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Hu L, Shi Y, Wylie-Rosett J, Sevick MA, Xu X, Lieu R, Wang C, Li H, Bao H, Jiang Y, Zhu Z, Yeh MC, Islam N. Feasibility of a family-oriented mHealth intervention for Chinese Americans with type 2 diabetes: A pilot randomized control trial. PLoS One 2024; 19:e0299799. [PMID: 38466714 PMCID: PMC10927140 DOI: 10.1371/journal.pone.0299799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 01/30/2024] [Indexed: 03/13/2024] Open
Abstract
OBJECTIVES To test the feasibility, acceptability, and potential efficacy of a mHealth intervention tailored for Chinese immigrant families with type 2 diabetes (T2D). METHODS We conducted a pilot randomized controlled trial (RCT) with baseline, 3-, and 6-month measurements. Participating dyads, T2D patients and families/friends from NYC, were randomized into the intervention group (n = 11) or the wait-list control group (n = 12). Intervention includes 24 videos covering T2D self-management, behavioral techniques, and family-oriented sessions. Feasibility and acceptability were measured respectively by the retention rate and video watch rate, and a satisfaction survey. Patients' HbA1c, weight, and self-management were also assessed to test potential efficacy. RESULTS Most T2D patients (n = 23; mean age 56.2±9.4 years; 52.2% male) and families/friends (n = 23, mean age 54.6±11.2 years; 52.2% female) had high school education or less (69.6% and 69.6%), annual household income < $25,000 (65.2% and 52.2%), and limited English proficiency (95.7% and 95.7%). The retention rates were not significantly different between the intervention and the control groups for both the patients (90.91% vs 83.3%, p = 0.589); and their families/friends (3-month: 90.9% vs 75%, p = 0.313; 6-month: 90.9% vs 83.3%, p = 0.589). The mean video watch rate was 76.8% (7%). T2D patients and families/friends rated satisfaction as 9.4 and 10 out of 10, respectively. Despite no between-group differences, the intervention group had significantly lower HbA1c (p = 0.014) and better self-management (p = 0.009), and lost 12 lbs. on average at 6 months (p = 0.079), compared to their baseline levels. CONCLUSIONS A culturally-tailored, family-based mHealth intervention is feasible and acceptable among low-income, limited English-proficient Chinese families with T2D in NYC. Significant changes in HbA1c and self-management within the intervention group indicate this intervention may have potential efficacy. Given the small sample size of this study, a future RCT with adequate power is needed to test efficacy.
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Affiliation(s)
- Lu Hu
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, NYU Langone Health, New York, NY, United States of America
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - Yun Shi
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, NYU Langone Health, New York, NY, United States of America
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - Judith Wylie-Rosett
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, New York, NY, United States of America
- Department of Medicine, Albert Einstein College of Medicine, New York, NY, United States of America
| | - Mary Ann Sevick
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, NYU Langone Health, New York, NY, United States of America
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
- Department of Medicine, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - Xinyi Xu
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, NYU Langone Health, New York, NY, United States of America
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - Ricki Lieu
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, NYU Langone Health, New York, NY, United States of America
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - Chan Wang
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - Huilin Li
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - Han Bao
- Jacobi Medical Center, New York, NY, United States of America
| | - Yulin Jiang
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, NYU Langone Health, New York, NY, United States of America
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - Ziqiang Zhu
- Wellsure Medical Practice, New York, NY, United States of America
| | - Ming-Chin Yeh
- School of Urban Public Health, Hunter College, City University of New York, New York, NY, United States of America
| | - Nadia Islam
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
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Lekha PPS, Azeez EPA. Psychosocial Facilitators and Barriers to Type 2 Diabetes Management in Adults: A Meta-Synthesis. Curr Diabetes Rev 2024; 20:110-123. [PMID: 38310483 DOI: 10.2174/0115733998283436231207093250] [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: 10/04/2023] [Revised: 11/10/2023] [Accepted: 11/29/2023] [Indexed: 02/05/2024]
Abstract
BACKGROUND Globally, the cases of type 2 diabetes are increasing, and this is largely attributed to lifestyle changes. Though diabetes is primarily a metabolic disease determined by biological factors, psychosocial aspects play a crucial role in its progression and management. However, the literature on psychosocial dimensions of diabetes management is minuscule and scattered. OBJECTIVE This synthesis sought to understand the psychosocial facilitators and barriers to type 2 diabetes management and coping among adults. METHODS We have adopted a meta-synthesis to review available qualitative studies using Pub- Med and Scopus databases. Based on inclusion criteria, we have chosen 24 studies published between 2010 and 2023. We have considered studies across countries, among which 63% of the studies included were from Western countries, and most have employed qualitative descriptive design. The selected studies were analyzed thematically using a deductive framework. RESULTS Six themes emerged as the psychosocial barriers and facilitators of managing and coping with type 2 diabetes: 1) cognitive-emotional factors, 2) faith, 3) constraints to behavioural change, 4) social constraints and support, 5) healthcare provider-patient relationship, and 6) awareness. Further, a conceptual framework was developed from the synthesis. CONCLUSION The patients' experiences evident from this synthesis signify the crucial role of psychosocial factors in diabetes management and coping. This evidence emphasizes the need for integrated care so that psychosocial aspects are addressed by healthcare providers and behavioural health professionals, which may lead to the promotion of facilitators and the minimization of barriers.
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Affiliation(s)
- P Padma Sri Lekha
- School of Social Sciences and Languages, Vellore Institute of Technology, Vellore, India
| | - E P Abdul Azeez
- School of Social Sciences and Languages, Vellore Institute of Technology, Vellore, India
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Zhu T, Martina D, van der Heide A, Korfage IJ, Rietjens JAC. The role of acculturation in the process of advance care planning among Chinese immigrants: A narrative systematic review. Palliat Med 2023; 37:1063-1078. [PMID: 37309994 PMCID: PMC10503260 DOI: 10.1177/02692163231179255] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Acculturation is the process of two different cultures coming into contact. It is unclear how acculturation influences Chinese immigrants' engagement in advance care planning due to the complexity and multifaceted nature of both acculturation and advance care planning. AIMS To synthesize evidence regarding the role of Chinese immigrants' acculturation in their engagement in advance care planning. DESIGN Systematic mixed-method review, registered in PROSPERO (CRD42021231822). DATA SOURCES EMBASE, MEDLINE, Web of Science, and Google Scholar were searched for publications until January 21, 2021. RESULTS Twenty-one out of 1112 identified articles were included in the analysis. Of those 21 articles, 17 had a qualitative design and 13 originated from the United States. Three of four quantitative studies reported that higher acculturation levels were associated with better knowledge or higher rate of engagement in advance care planning. Analysis of qualitative studies showed that Chinese immigrants' engagement in advance care planning was associated with their: (1) self-perceived cultural identity (native or non-native); (2) interpretation of filial piety (traditional or modern); and (3) interpretation of autonomy (individual or familial). To facilitate their engagement, Chinese immigrants prefer an implicit approach, non-family-related initiators, contextualization advance care planning in Chinese culture and using Chinese language. CONCLUSION Chinese immigrants' willingness to engage in advance care planning varied with their acculturation level. To engage them in advance care planning, we recommend adapting the introduction of advance care planning to address people's perceptions of their cultural identity, filial piety, and autonomy, as well as their preference for certain approach, initiator, context, and language.
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Affiliation(s)
- Tingting Zhu
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Diah Martina
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Division of Psychosomatic and Palliative Medicine, Department of Internal Medicine, Universitas Indonesia, Jakarta, Indonesia
- Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Ida J Korfage
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Judith AC Rietjens
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Department of Design, Organization and Strategy, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
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Springer P, Franzen-Castle L, Gratopp E, Schmader B. What is a healthy community? Refugee youth’s perspective on freedom, safety, and trust: a photovoice project. INTERNATIONAL JOURNAL OF SYSTEMIC THERAPY 2022. [DOI: 10.1080/2692398x.2022.2135344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Paul Springer
- Department of Child, Youth and Family Studies, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Lisa Franzen-Castle
- Department of Nutrition and Health Sciences, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Emily Gratopp
- Lancaster County Extension, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Brenna Schmader
- Department of Nutrition and Health Sciences, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
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Akbar H, Gallegos D, Anderson D, Windsor C. Deconstructing type 2 diabetes self-management of Australian Pacific Islander women: Using a community participatory research and talanoa approach. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1988-1999. [PMID: 34580935 DOI: 10.1111/hsc.13580] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 07/20/2021] [Accepted: 09/03/2021] [Indexed: 06/13/2023]
Abstract
Community-based participatory research using culturally appropriate talanoa approaches provided the framework to explore diabetes self-management of Australian Pacific Islander (API) women living with type 2 diabetes in South-East Queensland. Data collection included interviews with key informants (21), in-depth interviews with API women with diabetes (10), talanoa group discussions (7) and monthly steering committee meetings. Using an interpretive-constructionist lens and the interpretations of community members, four cultural constructs in diabetes self-management emerged: self-identity, spirituality, stigma and denial, and structural factors. Self-identity connected the women to their Pacific heritage that framed their collective roles as primary caregivers in the community. This gave the women a strong sense of belonging and helped maintain cultural, family and relational connections which were important for their day-to-day management of diabetes. Although spirituality through religion supported the women to cope with their diabetes a total reliance on God resulted in disengagement with self-care. Shame associated with disclosure also prevented effective self-management. Finally, structural factors such as access to healthcare, poor health literacy and cultural barriers associated with obesogenic environments impeded women from seeking appropriate diabetes care. However, family and community were critical in ensuring women were supported with their diabetes self-management. The findings highlight the importance of engaging families in healthcare planning decisions in the development of culturally responsive models of diabetes support care for API women with type 2 diabetes.
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Affiliation(s)
- Heena Akbar
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Australia, Brisbane, Queensland, Australia
- Pasifika Women's Alliance Inc (PWA), Brisbane, Queensland, Australia
| | - Danielle Gallegos
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
- Woolworths Centre for Childhood Nutrition Research, Queensland University of Technology, Brisbane, Queensland, 4101, Australia
| | - Debra Anderson
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Carol Windsor
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
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Mavragani A, Islam N, Trinh-Shevrin C, Wu B, Feldman N, Tamura K, Jiang N, Lim S, Wang C, Bubu OM, Schoenthaler A, Ogedegbe G, Sevick MA. A Social Media-Based Diabetes Intervention for Low-Income Mandarin-Speaking Chinese Immigrants in the United States: Feasibility Study. JMIR Form Res 2022; 6:e37737. [PMID: 35544298 PMCID: PMC9492091 DOI: 10.2196/37737] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/31/2022] [Accepted: 04/06/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Chinese immigrants bear a high diabetes burden and face significant barriers to accessing diabetes self-management education (DSME) and counseling programs. OBJECTIVE The goal of this study was to examine the feasibility and acceptability and to pilot test the potential efficacy of a social media-based DSME intervention among low-income Chinese immigrants with type 2 diabetes (T2D) in New York City. METHODS This was a single group pretest and posttest study in 30 Chinese immigrants with T2D. The intervention included 24 culturally and linguistically tailored DSME videos, focusing on diabetes education and behavioral counseling techniques. Over 12 weeks, participants received 2 brief videos each week via WeChat, a free social media app popular among Chinese immigrants. Primary outcomes included the feasibility and acceptability of the intervention. Feasibility was evaluated by recruitment processes, retention rates, and the video watch rate. Acceptability was assessed via a satisfaction survey at 3 months. Secondary outcomes, that is, hemoglobin A1c (HbA1c), self-efficacy, dietary intake, and physical activity, were measured at baseline, 3 months, and 6 months. Descriptive statistics and paired 2-sided t tests were used to summarize the baseline characteristics and changes before and after the intervention. RESULTS The sample population (N=30) consisted of mostly females (21/30, 70%) who were married (19/30, 63%), with limited English proficiency (30/30, 100%), and the mean age was 61 (SD 7) years. Most reported an annual household income of <US $25,000 (24/30, 80%) and a high school education or less (19/30, 63%). Thirty participants were recruited within 2 months (January and February 2020), and 97% (29/30) of the participants were retained at 6 months. A video watch rate of 92% (28/30) was achieved. The mean baseline HbA1c level was 7.3% (SD 1.3%), and this level declined by 0.5% (95% CI -0.8% to -0.2%; P=.003) at 6 months. The mean satisfaction score was 9.9 (SD 0.6) out of 10, indicating a high level of satisfaction with the program. All strongly agreed or agreed that they preferred this video-based DSME over face-to-face visits. Compared to baseline, there were significant improvements in self-efficacy, dietary, and physical activity behaviors at 6 months. CONCLUSIONS This pilot study demonstrated that a social media-based DSME intervention is feasible, acceptable, and potentially efficacious in a low-income Chinese immigrant population with T2D. Future studies need to examine the efficacy in an adequately powered clinical trial.
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Affiliation(s)
| | - Nadia Islam
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Chau Trinh-Shevrin
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Naumi Feldman
- Charles B Wang Community Health Center, New York, NY, United States
| | - Kosuke Tamura
- Socio-Spatial Determinants of Health (SSDH) Laboratory, Population and Community Health Sciences Branch, Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institute of Health, Bethesda, MD, United States
| | - Nan Jiang
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Sahnah Lim
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Chan Wang
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Omonigho M Bubu
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States.,Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, United States
| | - Antoinette Schoenthaler
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Langone Health, New York, NY, United States.,Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States.,Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - Gbenga Ogedegbe
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Langone Health, New York, NY, United States.,Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States.,Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - Mary Ann Sevick
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Langone Health, New York, NY, United States.,Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States.,Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States
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Martos-Méndez MJ, Gómez-Jacinto L, Hombrados-Mendieta I, Melguizo-Garín A, Ruiz-Rodríguez I. Psychosocial and Sociodemographic Determinants Related to Chronic Diseases in Immigrants Residing in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3900. [PMID: 35409583 PMCID: PMC8997881 DOI: 10.3390/ijerph19073900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/17/2022] [Accepted: 03/22/2022] [Indexed: 02/05/2023]
Abstract
The aim of the study is to analyze the effect of the psychosocial determinants of satisfaction with social support, resilience and satisfaction with life, and the sociodemographic determinants of age, gender and length of residence on chronic diseases in immigrants living in Spain. The sample was composed of 1131 immigrants from Africa, Eastern Europe, Latin America and Asia. 47.1% were men and 52.9% were women. Most relevant results point to age as the sociodemographic variable with the highest predictive effect in the six chronic diseases analyzed. Gender, in this case female, predicts arthrosis, chronic back pain and migraine, whereas length of residence was only significant in the case of chronic allergies. Regarding psychosocial variables, resilience is a good predictor of hypertension, chronic allergies and arthrosis. However, satisfaction with social support appears to be the best predictor for chronic back pain in the regression equation, satisfaction with life being a significant variable in migraine, arthrosis, allergies and high cholesterol. Results are notably relevant for the design of preventive health programs in immigrants, as well as in ensuring their appropriate access to the health system so that their chronic diseases can be diagnosed. Given the relevance and incidence of the chronic diseases analyzed in immigrants, preventive strategies should be improved to tackle chronic diseases that can have a serious impact on immigrants' health.
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Affiliation(s)
- María José Martos-Méndez
- Faculty of Psychology, University of Málaga, 29071 Málaga, Spain; (I.H.-M.); (A.M.-G.); (I.R.-R.)
| | - Luis Gómez-Jacinto
- Faculty of Social and Labor Studies, University of Málaga, 29071 Málaga, Spain;
| | | | - Anabel Melguizo-Garín
- Faculty of Psychology, University of Málaga, 29071 Málaga, Spain; (I.H.-M.); (A.M.-G.); (I.R.-R.)
| | - Iván Ruiz-Rodríguez
- Faculty of Psychology, University of Málaga, 29071 Málaga, Spain; (I.H.-M.); (A.M.-G.); (I.R.-R.)
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Hu L, Trinh-Shevrin C, Islam N, Wu B, Cao S, Freeman J, Sevick MA. Mobile Device Ownership, Current Use, and Interest in Mobile Health Interventions Among Low-Income Older Chinese Immigrants With Type 2 Diabetes: Cross-sectional Survey Study. JMIR Aging 2022; 5:e27355. [PMID: 35107426 PMCID: PMC9135111 DOI: 10.2196/27355] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/28/2021] [Accepted: 12/23/2021] [Indexed: 01/29/2023] Open
Abstract
Background Chinese immigrants suffer a disproportionately high type 2 diabetes (T2D) burden and tend to have poorly controlled disease. Mobile health (mHealth) interventions have been shown to increase access to care and improve chronic disease management in minority populations. However, such interventions have not been developed for or tested in Chinese immigrants with T2D. Objective This study aims to examine mobile device ownership, current use, and interest in mHealth interventions among Chinese immigrants with T2D. Methods In a cross-sectional survey, Chinese immigrants with T2D were recruited from Chinese community centers in New York City. Sociodemographic characteristics, mobile device ownership, current use of social media software applications, current use of technology for health-related purposes, and interest in using mHealth for T2D management were assessed. Surveys were administered face-to-face by bilingual study staff in the participant’s preferred language. Descriptive statistics were used to characterize the study sample and summarize technology use. Results The sample (N=91) was predominantly female (n=57, 63%), married (n=68, 75%), and had a high school education or less (n=58, 64%); most participants had an annual household income of less than US $25,000 (n=63, 69%) and had limited English proficiency (n=78, 86%). The sample had a mean age of 70 (SD 11) years. Almost all (90/91, 99%) participants had a mobile device (eg, basic cell phones, smart devices), and the majority (n=83, 91%) reported owning a smart device (eg, smartphone or tablet). WeChat was the most commonly used social media platform (65/91, 71%). When asked about their top source for diabetes-related information, 63 of the 91 participants (69%) reported health care providers, followed by 13 who reported the internet (14%), and 10 who reported family, friends, and coworkers (11%). Less than one-quarter (21/91, 23%) of the sample reported using the internet to search for diabetes-related information in the past 12 months. About one-third of the sample (34/91, 37%) reported that they had watched a health-related video on their cell phone or computer in the past 12 months. The majority (69/91, 76%) of participants reported interest in receiving an mHealth intervention in the future to help with T2D management. Conclusions Despite high mobile device ownership, the current use of technology for health-related issues remained low in older Chinese immigrants with T2D. Given the strong interest in future mHealth interventions and high levels of social media use (eg, WeChat), future studies should consider how to leverage these existing low-cost platforms and deliver tailored mHealth interventions to this fast-growing minority group.
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Affiliation(s)
- Lu Hu
- Center for Healthful Behavior Change, Department of Population Health, New York University Grossman School of Medicine, New York University Langone Health, New York, NY, United States
| | - Chau Trinh-Shevrin
- Department of Population Health, New York University Grossman School of Medicine, New York University Langone Health, New York, NY, United States
| | - Nadia Islam
- Department of Population Health, New York University Grossman School of Medicine, New York University Langone Health, New York, NY, United States
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Shimin Cao
- Charles B Wang Community Health Center, New York, NY, United States
| | - Jincong Freeman
- Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Mary Ann Sevick
- Center for Healthful Behavior Change, Department of Population Health, New York University Grossman School of Medicine, New York University Langone Health, New York, NY, United States
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Lee A, Yeh VJH, Knafl KA, Van Riper M. Perceived Experiences of Korean Immigrant Mothers Raising Children With Disabilities in the United States. J Transcult Nurs 2021; 33:219-227. [PMID: 34872416 DOI: 10.1177/10436596211062935] [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] Open
Abstract
INTRODUCTION The challenges of acculturation that immigrant families experience could intensify if they have a child with a disability. This qualitative descriptive study aimed to describe the experiences of Korean mothers raising children with a disability in the United States. METHODOLOGY Semi-structured interviews were conducted based on the Resilience Model of Family Stress, Adjustment, and Adaptation. Directed content analysis was used. RESULTS Six Korean mothers participated in the interview and 16 codes were identified in relation to the five concepts of the Resilience Model, namely family demands, family resources, family appraisal, family problem-solving and coping, and family adaptation. Overall, mothers thought their families were well-functioning and viewed their quality of life positively within the context of immigration despite experiencing various family demands. DISCUSSION Findings of this study showed the resilience of Korean immigrant mothers and revealed the importance of understanding and considering unique cultural differences when providing care to this population.
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Kusnanto K, Arifin H, Widyawati IY. A qualitative study exploring diabetes resilience among adults with regulated type 2 diabetes mellitus. Diabetes Metab Syndr 2020; 14:1681-1687. [PMID: 32905940 DOI: 10.1016/j.dsx.2020.08.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 08/27/2020] [Accepted: 08/28/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIMS Type 2 diabetes mellitus (T2DM) patients often experience unregulated blood glucose due to the lack of resilience. The aim of this study was to explore diabetes resilience among adults with regulated T2DM. METHODS This study used a qualitative case study design. A total of 15 participants with T2DM were recruited through snowball sampling. The study was conducted in four Health Primary Centers in Surabaya, Indonesia. The indicators of diabetes resilience were proper management of diet, activity, stress, and drugs. Interview guidelines were used to collect the data through in-depth interviews. The data were subjected to thematic analysis. RESULTS In this study, the results identified four themes, namely, resilient, support, benefits, and self-care agency. These themes were found among the participants with a resilient condition and regulated blood glucose. CONCLUSIONS Resilient, support, benefits, and self-care agency are the themes for achieving diabetes resilience by adults with T2DM. Policymakers and health workers need to consider health interventions for increasing the resilience of T2DM patients so that they can achieve a better glycemic control condition, and manage their diet, medication, activity and stress properly.
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Affiliation(s)
| | - Hidayat Arifin
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
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Ho EY, Pak S, Leung G, Xu S, Yu CK, Hecht FM, Jih J, Chao MT. Pilot Cluster Randomized Controlled Trial of Integrative Nutritional Counseling Versus Standard Diabetes Self-Management Education for Chinese Americans with Type 2 Diabetes. Health Equity 2020; 4:410-420. [PMID: 33111026 PMCID: PMC7585608 DOI: 10.1089/heq.2020.0002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose: Chinese Americans (CAs) with diabetes and limited English proficiency often struggle to adhere to standard diabetes diets focused on food measurement/restriction. Chinese medicine principles commonly inform food choices among CAs but are rarely acknowledged in nutritional interventions. We developed and tested feasibility of a theoretically informed integrative nutritional counseling (INC) program that combines Chinese medicine principles with biomedical nutrition standards. Methods: We randomized diabetes self-management education (DSME) classes to include either: (1) usual nutrition curriculum based on American Diabetes Association (ADA) recommendations delivered by a diabetes educator (control) or (2) INC curriculum based on a combination of ADA recommendations and Chinese medicine principles delivered by a diabetes educator and a licensed acupuncturist (intervention). All DSME enrollees were invited to participate in research entailing data collection at three time points: baseline, after the DSME nutrition class, and at 6-month follow-up. Using validated measures, we collected dietary self-efficacy, diabetes distress, diet satisfaction, and dietary adherence. We also measured weight and glycemic control. Results: Study participants were 18 Cantonese-speaking patients with diabetes who were predominantly female and older, with low levels of income and acculturation. Intervention and control groups were similar at baseline. INC performed similarly to usual DSME with 100% of participants reporting the INC booklet helped their learning. Dietary adherence significantly improved in participants who received the INC curriculum. Conclusion: INC is feasible to implement as part of DSME classes and shows promise as a complementary culturally sensitive addition to usual diabetes nutrition education for CA patients.
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Affiliation(s)
- Evelyn Y Ho
- Department of Communication Studies, University of San Francisco, San Francisco, California, USA.,Asian American Research Center on Health, San Francisco, California, USA
| | - Sunny Pak
- Chinatown Public Health Center, San Francisco, California, USA
| | - Genevieve Leung
- Department of Rhetoric and Language, University of San Francisco, San Francisco, California, USA
| | - Shuwen Xu
- School of Nursing and Health Professions, University of San Francisco, San Francisco, California, USA
| | - Choi Kwun Yu
- School of Nursing and Health Professions, University of San Francisco, San Francisco, California, USA
| | - Frederick M Hecht
- Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, California, USA.,Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jane Jih
- Asian American Research Center on Health, San Francisco, California, USA.,Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, California, USA.,Multiethnic Health Equity Research Center, University of California San Francisco, San Francisco, California, USA
| | - Maria T Chao
- Asian American Research Center on Health, San Francisco, California, USA.,Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, California, USA.,Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
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12
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Martinez-Cardoso A, Jang W, Baig AA. Moving Diabetes Upstream: the Social Determinants of Diabetes Management and Control Among Immigrants in the US. Curr Diab Rep 2020; 20:48. [PMID: 32857197 PMCID: PMC9328159 DOI: 10.1007/s11892-020-01332-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Relative to the US-born population, immigrants are less likely to successfully manage and control their diabetes, leading to a host of diabetes-related complications. This review draws on the social determinants of health framework (SDoH) to summarize the multilevel factors that shape diabetes care and management among immigrants in the USA. RECENT FINDINGS While the diabetes literature is replete with research on individual-level risk factors and health behaviors, empirical literature linking the SDoH to diabetes management among immigrants is limited. However, housing precarity, food insecurity, poverty, uninsurance and underinsurance, and limited support for immigrants in healthcare systems are consistently shown to deter diabetes management and care. Immigrants with diabetes face a multitude of structural constraints to managing their diabetes. More research that theorizes the role of SDoH in diabetes management along with empirical qualitative and quantitative studies are needed. Interventions to address diabetes also require a more upstream approach in order to mitigate the drivers of diabetes disparities among immigrants.
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Affiliation(s)
- Aresha Martinez-Cardoso
- Department of Public Health Sciences, University of Chicago, 5841 South Maryland Ave, MC 2000, Chicago, IL, 60637, USA.
| | - Woorin Jang
- The College, University of Chicago, Chicago, IL, USA
| | - Arshiya A Baig
- Department of Medicine, University of Chicago, Chicago, IL, USA
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13
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Huang YC, Zuñiga J, Hua Y, García A. Emotional Distress and Self-Rated Health Among Middle-Aged and Older Chinese Americans with Type 2 Diabetes. J Immigr Minor Health 2020; 23:487-493. [DOI: 10.1007/s10903-020-01062-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Perceived Discrimination, Psychological Distress and Cardiovascular Risk in Migrants in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124601. [PMID: 32604844 PMCID: PMC7345483 DOI: 10.3390/ijerph17124601] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/16/2020] [Accepted: 06/24/2020] [Indexed: 01/29/2023]
Abstract
The aim of the present study is to determine the effect of discrimination and psychological distress on the cardiovascular health of immigrants, as well as to analyse potential differences based on age, gender, length of residence in host country and geographic origin. The sample was formed by 1714 immigrants from Africa, Eastern Europe and Latin America. Of the sample, 48.7% were men and 51.3% were women. Most relevant results show that discrimination (t = 4.27; p = 0.000) and psychological distress (t = 4.35; p = 0.000) experienced by immigrants predict their cardiovascular risk. Furthermore, psychological distress mediates the relation between discrimination and risk (t = 4.03; p = 0.000). Significant differences between men and women were found, as well as differences based on ethnicity, although to a lesser extent. Age affects the relation between discrimination, psychological distress and arterial hypertension and hypercholesterolemia. Results are notably relevant for the design of preventive health programmes for immigrants and intervention strategies in order to prevent diseases that may imply cardiovascular risks and seriously affect immigrants' health.
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15
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Xia A, Yau KW, Tang TS. When qualitative data contradict quantitative data: diabetes distress in the Chinese-Canadian community. Diabet Med 2020; 37:963-970. [PMID: 31498471 DOI: 10.1111/dme.14129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2019] [Indexed: 12/13/2022]
Abstract
AIMS To use both quantitative and qualitative approaches to characterize the diabetes distress profile of Chinese-Canadians with Type 2 diabetes and to better understand their experience of living with diabetes. METHODS We recruited 40 Chinese-Canadian adults with Type 2 diabetes who completed a Mandarin- or Cantonese-language diabetes education programme in Richmond, British Columbia. Using a mixed-methods sequential explanatory research design, participants first completed a 15-item Chinese version of the Diabetes Distress Scale, which included three subscales: emotional burden, regimen-related distress, and physician distress. The self-report survey was followed by a semi-structured interview that addressed the following diabetes-related topics: perspectives towards the healthcare team, emotional health, diabetes-related concerns and stressors, diabetes diagnosis experience, and sources of social support and diabetes education. RESULTS The mean (sd) scores for total distress 1.5 (0.5), emotional burden 1.7 (0.7), regimen-related distress 1.4 (0.5), and physician distress 1.4 (0.9), fell within the 'low distress' range (< 2.0). Qualitative analysis of semi-structured interviews showed that some participants were dissatisfied with diabetes care providers and experienced emotional challenges, particularly early in their diagnosis. Other themes that emerged included eating distress, fear of complications, language barriers, and medication concerns. CONCLUSIONS Not only did the qualitative findings from semi-structured interviews capture aspects of diabetes distress that were not included in the quantitative survey, it also uncovered inconsistencies between the two datasets. To more accurately understand the diabetes distress experience of any ethnic community, both quantitative and qualitative approaches contribute unique value.
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Affiliation(s)
- A Xia
- School of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - K W Yau
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - T S Tang
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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16
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Mao W, Li J, Xu L, Chi I. Acculturation and health behaviors among older Chinese immigrants in the United States: A qualitative descriptive study. Nurs Health Sci 2020; 22:714-722. [PMID: 32243730 DOI: 10.1111/nhs.12718] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 03/18/2020] [Accepted: 03/25/2020] [Indexed: 11/30/2022]
Abstract
Older immigrants tend to experience rapid deterioration in health after immigration. Changes in health behaviors over the course of acculturation are considered attributable factors. However, much remains unknown when it comes to acculturation experiences and health behaviors among older immigrants. This study explored acculturation in three domains (behavioral, cognitive, and identificational) and described how each domain of acculturation could influence various health behaviors among community-dwelling older Chinese immigrants in the United States. In this qualitative descriptive study, trained bilingual interviewers conducted in-depth individual interviews with 24 participants in the greater Los Angeles area. Acculturation experiences emerged from qualitative content analysis, such as high dependence on Chinese behavioral patterns and intraethnic networks and limited intergroup interactions (behavioral acculturation), strong maintenance of Chinese cultural values and some American cultural learning (cognitive acculturation), and strong identification with Chinese ethnicity (identificational acculturation). Behavioral acculturation and cognitive acculturation may influence various health behaviors, including eating/diet, exercise, chronic disease, and mental health management. By recognizing the unique acculturation experiences, interventions could be developed to promote healthy behaviors in achieving optimal health in this population.
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Affiliation(s)
- Weiyu Mao
- School of Social Work, University of Nevada, Reno, Reno, Nevada, USA
| | - Jia Li
- Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong, China
| | - Ling Xu
- School of Social Work, University of Texas at Arlington, Arlington, Texas, USA
| | - Iris Chi
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
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17
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Li-Geng T, Kilham J, McLeod KM. Cultural Influences on Dietary Self-Management of Type 2 Diabetes in East Asian Americans: A Mixed-Methods Systematic Review. Health Equity 2020; 4:31-42. [PMID: 32195450 PMCID: PMC7081245 DOI: 10.1089/heq.2019.0087] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose: Many East Asian Americans (EAAs) (populations originating from China, Korea, Japan, and Taiwan) with type 2 diabetes mellitus (T2DM) experience unique challenges in managing their disease, including language barriers and traditional cultural beliefs, particularly among first-generation immigrants.. The purpose of this mixed-methods systematic review was to examine cultural perspectives of EAAs that influence dietary self-management of T2DM and identify education interventions and their approaches to enhance EAAs' dietary self-management of diabetes. Methods: A mixed-methods systematic review was conducted to examine EAAs' perspectives from qualitative studies and to identify education interventions and their approaches from quantitative studies. A literature search was conducted using PubMed/MEDLINE, SCOPUS, CINAHL, and Web of Science from 1995 to 2018. Sixteen studies (10 qualitative and 6 quantitative) met criteria for analysis. Thematic synthesis of qualitative data was conducted using a line-by-line coding strategy. Extracted quantitative data were assessed for cultural approaches used in the interventions and diabetes-related outcomes. Results: In the qualitative studies, beliefs about food impacted EAAs' abilities to adopt appropriate dietary recommendations for diabetes management. Requiring a specialized diet disrupted social harmony and made EAAs feel burdensome to others. Having bilingual and bicultural resources eased the stress of making dietary modifications. The most commonly incorporated approaches in diabetes education interventions were bilingual education and culturally specific dietary recommendations. Social roles and harmony were not discussed. Significant reductions in hemoglobin A1c and increases in diabetes knowledge were reported post-intervention. Conclusions: Beliefs about food, beliefs about social roles, and access to culturally competent care play an important role in dietary self-management of T2DM among EAAs. Understanding the cultural influences on dietary self-management of T2DM and tailoring interventions to meet the needs of EAAs are essential in effort to address the growing epidemic and improve patient outcomes.
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Affiliation(s)
- Tony Li-Geng
- Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, Connecticut
| | - Jessica Kilham
- Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, Connecticut.,University of Massachusetts Medical School, Worcester, Massachusetts
| | - Katherine M McLeod
- Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, Connecticut
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18
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Qiu R, Schick-Makaroff K, Tang L, Wang X, Zhang Q, Ye Z. Chinese Hospitalized Cardiovascular Patients' Attitudes Towards Self-Management: A Qualitative Study. Patient Prefer Adherence 2020; 14:287-300. [PMID: 32109995 PMCID: PMC7034970 DOI: 10.2147/ppa.s236348] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 02/01/2020] [Indexed: 11/24/2022] Open
Abstract
PURPOSE This study is aiming to investigate cardiovascular patients' attitudes towards self-management during hospitalization in China. PATIENTS AND METHODS Twenty-nine individuals living with cardiovascular disease from one designated Cardiology Department in Hangzhou, China, were recruited through a purposive sampling procedure. A qualitative descriptive methodology was used. Semi-structured interviews were also used to gain attitudes toward self-management. The interviews were audio-recorded, transcribed and analyzed by thematic analysis to develop the results. RESULTS Four themes were identified from the qualitative data: (1): Responsibilities of self-management; (2): Reflections on self-management; (3): Acknowledgement of self-management support; (4): Challenges in implementing and adherence to self-management. Additionally, interview data were also given to illustrate these main themes emerging during the analysis. Patients gradually took their responsibilities to manage chronic symptoms. During their self-management process, they did reflections to help correct their regiments through supportive interactions. Health system responsiveness, health disparities, social capital, and cultural setting were the main external factors influencing better self-management implementation and adherence. CONCLUSION This study revealed the hospitalized cardiovascular patients' attitudes towards self-management in China. These findings emphasized the importance of patients' responsibility, reflections, and various social support receiving and pointed out specific external factors influencing the health outcomes and their quality of life. This study also proves the guide for the policymakers and health system better instructions to develop individually and culturally tailored advanced self-management interventions and programs.
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Affiliation(s)
- Ruolin Qiu
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | | | - Leiwen Tang
- Zhejiang University School of Medicine, Affiliated Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, People’s Republic of China
| | - Xiyi Wang
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Qi Zhang
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Zhihong Ye
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
- Correspondence: Zhihong Ye Faculty of Nursing, Zhejiang University School of Medicine, #704, Administrative Building, 3 East Qingchun Road, Hangzhou, Zhejiang310016, People’s Republic of ChinaTel +86 136 0661 2119 Email
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19
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Hombrados-Mendieta I, Millán-Franco M, Gómez-Jacinto L, Gonzalez-Castro F, Martos-Méndez MJ, García-Cid A. Positive Influences of Social Support on Sense of Community, Life Satisfaction and the Health of Immigrants in Spain. Front Psychol 2019; 10:2555. [PMID: 31803103 PMCID: PMC6872520 DOI: 10.3389/fpsyg.2019.02555] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 10/29/2019] [Indexed: 11/13/2022] Open
Abstract
The main objective of this study was to investigate the association of social support and the sense of community (SOC) with satisfaction with life (SWL) and immigrant health. We propose a model in which perceived social support from close sources (family and friends), as mediated by SOC and life satisfaction, would be positively associated with mental and physical health. Limited evidence exists from multivariate models that concurrently examine the association of both factors with SWL and health-related outcomes. We investigate the hypothesized association in a structural equations model (SEM) analysis. The participants consisted of 1131 immigrants (49% men and 51% women) (age 18-70, M = 33). The study was conducted in Malaga (Spain). Cross-sectional data were collected using a random-route sampling and survey methodology. In this model, greater social support from native friends was associated with a greater SOC. Social support from family and native friends was associated with greater SWL. Also, a greater SOC was associated with greater SWL. No association was found between SOC and mental health symptoms, whereas, greater SWL was associated with fewer mental health and illness symptoms. These results suggest that among immigrants, support networks involving family and native friends, and integration into the community are important influences for immigrants to achieve life satisfaction. These results are widely applicable and have implications that are relevant to the design of health promotion interventions.
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Affiliation(s)
- Isabel Hombrados-Mendieta
- Department of Social Psychology, University of Málaga, Málaga, Spain
- Facultad de Psicología, Universidad de Málaga, Málaga, Spain
| | | | - Luis Gómez-Jacinto
- Faculty of Social and Labour Studies, University of Málaga, Málaga, Spain
| | - Felipe Gonzalez-Castro
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, AZ, United States
| | | | - Alba García-Cid
- Facultad de Psicología, Universidad de Málaga, Málaga, Spain
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20
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Understanding the neighbourhood environment and the health and wellbeing of older Chinese immigrants: a systematic literature review. AGEING & SOCIETY 2019. [DOI: 10.1017/s0144686x1900134x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractNeighbourhood environment has a significant impact on the health and wellbeing of older people. In recent years, the increase in older Chinese immigrants globally has attracted a growing amount of research which has investigated the health and wellbeing of these elderly residents. The aim of this study is to provide a systematic literature review of empirical findings on the health and wellbeing of older Chinese immigrants and the ways in which the neighbourhood environment impacts them. A systematic search was conducted using online databases where 52 articles met specific criteria and were subsequently reviewed critically. An inductive approach was undertaken to analyse the data extracted from the selected articles. The review was categorised according to the following themes: neighbourhood social environment, neighbourhood physical environment and place attachment. The findings show that the majority of research has investigated the health status of older immigrants, and in particular, the impacts related to the social environments in which they live. The literature review indicated that there is scope for future studies to investigate the impact of the physical neighbourhood environment on this group of people.
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21
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Shamshirgaran SM, Jorm L, Lujic S, Bambrick H. Health related outcomes among people with type 2 diabetes by country of birth: Result from the 45 and Up Study. Prim Care Diabetes 2019; 13:71-81. [PMID: 30266514 DOI: 10.1016/j.pcd.2018.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 06/15/2018] [Accepted: 08/06/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ethnic variation in the occurrence of type 2 diabetes, complications, mortality, and health behaviours has been reported. The current research examined patterns of health-related outcomes by country of birth in people with diabetes aged 45years and over in New South Wales, Australia. METHODS This study was based on the baseline data of 266,848 participants aged 45years and over from "The Sax Institute's 45 and Up Study" (2006-2009), NSW; Australia's most populous state. Health-related factors including self-rated overall health, Quality of Life (QoL), eyesight, subjective memory complaint, hearing loss, psychological distress and functional limitation were examined according to country of birth among 23,112 people with type 2 diabetes. Logistic regression modelling was used to compare the odds of poor outcomes between Australian-born and overseas-born participants, adjusting for potential confounding and mediating variables. Both age-sex and fully adjusted odds ratios (aORs) are reported. RESULTS Nearly half of the people with diabetes in the sample reported hearing loss and high levels of functional limitations, a third reported poor overall health. Compared to people with diabetes born in Australia, people born in South East Europe, North Africa, the Middle East had significantly greater odds of poor outcomes across the majority of examined health-related factors, with the largest odds observed in the elevated level of psychological distress outcome (aOR=3.4 in North African and the Middle East group). Higher aORs of poor overall health, QoL, memory problems and poor eyesight, and lower aORs for hearing loss, were also found among those born in the Asian countries. CONCLUSIONS The results demonstrated significant ethnic disparity in the prevalence of health-related outcomes. These findings provide important context for the formulation of culturally sensitive secondary prevention strategies.
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Affiliation(s)
- Seyed Morteza Shamshirgaran
- Department of Statistics and Epidemiology, Tabriz University of Medical Science, Tabriz, Iran; Neyshabour Longitudinal Study on Aging Centre (NeLSA), Neyshabour University of Medical Sciences, Neyshabour, Iran.
| | - Louisa Jorm
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia.
| | - Sanja Lujic
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia.
| | - Hilary Bambrick
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia.
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22
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Chesla CA, Chun KM, Kwan CML. Biculturalism in couple support for diabetes care in U.S.-born Chinese Americans. Res Nurs Health 2019; 42:39-47. [PMID: 30620088 DOI: 10.1002/nur.21926] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 11/07/2018] [Indexed: 11/09/2022]
Abstract
Support in couples living with type 2 diabetes is associated with better health outcomes but support provision in collectivistic cultures has received limited research attention. To address this gap, we focused on couple dynamics and support in type 2 diabetes in U.S.-born Chinese Americans. Acculturation processes, particularly biculturalism, that is, the capacity to enact habits and practices from both the heritage and U.S. mainstream culture, were explored. Employing interpretive phenomenological methods, we conducted multiple narrative interviews with each of 15 couples regarding illness challenges and couple responses. Interviews were conducted in varied contexts, including with the couple, and in group interviews with people with diabetes or spouses. The unit of analysis was the couple, and narrative themes within the text were explored within the context of holistic couple summaries. We identified three key aspects of couple support: (i) Assisting with the diabetes treatment regimen; (ii) Moderating social and contextual factors that impede diabetes care; and (iii) Providing relational care and empathy for living with this challenging chronic condition. Support reflecting cultural maintenance of Chinese beliefs and practices include other directedness, family centeredness, and concerns for harmony and balance. Bicultural support patterns were also apparent in spousal communication that was both indirect and direct, and relationships marked by both interdependence and respect for independence or autonomy, reflecting both Chinese and U.S. cultural orientations, respectively. Working clinically with second and third generation Chinese immigrants requires clinical assessment of and responsiveness to couples' acculturation levels and bicultural skills.
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Affiliation(s)
- Catherine A Chesla
- Department of Family Health Care Nursing, University of California, San Francisco, California
| | - Kevin M Chun
- Department of Psychology, University of San Francisco, San Francisco, California
| | - Christine M L Kwan
- Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong
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23
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Nayar S, Wright-St Clair VA. Strengthening Community: Older Asian Immigrants’ Contributions to New Zealand Society. J Cross Cult Gerontol 2018; 33:355-368. [DOI: 10.1007/s10823-018-9357-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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24
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Pan W, Ge S, Xu Y, Toobert D. Cross-Validating a Structural Model of Factors Influencing Diabetes Self-Management in Chinese Americans with Type 2 Diabetes. J Transcult Nurs 2018; 30:163-172. [DOI: 10.1177/1043659618790085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Introduction: The purpose of this study was to cross-validate a structural model depicting the effects of individual and environmental factors on diabetes self-management in Chinese Americans with type 2 diabetes. Methodology: A cross-sectional survey was administered to a convenience sample of 209 Chinese Americans with type 2 diabetes in the Midwest of the United States. Structural equation modeling was used to cross-validate the model fit. Results: Provider–patient communication indirectly influenced self-management via belief in treatment. Knowledge indirectly influenced self-management via belief in treatment and self-efficacy. Social support indirectly influenced self-management via belief in treatment and knowledge. Discussion: This study demonstrated that the structural model, previously tested with Chinese diabetes patients in China, also fits Chinese Americans in the United States with few modifications. The cross-validated model provides a theoretical basis for developing culturally relevant diabetes self-management interventions for Chinese Americans, which may lead to health improvements in this ethnic population.
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Affiliation(s)
- Wei Pan
- Duke University, Durham, NC, USA
| | | | - Yin Xu
- Innovative Spine and Orthopedic Clinic, San Antonio, TX, USA
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25
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Vongmany J, Luckett T, Lam L, Phillips JL. Family behaviours that have an impact on the self-management activities of adults living with Type 2 diabetes: a systematic review and meta-synthesis. Diabet Med 2018; 35:184-194. [PMID: 29150863 DOI: 10.1111/dme.13547] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2017] [Indexed: 12/27/2022]
Abstract
AIMS To identify family behaviours that adults with Type 2 diabetes' perceive as having an impact on their diabetes self-management. BACKGROUND Research suggests that adults with Type 2 diabetes perceive that family members have an important impact on their self-management; however, it is unclear which family behaviours are perceived to influence self-management practices. METHODS This meta-synthesis identified and synthesized qualitative studies from the databases EMBASE, Medline and CINAHL published between the year 2000 and October 2016. Studies were eligible if they provided direct quotations from adults with Type 2 diabetes, describing the influence of families on their self-management. This meta-synthesis adheres to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. RESULTS Of the 2606 studies screened, 40 were included. This meta-synthesis identified that adults with Type 2 diabetes perceive family behaviours to be either: 1) facilitators of diabetes self-management; 2) barriers to diabetes self-management; or 3) equivocal behaviours with the potential to both support and/or impede diabetes self-management. Seven sub-themes were identified within these themes, including: four facilitator sub-themes ('positive care partnerships'; 'family watchfulness'; 'families as extrinsic motivator' and 'independence from family'); two barrier sub-themes ('obstructive behaviours' and 'limited capacity for family support'); and one equivocal behaviours subtheme ('regular reminders and/or nagging'). CONCLUSION While most family behaviours are unambiguously perceived by adults with Type 2 diabetes to act as facilitators of or barriers to self-management, some behaviours were perceived as being neither clear facilitators nor barriers; these were termed 'equivocal behaviours'. If the concept of 'equivocal behaviours' is confirmed, it may be possible to encourage the adult living with Type 2 diabetes to reframe these behaviours so that they are perceived as enabling their diabetes self-management.
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Affiliation(s)
- J Vongmany
- Centre for Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - T Luckett
- Centre for Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - L Lam
- Centre for Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - J L Phillips
- Centre for Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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Martinez K, Orellana MF, Murillo MA, Rodriguez MA. Health Insurance, from a Child Language Broker's Perspective. INTERNATIONAL MIGRATION 2017. [DOI: 10.1111/imig.12380] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
| | | | | | - Michael A. Rodriguez
- UCLA Department of Family Medicine at the David Geffen School of Medicine
- UCLA Blum Center on Poverty and Health in Latin America, and AltaMed Institute for Health Equity
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Chun KM, Kwan CML, Strycker LA, Chesla CA. Acculturation and bicultural efficacy effects on Chinese American immigrants' diabetes and health management. J Behav Med 2016; 39:896-907. [PMID: 27412776 PMCID: PMC5014659 DOI: 10.1007/s10865-016-9766-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 07/04/2016] [Indexed: 10/21/2022]
Abstract
The primary goal of this study was to examine effects of bicultural efficacy, or perceived confidence in dealing with bicultural acculturation stressors, on type 2 diabetes management and health for first-generation, Cantonese-speaking, Chinese American immigrants (N = 162) recruited for a larger community-based diabetes intervention study (Chesla et al. in Res Nurs Health 36(4):359-372, 2013. doi: 10.1002/nur.21543 ). The current study also tested whether a new Bicultural Efficacy in Health Management (BEFF-HM) scale is a more robust predictor of diabetes and health outcomes than proxy (years in the U.S.) and general acculturation measures. Hierarchical regression analyses of cross-sectional data revealed that high BEFF-HM was significantly related to positive outcomes on five of six diabetes and health measures as hypothesized after accounting for participant characteristics, proxy and general acculturation measures, and social support. Proxy and general acculturation measures failed to predict any study outcome supporting our secondary hypothesis that BEFF-HM is a better predictor of Chinese American immigrants' diabetes and health management. An immigrant-focused research approach advances understanding of acculturation and bicultural efficacy effects on health by identifying key acculturation domains for study.
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Affiliation(s)
- Kevin M Chun
- Department of Psychology, University of San Francisco, 2130 Fulton Street, San Francisco, CA, USA.
| | - Christine M L Kwan
- Sau Po Centre on Ageing, The University of Hong Kong, Pok Fu Lam Road, Hong Kong, Hong Kong
| | | | - Catherine A Chesla
- Department of Family Health Care Nursing, University of California, San Francisco, CA, USA
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Chesla CA, Chun KM, Kwong Y, Gay CL, Chi HL, Gu Y, Hernandez L, Huang P, Strycker LA, Ma J. Cultural Adaptation of the Group Lifestyle Balance Program for Chinese Americans. DIABETES EDUCATOR 2016; 42:686-696. [PMID: 27624905 DOI: 10.1177/0145721716666679] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this pilot study was to develop and evaluate a culturally adapted, language-translated diabetes prevention program for Chinese Americans. METHODS This pilot study had a single-group repeated-measures design. Participants were 25 first-generation (n = 20) or second-generation (n = 5) Chinese Americans at risk for diabetes because of overweight (using the Asian-specific criterion of body mass index ≥ 23) and either prediabetes or metabolic syndrome. The 16-session program was administered over 6 months in separate Mandarin (n = 9) and English (n = 16) groups. Outcomes were assessed at baseline and at 3 and 6 months. Four participants dropped out. Multilevel regression models were used to examine change in study outcomes over time. RESULTS Participants lost an average of 5.4% of their body weight across the 6 months of the study. Self-report questionnaires suggested improved dietary intake and increased physical activity. Both total and low-density lipoprotein cholesterol levels improved. There were no statistically significant changes in fasting plasma glucose or A1C levels. Participants reported high satisfaction with and acceptance of the program. CONCLUSION Results suggest that the culturally adapted Group Lifestyle Balance program for Chinese Americans was both acceptable and effective. The culturally adapted program warrants further examination using scientific approaches for dissemination and implementation.
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Affiliation(s)
- Catherine A Chesla
- Department of Family Health Care Nursing, University of California, San Francisco, San Francisco, California (Dr Chesla, Dr Gay, Dr Hernandez)
| | - Kevin M Chun
- University of San Francisco, San Francisco, California (Dr Chun)
| | - Yulanda Kwong
- Donaldina Cameron House, San Francisco, California (Ms Kwong)
| | - Caryl L Gay
- Department of Family Health Care Nursing, University of California, San Francisco, San Francisco, California (Dr Chesla, Dr Gay, Dr Hernandez)
| | - Han-Lin Chi
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, California (Dr Chi)
| | - Yunzi Gu
- San Francisco Veterans Affairs Health Care System, San Francisco, California (Ms Gu)
| | - Lenore Hernandez
- Department of Family Health Care Nursing, University of California, San Francisco, San Francisco, California (Dr Chesla, Dr Gay, Dr Hernandez)
| | - Peggy Huang
- Diabetes Teaching Center, University of California, San Francisco, San Francisco, California (Ms Huang)
| | | | - Jun Ma
- University of Illinois at Chicago, Chicago, Illinois (Dr Ma)
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Gandhi KK, Baranowski T, Anderson BJ, Bansal N, Redondo MJ. Psychosocial aspects of type 1 diabetes in Latino- and Asian-American youth. Pediatr Res 2016; 80:347-55. [PMID: 27074124 DOI: 10.1038/pr.2016.87] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 02/18/2016] [Indexed: 11/09/2022]
Abstract
Latino and Asian-Americans represent the fastest growing immigrant populations in the United States. We aimed to review the current knowledge on the psychosocial factors that influence type 1 diabetes (T1D) care, education, and outcomes in Latino and Asian-American youth immigrants in the United States, as well as culturally sensitive programs to address health disparities. We conducted a narrative, conceptual review of studies on T1D in Latino and Asian-American youth and relevant studies in type 2 diabetes and adults. Approximately 50% of both Latino and Asian-American youth with T1D are in suboptimal glycemic control. Socioeconomic status, literacy, English proficiency, acculturation, access to health care, family functioning, mental health, and nutrition influence T1D care and outcomes. However, the degree to which these complex, inter-related and dynamic factors affect long-term T1D outcomes is largely unknown. Culturally sensitive programs for Latino or Asian-American youth with T1D are scarce in the United States. Research is needed among Latino and Asian-American youth with T1D so that comprehensive, culturally sensitive diabetes education, and care programs can be developed to decrease disparities in the health burden of these groups.
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Affiliation(s)
- Kajal K Gandhi
- Division of Pediatric Endocrinology and Metabolism, Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
| | - Tom Baranowski
- Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas
| | - Barbara J Anderson
- Division of Psychology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Nidhi Bansal
- Division of Pediatric Endocrinology and Metabolism, Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
| | - Maria J Redondo
- Division of Pediatric Endocrinology and Metabolism, Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
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Yan Z, FitzPatrick K. Acculturation and health behaviors among international students: A qualitative approach. Nurs Health Sci 2016; 18:58-63. [DOI: 10.1111/nhs.12232] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 05/14/2015] [Accepted: 05/26/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Zi Yan
- Health Sciences; Merrimack College; North Andover Massachusetts USA
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Park C, Nam S, Whittemore R. Incorporating Cultural Perspectives into Diabetes Self-Management Programs for East Asian Immigrants: A Mixed-Study Review. J Immigr Minor Health 2015; 18:454-67. [DOI: 10.1007/s10903-015-0181-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Hung SLL, Fu SN, Lau PS, Wong SYS. A qualitative study on why did the poorly-educated Chinese elderly fail to attend nurse-led case manager clinic and how to facilitate their attendance. Int J Equity Health 2015; 14:10. [PMID: 25636857 PMCID: PMC4322441 DOI: 10.1186/s12939-015-0137-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 01/06/2015] [Indexed: 11/25/2022] Open
Abstract
Objectives This study explored the views, barriers and facilitators of the poorly-educated elderly who were non-attendee of the nurse-led case manager clinic. The case managers provide assessment for diabetes complication screening and can refer patients to the appropriate multidisciplinary team in public outpatient primary care setting. Methods We adopted qualitative research method by individual semi-structured face to face interviews. Nineteen Chinese type 2 diabetes mellitus subjects aged ≥ 60 who failed to attend the nurse-led case manager clinic were interviewed. They all came from a socially deprived urban district in Hong Kong. Content and thematic analysis was performed. Results Seven men and twelve women aged 60 to 89 were interviewed. Nine of them received no formal education and ten of them attended up to primary school. The reasons for non-attendance included attitude and poor knowledge towards diabetes complication screening and confusion of the nurse-led clinic as an educational talk. Most respondents could not understand the reason for the screening of diabetic complications, the concept of multidisciplinary care and the procedure and outcomes of nurse assessment. Five respondents were unable to follow multiple appointments because they could not read. Other reasons included physical barriers and comorbidity, family and financial constraint. They either had a tight daily schedule because of the need to take care of family members, or the family members who brought them to clinic had difficulty in attending multiple appointments. Enhanced understanding of the importance and procedure of diabetes multidisciplinary management, a flexible appointment system and a single clear appointment sheet may facilitate their attendance. Conclusion Poorly-educated Chinese elderly with DM and their care givers faced physical, social and psychological barriers when attending the nurse-led case manager clinic. Strategies targeting on their low literacy include effective communication and education by health care professionals to arrive a shared understanding of care plan as well as a flexible appointment and schedule system.
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Affiliation(s)
- Susanna Lok Lam Hung
- Department of Family Medicine and Primary Health Care, Kowloon West Cluster, Hospital Authority, 1/F, Our Lady of Maryknoll Hospital, Wong Tai Sin, Kowloon, Hong Kong S.A.R., China.
| | - Sau Nga Fu
- Department of Family Medicine and Primary Health Care, Kowloon West Cluster, Hospital Authority, 1/F, Our Lady of Maryknoll Hospital, Wong Tai Sin, Kowloon, Hong Kong S.A.R., China.
| | - Po Shan Lau
- Department of Family Medicine and Primary Health Care, Kowloon West Cluster, Hospital Authority, 1/F, Our Lady of Maryknoll Hospital, Wong Tai Sin, Kowloon, Hong Kong S.A.R., China.
| | - Samuel Yeung Shan Wong
- Division of Family Medicine and Primary Healthcare, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, 4/F, School of Public Health, Prince of Wales Hospital, Shatin, N.T., Hong Kong S.A.R., China.
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Development of culturally appropriate low GI breakfast meals for Asian populations. Proc Nutr Soc 2015. [DOI: 10.1017/s0029665115002669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Wang W, Yu N. Coping with a New Health Culture: Acculturation and Online Health Information Seeking Among Chinese Immigrants in the United States. J Immigr Minor Health 2014; 17:1427-35. [PMID: 25228489 DOI: 10.1007/s10903-014-0106-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Weirui Wang
- Department of Advertising and Public Relations, School of Journalism and Mass Communication, Florida International University, 3000 NE 151 ST., ACII-328, North Miami, FL, 33181, USA,
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Chen WT. Chinese female immigrants english-speaking ability and breast and cervical cancer early detection practices in the New York metropolitan area. Asian Pac J Cancer Prev 2014; 14:733-8. [PMID: 23621228 DOI: 10.7314/apjcp.2013.14.2.733] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Breast and cervical cancers are significant causes of mortality and morbidity for Asian women, and poor English-speaking ability is a barrier to cancer prevention practices. MATERIALS AND METHODS This project tested relationships among English-speaking ability and early detection practices regarding to breast and cervical cancer among female Chinese immigrants. A descriptive cross-sectional survey was used. RESULTS 175 female Chinese immigrants completed the survey in the breast cancer prevention section, and 35 of them also completed the cervical cancer prevention section. Some 63% of them had heard about the clinical breast exam (CBE), but only 54% had had a CBE. While 46% of the participants were aware of their need for a Pap smear, only 31% had heard about it and had undergone a pelvic exam. CONCLUSIONS English-speaking ability was strongly associated with immigrant women's knowledge of female cancer early detection. Culturally and linguistic issues should be considered as the first step to access immigrant population in designing future education intervention.
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Affiliation(s)
- Wei-Ti Chen
- School of Nursing , Yale University, CT, USA.
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36
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Towards a conceptual model of diabetes self-management among Chinese immigrants in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:6727-42. [PMID: 24978878 PMCID: PMC4113840 DOI: 10.3390/ijerph110706727] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 06/06/2014] [Accepted: 06/06/2014] [Indexed: 11/29/2022]
Abstract
Background: Chinese immigrants have been disproportionally affected by type 2 diabetes. This paper presents the state of science regarding the factors that may influence diabetes self-management among Chinese immigrants in the US and the potential health outcomes. Design: Using Walker and Avant’s techniques, a search of the literature was conducted from CINAHL, PubMed, OVID, and Web of Science. Findings: Factors most relevant to diabetes self-management were grouped under five categories: socio-demographic characteristics, behavioral and psychological characteristics, social support, linguistic barriers, and cultural characteristics. Potential outcomes derived from improved diabetes self-management include quality of life, glycosylated hemoglobin, and blood pressure and other cardiovascular risk factors. Discussion: A conceptual model was provided to guide future research. Based on the review of the literature, specific research topics that need to fill the gaps in the literature were provided, including family-focused interventions for Chinese immigrant patients with diabetes and the effectiveness of these interventions to improve family functioning.
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Abstract
OBJECTIVE Among Chinese immigrant populations, increasing duration of US residence is associated with elevated risk for various chronic diseases. Although life-style changes after migration have been extensively studied in immigrant populations, the psychosocial impact of acculturative stress on biological markers of health is less understood. Thus, the purpose of the present study is to examine associations between acculturative stress and inflammatory markers in a Chinese immigrant population. METHODS Study participants (n = 407 foreign-born Chinese American women) completed questionnaires assessing levels of stress, including acculturative stress and positive and negative life events in the previous year. Participant height and weight were measured using standard protocols, and blood samples were drawn for assessment of circulating serum levels of C-reactive protein (CRP) and soluble tumor necrosis factor receptor 2 (sTNFR2). RESULTS Higher levels of acculturative stress were significantly associated with higher levels of CRP (B = 0.07, 95% confidence interval = 0.01-0.13, p = .031) and sTNFR2 (B = 0.02, 95% confidence interval = 0.004-0.03, p = .012), adjusting for age and body mass index. The latter association was no longer statistically significant when overall acculturation (i.e., identification with American culture) was included in the model. Life events were not associated with CRP or sTNFR2. CONCLUSIONS This is one of the first studies to demonstrate that acculturative stress is associated with inflammatory markers in a Chinese immigrant population. Replication in other immigrant samples is needed to fully establish the biological correlates and clinical consequences of acculturative stress.
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Abstract
Increasing cultural diversity in the United States and significant health disparities among immigrant populations make acculturation an important concept to measure in health research. The purpose of this cross-sectional, descriptive study was to examine acculturation and health of Korean American adults. A convenience sample of 517 Korean American adults in a Midwestern city completed a survey in either English or Korean. All four groups of Berry's acculturation model were identified using cluster analysis with Lee's Acculturation Scale. Assimilation, integration, and separation were found in the English survey sample, whereas integration, separation, and marginalization were found in the Korean survey sample. Moreover, the findings revealed that acculturation is a bidimensional process, and the unique nature of samples may determine acculturation groups. Physical health and mental health were significantly related to acculturation in the English survey sample. However, there was not a significant relationship between health and acculturation in the Korean survey sample.
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Chesla CA, Kwan CML, Chun KM, Stryker L. Gender differences in factors related to diabetes management in Chinese American immigrants. West J Nurs Res 2014; 36:1074-90. [PMID: 24558055 DOI: 10.1177/0193945914522718] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Chinese American women with type 2 diabetes (T2DM) are more vulnerable to poor diabetes outcomes than men because immigrant status, ethnicity, and economics intersect with gender to diminish disease management opportunities. We explored gender differences in factors associated with diabetes management at intake and after treatment with a behavioral intervention in first-generation Chinese American immigrants. A sample of 178 Chinese Americans with T2DM was enrolled in a single-cohort, repeated-measures delayed-treatment trial. Data were collected at baseline, 8, 16, 24, and 32 weeks with 6-week treatment provided after 16 weeks. Gender differences at baseline and gender by treatment interactions were noted. Women at baseline reported significantly worse depressive symptoms and general health. Significant gender by treatment interactions were observed for diabetes self-efficacy, bicultural efficacy, family instrumental support, and diabetes quality of life-satisfaction. Only women showed improvement, suggesting women benefited more from the intervention in psychosocial factors related to diabetes management.
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Tseng J, Halperin L, Ritholz MD, Hsu WC. Perceptions and management of psychosocial factors affecting type 2 diabetes mellitus in Chinese Americans. J Diabetes Complications 2013; 27:383-90. [PMID: 23545465 DOI: 10.1016/j.jdiacomp.2013.01.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2012] [Revised: 12/11/2012] [Accepted: 01/10/2013] [Indexed: 10/27/2022]
Abstract
Diabetes has become a global pandemic and Chinese Americans are at least 60% more likely to develop type 2 diabetes than White Americans, despite having lower body weight, due to a combination of genetic and environmental factors. Because of the increased risk, it is vitally important to address the issues of treatment adherence and diabetes self-management in the Chinese American population. Many factors affect an individual's ability to manage diabetes, including cultural beliefs, immigration experience, language abilities/health literacy, educational background, employment, and accessibility of healthcare services. In treating Chinese American patients, these factors must be considered to determine appropriate treatment. Eastern cultural and individual beliefs differ greatly from Western beliefs and, therefore, may affect the presentation of the patients. If left unacknowledged, these differences might be misinterpreted by healthcare providers as merely treatment non-adherence or unwillingness to change. Suggestions for providing culturally competent healthcare are discussed.
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Affiliation(s)
- Juliana Tseng
- Asian American Diabetes Initiative, Joslin Diabetes Center, Boston, MA 02215, USA
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41
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Korean Americans' Beliefs about Colorectal Cancer Screening. Asian Nurs Res (Korean Soc Nurs Sci) 2013; 7:45-52. [DOI: 10.1016/j.anr.2012.10.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 09/07/2012] [Accepted: 09/29/2012] [Indexed: 11/19/2022] Open
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Chesla CA, Chun KM, Kwan CML, Mullan JT, Kwong Y, Hsu L, Huang P, Strycker LA, Shum T, To D, Kao R, Waters CM. Testing the efficacy of culturally adapted coping skills training for Chinese American immigrants with type 2 diabetes using community-based participatory research. Res Nurs Health 2013; 36:359-72. [PMID: 23606271 DOI: 10.1002/nur.21543] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2013] [Indexed: 11/08/2022]
Abstract
Chinese Americans demonstrate greater prevalence of diabetes than non-Hispanic whites and find standard diabetes care disregards their cultural health beliefs. Academic researchers and Chinatown agencies collaborated to culturally adapt and test an efficacious cognitive-behavioral intervention using community-based participatory research. Using a delayed-treatment repeated-measures design, 145 adult Chinese immigrants with Type 2 diabetes completed treatment. Immediate benefits of treatment were evident in the improvement (p < .05) in diabetes self-efficacy, diabetes knowledge, bicultural efficacy, family emotional and instrumental support, diabetes quality of life, and diabetes distress. Prolonged benefits were evident in all changed variables 2 months post-intervention. The CBPR approach enabled the development of a culturally acceptable, efficacious behavioral intervention, and provides a model for working with communities that demonstrate health disparities.
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Affiliation(s)
- Catherine A Chesla
- Department of Family Health Care Nursing, University of California San Francisco, 2 Koret Way, Box 0606, San Francisco, CA 94143-0606, USA
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Deng F, Zhang A, Chan CB. Acculturation, Dietary Acceptability, and Diabetes Management among Chinese in North America. Front Endocrinol (Lausanne) 2013; 4:108. [PMID: 23986745 PMCID: PMC3753561 DOI: 10.3389/fendo.2013.00108] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 08/07/2013] [Indexed: 12/16/2022] Open
Abstract
Immigrants to a new country face many challenges when diagnosed with type 2 diabetes, a chronic disease with a complex treatment involving both medical and behavioral interventions. These challenges will depend upon the extent to which the patient has adapted to the new country's social and cultural norms, as well as individual factors such as age, education, and gender. This adaptation is termed acculturation. With respect to nutritional interventions for type 2 diabetes, uptake and adherence over the long term will depend upon overall health literacy, the cultural acceptability of the recommended diet. This review has focused on acculturation and its effects on diabetes management in ethnic Chinese in North America as an example of one populous minority and the challenges faced in adopting nutritional recommendations. Research directions and practical considerations are suggested.
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Affiliation(s)
- Feiyue Deng
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Anran Zhang
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Catherine B. Chan
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
- Department of Physiology, University of Alberta, Edmonton, AB, Canada
- *Correspondence: Catherine B. Chan, 6-002 Li Ka Shing Centre, University of Alberta, Edmonton, Alberta T6G 2R3, Canada e-mail:
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Naranjo D, Hessler DM, Deol R, Chesla CA. Health and psychosocial outcomes in U.S. adult patients with diabetes from diverse ethnicities. Curr Diab Rep 2012; 12:729-38. [PMID: 22961116 DOI: 10.1007/s11892-012-0319-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Within the United States, diabetes is a serious public health concern and patients with diabetes are more likely to experience clinical depression, psychological distress, and depressive symptoms than those without. Negative psychosocial factors are associated with poorer diabetes management and glycemic control. Overall, both the rates of diabetes and related psychological distress are greater for persons of diverse ethnicities than for non-Latino whites, and have reached epidemic proportions in certain groups. The following article will provide an overview across ethnicities of the rates of diabetes, health outcomes, psychosocial outcomes, and unique cultural and linguistic challenges that contribute to disparities within US diabetes patients of diverse ethnicities. Using this information, our hope is that health care practitioners and researchers alike can better respond to the psychosocial needs of ethnically diverse patients.
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Affiliation(s)
- Diana Naranjo
- Department of Pediatrics, University of California San Francisco, 400 Parnassus Avenue, 4th Floor, UCSF, MailBox 0318, San Francisco, CA 94143-0318, USA.
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Kumsuk S, Flick LH, Schneider CSJK. Development of the Thai breast cancer belief scale for Thai immigrants in the United States. J Nurs Meas 2012; 20:123-41. [PMID: 22988783 DOI: 10.1891/1061-3749.20.2.123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Asian American women have not benefited from the decline in breast cancer mortality and have lower rates of mammography use. Understanding mammography behaviors among these Asian American women requires culturally specific measures. Champion's belief scale was translated into Thai and cultural items were added. The Thai breast cancer belief scale (TBCBS), the Suinn-Lew self-identification acculturation, and the Asian values scale-revised were administered to 250 Thai immigrants. The TBCBS was tested for face validity, construct validity, and internal consistency. Factor analysis reflected the 4 constructs of the health belief model and accounted for 45.8% of the variance. Cronbach's alpha ranged from .77 to .90. Modest correlations were observed between TBCBS subscales and acculturation scales. Results indicate that the TBCBS measures breast cancer beliefs among Thai immigrant population.
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Cha E, Yang K, Lee J, Min J, Kim KH, Dunbar SB, Jennings BM. Understanding cultural issues in the diabetes self-management behaviors of Korean immigrants. DIABETES EDUCATOR 2012; 38:835-44. [PMID: 23019236 DOI: 10.1177/0145721712460283] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE The purpose of this study was to explore potential factors affecting the self-management behaviors of Korean immigrants with type 2 diabetes mellitus (KIT2Ds). METHODS A qualitative descriptive design guided this study. Semistructured interviews lasting 45 to 60 minutes were conducted with 20 KIT2Ds in the participants' preferred language; in all cases, this was Korean. Each interview was audiotaped, transcribed, and analyzed using conventional content analysis. Data analysis was performed in two steps. The data written in Korean were initially analyzed by 3 bilingual researchers. A qualitative researcher then participated in the analysis to refine the findings for presentation to an English-speaking audience while staying true to the data and preserving the nuanced Korean meanings. RESULTS The mean age of the sample was 64. 5 ± 11.6 years (9 men and 11 women). The mean years of staying in the United States and age at diabetes mellitus diagnosis were 23.6 ± 9.7 years and 52.5 ± 12.3 years, respectively. Three major ideas were identified: (1) issues on treatment regimen related to medications and diet, (2) resources that helped or hindered ability to manage diabetes, and (3) the physician-patient relationship. CONCLUSIONS Important cultural nuances need to be addressed to better prepare KIT2Ds to manage their diabetes more effectively. A culture-specific program should extend beyond a diabetes self-management education delivered in Korean language. Rather, content and education methods need to consider acculturation effects on diabetes management behaviors.
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Affiliation(s)
- EunSeok Cha
- Emory University, Atlanta, Georgia (Dr Cha, Ms Min, Dr Dunbar, Dr Jennings)
| | - Kyeongra Yang
- University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Yang, Dr Kim)
| | - Jia Lee
- District 2 Public Health, Gainesville, Georgia (Ms Lee)
| | - Jiwon Min
- Emory University, Atlanta, Georgia (Dr Cha, Ms Min, Dr Dunbar, Dr Jennings)
| | - Kevin H Kim
- University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Yang, Dr Kim)
| | - Sandra B Dunbar
- Emory University, Atlanta, Georgia (Dr Cha, Ms Min, Dr Dunbar, Dr Jennings)
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Sun AC, Tsoh JY, Saw A, Chan JL, Cheng JW. Effectiveness of a culturally tailored diabetes self-management program for Chinese Americans. THE DIABETES EDUCATOR 2012; 38:685-94. [PMID: 22722610 PMCID: PMC4732271 DOI: 10.1177/0145721712450922] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of the study was to test the feasibility and efficacy of a diabetes self-management and education program for Chinese Americans in a support group format. The rationale for the study was to create culturally appropriate diabetes education and management programs in response to the growing diabetes prevalence among Chinese Americans. The investigators hypothesized that participants will have improved diabetes knowledge and practices, hemoglobin A1C, and social support. The study objectives were at least: 50% will have significant improvements in diabetes knowledge and practice activities, 30% of participants will have significant improvements in A1C, and 50% will report a gain in emotional support. METHODS The program consisted of 12 90-minute diabetes education and support group sessions offered in a medical office setting. The sample included 23 Chinese Americans with either type 1 or type 2 diabetes. Using a single-group, pre-post test design, A1C and diabetes knowledge were assessed at baseline and 6 months. Data were collected through clinical assessments and written questionnaires. RESULTS The results indicated high attendance and statistically significant increases in glycemic control and diabetes knowledge. Statistically insignificant differences were shown in diabetes management practices. Secondary outcomes assessed participants' perceived diabetes management and emotional and social support. CONCLUSIONS Diabetes Self-Management: A Cultural Approach (DSMCA) support group model demonstrates that a culturally tailored support group utilizing a community-based participatory research approach is an effective format to improve diabetes self-management skills among Chinese Americans. The program can be adapted for other ethnic populations. The efficacy of the intervention can be further tested in larger randomized trials.
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Affiliation(s)
- Angela C Sun
- Chinese Community Health Resource Center, San Francisco, California (Dr Sun, Ms Chan, Ms Cheng)
| | - Janice Y Tsoh
- University of California, San Francisco, San Francisco, California (Dr Tsoh)
| | - Anne Saw
- University of California, Davis, Davis, California (Dr Saw)
| | - Joanne L Chan
- Chinese Community Health Resource Center, San Francisco, California (Dr Sun, Ms Chan, Ms Cheng)
| | - Joyce W Cheng
- Chinese Community Health Resource Center, San Francisco, California (Dr Sun, Ms Chan, Ms Cheng)
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King GL, McNeely MJ, Thorpe LE, Mau MLM, Ko J, Liu LL, Sun A, Hsu WC, Chow EA. Understanding and addressing unique needs of diabetes in Asian Americans, native Hawaiians, and Pacific Islanders. Diabetes Care 2012; 35:1181-8. [PMID: 22517939 PMCID: PMC3329823 DOI: 10.2337/dc12-0210] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- George L King
- Asian American Diabetes Initiative, Joslin Diabetes Center, Harvard Medical School, Boston,Massachusetts, USA.
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Brämberg EB, Dahlborg-Lyckhage E, Määttä S. Lack of individualized perspective: a qualitative study of diabetes care for immigrants in Sweden. Nurs Health Sci 2012; 14:244-9. [PMID: 22490066 DOI: 10.1111/j.1442-2018.2012.00684.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study describes the care provided by a diabetes nurse specialist, and the care needs expressed by people with type 2 diabetes mellitus and an immigrant background. Clinical encounters between a diabetes nurse specialist and 10 people diagnosed with type 2 diabetes mellitus were observed and analyzed by means of qualitative content analysis. One theme, "the diabetes nurse specialist as the conductor of the visit", and four categories emerged from the findings, illustrating the power imbalance between the patients and the diabetes nurse specialist, as well as the lack of an individual perspective. Shifting from a medical perspective to one of openness towards the people's experiences provides a possibility for caregivers to empower patients suffering from type 2 diabetes mellitus. The medical perspective seemed to steer the visit towards curative activities. Thus, technique-centered care should be developed by including individualized care.
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Affiliation(s)
- Elisabeth Björk Brämberg
- Institution of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Hinder S, Greenhalgh T. "This does my head in". Ethnographic study of self-management by people with diabetes. BMC Health Serv Res 2012; 12:83. [PMID: 22458767 PMCID: PMC3349490 DOI: 10.1186/1472-6963-12-83] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 03/29/2012] [Indexed: 11/24/2022] Open
Abstract
Background Self-management is rarely studied 'in the wild'. We sought to produce a richer understanding of how people live with diabetes and why self-management is challenging for some. Method Ethnographic study supplemented with background documents on social context. We studied a socio-economically and ethnically diverse UK population. We sampled 30 people with diabetes (15 type 1, 15 type 2) by snowballing from patient groups, community contacts and NHS clinics. Participants (aged 5-88, from a range of ethnic and socio-economic groups) were shadowed at home and in the community for 2-4 periods of several hours (total 88 visits, 230 hours); interviewed (sometimes with a family member or carer) about their self-management efforts and support needs; and taken out for a meal. Detailed field notes were made and annotated. Data analysis was informed by structuration theory, which assumes that individuals' actions and choices depend on their dispositions and capabilities, which in turn are shaped and constrained (though not entirely determined) by wider social structures. Results Self-management comprised both practical and cognitive tasks (e.g. self-monitoring, menu planning, medication adjustment) and socio-emotional ones (e.g. coping with illness, managing relatives' input, negotiating access to services or resources). Self-management was hard work, and was enabled or constrained by economic, material and socio-cultural conditions within the family, workplace and community. Some people managed their diabetes skilfully and flexibly, drawing on personal capabilities, family and social networks and the healthcare system. For others, capacity to self-manage (including overcoming economic and socio-cultural constraints) was limited by co-morbidity, cognitive ability, psychological factors (e.g. under-confidence, denial) and social capital. The consequences of self-management efforts strongly influenced people's capacity and motivation to continue them. Conclusion Self-management of diabetes is physically, intellectually, emotionally and socially demanding. Non-engagement with self-management may make sense in the context of low personal resources (e.g. health literacy, resilience) and overwhelming personal, family and social circumstances. Success of self-management as a policy solution will be affected by interacting influences at three levels: [a] at micro level by individuals' dispositions and capabilities; [b] at meso level by roles, relationships and material conditions within the family and in the workplace, school and healthcare organisation; and [c] at macro level by prevailing economic conditions, cultural norms and expectations, and the underpinning logic of the healthcare system. We propose that the research agenda on living with diabetes be extended and the political economy of self-management systematically studied.
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Affiliation(s)
- Susan Hinder
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, London, UK
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