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Basinger ED, Cameron SJ, Allen G. Stigma, Self-Care, and Intuitive Eating in Black Americans with Type 2 Diabetes. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01772-6. [PMID: 37626193 DOI: 10.1007/s40615-023-01772-6] [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: 05/09/2023] [Revised: 07/20/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023]
Abstract
Type 2 diabetes is prevalent among Black Americans. Stigma associated with type 2 diabetes, both in general and specific to weight, is damaging to self-care, which is crucial for the effective management of diabetes. Family relationships may buffer the negative impact of stress, especially among Black Americans who have historically relied on informal support networks. Our goal was to investigate how type 2 diabetes stigma (H1) and weight stigma (H2) were related to self-care and intuitive eating - a non-restrictive approach to nutrition; H3 predicted that family relationship satisfaction would moderate the relationships predicted in H1 and H2. Black Americans diagnosed with type 2 diabetes (N = 225) were recruited via Qualtrics panels to complete an online survey of self-report measures. We used multiple linear regression to test our hypotheses. Both chronic illness and weight stigma were related as predicted to one subscale of intuitive eating (eating for physical hunger). Our moderation analyses revealed that family relationship satisfaction was protective against the harms of stigma at moderate to high levels. Intuitive eating is a promising non-restrictive treatment option for type 2 diabetes.
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Affiliation(s)
- Erin D Basinger
- Department of Communication Studies, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC, 28223, USA.
| | - Shanice Jones Cameron
- Department of Communication Studies, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC, 28223, USA
| | - Gracie Allen
- Department of Communication Studies, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC, 28223, USA
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2
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Duke N. Type 2 diabetes self-management: spirituality, coping and responsibility. J Res Nurs 2021; 26:743-760. [PMID: 35251282 PMCID: PMC8894753 DOI: 10.1177/17449871211026958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background In England, although The National Institute of Health and Care Excellence recommends that patients’ religious beliefs should be incorporated into individual healthcare plans, these components are often neglected in diabetes management care plans. A literature review identified a paucity of research regarding how the spirituality of British people may influence their approach to their self-management of type 2 diabetes (T2D). Aims To explore how the spirituality of a small group of adults with T2D, living in England, influenced their coping strategies and self-management of diet and exercise. Methods Biographic Narrative Interpretive Method of two interviews per participant and thematic analysis for data interrogation ( n = 8). Data as glycated haemoglobin, living situation, age, length of time since T2D diagnosis, body mass index and diabetic medicines contextualised the interview data. Results Participants’ spirituality, health beliefs, coping and sense of responsibility for T2D self-management overlapped in complex layers. Three themes were generated: (a) spirituality influences expectations in life; (b) beliefs influence coping styles of diabetes self-management; and (c) responsibility influences diabetes self-management. A model was created to assist nurses in addressing these components. Conclusion Nurses should consider how patients’ self-management of T2D may be influenced by their spirituality, health beliefs, coping and sense of responsibility.
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Affiliation(s)
- Natasha Duke
- Independent Consultant, School of Health Sciences, University of Southampton, UK
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3
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Basinger ED, Hartsell H. Communal Coping and Self-Care in Black and White Individuals Living with Type 2 Diabetes. HEALTH COMMUNICATION 2021; 36:1961-1969. [PMID: 32844697 DOI: 10.1080/10410236.2020.1808408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Type 2 diabetes mellitus is both prevalent and profoundly impactful, and how people cope with the illness is related to a variety of individual and relational outcomes. The goal of this investigation was to test the logic of the recently extended Theoretical Model of Communal Coping (TMCC), a communication theory that argues that race (in this study, Black and White) moderates the relationship between communal coping and disease-related outcomes (i.e., glucose, diet, and exercise self-care). In general, survey data from 348 participants (n = 224 Black participants, n = 124 White participants) revealed that although communal coping was directly and positively related to self-care, the relationship between communal coping and self-care was stronger for Black participants than White participants. The results of the study have implications for the TMCC and for researchers, families managing type 2 diabetes, and healthcare practitioners.
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Affiliation(s)
- Erin D Basinger
- Department of Communication Studies, University of North Carolina at Charlotte
| | - Haley Hartsell
- Department of Communication Studies, University of North Carolina at Charlotte
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Nixon AL, Leonardi-Bee J, Wang H, Chattopadhyay K. Barriers and facilitators to type 2 diabetes management in the Caribbean region: a qualitative systematic review. JBI Evid Synth 2021; 19:911-965. [PMID: 33394623 DOI: 10.11124/jbisrir-d-19-00424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this systematic review was to summarize the barriers and facilitators to type 2 diabetes mellitus management in the Caribbean region. INTRODUCTION The prevalence of type 2 diabetes mellitus in the Caribbean is of significant concern. Poor management of type 2 diabetes mellitus increases the risks of complications and death. Several studies have been conducted to explore the barriers and facilitators to type 2 diabetes mellitus management in the Caribbean; however, a systematic review has yet to be conducted. INCLUSION CRITERIA Eligible participants were adults (aged 18 and above) with type 2 diabetes mellitus, their families/carers, and health care professionals whose work involves the management of type 2 diabetes mellitus in the Caribbean. The review included studies that focused on their views, experiences, attitudes, understandings, perceptions, and perspectives regarding the barriers and facilitators to type 2 diabetes mellitus management. METHODS Electronic searches of MEDLINE, Embase, CINAHL/BNI (EBSCOhost), PsycINFO, AMED, Web of Science, and Scopus were conducted from database inception to March 2020. Additionally, gray literature was searched via EThOS, OpenGrey, and ProQuest Dissertations and Theses. JBI methodology for conducting qualitative systematic reviews was followed. Screening of studies, assessment of methodological quality, and data extraction were conducted independently by two reviewers. Findings from studies were synthesized using a meta-aggregation approach, and confidence in the findings was ranked using the ConQual approach. RESULTS Eight studies were included in the review, all of which focused on patients' perspectives. There were five synthesized findings, including i) cultural demands and pressures impact self-management and general care of type 2 diabetes mellitus (low confidence evidence); ii) support systems' influence on the general management of type 2 diabetes mellitus (moderate confidence evidence); iii) personal and environmental background/circumstances can encourage and limit good self-management and general management of type 2 diabetes mellitus (high confidence evidence); iv) psychological factors that influence patients' actions towards the management of type 2 diabetes mellitus (moderate confidence evidence); and v) psychological factors and their influence on patients' adherence to type 2 diabetes mellitus management (low confidence evidence). CONCLUSIONS Patients in the Caribbean have multiple barriers and facilitators that limit and promote effective management of their type 2 diabetes mellitus. Identifying the barriers and facilitators to type 2 diabetes mellitus management in the Caribbean will assist with development of effective type 2 diabetes mellitus management programs. However, further qualitative studies on barriers and facilitators to type 2 diabetes mellitus management in the Caribbean that target health care professionals and families/carers should be conducted. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42018097242.
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Affiliation(s)
- Amy Latifah Nixon
- The Nottingham Centre for Evidence Based Healthcare: A JBI Centre of Excellence, University of Nottingham, Nottingham, United Kingdom.,Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Jo Leonardi-Bee
- The Nottingham Centre for Evidence Based Healthcare: A JBI Centre of Excellence, University of Nottingham, Nottingham, United Kingdom.,Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Haiquan Wang
- The Nottingham Centre for Evidence Based Healthcare: A JBI Centre of Excellence, University of Nottingham, Nottingham, United Kingdom.,Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Kaushik Chattopadhyay
- The Nottingham Centre for Evidence Based Healthcare: A JBI Centre of Excellence, University of Nottingham, Nottingham, United Kingdom.,Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
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Rasmussen B, Wynter K, Rawson HA, Skouteris H, Ivory N, Brumby SA. Self-management of diabetes and associated comorbidities in rural and remote communities: a scoping review. Aust J Prim Health 2021; 27:243-254. [PMID: 34229829 DOI: 10.1071/py20110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 04/06/2021] [Indexed: 11/23/2022]
Abstract
Chronic health conditions are more prevalent in rural and remote areas than in metropolitan areas; living in rural and remote areas may present particular barriers to the self-management of chronic conditions like diabetes and comorbidities. The aims of this review were to: (1) synthesise evidence examining the self-management of diabetes and comorbidities among adults living in rural and remote communities; and (2) describe barriers and enablers underpinning self-management reported in studies that met our inclusion criteria. A systematic search of English language papers was undertaken in PsycINFO, Medline Complete, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete, EMBASE and the Cochrane Database of Systematic Reviews, searching for literature indexed from the beginning of the database until 6 March 2020. Essential key concepts were diabetes, comorbidities, self-management and rural or remote. Twelve studies met the inclusion criteria. Six of these reported interventions to promote self-management for adults with diabetes in rural and remote communities and described comorbidities. These interventions had mixed results; only three demonstrated improvements in clinical outcomes or health behaviours. All three of these interventions specifically targeted adults living with diabetes and comorbidities in rural and remote areas; two used the same telehealth approach. Barriers to self-management included costs, transport problems and limited health service access. Interventions should take account of the specific challenges of managing both diabetes and comorbidities; telehealth may address some of the barriers associated with living in rural and remote areas.
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Affiliation(s)
- Bodil Rasmussen
- Deakin University School of Nursing and Midwifery, 1 Gheringhap Street, Geelong, Vic. 3220, Australia; and Centre for Quality and Patient Safety Research - Western Health Partnership, Sunshine Hospital, 176 Furlong Road, St Albans, Vic. 3021, Australia; and Department of Public Health, University of Copenhagen, Denmark; and Faculty of Health Sciences, University of Southern Denmark, Denmark; and Corresponding author.
| | - Karen Wynter
- Deakin University School of Nursing and Midwifery, 1 Gheringhap Street, Geelong, Vic. 3220, Australia; and Centre for Quality and Patient Safety Research - Western Health Partnership, Sunshine Hospital, 176 Furlong Road, St Albans, Vic. 3021, Australia
| | - Helen A Rawson
- Deakin University School of Nursing and Midwifery, 1 Gheringhap Street, Geelong, Vic. 3220, Australia; and Nursing and Midwifery, Monash University, 35 Rainforest Walk, Clayton, Vic. 3800, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Vic. 3004, Australia
| | - Nicola Ivory
- Deakin University School of Psychology, 1 Gheringhap Street, Geelong, Vic. 3220, Australia
| | - Susan A Brumby
- School of Medicine, Deakin University, 75 Pigdons Road, Waurn Ponds, Vic. 3216, Australia; and National Centre for Farmer Health, Western District Health Service, 20 Foster Street, Hamilton, Vic. 3300, Australia
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Statz M, Evers K. Spatial barriers as moral failings: What rural distance can teach us about women's health and medical mistrust author names and affiliations. Health Place 2020; 64:102396. [PMID: 32739783 PMCID: PMC7391386 DOI: 10.1016/j.healthplace.2020.102396] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/01/2020] [Accepted: 07/09/2020] [Indexed: 11/15/2022]
Abstract
Policy attention to growing rural "health care deserts" tends to identify rural distance as a primary spatial barrier to accessing care. This paper brings together geography, health policy, and ethnographic methods to instead theorize distance as an expansive and illuminating concept that highlights place-based expertise. It specifically engages rural women's interpretations of rural distance as a multifaceted dimension of accessing health care, which includes but is not limited to women's health services and maternity care. Presenting qualitative research with 51 women in a rural region of the U.S., thematic findings reveal an interpretation of barriers to rural health care as moral failings rather than as purely spatial or operational challenges, along with wide communication of negative health care experiences owing to spatially-disparate but trusted social networks. Amid or owing to the rural crisis context, medical mistrust here emerges as a meaningful but largely unrecognized barrier to rural women's ability-and willingness-to obtain health care. This underscores how a novel interpretation of distance may inform policy efforts to address rural medical deserts.
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Affiliation(s)
- Michele Statz
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth Campus 1035 University Dr. Duluth, MN, 55812, USA.
| | - Kaylie Evers
- Medical Student University of Minnesota Medical School, Duluth Campus 1035 University Dr. Duluth, MN, 55812, USA.
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Ledford CJW, Seehusen DA, Crawford PF. Geographic and Race/Ethnicity Differences in Patient Perceptions of Diabetes. J Prim Care Community Health 2020; 10:2150132719845819. [PMID: 31088212 PMCID: PMC6537251 DOI: 10.1177/2150132719845819] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objectives: The present study takes a culture-centered approach to
better understand how the experiences of culture affect patient’s perception of
type 2 diabetes mellitus (T2DM). This study explores personal models of T2DM and
compares personal models across regional and race/ethnicity differences.
Methods: In a practice-based research network, a
cross-sectional survey was distributed to patients diagnosed with T2DM at
medical centers in Nevada and Georgia. In analyses of covariance, controlling
for age, health literacy, and patient activation, geographic location, and
race/ethnicity were tested onto 5 dimensions of illness representation.
Results: Among 685 patients, race/ethnicity was significantly
associated with lower reported understanding diabetes (P <
.01) and less perceived longevity of diabetes (P < .001).
Geographic location was significantly associated with seriousness of the disease
(P < .005) and impact of diabetes (P
< .001). Conclusion: Non-Hispanic White Americans report greater
understanding and perceive a longer disease course than non-Hispanic Black
Americans and Asian Americans. Regionally, patients in Nevada perceive T2DM as
more serious and having more impact on their lives than patients living in
Georgia. Primary care physicians should elicit patient perceptions of diabetes
within the context of the patient’s ethnic and geographic culture group to
improve discussions about diabetes self-management. Specifically, primary care
physicians should address the seriousness of a diabetes diagnosis and the
chronic nature of the disease with patients who belong to communities with a
higher prevalence of the disease.
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Affiliation(s)
| | | | - Paul F Crawford
- 3 Mike O'Callaghan Military Medical Center, Nellis Air Force Base, NV, USA
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8
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Hushie M. Exploring the barriers and facilitators of dietary self-care for type 2 diabetes: a qualitative study in Ghana. Health Promot Perspect 2019; 9:223-232. [PMID: 31508343 PMCID: PMC6717922 DOI: 10.15171/hpp.2019.31] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 07/14/2019] [Indexed: 11/16/2022] Open
Abstract
Background: There is an increasing prevalence of type 2 diabetes (T2D) globally and countries in Sub Sahara Africa, such as Ghana are contending with the epidemic. The main objective ofthis study was to explore the barriers and facilitators of T2D self-care as perceived by patients and health providers (HPs) in Ghana. Methods: A maximum variation sample of 33 adult patients with a range of demographic features, diabetic conditions and self-care regimens and 3 providers were purposely selected from the specialist diabetes clinic of a private hospital in Accra, Ghana. Data were collected using in-depth interviews, which were recorded and transcribed; and non-participant observational field notes-that were analyzed thematically through directed content analysis. Results: The findings reveal that T2D adult patients face many inter-related challenges to diabetes self-care, than enabling factors that fell into four major domains:1) the counselling process and context (patients missing follow-up appointments, unacceptance of diagnosis); 2)recommended food and diet regimens (changing habitual diets, dislike and confusion about recommended diets); 3) social aspects (social functions interfering with dietary regimens, family members diverting patient from dietary goals) and 4) fears (non-disclosure to family member/pretense of being well). Conclusion: Integrated self-management interventions are needed to address these barriers, including tailoring dietary education to patients' specific needs, guiding patients on how tomanage diet during social occasions and among family members; and as well, providing mental health support. Future research should focus on T2D self-care behaviours and practices outside the clinic, including home, work and shopping environments.
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Affiliation(s)
- Martin Hushie
- University for Development Studies, School of Allied Health Sciences Department of Behavioural Sciences, P. O. Box 1883, Tamale, N/R Ghana
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9
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Mogre V, Johnson NA, Tzelepis F, Paul C. Barriers to diabetic self-care: A qualitative study of patients' and healthcare providers' perspectives. J Clin Nurs 2019; 28:2296-2308. [PMID: 30791160 DOI: 10.1111/jocn.14835] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 01/15/2019] [Accepted: 02/12/2019] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore patient and healthcare provider (HCP) perspectives about patients' barriers to the performance of diabetic self-care behaviours in Ghana. BACKGROUND Sub-Saharan African urban populations are increasingly affected by type 2 diabetes due to nutrition transition, sedentary lifestyles and ageing. Diabetic self-care is critical to improving clinical outcomes. However, little is known about barriers to diabetic self-care (diet, exercise, medication taking, self-monitoring of blood glucose and foot care) in sub-Saharan Africa. DESIGN Qualitative study that followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. METHODS Semi-structured interviews were conducted among 23 people living with type 2 diabetes and 14 HCPs recruited from the diabetes clinics of three hospitals in Tamale, Ghana. Interviews were audiotaped and transcribed verbatim. The constant comparative method of data analysis was used and identified themes classified according to constructs of the theory of planned behaviour (TPB): attitudes/behavioural beliefs, subjective norms and perceived behavioural control. RESULTS Barriers relating to attitudes included misconceptions that diabetes was caused by spiritual forces or curses, use of herbal medicines, intentional nonadherence, difficulty changing old habits, and feeling or lacking motivation to exercise. Barriers relating to subjective norms were inadequate family support, social stigma (usually by spouses and other members of the community) and cultural beliefs. Perceived behavioural control barriers were poor income levels, lack of glucometers, busy work schedules, long distance to the hospital and inadequate access to variety of foods due to erratic supply of foods or seasonality. CONCLUSIONS Both patients and HCPs discussed similar barriers and those relating to attitude and behavioural control were commonly discussed. RELEVANCE TO CLINICAL PRACTICE Interventions to improve adherence to diabetic self-care should focus on helping persons with diabetes develop favourable attitudes and how to overcome behavioural control barriers. Such interventions should have both individualised and community-wide approaches.
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Affiliation(s)
- Victor Mogre
- Department of Health Professions Education and Innovative Learning, School of Medicine and Health Sciences, University for Development Studies, Tamale, Ghana.,School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Natalie A Johnson
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Flora Tzelepis
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton, New South Wales, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Christine Paul
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton, New South Wales, Australia
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Choi SA, Hastings JF. Religion, spirituality, coping, and resilience among African Americans with diabetes. JOURNAL OF RELIGION & SPIRITUALITY IN SOCIAL WORK 2018; 38:93-114. [PMID: 31607831 PMCID: PMC6788765 DOI: 10.1080/15426432.2018.1524735] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 09/13/2018] [Indexed: 05/28/2023]
Abstract
Study aims were to explore how religion and spirituality impacted attitudes about self-management practices among African Americans with homelessness histories and to understand resilience in diabetes care practices. Qualitative semi-structured face-to-face interviews were conducted with 42 African Americans older than 18 years. All audio-taped interviews lasted between 1-1.5 hr, transcribed verbatim, and analyzed using ATLAS.ti (version 7.0). Five resilience themes emerged. While participants recognized diabetes as an illness requiring professional treatment, the context of balancing treatment with religion and spiritual practices mattered. The study findings highlight the importance of spirituality, religious beliefs, and coping strategies in diabetes self-care activities.
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Affiliation(s)
- Sung Ah Choi
- School of Social Welfare, University at Albany, SUNY, Albany, New York, USA
| | - Julia F. Hastings
- School of Social Welfare, University at Albany, SUNY, Albany, New York, USA
- School of Public Health, Health Policy, Management, & Behavior University at Albany, SUNY, Rensselaer, New York, USA
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11
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Jones V, Crowe M. How people from ethnic minorities describe their experiences of managing type-2 diabetes mellitus: A qualitative meta-synthesis. Int J Nurs Stud 2017; 76:78-91. [DOI: 10.1016/j.ijnurstu.2017.08.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 08/22/2017] [Accepted: 08/27/2017] [Indexed: 11/29/2022]
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12
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Sumlin LL, Brown SA. Culture and Food Practices of African American Women With Type 2 Diabetes. DIABETES EDUCATOR 2017; 43:565-575. [PMID: 28929866 DOI: 10.1177/0145721717730646] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Purpose The goals of this descriptive ethnographic study were to (1) describe the day-to-day selection, preparation, and consumption of food among African American women (AAW) with type 2 diabetes mellitus (T2DM); (2) identify their typical food selections and consumption practices when dining out at restaurants and at social gatherings (ie, church functions, holidays); (3) highlight the valued behaviors and beliefs that influence these women's food practices; and (4) determine how social interactions influence those food practices. Methods Symbolic interactionism, a sensitizing framework, guided this study. Purposeful sampling was used to recruit 20 AAW from 35 to 70 years of age diagnosed with T2DM who shopped and prepared meals for their families and attended church functions where food was served. Data collection consisted of one-on-one interviews and observations of participants during church fellowship dinners, grocery shopping, and food preparation. A social anthropological approach to content analysis was used to describe behavioral regularities in food practices. Results Informants exhibited a constant struggle in food practices, particularly within the home setting. Difficulties in making dietary modifications resulted from conflicts between the need to change dietary practices to control diabetes and personal food preferences, food preferences of family members, and AAW's emotional dedication to the symbolism of food derived from traditional cultural food practices passed down from generation to generation. Conclusions African American women are the gatekeepers for family food practices, holding the keys to healthy dietary practices. This study helps to fill the research gap regarding cultural dietary food practices within this population.
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Affiliation(s)
- Lisa L Sumlin
- School of Nursing, The University of Texas at Austin, Austin, Texas (Dr Sumlin, Dr Brown)
| | - Sharon A Brown
- School of Nursing, The University of Texas at Austin, Austin, Texas (Dr Sumlin, Dr Brown)
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Sherman LD, Hawkins JM, Bonner T. An Analysis of the Recruitment and Participation of African American Men in Type 2 Diabetes Self-Management Research: A Review of the Published Literature. SOCIAL WORK IN PUBLIC HEALTH 2017; 32:38-48. [PMID: 27392167 DOI: 10.1080/19371918.2016.1188742] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Research studies have shown that African American men have experienced higher rates of serious complications of type 2 diabetes, due in part to poor disease management. Although type 2 diabetes research among minority populations is consistently advancing, there still remains a scarcity of African American male representation within these studies. It is unclear if this scarcity stems from lack of interest among men, location of recruitment, or ways in which these men are motivated to participate in research studies. As a result, an analysis of recruitment methods and locations of literature that includes African American men with type 2 diabetes is needed. The purpose of this review of the literature is threefold: (a) determine the number of published empirical studies specific to type 2 diabetes self-management that included African Americans in the sample, (b) to evaluate the percentage of men that were represented in the study sample as compared to how many women, and
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Affiliation(s)
- Ledric D Sherman
- a Health & Kinesiology, Texas A&M University , College Station , Texas , USA
| | | | - Timethia Bonner
- a Health & Kinesiology, Texas A&M University , College Station , Texas , USA
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14
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Shearer JE, Jenkins CH, Magwood GS, Pope CA. Contested Ownership of Disease and Ambulatory-Sensitive Emergency Department Visits for Type 2 Diabetes. Am J Med Sci 2016; 351:400-6. [PMID: 27079346 DOI: 10.1016/j.amjms.2016.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Approximately 21 million persons have diabetes and account for 11.9% of all emergency department (ED) visits for a total cost of $14.1 billion. Nonemergent visits for ambulatory-sensitive conditions that could be managed by the primary care provider make up almost one-third of the ED visits. African Americans comprise approximately 30% of South Carolina's population but make up approximately 50% of the ED visits for diabetes. The purpose of the research was to explore the experiences of 20 African-American adults with diabetes with ambulatory-sensitive ED use. RESEARCH DESIGN AND METHODS The research design for this study is grounded theory with dimensional analysis methods. Following ethics approval and informed consent, interviews were conducted, recorded and transcribed verbatim, and themes were analyzed to form the explanatory framework or matrix for ED use. The framework of context, conditions, processes and consequences provides a key for understanding the themes of the story embedded in the descriptive narratives. RESULTS The contested ownership of diabetes was the overarching perspective--"doing what I got to do," "it's always on mind… wishing not to be a diabetic" and "it's a constant burden." And handling diabetes involved taking decisions "into your hands." The context of perceived urgency of symptoms included all the reasons that precipitated ED visit--personal experience, primary care access and services and social network support for decisions--influenced ownership of these decisions.
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Affiliation(s)
- Jennifer E Shearer
- College of Nursing, Charleston Southern University, Charleston, South Carolina
| | - Carolyn H Jenkins
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina.
| | - Gayenell S Magwood
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina
| | - Charlene A Pope
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina; Ralph H. Johnson VA Medical Center, Charleston, South Carolina
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15
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Boonsatean W, Carlsson A, Östman M, Rosner ID. Living with Diabetes: Experiences of Inner and Outer Sources of Beliefs in Women with Low Socioeconomic Status. Glob J Health Sci 2016; 8:54203. [PMID: 27045410 PMCID: PMC5016349 DOI: 10.5539/gjhs.v8n8p200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 11/23/2015] [Indexed: 11/25/2022] Open
Abstract
The purpose of this study was to examine the life experiences of nineteen Thai women of low socioeconomic status who were living with type 2 diabetes. A qualitative research design was conducted, and the women were identified by the snowball technique. Data was collected through semi-structured interviews, and processes of induction and abstraction were used for data analysis. The theme "keeping equilibrium of one's mind" involved two sub-themes: experiencing an unpredictable future and being empowered by emerged beliefs. The first sub-theme encompassed worries concerning health and fears of being a burden to one's family. The second sub-theme comprised the experiences of continuing life without being conquered by the disease and believing in the natural law described in Buddhist teachings. These findings revealed that participants could maintain a balance among their concerns through empowerment by inner and outer sources of beliefs, particularly in Buddhist teachings. Despite the vulnerable situations caused by diabetes and low socioeconomic status, the women remained calm, with a consciousness to continue their lives with the disease. The Buddhist views on life, specifically natural law, assisted them to consider life with diabetes as simply a natural course. Buddhism served as a spiritual refuge and helped the women to cope with their psychological burden from diabetes. These findings may reflect the need for health care professionals to provide more holistic care that would assist patients to live with their disease. Buddhist beliefs can be used as a tool to assist Thai patients to empower themselves successfully.
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Affiliation(s)
- Wimonrut Boonsatean
- Faculty of Health and Society, Malmö University, Malmö, Sweden Faculty of Nursing Science, Rangsit University, Pathum Thani, Thailand.
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Schulman-Green D, Jaser SS, Park C, Whittemore R. A metasynthesis of factors affecting self-management of chronic illness. J Adv Nurs 2016; 72:1469-89. [PMID: 26781649 DOI: 10.1111/jan.12902] [Citation(s) in RCA: 169] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2015] [Indexed: 11/30/2022]
Abstract
AIM To identify factors that may serve as facilitators and barriers to self-management described by adults living with chronic illness by conducting a qualitative metasynthesis. BACKGROUND Self-management is an individuals' active management of a chronic illness in collaboration with their family members and clinicians. DESIGN Qualitative metasynthesis. DATA SOURCES We analysed studies (N = 53) published between January 2000-May 2013 that described factors affecting self-management in chronic illness as reported by adults aged over 18 years with chronic illness. REVIEW METHODS Sandelowsi and Barroso approach to qualitative metasynthesis: literature search; quality appraisal; analysis and synthesis of findings. RESULTS Collectively, article authors reported on sixteen chronic illnesses, most commonly diabetes (N = 28) and cardiovascular disease (N = 20). Participants included men and women (mean age = 57, range 18-94) from 20 countries representing diverse races and ethnicities. We identified five categories of factors affecting self-management: Personal/Lifestyle Characteristics; Health Status; Resources; Environmental Characteristics; and Health Care System. Factors may interact to affect self-management and may exist on a continuum of positive (facilitator) to negative (barrier). CONCLUSION Understanding factors that influence self-management may improve assessment of self-management among adults with chronic illness and may inform interventions tailored to meet individuals' needs and improve health outcomes.
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Affiliation(s)
| | | | - Chorong Park
- Yale School of Nursing, West Haven, Connecticut, USA
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Majeed‐Ariss R, Jackson C, Knapp P, Cheater FM. A systematic review of research into black and ethnic minority patients' views on self-management of type 2 diabetes. Health Expect 2015; 18:625-42. [PMID: 23710892 PMCID: PMC5060817 DOI: 10.1111/hex.12080] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2013] [Indexed: 01/01/2023] Open
Abstract
CONTEXT Eliciting patients' views of type 2 diabetes self-management provides insights on how policy and services might better support the needs of this population. OBJECTIVE To synthesize black and ethnic minority patients' views on the barriers and facilitators influencing the self-management of type 2 diabetes. SEARCH STRATEGY A systematic search of international literature published in nine electronic databases was undertaken in 2008. Search strategies used both MeSH and free-text terms. Two relevant journals were also hand searched. INCLUSION CRITERIA Any primary empirical study published in the English language since 1986 that reported black and ethnic minority patients' views on type 2 diabetes self-management. DATA EXTRACTION AND SYNTHESIS Data were extracted and study quality was formally assessed. Data were analysed using thematic synthesis. MAIN RESULTS Fifty-seven studies were included, of qualitative (n = 54), mixed-method (n = 2) or quantitative (n = 1) design. Studies were from North America (n = 41), Europe (n = 14) and Australia (n = 2), including 1735 participants in total. Three analytical themes emerged: 'Importance of identity'; 'Being understood by others' and 'Making sense of condition', all linked conceptually under the overarching theme 'Sense of self'. The quality of the studies varied. DISCUSSION AND CONCLUSIONS The findings provide insight into what black and minority ethnic people regard as the barriers to, and facilitators of self-management, as opposed to what health professionals, policy makers and trial researchers may have assumed. Recognition of the views of people with diabetes is essential for the design and delivery of patient-centred care and policies.
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Affiliation(s)
| | - Cath Jackson
- School of HealthcareBaines WingUniversity of LeedsUK
| | - Peter Knapp
- School of HealthcareBaines WingUniversity of LeedsUK
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Chen MF, Wang RH, Hung SL. Predicting health-promoting self-care behaviors in people with pre-diabetes by applying Bandura social learning theory. Appl Nurs Res 2015; 28:299-304. [PMID: 26608429 DOI: 10.1016/j.apnr.2015.01.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 01/12/2015] [Accepted: 01/13/2015] [Indexed: 10/23/2022]
Abstract
AIMS The aim of this study was to apply Bandura social learning theory in a model for identifying personal and environmental factors that predict health-promoting self-care behaviors in people with pre-diabetes. BACKGROUND The theoretical basis of health-promoting self-care behaviors must be examined to obtain evidence-based knowledge that can help improve the effectiveness of pre-diabetes care. However, such behaviors are rarely studied in people with pre-diabetes. METHODS This quantitative, cross-sectional survey study was performed in a convenience sample of two hospitals in southern Taiwan. Two hundred people diagnosed with pre-diabetes at a single health examination center were recruited. A questionnaire survey was performed to collect data regarding personal factors (i.e., participant characteristics, pre-diabetes knowledge, and self-efficacy) and data regarding environmental factors (i.e., social support and perceptions of empowerment process) that may have associations with health-promoting self-care behaviors in people with pre-diabetes. RESULTS Multiple linear regression showed that the factors that had the largest influence on the practice of health-promoting self-care behaviors were self-efficacy, diabetes history, perceptions of empowerment process, and pre-diabetes knowledge. These factors explained 59.3% of the variance in health-promoting self-care behaviors. CONCLUSIONS To prevent the development of diabetes in people with pre-diabetes, healthcare professionals should consider both the personal and the environmental factors identified in this study when assessing health promoting self-care behaviors in patients with pre-diabetes and when selecting the appropriate interventions.
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Affiliation(s)
- Mei-Fang Chen
- Department of Nursing, National Tainan Junior College of Nursing, Taiwan.
| | - Ruey-Hsia Wang
- College of Nursing, Kaohsiung Medical University, Taiwan
| | - Shu-Ling Hung
- Department of Nursing, National Tainan Junior College of Nursing, Taiwan
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19
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Namageyo-Funa A, Muilenburg J, Wilson M. The role of religion and spirituality in coping with type 2 diabetes: a qualitative study among Black men. JOURNAL OF RELIGION AND HEALTH 2015; 54:242-252. [PMID: 24357011 DOI: 10.1007/s10943-013-9812-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Religion and spirituality are instrumental to coping with health; however, there is limited literature on the use of religion and spirituality among Black men with type 2 diabetes. The purpose of this study is to explore how Black men use religion or spirituality to cope with diabetes management. We conducted in-depth interviews with 30 Black men recruited from a diabetes clinic in Atlanta, Georgia as part of a larger study. This article reports on data from 12 of the 30 Black men who reported the use of religion and spirituality as a coping strategy for diabetes management. The following coping strategies were reported: prayer and belief in God, keeping me alive, turning things over to God, changing my unhealthy behaviors, supplying my needs, reading the Bible, and religious or spiritual individuals helping me. Healthcare professionals and researchers involved in diabetes management among Black men should consider these findings in their efforts.
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Affiliation(s)
- Apophia Namageyo-Funa
- Department of Health Promotion and Behavior, University of Georgia, 300 River Road, Athens, GA, 30602-6522, USA,
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20
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Spruill IJ, Magwood GS, Nemeth LS, Williams TH. African Americans' Culturally Specific Approaches to the Management of Diabetes. Glob Qual Nurs Res 2015; 2:2333393614565183. [PMID: 27175439 PMCID: PMC4868398 DOI: 10.1177/2333393614565183] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Spirituality is an important multidimensional cultural resource and coping strategy used by many African Americans for managing chronic diseases such as diabetes. Yet, few studies examine meaning and interpretation of colloquial terms frequently used for coping within the context of a community culture. We designed an interpretive qualitative study to gain a deeper understanding of a colloquial phrase, "I ain't claiming it," used among Project SuGar research participants when discussing diabetes. Thematic analysis revealed two major themes, Acknowledgment and Denial, as coping mechanisms through an active or passive relationship with God. Sub-theme of acknowledgment was presented as front seat driver and sub-theme for denial of the disease presented as back seat driver. These meanings encompass a range of culturally specific coping strategies for self-management that health providers should consider and implement as part of providing patient-centered care to enhance better outcome strategies.
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Affiliation(s)
- Ida J. Spruill
- Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Lynne S. Nemeth
- Medical University of South Carolina, Charleston, South Carolina, USA
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21
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Jeragh-Alhaddad FB, Waheedi M, Barber ND, Brock TP. Barriers to medication taking among Kuwaiti patients with type 2 diabetes: a qualitative study. Patient Prefer Adherence 2015; 9:1491-503. [PMID: 26604702 PMCID: PMC4629974 DOI: 10.2147/ppa.s86719] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Nonadherence to medications among Kuwaitis with type 2 diabetes mellitus (T2DM) is believed to be a major barrier to appropriate management of the disease. Published studies of barriers to medication adherence in T2DM suggest a Western bias, which may not adequately describe the Kuwaiti experience. AIM The purpose of this study was to explore barriers to medication adherence among Kuwaiti adults with T2DM. METHODS Semi-structured interviews were conducted with 20 Kuwaiti patients with type 2 diabetes. The interviews were digitally recorded, transcribed, and analyzed using thematic analysis. RESULTS Barriers to medication adherence were identified. Emerging themes were: 1) lack of education/awareness about diabetes/medications, 2) beliefs about medicines/diabetes, 3) spirituality and God-centered locus of control, 4) attitudes toward diabetes 5) perceptions of self-expertise with the disease and body awareness, 6) social stigma, 7) perceptions of social support, 8) impact of illness on patient's life, 9) perceptions of health care providers' attitudes toward patients, and 10) health system-related factors, such as access difficulties and inequalities of medication supply and services. CONCLUSION Personal, sociocultural, religious, health care provider, and health care system-related factors may impede medication adherence among Kuwaitis with type 2 diabetes. Interventions to improve care and therapeutic outcomes in this particular population must recognize and attempt to resolve these factors.
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Affiliation(s)
- Fatima B Jeragh-Alhaddad
- Department of Practice and Policy, University College London School of Pharmacy, London, UK
- Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University, Kuwait City, Kuwait
- Correspondence: Fatima B Jeragh-Alhaddad, Department of Pharmacy Practice, Faculty of Pharmacy, HSC Building – 2nd Floor – Room 2-66, Kuwait University, Kuwait City, Kuwait, Tel +965 2463 6075, Fax +965 2463 6840, Email
| | - Mohammad Waheedi
- Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University, Kuwait City, Kuwait
| | - Nick D Barber
- Department of Practice and Policy, University College London School of Pharmacy, London, UK
| | - Tina Penick Brock
- Department of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco, CA, USA
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22
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Simmons LA, Wu Q, Yang N, Bush HM, Crofford LJ. Sources of health information among rural women in Western Kentucky. Public Health Nurs 2014; 32:3-14. [PMID: 24905745 DOI: 10.1111/phn.12134] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To identify sources of general and mental health information for rural women to inform the development of public health nursing interventions that consider preferences for obtaining information. DESIGN AND SAMPLE One thousand women (mean age = 57 years; 96.9% White) living in primarily nonmetropolitan areas of Western Kentucky participated via a random-digit-dial survey. MEASURES Data were collected on demographics, sources of health information, depression, and stigma. RESULTS Most participants preferred anonymous versus interpersonal sources for both general (68.1%) and mental health (69.4%) information. All participants reported at least one source of general health information, but 20.8% indicated not seeking or not knowing where to seek mental health information. The Internet was the most preferred anonymous source. Few women cited health professionals as the primary information source for general (11.4%) or mental (9.9%) health. Public stigma was associated with preferring anonymous sources and not seeking information. CONCLUSIONS Public health nurses should understand the high utilization of anonymous sources, particularly for mental health information, and focus efforts on helping individuals to navigate resources to ensure they obtain accurate information about symptoms, effective treatments, and obtaining care. Reducing stigma should remain a central focus of prevention and education in rural areas.
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Hunt CW, Grant JS, Palmer JJ, Steadman L. Facilitators of diabetes self-management among rural individuals. HOME HEALTHCARE NURSE 2014; 32:154-166. [PMID: 24584312 DOI: 10.1097/nhh.0000000000000027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The prevalence of Type 2 diabetes mellitus has increased dramatically with a higher rate in rural populations. Diabetes self-management behaviors such as medication administration, blood glucose testing, and appropriate diet and exercise regimens must be implemented daily to increase chances of achieving therapeutic patient outcomes. Home healthcare clinicians are pivotal in assisting these individuals to be more self-confident and independent in managing their diabetes, achieving therapeutic goals, and addressing diabetes-related complications. This article will discuss facilitators of diabetes self-management in rural populations and implications for home healthcare clinicians.
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Affiliation(s)
- Caralise W Hunt
- Caralise W. Hunt, PhD, RN, is an Assistant Professor, Auburn University School of Nursing, Auburn, Alabama. Joan S. Grant, PhD, RN, is a Professor, University of Alabama at Birmingham School of Nursing, Birmingham, Alabama. Jennifer J. Palmer, MSN, RN, is a PhD Student, University of Alabama at Birmingham School of Nursing, Birmingham, Alabama. Laura Steadman, EdD, CRNP, RN, is an Assistant Professor, University of Alabama at Birmingham School of Nursing, Birmingham, Alabama
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Williams IC, Utz SW, Hinton I, Yan G, Jones R, Reid K. Enhancing diabetes self-care among rural African Americans with diabetes: results of a two-year culturally tailored intervention. DIABETES EDUCATOR 2014; 40:231-9. [PMID: 24478047 DOI: 10.1177/0145721713520570] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE The purpose of this study is to test the feasibility of conducting a community-based randomized controlled trial evaluating a culturally tailored community-based group diabetes self-management education (DSME) program among rural African Americans. METHODS Thirty-two African American rural adults with type 2 diabetes were recruited and 25 adults were retained and participated in an interventional study designed to test the effectiveness of the "Taking Care of Sugar" DSME program for the 2-year follow-up. Participants were selected from rural central Virginia. Primary outcomes variables included average blood sugar levels, cardiovascular risk factors, and general physical and mental health. These outcomes were assessed at baseline, 3 months, 6 months, and 12 months post baseline. RESULTS From baseline to 3-month follow-up assessment, participants exhibited significant improvement on several physiological and behavioral measures. Given the small sample size, hypothesis testing was limited. Results show change from baseline over time, illustrating that the primary outcome of A1C decreased, although not significant. Additionally, participants reported more knowledge about diabetes self-management and personal care skills (ie, exercise and foot care) that persisted over time. The feasibility of the culturally tailored DSME was established, and participation with the program was high. CONCLUSIONS A community-based group DSME program using storytelling is feasible. This research will help to inform clinicians and health policymakers as to the types of interventions that are feasible in a larger rural population. If such a program is carried out, we can improve knowledge, reduce complications, and improve quality of life among rural African Americans.
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Affiliation(s)
- Ishan C Williams
- School of Nursing, University of Virginia, Charlottesville, Virginia (Dr Williams, Dr Utz, Dr Hinton, Dr Yan, Dr Jones, Dr Reid)
| | - Sharon W Utz
- School of Nursing, University of Virginia, Charlottesville, Virginia (Dr Williams, Dr Utz, Dr Hinton, Dr Yan, Dr Jones, Dr Reid)
| | - Ivora Hinton
- School of Nursing, University of Virginia, Charlottesville, Virginia (Dr Williams, Dr Utz, Dr Hinton, Dr Yan, Dr Jones, Dr Reid)
| | - Guofen Yan
- School of Nursing, University of Virginia, Charlottesville, Virginia (Dr Williams, Dr Utz, Dr Hinton, Dr Yan, Dr Jones, Dr Reid),Department of Public Health, Charlottesville, Virginia (Dr Yan)
| | - Randy Jones
- School of Nursing, University of Virginia, Charlottesville, Virginia (Dr Williams, Dr Utz, Dr Hinton, Dr Yan, Dr Jones, Dr Reid)
| | - Kathryn Reid
- School of Nursing, University of Virginia, Charlottesville, Virginia (Dr Williams, Dr Utz, Dr Hinton, Dr Yan, Dr Jones, Dr Reid)
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25
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Lundberg PC, Thrakul S. Religion and self-management of Thai Buddhist and Muslim women with type 2 diabetes. J Clin Nurs 2014; 22:1907-16. [PMID: 23745642 DOI: 10.1111/jocn.12130] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2012] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To report of a qualitative study of how religion affects the self-management of Thai Buddhist and Muslim women with type 2 diabetes. BACKGROUND The importance of diabetes self-management is well recognised. However, research on such self-management in Thailand is scarce, in particular on the influence of religion on the self-management of Thai Buddhist and Muslim women with type 2 diabetes. DESIGN A descriptive qualitative study was conducted. METHODS Purposive convenience sampling was used, and 48 women, 19 Buddhist and 29 Muslim, aged from 28-80 years, participated. Data were collected in 2008-09 and analysed by use of manifest and latent content analysis. RESULTS Four themes of the influence of religion on the self-management among Thai women with type 2 diabetes emerged: religion - a way of coping with diabetes, spiritual practice - a help for disease control, spiritual practice - an effort to struggle with everyday life, and support from family - a cultural practice. CONCLUSIONS The Buddhist and Muslim women had self-management capabilities that were often related to their religions. However, many of them had poor control of their blood sugar levels and needed assistance. RELEVANCE TO CLINICAL PRACTICE Reference to religion and spiritual practice can be an effective means of helping diabetes patients better manage their disease and change their lifestyles. Furthermore, family and economic and social environments should be taken into account both in care and in interventions aimed at helping patients cope and empowering them to control their disease.
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Affiliation(s)
- Pranee C Lundberg
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
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26
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Cuesta-Briand B, Saggers S, McManus A. ‘It still leaves me sixty dollars out of pocket’: experiences of diabetes medical care among low-income earners in Perth. Aust J Prim Health 2014; 20:143-50. [DOI: 10.1071/py12096] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 01/22/2013] [Indexed: 11/23/2022]
Abstract
Diabetes prevalence is increasing in Australia, and there are stark inequities in prevalence and clinical outcomes experienced by Indigenous people and low socioeconomic groups compared with non-Indigenous and socioeconomically advantaged groups. This paper explores the impact of Indigenous status and socioeconomic disadvantage on the experience of diabetes care in the primary health setting. Data were collected through focus groups and interviews. The sample, comprising 38 participants (Indigenous and non-Indigenous), was recruited from disadvantaged areas in Perth, Australia. Data analysis was mainly deductive and based on a conceptual framework for the relationship between socioeconomic position and diabetes health outcomes. Most participants reported accessing general practitioners regularly; however, evidence of access to dietitians and podiatrists was very limited. Perceived need, cost, lack of information on available services and previous negative experiences influenced health care-seeking behaviour. Complexity and lack of coordination characterised the model of care reported by most participants. In contrast, Indigenous participants accessing an Aboriginal community-controlled health organisation reported a more accessible and coordinated experience of care. Our analysis suggests that Indigenous and socioeconomically disadvantaged people tailor their health care-seeking behaviour to the limitations imposed by their income and disadvantaged circumstances. To reduce inequities in care experiences, diabetes services in primary care need to be accessible and responsive to the needs of such groups in the community.
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Ricci-Cabello I, Ruiz-Perez I, Rojas-García A, Pastor G, Gonçalves DC. Improving diabetes care in rural areas: a systematic review and meta-analysis of quality improvement interventions in OECD countries. PLoS One 2013; 8:e84464. [PMID: 24367662 PMCID: PMC3868600 DOI: 10.1371/journal.pone.0084464] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 11/21/2013] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND AIMS Despite well documented disparities in health and healthcare in rural communities, evidence in relation to quality improvement (QI) interventions in those settings is still lacking. The main goals of this work were to assess the effectiveness of QI strategies designed to improve diabetes care in rural areas, and identify characteristics associated with greater success. METHODS We conducted a systematic review and meta-analysis. Systematic electronic searches were conducted in MEDLINE, EMBASE, CINAHL, and 12 additional bibliographic sources. Experimental studies carried out in the OECD member countries assessing the effectiveness of QI interventions aiming to improve diabetes care in rural areas were included. The effect of the interventions and their impact on glycated hemoglobin was pooled using a random-effects meta-analysis. RESULTS Twenty-six studies assessing the effectiveness of twenty QI interventions were included. Interventions targeted patients (45%), clinicians (5%), the health system (15%), or several targets (35%), and consisted of the implementation of one or multiple QI strategies. Most of the interventions produced a positive impact on processes of care or diabetes self-management, but a lower effect on health outcomes was observed. Interventions with multiple strategies and targeting the health system and/or clinicians were more likely to be effective. Six QI interventions were included in the meta-analysis (1,496 patients), which showed a significant reduction in overall glycated hemoglobin of 0.41 points from baseline in those patients receiving the interventions (95% CI -0.75% to -0.07%). CONCLUSIONS This work identified several characteristics associated with successful interventions to improve the quality of diabetes care in rural areas. Efforts to improve diabetes care in rural communities should focus on interventions with multiple strategies targeted at clinicians and/or the health system, rather than on traditional patient-oriented interventions.
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Affiliation(s)
- Ignacio Ricci-Cabello
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- CIBER en Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
| | - Isabel Ruiz-Perez
- CIBER en Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
- Andalusian School of Public Health, Granada, Spain
| | - Antonio Rojas-García
- CIBER en Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
- Andalusian School of Public Health, Granada, Spain
| | | | - Daniela C. Gonçalves
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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28
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Li J, Drury V, Taylor B. ‘Diabetes is nothing’ :The experience of older Singaporean women living and coping with type 2 diabetes. Contemp Nurse 2013. [DOI: 10.5172/conu.2013.3430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Purcell N, Cutchen L. Diabetes Self-Management Education for African Americans: Using the PEN-3 Model to Assess Needs. AMERICAN JOURNAL OF HEALTH EDUCATION 2013. [DOI: 10.1080/19325037.2013.798212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Shen H, Edwards H, Courtney M, McDowell J, Wei J. Barriers and facilitators to diabetes self-management: perspectives of older community dwellers and health professionals in China. Int J Nurs Pract 2013; 19:627-35. [PMID: 24330214 DOI: 10.1111/ijn.12114] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Little is known about self-management among people with Type 2 diabetes living in mainland China. Understanding the experiences of this target population is needed to provide socioculturally relevant education to effectively promote self-management. The aim of this study was to explore perceived barriers and facilitators to diabetes self-management for both older community dwellers and health professionals in China. Four focus groups, two for older people with diabetes and two for health professionals, were conducted. All participants were purposively sampled from two communities in Shanghai, China. Six barriers were identified: overdependence on but dislike of western medicine, family role expectations, cuisine culture, lack of trustworthy information sources, deficits in communication between clients and health professionals, and restriction of reimbursement regulations. Facilitators included family and peer support, good relationships with health professionals, simple and practical instruction and a favourable community environment. The findings provide valuable information for diabetes self-management intervention development in China, and have implications for programmes tailored to populations in similar sociocultural circumstances.
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Affiliation(s)
- Huixia Shen
- Department of Nursing, School of Medicine, Tongji University, Shanghai, China
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31
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Chlebowy DO, Hood S, LaJoie AS. Gender differences in diabetes self-management among African American adults. West J Nurs Res 2013; 35:703-21. [PMID: 23345461 DOI: 10.1177/0193945912473370] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The rising incidence of diabetes complications among African Americans is a major health concern. Few studies have addressed gender differences in diabetes self-management in this population. The purpose of this study was to determine whether gender differences in facilitators and barriers to self-management exist among African American adults with type 2 diabetes. Thirty-eight participants were recruited from community agencies and each participated in one of seven audio-recorded focus group sessions. Regular health care visits, positive outlook, prioritization of health, and independence facilitated self-management behaviors in men, whereas acceptance of diabetes was a facilitator for women. Lack of time at work, lack of family support, and lack of knowledge were barriers for men, whereas lack of finances, embarrassment, negative outlook, perceived lack of disease control, and adverse effects of medications were barriers for women. Further research is necessary to design and test gender-specific tailored interventions to improve diabetes self-management in this population.
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Affiliation(s)
- Diane Orr Chlebowy
- University of Louisville School of Nursing, 555 South Floyd Street, Louisville, KY 40202, USA.
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32
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Lynch EB, Fernandez A, Lighthouse N, Mendenhall E, Jacobs E. Concepts of diabetes self-management in Mexican American and African American low-income patients with diabetes. HEALTH EDUCATION RESEARCH 2012; 27:814-824. [PMID: 22641792 DOI: 10.1093/her/cys058] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The goal of the study was to explore low-income minority patients' concepts of diabetes self-management and assess the extent to which patient beliefs correspond to evidence-based recommendations. African American and Mexican American patients with type 2 diabetes were recruited from safety net clinics that serve the uninsured and under-insured in Chicago and San Francisco to participate in focus group discussions. Grounded theory was used to identify themes related to diabetes self-management. Strategies participants mentioned for diabetes self-care were medication use, diet, weight loss and exercise. Eating more fruit and vegetables and consuming smaller portions were the most commonly mentioned dietary behaviors to control diabetes. African Americans expressed skepticism about taking medications. Mexican Americans discussed barriers to acquiring medications and use of herbal remedies. Mexican Americans frequently mentioned intentional exercise of long duration as a management strategy, whereas African Americans more frequently described exercise as regular activities of daily living. Blood glucose self-monitoring and reducing risks of diabetes complications were rarely mentioned as diabetes self-management behaviors. African American and Mexican American patients have different concepts of diabetes self-management, especially with regard to medication use and physical activity. Consideration of these differences may facilitate design of effective self-management interventions for these high-risk populations.
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Affiliation(s)
- E B Lynch
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL 60612, USA.
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Hershey DS, Tipton J, Given B, Davis E. Perceived impact of cancer treatment on diabetes self-management. DIABETES EDUCATOR 2012; 38:779-90. [PMID: 22983823 DOI: 10.1177/0145721712458835] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this study was to identify the impact that cancer and its treatment had on diabetes self-management and to identify common issues that individuals with diabetes encounter while undergoing chemotherapy. METHODS This exploratory study utilized a baseline self-administered written survey and an 8-week telephone follow-up survey that included 2 open-ended questions. Forty-three adults aged 50 or older with diabetes and a solid tumor cancer receiving chemotherapy were recruited from 8 community outpatient cancer centers in Michigan and Ohio. Descriptives, t tests, and correlations were utilized to analyze the data. Content analysis was used to analyze the data from the open-ended questions. RESULTS After a minimum of 8 weeks of chemotherapy, patients performed significantly fewer diabetes self-management behaviors. The majority of individuals experienced a moderate to high impact on their ability to perform diabetes self-management activities while receiving chemotherapy. Exercise, ability to eat and drink, and monitoring blood sugars were most affected. Three themes identifying patient issues were noted: self-management issues, health issues, and prioritization. CONCLUSIONS Cancer treatment and cancer-related symptoms can have a negative impact on diabetes self-management behaviors in adults with diabetes who are undergoing chemotherapy. Diabetes self-management education is targeted to improve health outcomes in patients with diabetes and cancer and addresses the "cause" not just the "source" of the problem needs to be developed. Further research needs to be done to address issues related to glycemic control and health-related outcomes in this population.
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Affiliation(s)
- Denise Soltow Hershey
- The College of Nursing, Michigan State University, East Lansing, Michigan (Dr Hershey, Dr Given)
| | - Janelle Tipton
- The University of Toledo Medical Center, Toledo, Ohio (Ms Tipton)
| | - Barbara Given
- The College of Nursing, Michigan State University, East Lansing, Michigan (Dr Hershey, Dr Given)
| | - Ellen Davis
- Duke University Health System, Durham, North Carolina (Ms Davis)
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Tonks SA, Makwana S, Salanitro AH, Safford MM, Houston TK, Allison JJ, Curry W, Estrada CA. Quality of diabetes mellitus care by rural primary care physicians. J Rural Health 2012; 28:364-71. [PMID: 23083082 DOI: 10.1111/j.1748-0361.2012.00410.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To explore the relationship between degree of rurality and glucose (hemoglobin A1c), blood pressure (BP), and lipid (LDL) control among patients with diabetes. METHODS Descriptive study; 1,649 patients in 205 rural practices in the United States. Patients' residence ZIP codes defined degree of rurality (Rural-Urban Commuting Areas codes). Outcomes were measures of acceptable control (A1c < = 9%, BP < 140/90 mmHg, LDL < 130 mg/dL) and optimal control (A1c < 7%, BP < 130/80 mmHg, LDL < 100 mg/dL). Statistical significance was set at P < .008 (Bonferroni's correction). FINDINGS Although the proportion of patients with reasonable A1c control worsened by increasing degree of rurality, the differences were not statistically significant (urban 90%, large rural 88%, small rural 85%, isolated rural 83%; P = .10); mean A1c values also increased by degree of rurality, although not statistically significant (urban 7.2 [SD 1.6], large rural 7.3 [SD 1.7], small rural 7.5 [SD 1.8], isolated rural 7.5 [SD 1.9]; P = .16). We observed no differences between degree of rural and reasonable BP or LDL control (P = .42, P = .23, respectively) or optimal A1c or BP control (P = .52, P = .65, respectively). Optimal and mean LDL values worsened as rurality increased (P = .08, P = .029, respectively). CONCLUSIONS In patients with diabetes who seek care in the rural Southern United States, we observed no relationship between degree of rurality of patients' residence and traditional measures of quality of care. Further examination of the trends and explanatory factors for relative worsening of metabolic control by increasing degree of rurality is warranted.
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Affiliation(s)
- Stephen A Tonks
- The University of Alabama, Birmingham, Alabama 35294-3407, USA
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Psychosocial Impacts of Type 2 Diabetes Self-Management in a Rural African-American Population. J Immigr Minor Health 2012; 14:1071-81. [DOI: 10.1007/s10903-012-9585-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Beatriz CB, Sherry S, Alexandra M. 'You get the quickest and the cheapest stuff you can': Food security issues among low-income earners living with diabetes. Australas Med J 2011; 4:683-91. [PMID: 22905044 DOI: 10.4066/amj.20111104] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Diabetes prevalence is increasing worldwide. More than 800,000 Australians live with diabetes, and there are stark inequities in prevalence and clinical outcomes among Indigenous people and low socio-economic groups. AIMS This paper focuses on food security issues experienced by low-income earners living with type 2 diabetes in Perth, Western Australia. The results presented here are part of a broader qualitative study exploring the impact of socioeconomic disadvantage on diabetes. METHOD Data was collected through focus groups and semistructured interviews conducted from October 2008 to November 2009. The sample, comprising 38 participants ( Indigenous and non-Indigenous), was recruited from areas with high indices of socio-economic disadvantage in Perth. Deductive data analysis identified categories from an existing conceptual framework for the relationship between socio-economic position and diabetes health outcomes, while an inductive approach was adopted to identify new themes. RESULTS Participants had a good understanding of their dietary requirements. However, access to healthy food was not always realised, as many participants depended on others for food provision and meal preparation and had little control over their diets. Furthermore, the majority struggled to accommodate the price of healthy food within a limited budget. CONCLUSION In this study, low-income earners living with diabetes faced food security issues. Participants reported cost barriers, but also physical barriers relating to functional limitations and lack of transport. This study highlights that the socioeconomic circumstances in which vulnerable populations experience their disease need to be understood and addressed in order to reduce the inequities surrounding diabetes outcomes.
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Abstract
In this qualitative study, African Americans described 3 orientations about spiritual practices and diabetes self-management: Spiritual practice as effort toward self-management; spiritual practice and self-management as effort toward healing; and spiritual practice as effort toward healing. Spiritual practices may influence diabetes self-management in African Americans and be a resource in care.
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Orr Chlebowy D, Hood S, LaJoie AS. Facilitators and Barriers to Self-management of Type 2 Diabetes Among Urban African American Adults. DIABETES EDUCATOR 2010; 36:897-905. [DOI: 10.1177/0145721710385579] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose The purpose of this study was to identify facilitators and barriers to self-management of type 2 diabetes mellitus (T2DM) among urban African American adults. Methods Thirty-eight African American adults with T2DM were recruited from 1 of 3 health care agencies in a midsized city in the southeastern United States. Qualitative data were obtained using focus groups, wherein each participant engaged in a 60- to 90-minute audio-recorded session. Focus group data were transcribed and analyzed using Atlas ti 6 ® data analysis software. Demographic and medical history information was also collected. Results Factors relating to external locus of control primarily facilitated adherence to T2DM self-management behaviors. Support from family, peers, and health care providers positively influenced adherence behaviors by providing cues to action, direct assistance, reinforcement, and knowledge. Internal factors were primarily described as barriers to self-management behaviors and included fears associated with glucose monitoring, lack of self-control over dietary habits, memory failure, and perceived lack of personal control over diabetes. Conclusions African Americans perceived external factors as facilitators of their T2DM management behaviors and internal factors as barriers to self-management. Further research is necessary to design and test interventions that capitalize on the external facilitators while helping African Americans to overcome perceived barriers identified in this study.
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Affiliation(s)
| | - Sula Hood
- School of Public Health and Information Sciences University
of Louisville, Louisville, Kentucky
| | - A. Scott LaJoie
- School of Public Health and Information Sciences, University
of Louisville, Louisville, Kentucky
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DiIorio C, Escoffery C, McCarty F, Yeager KA, Henry TR, Koganti A, Reisinger EL, Wexler B. Evaluation of WebEase: an epilepsy self-management Web site. HEALTH EDUCATION RESEARCH 2009; 24:185-197. [PMID: 18682382 DOI: 10.1093/her/cyn012] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
People with epilepsy have various education needs and must adopt many self-management behaviors in order to control their condition. This study evaluates WebEase, an Internet-based, theory-driven, self-management program for adults with epilepsy. Thirty-five participants took part in a 6-week pilot implementation of WebEase. The main components of WebEase are My Log, a behavioral journal, and the Medication, Stress and Sleep Modules, which provide tailored information and feedback designed to prompt participants to assess their status with self-management behaviors, think about their behaviors and make a goal. In this article, we discuss the results of the feasibility, acceptability and usability assessments and the behavioral outcomes. The process results indicate that theoretical components that served as the program framework were successfully integrated into the program and that participants viewed WebEase as relevant, acceptable and easy to use. Additionally, participants showed some improvement in epilepsy self-management, adherence, sleep quality, self-efficacy and social support following the program. The initial results are encouraging and continued development of WebEase has the potential to facilitate education and self-management strategies among people with epilepsy.
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Affiliation(s)
- Colleen DiIorio
- Department of Behavioral Sciences.ealth Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
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Abstract
OBJECTIVE Type 2 diabetes is a progressive disease requiring constant monitoring of patients to ensure maintenance of glycemic goals and advancement of therapy when necessary. The challenges of treatment in rural areas may be different from those in urban areas. This review article will evaluate the barriers to treatment of type 2 diabetes and the role of insulin analogs in overcoming such barriers and in treating the disease, particularly with respect to rural communities. RESEARCH DESIGN AND METHODS A literature review of English language articles in the Medline Database was conducted to identify published articles through April 2008. Search terms included rural, diabetes, insulin, treatment, and treatment challenges/barriers and were used either alone or in various combinations with one another. Articles were included if they pertained to rural communities in the United States. Barriers related to treatment of type 2 diabetes and the role of insulin analogs in treatment and in overcoming such barriers, were examined. RESULTS Health-care providers and patients in rural areas face barriers both common to the general population and unique to the rural setting. Challenges include limited access to health care, lack of health-care resources, and lack of multidisciplinary staff. CONCLUSIONS A number of strategies exist, including simple, stepwise treatment algorithms for insulin therapy, to manage type 2 diabetes in rural populations effectively. Because this article focused on rural communities in the United States, barriers in other rural communities may not have been identified. Additionally, although Medline is one of the largest and most comprehensive databases of published medical literature, publications not in the Medline database have not been included in this analysis.
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Affiliation(s)
- Scott Nelson
- Cleveland Family Medicine, Cleveland, MS 38732, USA.
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Alexander GK, Uz SW, Hinton I, Williams I, Jones R. Culture Brokerage Strategies in Diabetes Education. Public Health Nurs 2008; 25:461-70. [PMID: 18816363 DOI: 10.1111/j.1525-1446.2008.00730.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Gina K Alexander
- Center for the Study of Complementary and Alternative Therapies, University of Virginia School of Nursing, Charlottesville, Virginia, USA.
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Jones RA, Utz SW, Williams IC, Hinton I, Alexander G, Moore C, Blankenship J, Steeves R, Oliver N. Family interactions among African Americans diagnosed with type 2 diabetes. THE DIABETES EDUCATOR 2008; 34:318-26. [PMID: 18375781 PMCID: PMC3616190 DOI: 10.1177/0145721708314485] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to examine the impact of family and friends on the management of persons with diabetes and their willingness to be involved in a culturally tailored program. METHODS This qualitative study was based within a larger quasi-experimental study that focused on the impact of a culturally tailored group intervention compared with individual standard diabetes education on the outcomes of self-management and glycemic control among rural African Americans with type 2 diabetes. Twenty-one participants were randomly assigned to an individual education group or a culturally tailored intervention group. Family members/peers (n = 6) attended invited group sessions to obtain information about diabetes and family/peer support. The facilitator of the invited group sessions used a guide to help with group discussions. The investigators used an iterative approach to enhance the examination of the responses from the discussion guide, thus identifying recurring themes within the participants' responses. RESULTS The data revealed that family and friends made a difference in the diabetes management of individuals with diabetes. Although family and friends may have been helpful at times, they also created moments of problems and an environment that made it more difficult to care for diabetes. The data also revealed that diabetes is hard to manage and control. Participants reported that taking medications and being aware of types of foods to keep a well-maintained glucose level were often challenging. CONCLUSIONS These findings confirm that family and peers greatly influence diabetes management among rural African Americans. The study's results will help health care providers understand the importance of involving family members and friends in the treatment and diabetes management of individuals with type 2 diabetes, particularly within rural African American communities where resources are limited.
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Affiliation(s)
- Randy A Jones
- The University of Virginia School of Nursing, Charlottesville, Virginia (RAJ, SWU, ICW, IH, GA, RS)
| | - Sharon W Utz
- The University of Virginia School of Nursing, Charlottesville, Virginia (RAJ, SWU, ICW, IH, GA, RS)
| | - Ishan C Williams
- The University of Virginia School of Nursing, Charlottesville, Virginia (RAJ, SWU, ICW, IH, GA, RS)
| | - Ivora Hinton
- The University of Virginia School of Nursing, Charlottesville, Virginia (RAJ, SWU, ICW, IH, GA, RS)
| | - Gina Alexander
- The University of Virginia School of Nursing, Charlottesville, Virginia (RAJ, SWU, ICW, IH, GA, RS)
| | - Cynthia Moore
- University of Virginia Medical Center, Charlottesville, Virginia (CM, JB)
| | - Jean Blankenship
- University of Virginia Medical Center, Charlottesville, Virginia (CM, JB)
| | - Rick Steeves
- The University of Virginia School of Nursing, Charlottesville, Virginia (RAJ, SWU, ICW, IH, GA, RS)
| | - Norman Oliver
- University of Virginia School of Medicine, Charlottesville, Virginia (NO)
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Valitutto M. Common crossroads in diabetes management. OSTEOPATHIC MEDICINE AND PRIMARY CARE 2008; 2:4. [PMID: 18279520 PMCID: PMC2276216 DOI: 10.1186/1750-4732-2-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2007] [Accepted: 02/15/2008] [Indexed: 12/13/2022]
Abstract
The prevalence and impact of type 2 diabetes are reaching epidemic proportions in the United States. Data suggest that effective management can reduce the risk for both microvascular and macrovascular complications of diabetes. In treating patients with diabetes, physicians must be prepared not only to tailor the initial treatment to the individual and his or her disease severity but also to advance treatment as necessary and in step with disease progression. The majority of patients with diabetes are not at goal for glycated hemoglobin A1C, fasting plasma glucose, or postprandial plasma glucose levels. Although lifestyle changes based on improved diet and exercise practices are basic elements of therapy at every stage, pharmacologic therapy is usually necessary to achieve and maintain glycemic control. Oral antidiabetic agents may be effective early in the disease but, eventually, they are unable to compensate as the disease progresses. For patients unable to achieve glycemic control on 2 oral agents, current guidelines strongly urge clinicians to consider the initiation of insulin as opposed to adding a third oral agent. Recent research suggests that earlier initiation of insulin is more physiologic and may be more effective in preventing complications of diabetes. Newer, longer-lasting insulin analogs and the use of simplified treatment plans may overcome psychological resistance to insulin on the part of physicians and patients. This article summarizes the risks associated with uncontrolled fasting and postprandial hyperglycemia, briefly reviews the various treatment options currently available for type 2 diabetes, presents case vignettes to illustrate crossroads encountered when advancing treatment, and offers guidance to the osteopathic physician on the selection of appropriate treatments for the management of type 2 diabetes.
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Wenzel J, Utz SW, Steeves RH, Hinton I, Jones RA. Stories of diagnosis from rural Blacks with diabetes. FAMILY & COMMUNITY HEALTH 2006; 29:206-13. [PMID: 16775470 DOI: 10.1097/00003727-200607000-00007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Diabetes has a disproportionate impact on people of color, including Black Americans. An understanding of the perspectives of rural Blacks is needed to design effective programs of diabetes care. The purpose of this study was to examine the experience of being diagnosed with diabetes as described by rural Blacks. This descriptive, exploratory study conducted gender-separated focus groups in 3 rural communities to capture diagnosis perspectives. Findings may be useful to healthcare professionals providing diabetes care to rural Blacks. Participants could describe events surrounding diagnosis with clarity. For many, the diagnosis was not an emotional and/or surprising experience. Participants commonly used expressive or figurative language to relate their stories of diagnosis, and gender differences were noted. Descriptions of diagnosis revealed valuable infor-mation about participants' perceptions of their diabetes.
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