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Grant V, Litchfield I. Acceptability of community health worker and peer supported interventions for ethnic minorities with type 2 diabetes: a qualitative systematic review. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2024; 5:1306199. [PMID: 38836261 PMCID: PMC11148349 DOI: 10.3389/fcdhc.2024.1306199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/26/2024] [Indexed: 06/06/2024]
Abstract
Objective Ethnic minority groups in high income countries in North America, Europe, and elsewhere are disproportionately affected by T2DM with a higher risk of mortality and morbidity. The use of community health workers and peer supporters offer a way of ensuring the benefits of self-management support observed in the general population are shared by those in minoritized communities. Materials and methods The major databases were searched for existing qualitative evidence of participants' experiences and perspectives of self-management support for type 2 diabetes delivered by community health workers and peer supporters (CHWPs) in ethnically minoritized populations. The data were analysed using Sekhon's Theoretical Framework of Acceptability. Results The results are described within five domains of the framework of acceptability collapsed from seven for reasons of clarity and concision: Affective attitude described participants' satisfaction with CHWPs delivering the intervention including the open, trusting relationships that developed in contrast to those with clinical providers. In considering Burden and Opportunity Costs, participants reflected on the impact of health, transport, and the responsibilities of work and childcare on their attendance, alongside a lack of resources necessary to maintain healthy diets and active lifestyles. In relation to Cultural Sensitivity participants appreciated the greater understanding of the specific cultural needs and challenges exhibited by CHWPs. The evidence related to Intervention Coherence indicated that participants responded positively to the practical and applied content, the range of teaching materials, and interactive practical sessions. Finally, in examining the impact of Effectiveness and Self-efficacy participants described how they changed a range of health-related behaviours, had more confidence in dealing with their condition and interacting with senior clinicians and benefitted from the social support of fellow participants and CHWPs. Conclusion Many of the same barriers around attendance and engagement with usual self-management support interventions delivered to general populations were observed, including lack of time and resource. However, the insight of CHWPs, their culturally-sensitive and specific strategies for self-management and their development of trusting relationships presented considerable advantages.
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Affiliation(s)
- Vivene Grant
- Birmingham Medical School, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Ian Litchfield
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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Davies MJ, Bodicoat DH, Brennan A, Dixon S, Eborall H, Glab A, Gray LJ, Hadjiconstantinou M, Huddlestone L, Hudson N, Keetharuth A, Khunti K, Martin G, Northern A, Pritchard R, Schreder S, Speight J, Sturt J, Turner J. Uptake of self-management education programmes for people with type 2 diabetes in primary care through the embedding package: a cluster randomised control trial and ethnographic study. BMC PRIMARY CARE 2024; 25:136. [PMID: 38664727 PMCID: PMC11046789 DOI: 10.1186/s12875-024-02372-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 04/08/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Self-management education programmes are cost-effective in helping people with type 2 diabetes manage their diabetes, but referral and attendance rates are low. This study reports on the effectiveness of the Embedding Package, a programme designed to increase type 2 diabetes self-management programme attendance in primary care. METHODS Using a cluster randomised design, 66 practices were randomised to: (1) a wait-list group that provided usual care for nine months before receiving the Embedding Package for nine months, or (2) an immediate group that received the Embedding Package for 18 months. 'Embedders' supported practices and self-management programme providers to embed programme referral into routine practice, and an online 'toolkit' contained embedding support resources. Patient-level HbA1c (primary outcome), programme referral and attendance data, and clinical data from 92,977 patients with type 2 diabetes were collected at baseline (months - 3-0), step one (months 1-9), step 2 (months 10-18), and 12 months post-intervention. An integrated ethnographic study including observations, interviews, and document analysis was conducted using interpretive thematic analysis and Normalisation Process Theory. RESULTS No significant difference was found in HbA1c between intervention and control conditions (adjusted mean difference [95% confidence interval]: -0.10 [-0.38, 0.18] mmol/mol; -0.01 [-0.03, 0.02] %). Statistically but not clinically significantly lower levels of HbA1c were found in people of ethnic minority groups compared with non-ethnic minority groups during the intervention condition (-0.64 [-1.08, -0.20] mmol/mol; -0.06% [-0.10, -0.02], p = 0.004), but not greater self-management programme attendance. Twelve months post-intervention data showed statistically but not clinically significantly lower HbA1c (-0.56 [95% confidence interval: -0.71, -0.42] mmol/mol; -0.05 [-0.06, -0.04] %; p < 0.001), and higher self-management programme attendance (adjusted odds ratio: 1.13; 95% confidence interval: 1.02, 1.25; p = 0.017) during intervention conditions. Themes identified through the ethnographic study included challenges for Embedders in making and sustaining contact with practices and providers, and around practices' interactions with the toolkit. CONCLUSIONS Barriers to implementing the Embedding Package may have compromised its effectiveness. Statistically but not clinically significantly improved HbA1c among ethnic minority groups and in longer-term follow-up suggest that future research exploring methods of embedding diabetes self-management programmes into routine care is warranted. TRIAL REGISTRATION ISRCTN23474120, registered 05/04/2018.
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Affiliation(s)
- Melanie J Davies
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK.
- Diabetes Research Centre, University of Leicester, Gwendolen Road, Leicester, LE5 4PW, UK.
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK.
| | | | - Alan Brennan
- School of Health and Related Research, University of Sheffield, Regent Court (ScHARR), 30 Regent Street, Sheffield, S1 4DA, UK
| | - Simon Dixon
- School of Health and Related Research, University of Sheffield, Regent Court (ScHARR), 30 Regent Street, Sheffield, S1 4DA, UK
| | - Helen Eborall
- Usher Institute, Old Medical School, The University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Agnieszka Glab
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK
- Diabetes Research Centre, University of Leicester, Gwendolen Road, Leicester, LE5 4PW, UK
| | - Laura J Gray
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK
- Department of Population Health Sciences, George Davies Centre, University of Leicester, University Road, Leicester, LE1 7RH, UK
| | - Michelle Hadjiconstantinou
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK
- Diabetes Research Centre, University of Leicester, Gwendolen Road, Leicester, LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK
| | - Lisa Huddlestone
- Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, YO10 5DD, York, UK
| | - Nicky Hudson
- School of Applied Health Sciences, De Montfort University, The Gateway, Leicester, LE1 9BH, UK
| | - Anju Keetharuth
- School of Health and Related Research, University of Sheffield, Regent Court (ScHARR), 30 Regent Street, Sheffield, S1 4DA, UK
| | - Kamlesh Khunti
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK
- Diabetes Research Centre, University of Leicester, Gwendolen Road, Leicester, LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK
| | - Graham Martin
- THIS Institute, University of Cambridge, Clifford Allbutt Building, Cambridge Biomedical Campus, Cambridge, CB2 0AH, UK
| | - Alison Northern
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK
| | - Rebecca Pritchard
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK
- Diabetes Research Centre, University of Leicester, Gwendolen Road, Leicester, LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK
| | - Sally Schreder
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK
- Diabetes Research Centre, University of Leicester, Gwendolen Road, Leicester, LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK
| | - Jane Speight
- The Australian Centre for Behavioural Research in Diabetes, 570 Elizabeth Street, Melbourne, VIC, 3000, Australia
- School of Psychology, Deakin University, Geelong VIC, 3220, Australia
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, Strand, London, WC2R 2LS, UK
| | - Jessica Turner
- School of Applied Health Sciences, De Montfort University, The Gateway, Leicester, LE1 9BH, UK
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Njuguna C, Tola HH, Maina BN, Magambo KN, Phoebe N, Mgamb EA, Tibananuka E, Turyashemererwa FM, Rubangakene M, Richard K, Opong G, Richard S, Opesen C, Mateeba T, Muyingo E, George U, Namukose S, Woldemariam YT. Perceived barriers of access to health and nutrition services under drought and food insecurity emergency in north-east Uganda: a qualitative study. BMC Public Health 2024; 24:390. [PMID: 38321413 PMCID: PMC10848454 DOI: 10.1186/s12889-024-17830-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 01/20/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND In the face of drought and food insecurity emergency, evidence on access to health and nutrition services is important. Karamoja is one of the regions that have experienced extreme drought and food insecurity emergency in Uganda. As a part of the drought and food insecurity emergency response, World Health Organization (WHO) with Ministry of Health (MoH) has designed and implemented a qualitative study in 15 districts that have experienced drought and food insecurity emergency in north-east Uganda. Thus, we aimed to explore the barriers of access to health and nutrition services in drought and food insecurity emergency affected districts in north-east Uganda. METHODS We employed a descriptive qualitative study design. We interviewed 30 patients and 20 Village Health Teams (VHT) from 15 districts. We employed an in-depth interview with semi-structured questions to collect data until information saturation reached. We used thematic data analysis approach by ATLAS.ti version 7.5.1.8 software. RESULTS Of the 30 interviewed subjects, 15 were female, and the median age of the subjects was 29 years with interquartile range (IQR) of 23 to 37 years. Majority (68.8%) of subjects reported that access to health and nutrition services was harder to them. Four themes: sociocultural and economic; environmental; health system, and individual related factors were identified as the barriers of access to health and nutrition services. CONCLUSION The present study identified several modifiable barriers that hinder access to health and nutrition services in drought and food insecurity affected districts. Comprehensive interventions aimed at addressing sociocultural, economic, environmental, health system and subject related challenges are required to improve access to health and nutrition services in drought and food insecurity affected setups.
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Affiliation(s)
- Charles Njuguna
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda.
| | - Habteyes Hailu Tola
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - Benson Ngugi Maina
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - Kwikiriza Nicholas Magambo
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - Nabunya Phoebe
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - Elizabeth Adhiambo Mgamb
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - Evelyne Tibananuka
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - Florence M Turyashemererwa
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - Moses Rubangakene
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - Kisubika Richard
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - George Opong
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - Ssekitoleko Richard
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - Chris Opesen
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - Tim Mateeba
- Ministry of Health of Uganda, Kampala, Uganda
| | | | | | | | - Yonas Tegegn Woldemariam
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
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Phillips A. Call to action on diabetes care: reaching communities facing health inequalities, health inequities and deprivation. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:16-20. [PMID: 38194328 DOI: 10.12968/bjon.2024.33.1.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
This article presents evidence and policy on the importance of reaching out into local communities with inclusive approaches to try to reduce and prevent inequities and inequalities in diabetes care. The global emergency diabetes is causing and the risks and disproportionately high ethnic disparities are investigated. The article includes some suggestions on changing approaches to reduce health inequalities to enable diabetes care to become more accessible for those who need it the most.
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Affiliation(s)
- Anne Phillips
- Professor in Diabetes Care, Birmingham City University
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Waqar M, Kuuire VZ. "The Critical Services Are Out of Reach": Diabetes Management and the Experiences of South Asian Immigrants in Ontario. J Prim Care Community Health 2024; 15:21501319241240635. [PMID: 38523416 PMCID: PMC10962024 DOI: 10.1177/21501319241240635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/13/2024] [Accepted: 03/04/2024] [Indexed: 03/26/2024] Open
Abstract
Type 2 diabetes is a serious chronic condition affecting millions of people worldwide. South Asians (individuals originating from Pakistan, India, Bangladesh, Sri Lanka, and Nepal) represent a high-risk ethnicity for developing type 2 diabetes (T2D) and experience a high prevalence of the disease, even in migrant populations. The objective of this study was to investigate perceptions and experiences of South Asians living with T2D in Ontario, and their utilization of diabetes related services within the provincial healthcare system. Data were obtained from 20 in-depth interviews with South Asian participants diagnosed with T2D and living in the Greater Toronto Area. Our findings indicate a dissatisfaction with Ontario's coverage for diabetes services; varying uptake of recommended health tests, exams, and monitoring equipment; low utilization of additional resources (diabetes centers); and a need for primary care physicians to better facilitate awareness and utilization of available coverages and resources in the community. This study provides support for the fact that even in Canada's universal healthcare system, disparities exist, particularly for ethnic minorities, and that a universal prescription drug coverage component is a crucial step forward to ensure equitable access to health services utilization for all.
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Affiliation(s)
- Minal Waqar
- Department of Geography, Geomatics & Environment, University of Toronto – Mississauga, Mississauga, ON, Canada
| | - Vincent Z. Kuuire
- Department of Geography, Geomatics & Environment, University of Toronto – Mississauga, Mississauga, ON, Canada
- Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto – St. George, Toronto, ON, Canada
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Pettersson S, Klompstra L, Jirwe M, Jaarsma T. Developing a Culturally Appropriate Tool to Support Self-Care in Migrants with Type 2 Diabetes - A Co-Design Study. Patient Prefer Adherence 2023; 17:2557-2567. [PMID: 37854029 PMCID: PMC10581012 DOI: 10.2147/ppa.s426908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/08/2023] [Indexed: 10/20/2023] Open
Abstract
Introduction Migrants, especially from the Middle East, experience poorer health outcomes and face greater difficulties in accessing healthcare compared to native populations and there is a need for culturally appropriate education for this vulnerable group. The purpose of this study is to describe the process of developing a culturally appropriate tool to support self-care in migrants with type 2 diabetes. Methods In this Co-design study, a tool for supporting self-care in migrants with type 2 diabetes was developed. Migrant patients with type 2 diabetes, healthcare providers and researchers participated in the process, which was based on six elements; engage, plan, explore, develop, decide and change. From February 2021 to December 2022, idea groups were conducted, and a tool was developed through brainstorming, prioritizing and prototyping. Results In total, 14 migrant patients, ten health care providers and four researchers participated in the Co-design process. The patients wished to receive information about type 2 diabetes self-care behaviour in their own languages. The healthcare providers asked for clear instructions on where to guide their patients regarding reliable information about diabetes in the patient's own language. All participants agreed that information can be presented in different formats, either: text (paper or online), audio-visual via recorded videos and/or lectures and pictures. Discussion The Co-design process led to several important insights and experiences related to the importance of diverse cultural backgrounds. When conducting a Co-design study with end-users as stakeholders, it is significant that the stakeholders have a diverse background in experiences, both as patients as well as those who deliver or implement the health service. In this study it was of great importance to include patients with diverse backgrounds regarding; gender, age, health literacy, occupation, years living in Sweden and duration of diabetes.
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Affiliation(s)
- Sara Pettersson
- Linkoping University, Department of Health, Medicine and Caring Sciences, Linkoping, Sweden
| | - Leonie Klompstra
- Linkoping University, Department of Health, Medicine and Caring Sciences, Linkoping, Sweden
| | - Maria Jirwe
- Red Cross University College, Department of Health Sciences, Huddinge, Sweden
| | - Tiny Jaarsma
- Linkoping University, Department of Health, Medicine and Caring Sciences, Linkoping, Sweden
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Watt L, Li M, Bladon S, Martin GP, White C, Majeed-Ariss R. Use of SARC services by victims of sexual violence: Auditing the ethnicity of Saint Mary's Sexual Assault Referral Centre's clients. J Forensic Leg Med 2023; 99:102593. [PMID: 37734254 DOI: 10.1016/j.jflm.2023.102593] [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: 08/09/2023] [Revised: 09/09/2023] [Accepted: 09/12/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION Saint Mary's Sexual Assault Referral Centre (SARC) in Manchester provides services to adults and children who have suffered sexual assault. The ethnic composition of those who attended the centre was audited in 2001 and 2003 to measure how well it serves different ethnic groups. This paper provides an updated audit using 2019 data. METHODOLOGY Census data for Greater Manchester, and data from the Crime Survey of England and Wales (CSEW) showing rates of sexual assault for different ethnic groups, were used to predict the ethnic composition of sexual assault victims in Greater Manchester. These predicted figures were then compared with the ethnic composition of Saint Mary's SARC 2019 client base to measure how well the SARC is serving different groups. This comparison was repeated using data from the 2001 SARC client base to explore change over time. RESULTS The analysis shows that South Asians and Chinese individuals are underrepresented in the SARC client base, and that this issue has become more pronounced over time. Every other group is overrepresented. CONCLUSION The underrepresentation of South Asian and Chinese clients at Saint Mary's SARC is concerning. Making the service more accessible to those from these ethnic groups should be a priority for the centre.
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Affiliation(s)
- Laura Watt
- Department of Sociology, Manchester Metropolitan University, Manchester, United Kingdom
| | - Mingze Li
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Sian Bladon
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Glen P Martin
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Catherine White
- University of Manchester, Manchester, United Kingdom; Institute for Addressing Strangulation Sexual Offences, Manchester, United Kingdom
| | - Rabiya Majeed-Ariss
- University of Manchester, Manchester, United Kingdom; Saint Mary's Sexual Assault Referral Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom.
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Calderón-Mora J, Alomari A, Shokar N. Comparison of Narrative Video and Flipchart Presentation to Promote Cervical Cancer Screening Among Latinas Along the Border. HEALTH EDUCATION & BEHAVIOR 2023; 50:561-571. [PMID: 35112582 DOI: 10.1177/10901981221074918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Cervical cancer incidence and mortality is higher among Latinas compared with non-Hispanic White women and barriers to screening include lack of knowledge, lack of access to health care, and cultural factors. Both video and printed material have been found effective as health education tools in underserved populations. The purpose of this study was to show no difference between a flipchart presentation facilitated by a community health worker and a narrative video with limited in-person interaction in increasing cervical cancer screening rates among Latinas along the U.S.-Mexico border. METHODS Study design: Randomized controlled study. Participants: women in a community-based cervical cancer screening program. OUTCOMES Primary outcome was screening completion and secondary outcomes were changes in psychosocial variables. RESULTS Total sample size was 500. Most participants were born in Mexico, had a low annual income, preferred Spanish, and did not have a regular doctor. Overall, 371 (74.2%) participants completed screening. There was no significant difference in screening completion between educational delivery modes. The only variable significantly associated with screening completion was age, with 51- to 65-year-olds being 44% more likely than 21- to 40-year-olds to have a Pap test. The only psychosocial variable that was significantly different by delivery mode was perceived susceptibility. The majority of all participants found both the video and flipchart presentation to be acceptable. CONCLUSION A health promotion program delivered via self-administered video or PowerPoint slides showed no difference in increasing cervical cancer screening rates.
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Affiliation(s)
| | - Adam Alomari
- Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Navkiran Shokar
- The University of Texas at Austin, Dell Medical School, Austin, TX, USA
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Litchfield I, Barrett T, Hamilton-Shield J, Moore T, Narendran P, Redwood S, Searle A, Uday S, Wheeler J, Greenfield S. Current evidence for designing self-management support for underserved populations: an integrative review using the example of diabetes. Int J Equity Health 2023; 22:188. [PMID: 37697302 PMCID: PMC10496394 DOI: 10.1186/s12939-023-01976-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/26/2023] [Indexed: 09/13/2023] Open
Abstract
AIMS With numerous and continuing attempts at adapting diabetes self-management support programmes to better account for underserved populations, its important that the lessons being learned are understood and shared. The work we present here reviews the latest evidence and best practice in designing and embedding culturally and socially sensitive, self-management support programmes. METHODS We explored the literature with regard to four key design considerations of diabetes self-management support programmes: Composition - the design and content of written materials and digital tools and interfaces; Structure - the combination of individual and group sessions, their frequency, and the overall duration of programmes; Facilitators - the combination of individuals used to deliver the programme; and Context - the influence and mitigation of a range of individual, socio-cultural, and environmental factors. RESULTS We found useful and recent examples of design innovation within a variety of countries and models of health care delivery including Brazil, Mexico, Netherlands, Spain, United Kingdom, and United States of America. Within Composition we confirmed the importance of retaining best practice in creating readily understood written information and intuitive digital interfaces; Structure the need to offer group, individual, and remote learning options in programmes of flexible duration and frequency; Facilitators where the benefits of using culturally concordant peers and community-based providers were described; and finally in Context the need to integrate self-management support programmes within existing health systems, and tailor their various constituent elements according to the language, resources, and beliefs of individuals and their communities. CONCLUSIONS A number of design principles across the four design considerations were identified that together offer a promising means of creating the next generation of self-management support programme more readily accessible for underserved communities. Ultimately, we recommend that the precise configuration should be co-produced by all relevant service and patient stakeholders and its delivery embedded in local health systems.
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Affiliation(s)
- Ian Litchfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Tim Barrett
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- Diabetes and Endocrinology, Birmingham Women's and Children's Hospital, Birmingham, B4 6NH, UK
| | - Julian Hamilton-Shield
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS1 2NT, UK
- The Royal Hospital for Children in Bristol, Bristol, BS2 8BJ, UK
- NIHR Bristol BRC Nutrition Theme, University Hospitals Bristol and Weston Foundation Trust, Bristol, B52 8AE, UK
| | - Theresa Moore
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS1 1TH, B52 8EA, UK
| | - Parth Narendran
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
- Queen Elizabeth Hospital, Birmingham, B15 2GW, UK
| | - Sabi Redwood
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS1 1TH, B52 8EA, UK
| | - Aidan Searle
- NIHR Bristol BRC Nutrition Theme, University Hospitals Bristol and Weston Foundation Trust, Bristol, B52 8AE, UK
| | - Suma Uday
- Diabetes and Endocrinology, Birmingham Women's and Children's Hospital, Birmingham, B4 6NH, UK
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Jess Wheeler
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS1 1TH, B52 8EA, UK
| | - Sheila Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
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Access to Long-Term Care for Minority Populations: A Systematic Review. Can J Aging 2022; 41:577-592. [PMID: 35331343 DOI: 10.1017/s0714980822000046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
It has been shown that there is disparity in access to long-term care and other services for minority populations. This study assessed long-term care access among older individuals belonging to minority populations including visible, ethnocultural, linguistic, and sexual minorities. Barriers and facilitators influencing admission were identified and evaluated.A search for articles from 10 databases published between January 2000 and January 2021 was conducted. Included studies evaluated factors affecting minority populations' admission to long-term care, and non-residents' perceptions of future admission. This review was registered with PROSPERO: CRD42018038662. Sixty included quantitative and qualitative studies, ranging in quality from fair to excellent. Findings suggest minority status is associated with reduced admission to long-term care, controlling for confounding variables. Barriers identified include discordant language, fear of discrimination, lack of information, and family obligations. Findings suggest that minority populations experienced barriers accessing long-term care and had unmet cultural and language needs while receiving care in this setting.
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Liu Y, Jiang J, You W, Gong D, Ma X, Wu M, Li F. Exploring facilitators and barriers to self-management engagement of Chinese people with type 2 diabetes mellitus and poor blood glucose control: a descriptive qualitative study. BMC Endocr Disord 2022; 22:294. [PMID: 36435767 PMCID: PMC9701421 DOI: 10.1186/s12902-022-01214-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 11/11/2022] [Indexed: 11/28/2022] Open
Abstract
AIMS To explore facilitators and barriers to self-management engagement of Chinese people with poorly controlled type 2 diabetes. METHODS Purposive sampling method was used for recruitment. Semi-structured interview and thematic analysis was used for data collection and analysis. RESULTS Twenty-six semi-structured interviews were conducted. Poor blood glucose control introduced awareness of susceptibility to complications, while mental disorders could be concomitant. General knowledge about healthy lifestyle and unhealthy habits impeded lifestyle management. Temporary remission of hyperglycemia and no perceived symptoms interfered engagement of medication therapy and regular blood glucose monitoring. Family and work environments could impact self-management engagement. Accessibility to reliable diabetes-related information influenced self-management engagement. CONCLUSIONS Awareness of susceptibility to complications motivated self-management engagement, while the awareness could cause mental disorders that need to be addressed. Customized lifestyle plans and behavior change technologies were crucial for lifestyle management. The progression of diabetes, importance of continuity of medication therapy, and the value of blood glucose monitoring should be clarified in diabetes education. Building diabetes-friendly social environments and providing reliable diabetes-related information were essential.
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Affiliation(s)
- Yuan Liu
- National Metabolic Management Center, Institute for Chronic Disease Management, Jining No. 1 People's Hospital, Jining, China.
| | - Jiajia Jiang
- National Metabolic Management Center, Institute for Chronic Disease Management, Jining No. 1 People's Hospital, Jining, China
| | - Wenjun You
- Department of Endocrinology, Jining No. 1 People's Hospital, Jining, China
| | - Dandan Gong
- Department of Endocrinology, Jining No. 1 People's Hospital, Jining, China
| | - Xiaoqing Ma
- Department of Endocrinology, Jining No. 1 People's Hospital, Jining, China
| | - Min Wu
- Department of Endocrinology, Jining No. 1 People's Hospital, Jining, China
| | - Feng Li
- Department of Endocrinology, Jining No. 1 People's Hospital, Jining, China
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12
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Lowry S, Goff L, Irwin S, Brady O, Curran N, Lelliott Z, Sevdalis N, Walker A. Mixed-methods implementation study of a virtual culturally tailored diabetes self-management programme for African and Caribbean communities (HEAL-D) in south London and its scaling up across NHS regions in England: study protocol. BMJ Open 2022; 12:e067161. [PMID: 36351722 PMCID: PMC9644082 DOI: 10.1136/bmjopen-2022-067161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION The National Health Service Insight Prioritisation Programme was established to accelerate the implementation and evaluation of innovation that supports post-pandemic working. Supporting this, the Academic Health Science Network and National Institute for Health and Care Research Applied Research Collaboration in South London are testing and evaluating the implementation and scale-up of a type 2 diabetes (T2D) intervention.T2D is estimated to be three times more prevalent in UK African and Caribbean communities than in white Europeans. To tackle ethnic inequities in T2D healthcare access, an evidence-based, culturally tailored self-management and education programme for African and Caribbean adults (Healthy Eating & Active Lifestyles for Diabetes, HEAL-D) has been codeveloped with people with lived experience. Initially a face-to-face programme, HEAL-D pivoted to virtual delivery in response to COVID-19.The purpose of this study is to explore the (1) feasibility and acceptability of a virtual delivery model for HEAL-D in south London and (2) factors affecting its scale-up across other areas in England. METHODS AND ANALYSIS The study will have two strands: (1) mixed-methods prospective evaluation of HEAL-D virtual delivery in south London using routinely collected service-level data, service delivery staff and service user interviews and observations; and (2) prospective qualitative study of the scale-up of this virtual delivery comprising interviews and focus groups with members of the public, and diabetes services commissioners and providers across England. Qualitative data will be analysed using thematic analysis. Quantitative analysis will use descriptive statistics and reporting summary tables and figures. The study will be grounded in well-established implementation frameworks and service user involvement. ETHICS AND DISSEMINATION 'Minimal Risk Registration' ethical clearance was granted by King's College London's Research Ethics Office (ref: MRA-21/22-28498). Results will be published in a peer-reviewed journal and summaries provided to the study funders and participants.
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Affiliation(s)
| | - Louise Goff
- Department of Nutritional Sciences, Kings College London, London, UK
| | | | | | | | | | - Nick Sevdalis
- Centre for Implementation Science, King's College London, London, UK
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13
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Alzahrani AS, Greenfield SM, Paudyal V. Complementary and alternative medicine use in self-management of diabetes: A qualitative study of patient and user conversations in online forums. Int J Clin Pharm 2022; 44:1312-1324. [PMID: 36136208 PMCID: PMC9510465 DOI: 10.1007/s11096-022-01469-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 08/04/2022] [Indexed: 11/18/2022]
Abstract
Background An important part of diabetes self-management includes discussing and seeking informal advice from others. Aim This study aimed to explore beliefs and experiences of patients in relation to their use of CAM in diabetes through the use of data from online patient forum discussions. Method Google search engine was used to identify relevant web-based online discussion forums in English language focussing on CAM use (including herbal and other unorthodox therapies) in diabetes and posted by either patients or carers. No date limit was imposed. A qualitative content analysis was adopted for analysis. Results Twenty-two online forums containing 77 threads with 1156 posts and replies were identified. Seven major themes emerged from the data analysis including: patient beliefs regarding CAM use, perceived effectiveness and safety of CAM, evidence base and information seeking. Patients used online forums to seek information about the benefits, side effects and share positive and negative experiences of CAM use. Feeling stressed, frustrated or overwhelmed with diabetes and prescribed medications was often linked to their decisions to use CAM. They described that healthcare professionals were often unaware or unable to help in regards to their queries around CAMs. Conclusion Patients with diabetes use online forums to share information regarding CAM use. There is a scope for professional societies, patient charities and health systems to offer such online platforms to promote rationale use of CAM, provide evidence-based information to patients and alleviate fears and concerns around diabetes and prescribed medicines.
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Affiliation(s)
- Abdulaziz Saud Alzahrani
- School of Pharmacy, College of Medical and Dental Sciences, Sir Robert Aitken Institute for Medical Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Sheila M Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Vibhu Paudyal
- School of Pharmacy, College of Medical and Dental Sciences, Sir Robert Aitken Institute for Medical Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
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14
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Coleman P, Barber TM, van Rens T, Hanson P, Coffey A, Oyebode O. COVID-19 Outcomes in Minority Ethnic Groups: Do Obesity and Metabolic Risk Play a Role? Curr Obes Rep 2022; 11:107-115. [PMID: 34655051 PMCID: PMC8518892 DOI: 10.1007/s13679-021-00459-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/02/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE OF REVIEW Globally, minority ethnic groups have been at higher risk of COVID-19 mortality and morbidity than majority populations. This review outlines factors that may interact to create these inequalities and explores the hypothesis that differing levels of cardio-metabolic risk, according to ethnic group, play a role. RECENT FINDINGS Two UK Biobank studies have reported that the body mass index is more strongly associated with an increased risk of COVID-19 infection and mortality in minority ethnic populations than in White populations. A study of UK patients found that the strongest association between obesity and adverse COVID-19 outcomes was in people of Black ethnicity. Differences in the prevalence of obesity and its metabolic sequelae have been shown to partly mediate ethnic inequalities in COVID-19 outcomes, although not always consistently. It is possible that ethnic differences in the consequences of obesity may explain some of the remaining disparity in COVID-19 risk.
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Affiliation(s)
- Paul Coleman
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Thijs van Rens
- Department of Economics, University of Warwick, Coventry, UK
| | - Petra Hanson
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Alice Coffey
- Warwick Medical School, University of Warwick, Coventry, UK
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15
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Goff LM, Moore AP, Harding S, Rivas C. Development of Healthy Eating and Active Lifestyles for Diabetes, a culturally tailored diabetes self-management education and support programme for Black-British adults: A participatory research approach. Diabet Med 2021; 38:e14594. [PMID: 33961307 DOI: 10.1111/dme.14594] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/25/2021] [Accepted: 05/04/2021] [Indexed: 11/30/2022]
Abstract
AIMS To develop an evidence-based, culturally tailored, diabetes self-management education and support programme for Black-British adults, called Healthy Eating and Active Lifestyles for Diabetes (HEAL-D), using participatory methods to engage key stakeholders in the intervention design process. METHODS Black-British adults living with type 2 diabetes, healthcare professionals and community leaders were engaged in an intervention development study. The intervention structure, format, content and delivery were developed through three phases of participatory research: Phase 1, formative research, involved focus groups and interviews; interactive co-development workshops were conducted in Phase 2; and Phase 3 focused on materials development. RESULTS In Phase 1, focus groups and interviews identified the importance of nurturing collectivism, a reliance on informal sources of information/advice, barriers to attending appointments associated with competing priorities of work, travel and carer commitments, and a preference for directness and simple, clear advice/messages. A priority for healthcare professionals was the intervention embedding within current primary care structures and aligning with incentivised targets/metrics. Phase 2 (workshops) highlighted key requirements: avoidance of medical settings, appropriately trained and culturally knowledgeable educators, flexible appointments, preference for verbal and visual information and avoidance of technical/medical terminology. In Phase 3 (materials development), culturally sensitive videos, short films and information booklets were developed to convey educational messages, and food photography was used to provide culturally relevant dietary advice. CONCLUSIONS Participatory methods provide a means to understand the needs of specific communities. This approach enables the development of healthcare interventions that are sensitive to the needs of service users and providers.
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Affiliation(s)
- Louise M Goff
- Departments of Diabetes & Nutritional Sciences, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Amanda P Moore
- Departments of Diabetes & Nutritional Sciences, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Seeromanie Harding
- Departments of Diabetes & Nutritional Sciences, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Carol Rivas
- Department of Social Science, University College London, London, UK
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16
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Goff LM, Rivas C, Moore A, Beckley-Hoelscher N, Reid F, Harding S. Healthy Eating and Active Lifestyles for Diabetes (HEAL-D), a culturally tailored self-management education and support program for type 2 diabetes in black-British adults: a randomized controlled feasibility trial. BMJ Open Diabetes Res Care 2021; 9:e002438. [PMID: 34518159 PMCID: PMC8438730 DOI: 10.1136/bmjdrc-2021-002438] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/08/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Black-British communities are disproportionately affected by type 2 diabetes (T2D). Structured education programs are a core component of T2D healthcare but they are less successful in people from minority ethnic groups. Culturally tailored T2D education has demonstrated greater benefits than usual care. The aim of our study was to evaluate acceptability, fidelity and trial feasibility of the Healthy Eating and Active Lifestyles for Diabetes ('HEAL-D') culturally tailored T2D self-management education and support (DSMES) program. RESEARCH DESIGN AND METHODS A mixed-methods randomized controlled feasibility trial in black-British adults with T2D was conducted. Participants were assigned to control (usual care) or intervention (HEAL-D; 7 sessions, 14 hours of group-based culturally tailored diet and lifestyle education, behavior change support and supervised physical activity), in a ratio of 1:1. Primary outcomes were recruitment and retention rates, intervention attendance and completion. Fidelity was assessed through observations and qualitative evaluation was undertaken with participants and educators. RESULTS 102 patients responded to invitation letters (n=1335); 63 were randomized but 8 were subsequently deemed ineligible due to high baseline glycosylated hemoglogin (HbA1c) requiring intensive medical management or missing baseline HbA1c measurement. Of the remaining 55 participants (27 intervention, 28 control), 69% were female, 47% were of African and 51% were of Caribbean ethnicity. 93% completed the trial, providing end point data. Intervention attendance was high; 85% completed the program (attendance at ≥5 sessions), and 74% attended ≥6 sessions. The intervention was delivered with acceptable fidelity, although the qualitative evaluations identified some areas of structure and format in need of refinement. CONCLUSIONS We have shown it is feasible to recruit and randomize black-British adults with T2D to a trial of a culturally tailored DSMES program. We have shown the intervention is highly acceptable for both patients and healthcare providers. A future trial should assess clinical and cost-effectiveness of HEAL-D. TRIAL REGISTRATION NUMBER NCT03531177.
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Affiliation(s)
- Louise M Goff
- Department of Nutritional Sciences, King's College London, Faculty of Life Sciences and Medicine, London, UK
| | - Carol Rivas
- Social Research Institute, University College London, London, UK
| | - Amanda Moore
- Department of Nutritional Sciences, King's College London, Faculty of Life Sciences and Medicine, London, UK
| | | | - Fiona Reid
- Population Health, King's College London, Faculty of Life Sciences and Medicine, London, UK
| | - Seeromanie Harding
- Department of Nutritional Sciences, King's College London, Faculty of Life Sciences and Medicine, London, UK
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17
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Alexandre K, Campbell J, Bugnon M, Henry C, Schaub C, Serex M, Elmers J, Desrichard O, Peytremann-Bridevaux I. Factors influencing diabetes self-management in adults: an umbrella review of systematic reviews. JBI Evid Synth 2021; 19:1003-1118. [PMID: 33741836 DOI: 10.11124/jbies-20-00020] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The objective of this review was to identify and describe the factors influencing diabetes self-management in adults by summarizing the available evidence concerning their types, categories, and relative importance. INTRODUCTION A wide range of factors, acting simultaneously, influence diabetes self-management and interfere with its actual application by patients. There is a variety of systematic reviews of these factors; however, a more thorough examination of their influences was lacking. INCLUSION CRITERIA Systematic reviews of qualitative or quantitative literature focusing on factors influencing adult diabetes self-management in general or on individual behaviors (ie, management of oral antidiabetic medication and insulin injections, self-monitoring of blood glucose, foot care, healthy eating, regular exercise, and smoking cessation) will be included. METHODS We performed an extensive search of 11 bibliographic databases, including gray literature, up to June 2019. Quantitative and qualitative findings were summarized separately and labeled according to their types (eg, facilitator/barrier, strength and direction of association), categories (eg, demographic, social), and frequency of occurrence. RESULTS We identified 51 types of factors within 114 systematic reviews, which mostly addressed medication-taking behavior. Thirty-two (62.7%) factors were reported in both qualitative and quantitative literature. The predominant influences were psychological factors and behavioral attributes/skills factors. The most frequently reported facilitators of diabetes self-management were motivation to diabetes self-management, a favorable attitude to diabetes self-management, knowledge about the disease, medication and behaviors associated with diabetes self-management, skills, and self-efficacy/perceived behavioral control. The predominant barriers were the presence of depression, and polypharmacy or drug regimen complexity. The demographic factor of female sex was frequently reported for its negative influence on diabetes self-management, whereas older age was a positive factor. The social/cultural and physical environment were the least-studied categories. Other factors such as social support from family, friends, or networks; interventions led by health professionals; and a strong community environment with good social services favoring diabetes self-management were reported as major facilitators of diabetes self-management. CONCLUSIONS Essential components of interventions to promote effective diabetes self-management should aim to help adults manage the effects of specific factors related to their psychological and practical self-management experience. Screening for depression, in particular, should become an integral part of the support for adult diabetes self-management, as depression is a particular obstacle to the effectiveness of diabetes self-management. Future studies should more deeply examine the influence of factors identified in the sociocultural and physical environment categories. Research should properly consider and invest efforts in strengthening social support and innovative community care approaches, including pharmacist- and nurse-led care models for encouraging and improving adult diabetes self-management. Finally, researchers should examine non-modifiable factors - age, sex, or socioeconomic status - in the light of factors from other categories in order to deepen understanding of their real-world patterns of action on adult diabetes self-management. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42018084665.
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Affiliation(s)
- Ketia Alexandre
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland.,Bureau d'Echange des Savoirs pour des praTique exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
| | - Joan Campbell
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland.,Bureau d'Echange des Savoirs pour des praTique exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
| | - Marie Bugnon
- Faculté de Psychologie et des Sciences de l'Education, University of Geneva, Geneva, Switzerland
| | - Cristina Henry
- Association Vaudoise d'Aide et de Soins À Domicile (AVASAD), Lausanne, Switzerland
| | - Corinne Schaub
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland.,Bureau d'Echange des Savoirs pour des praTique exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
| | - Magali Serex
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland.,Bureau d'Echange des Savoirs pour des praTique exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
| | - Jolanda Elmers
- Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Olivier Desrichard
- Faculté de Psychologie et des Sciences de l'Education, University of Geneva, Geneva, Switzerland
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18
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McErlean G, Brice L, Gilroy N, Kabir M, Greenwood M, Larsen SR, Moore J, Gottlieb D, Hertzberg M, Brown L, Hogg M, Huang G, Ward C, Kerridge I. Long-term treatment burden following allogeneic blood and marrow transplantation in NSW, Australia: a cross-sectional survey. J Cancer Surviv 2021; 16:432-444. [PMID: 33813667 DOI: 10.1007/s11764-021-01038-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/27/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Allogenic blood and marrow transplant (allo-BMT) is an arduous treatment used increasingly for many life-threatening conditions. Recognition of the profound impacts of the long term and late effects is ever-growing, as is the healthcare workload (treatment burden) of survivorship. PURPOSE To quantify the treatment burden of long-term survival following allo-BMT, regarding the range of health services, therapies and investigations accessed by survivors. METHODS A large, multi-centre cross-sectional survey of adult allo-BMT survivors transplanted between 2000 and 2012 in Sydney, Australia. Participants completed six validated instruments and one purposed designed for the study, the Sydney Post BMT Study (SPBS), answering questions relating to medication use, medical treatments, referrals, assessments and frequency of hospital/clinic attendance. RESULTS Of the 441 allo-BMT survivors, over a quarter who were more than 2 years post BMT attended the hospital clinic at least monthly, and 26.7% required a number of regular medical procedures (e.g. venesection, extracorpororeal photopheresis). Specialist medical and allied health referral was very common, and compliance with internationally recommended long-term follow-up (LTFU) care was suboptimal and decreased as time from BMT increased. CONCLUSION Respondents reported a large medication (conventional and complementary), screening, assessment and health care burden. IMPLICATIONS FOR CANCER SURVIVORS Treatment burden contributes significantly to the 'workload' of survivorship and can have a severe and negative impact on BMT survivors, carers and the healthcare system-making it difficult to comply with optimal care. Clinicians must be primed with skills to identify survivors who are overburdened by the health care required for survival and develop strategies to help ease the burden.
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Affiliation(s)
- Gemma McErlean
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia. .,Cancer Services, South Western Sydney Local Health District, Sydney, NSW, Australia. .,Centre for Applied Nursing Research and Ingham Institute of Applied Medical Research, Sydney, NSW, Australia. .,Blood and Marrow Transplant Network, New South Wales Agency for Clinical Innovation, Sydney, NSW, Australia.
| | - Lisa Brice
- Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Nicole Gilroy
- Blood and Marrow Transplant Network, New South Wales Agency for Clinical Innovation, Sydney, NSW, Australia.,Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney, NSW, Australia
| | - Masura Kabir
- Westmead Breast Cancer Institute, Sydney, NSW, Australia
| | - Matt Greenwood
- Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia.,Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Stephen R Larsen
- Institute of Haematology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - John Moore
- Department of Haematology, St Vincents Hospital, Sydney, NSW, Australia
| | - David Gottlieb
- Department of Haematology, Westmead Hospital, Sydney, NSW, Australia.,Faculty of Medicine and Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - Mark Hertzberg
- Department of Haematology, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Louisa Brown
- Department of Haematology, Calvary Mater Hospital, Newcastle, NSW, Australia
| | - Megan Hogg
- Department of Haematology, Westmead Hospital, Sydney, NSW, Australia
| | - Gillian Huang
- Department of Haematology, Westmead Hospital, Sydney, NSW, Australia
| | - Christopher Ward
- Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia.,Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine and Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - Ian Kerridge
- Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia.,Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine and Health Sciences, University of Sydney, Sydney, NSW, Australia
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19
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Pekmezaris R, Williams MS, Pascarelli B, Finuf KD, Harris YT, Myers AK, Taylor T, Kline M, Patel VH, Murray LM, McFarlane SI, Pappas K, Lesser ML, Makaryus AN, Martinez S, Kozikowski A, Polo J, Guzman J, Zeltser R, Marino J, Pena M, DiClemente RJ, Granville D. Adapting a home telemonitoring intervention for underserved Hispanic/Latino patients with type 2 diabetes: an acceptability and feasibility study. BMC Med Inform Decis Mak 2020; 20:324. [PMID: 33287815 PMCID: PMC7720574 DOI: 10.1186/s12911-020-01346-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 11/22/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Home telemonitoring is a promising approach to optimizing outcomes for patients with Type 2 Diabetes; however, this care strategy has not been adapted for use with understudied and underserved Hispanic/Latinos (H/L) patients with Type 2 Diabetes. METHODS A formative, Community-Based Participatory Research approach was used to adapt a home telemonitoring intervention to facilitate acceptability and feasibility for vulnerable H/L patients. Utilizing the ADAPT-ITT framework, key stakeholders were engaged over an 8-month iterative process using a combination of strategies, including focus groups and structured interviews. Nine Community Advisory Board, Patient Advisory, and Provider Panel Committee focus group discussions were conducted, in English and Spanish, to garner stakeholder input before intervention implementation. Focus groups and structured interviews were also conducted with 12 patients enrolled in a 1-month pilot study, to obtain feedback from patients in the home to further adapt the intervention. Focus groups and structured interviews were approximately 2 hours and 30 min, respectively. All focus groups and structured interviews were audio-recorded and professionally transcribed. Structural coding was used to mark responses to topical questions in the moderator and interview guides. RESULTS Two major themes emerged from qualitative analyses of Community Advisory Board/subcommittee focus group data. The first major theme involved intervention components to maximize acceptance/usability. Subthemes included tablet screens (e.g., privacy/identity concerns; enlarging font sizes; lighter tablet to facilitate portability); cultural incongruence (e.g., language translation/literacy, foods, actors "who look like me"); nursing staff (e.g., ensuring accessibility; appointment flexibility); and, educational videos (e.g., the importance of information repetition). A second major theme involved suggested changes to the randomized control trial study structure to maximize participation, including a major restructuring of the consenting process and changes designed to optimize recruitment strategies. Themes from pilot participant focus group/structured interviews were similar to those of the Community Advisory Board such as the need to address and simplify a burdensome consenting process, the importance of assuring privacy, and an accessible, culturally congruent nurse. CONCLUSIONS These findings identify important adaptation recommendations from the stakeholder and potential user perspective that should be considered when implementing home telemonitoring for underserved patients with Type 2 Diabetes. TRIAL REGISTRATION NCT03960424; ClinicalTrials.gov (US National Institutes of Health). Registered 23 May 2019. Registered prior to data collection. https://www.clinicaltrials.gov/ct2/show/NCT03960424?term=NCT03960424&draw=2&rank=1.
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Affiliation(s)
- Renee Pekmezaris
- Department of Medicine, Division of Health Services Research, Northwell Health, Manhasset, NY, USA.
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
- Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA.
- Center for Health Innovations and Outcomes Research, Northwell Health, Manhasset, NY, USA.
| | - Myia S Williams
- Department of Medicine, Division of Health Services Research, Northwell Health, Manhasset, NY, USA
- Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA
- Center for Health Innovations and Outcomes Research, Northwell Health, Manhasset, NY, USA
| | - Briana Pascarelli
- Department of Medicine, Division of Health Services Research, Northwell Health, Manhasset, NY, USA
- Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA
- Center for Health Innovations and Outcomes Research, Northwell Health, Manhasset, NY, USA
| | - Kayla D Finuf
- Department of Medicine, Division of Health Services Research, Northwell Health, Manhasset, NY, USA.
- Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA.
- Center for Health Innovations and Outcomes Research, Northwell Health, Manhasset, NY, USA.
| | - Yael T Harris
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Medicine, Division of Endocrinology, North Shore University Hospital, Manhasset, NY, USA
| | - Alyson K Myers
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA
- Center for Health Innovations and Outcomes Research, Northwell Health, Manhasset, NY, USA
- Department of Medicine, Division of Endocrinology, North Shore University Hospital, Manhasset, NY, USA
| | - Tonya Taylor
- College of Medicine, Division of Infectious Disease, SUNY-Downstate Health Sciences University, Brooklyn, NY, USA
| | - Myriam Kline
- Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Vidhi H Patel
- Department of Medicine, Division of Health Services Research, Northwell Health, Manhasset, NY, USA
- Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA
- Center for Health Innovations and Outcomes Research, Northwell Health, Manhasset, NY, USA
| | - Lawrence M Murray
- Annie E. Casey Foundation Children and Family Fellowship, Baltimore, MD, USA
| | - Samy I McFarlane
- Department of Medicine, SUNY-Downstate Health Sciences University, Brooklyn, NY, USA
| | - Karalyn Pappas
- Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Martin L Lesser
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Amgad N Makaryus
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY, USA
| | - Sabrina Martinez
- Center for Health Innovations and Outcomes Research, Northwell Health, Manhasset, NY, USA
| | - Andrjez Kozikowski
- Department of Medicine, Division of Health Services Research, Northwell Health, Manhasset, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA
- Center for Health Innovations and Outcomes Research, Northwell Health, Manhasset, NY, USA
| | | | | | - Roman Zeltser
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Nassau University Medical Center, East Meadow, NY, USA
| | - Jose Marino
- Center for Health Innovations and Outcomes Research, Northwell Health, Manhasset, NY, USA
| | - Maria Pena
- Nassau University Medical Center, East Meadow, NY, USA
- Mount Sinai Hospital, Mount Sinai Health System, New York, NY, USA
| | - Ralph J DiClemente
- Department of Social and Behavioral Sciences, NYU School of Global Public Health, New York, NY, USA
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20
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Goff LM, Moore A, Harding S, Rivas C. Providing culturally sensitive diabetes self-management education and support for black African and Caribbean communities: a qualitative exploration of the challenges experienced by healthcare practitioners in inner London. BMJ Open Diabetes Res Care 2020; 8:8/2/e001818. [PMID: 33293296 PMCID: PMC7725076 DOI: 10.1136/bmjdrc-2020-001818] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/29/2020] [Accepted: 11/17/2020] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Poor access to, and engagement with, diabetes healthcare is a significant issue for black British communities who are disproportionately burdened by type 2 diabetes (T2D). Tackling these inequalities is a healthcare priority. The purpose of this research was to explore the experiences of healthcare practitioners providing diabetes self-management education and support (DSMES) to African and Caribbean adults living with T2D to inform the development of a culturally tailored DSMES program. RESEARCH DESIGN AND METHODS Semi-structured interviews were carried out with a range of healthcare practitioners including diabetes specialist nurses, dietitians and general practitioners based in primary care in inner London. Thematic content analysis was used to identify barriers and facilitators relating to the provision of effective DSMES. RESULTS Ten interviews were conducted. There was a strong consensus among healthcare practitioners for the importance of DSMES in T2D healthcare. However, practitioners discussed this area of practice as overwhelmingly challenging and recognized a wide range of barriers that they face. Four themes were identified: (1) The tension between structural and responsive care needs, particularly with growing numbers of patients alongside incentivized targets driving a care agenda that does not meet the needs of diverse communities; (2) challenges posed by cultural beliefs and practices, particularly a distrust of conventional medicine, rejection of body mass index standards and a belief in 'God's will'; (3) building relationships through cultural understanding: insiders and outsiders, particularly the benefits of racial concordance and cultural knowledge/resources and (4) getting the messages across, particularly the need to address gaps in structured education. CONCLUSION Provision of culturally sensitive DSMES is a challenging area of practice for practitioners, who recognize the need for more training and resources to support them in developing cultural competence. Nonetheless, practitioners recognize the importance of DSMES and are striving to provide culturally sensitive care to their patients.
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Affiliation(s)
- Louise M Goff
- Department of Nutritional Sciences, King's College London, London, UK
| | - Amanda Moore
- Department of Nutritional Sciences, King's College London, London, UK
| | | | - Carol Rivas
- Department of Social Science, University College London, London, UK
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Pekmezaris R, Kozikowski A, Pascarelli B, Wolf-Klein G, Boye-Codjoe E, Jacome S, Madera D, Tsang D, Guerrero B, Medina R, Polo J, Williams M, Hajizadeh N. A Telehealth-Delivered Pulmonary Rehabilitation Intervention in Underserved Hispanic and African American Patients With Chronic Obstructive Pulmonary Disease: A Community-Based Participatory Research Approach. JMIR Form Res 2020; 4:e13197. [PMID: 32012039 PMCID: PMC7055744 DOI: 10.2196/13197] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 08/08/2019] [Accepted: 09/26/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Although home telemonitoring (TM) is a promising approach for patients managing their chronic disease, rehabilitation using home TM has not been tested for use with individuals living with chronic obstructive pulmonary disease (COPD) residing in underserved communities. OBJECTIVE This study aimed to analyze qualitative data from focus groups with key stakeholders to ensure the acceptability and usability of the TM COPD intervention. METHODS We utilized a community-based participatory research (CBPR) approach to adapt a home TM COPD intervention to facilitate acceptability and feasibility in low-income African American and Hispanic patients. The study engaged community stakeholders in the process of modifying the intervention in the context of 2 community advisory board meetings. Discussions were audio recorded and professionally transcribed and lasted approximately 2 hours each. Structural coding was used to mark responses to topical questions in interview guides. RESULTS We describe herein the formative process of a CBPR study aimed at optimizing telehealth utilization among African American and Latino patients with COPD from underserved communities. A total of 5 major themes emerged from qualitative analyses of community discussions: equipment changes, recruitment process, study logistics, self-efficacy, and access. The identification of themes was instrumental in understanding the concerns of patients and other stakeholders in adapting the pulmonary rehabilitation (PR) home intervention for acceptability for patients with COPD from underserved communities. CONCLUSIONS These findings identify important adaptation recommendations from the stakeholder perspective that should be considered when implementing in-home PR via TM for underserved COPD patients. TRIAL REGISTRATION ClinicalTrials.gov NCT03007485; https://clinicaltrials.gov/ct2/show/NCT03007485.
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Affiliation(s)
- Renee Pekmezaris
- Northwell Health, Manhasset, NY, United States.,Department of Medicine, Hofstra Northwell School of Medicine, Manhasset, NY, United States.,Department of Occupational Medicine, Epidemiology, and Prevention, Hofstra Northwell School of Medicine, Great Neck, NY, United States
| | | | | | | | | | | | | | - Donna Tsang
- Northwell Health, Manhasset, NY, United States
| | | | | | | | - Myia Williams
- Department of Occupational Medicine, Epidemiology, and Prevention, Hofstra Northwell School of Medicine, Great Neck, NY, United States
| | - Negin Hajizadeh
- Northwell Health, Manhasset, NY, United States.,Department of Medicine, Hofstra Northwell School of Medicine, Manhasset, NY, United States
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22
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Appoh L, Felix F, Pedersen PU. Barriers to access of healthcare services by the immigrant population in Scandinavia: a scoping review protocol. BMJ Open 2020; 10:e032596. [PMID: 31915164 PMCID: PMC6955476 DOI: 10.1136/bmjopen-2019-032596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Access to healthcare services for legal immigrants in Scandinavia is part of the policy agenda of the various governments as they strive to provide equal healthcare services to its citizens. Legal immigrants have the same rights as natives; however, studies have shown that there are inequalities in access to healthcare services between legal immigrants and natives. The extent of access depends on several factors, including organisational, social, financial and cultural factors. The lack of these factors acts as a barrier to access of healthcare services. The aim of this review is to map and report the evidence available on the barriers to access of healthcare services by legal immigrants in Scandinavia. METHODS AND ANALYSIS We will adopt the six-stage framework developed by Arksey and O'Malley: (1) identifying the research question(s); (2) searching for relevant studies; (3) selecting studies; (4) charting the data; (5) collating, summarising and reporting the results; (6) conducting consultation exercises refined by Levac et al and the Joanna Briggs Institute. The search strategy for this scoping review will involve electronic databases including Ovid Medline, PsycINFO, Ovid EMBASE, PubMed and Google Scholar, in addition to grey literature from websites of relevant organisations. Data will be extracted and charted by two independent reviewers. A narrative summary of the findings will be presented. ETHICS AND DISSEMINATION This is a review of the literature and all data will be obtained from publicly available materials; therefore, ethics approval is not required. The findings from this study will be disseminated as publications in peer-reviewed journals, at relevant national and international conferences, and as presentations to the health authorities in several municipalities in the Trøndelag region of Norway.
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Affiliation(s)
- Lily Appoh
- Faculty for Nursing and Health Science, Nord Universitet-Namsos Campus, Namsos, Norway
| | - Franca Felix
- Faculty of Health Sciences, The Artic University of Norway, Tromsø, Norway
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Abstract
Type 2 diabetes is a major UK public health priority. Among minority ethnic communities, the prevalence is alarmingly high, approximately three to five times higher than in the white British population. Particularly striking is the earlier onset of Type 2 diabetes, which occurs some 10-12 years younger, with a significant proportion of cases being diagnosed before the age of 40 years. This review focuses on the UK context and Type 2 diabetes in adult populations, exploring the available evidence regarding the complex interplay of biological, lifestyle, social, clinical and healthcare system factors that are known to drive these disparities.
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Affiliation(s)
- L M Goff
- Diabetes Research Group, Departments of Diabetes and Nutritional Sciences, King's College London, London, UK
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24
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Alloh FT, Hemingway A, Turner-Wilson A. Systematic review of diabetes management among black African immigrants, white and South Asian populations. JOURNAL OF GLOBAL HEALTH REPORTS 2019. [DOI: 10.29392/joghr.3.e2019020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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25
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Goff LM, Moore AP, Rivas C, Harding S. Healthy Eating and Active Lifestyles for Diabetes (HEAL-D): study protocol for the design and feasibility trial, with process evaluation, of a culturally tailored diabetes self-management programme for African-Caribbean communities. BMJ Open 2019; 9:e023733. [PMID: 30826792 PMCID: PMC6398623 DOI: 10.1136/bmjopen-2018-023733] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 12/18/2018] [Accepted: 01/08/2019] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Black British communities are disproportionately burdened by type 2 diabetes (T2D) and its complications. Tackling these inequalities is a priority for healthcare providers and patients. Culturally tailored diabetes education provides long-term benefits superior to standard care, but to date, such programmes have only been developed in the USA. The current programme of research aims to develop the Healthy Eating and Active Lifestyles for Diabetes (HEAL-D) culturally tailored T2D self-management programme for black British communities and to evaluate its delivery, acceptability and the feasibility of conducting a future effectiveness trial of HEAL-D. METHODS AND ANALYSIS Informed by Medical Research Council Complex Interventions guidance, this research will rigorously develop and evaluate the implementation of the HEAL-D intervention to understand the feasibility of conducting a full-scale effectiveness trial. In phase 1, the intervention will be developed. The intervention curriculum will be based on existing evidence-based T2D guidelines for diet and lifestyle management; codesign methods will be used to foster community engagement, identify the intervention's underpinning theory, identify the optimal structure, format and delivery methods, ascertain adaptations that are needed to ensure cultural sensitivity and understand issues of implementation. In phase 2, the intervention will be delivered and compared with usual care in a feasibility trial. Process evaluation methods will evaluate the delivery and acceptability of HEAL-D. The effect size of potential primary outcomes, such as HbA1c and body weight, will be estimated. The feasibility of conducting a future effectiveness trial will also be evaluated, particularly feasibility of randomisation, recruitment, retention and contamination. ETHICS AND DISSEMINATION This study is funded by a National Institute of Health Research Fellowship (CDF-2015-08-006) and approved by National Health Service Research Ethics Committee (17-LO-1954). Dissemination will be through national and international conferences, peer-reviewed publications and local and national clinical diabetes networks. TRIAL REGISTRATION NUMBER NCT03531177; Pre-results.
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Affiliation(s)
- Louise M Goff
- Diabetes and Nutritional Sciences, Kings College London, London, UK
| | - Amanda P Moore
- Diabetes and Nutritional Sciences, Kings College London, London, UK
| | - Carol Rivas
- Faculty of Health Sciences, University of Southamptom, Southamptom, UK
| | - Seeromanie Harding
- Diabetes & Nutritional Sciences Division, King's College London, London, UK
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26
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Vandan N, Wong JYH, Fong DYT. Accessing health care: Experiences of South Asian ethnic minority women in Hong Kong. Nurs Health Sci 2018; 21:93-101. [DOI: 10.1111/nhs.12564] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 06/08/2018] [Accepted: 07/03/2018] [Indexed: 01/21/2023]
Affiliation(s)
- Nimisha Vandan
- School of Nursing; Li Ka Shing Faculty of Medicine, The University of Hong Kong; Pokfulam Hong Kong
| | - Janet Y-H Wong
- School of Nursing; Li Ka Shing Faculty of Medicine, The University of Hong Kong; Pokfulam Hong Kong
| | - Daniel Y-T Fong
- School of Nursing; Li Ka Shing Faculty of Medicine, The University of Hong Kong; Pokfulam Hong Kong
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27
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Paduch A, Kuske S, Schiereck T, Droste S, Loerbroks A, Sørensen M, Maggini M, Icks A. Psychosocial barriers to healthcare use among individuals with diabetes mellitus: A systematic review. Prim Care Diabetes 2017; 11:495-514. [PMID: 28918199 DOI: 10.1016/j.pcd.2017.07.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 06/26/2017] [Accepted: 07/31/2017] [Indexed: 01/20/2023]
Abstract
PURPOSE To conduct a systematic review regarding psychosocial barriers to healthcare use in individuals with diabetes mellitus, using a well-established model of health-service use as a theoretical framework. METHODS We used database-specific controlled vocabularies and additional free text terms, and conducted searches via MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science, OVID Journals. Included studies were rated according to the UK National Institute for Health and Care Excellence (NICE) criteria. A narrative data synthesis was conducted, using the Andersen model and developing categories from the included studies. PRINCIPAL RESULTS In total, 2923 studies were identified, and 15 finally included. We identified barriers according to the main categories "population characteristics", "norms and values", and "healthcare services" on a contextual and individual level, as well as "health status". Frequently reported barriers were "socioeconomic status", and "physician characteristics". Ethnic minorities were frequently analysed and may have specific barriers, e.g. "cultural beliefs" and "language". MAJOR CONCLUSIONS We identified a broad range of barriers to healthcare use in individuals with diabetes mellitus. However, the number of studies is low. Further research is needed to analyse barriers in more detail considering special subgroups.
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Affiliation(s)
- Andrea Paduch
- Heinrich Heine University Düsseldorf, Faculty of Medicine, Institute for Health Services Research and Health Economics, Centre for Health and Society, Moorenstraße 5, 40225 Düsseldorf, Germany.
| | - Silke Kuske
- Heinrich Heine University Düsseldorf, Faculty of Medicine, Institute for Health Services Research and Health Economics, Centre for Health and Society, Moorenstraße 5, 40225 Düsseldorf, Germany; German Diabetes Center (DDZ), Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Institute for Health Services Research and Health Economics, Auf'm Hennekamp 65, 40225 Düsseldorf, Germany.
| | - Tim Schiereck
- Heinrich Heine University Düsseldorf, Faculty of Medicine, Institute for Health Services Research and Health Economics, Centre for Health and Society, Moorenstraße 5, 40225 Düsseldorf, Germany.
| | - Sigrid Droste
- Heinrich Heine University Düsseldorf, Faculty of Medicine, Institute for Health Services Research and Health Economics, Centre for Health and Society, Moorenstraße 5, 40225 Düsseldorf, Germany.
| | - Adrian Loerbroks
- Heinrich Heine University Düsseldorf, Faculty of Medicine, Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Moorenstraße 5, 40225 Düsseldorf, Germany.
| | - Monica Sørensen
- The Norwegian Directorate of Health, Pb 7000 St. Olavs plass, 0130 Oslo, Norway.
| | - Marina Maggini
- Centro Nazionale di Epidemiologia, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
| | - Andrea Icks
- Heinrich Heine University Düsseldorf, Faculty of Medicine, Institute for Health Services Research and Health Economics, Centre for Health and Society, Moorenstraße 5, 40225 Düsseldorf, Germany; German Diabetes Center (DDZ), Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Institute for Health Services Research and Health Economics, Auf'm Hennekamp 65, 40225 Düsseldorf, Germany; German Centre for Diabetes Research, Munich-Neuherberg, Germany.
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28
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Mulligan K, McBain H, Lamontagne‐Godwin F, Chapman J, Haddad M, Jones J, Flood C, Thomas D, Simpson A. Barriers and enablers of type 2 diabetes self-management in people with severe mental illness. Health Expect 2017; 20:1020-1030. [PMID: 28306182 PMCID: PMC5600230 DOI: 10.1111/hex.12543] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND People with diabetes and severe mental illness (SMI) experience poorer outcomes than those with diabetes alone. To improve outcomes, it is necessary to understand the difficulties that people with SMI experience in managing their diabetes. AIMS To identify barriers and enablers to effective diabetes self-management experienced by people with SMI and type 2 diabetes. METHOD Qualitative methodology using semi-structured interviews was employed. Development of the interview topic guide and analysis of the transcripts were informed by the Theoretical Domains Framework for behaviour change, which consists of fourteen theoretical domains that have been found to influence behaviour. RESULTS Fourteen people with SMI and type 2 diabetes took part in the study. Participants considered diabetes self-management to be important, were aware of the risks of poor diabetes control but struggled to follow recommended advice, particularly if their mental health was poor. Support from family and health professionals was considered an important enabler of diabetes self-management. CONCLUSIONS New approaches are required to support diabetes self-management in people with SMI. This study identified some of the important domains that may be targeted in new interventions.
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Affiliation(s)
- Kathleen Mulligan
- Centre for Health Services ResearchSchool of Health SciencesCity, University of LondonLondonUK
- East London NHS Foundation TrustLondonUK
| | - Hayley McBain
- Centre for Health Services ResearchSchool of Health SciencesCity, University of LondonLondonUK
- East London NHS Foundation TrustLondonUK
| | - Frederique Lamontagne‐Godwin
- Centre for Health Services ResearchSchool of Health SciencesCity, University of LondonLondonUK
- Centre for Mental Health ResearchSchool of Health SciencesCity, University of LondonLondonUK
| | | | - Mark Haddad
- East London NHS Foundation TrustLondonUK
- Centre for Mental Health ResearchSchool of Health SciencesCity, University of LondonLondonUK
| | - Julia Jones
- Centre for Research in Primary and Community Care (CRIPACC)School of Health and Social WorkUniversity of HertfordshireHatfieldUK
| | - Chris Flood
- East London NHS Foundation TrustLondonUK
- Centre for Mental Health ResearchSchool of Health SciencesCity, University of LondonLondonUK
| | - David Thomas
- East London NHS Foundation TrustLondonUK
- Centre for Mental Health ResearchSchool of Health SciencesCity, University of LondonLondonUK
| | - Alan Simpson
- East London NHS Foundation TrustLondonUK
- Centre for Mental Health ResearchSchool of Health SciencesCity, University of LondonLondonUK
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Siddique MKB, Islam SMS, Banik PC, Rawal LB. Diabetes knowledge and utilization of healthcare services among patients with type 2 diabetes mellitus in Dhaka, Bangladesh. BMC Health Serv Res 2017; 17:586. [PMID: 28830414 PMCID: PMC5567438 DOI: 10.1186/s12913-017-2542-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 08/14/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Diabetes is a significant global public health concern. Poor knowledge of disease and healthcare utilization is associated with worse health outcomes, leading to increasing burden of diabetes in many developing countries. This study aimed to determine diabetes related knowledge and factors affecting utilization of healthcare services among patients with type 2 diabetes mellitus in Bangladesh. METHODS This analytical study was conducted among 318 patients with type 2 diabetes (T2DM) attending two large tertiary hospitals in Dhaka, Bangladesh between August 2014 and January 2015. Interviewer assisted semi-structured survey questionnaire was used to collect data on diabetes knowledge (measured by a validated Likert scale) and self-reported utilization of service for diabetes. Univariate and bivariate analyses were conducted to determine the factors associated with diabetes knowledge and healthcare utilization. RESULTS The mean (±SD) age of participants was 52 (±10) years. Majority of the participants were females (58%) and urban residents (74%). Almost two-third (66%) of the participants had an average level of knowledge of T2DM. One-fifth (21%) of the participants had poor knowledge which was significantly associated with gender (P < 0.002), education (P < 0 .001) and income (P < 0.001). The median travel and waiting time at the facility was 30 and 45 min respectively. More than one-third (37%) of the participants checked their blood glucose monthly. Most patients were satisfied regarding the family (55%) and hospital (67%) support. CONCLUSION T2DM patients had average knowledge of diabetes which might affect the utilization of healthcare services for diabetes management. Innovations in increasing diabetes knowledge and health behavior change are recommended specially for females, those with lower education and less income.
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Affiliation(s)
- Md Kaoser Bin Siddique
- James P. Grant School of Public Health (JPGSPH), BRAC University, Dhaka, Bangladesh.,PhysioCare, Physiotherapy, Rehab & Research Center (PPRRC), Dhaka, Bangladesh
| | - Sheikh Mohammed Shariful Islam
- Non-Communicable Diseases Initiative, icddr,b, Dhaka, Bangladesh. .,The George Institute for Global Health, University of Sydney, Sydney, Australia. .,Institute for Physical Activity and Nutrition (IPAN), Deakin University, Melbourne, Australia.
| | - Palash Chandra Banik
- Department of Noncommunicable Diseases, Bangladesh University of Health Sciences (BUHS), Dhaka, Bangladesh
| | - Lal B Rawal
- James P. Grant School of Public Health (JPGSPH), BRAC University, Dhaka, Bangladesh.,Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
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Lapostolle F, Hamdi N, Barghout M, Soulat L, Faucher A, Lambert Y, Peschanski N, Ricard-Hibon A, Chassery C, Roti M, Bounes V, Debaty G, Mokni T, Egmann G, Fort PA, Boudenia K, Alayrac L, Safraou M, Galinski M, Adnet F. Diabetes education of patients and their entourage: out-of-hospital national study (EDUCATED 2). Acta Diabetol 2017; 54:353-360. [PMID: 28005173 DOI: 10.1007/s00592-016-0950-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 11/28/2016] [Indexed: 10/20/2022]
Abstract
AIMS To determine the contributing factors in the successful diabetes education of patients and their entourage. METHODS Prospective observational study conducted in a pre-hospital setting by 17 emergency services across France (September 2009-January 2011) included all insulin-treated patients (≥18 years) provided that at least one family member was present on scene. Data were collected from patients and their entourage: (1) personal details including language proficiency and educational attainment, (2) treatments, (3) diabetes-related data (log sheets, glucose meter, glucagon, glycated hemoglobin, prior hypoglycemic episodes); (4) care by diabetologist, general practitioner and/or visiting nurse. The main end points were ability to measure capillary blood sugar (patient) and awareness of hypoglycemia symptoms and ability to administer glucagon (entourage). RESULTS Overall, 561 patients and 736 family members were included; 343 patients (61%) were experiencing a hypoglycemic episode (<2.5 mmol/L). A total of 141 (75%) patients and 343 (50%) family members could measure capillary blood sugar. They could name a median of 2 [0-3‰] hypoglycemia symptoms although 217 (39%) patients and 262 (39%) family members could name no symptom. Few patients (33%) had glucagon available. In multivariate analyses, the main factor associated with better patient education was care by a diabetologist. Lack of an educational qualification and visits by a nurse were associated with poor patient education, and French mother tongue and care by a diabetologist with better education of the entourage. CONCLUSIONS In France, diabetic patients and their entourage are inadequately educated. Their education benefits most from care by a diabetologist.
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Affiliation(s)
- Frédéric Lapostolle
- AP-HP, Urgences - SAMU 93, Unité Recherche-Enseignement-Qualité, Hôpital Avicenne, 125 rue de Stalingrad, 93000, Bobigny, France.
- Université Paris 13, Sorbonne Paris Cité, EA 3509, 93000, Bobigny, France.
| | - Nadia Hamdi
- AP-HP, Urgences - SAMU 93, Unité Recherche-Enseignement-Qualité, Hôpital Avicenne, 125 rue de Stalingrad, 93000, Bobigny, France
- Université Paris 13, Sorbonne Paris Cité, EA 3509, 93000, Bobigny, France
| | - Majed Barghout
- SAMU 94, Hôpital Henri Mondor, 51 avenue du Mal de Lattre de Tassigny, 94010, Créteil, France
| | - Louis Soulat
- SAMU 36, C.H. de Chateauroux, 216 avenue de Verdun, 36000, Chateauroux, France
| | - Anna Faucher
- SAMU 74, C.H. de la région d'Annecy, 1 avenue de l'hôpital - Metz-Tessy, BP 90074, 74374, Pringy, France
| | - Yves Lambert
- SAMU 78, C.H. André Mignot, 177 rue de Versailles, 78150, Le Chesnay, France
| | | | - Agnès Ricard-Hibon
- SMUR de l'hôpital Beaujon, 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Carine Chassery
- SAMU 69, C.H. Edouard Herriot, 5 place d'Arsonval, 69437, Lyon Cedex 3, France
| | - Maryline Roti
- SAMU 83, C.H. de Toulon, 1208 avenue Colonel Picot, BP 1412, 83056, Toulon, France
| | - Vincent Bounes
- SAMU 31, C.H. de Purpan, Place du Dr Baylac, 31059, Toulouse Cedex 9, France
| | - Guillaume Debaty
- SAMU 38, C.H.U. de Grenoble, BP 217, 38043, Grenoble Cedex 9, France
| | - Tarak Mokni
- SAMU 64, C.H. de la Côte Basque, Avenue Loeb, 64109, Bayonne, France
| | - Gérald Egmann
- SAMU Guyane, C.H. de Cayenne, Rue des flamboyants, BP 6006, 97306, Cayenne, France
| | | | - Karim Boudenia
- SAMU 21, C.H.U. de Dijon, 3 rue du Faubourg Raines, 21033, Dijon, France
| | - Laurent Alayrac
- SMUR Orsay, C.H. d'Orsay, Place du Général Leclerc, BP 27, 91401, Orsay, France
| | - Mohamed Safraou
- SAMU 56, C.H. de Vannes, 20 boulevard du Général Guillaudot, 56017, Vannes, France
| | - Michel Galinski
- AP-HP, Urgences - SAMU 93, Unité Recherche-Enseignement-Qualité, Hôpital Avicenne, 125 rue de Stalingrad, 93000, Bobigny, France
- Université Paris 13, Sorbonne Paris Cité, EA 3509, 93000, Bobigny, France
| | - Frédéric Adnet
- AP-HP, Urgences - SAMU 93, Unité Recherche-Enseignement-Qualité, Hôpital Avicenne, 125 rue de Stalingrad, 93000, Bobigny, France
- Université Paris 13, Sorbonne Paris Cité, EA 3509, 93000, Bobigny, France
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Alvarado MM, Kum HC, Gonzalez Coronado K, Foster MJ, Ortega P, Lawley MA. Barriers to Remote Health Interventions for Type 2 Diabetes: A Systematic Review and Proposed Classification Scheme. J Med Internet Res 2017; 19:e28. [PMID: 28193598 PMCID: PMC5329647 DOI: 10.2196/jmir.6382] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 11/05/2016] [Accepted: 11/23/2016] [Indexed: 01/17/2023] Open
Abstract
Background Diabetes self-management involves adherence to healthy daily habits typically involving blood glucose monitoring, medication, exercise, and diet. To support self-management, some providers have begun testing remote interventions for monitoring and assisting patients between clinic visits. Although some studies have shown success, there are barriers to widespread adoption. Objective The objective of our study was to identify and classify barriers to adoption of remote health for management of type 2 diabetes. Methods The following 6 electronic databases were searched for articles published from 2010 to 2015: MEDLINE (Ovid), Embase (Ovid), CINAHL, Cochrane Central, Northern Light Life Sciences Conference Abstracts, and Scopus (Elsevier). The search identified studies involving remote technologies for type 2 diabetes self-management. Reviewers worked in teams of 2 to review and extract data from identified papers. Information collected included study characteristics, outcomes, dropout rates, technologies used, and barriers identified. Results A total of 53 publications on 41 studies met the specified criteria. Lack of data accuracy due to input bias (32%, 13/41), limitations on scalability (24%, 10/41), and technology illiteracy (24%, 10/41) were the most commonly cited barriers. Technology illiteracy was most prominent in low-income populations, whereas limitations on scalability were more prominent in mid-income populations. Barriers identified were applied to a conceptual model of successful remote health, which includes patient engagement, patient technology accessibility, quality of care, system technology cost, and provider productivity. In total, 40.5% (60/148) of identified barrier instances impeded patient engagement, which is manifest in the large dropout rates cited (up to 57%). Conclusions The barriers identified represent major challenges in the design of remote health interventions for diabetes. Breakthrough technologies and systems are needed to alleviate the barriers identified so far, particularly those associated with patient engagement. Monitoring devices that provide objective and reliable data streams on medication, exercise, diet, and glucose monitoring will be essential for widespread effectiveness. Additional work is needed to understand root causes of high dropout rates, and new interventions are needed to identify and assist those at the greatest risk of dropout. Finally, future studies must quantify costs and benefits to determine financial sustainability.
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Affiliation(s)
- Michelle M Alvarado
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
| | - Hye-Chung Kum
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States.,Department of Health Policy and Management, School of Public Health, Texas A&M Health Science Center, College Station, TX, United States
| | - Karla Gonzalez Coronado
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
| | - Margaret J Foster
- Medical Sciences Library, Texas A&M University, College Station, TX, United States
| | - Pearl Ortega
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
| | - Mark A Lawley
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
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Isaacs T, Hunt D, Ward D, Rooshenas L, Edwards L. The Inclusion of Ethnic Minority Patients and the Role of Language in Telehealth Trials for Type 2 Diabetes: A Systematic Review. J Med Internet Res 2016; 18:e256. [PMID: 27670360 PMCID: PMC5057063 DOI: 10.2196/jmir.6374] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 08/17/2016] [Accepted: 08/21/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Type 2 diabetes is a serious, pervasive metabolic condition that disproportionately affects ethnic minority patients. Telehealth interventions can facilitate type 2 diabetes monitoring and prevent secondary complications. However, trials designed to test the effectiveness of telehealth interventions may underrecruit or exclude ethnic minority patients, with language a potential barrier to recruitment. The underrepresentation of minorities in trials limits the external validity of the findings for this key patient demographic. OBJECTIVE This systematic review examines (1) the research reporting practices and prevalence of ethnic minority patients included in telehealth randomized controlled trials (RCTs) targeting type 2 diabetes and the trial characteristics associated with recruiting a high proportion of minority patients, and (2) the proportion of included RCTs that report using English language proficiency as a patient screening criterion and how and why they do so. METHODS Telehealth RCTs published in refereed journals targeting type 2 diabetes as a primary condition for adults in Western majority English-speaking countries were included. Ethnically targeted RCTs were excluded from the main review, but were included in a post hoc subgroup analysis. Abstract and full-text screening, risk of bias assessment, and data extraction were independently conducted by two reviewers. RESULTS Of 3358 records identified in the search, 79 articles comprising 58 RCTs were included. Nearly two-thirds of the RCTs (38/58) reported on the ethnic composition of participants, with a median proportion of 23.5% patients (range 0%-97.7%). Fourteen studies (24%) that included at least 30% minority patients were all US-based, predominantly recruited from urban areas, and described the target population as underserved, financially deprived, or uninsured. Eight of these 14 studies (57%) offered intervention materials in a language other than English or employed bilingual staff. Half of all identified RCTs (29/58) included language proficiency as a participant-screening criterion. Language proficiency was operationalized using nonstandardized measures (eg, having sufficient "verbal fluency"), with only three studies providing reasons for excluding patients on language grounds. CONCLUSIONS There was considerable variability across studies in the inclusion of ethnic minority patients in RCTs, with higher participation rates in countries with legislation to mandate their inclusion (eg, United States) than in those without such legislation (eg, United Kingdom). Less than 25% of the RCTs recruited a sizeable proportion of ethnic minorities, which raises concerns about external validity. The lack of objective measures or common procedures for assessing language proficiency across trials implies that language-related eligibility decisions are often based on trial recruiters' impressionistic judgments, which could be subject to bias. The variability and inconsistent reporting on ethnicity and other socioeconomic factors in descriptions of research participants could be more specifically emphasized in trial reporting guidelines to promote best practice. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews: CRD42015024899; http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42015024899 (Archived by WebCite at http://www.webcitation.org/6kQmI2bdF).
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Affiliation(s)
- Talia Isaacs
- University of Bristol, Graduate School of Education, Bristol, United Kingdom.
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Pekmezaris R, Schwartz RM, Taylor TN, DiMarzio P, Nouryan CN, Murray L, McKenzie G, Ahern D, Castillo S, Pecinka K, Bauer L, Orona T, Makaryus AN. A qualitative analysis to optimize a telemonitoring intervention for heart failure patients from disparity communities. BMC Med Inform Decis Mak 2016; 16:75. [PMID: 27343060 PMCID: PMC4919886 DOI: 10.1186/s12911-016-0300-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 05/29/2016] [Indexed: 11/23/2022] Open
Abstract
Background The use of telemonitoring is a promising approach to optimizing outcomes in the treatment of heart failure (HF) for patients living in the community. HF telemonitoring interventions, however, have not been tested for use with individuals residing in disparity communities. Methods The current study describes the results of a community based participatory research approach to adapting a telemonitoring HF intervention so that it is acceptable and feasible for use with a lower-income, Black and Hispanic patient population. The study uses the ADAPT-ITT framework to engage key community stakeholders in the process of adapting the intervention in the context of two consecutive focus groups. In addition, data from a third focus group involving HF telemonitoring patient participants was also conducted. All three focus group discussions were audio recorded and professionally transcribed and lasted approximately two hours each. Structural coding was used to mark responses to topical questions in the interview guide. Results This is the first study to describe the formative process of a community-based participatory research study aimed at optimizing telehealth utilization among African-American and Latino patients from disparity communities. Two major themes emerged from qualitative analyses of the focus group data. The first theme that arose involved suggested changes to the equipment that would maximize usability. Subthemes identified included issues that reflect the patient populations targeted, such as Spanish translation, font size and medical jargon. The second theme that arose involved suggested changes to the RCT study structure in order to maximize participant engagement. Subthemes also identified issues that reflect concerns of the targeted patient populations, such as the provision of reassurances regarding identity protection to undocumented patients in implementing an intervention that utilizes a camera, and that their involvement in telehealth monitoring would not replace their clinic care, which for many disparity patients is their only connection to medical care. Conclusions The adaptation, based on the analysis of the data from the three focus groups, resulted in an intervention that is acceptable and feasible for HF patients residing in disparity communities. Trial registration NCT02196922; ClinicalTrials.gov (US National Institutes of Health). Electronic supplementary material The online version of this article (doi:10.1186/s12911-016-0300-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- R Pekmezaris
- Department of Medicine, Hofstra Northwell School of Medicine, Manhasset, NY, USA.,Department of Occupational Medicine, Epidemiology, and Prevention, Hofstra Northwell School of Medicine, 175 Community Drive, Great Neck, NY, 11021, USA.,Northwell Health, 175 Community Drive, Great Neck, NY, 11021, USA
| | - R M Schwartz
- Department of Occupational Medicine, Epidemiology, and Prevention, Hofstra Northwell School of Medicine, 175 Community Drive, Great Neck, NY, 11021, USA. .,Northwell Health, 175 Community Drive, Great Neck, NY, 11021, USA.
| | - T N Taylor
- SUNY Downstate School of Medicine, 450 Clarkson Ave, Brooklyn, NY, 11203, USA
| | - P DiMarzio
- Department of Medicine, Hofstra Northwell School of Medicine, Manhasset, NY, USA.,Department of Occupational Medicine, Epidemiology, and Prevention, Hofstra Northwell School of Medicine, 175 Community Drive, Great Neck, NY, 11021, USA.,Northwell Health, 175 Community Drive, Great Neck, NY, 11021, USA
| | - C N Nouryan
- Department of Medicine, Hofstra Northwell School of Medicine, Manhasset, NY, USA.,Department of Occupational Medicine, Epidemiology, and Prevention, Hofstra Northwell School of Medicine, 175 Community Drive, Great Neck, NY, 11021, USA.,Northwell Health, 175 Community Drive, Great Neck, NY, 11021, USA
| | - L Murray
- Community Advisory Board, Northwell Health, 175 Community Drive, Great Neck, NY, 11021, USA
| | - G McKenzie
- Community Advisory Board, Northwell Health, 175 Community Drive, Great Neck, NY, 11021, USA
| | - D Ahern
- Nassau University Medical Center, 2201 Hempstead Tpke, East Meadow, NY, 11554, USA
| | - S Castillo
- Nassau University Medical Center, 2201 Hempstead Tpke, East Meadow, NY, 11554, USA
| | - K Pecinka
- Northwell Health, 175 Community Drive, Great Neck, NY, 11021, USA
| | - L Bauer
- Nassau University Medical Center, 2201 Hempstead Tpke, East Meadow, NY, 11554, USA
| | - T Orona
- Northwell Health, 175 Community Drive, Great Neck, NY, 11021, USA
| | - A N Makaryus
- Nassau University Medical Center, 2201 Hempstead Tpke, East Meadow, NY, 11554, USA.,Department of Cardiology, Hofstra Northwell School of Medicine, Manhasset, NY, USA
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Knowles S, Combs R, Kirk S, Griffiths M, Patel N, Sanders C. Hidden caring, hidden carers? Exploring the experience of carers for people with long-term conditions. HEALTH & SOCIAL CARE IN THE COMMUNITY 2016; 24:203-13. [PMID: 25706665 PMCID: PMC4744729 DOI: 10.1111/hsc.12207] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/12/2014] [Indexed: 05/14/2023]
Abstract
Informal carers make a significant contribution to illness management in communities, but many struggle to access support and remain 'hidden carers'. We aimed to explore how carers of people with common long-term conditions (LTCs, such as coronary heart disease or kidney disease) conceptualised their caring, and whether they struggled to identify themselves with the term 'carer' or access for support. We conducted semi-structured interviews with 19 informal carers of people with LTCs recruited from local support groups. Topic guides were designed to encourage participants to provide their retrospective accounts of identifying as a carer or struggling to do so. Data were analysed using the constant comparative method. The study was designed collaboratively with a patient and public involvement (PPI) partner, and we consulted with a PPI steering group of people with lived experience of caring during the study. Results showed how participants drew on comparisons with those caring for more dependent relatives in explaining their reluctance to define themselves as a carer, and resisted adopting the label due to concerns that it would threaten the identity of the cared-for person. The data were interpreted in terms of types of 'work' undertaken to manage LTCs, and revealed that carers of patients with LTCs appear to primarily engage in biographical and emotional support, which may be more difficult to conceptualise as legitimate caring 'work'. Participants indicated that health professionals may be in a unique position to validate their role as carers and encourage support seeking. The study suggests how the greater focus on self-management of LTCs in the community must be complemented by recognition of this group as potentially 'hidden carers', who support the patient to minimise the impact the illness has on their lives and consequently may minimise their own caring role, with negative implications for support seeking.
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Affiliation(s)
- Sarah Knowles
- Centre for Primary CareInstitute of Population HealthUniversity of ManchesterManchesterUK
| | - Ryan Combs
- Centre for Primary CareInstitute of Population HealthUniversity of ManchesterManchesterUK
| | - Sue Kirk
- School of Nursing, Midwifery and Social WorkUniversity of ManchesterManchesterUK
| | - May Griffiths
- Centre for Primary CareInstitute of Population HealthUniversity of ManchesterManchesterUK
| | - Neesha Patel
- Centre for Primary CareInstitute of Population HealthUniversity of ManchesterManchesterUK
| | - Caroline Sanders
- Centre for Primary CareInstitute of Population HealthUniversity of ManchesterManchesterUK
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Alzubaidi H, Mc Namara K, Browning C, Marriott J. Barriers and enablers to healthcare access and use among Arabic-speaking and Caucasian English-speaking patients with type 2 diabetes mellitus: a qualitative comparative study. BMJ Open 2015; 5:e008687. [PMID: 26576809 PMCID: PMC4654379 DOI: 10.1136/bmjopen-2015-008687] [Citation(s) in RCA: 39] [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: 05/07/2015] [Revised: 08/25/2015] [Accepted: 08/27/2015] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE The objective of this study was to explore the decision-making processes and associated barriers and enablers that determine access and use of healthcare services in Arabic-speaking and English-speaking Caucasian patients with diabetes in Australia. STUDY SETTING AND DESIGN Face-to-face semistructured individual interviews and group interviews were conducted at various healthcare settings-diabetes outpatient clinics in 2 tertiary referral hospitals, 6 primary care practices and 10 community centres in Melbourne, Australia. PARTICIPANTS A total of 100 participants with type 2 diabetes mellitus were recruited into 2 groups: 60 Arabic-speaking and 40 English-speaking Caucasian. DATA COLLECTION Interviews were audio-taped, translated into English when necessary, transcribed and coded thematically. Sociodemographic and clinical information was gathered using a self-completed questionnaire and medical records. PRINCIPAL FINDINGS Only Arabic-speaking migrants intentionally delayed access to healthcare services when obvious signs of diabetes were experienced, missing opportunities to detect diabetes at an early stage. Four major barriers and enablers to healthcare access and use were identified: influence of significant other(s), unique sociocultural and religious beliefs, experiences with healthcare providers and lack of knowledge about healthcare services. Compared with Arabic-speaking migrants, English-speaking participants had no reluctance to access and use medical services when signs of ill-health appeared; their treatment-seeking behaviours were straightforward. CONCLUSIONS Arabic-speaking migrants appear to intentionally delay access to medical services even when symptomatic. Four barriers to health services access have been identified. Tailored interventions must be developed for Arabic-speaking migrants to improve access to available health services, facilitate timely diagnosis of diabetes and ultimately to improve glycaemic control.
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Affiliation(s)
- H Alzubaidi
- Centre for Medicine Use and Safety, Monash University, Parkville, Victoria, Australia
| | - K Mc Namara
- Centre for Medicine Use and Safety, Monash University, Parkville, Victoria, Australia
- Greater Green Triangle University Department of Rural Health, Flinders University and Deakin University, Warrnambool, Victoria, Australia
| | - Colette Browning
- Institute at Royal District Nursing Service, Melbourne, Australia
| | - J Marriott
- Centre for Medicine Use and Safety, Monash University, Parkville, Victoria, Australia
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Park YH, Bang HL, Kim GH, Ha JY. Facilitators and barriers to self-management of nursing home residents: perspectives of health-care professionals in Korean nursing homes. Clin Interv Aging 2015; 10:1617-24. [PMID: 26491277 PMCID: PMC4608591 DOI: 10.2147/cia.s93333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To explore facilitators and barriers to self-management from the viewpoint of staff taking care of nursing home (NH) residents with chronic diseases in South Korea. Patients and methods A qualitative content analysis was done using the focus group interview method. A total of 23 health-care professionals (16 registered nurses and 7 social workers) were interviewed from three urban NHs, each with more than 100 beds. Results Five facilitators were identified: grouping the residents; the resident’s awareness of his/her current health status; the willingness of residents to engage in self-management; residence in the facility; and support from the staff. Additionally, seven barriers were identified: deterioration of the resident’s health; the dependency expectations of the resident; hesitation in asking for help; difference in expectations between the staff and the resident’s family; insufficient staffing and time; lack of standardized guidelines; and conservative tendencies of the staff due to rigid policies. Conclusion The findings of this study can help health-care professionals recognize the factors that influence self-management and provide direction for registered nurses and other health professionals involved in supporting self-management programs for NH residents.
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Affiliation(s)
- Yeon-Hwan Park
- College of Nursing, Seoul National University, Seoul, Korea ; The Research Institute of Nursing Science, Seoul National University, Seoul, Korea
| | - Hwal Lan Bang
- The Research Institute of Nursing Science, Seoul National University, Seoul, Korea ; Department of Nursing Science, College of Industry, Sangmyung University, Cheonan, Korea
| | - Ga Hye Kim
- College of Nursing, Seoul National University, Seoul, Korea
| | - Ji Yeon Ha
- College of Nursing, Seoul National University, Seoul, Korea
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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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Pesantes MA, Lazo-Porras M, Abu Dabrh AM, Ávila-Ramírez JR, Caycho M, Villamonte GY, Sánchez-Pérez GP, Málaga G, Bernabé-Ortiz A, Miranda JJ. Resilience in Vulnerable Populations With Type 2 Diabetes Mellitus and Hypertension: A Systematic Review and Meta-analysis. Can J Cardiol 2015; 31:1180-8. [PMID: 26239007 PMCID: PMC4556590 DOI: 10.1016/j.cjca.2015.06.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 06/11/2015] [Accepted: 06/11/2015] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Patients with chronic conditions and limited access to health care experience stressful challenges resulting from the burden of managing both their conditions and their daily life demands. Resilience provides a mechanism of adapting to stressful experiences. We conducted a systematic review and meta-analysis to synthesize the evidence about interventions to enhance resiliency in managing hypertension or type 2 diabetes in vulnerable populations and to assess the efficacy of these interventions on clinical outcomes. METHODS We searched multiple databases from early inception through February 2015 including randomized controlled trials that enrolled patients with type 2 diabetes or hypertension. All interventions that targeted resilience in vulnerable populations were included. Data were synthesized to describe the characteristics and efficacy of resiliency interventions. We pooled the total effects by calculating standardized mean difference using the random-effects model. RESULTS The final search yielded 17 studies. All studies were conducted in the United States and generally targeted minority participants. Resiliency interventions used diverse strategies; discussion groups or workshops were the most common approach. CONCLUSIONS Interventions aimed at enhancing the resiliency of patients from vulnerable groups are diverse. Outcomes were not fully conclusive. There was some evidence that resiliency interventions had a positive effect on hemoglobin A1C levels but not blood pressure. The incorporation of resiliency-oriented interventions into the arsenal of preventing and managing chronic conditions appears to be an opportunity that remains to be better investigated and exploited, and there is need to pursue further understanding of the core components of any intervention that claims to enhance resilience.
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Affiliation(s)
- M Amalia Pesantes
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - María Lazo-Porras
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Abd Moain Abu Dabrh
- Knowledge and Evaluation Research (KER) Unit Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Jaime R Ávila-Ramírez
- Knowledge and Evaluation Research (KER) Unit Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - María Caycho
- Knowledge and Evaluation Research (KER) Unit Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Georgina Y Villamonte
- Knowledge and Evaluation Research (KER) Unit Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Grecia P Sánchez-Pérez
- Knowledge and Evaluation Research (KER) Unit Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Germán Málaga
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Antonio Bernabé-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru.
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Knight H, Stetson B, Krishnasamy S, Mokshagundam SP. Diet self-management and readiness to change in underserved adults with type 2 diabetes. Prim Care Diabetes 2015; 9:219-225. [PMID: 25457433 DOI: 10.1016/j.pcd.2014.09.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 09/28/2014] [Indexed: 11/21/2022]
Abstract
AIM Dietary assessment in diabetes may be enhanced by considering patient-centered perspectives and barriers to change within IDF guidelines. Consideration of readiness to change (RTC) diet in underserved samples may guide future interventions in high risk populations. This study assesses the utility of a rapid assessment of RTC diet in a medically underserved sample. METHOD Participants were 253 Black (43.7%) and White (55.1%) American adults with type 2 diabetes [M age=57.93 (11.52); 60.5% female; 19% below the US poverty threshold]. Participants were recruited at medical clinics and completed validated self-report measures assessing diabetes knowledge, self-efficacy and dietary behaviors and barriers by RTC. RESULTS Stage-based comparisons identified significant differences in diabetes and dietary domains: participants in the Action stage endorsed fewer behavioral dietary barriers (p<.001), more frequent dietary problem-solving (p<.001), and greater diabetes self-efficacy (p<.001) than participants in the Contemplation and Preparation stages. Women were more likely to be in the Preparation stage and beyond (p<.05). CONCLUSIONS Findings highlight the clinical utility of a brief measure of RTC in understanding patient perspectives toward dietary behaviors in a medically underserved sample. The impact of gender on RTC diet warrants further exploration.
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Greenhalgh T, Clinch M, Afsar N, Choudhury Y, Sudra R, Campbell-Richards D, Claydon A, Hitman GA, Hanson P, Finer S. Socio-cultural influences on the behaviour of South Asian women with diabetes in pregnancy: qualitative study using a multi-level theoretical approach. BMC Med 2015; 13:120. [PMID: 25998551 PMCID: PMC4455920 DOI: 10.1186/s12916-015-0360-1] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 05/05/2015] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Diabetes in pregnancy is common in South Asians, especially those from low-income backgrounds, and leads to short-term morbidity and longer-term metabolic programming in mother and offspring. We sought to understand the multiple influences on behaviour (hence risks to metabolic health) of South Asian mothers and their unborn child, theorise how these influences interact and build over time, and inform the design of culturally congruent, multi-level interventions. METHODS Our sample for this qualitative study was 45 women of Bangladeshi, Indian, Sri Lankan, or Pakistani origin aged 21-45 years with a history of diabetes in pregnancy, recruited from diabetes and antenatal services in two deprived London boroughs. Overall, 17 women shared their experiences of diabetes, pregnancy, and health services in group discussions and 28 women gave individual narrative interviews, facilitated by multilingual researchers, audiotaped, translated, and transcribed. Data were analysed using the constant comparative method, drawing on sociological and narrative theories. RESULTS Key storylines (over-arching narratives) recurred across all ethnic groups studied. Short-term storylines depicted the experience of diabetic pregnancy as stressful, difficult to control, and associated with negative symptoms, especially tiredness. Taking exercise and restricting diet often worsened these symptoms and conflicted with advice from relatives and peers. Many women believed that exercise in pregnancy would damage the fetus and drain the mother's strength, and that eating would be strength-giving for mother and fetus. These short-term storylines were nested within medium-term storylines about family life, especially the cultural, practical, and material constraints of the traditional South Asian wife and mother role and past experiences of illness and healthcare, and within longer-term storylines about genetic, cultural, and material heritage - including migration, acculturation, and family memories of food insecurity. While peer advice was familiar, meaningful, and morally resonant, health education advice from clinicians was usually unfamiliar and devoid of cultural meaning. CONCLUSIONS 'Behaviour change' interventions aimed at preventing and managing diabetes in South Asian women before and during pregnancy are likely to be ineffective if delivered in a socio-cultural vacuum. Individual education should be supplemented with community-level interventions to address the socio-material constraints and cultural frames within which behavioural 'choices' are made.
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Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, New Radcliffe House, Walton St, Oxford, OX2 6GG, UK.
| | - Megan Clinch
- Blizard Institute, Barts and the London School of Medicine and Dentistry, London, E1 2AT, UK.
| | - Nur Afsar
- Community Health and Social Medicine Department, Sophie Davis School of Biomedical Education, City University of New York Medical School, New York, 10031, USA.
| | - Yasmin Choudhury
- Blizard Institute, Barts and the London School of Medicine and Dentistry, London, E1 2AT, UK.
| | - Rita Sudra
- Department of Diabetes, Newham University Hospital, Glen Road, Plaistow, London, E13 8SL, UK.
| | | | - Anne Claydon
- Department of Diabetes, Newham University Hospital, Glen Road, Plaistow, London, E13 8SL, UK.
| | - Graham A Hitman
- Blizard Institute, Barts and the London School of Medicine and Dentistry, London, E1 2AT, UK. .,Department of Diabetes, Royal London Hospital, Whitechapel Rd, London, E1 1BB, UK.
| | - Philippa Hanson
- Department of Diabetes, Royal London Hospital, Whitechapel Rd, London, E1 1BB, UK.
| | - Sarah Finer
- Blizard Institute, Barts and the London School of Medicine and Dentistry, London, E1 2AT, UK. .,Department of Diabetes, Royal London Hospital, Whitechapel Rd, London, E1 1BB, UK.
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Dauvrin M, Lorant V. Leadership and cultural competence of healthcare professionals: a social network analysis. Nurs Res 2015; 64:200-10. [PMID: 25871625 PMCID: PMC4418777 DOI: 10.1097/nnr.0000000000000092] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND International migration is a global phenomenon challenging healthcare professionals to provide culturally competent care. OBJECTIVES The purpose of this study was to investigate the influence of leaders on the cultural competence of healthcare professionals. METHODS A cross-sectional survey was conducted from 2010 to 2012 to obtain data for a social network analysis in 19 inpatient services and five primary care services in Belgium. The Competences in Ethnicity and Health questionnaire was used. A total of 507 healthcare professionals, including 302 nurses, identified their social relationships with other healthcare professionals working in their service. Highest in-degree centrality was used to identify the leaders within each health service. Multiple regressions with the Huber sandwich estimator were used to link cultural competence of leaders with the cultural competence of the rest of the healthcare staff. RESULTS Cultural competence of the healthcare staff was associated with the cultural competence of the leaders. This association remained significant for two specific domains of cultural competence-mediation and paradigm-after controlling for contextual and sociodemographic variables. Interaction analysis suggested that the leadership effect varied with the degree of cultural competence of the leaders. DISCUSSION Cultural competence among healthcare professionals is acquired partly through leadership. Social relationships and leadership effects within health services should be considered when developing and implementing culturally competent strategies. This requires a cautious approach as the most central individuals are not always the same persons as the formal leaders.
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Affiliation(s)
- Marie Dauvrin
- Marie Dauvrin, RN, MPH, PhD, is Postdoctoral Researcher, Fonds de la Recherche Scientifique-FNRS, Prospective Research for Brussels (INNOVIRIS) and Institute of Health and Society IRSS, Université catholique de Louvain, Belgium. Vincent Lorant, PhD, is Professor, Institute of Health Society IRSS, Université catholique de Louvain, Belgium
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Dauvrin M, Lorant V, d’Hoore W. Is the Chronic Care Model Integrated Into Research Examining Culturally Competent Interventions for Ethnically Diverse Adults With Type 2 Diabetes Mellitus? A Review. Eval Health Prof 2015; 38:435-63. [DOI: 10.1177/0163278715571004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The chronic care model (CCM) concerns both the medical and the cultural and linguistic needs of patients through the inclusion of cultural competence in the delivery system design. This literature review attempted to@@ identify the domains of the CCM culturally competent (CC) interventions that the adults from ethnic minorities suffering from type 2 diabetes mellitus report. We identified the CCM and the CC components in the relevant studies published between 2005 and 2014. Thirty-two studies were included. Thirty-one articles focused on self-management and 20 on community resources. Twenty-three interventions integrated cultural norms from the patients’ backgrounds. CC interventions reported the CCM at the individual level but need to address the organizational level more effectively. The scope of CC interventions should be expanded to transform health care organizations and systems.
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Affiliation(s)
- Marie Dauvrin
- Fonds de la Recherche Scientifique (F.R.S.-FNRS), Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium
| | - Vincent Lorant
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium
| | - William d’Hoore
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium
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Norris M, Jones F, Kilbride C, Victor C. Exploring the experience of facilitating self-management with minority ethnic stroke survivors: a qualitative study of therapists' perceptions. Disabil Rehabil 2014; 36:2252-61. [PMID: 24670190 PMCID: PMC4364271 DOI: 10.3109/09638288.2014.904936] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 03/03/2014] [Accepted: 03/12/2014] [Indexed: 11/13/2022]
Abstract
PURPOSE The utility of self-management with people from minority ethnic backgrounds has been questioned, resulting in the development of culturally specific tools. Yet, the use of stroke specific self-management programmes is underexplored in these high risk groups. This article presents the experience of stroke therapists in using a stroke specific self-management programme with stroke survivors from minority ethnic backgrounds. METHODS 26 stroke therapists with experience of using the self-management programme with stroke survivors from minority ethnic backgrounds participated in semi-structured interviews. These were audio recorded, transcribed verbatim and analysed thematically. RESULTS Three themes were identified. One questioned perceived differences in stroke survivors interaction with self-management based on ethnicity. The other themes contrasted with this view demonstrating two areas in which ethnic and cultural attributes were deemed to influence the self-management process both positively and negatively. Aspects of knowledge of health, illness and recovery, religion, family and the professionals themselves are highlighted. CONCLUSIONS This study indicates that ethnicity should not be considered a limitation to the use of an individualized stroke specific self-management programme. However, it highlights potential facilitators and barriers, many of which relate to the capacity of the professional to effectively navigate cultural and ethnic differences.
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Affiliation(s)
- Meriel Norris
- Centre for Research in Rehabilitation, School of Health Sciences and Social Care, Brunel University, London, UK
| | - Fiona Jones
- Faculty of Health and Social Care Science, St George's University of London & Kingston University, London, UK
| | - Cherry Kilbride
- Centre for Research in Rehabilitation, School of Health Sciences and Social Care, Brunel University, London, UK
| | - Christina Victor
- Brunel Institute of Ageing Studies, School of Health Sciences and Social Care, Brunel University, London, UK
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Abstract
This study aims to explore the health literacy needs of South Asian men with diabetes to generate scoping data to inform culturally appropriate interventions with this group. Health literacy levels were measured using the TOFHLA-UK (n=45) and supplemented by semi-structured interviews with healthcare providers (n=12). Data suggest that the majority of participants from this cohort tend to have marginal to inadequate health literacy levels. A generational gap was also found. Although language is a common barrier, low literacy confounds this issue since some patients are unable to read even in their own language. Thus health communication and care plans need to be simplified to match current health literacy levels of South Asian men with diabetes. Interventions need to work around cultural norms and collaborate with community members. Research and interventions that consider the needs of older generations of South Asian people with diabetes are also needed.
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Sav A, Kendall E, McMillan SS, Kelly F, Whitty JA, King MA, Wheeler AJ. 'You say treatment, I say hard work': treatment burden among people with chronic illness and their carers in Australia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2013; 21:665-674. [PMID: 23701664 DOI: 10.1111/hsc.12052] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/16/2013] [Indexed: 06/02/2023]
Abstract
The aim of this study was to explore treatment burden among people with a variety of chronic conditions and comorbidities and their unpaid carers. The burden of living with ongoing chronic illness has been well established. However, the burden associated with proactively treating and managing chronic illness, commonly referred to as 'treatment burden', is less understood. This study helps to bridge this gap in our understanding by providing an in-depth analysis of qualitative data collected from a large sample of adults from diverse backgrounds and with various chronic conditions. Using semi-structured in-depth interviews, data were collected with a large sample of 97 participants that included a high representation of people from culturally and linguistically diverse backgrounds and indigenous populations across four regions of Australia. Interviews were conducted during May-October 2012, either face to face (n = 49) or over the telephone (n = 48) depending on the participant's preference and location. Data were analysed using an iterative thematic approach and the constant comparison method. The findings revealed four interrelated components of treatment burden: financial burden, time and travel burden, medication burden and healthcare access burden. However, financial burden was the most problematic component with the cost of treatment being significant for most people. Financial burden had a detrimental impact on a person's use of medication and also exacerbated other types of burden such as access to healthcare services and the time and travel associated with treatment. The four components of treatment burden operated in a cyclical manner and although treatment burden was objective in some ways (number of medications, and time to access treatment), it was also a subjective experience. Overall, this study underscores the urgent need for healthcare professionals to identify patients overwhelmed by their treatment and develop 'individualised' treatment options to alleviate treatment burden.
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Affiliation(s)
- Adem Sav
- Population and Social Health Research Program, School of Human Services and Social Work, Griffith Health Institute, Griffith University, Meadowbrook, Qld, Australia
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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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Rutebemberwa E, Katureebe SK, Gitta SN, Mwaka AD, Atuyambe L. Perceptions of diabetes in rural areas of Eastern Uganda. Curationis 2013; 36:E1-7. [PMID: 23718775 DOI: 10.4102/curationis.v36i1.121] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 03/01/2013] [Accepted: 04/14/2013] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND People diagnosed with diabetes mellitus are increasing in sub-Saharan Africa and prompt care seeking depends on perceptions of the illness. OBJECTIVE The objective was to explore perceptions of diabetes in rural areas. METHOD We conducted a qualitative, explorative and descriptive study in rural eastern Uganda. Eight focus group discussions with community members were conducted. Community members were presented with a story about a person with diabetes symptoms and their perceptions of the diagnosis and treatment elicited. Four focus group discussions with people with diabetes and seven key informant interviews with health workers were conducted. Respondents were asked how the community interpreted symptoms of diabetes, its causes and whether it was curable. Manifest content analysis was used. RESULTS Some respondents thought people with diabetes symptoms had HIV or were bewitched. Causes of diabetes mentioned included consuming too much fatty food. Some respondents thought diabetes is transmitted through air, sharing utensils with or sitting close to people with diabetes. Some respondents thought that diabetes could heal fast whilst others thought it was incurable. CONCLUSION Misdiagnosis may cause delay in seeking proper care. Preventive programmes could build on people's thinking that too much fatty food causes diabetes to promote diets with less fat. The perception of diabetes as a contagious disease leads to stigmatisation and affects treatment seeking. Seeing diabetes as curable could create patient expectations that may not be fulfilled in the management of diabetes. Rural communities would benefit from campaigns creating awareness of prevention, symptoms, diagnosis and management of diabetes.
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Affiliation(s)
- Elizeus Rutebemberwa
- Department of Health Policy, Planning and Management, Makerere University School of Public Health.
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Glasgow T, Cheek L, Tabet N. Efficacy of non-pharmacological interventions in controlling type 2 diabetes in patients of African descent: A systematic review. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/jbise.2013.65a007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kim G, Ford KL, Chiriboga DA, Sorkin DH. Racial and ethnic disparities in healthcare use, delayed care, and management of diabetes mellitus in older adults in California. J Am Geriatr Soc 2012. [PMID: 23194086 DOI: 10.1111/jgs.12003] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study examined racial and ethnic differences in healthcare use, delayed care, and management of care of older adults with a self-reported diagnosis of diabetes mellitus. Drawing on the 2009 California Health Interview Survey (CHIS), the sample included 3,003 adults (representative of N = 998,795) aged 60 and older from five racial and ethnic groups: non-Hispanic white (n = 2,153), African American (n = 213), Hispanic (n = 336), Asian (n = 306), and American Indian and Alaska Native (AI/AN) (n = 59). All self-reported a diagnosis of diabetes mellitus. Descriptive statistics and logistic regression analyses were conducted using weighted data. Results from adjusted logistic regressions indicated significant racial and ethnic differences between non-Hispanic white elderly and the other groups examined. Specifically, African Americans were significantly less likely than whites to see a doctor and to have a usual source of care, and were more likely to visit the emergency department (ED) for diabetes mellitus and to have their feet examined by a provider. Hispanics were significantly less likely to take medicine to lower cholesterol but were more likely to test their blood glucose regularly (following ADA guidelines). Asians were significantly less likely than whites to test their blood glucose regularly or have a foot examination. AI/ANs were significantly less likely than whites to see a doctor, visit an ED, and take medication to reduce heart attack risk but were more likely to use insulin, oral diabetic medication, or both. The findings suggest the need for racial- and ethnic-specific interventions for managing diabetes mellitus to help reduce existing racial and ethnic disparities among elderly adults.
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Affiliation(s)
- Giyeon Kim
- Center for Mental Health and Aging, University of Alabama, Tuscaloosa, Alabama 35487, USA.
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