 710061, China.,School of Nursing, Lanzhou University, Lanzhou, 730000, China
| | - Shaoru Zhang
- Department of Nursing, Xi'an Jiaotong University, Xian, 710061, China.
| | - Tianhua Zhang
- Shaanxi Provincial Institute for TB Control and Prevention, Xian, 710048, China
| | - Yi Cao
- Department of Nursing, Xi'an Jiaotong University, Xian, 710061, China
| | - Weiping Liu
- Shaanxi Provincial Institute for TB Control and Prevention, Xian, 710048, China
| | - Hualin Jiang
- Department of Nursing, Xi'an Jiaotong University, Xian, 710061, China
| | - Dan Ren
- Department of Nursing, Xi'an Jiaotong University, Xian, 710061, China
| | - Jing Ren
- Department of Nursing, Xi'an Jiaotong University, Xian, 710061, China
| | - Haini Liu
- Department of Nursing, Xi'an Jiaotong University, Xian, 710061, China
| | - Zhongqiu Hua
- Department of Nursing, Xi'an Jiaotong University, Xian, 710061, China
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Abdullah A, Liew SM, Salim H, Ng CJ, Chinna K. Prevalence of limited health literacy among patients with type 2 diabetes mellitus: A systematic review. PLoS One 2019; 14:e0216402. [PMID: 31063470 DOI: 10.1371/journal.pone.0216402.t001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 04/21/2019] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Health literacy (HL) skills are essential to enable self-management and shared decision-making in patients with type 2 diabetes mellitus (T2DM). Limited HL in these patients is associated with poorer outcomes. It is not clear what the burden of limited HL in patients with T2DM across countries and what factors influence it. METHODS A systematic review was conducted according to the PRISMA guidelines. The study protocol was registered with PROSPERO (CRD42017056150). We searched MEDLINE, EMBASE, PsycINFO, CINAHL and ERIC for articles published up to January 2017. Articles that measured HL levels in adult patients with T2DM; that used validated HL tools; and that were reported in English were included. Two reviewers assessed studies for eligibility and quality, and extracted the data. Prevalence of limited HL is calculated from the number of patients with less than adequate HL over the total number of patients with T2DM in the study. Meta-analysis and meta-regression analysis were conducted using the Open Meta-analyst software. RESULTS Twenty-nine studies involving 13,457 patients with T2DM from seven countries were included. In total, seven different HL measurement tools were used. The prevalence of limited HL ranged from 7.3% to 82%, lowest in Switzerland and the highest in Taiwan. Meta-regression analysis of all included studies showed the country of study (p<0.001), HL tool used (p = 0.002), and the country's region (p<0.001) contributed to the variation findings. Thirteen studies in the USA measured functional HL. The pooled prevalence of inadequate functional HL among patients with T2DM in the USA was 28.9% (95% CI: 20.4-37.3), with high heterogeneity (I2 = 97.9%, p <0.001). Studies were done in the community as opposed to a hospital or primary care (p = 0.005) and populations with education level lower than high school education (p = 0.009) reported a higher prevalence of limited HL. CONCLUSION The prevalence of limited HL in patients with T2DM varied widely between countries, HL tools used and the country's region. Pooled prevalence showed nearly one in three patients with T2DM in the USA had limited functional HL. Interactions with healthcare providers and educational attainment were associated with reported of prevalence in the USA.
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Affiliation(s)
- Adina Abdullah
- Department of Primary Care Medicine, University Malaya Primary Care Research Group (UMPCRG), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Su May Liew
- Department of Primary Care Medicine, University Malaya Primary Care Research Group (UMPCRG), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Hani Salim
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, University Malaya Primary Care Research Group (UMPCRG), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Karuthan Chinna
- School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Kuala Lumpur, Malaysia
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Abdullah A, Liew SM, Salim H, Ng CJ, Chinna K. Prevalence of limited health literacy among patients with type 2 diabetes mellitus: A systematic review. PLoS One 2019; 14:e0216402. [PMID: 31063470 PMCID: PMC6504081 DOI: 10.1371/journal.pone.0216402] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 04/21/2019] [Indexed: 12/17/2022] Open
Abstract
Background Health literacy (HL) skills are essential to enable self-management and shared decision-making in patients with type 2 diabetes mellitus (T2DM). Limited HL in these patients is associated with poorer outcomes. It is not clear what the burden of limited HL in patients with T2DM across countries and what factors influence it. Methods A systematic review was conducted according to the PRISMA guidelines. The study protocol was registered with PROSPERO (CRD42017056150). We searched MEDLINE, EMBASE, PsycINFO, CINAHL and ERIC for articles published up to January 2017. Articles that measured HL levels in adult patients with T2DM; that used validated HL tools; and that were reported in English were included. Two reviewers assessed studies for eligibility and quality, and extracted the data. Prevalence of limited HL is calculated from the number of patients with less than adequate HL over the total number of patients with T2DM in the study. Meta-analysis and meta-regression analysis were conducted using the Open Meta-analyst software. Results Twenty-nine studies involving 13,457 patients with T2DM from seven countries were included. In total, seven different HL measurement tools were used. The prevalence of limited HL ranged from 7.3% to 82%, lowest in Switzerland and the highest in Taiwan. Meta-regression analysis of all included studies showed the country of study (p<0.001), HL tool used (p = 0.002), and the country’s region (p<0.001) contributed to the variation findings. Thirteen studies in the USA measured functional HL. The pooled prevalence of inadequate functional HL among patients with T2DM in the USA was 28.9% (95% CI: 20.4–37.3), with high heterogeneity (I2 = 97.9%, p <0.001). Studies were done in the community as opposed to a hospital or primary care (p = 0.005) and populations with education level lower than high school education (p = 0.009) reported a higher prevalence of limited HL. Conclusion The prevalence of limited HL in patients with T2DM varied widely between countries, HL tools used and the country’s region. Pooled prevalence showed nearly one in three patients with T2DM in the USA had limited functional HL. Interactions with healthcare providers and educational attainment were associated with reported of prevalence in the USA.
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Affiliation(s)
- Adina Abdullah
- Department of Primary Care Medicine, University Malaya Primary Care Research Group (UMPCRG), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Su May Liew
- Department of Primary Care Medicine, University Malaya Primary Care Research Group (UMPCRG), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- * E-mail:
| | - Hani Salim
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, University Malaya Primary Care Research Group (UMPCRG), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Karuthan Chinna
- School of Medicine, Faculty of Health and Medical Sciences, Taylor’s University, Kuala Lumpur, Malaysia
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Magny-Normilus C, Mawn B, Dalton J. Self-Management of Type 2 Diabetes in Adult Haitian Immigrants: A Qualitative Study. J Transcult Nurs 2019; 31:51-58. [PMID: 30957666 DOI: 10.1177/1043659619841586] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: A large body of literature exists on self-management of type 2 diabetes (T2D) in a variety of populations. However, research is limited on how Haitian immigrants self-manage their T2D despite a prevalence of 6.9% in Haiti. The purpose of this study was to explore and describe the lived experience of adult Haitian immigrants managing T2D living in the United States. Methodology: Moustakas's phenomenological approach guided this qualitative study. Adult Haitian immigrants diagnosed with T2D for at least 1 year were interviewed. Individual interviews were audio-recorded, transcribed verbatim, uploaded into NVivo, and analyzed using Moustakas's existential data analysis process. Results: We interviewed 16 participants (mean age 56;12 females; an average of 11 years living in the United States; mean hemoglobin A1c 8.1%). Four themes emerged: self-reliance, spirituality, nostalgia for home, and a desire for positive patient-provider relationships. Cultural influences and health beliefs may affect individual self-management of T2D in this population. Conclusions: These results may assist clinicians in identifying factors that contribute to suboptimal self-management in Haitian immigrants and help patients reach glycemic control. Culturally competent assessment and interventions for Haitian immigrants with T2D may not be provided without considering these four themes.
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Affiliation(s)
- Cherlie Magny-Normilus
- University of Massachusetts Lowell, Lowell, MA, USA.,Yale School of Nursing, West Haven, CT, USA
| | - Barbara Mawn
- University of Massachusetts Lowell, Lowell, MA, USA
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Şekerci YG, Kitiş Y. Effects of the stages of change model-based education and motivational interview on exercise behavior in diabetic women. Transl Behav Med 2018; 9:256-265. [DOI: 10.1093/tbm/iby047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Yeter Kitiş
- Community Health Nursing Department, Gazi University, Ankara, Turkey
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Gibbs HD, Ellerbeck EF, Gajewski B, Zhang C, Sullivan DK. The Nutrition Literacy Assessment Instrument is a Valid and Reliable Measure of Nutrition Literacy in Adults with Chronic Disease. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2018; 50:247-257.e1. [PMID: 29246567 PMCID: PMC5845801 DOI: 10.1016/j.jneb.2017.10.008] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 10/12/2017] [Accepted: 10/19/2017] [Indexed: 05/14/2023]
Abstract
OBJECTIVE To test the reliability and validity of the Nutrition Literacy Assessment Instrument (NLit) in adult primary care and identify the relationship between nutrition literacy and diet quality. DESIGN This instrument validation study included a cross-sectional sample participating in up to 2 visits 1 month apart. SETTING/PARTICIPANTS A total of 429 adults with nutrition-related chronic disease were recruited from clinics and a patient registry affiliated with a Midwestern university medical center. MAIN OUTCOME MEASURES Nutrition literacy was measured by the NLit, which was composed of 6 subscales: nutrition and health, energy sources in food, food label and numeracy, household food measurement, food groups, and consumer skills. Diet quality was measured by Healthy Eating Index-2010 with nutrient data from Diet History Questionnaire II surveys. ANALYSIS The researchers measured factor validity and reliability by using binary confirmatory factor analysis; test-retest reliability was measured by Pearson r and the intraclass correlation coefficient, and relationships between nutrition literacy and diet quality were analyzed by linear regression. RESULTS The NLit demonstrated substantial factor validity and reliability (0.97; confidence interval, 0.96-0.98) and test-retest reliability (0.88; confidence interval, 0.85-0.90). Nutrition literacy was the most significant predictor of diet quality (β = .17; multivariate coefficient = 0.10; P < .001). CONCLUSIONS The NLit is a valid and reliable tool for measuring nutrition literacy in adult primary care patients.
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Affiliation(s)
- Heather D Gibbs
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS.
| | - Edward F Ellerbeck
- Department of Preventive Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Byron Gajewski
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS
| | - Chuanwu Zhang
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS
| | - Debra K Sullivan
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS
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Cheung MKT, Chan SCC, Hung ATF, Leung AYM, Lee A, Chan FWK, Chung KL, Poon PKK, Chan CCH. A latent profile analysis on patient empowerment programme in a Hong Kong primary care setting. PATIENT EDUCATION AND COUNSELING 2017; 100:1890-1897. [PMID: 28599868 DOI: 10.1016/j.pec.2017.05.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 04/29/2017] [Accepted: 05/21/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE This study identified the profiles of subgroups of type 2 diabetic (T2DM) patients of the Patient Empowerment Programme (PEP) by different levels of benefits gained in diabetic self-management behaviors, self-efficacy, and health literacy. METHODS This study adopted a non-experimental repeated-measures design on T2DM patients who joined PEP, using structured questionnaires. Latent profile analysis (LPA) was used to identify patterns of participants' change on the outcome measures. RESULTS Findings of LPA revealed that participants who were older, unemployed, weaker in diabetic self-management, and having a higher self-perception in personal disease risk were more likely to join the empowerment sessions and gained more benefits from the program. Participants with lower impairment in energy function and lower autonomy in personal health care showed more improvement in the outcomes. CONCLUSION The study identified significant factors associated with patients' participation on and benefits gained from a service delivery model integrating health education and patient empowerment in a primary care setting. PRACTICE IMPLICATION Findings from this study shed light on strategies to improve the PEP design in order to meet the needs of individuals with different health-related profiles.
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Affiliation(s)
- Mike K T Cheung
- Centre on Research and Advocacy, The Hong Kong Society for Rehabilitation, Hong Kong, China
| | - Sam C C Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Anchor T F Hung
- Centre on Research and Advocacy, The Hong Kong Society for Rehabilitation, Hong Kong, China.
| | - Angela Y M Leung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Albert Lee
- Centre for Health Education and Health Promotion, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Frank W K Chan
- Hospital Authority Head Office, Hong Kong Hospital Authority, Hong Kong, China
| | - K L Chung
- Hospital Authority Head Office, Hong Kong Hospital Authority, Hong Kong, China
| | - Peter K K Poon
- Centre on Research and Advocacy, The Hong Kong Society for Rehabilitation, Hong Kong, China
| | - Chetwyn C H Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
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Dawson AZ, Walker RJ, Egede LE. Differential Relationships Between Diabetes Knowledge Scales and Diabetes Outcomes. DIABETES EDUCATOR 2017; 43:360-366. [PMID: 28595504 DOI: 10.1177/0145721717713316] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Diabetes affects more than 29 million people in the US and requires daily self-management in addition to knowledge of the disease. Three knowledge assessments used are the Michigan Brief Diabetes Knowledge Test (DKT), Starr County Diabetes Knowledge Questionnaire (DKQ), and Kaiser DISTANCE Survey (DISTANCE). Purpose The purpose of the study was to test the discriminate validity of 3 diabetes knowledge scales and determine which is best associated with diabetes self-care and glycemic control. Methods Three hundred sixty-one adults with type 2 diabetes were recruited from primary care clinics. Four analyses were conducted to investigate the validity and relationships of the scale: alpha statistic to test internal validity, factor analysis to determine how much of the variance was explained, Pearson's correlation between the 3 scales, and Pearson's correlation between each scale, self-care, and outcomes. Results The DKQ had an alpha of 0.75, the DKT had an alpha of 0.49, and DISTANCE had an alpha of 0.36. The DKQ was significantly correlated with glycemic control. The DKT scale was significantly associated with general diet, the DISTANCE survey was significantly associated with exercise, and both DKT and DISTANCE were significantly associated with foot care. Conclusion Correlations among the 3 scales were modest, suggesting the scales are not measuring the same underlying construct. These findings indicate that researchers should carefully select scales appropriate for study goals or to appropriately capture the information being sought to inform practice.
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Affiliation(s)
- Aprill Z Dawson
- Division of General Internal Medicine, Department of Medicine, Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin (Ms Dawson, Dr Walker, Dr Egede)
- Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, Wisconsin (Ms Dawson, Dr Walker, Dr Egede)
| | - Rebekah J Walker
- Division of General Internal Medicine, Department of Medicine, Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin (Ms Dawson, Dr Walker, Dr Egede)
- Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, Wisconsin (Ms Dawson, Dr Walker, Dr Egede)
| | - Leonard E Egede
- Division of General Internal Medicine, Department of Medicine, Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin (Ms Dawson, Dr Walker, Dr Egede)
- Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, Wisconsin (Ms Dawson, Dr Walker, Dr Egede)
- Cancer Disparities, Cancer Center, The Medical College of Wisconsin, Milwaukee, Wisconsin (Dr Egede)
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