When adults with diabetes attempt to drink less soda: resulting adult-child interactions and household changes

A randomized controlled trial of a community-based obesity intervention utilizing motivational interviewing and community resource mobilization for low-income families: Study protocol and baseline characteristics

Low-income, racially diverse families with one parent with obesity are at high risk for child obesity. Effective approaches to promote healthy behaviors and prevent additional weight gain in family members are needed. Motivational interviewing (MI) may assist families to engage, identify motivations for change and establish goals. However, families with limited resources face other barriers to goal achievement that may be addressed through connection with community organizations. This paper describes a unique protocol combining MI and community connection. This randomized controlled trial includes low-income families with one parent with obesity and at least one child aged 6 to 12 years. Families in the intervention group receive an innovative, 12-month intervention combining health coaching using MI to promote lifestyle behavior change goals and community resource mobilization to assist with basic needs and resources to aid goals. The study protocol is modeled on community-based participatory research principles. Data is collected at baseline, 6 months, 12 months, and 18 months include questionnaires, body measurements, and accelerometer data. For adults, primary outcomes are Body Mass Index (BMI), minutes of moderate to vigorous physical activity (MVPA), and hours of sedentary time per day. For children, primary outcomes are sedentary time, MVPA, and the Family Nutrition and Physical Activity Score. From this hard-to-reach population, 236 diverse families were recruited. If the study is deemed effective, it has the potential to demonstrate that the combination of MI, resource mobilization, and utilization of existing community organizations is a sustainable model to assist families at risk for obesity.

Leveraging Delivery of Blood Pressure Control Interventions among Low-income African American Adults: Opportunities to Increase Social Support and Produce Family-level Behavior Change

Purpose

Few family-oriented cardiovascular risk reduction interventions exist that leverage the home environment to produce health behavior change among multiple family members. We identified opportunities to adapt disease self-management interventions included in a blood pressure control comparative effectiveness trial for hypertensive African American adults to address family-level factors.

Methods

We conducted and analyzed semi-structured interviews with five intervention study staff (all study interventionists and the study coordinator) between December 2016 and January 2017 and with 11 study participants between September and November 2015.1 All study staff involved with intervention delivery and coordination were interviewed. We sampled adult participants from the parent study, and we analyzed interviews that were originally obtained as part of a previous study based on their status as a caregiver of an adolescent family member.

Results

Thematic analysis identified family influences on disease management and the importance of relationships between index patients and family members, between index patients and study peers, and between index patients and study staff through study participation to understand social effects on healthy behaviors. We identified four themes: 1) the role of family in health behavior change; 2) the impact of family dynamics on health behaviors; 3) building peer relationships through intervention participation; and 4) study staff role conflict.

Conclusions

These findings inform development of family-oriented interventions to improve health behaviors among African American index patients at high risk for cardiovascular disease and their family members.

Understanding Family-Level Effects of Adult Chronic Disease Management Programs: Perceived Influences of Behavior Change on Adolescent Family Members' Health Behaviors Among Low-Income African Americans With Uncontrolled Hypertensions

Background: Despite improvements in cardiovascular disease (CVD) prevention and treatment, low-income African Americans experience disparities in CVD-related morbidity and mortality. Childhood obesity disparities and poor diet and physical activity behaviors contribute to CVD disparities throughout the life course. Given the potential for intergenerational transmission of CVD risk, it is important to determine whether adult disease management interventions could be modified to achieve family-level benefits and improve primary prevention among high-risk youth. Objective: To explore mechanisms by which African-American adults' (referred to as index patients) participation in a hypertension disease management trial influences adolescent family members' (referred to as adolescents) lifestyle behaviors. Design/Methods: The study recruited index patients from the Achieving blood pressure Control Together (ACT) study who reported living with an adolescent ages 12-17 years old. Index patients and adolescents were recruited for in-depth interviews and were asked about any family-level changes to diet and physical activity behaviors during or after participation in the ACT study. If family-level changes were described, index patients and adolescents were asked whether role modeling, changes in the home food environment, meal preparation, and family functioning contributed to these changes. These mechanisms were hypothesize to be important based on existing research suggesting that parental involvement in childhood obesity interventions influences child and adolescent weight status. Thematic content analysis of transcribed interviews identified both a priori and emergent themes. Results: Eleven index patients and their adolescents participated in in-depth interviews. Index patients and adolescents both described changes to the home food environment and meal preparation. Role modeling was salient to index patients, particularly regarding healthy eating behaviors. Changes in family functioning due to study participation were not endorsed by index patients or adolescents. Emergent themes included adolescent care-taking of index patients and varying perceptions by index patients of their influence on adolescents' health behaviors. Conclusions: Our findings suggest that disease management interventions directed at high-risk adult populations may influence adolescent family members' health behaviors. We find support for the hypotheses that role modeling and changes to the home food environment are mechanisms by which family-level health behavior change occurs. Adolescents' roles as caretakers for index patients emerged as another potential mechanism. Future research should explore these mechanisms and ways to leverage disease management to support both adult and adolescent health behavior change.

Diet modification challenges faced by marginalized and nonmarginalized adults with type 2 diabetes: A systematic review and qualitative meta-synthesis

Objectives Diet modification is an important part of the prevention and treatment of type 2 diabetes, but sustained dietary change remains elusive for many individuals. This paper describes and interprets the barriers to diet modification from the perspective of people with type 2 diabetes, paying particular attention to the experiences of people who experience social marginalization. Methods A systematic review of primary, empirical qualitative research was performed, capturing 120 relevant studies published between 2002 and 2015. Qualitative meta-synthesis was used to provide an integrative analysis of this knowledge. Results Due to the central role of food in social life, dietary change affects all aspects of a person's life, and barriers related to self-discipline, emotions, family and social support, social significance of food, and knowledge were identified. These barriers are inter-linked and overlapping. Social marginalization magnifies barriers; people who face social marginalization are trying to make the same changes as other people with diabetes with fewer socio-material resources in the face of greater challenges. Discussion A social-ecological model of behavior supports our findings of challenges at all levels, and highlights the need for interventions and counseling strategies that address the social and environmental factors that shape and sustain dietary change.

Children's roles in parents' diabetes self-management

BACKGROUND

Family support is important in diabetes self-management. However, children as providers of support have received little attention. This study examines the role of children in their parents' diabetes self-management, diet, and exercise.

METHODS

This research used community-based participatory research principles. Researchers conducted semi-structured parallel interviews of 24 Latino and African-American adults with diabetes and with a child (aged 10-17 years) in their home (2004-2006). Interviews were transcribed, coded, and analyzed for themes (2004-2007).

RESULTS

Adults and children perceived that children play many roles related to adults' diabetes self-management. Parents described children as monitoring parents' dietary intake and reminding them what they should not be eating. Some children helped with shopping and meal preparation. Families described children reminding parents to exercise and exercising with their parents. Children reminded parents about medications and assisted with tasks such as checking blood sugar. Parents and children perceived that children played a role in tempting parents to stray from their diabetes diet, because children's diets included food that parents desired but tried to avoid.

CONCLUSIONS

Children and parents perceived that children have many roles in both supporting and undermining adults' diabetes self-management. There is more to learn about the bi-directional relationships between adults and children in this setting, and the most beneficial roles children can play. Healthcare providers should encourage family lifestyle changes, strengthen social support for families, and direct children toward roles that are beneficial for both parent and child without placing an unreasonable level of responsibility on the child.