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Mangan J, del Cid Nunez P, Daou S, Richandi GEK, Siddiqui A, Wong J, Birk-Urovitz L, Bond A, Orkin AM. Peer and lay health work for people experiencing homelessness: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003332. [PMID: 38913605 PMCID: PMC11195950 DOI: 10.1371/journal.pgph.0003332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 05/20/2024] [Indexed: 06/26/2024]
Abstract
Homelessness poses complex health obstacles for individuals and communities. Peer and lay health worker programs aim to increase access to health care and improve health outcomes for PEH by building trust and empowering community-based workers. The scope and breadth of peer and lay health worker programs among PEH has not been synthesized. The primary objective of this scoping review is to understand the context (setting, community, condition or disease) encompassing peer and lay health worker programs within the homelessness sector. The secondary objective is to examine the factors that either facilitate or hinder the effectiveness of peer and lay health worker programs when applied to people experiencing homelessness (PEH). We searched CINHAL, Cochrane, Web of Science Core Collection, PsycINFO, Google Scholar and MEDLINE. We conducted independent and duplicate screening of titles and abstracts, and extracted information from eligible studies including study and intervention characteristics, peer personnel characteristics, outcome measures, and the inhibitors and enablers of effective programs. We discuss how peer and lay health work programs have successfully been implemented in various contexts including substance use, chronic disease management, harm reduction, and mental health among people experiencing homelessness. These programs reported four themes of enablers (shared experiences, trust and rapport, strong knowledge base, and flexibility of role) and five themes of barriers and inhibitors (lack of support and clear scope of role, poor attendance, precarious work and high turnover, safety, and mental well-being and relational boundaries). Organizations seeking to implement these interventions should anticipate and plan around the enablers and barriers to promote program success. Further investigation is needed to understand how peer and lay health work programs are implemented, the mechanisms and processes that drive effective peer and lay health work among PEH, and to establish best practices for these programs.
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Affiliation(s)
- Jessica Mangan
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
| | - Pablo del Cid Nunez
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sara Daou
- Population Health Services, Inner City Health Associates, Toronto, Ontario, Canada
| | | | - Amna Siddiqui
- Population Health Services, Inner City Health Associates, Toronto, Ontario, Canada
| | - Jonathan Wong
- Family Health Team, Inner City Health Associates, Toronto, Ontario, Canada
- St Michael’s Hospital, Toronto, Ontario, Canada
| | - Liz Birk-Urovitz
- Population Health Services, Inner City Health Associates, Toronto, Ontario, Canada
| | - Andrew Bond
- Inner City Health Associates, Toronto, Ontario, Canada
- National Health Fellow, McMaster University, Hamilton, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Canadian Network for the Health and Housing of People Experiencing Homelessness, Toronto, Ontario, Canada
| | - Aaron M. Orkin
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Inner City Health Associates, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Unity Health, Toronto, Ontario, Canada
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Vickery KD, Gelberg L, Hyson AR, Strother E, Carter J, Oranday Perez O, Franco M, Kavistan S, Gust S, Adair E, Anderson-Campbell A, Brito L, Butler A, Robinson T, Connett J, Evans MD, Emmons KM, Comulada WS, Busch AM. Pilot trial results of D-HOMES: a behavioral-activation based intervention for diabetes medication adherence and psychological wellness among people who have been homeless. Front Psychiatry 2024; 15:1329138. [PMID: 38487573 PMCID: PMC10937567 DOI: 10.3389/fpsyt.2024.1329138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 02/15/2024] [Indexed: 03/17/2024] Open
Abstract
Introduction People living with type 2 diabetes who experience homelessness face a myriad of barriers to engaging in diabetes self-care behaviors that lead to premature complications and death. This is exacerbated by high rates of comorbid mental illness, substance use disorder, and other physical health problems. Despite strong evidence to support lay health coach and behavioral activation, little research has effectively engaged people living with type 2 diabetes who had experienced homelessness (DH). Methods We used community engaged research and incremental behavioral treatment development to design the Diabetes HOmeless MEdication Support (D-HOMES) program, a one-on-one, 3 month, coaching intervention to improve medication adherence and psychological wellness for DH. We present results of our pilot randomized trial (with baseline, 3 mo., 6 mo. assessments) comparing D-HOMES to enhanced usual care (EUC; brief diabetes education session and routine care; NCT05258630). Participants were English-speaking adults with type 2 diabetes, current/recent (<24 mo.) homelessness, and an HbA1c‗7.5%. We focused on feasibility (recruitment, retention, engagement) and acceptability (Client Satisfaction Questionnaire, CSQ-8). Our primary clinical outcome was glycemic control (HbA1c) and primary behavioral outcome was medication adherence. Secondary outcomes included psychological wellness and diabetes self-care. Results Thirty-six eligible participants enrolled, 18 in each arm. Most participants identified as Black males, had high rates of co-morbidities, and lived in subsidized housing. We retained 100% of participants at 3-months, and 94% at 6-months. Participants reported high satisfaction (mean CSQ-8 scores=28.64 [SD 3.94] of 32). HbA1c reduced to clinically significant levels in both groups, but we found no between group differences. Mean blood pressure improved more in D-HOMES than EUC between baseline and 6 mo. with between group mean differences of systolic -19.5 mmHg (p=0.030) and diastolic blood pressure -11.1 mmHg (p=0.049). We found no significant between group differences in other secondary outcomes. Conclusion We effectively recruited and retained DH over 6 months. Data support that the D-HOMES intervention was acceptable and feasible. We observe preliminary blood pressure improvement favoring D-HOMES that were statistically and clinically significant. D-HOMES warrants testing in a fully powered trial which could inform future high quality behavioral trials to promote health equity. Clinical trial registration https://clinicaltrials.gov/study/NCT05258630?term=D-HOMES&rank=1, identifier NCT05258630.
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Affiliation(s)
- Katherine Diaz Vickery
- The Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, United States
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Lillian Gelberg
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
- UCLA Fielding School of Public Health, Los Angeles, CA, United States
| | - Audrey Rose Hyson
- The Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - Ella Strother
- The Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - Jill Carter
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, United States
| | - Oscar Oranday Perez
- The Behavioral Health Equity Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
| | - Moncies Franco
- The Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - Silvio Kavistan
- The Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - Susan Gust
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - Edward Adair
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | | | - Lelis Brito
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - Annette Butler
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - Tahiti Robinson
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - John Connett
- School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Michael D. Evans
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, United States
| | - Karen M. Emmons
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - W. Scott Comulada
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
- UCLA Fielding School of Public Health, Los Angeles, CA, United States
| | - Andrew M. Busch
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, United States
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States
- The Behavioral Health Equity Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
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Asgary R. Cancer care and treatment during homelessness. Lancet Oncol 2024; 25:e84-e90. [PMID: 38301706 DOI: 10.1016/s1470-2045(23)00567-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/24/2023] [Accepted: 10/27/2023] [Indexed: 02/03/2024]
Abstract
People experiencing homelessness have not yet benefited from the substantial progress made in managing cancers, including advances in chemotherapy and radiotherapy, surgical interventions, multidisciplinary team approaches, and integrated cancer care models. People experiencing homelessness are at higher risks of developing cancers and their mortality due to cancer is twice that of the general population. Potential interventions to improve access to cancer treatment include alliances and active engagement with community organisations and shelters, cancer case management and peer-to-peer support, mHealth and navigation strategies, tailored hospital discharge to adult group homes, well equipped subacute rehabilitation centres, and specialised shelters and respite housing to assure appropriate follow-up care. Other interventions include improving preventive care, expanding data, targeted policy efforts, and broader housing advocacy. In this Personal View, I discuss challenges and opportunities in cancer treatment, with a review of the current evidence on potential interventions, and highlight strategies to improve access to cancer care for homeless populations.
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Affiliation(s)
- Ramin Asgary
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Hassan S, Rac VE, Hodges B, Leake P, Cobbing S, Gray CM, Bartley N, Etherington A, Abdulwasi M, Cheung HCK, Anderson M, Woods NN. Upskilling programmes for unregulated care providers to provide diabetic foot screening for systematically marginalised populations: how, why and in what contexts do they work? A realist review. BMJ Open 2024; 14:e081006. [PMID: 38262651 PMCID: PMC10806612 DOI: 10.1136/bmjopen-2023-081006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/09/2024] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVE We aimed to understand how, why and in what context upskilling programmes for unregulated care providers (UCPs) to provide foot screening for systematically marginalised groups living with diabetes were implemented. DESIGN We used realist synthesis based on Realist And Meta-narrative Evidence Syntheses: Evolving Standards guidance. DATA SOURCES We searched the Medline, Embase, PsycINFO, CINAHL, ERIC, Web of Science Core Collection, and Scopus databases and the grey literature (Google Scholar, ProQuest Dissertations and Theses) up to November 2022. ELIGIBILITY CRITERIA We included experimental and non-experimental articles in English that either described mechanisms or discussed expected outcomes for educational interventions for patients and family caregivers or healthcare providers, both regulated and unregulated. We also included articles that evaluated the impact of foot care programmes if the UCPs' training was described. DATA EXTRACTION AND SYNTHESIS The lead author extracted, annotated and coded uploaded relevant data to identify contexts, mechanisms and outcome configurations using MAXQDA (a qualitative data analysis software). We used deductive and inductive coding to structure the process. Our team members double-reviewed and appraised a random sample of 20% of articles at all stages to ensure consistency. RESULTS Our search identified 52 articles. Evidence suggested the necessity of developing upskilling foot screening programmes within the context of preventive care programmes that also provide education in diabetes, and early referrals for appropriate interventions. Multidisciplinary programmes created an ideal context facilitating coordination between UCPs and their regulated counterparts. Engaging patients and community partners, using a competency-based model, and incorporating cultural competencies were determinants of success for these programmes. CONCLUSION This review provides a realistic programme theory for the mechanisms used, the context in which these programmes were developed, and the expected outcomes to train UCPs to provide preventive foot care for systematically marginalised populations. PROSPERO REGISTRATION NUMBER CRD42022369208.
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Affiliation(s)
- Samah Hassan
- University Health Network, Toronto, Ontario, Canada
- Program for Health System and Technology Evaluation, Ted Rogers Centre for Heart Research at Peter Munk Cardiac Centre, Toronto General Hospital Research Institute (TGHRI), University Health Network (UHN), Toronto, Ontario, Canada
| | - Valeria E Rac
- University Health Network, Toronto, Ontario, Canada
- Program for Health System and Technology Evaluation, Ted Rogers Centre for Heart Research at Peter Munk Cardiac Centre, Toronto General Hospital Research Institute (TGHRI), University Health Network (UHN), Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute (TGHRI), University Health Network (UHN), Toronto, Ontario, Canada
- Diabetes Action Canada, CIHR SPOR Network, Toronto, Ontario, Canada
| | - Brian Hodges
- University Health Network, Toronto, Ontario, Canada
- The Institute of Education Research, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Patti Leake
- University Health Network, Toronto, Ontario, Canada
- The Institute of Education Research, University Health Network, Toronto, Ontario, Canada
| | - Saul Cobbing
- University Health Network, Toronto, Ontario, Canada
- The Institute of Education Research, University Health Network, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Department of Physiotherapy, University of KwaZulu-Natal, Durban, South Africa
| | - Catharine Marie Gray
- University Health Network, Toronto, Ontario, Canada
- The Michener Institute of Education, University Health Network, Toronto, Ontario, Canada
| | - Nicola Bartley
- University Health Network, Toronto, Ontario, Canada
- The Michener Institute of Education, University Health Network, Toronto, Ontario, Canada
| | - Andrea Etherington
- University Health Network, Toronto, Ontario, Canada
- The Institute of Education Research, University Health Network, Toronto, Ontario, Canada
| | - Munira Abdulwasi
- University Health Network, Toronto, Ontario, Canada
- The Institute of Education Research, University Health Network, Toronto, Ontario, Canada
- The Michener Institute of Education, University Health Network, Toronto, Ontario, Canada
| | - Hei-Ching Kristy Cheung
- University Health Network, Toronto, Ontario, Canada
- The Institute of Education Research, University Health Network, Toronto, Ontario, Canada
| | - Melanie Anderson
- University Health Network, Toronto, Ontario, Canada
- Library and Information Services, University Health Network, Toronto, Ontario, Canada
| | - Nicole N Woods
- University Health Network, Toronto, Ontario, Canada
- The Institute of Education Research, University Health Network, Toronto, Ontario, Canada
- The Michener Institute of Education, University Health Network, Toronto, Ontario, Canada
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McSweeney B, Campbell RB, Grewal EK, Gu J, Campbell DJT. Group Versus Individual Diabetes Education for Persons With Experience of Homelessness in Canada. Sci Diabetes Self Manag Care 2023; 49:415-425. [PMID: 37771237 PMCID: PMC10666507 DOI: 10.1177/26350106231201365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
PURPOSE The purpose of the study was to explore various forms of diabetes self-management education (DSME), including group and individual sessions, for persons with lived experiences of homelessness (PWLEH) in Canada. METHODS A qualitative descriptive study using open-ended interviews with health care and homeless sector service providers was utilized to serve those experiencing homelessness in 5 cities across Canada. NVivo qualitative data analysis software was used to facilitate thematic analysis, focusing on variations in DSME for PWLEH. RESULTS We conducted interviews with 96 unique health and social care providers. Four themes were identified through focused coding of interviews. First, the use of a harm reduction approach during diabetes education tailored to PWLEH considered patients' access to food, medications, and supplies and other comorbidities, including mental health and substance use disorders. The second theme related to the unsuitability of the curriculum in mainstream diabetes education in a group setting for PWLEH. Third, the role of group education in community building is to create supportive relationships among members. The final theme was the importance of trust and confidentiality in DSME, which were most easily maintained during individual education, compared to group formats. CONCLUSIONS Overall, PWLEH experience unique challenges in managing diabetes. DSME adapted to these individuals' unique needs may be more successful and could be delivered in both individual and group settings.
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Affiliation(s)
- Breanna McSweeney
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Rachel B. Campbell
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Eshleen K. Grewal
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Jenny Gu
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - David J. T. Campbell
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta
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Al-Shorman NAD, Atiyeh H, Kassab M, Al-Rjoub SF. Effects of an educational program on self-efficacy towards type 1 diabetes mellitus disease among parents and adolescents in Jordan. J Pediatr Nurs 2023; 71:66-72. [PMID: 37004312 DOI: 10.1016/j.pedn.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 03/22/2023] [Accepted: 03/22/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Type 1 diabetes mellitus is one of the most common childhood chronic diseases worldwide. In Jordan, the prevalence of type 1 diabetes mellitus is increasing rapidly over the last few years. Type 1 diabetes mellitus is a challenging disease since appropriate management of parents' and adolescents' diabetes requires knowledge, skills, and behavioral changes. OBJECTIVES To assess the effectiveness of a diabetes education program on self-efficacy towards type 1 diabetes mellitus among parents of young children and adolescents. METHODS A one-group pre-test-post-test study design was used. Participants registered in a diabetes education program and completed both pre-and post-test. RESULTS A total of 44 participants; 29 parents and 15 adolescents completed pre- and post-education tests. There was a statistically significant difference in the average mean score from the pre-test (M = 3.51, SD = 0.615) to the post-test [M = 4.22, SD = 0.484, t (43) =6.704, p < 0.000] for the self-efficacy scale, and overall self-efficacy scores were significantly improved after undertaking the education program. CONCLUSION Based on the findings, it is suggested that providing an evidence-based type 1 diabetes mellitus education program could significantly positively affect the self-efficacy of adolescents and parents of young children with type 1 diabetes mellitus. RECOMMENDATION Staff nurses should be competent enough to provide basic diabetic health education to the adolescents, parents, and caregivers of children with type 1 diabetes mellitus.
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Affiliation(s)
| | - Huda Atiyeh
- Zarqa University, Faculty of Nursing, Nursing, Jordan
| | - Manal Kassab
- Jordan University of Science and Technology, Faculty of Nursing, Department of Maternal and Child Health Nursing. Clinical research fellows at faculty of health, UTS, Sydney, Australia
| | - Saleem Faek Al-Rjoub
- The Hashemite University, Faculty of Nursing, Department of Community & Mental Health Nursing, PO Box 330127, Zarqa 13133, Jordan.
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SMS texting for uncontrolled diabetes among persons experiencing homelessness: Study protocol for a randomized trial. Contemp Clin Trials 2023; 128:107149. [PMID: 36918092 DOI: 10.1016/j.cct.2023.107149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 02/20/2023] [Accepted: 03/09/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND Diabetes mellitus (DM) is common among persons experiencing homelessness (PEH), often inadequately managed, and carries significant costs. mHealth strategies including short messaging service (SMS) texting have been feasible and acceptable, and improved control of chronic diseases including DM. SMS strategies for DM have not been tested among PEH despite the accessibility of mobile phones. We propose an SMS strategy could offer better communication, education, and information management; improve outreach; facilitate care coordination; explore barriers to care; and support behavior changes. METHODS AND ANALYSIS This mixed-methods (RCT and qualitative) study will be implemented in shelter-clinics in New York City in collaboration with community organizations, allowing for sustainability and scalability. Aim 1 will evaluate the efficacy of a 6-month SMS program for DM management versus an attention control on changes in HbA1c and adherence to DM self-care activities, medications, and appointments at 9 months in adult PEH with uncontrolled DM (n = 100). Outcomes will be measured at 0, 3, 6, &9 months. AIM 2 will assess patients' and providers' attitudes, acceptability, and experience of the program through semi-structured interviews with PEH (n = 20) and providers (n = 10). DISCUSSION DM is not well-addressed among PEH. SMS strategies for DM have never been tested in PEH despite evidence of their effectiveness and access to mobile phones among PEH. Results from this study will provide important empirical data to inform evidence-based strategies to avert personal suffering and significant costs. It will have broader policy implications in control of DM and other chronic diseases.
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Lu S, Leduc N, Moullec G. Type 2 diabetes peer support interventions as a complement to primary care settings in high-income nations: A scoping review. PATIENT EDUCATION AND COUNSELING 2022; 105:3267-3278. [PMID: 36038395 DOI: 10.1016/j.pec.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 08/13/2022] [Accepted: 08/17/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Inadequate social support make way for peer support initiatives to complement the health system delivery of diabetes self-management education programs for type 2 diabetes (T2D). This review synthesizes knowledge about T2D peer support in terms of their various models and impact, endorsement, and contextual information in high-income nations. METHODS A scoping review was conducted on published and grey literature in four electronic bibliographic databases between January 2007 to December 2021. RESULTS 76 records were included. Face-to-face self-management programs and telephone-based peer support seem the most promising modalities given the largest scientific coverage on T2D outcomes. Face-to-face self-management programs were the most preferred by ethnic minority groups. Unlike peer supporters, healthcare professionals had mixed views about T2D peer support interventions. Managers of peer support programs perceived cultural competency as a cornerstone for peer support implementation. Care must be taken in recruiting, training and retaining peer supporters for sustainable practice. CONCLUSIONS Various T2D peer support models lie at the interface between primary care and community-based settings. PRACTICE IMPLICATIONS Fostering the role of peer support beyond healthcare organizations should be encouraged to engage the hardly reached, and to leverage community support to complement the health system.
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Affiliation(s)
- Sonia Lu
- University of Montreal, School of Public Health, Department of Social and Preventive Medicine, Montreal, Canada.
| | - Nicole Leduc
- University of Montreal, School of Public Health, Department of Health Management, Evaluation and Policy, Montreal, Canada
| | - Grégory Moullec
- University of Montreal, School of Public Health, Department of Social and Preventive Medicine, Montreal, Canada
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Asgary R, Beideck E, Naderi R. Diabetes care and its predictors among persons experiencing homelessness compared with domiciled adults with diabetes in New York City; An observational study. EClinicalMedicine 2022; 48:101418. [PMID: 35516444 PMCID: PMC9062666 DOI: 10.1016/j.eclinm.2022.101418] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/01/2022] [Accepted: 04/08/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND There is a dearth of data regarding diabetes control among patients experiencing homelessness. METHODS We retrospectively collected type 2 diabetes-related measurements, sociodemographic, and clinical indicators from medical records of all incoming adults with diabetes (n = 418; homeless: 356 and domiciled: 58) seen in shelter-clinics in New York City in 2019. The outcomes were the rates of inadequately managed diabetes and associated factors. FINDINGS Bivariate analysis showed that patients experiencing homelessness (63% Black; 32% Hispanic) 134/304 (43⋅9%) were more likely than domiciled patients 13/57 (22·8%) to have inadequately managed diabetes (OR 2⋅67, CI 1·38-5·16, p = 0⋅003). The average HbA1c among homeless (8·4%, SD± 2·6) was higher than that of domiciled persons (7·3%, SD± 1·8, p = 0·002). In logistic regression, domiciled status (OR 0⋅ 42, CI 0·21 - 0·84, p = 0·013), older age (OR 0·97, CI 0·95 - 0·99, p = 0·004), and non-Hispanic/Latino ethnicity were associated with well-managed diabetes. Among persons experiencing homelessness, non-Hispanic/Latino (OR 0·61, CI 0·37-0·99, p = 0·047) and older age (0·96, CI 0·94-0·99, p = 0·003) were associated with well-managed diabetes. In linear regression, mental illness (-0·11, p = 0·048) and older age (-0·15, p = 0·010) were associated with lower HbA1c, suggesting better support in respective shelters. There was no statistically significant association between inadequately managed diabetes with several traditional risk factors including substance or alcohol use disorder, health insurance, or other chronic diseases. INTERPRETATION Interventions at shelters or shelter-clinics should target subgroups in addition to addressing traditional risk factors to improve diabetes control. mHealth strategies could be considered to improve engagement, care delivery, and medication taking. Ultimately, homelessness itself needs to be addressed. FUNDING There are no funding sources to declare.
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Key Words
- BMI, body mass index
- BP, blood pressure
- CAD, coronary artery disease
- CKD, chronic kidney disease
- DM, diabetes mellitus
- Diabetes mellitus
- GFR, glomerular filtration rate
- HTN, hypertension
- HbA1c, hemoglobin A1c
- Health disparities
- Homeless
- LDL, low density lipoprotein
- PCP, primary care physician
- Primary care
- Quality care
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Affiliation(s)
- Ramin Asgary
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave NW, Washington, D.C. 20052, USA
- Weill Cornell Medical College of Cornell University, 525 East 68th Street, New York, NY 10065, USA
- Corresponding author.
| | - Elena Beideck
- Weill Cornell Medical College of Cornell University, 525 East 68th Street, New York, NY 10065, USA
| | - Rosanna Naderi
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave NW, Washington, D.C. 20052, USA
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Abstract
Purpose
The purpose of this paper is to develop a research framework for exploring and improving patient empowerment through the analysis of the effects produced by a satisfying physician relationship on patient involvement in the healthcare process.
Design/methodology/approach
The authors begin with a literature review of patient empowerment in healthcare, useful to highlight the importance of relational aspects. Then, the authors tested the hypotheses of the research through the analysis of 450 questionnaires. The results are analyzed through covariance-based structural equation modeling.
Findings
This paper highlights how empowerment is a more complex phenomenon, needing many dimensions to be investigated. The hypotheses were tested, and correlations computed, highlighting a medium-strong positive correlation between physician relationship and patient involvement determining satisfying patient empowerment.
Research limitations/implications
The considerations conducted in the paper are restricted to physician relationship and needs further research aimed to analyze and evaluate the changes in the patient behaviors influenced by empowerment.
Practical implications
The research points offer new insight into patient empowerment and allow the healthcare provider to create new opportunities for promoting patient empowerment through the development of quality relationship for effective patient involvement.
Originality/value
The study developed contributes new insight about patient empowerment in the healthcare management literature, proving the key role of satisfying physician relationship useful for future researches.
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Religious Faith and Diabetes Health Beliefs in a Homeless Population: A Qualitative Study. J Christ Nurs 2019; 36:228-235. [PMID: 31490877 DOI: 10.1097/cnj.0000000000000655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This participatory action research project explored the perspectives and challenges of homeless persons living with, or at risk for, type 2 diabetes. Because these persons were sheltered in and served by a church, their perspectives provide understanding about how religious faith may influence diabetes self-management.
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Baggett TP, Liauw SS, Hwang SW. Cardiovascular Disease and Homelessness. J Am Coll Cardiol 2019; 71:2585-2597. [PMID: 29852981 DOI: 10.1016/j.jacc.2018.02.077] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 02/09/2018] [Accepted: 02/11/2018] [Indexed: 01/14/2023]
Abstract
Cardiovascular disease (CVD) is a major cause of death among homeless adults, at rates that exceed those in nonhomeless individuals. A complex set of factors contributes to this disparity. In addition to a high prevalence of cigarette smoking and suboptimal control of traditional CVD risk factors such as hypertension and diabetes, a heavy burden of nontraditional psychosocial risk factors like chronic stress, depression, heavy alcohol use, and cocaine use may confer additional risk for adverse CVD outcomes beyond that predicted by conventional risk estimation methods. Poor health care access and logistical challenges to cardiac testing may lead to delays in presentation and diagnosis. The management of established CVD may be further challenged by barriers to medication adherence, communication, and timely follow-up. The authors present practical, patient-centered strategies for addressing these challenges, emphasizing the importance of multidisciplinary collaboration and partnership with homeless-tailored clinical programs to improve CVD outcomes in this population.
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Affiliation(s)
- Travis P Baggett
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, Massachusetts
| | - Samantha S Liauw
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stephen W Hwang
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.
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McGowan P, Lynch S, Hensen F. The Role and Effectiveness of Telephone Peer Coaching for Adult Patients With Type 2 Diabetes. Can J Diabetes 2019; 43:399-405. [PMID: 31080092 DOI: 10.1016/j.jcjd.2019.03.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 02/07/2019] [Accepted: 03/20/2019] [Indexed: 10/27/2022]
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Hadenfeldt C, Knezevich E, Black S. Diabetes Risk Assessment, A1C Measurement, and Goal Achievement of Standards of Care in Adults Experiencing Homelessness. DIABETES EDUCATOR 2019; 45:295-301. [DOI: 10.1177/0145721719843680] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this study was to explore diabetes in adults experiencing homelessness by evaluating diabetes risk, A1C measurement, and achievement of the goals of the American Diabetes Association (ADA) Standards of Medical Care in Diabetes. Methods Project Homeless Connect Omaha is a 1-day health and social services event for adults who are homeless. The event seeks to meet immediate needs, identify potential future needs, and provide a connection with community resources for further follow-up for these adults. Health professions students and faculty from the university where the event is held volunteer their time to provide these services. Risk assessment for type 2 diabetes, A1C measurement, and evaluation of the ADA Standards of Medical Care were available for participants of this event. Results Of the 478 participants who completed a risk assessment for diabetes, 91 underwent rapid A1C testing. Four participants at the diabetes station (4%) were newly identified as having diabetes with elevated A1C, and 32% of the participants had elevated A1C levels demonstrating prediabetes. Twelve individuals reported being previously diagnosed with diabetes, and of those, 50% had A1C levels between 7.3% and >13% (56 to 119 mmol/mol). Participants whose A1Cs classified them as having prediabetes or diabetes (n = 40) completed an evaluation of standards of medical care goals. Participants identified eye, foot, and dental examinations; lipid management; and urine protein screening as some of the areas in which the standards were not yet achieved. Conclusion Adults experiencing homelessness have a significant need for diabetes screening and management. Diabetes educators can provide education to equip adults with the ability to effectively manage their illness and prevent complications.
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Affiliation(s)
| | - Emily Knezevich
- School of Pharmacy and Health Professions, Department of Pharmacy Practice, Creighton University, Omaha, Nebraska
| | - Susannah Black
- College of Nursing, Creighton University, Omaha, Nebraska
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