Culturally tailored education to promote lifestyle change in Mexican Americans with type 2 diabetes

Preparedness of diabetic patients for receiving telemedical health care: A cross-sectional study

Introduction

This study evaluates feasibility of telemedicine to deliver diabetic care among different regions of the country.

Materials and Methods

Medical interns affiliated with Rotaract Club of Medicrew (RCM) organized a Free Diabetes Screening Camp called "Diab-at-ease" at multiple sites across the country. Of all beneficiaries of the camp >18 years of age, patients previously diagnosed with diabetes and undiagnosed patients with a random blood sugar level of more than 200 mg/dL were interviewed regarding their knowledge, attitude, and practice regarding diabetes care and preparedness and vigilance to receiving care through telemedicine. Random blood sugar, height, weight, and waist circumference were also documented.

Results

About 51.1% (N = 223) of female patients aged 57.57 ± 13.84 years (>18 years) with body mass index (BMI) =26.11 ± 4.63 were the beneficiaries of the health camps. About 75.3% (n = 168) of them were on oral hypoglycemic agents (OHAs), 15.7% (n = 35) were on insulin preparations, and 59.6% (n = 156) and 88.5% (n = 31) of which were highly compliant with treatment, respectively. About 35% (n = 78) and 43.9% (n = 98) of them were unaware of their frequency of hypoglycemic and hyperglycemic episodes, respectively. About 64.6% (n = 144) of the patients were equipped for receiving teleconsultation. Glucometer was only possessed by 51.6% (115) of which only 46.95% (n = 54) can operate it independently. Only 80 patients (35.9%) were aware of the correct value of blood glucose levels.

Conclusion

While a majority of the population is compliant with treatment and aware about diabetes self-care, they lack adequate knowledge and resource equipment for the same leading to very limited utilization.

Reducing health inequalities through general practice: a realist review and action framework

Background

Socio-economic inequalities in health have been in the public agenda for decades. General practice has an influential role to play in mitigating the impact of inequalities especially regarding chronic conditions. At the moment, general practice is dealing with serious challenges in relation to workforce shortages, increasing workload and the impact of the COVID-19 pandemic. It is important to identify effective ways so that general practice can play its role in reducing health inequalities.

Objectives

We explored what types of interventions and aspects of routine care in general practice decrease or increase inequalities in health and care-related outcomes. We focused on cardiovascular disease, cancer, diabetes and/or chronic obstructive pulmonary disease. We explored for whom these interventions and aspects of care work best, why, and in what circumstances. Our main objective was to synthesise this evidence into specific guidance for healthcare professionals and decision-makers about how best to achieve equitable general practice.

Design

Realist review.

Main outcome measures

Clinical or care-related outcomes by socio-economic group, or other PROGRESS-Plus criteria.

Review methods

Realist review based on Pawson's five steps: (1) locating existing theories, (2) searching for evidence, (3) selecting articles, (4) extracting and organising data and (5) synthesising the evidence.

Results

Three hundred and twenty-five studies met the inclusion criteria and 159 of them were selected for the evidence synthesis. Evidence about the impact of general practice interventions on health inequalities is limited. To reduce health inequalities, general practice needs to be: • connected so that interventions are linked and coordinated across the sector; • intersectional to account for the fact that people's experience is affected by many of their characteristics; • flexible to meet patients' different needs and preferences; • inclusive so that it does not exclude people because of who they are; • community-centred so that people who receive care engage with its design and delivery. These qualities should inform action across four domains: structures like funding and workforce distribution, organisational culture, everyday regulated procedures involved in care delivery, interpersonal and community relationships.

Limitations

The reviewed evidence offers limited detail about the ways and the extent to which specific interventions increase or decrease inequalities in general practice. Therefore, we focused on the underpinning principles that were common across interventions to produce higher-level, transferrable conclusions about ways to achieve equitable care.

Conclusions

Inequalities in general practice result from complex processes across four different domains that include structures, ideas, regulated everyday procedures, and relationships among individuals and communities. To achieve equity, general practice needs to be connected, intersectional, flexible, inclusive and community-centred.

Future work

Future work should focus on how these five essential qualities can be better used to shape the organisational development of future general practice.

Study registration

This trial is registered as PROSPERO CRD42020217871.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR130694) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 7. See the NIHR Funding and Awards website for further award information.

Community Exercise Program Participation and Mental Well-Being in the U.S. Texas-Mexico Border Region

Hispanics are disproportionately affected by low rates of physical activity and high rates of chronic diseases. Hispanics generally and Mexican Americans specifically are underrepresented in research on physical activity and its impact on mental well-being. Some community-based interventions have been effective in increasing physical activity among Hispanics. This study examined data from a sample of low-income Hispanic participants in free community exercise classes to characterize the association between self-reported frequency of exercise class attendance, intensity of physical activity, and participant well-being. As part of two cross-sectional samples recruited from a stratified random sample of community exercise classes, 302 participants completed a questionnaire consisting of a modified version of the Godin-Shephard Leisure-Time Exercise Questionnaire (LTEQ) and the Mental Health Continuum Short Form (MHC-SF). Adjusted logistic regression analyses indicated that those who achieve mild, moderate, and strenuous self-reported physical activity have 130% higher odds (p = 0.0422) of positive mental well-being after adjustment for age, frequency of attendance, and self-reported health. This study provides evidence that the intensity of physical activity is associated with flourishing mental well-being among Hispanic adults. The association between physical activity and mental well-being is more pronounced when considering participants engaged in mild levels of physical activity. The study further provides insight into the planning and development of community-based physical activity programming tailored to low-income populations.

Reducing health inequalities through general practice

Although general practice can contribute to reducing health inequalities, existing evidence provides little guidance on how this reduction can be achieved. We reviewed interventions influencing health and care inequalities in general practice and developed an action framework for health professionals and decision makers. We conducted a realist review by searching MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, and Cochrane Library for systematic reviews of interventions into health inequality in general practice. We then screened the studies in the included systematic reviews for those that reported their outcomes by socioeconomic status or other PROGRESS-Plus (Cochrane Equity Methods Group) categories. 159 studies were included in the evidence synthesis. Robust evidence on the effect of general practice on health inequalities is scarce. Focusing on common qualities of interventions, we found that to reduce health inequalities, general practice needs to be informed by five key principles: involving coordinated services across the system (ie, connected), accounting for differences within patient groups (ie, intersectional), making allowances for different patient needs and preferences (ie, flexible), integrating patient worldviews and cultural references (ie, inclusive), and engaging communities with service design and delivery (ie, community-centred). Future work should explore how these principles can inform the organisational development of general practice.

Protocol: Implementation and evaluation of an adolescent-mediated intervention to improve glycemic control and diabetes self-management among Samoan adults

BACKGROUND

Diagnoses of Type 2 Diabetes in the United States have more than doubled in the last two decades. One minority group at disproportionate risk are Pacific Islanders who face numerous barriers to prevention and self-care. To address the need for prevention and treatment in this group, and building on the family-centered culture, we will pilot test an adolescent-mediated intervention designed to improve the glycemic control and self-care practices of a paired adult family member with diagnosed diabetes.

METHODS

We will conduct a randomized controlled trial in American Samoa among n = 160 dyads (adolescent without diabetes, adult with diabetes). Adolescents will receive either a six-month diabetes intervention or a leadership and life skills-focused control curriculum. Aside from research assessments we will have no contact with the adults in the dyad who will proceed with their usual care. To test our hypothesis that adolescents will be effective conduits of diabetes knowledge and will support their paired adult in the adoption of self-care strategies, our primary efficacy outcomes will be adult glycemic control and cardiovascular risk factors (BMI, blood pressure, waist circumference). Secondarily, since we believe exposure to the intervention may encourage positive behavior change in the adolescent themselves, we will measure the same outcomes in adolescents. Outcomes will be measured at baseline, after active intervention (six months post-randomization) and at 12-months post-randomization to examine maintenance effects. To determine potential for sustainability and scale up, we will examine intervention acceptability, feasibility, fidelity, reach, and cost.

DISCUSSION

This study will explore Samoan adolescents' ability to act as agents of familial health behavior change. Intervention success would produce a scalable program with potential for replication in other family-centered ethnic minority groups across the US who are the ideal beneficiaries of innovations to reduce chronic disease risk and eliminate health disparities.

Lifestyle Interventions for Prevention and Management of Diet-Linked Non-Communicable Diseases among Adults in Arab Countries

The increased incidences of diet-related non-communicable diseases (NCDs) such as diabetes, obesity, and cardiovascular diseases among adults are becoming the chief public health concern in most Arab countries. Economic expansion has contributed to a nutrition shift from a traditional seasonal diet to Westernized eating habits coupled with a sedentary lifestyle. Despite the rising concern for NCD mortality, public health policies are inadequately addressed. This narrative review aims to discuss the effectiveness of nutritional interventions focusing on diet and physical activity in the management of NCDs among Arab adults. A comprehensive literature search was performed using different database platforms such as Cochrane reviews, Scopus, and PubMed for articles published between 1 December 2012 and 31 December 2021. Fifteen recent research articles addressing NCDs, mainly diabetes and obesity, from different Arab countries were included in this review. Structured lifestyle interventions involving behavioral therapy approaches and personalized goals for diet and physical activity were found to improve specific health outcomes in most studies. Significant improvements in health outcomes were reported for longer-duration interventions with follow-ups. A combination of both online and face-to-face sessions was found to be effective. It is important to identify barriers to physical activity for a culturally acceptable lifestyle intervention and conduct further studies to evaluate interventions for the long-term maintenance of health outcomes.

The effects of a nurse-led integrative medicine-based structured education program on self-management behaviors among individuals with newly diagnosed type 2 diabetes: a randomized controlled trial

Background

International guidelines advocate providing prompt structured education to individuals with diabetes at diagnosis. However, among the few eligible structured education programs, heterogeneous intervention regimens and inconsistent findings were reported. Eligible programs for Chinese individuals with diabetes are lacking. This study aimed to investigate the effects of a nurse-led integrative medicine-based structured education program on self-management behaviors, glycemic control and self-efficacy among individuals with newly diagnosed type 2 diabetes.

Methods

Employing a randomized controlled trial, 128 individuals with type 2 diabetes diagnosed in the preceding three to nine months were recruited from four university-affiliated tertiary hospitals in Xi’an City, Northwest China, and randomly allocated to the intervention or control groups after baseline assessments. Participants in the intervention group received a 4-week nurse-led integrative medicine-based structured education program, which is theoretically based on the Health Belief Model and Self-Efficacy Theory, in line with updated diabetes management guidelines, and informed by relevant systematic reviews. Participants in the control group received routine care. Self-management behaviors and self-efficacy were measured with the Summary of Diabetes Self-Care Activities and the Diabetes Management Self-Efficacy Scale at baseline, immediate post-intervention and 12 weeks following the intervention while Glycated Hemoglobin A was measured at baseline and the 12th-week follow-up. The intervention effects were estimated using the generalized estimating equation models.

Results

Participants in the intervention group exhibited significantly better self-management performance in specific diet regarding intake of fruits and vegetables at both follow-ups (β = 1.02, p = 0.011 and β = 0.98, p = 0.016, respectively), specific diet regarding intake of high-fat foods at the immediate post-intervention follow-up (β = 0.83, p = 0.023), blood glucose monitoring at the 12th-week follow-up (β = 0.64, p = 0.004), foot care at both follow-ups (β = 1.80, p <  0.001 and β = 2.02, p <  0.001, respectively), and medication management at both follow-ups (β = 0.83, p = 0.005 and β = 0.95, p = 0.003, respectively). The intervention also introduced significant improvements in Glycated Hemoglobin A (β = − 0.32%, p <  0.001), and self-efficacy at both follow-ups (β = 8.73, p <  0.001 and β = 9.71, p <  0.001, respectively).

Conclusions

The nurse-led integrative medicine-based structured education program could produce beneficial effects on multiple diabetes self-management behaviors, glycemic control and self-efficacy.

Trial registration

This study was retrospectively registered in the ClinicalTrials.gov. on 25/08/2017; registration number: NCT03261895.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-022-00970-7.

Culturally Tailoring Plant-Based Nutrition Interventions for Hispanic/Latino Adults at Risk for or With Type 2 Diabetes: An Integrative Review

Introduction: Type 2 diabetes mellitus (T2DM) prevalence continues to increase among Hispanic/Latino adults. The purpose of this study was to explore and analyze literature on culturally tailored nutrition interventions to identify how to best implement a whole food plant-based (WFPB) culinary intervention to improve health outcomes for Hispanic/Latino adults at risk for developing or diagnosed with T2DM. Methods: A methodological review was performed by searching PubMed, CINAHL Complete, PsycINFO, and Food Science and Technology Abstracts. Inclusion criteria consisted of peer-reviewed articles in English, from January 2009 to January 2020, using the search terms: “Hispanic adults or Latino adults”, “culturally tailored or ethnic”, “diabetes”, “dietary or nutrition”, “intervention”, and “vegan or plant based”. Studies included adults at risk for/diagnosed with T2DM. Results: Of 1,474 articles retrieved, 15 met the inclusion criteria. Four main themes were identified: participant interest, feasibility of intervention, development and implementation of intervention, and impact of the intervention. Conclusion: Further research should focus on culturally tailored nutrition interventions and use of a WFPB diet to reduce risk for T2DM in Hispanic/Latino adults. Continued discussion should be patient- and community-centered to promote equity, health, and disease prevention through the use of culturally tailored methods and design, not only limited to curriculum and language.

Physical Activity Assessment and Promotion in Clinical Settings in the United States: A Scoping Review

OBJECTIVE

The purpose of this scoping review was to systematically examine interventions that focused on physical activity assessment and promotion in clinical settings in the United States.

DATA SOURCES

A literature search was performed in 6 major databases to extract published peer-reviewed studies from 2008 to 2019.

INCLUSION AND EXCLUSION CRITERIA

Interventions with practicing health professionals in the United States who performed physical activity assessment and promotion with adult patients 18 years of age and older. Studies were excluded if they were published in non-English, observational or case study designs, or gray literature.

DATA EXTRACTION

Studies were screened and coded based on the population, intervention, comparison, outcomes and study setting for scoping reviews (PRISMA-ScR) framework. Of 654 studies that were identified and screened for eligibility, 78 met eligibility criteria and were independently coded by two coders.

DATA SYNTHESIS

Data were synthesized using qualitative and descriptive methods.

RESULTS

Forty-three of the included studies were randomized controlled trials with a majority being delivered by physicians and nurses in primary care settings. Fifty-six studies reported statistically significant findings in outcome measures such as anthropometrics and chronic disease risk factors, with 17 demonstrating improvements in physical activity levels as a result of the interventions.

CONCLUSION

The assessment and promotion of physical activity in clinical settings appears to be effective but warrants continued research.

Influence of the Model of Care on the Outcomes of Diabetes Self-Management Education Program: A Scoping Review

BACKGROUND

Type 2 diabetes mellitus (T2DM) accounts for approximately 95% of all diabetes cases, making the disease a global public health concern. The increasing prevalence of T2DM has highlighted the importance of evidence-based guidelines for effective prevention, management, and treatment. Diabetes self-management education (DSME) can produce positive effects on patient behaviors and health status. Study objective. We synthesized findings from the existing studies to find out whether or not the impact of DSME on patient health behaviors and outcomes differ by the different models of diabetes care. That is, we determined whether there are differences in DSME outcomes when patient's care provider is a general practitioner, a specialist, a nurse, or a combination of these health professionals.

METHODS

Searches were made of six electronic databases to identify relevant English language publications on DSME from 2000 through 2019. Titles and abstracts of the search results were screened to select eligible papers for full-text screening. All eligible papers were retrieved, and full-text screening was done by three independent reviewers to select studies for inclusion in the final analysis. Twenty-one studies were included in the final analysis. The main outcome measures assessed were glycated hemoglobin (HbA1c), body mass index (BMI), diet, and physical activity.

RESULTS

The majority of the patients with diabetes were seen by primary care physicians. In general, the studies reported significant improvements in patient health behaviors and outcomes. Some differences in outcomes between the different models of care were observed.

CONCLUSION

Our findings suggest that the effects of DSME on patients' health behaviors and outcomes could differ by the different models of diabetes care. However, considering the limited sample of publications reviewed, and because none of the reviewed studies directly measured the impact of the DSME program on patient behaviors and outcomes, significant conclusions could not be reached.

Workplace pedometer interventions for increasing physical activity

BACKGROUND

The World Health Organization (WHO) recommends undertaking 150 minutes of moderate-intensity physical activity per week, but most people do not. Workplaces present opportunities to influence behaviour and encourage physical activity, as well as other aspects of a healthy lifestyle. A pedometer is an inexpensive device that encourages physical activity by providing feedback on daily steps, although pedometers are now being largely replaced by more sophisticated devices such as accelerometers and Smartphone apps. For this reason, this is the final update of this review.

OBJECTIVES

To assess the effectiveness of pedometer interventions in the workplace for increasing physical activity and improving long-term health outcomes.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Occupational Safety and Health (OSH) UPDATE, Web of Science, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform from the earliest record to December 2016. We also consulted the reference lists of included studies and contacted study authors to identify additional records. We updated this search in May 2019, but these results have not yet been incorporated. One more study, previously identified as an ongoing study, was placed in 'Studies awaiting classification'.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) of workplace interventions with a pedometer component for employed adults, compared to no or minimal interventions, or to alternative physical activity interventions. We excluded athletes and interventions using accelerometers. The primary outcome was physical activity. Studies were excluded if physical activity was not measured.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane. When studies presented more than one physical activity measure, we used a pre-specified list of preferred measures to select one measure and up to three time points for analysis. When possible, follow-up measures were taken after completion of the intervention to identify lasting effects once the intervention had ceased. Given the diversity of measures found, we used ratios of means (RoMs) as standardised effect measures for physical activity.

MAIN RESULTS

We included 14 studies, recruiting a total of 4762 participants. These studies were conducted in various high-income countries and in diverse workplaces (from offices to physical workplaces). Participants included both healthy populations and those at risk of chronic disease (e.g. through inactivity or overweight), with a mean age of 41 years. All studies used multi-component health promotion interventions. Eleven studies used minimal intervention controls, and four used alternative physical activity interventions. Intervention duration ranged from one week to two years, and follow-up after completion of the intervention ranged from three to ten months. Most studies and outcomes were rated at overall unclear or high risk of bias, and only one study was rated at low risk of bias. The most frequent concerns were absence of blinding and high rates of attrition. When pedometer interventions are compared to minimal interventions at follow-up points at least one month after completion of the intervention, pedometers may have no effect on physical activity (6 studies; very low-certainty evidence; no meta-analysis due to very high heterogeneity), but the effect is very uncertain. Pedometers may have effects on sedentary behaviour and on quality of life (mental health component), but these effects were very uncertain (1 study; very low-certainty evidence). Pedometer interventions may slightly reduce anthropometry (body mass index (BMI) -0.64, 95% confidence interval (CI) -1.45 to 0.18; 3 studies; low-certainty evidence). Pedometer interventions probably had little to no effect on blood pressure (systolic: -0.08 mmHg, 95% CI -3.26 to 3.11; 2 studies; moderate-certainty evidence) and may have reduced adverse effects (such as injuries; from 24 to 10 per 100 people in populations experiencing relatively frequent events; odds ratio (OR) 0.50, 95% CI 0.30 to 0.84; low-certainty evidence). No studies compared biochemical measures or disease risk scores at follow-up after completion of the intervention versus a minimal intervention. Comparison of pedometer interventions to alternative physical activity interventions at follow-up points at least one month after completion of the intervention revealed that pedometers may have an effect on physical activity, but the effect is very uncertain (1 study; very low-certainty evidence). Sedentary behaviour, anthropometry (BMI or waist circumference), blood pressure (systolic or diastolic), biochemistry (low-density lipoprotein (LDL) cholesterol, total cholesterol, or triglycerides), disease risk scores, quality of life (mental or physical health components), and adverse effects at follow-up after completion of the intervention were not compared to an alternative physical activity intervention. Some positive effects were observed immediately at completion of the intervention periods, but these effects were not consistent, and overall certainty of evidence was insufficient to assess the effectiveness of workplace pedometer interventions.

AUTHORS' CONCLUSIONS

Exercise interventions can have positive effects on employee physical activity and health, although current evidence is insufficient to suggest that a pedometer-based intervention would be more effective than other options. It is important to note that over the past decade, technological advancement in accelerometers as commercial products, often freely available in Smartphones, has in many ways rendered the use of pedometers outdated. Future studies aiming to test the impact of either pedometers or accelerometers would likely find any control arm highly contaminated. Decision-makers considering allocating resources to large-scale programmes of this kind should be cautious about the expected benefits of incorporating a pedometer and should note that these effects may not be sustained over the longer term. Future studies should be designed to identify the effective components of multi-component interventions, although pedometers may not be given the highest priority (especially considering the increased availability of accelerometers). Approaches to increase the sustainability of intervention effects and behaviours over a longer term should be considered, as should more consistent measures of physical activity and health outcomes.

The cultural practices of Bamar diabetic patients: An ethnographic study

Background

Many qualitative studies on the feelings and lived experiences of diabetic patients have already been conducted in European and Asian countries. However, little is known about the cultural practices of diabetic patients among the Bamar population of Myanmar.

Aim

The aim of this study was to explore the cultural practices of Bamar diabetic patients in Myanmar.

Methods

The conceptual framework of this ethnographic study was based on Spradley's ethnographic theory and Leininger's cultural care theory. Seven participants who met the preset criteria were purposively selected from Anawmar quarter, Tharkayta Township, Yangon. Their cultural practices were studied through participant observations, ethnographic interviews and writing field notes. Collected data were analyzed step-by-step using Creswell's data analysis method.

Findings

The nine main themes that emerged were: reasons for late awareness of diabetes, misconceptions, cultural beliefs and practices, non-adherence, cultural influences on controlling diet, limitations in physical activities, suffering of living with diabetes, emotional reactions and coping by way of religious or spiritual beliefs. Fourty-six subthemes support the main themes.

Discussion

It was found that Bamar diabetics in this study were being strongly influenced by cultural beliefs and practices on treatment choice and controlling diet. They believed that diabetes is a curable disease, and its cause is due to cultural factors such as karma from either a previous or their current life. Bamar diabetic patients in this study used a variety of medicinal plants and traditional medicines due to availability at affordable prices.

Conclusion

Although some cultural beliefs are not harmful, some have detrimental effects on these patients' health. Hopefully, this study may provide information which can reduce cultural influences on Bamar diabetic patients. The results of this study highlight patients' needs for nursing personnel when it comes to providing effective culturally-tailored care.

Effect of diabetes self-management education on glycemic control in Latino adults with type 2 diabetes: A systematic review and meta-analysis

PURPOSE

This systematic review and meta-analysis evaluated the effectiveness of diabetes self-management education (DSME) in reducing glycosylated hemoglobin (A1C) levels in adult Latinos with type 2 diabetes (T2DM).

METHODS

Five databases were searched for DSME randomized controlled trials or quasi-experimental trials published between January 1997 and March 2019. A random effects model was utilized to calculate combined effect sizes. Subgroup analyses were performed to explore possible sources of heterogeneity between studies.

RESULTS

Twenty-three unique studies met criteria for this systematic review and of these, 18 were included in the meta-analysis. Pooled estimate effect of DSME on A1C from the random effect model was -0.240 (95% confidence interval = -0.345, -0.135, p <  0.001). There was moderate heterogeneity (Cochrane Q=30.977, P=0.020, I^2 = 45.121) between the studies. Subgroup analyses demonstrated greater A1C reductions in studies with intervention duration ≤6 months, initial A1C baseline values >8.0 [69 mmol/mol], and team-based approach.

CONCLUSIONS

Meta-analysis results showed that culturally tailored DSME interventions significantly reduce AIC in Latinos with T2DM despite the heterogeneity across the studies.

IMPLICATIONS

The heterogeneity in the study methodologies reinforce the need for additional studies to better understand DSME interventions to reduce disparities in Latino adults with T2DM.

Associations of Partner Support and Acculturation With Physical Activity in Mexican American Women

INTRODUCTION

Insufficient physical activity (PA) and obesity-related health conditions have reached epidemic proportions worldwide. Mexican American women (MAW) report low leisure time physical activity. Few studies examine activities beyond leisure time. Qualitative research suggests that partner support influence provides a cultural approach relevant to PA among MAW.

METHOD

This cross-sectional study used an ecological model to investigate community (the physical environment), interpersonal (partner support, attitudinal familism), and intrapersonal (age, health conditions, acculturation, employment, and body mass index) factors associated with PA among 112 MAW. Community-based participatory research recommendations guided the preparatory phase of the study and the face-to-face interviews. Frequencies and descriptive statistics were computed. Multivariable linear regression analyses were used to examine associations between study variables.

RESULTS

Moderate to high PA levels were found based on combined activities performed during leisure time, transportation, household tasks, and occupational duties. Women with greater partner support reported higher PA levels. Although acculturation levels were low among women, those with higher acculturation were found to be more physically active.

CONCLUSIONS

Future studies should examine strategies to increase partner support and address acculturation within intervention programs to enhance overall PA among MAW.

Experience of Culturally-Tailored Diabetes Interventions for Ethnic Minorities: A Qualitative Systematic Review

This qualitative systematic review synthesizes recent qualitative studies of culturally tailored interventions to better understand the experiences that individuals who are members of ethnic minorities have when undergoing type 2 diabetes treatment in the United States. Such interventions have been shown to be effective among ethnic minority populations; however, no qualitative synthesis has reported on recent findings from studies of these interventions. This systematic review identified seven relevant qualitative studies from five electronic databases-CINAHL, PsycINFO, PubMed, Ovid, and Web of Science-published from 2009 to 2019, and used a thematic synthesis review methodology. Methodological rigor was assessed for an appraisal of study quality. Five themes were identified as experiences of culturally tailored diabetes interventions: culturally appropriate healthy lifestyle behaviors, knowledge about diabetes care, emotional supports, access to the healthcare system, and family involvement. The findings of this review can be utilized as resources for improving diabetes care for ethnic minorities.

Taxi Drivers at Risk: Tailoring Nutrition and Exercise Materials

Cognitive interviewing was used to refine nutrition and exercise health education materials for use in the New York City taxi driver community. Cognitive interviews were conducted with taxi drivers at garages and community centers across New York City. Interviews were conducted in five rounds with approximately 10 interviews conducted in each round. Modifications were made to the education materials between rounds based on driver feedback. Interviews were transcribed, coded to identify areas needing improvement, and then used to modify materials. Areas that needed adaptation included colloquialisms, literacy level, complex jargon/terminology, vague/confusing phrasing, driver-specific and ethnic-specific preferences, visual aids, and mathematical calculations. These were organized into four key themes: linguistic responsiveness, occupational and cultural adaptation, visuals, and calculations. Cognitive interviewing is a useful method for refining health education materials in the diverse driver population. Cognitive interviewing revealed a need to reduce literacy level, avoid complex terminology, make further occupational and cultural adaptations, use clear visual aids, and avoid the use of complex calculations. Cognitive interviewing is an effective method for refining health education materials for immigrant and low literacy populations.

Motivators and Deterrents to Diet Change in Low Socio-Economic Pakistani Patients With Cardiovascular Disease

This study explores factors that affect the people of low socioeconomic status regarding food choices after diagnosis with cardiovascular disease. Qualitative approach was used to identify the important factors associated with dietary changes as a result of their disease. Twenty-four participants were interviewed from two cardiac facilities in Karachi, the largest metropolitan city of Pakistan. Data were analyzed to identify the themes using the interpretative description approach. While most participants understood the need for dietary changes, few were able to follow recommended diets. Their food choices were primarily influenced by financial constraints as well as cultural, familial, and religious values and practices. The challenge for health care providers lies in understanding the economical, sociocultural, and religious factors that influence behavioral changes which, in turn, affect dietary choices. It is apparent that cardiovascular risk and disease outcomes for the people of low socioeconomic status are likely to escalate. Thus, it is necessary to address the sociocultural, religious, and behavioral factors affecting dietary choices. Achieving this imperative requires an intersectorial, multilevel intervention for the prevention of cardiovascular diseases in people of low socioeconomic status.

Patient Perspective on Factors Contributing to Nonadherence to Dietary Therapy: A Qualitative Study in Multicultural Population of Kedah, Malaysia

The purpose of this study is to explore diabetes patients' views on various factors contributing to nonadherence to dietary therapy. Using a qualitative approach, 17 in-depth interviews were conducted with type 2 diabetes mellitus patients at Hospital Sultanah Bahiyah, Kedah state, Malaysia. All interviews were audio recorded, transcribed verbatim, and translated before analysis. Thematic content analysis was used and three main themes emerged. The main factors that affect diabetes patients' dietary adherence were "individual preference," "family support," and "social and cultural activities." Difficulty to change the existing meals, poor family support, practice of eating out, and social and cultural gatherings were among the factors that influenced diabetes patients' adherence toward dietary therapy. Most challenges were related to the social role of food in the multicultural population. Therefore, in addition to the family and community involvement, dietary therapy should be individualized to improve patient adherence.

Systematic Review of Physical Activity Interventions in Hispanic Adults

INTRODUCTION

Physical activity (PA) has demonstrated substantial physical and psychological benefits. However, Hispanics engage in less leisure-time PA when compared with other groups, putting them at higher risk for diseases associated with obesity, such as diabetes mellitus type 2. This literature review was conducted to identify best practices with regard to interventions designed to increase PA among Hispanic adults.

METHODS

Extensive searching located 21 randomized controlled studies conducted in the United States.

RESULTS

Common conceptual frameworks were the transtheoretical model and social cognitive theory. Most interventions used educational sessions with a variety of topics and many used promotoras to increase PA. Outcomes were predominantly examined using self-report PA measures. Walking was the most commonly reported PA behavior. Studies with significant results were those that measured moderate-to-vigorous PA and used theory to guide interventions. Male and older participants were underrepresented.

CONCLUSIONS

Effective culturally appropriate PA interventions for Hispanics adults are needed. Particular attention to intervention tailoring based on country of origin could enhance intervention effectiveness.

Family functioning integrated with diabetes self-management: a concept analysis

Although the concept of family functioning has gained recent popularity, the terms "family functioning" and "family resilience" are sometimes confused and used interchangeably. The aim of this concept analysis was to clarify what is meant by family functioning in the context of diabetes self-management by assessing specific attributes, antecedents, and consequences. A concept analysis model by Walker and Avant was applied. The Identified attributes of family functioning in a diabetes self-management context Included problem-solving, communication, roles, affective responsiveness, affective involvement, and behavioral control. Antecedents Included family structure, socloeconomic status, family functioning relationships, family stage, and life events. Consequences Included family satisfaction, family cohesion, and family relationships. This analysis provided a deeper understanding of a family functioning concept within a diabetes self-management context. It is recommended that health care providers should be aware of antecedent factors that could inhibit outcome improvement. Further research is needed to explain family functioning attributes in relation to antecedents and potential consequences.

The diabetes self-management educational programs and their integration in the usual care: A systematic literature review

The increasing prevalence of type 2 diabetes has highlighted the importance of evidence-based guidelines for effective prevention, management and treatment. Diabetes self-management education (SME) produces positive effects on patient behaviours and health status. We analyzed the literature to identify (i) the level of integration between usual care and SME programs and (ii) any possible differences across them in terms of outcomes. Searches were made on three databases - PubMed, Scopus and Web of Science - to identify relevant publications on diabetes SME to 2015, which also describe the provider of usual care. In total, 49 studies met the inclusion criteria. We identified three levels of integration (high, medium and low) between usual care and SME programs based on the level of involvement of usual care professionals within the SME programs. In most cases, the primary care physician was responsible for the diabetes patients. Patient health behaviors and/or outcomes improve in most of the studies, independently from the level of integration. However, findings suggest that when patients/participants could perceive that usual care provider is highly involved in SME delivery, educational programs produced results that appear to be more positive.

A Systematic Review: Family Support Integrated with Diabetes Self-Management among Uncontrolled Type II Diabetes Mellitus Patients

The rate of type-2 diabetes mellitus (T2D) is dramatically increasing worldwide. Continuing diabetes mellitus (DM) care needs effective self-management education and support for both patients and family members. This study aimed to review and describe the impacts of diabetes mellitus self-management education (DSME) that involve family members on patient outcomes related to patient health behaviors and perceived self-efficacy on self-management such as medication adherence, blood glucose monitoring, diet and exercise changes, health outcomes including psychological well-being and self-efficacy, and physiological markers including body mass index, level of blood pressure, cholesterol level and glycemic control. Three databases, PubMed, CINAHL, and Scopus were reviewed for relevant articles. The search terms were "type 2 diabetes," "self-management," "diabetes self-management education (DSME)," "family support," "social support," and "uncontrolled glycaemia." Joanna Briggs Institute (JBI) guidelines were used to determine which studies to include in the review. Details of the family support components of DSME intervention and the impacts of these interventions had on improving the health outcomes patients with uncontrolled glycaemia patients. A total of 22 intervention studies were identified. These studies involved different DSME strategies, different components of family support provided, and different health outcomes to be measured among T2D patients. Overall, family support had a positive impact on healthy diet, increased perceived support, higher self-efficacy, improved psychological well-being and better glycemic control. This systematic review found evidence that DSME with family support improved self-management behaviors and health outcomes among uncontrolled glycaemia T2D patients. The findings suggest DSME models that include family engagement can be a useful direction for improving diabetes care.

A systematic review of lifestyle counseling for diverse patients in primary care

Prior research and systematic reviews have examined strategies related to weight management, less is known about lifestyle and behavioral counseling interventions optimally suited for implementation in primary care practices generally, and among racial and ethnic patient populations. Primary care practitioners may find it difficult to access and use available research findings on effective behavioral and lifestyle counseling strategies and to assess their effects on health behaviors among their patients. This systematic review compiled existing evidence from randomized trials to inform primary care providers about which lifestyle and behavioral change interventions are shown to be effective for changing patients' diet, physical activity and weight outcomes. Searches identified 444 abstracts from all sources (01/01/2004-05/15/2014). Duplicate abstracts were removed, selection criteria applied and dual abstractions conducted for 106 full text articles. As of June 12, 2015, 29 articles were retained for inclusion in the body of evidence. Randomized trials tested heterogeneous multi-component behavioral interventions for an equally wide array of outcomes in three population groups: diverse patient populations (23 studies), African American patients only (4 studies), and Hispanic/Mexican American/Latino patients only (2 studies). Significant and consistent findings among diverse populations showed that weight and physical activity related outcomes were more amenable to change via lifestyle and behavioral counseling interventions than those associated with diet modification. Evidence to support specific interventions for racial and ethnic minorities was promising, but insufficient based on the small number of studies.

Making It All Work: Qualitative Descriptions of Hispanic Adults Managing Type 2 Diabetes With Limited Resources

The greater prevalence of type 2 diabetes is a critical issue among the U.S. Hispanic population. This study examined the struggles of Hispanic adults managing type 2 diabetes with limited resources. Ten Hispanic adults (enrolled in a larger study to determine the effects of diabetes self-management intervention), 25 to 80 years of age and living in a rural West Texas county in the United States, were selected. Three categories of challenges emerged: (a) diabetes self-care behaviors and challenges, (b) challenges with limited resources, and (c) challenges with support mechanisms. "Making it all work" was the overarching theme that tied all the categories together. This study offers lessons for health care providers and policymakers on how to maximize the availability of resources for Hispanic individuals with type 2 diabetes living within the constraints of limited resources.

Sociocultural construction of food ways in low-income Mexican-American women with diabetes: a qualitative study

AIMS AND OBJECTIVES

The aim of the study was to explore how low-income Hispanic women, with at least 10 years of having type 2 diabetes, successfully manage the disease within a sociocultural context, especially in relation to foodways.

BACKGROUND

Managing type 2 diabetes is challenging, particularly for underserved populations such as low-income Hispanic women. This population segment has higher rates of type 2 diabetes, diabetes-related complications, obesity, and sedentary lifestyles than the general U.S.

POPULATION

Dietary management is a critical aspect of diabetes care, but it is perhaps the most difficult health behaviour to modify.

DESIGN

A qualitative and ethnographically based study was used.

METHODS

Participant observation and individual interviews explored the interrelationships of culture, food habits and type 2 diabetes among 12 low-income Hispanic women residing in an impoverished rural community located on the Texas-Mexico border.

RESULTS

Hispanic women used unique strategies to adjust their diet, particularly portion control; for example, they emphasised the 'use of the fork', based on the notion that Hispanic finger foods are less healthy. Women categorised foods as bad or acceptable, depending on the context, such as important family or social gatherings. Those with years of diabetes experience confidently took charge of the disease based on knowledge of their bodies and a desire to avoid complications, while acknowledging brief infractions of dietary 'rules' and balancing various social roles and expectations.

CONCLUSIONS

Hispanic women manage their type 2 diabetes within a sociocultural environment. Those with expertise make changes in how they eat to care for their diabetes, but also continue to maintain traditional foodways.

RELEVANCE TO CLINICAL PRACTICE

Foodways are critical to most cultural groups and modifying dietary behaviours can be challenging. Clinicians must develop self-management guidance within the sociocultural context of the patient if diabetes outcomes are to improve and be sustained.

The Social Ecological Model and Physical Activity Interventions for Hispanic Women With Type 2 Diabetes: A Review

Hispanic women are less physically active and have higher rates of type 2 diabetes (DM2) when compared with other population groups. This review uses the social ecological model as a framework to identify the individual and social environmental factors associated with successful physical activity (PA) interventions for Hispanic women with DM2. Research questions include (a) Which social ecological levels have been applied to PA interventions? (b) Which individual and social environmental intervention strategies are associated with successful PA outcomes? Database searches using CINAHL, PubMed, and Scopus for the years 2000 to 2015 identified 10 studies; with 6 using quasi-experimental study designs and 4 using randomized controlled designs. Inclusion criteria were Hispanic/Latina women with DM2, ≥70% women, PA interventions, measures of PA, and quantitative designs. Future research should focus on a combination of intervention levels, and DM2 programs should place a greater emphasis on PA intervention strategies.

Exploring Cultural Influences of Self-Management of Diabetes in Coastal Kenya: An Ethnography

In spite of increasing prevalence of diabetes among Kenyans and evidence suggesting Kenyans with diabetes maintain poor glycemic control, no one has examined the role of cultural attitudes, beliefs, and practices in their self-management of diabetes. The purpose of this ethnographic study was to describe diabetes self-management among the Swahili of coastal Kenya, and explore factors that affect diabetes self-management within the context of Swahili culture. Thirty men and women with type 2 diabetes from Lamu town, Kenya, participated in this study. Diabetes self-management was insufficiently practiced, and participants had limited understanding of diabetes. Economic factors such as poverty and the high cost of biomedical care appear to have more influence in self-management behavior than socio-cultural and educational factors do. Economic and socio-cultural influences on diabetes self-management should not be underestimated, especially in a limited resource environment like coastal Kenya, where biomedical care is not accessible or affordable to all.

Evaluating Por Nuestra Salud: A Feasibility Study

AIMS

This feasibility study evaluated the impact of a culturally consistent diabetes educational program, led by a Latino pastor, on Latino community diabetes knowledge levels.

METHOD

Latino adults were recruited from two churches serving Latino populations, one identified as intervention, the other as nonintervention. Both churches received the American Diabetes Association's booklets on diabetes education, "Four Steps to Control Your Diabetes for Life." The intervention group also received weekly reviews of the booklet's information from the church pastor, who was educated about diabetes by a Latino family nurse practitioner. Pre- and postintervention levels of diabetes knowledge were measured using the Diabetes Knowledge Questionnaire.

RESULTS

Mean changes in the Diabetes Knowledge Questionnaire (DKQ-24) survey from pretest to posttest indicated a significant increase in knowledge in both groups. Only the grades for the participants from the pastor-led group, however, moved from failure in knowledge to high levels of passing. One hundred percent of intervention group participants reported having read the literature.

CONCLUSIONS

This pilot study supports the feasibility of a local Latino pastor, as a culturally consistent diabetes educator, to increase Latino parishioner's knowledge of diabetes.

Tu Salud, ¡Si Cuenta!: Exposure to a community-wide campaign and its associations with physical activity and fruit and vegetable consumption among individuals of Mexican descent

Mexican Americans along the US-Mexico border have been found to be disproportionately affected by chronic diseases particularly related to lack of physical activity and healthful food choices. A community-wide campaign (CWC) is an evidence-based strategy to address these behaviors but with few examples of implementation in Mexican descent populations facing profound health disparities. We examined exposure to a CWC, titled Tu Salud ¡Sí Cuenta!, and its association with meeting the recommended minutes of moderate and vigorous physical activity weekly and consuming more portions of fruits and vegetables daily. A cross-sectional sample of 1438 Mexican descent participants was drawn from a city-wide, randomly-selected cohort interviewed between the years 2008 and 2012. Multivariable comparisons of participants exposed and not exposed to the CWC and meeting physical activity guidelines or their fruit and vegetable consumptions using mixed effects models were conducted. The community-wide campaign components included different forms of mass media and individually-focused components such as community health worker (CHW) home visits. After adjusting for gender, age, marital status, educational attainment, language preference, health insurance, and diabetes diagnosis, the strongest association was found between meeting physical activity guidelines and exposure to both CHW discussions and radio messages (adjusted OR = 3.83; 95% CI = [1.28, 6.21]; p = 0.0099). Participants who reported exposure to both radio and TV messages consumed more portions of fruits and vegetables than those who reported no exposure (adjusted RR = 1.30; 95% CI = [1.02, 1.66]; p = 0.0338). This study provides insights into the implementation and behavioral outcomes associated with exposure to a community-wide campaign, a potential model for addressing lifestyle modifications in populations affected by health disparities.

Family interventions to improve diabetes outcomes for adults

Diabetes self-care is a critical aspect of disease management for adults with diabetes. Since family members can play a vital role in a patient's disease management, involving them in self-care interventions may positively influence patients' diabetes outcomes. We systematically reviewed family-based interventions for adults with diabetes published from 1994 to 2014 and assessed their impact on patients' diabetes outcomes and the extent of family involvement. We found 26 studies describing family-based diabetes interventions for adults. Interventions were conducted across a range of patient populations and settings. The degree of family involvement varied across studies. We found evidence for improvement in patients' self-efficacy, perceived social support, diabetes knowledge, and diabetes self-care across the studies. Owing to the heterogeneity of the study designs, types of interventions, reporting of outcomes, and family involvement, it is difficult to determine how family participation in diabetes interventions may affect patients' clinical outcomes. Future studies should clearly describe the role of family in the intervention, assess quality and extent of family participation, and compare patient outcomes with and without family involvement.

"The group facilitates everything": meanings patients with type 2 diabetes mellitus assigned to health education groups

OBJECTIVE:

to interpret the meanings patients with type 2 diabetes mellitus assign to health education groups.

METHOD:

ethnographic study conducted with Hyperdia groups of a healthcare unit with 26 informants, with type 2 diabetes mellitus, and having participated in the groups for at least three years. Participant observation, social characterization, discussion groups and semi-structured interviews were used to collect data. Data were analyzed through the thematic coding technique.

RESULTS:

four thematic categories emerged: ease of access to the service and healthcare workers; guidance on diabetes; participation in groups and the experience of diabetes; and sharing knowledge and experiences. The most relevant aspect of this study is the social use the informants in relation to the Hyperdia groups under study.

CONCLUSION:

the studied groups are agents producing senses and meanings concerning the process of becoming ill and the means of social navigation within the official health system. We expect this study to contribute to the actions of healthcare workers coordinating these groups given the observation of the cultural universe of these individuals seeking professional care in the various public health care services.

Culturally appropriate health education for people in ethnic minority groups with type 2 diabetes mellitus

BACKGROUND

Ethnic minority groups in upper-middle-income and high-income countries tend to be socioeconomically disadvantaged and to have a higher prevalence of type 2 diabetes than is seen in the majority population.

OBJECTIVES

To assess the effectiveness of culturally appropriate health education for people in ethnic minority groups with type 2 diabetes mellitus.

SEARCH METHODS

A systematic literature search was performed of the following databases: The Cochrane Library, MEDLINE, EMBASE, PsycINFO, the Education Resources Information Center (ERIC) and Google Scholar, as well as reference lists of identified articles. The date of the last search was July 2013 for The Cochrane Library and September 2013 for all other databases. We contacted authors in the field and handsearched commonly encountered journals as well.

SELECTION CRITERIA

We selected randomised controlled trials (RCTs) of culturally appropriate health education for people over 16 years of age with type 2 diabetes mellitus from named ethnic minority groups residing in upper-middle-income or high-income countries.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed trial quality and extracted data. When disagreements arose regarding selection of papers for inclusion, two additional review authors were consulted for discussion. We contacted study authors to ask for additional information when data appeared to be missing or needed clarification.

MAIN RESULTS

A total of 33 trials (including 11 from the original 2008 review) involving 7453 participants were included in this review, with 28 trials providing suitable data for entry into meta-analysis. Although the interventions provided in these studies were very different from one study to another (participant numbers, duration of intervention, group versus individual intervention, setting), most of the studies were based on recognisable theoretical models, and we tried to be inclusive in considering the wide variety of available culturally appropriate health education.Glycaemic control (as measured by glycosylated haemoglobin A1c (HbA1c)) showed improvement following culturally appropriate health education at three months (mean difference (MD) -0.4% (95% confidence interval (CI) -0.5 to -0.2); 14 trials; 1442 participants; high-quality evidence) and at six months (MD -0.5% (95% CI -0.7 to -0.4); 14 trials; 1972 participants; high-quality evidence) post intervention compared with control groups who received 'usual care'. This control was sustained to a lesser extent at 12 months (MD -0.2% (95% CI -0.3 to -0.04); 9 trials; 1936 participants) and at 24 months (MD -0.3% (95% CI -0.6 to -0.1); 4 trials; 2268 participants; moderate-quality evidence) post intervention. Neutral effects on health-related quality of life measures were noted and there was a general lack of reporting of adverse events in most studies - the other two primary outcomes for this review. Knowledge scores showed improvement in the intervention group at three (standardised mean difference (SMD) 0.4 (95% CI 0.1 to 0.6), six (SMD 0.5 (95% CI 0.3 to 0.7)) and 12 months (SMD 0.4 (95% CI 0.1 to 0.6)) post intervention. A reduction in triglycerides of 24 mg/dL (95% CI -40 to -8) was observed at three months, but this was not sustained at six or 12 months. Neutral effects on total cholesterol, low-density lipoprotein (LDL) cholesterol or high-density lipoprotein (HDL) cholesterol were reported at any follow-up point. Other outcome measures (blood pressure, body mass index, self-efficacy and empowerment) also showed neutral effects compared with control groups. Data on the secondary outcomes of diabetic complications, mortality and health economics were lacking or were insufficient.Because of the nature of the intervention, participants and personnel delivering the intervention were rarely blinded, so the risk of performance bias was high. Also, subjective measures were assessed by participants who self-reported via questionnaires, leading to high bias in subjective outcome assessment.

AUTHORS' CONCLUSIONS

Culturally appropriate health education has short- to medium-term effects on glycaemic control and on knowledge of diabetes and healthy lifestyles. With this update (six years after the first publication of this review), a greater number of RCTs were reported to be of sufficient quality for inclusion in the review. None of these studies were long-term trials, and so clinically important long-term outcomes could not be studied. No studies included an economic analysis. The heterogeneity of the studies made subgroup comparisons difficult to interpret with confidence. Long-term, standardised, multi-centre RCTs are needed to compare different types and intensities of culturally appropriate health education within defined ethnic minority groups, as the medium-term effects could lead to clinically important health outcomes, if sustained.

The effects of a community-based, culturally tailored diabetes prevention intervention for high-risk adults of Mexican descent

PURPOSE

This article reports the results of a community-based, culturally tailored diabetes prevention program for overweight Mexican American adults on weight loss, waist circumference, diet and physical activity self-efficacy, and diet behaviors.

METHODS

The intervention used content from the Diabetes Prevention Program but culturally tailored the delivery methods into a community-based program for Spanish-speaking adults of Mexican descent. The design was a randomized controlled trial (N = 58) comparing the effects of a 5-month educational intervention with an attention control group. The primary study outcome was weight loss. Secondary outcomes included change in waist circumference, body mass index, diet self-efficacy, and physical activity self-efficacy.

RESULTS

There were significant intervention effects for weight, waist circumference, body mass index, and diet self-efficacy, with the intervention group doing better than the control group. These effects did not change over time.

CONCLUSIONS

Findings support the conclusion that a community-based, culturally tailored intervention is effective in reducing diabetes risk factors in a 5-month program.

Perspectives of Puerto Rican Adults about Heart Health and a Potential Community Program

BACKGROUND

Puerto Ricans are the second largest Hispanic group in the U.S. and older adults have significant health disparities. Educational programs that address heart disease risk for this population have rarely been developed and implemented.

PURPOSE

To address this gap, the Heart Healthy Initiative for Puerto Rican adults is being developed. To develop it as a participatory program, the community members were asked about their perspectives.

METHODS

Five focus groups with 28 participants, aged 45-60, were conducted, transcribed and analyzed using Thematic Analysis. In-depth analysis of meanings of health promoting behaviors, in the context of cultural beliefs and values was carried out.

RESULTS

The following themes were identified: Health as balance and integration; Health as connection of self, connection with others; Cultural meanings of lifestyle choices; Stresses and struggles. Participants suggested that the program should have significant variety and a holistic perspective, be sensitive to different needs and motivations, stimulate mutual understanding and shared cultural meanings.

DISCUSSION

The program needs to support lifestyle changes which maximally preserve traditions and to introduce multi-level changes.

TRANSLATION TO HEALTH EDUCATION PRACTICE

The identified cultural meanings of diet, physical activity and relationships were taken into account to develop the educational curriculum.

Factors that influence diabetes self-management in Hispanics living in low socioeconomic neighborhoods in San Bernardino, California

The growing incidence of diabetes among Hispanics is a serious public health concern. To identify factors that influence diabetes self-management in Hispanics, qualitative data gathered through five focus group interviews was examined using grounded theory methods. Four major themes emerged which were perceived by participants as enhancing or limiting factors: (1) access to resources, (2) struggle with diet, (3) self-efficacy, and (4) social support. The family's role as a determinant of diabetes self-management emerged as the underlying sub-theme to all four themes and underscores its importance among Hispanics living with diabetes. Results suggest that for the family to be an enhancing factor, health care providers need to educate, empower, and include the family in diabetes management and prevention. Programs which aim to improve the practice of self-management should incorporate the sociocultural and socioeconomic context in which Hispanics with diabetes live.

Análise biopolítica do discurso oficial sobre educação em saúde para pacientes diabéticos no Brasil

No contexto brasileiro de transição epidemiológica, a educação em saúde tem sido uma ferramenta na luta pela promoção de estilos de vida "saudáveis" e adesão ao tratamento. Dentre essas doenças destaca-se o diabetes mellitus, considerado um problema de saúde pública. O objetivo deste estudo é analisar o discurso oficial sobre educação em saúde para diabetes mellitus, na primeira década dos anos 2000, no Brasil, fundamentado nos conceitos de biopolítica e práticas discursivas de Michel Foucault. Foi feita a revisão bibliográfica de dois documentos publicados pelo Ministério da Saúde brasileiro relacionados ao tema em estudo: "Manual de hipertensão arterial e diabetes mellitus", de 2002; e o "Caderno de atenção básica, número 16, diabetes mellitus", de 2006. Essas publicações têm orientado as práticas dos profissionais de saúde nos últimos dez anos. A localização e obtenção das fontes foram realizadas no site da Biblioteca Virtual do Ministério da Saúde, em dezembro de 2010. São discutidas as características gerais dos discursos oficiais; os objetivos das ações educativas para pacientes diabéticos; as temáticas abordadas nessas ações; o imperativo técnico e moral que rege o incentivo à realização das práticas educativas; e os parâmetros para avaliação e acompanhamento dos adoecidos. Em seguida, expõe-se a configuração do campo de lutas e resistências no interior da educação em saúde para essa população. A análise do discurso oficial possibilitou a compreensão crítica e a produção de questionamento sobre a complexa rede de relações dos objetos postos em discurso nas práticas educativas em saúde para pacientes diabéticos no Brasil.

Effect of 'activity monitor-based' counseling on physical activity and health-related outcomes in patients with chronic diseases: A systematic review and meta-analysis

AIM

This review evaluated the effects of activity monitor-based counseling on physical activity (PA) and generic and disease-specific health-related outcomes in adults with diabetes mellitus type II (DMII), chronic obstructive pulmonary disease (COPD), or chronic heart failure (CHF).

METHODS

Four electronic databases were searched for randomized controlled trials using activity monitor-based counseling versus control intervention or usual care in adults with DMII, COPD, or CHF. Pooled effect sizes were calculated using a random effects model.

RESULTS

Twenty-four articles were included: 21 DMII studies and 3 COPD studies. No CHF studies were identified. Pooled analysis showed that activity monitor-based counseling resulted in a significantly greater improvement in PA compared to control intervention or usual care in DMII. Furthermore, these interventions had a beneficial effect on hemoglobin A1c (HbA1c), systolic blood pressure, and body mass index (BMI) (P < 0.05), whereas no differences were found on diastolic blood pressure, and health-related quality of life. Meta-analysis of COPD studies was not possible due to lack of available data.

CONCLUSION

Activity monitor-based counseling had a beneficial effect on PA, HbA1c, systolic blood pressure, and BMI in patients with DMII. Data in patients with COPD and CHF are limited or non-existing, respectively.

Evidence-based obesity treatment interventions for Latino adults in the U.S.: a systematic review

CONTEXT

Latinos have one of the highest prevalences of obesity in the U.S. Efforts to address U.S. Latino health have expanded to include obesity prevention and treatment initiatives. The objectives of this review were to (1) conduct a systematic review of obesity-related treatment interventions targeting U.S. Latino adults and (2) develop evidence-based recommendations to inform culturally relevant strategies for obesity treatment targeting U.S. Latino adults.

EVIDENCE ACQUISITION

Obesity treatment interventions, published between 1990 and 2010, were identified through a systematic search of electronic databases conducted between January 2010 and December 2011. Details of the screening process and selection/exclusion criteria are reported in the Guide to Obesity Prevention in Latin America and the U.S. (GOL) parent study.

EVIDENCE SYNTHESIS

Of the 325 studies identified in the GOL parent study, 105 met the inclusion criteria, and 22 involved obesity treatment interventions for Latinos and were included in the present review. The 22 studies were evaluated (between January 2010 and December 2011) for strength of study design and execution; effect sizes were also estimated for treatment effects on obesity-related outcomes. Interventions for physical activity or diet behavioral changes with strong or sufficient evidence included (1) community-based, culturally relevant, RCTs, and non-randomized controlled trials; (2) church-based interventions; and (3) promotora-led interventions.

CONCLUSIONS

Most interventions targeted physical activity and/or diet behavioral modification in Latinas and were led by bicultural/bilingual professionals. Potential key intervention settings include community clinics/centers and churches. Although there was limited literature on obesity treatment interventions for U.S. Latinos, the review findings provide valuable insight to researchers and practitioners involved in obesity treatment for U.S. Latino adults.

Workplace pedometer interventions for increasing physical activity

BACKGROUND

The World Health Organization and the World Economic Forum have recommended further research to strengthen current knowledge of workplace health programmes, particularly on effectiveness and using simple instruments. A pedometer is one such simple instrument that can be incorporated in workplace interventions.

OBJECTIVES

To assess the effectiveness of pedometer interventions in the workplace for increasing physical activity and improving subsequent health outcomes.

SEARCH METHODS

Electronic searches of the Cochrane Central Register of Controlled Trials (671 potential papers), MEDLINE (1001), Embase (965), CINAHL (1262), OSH UPDATE databases (75) and Web of Science (1154) from the earliest record to between 30th January and 6th February 2012 yielded 3248 unique records. Reference lists of articles yielded an additional 34 papers. Contact with individuals and organisations did not produce any further records.

SELECTION CRITERIA

We included individual and cluster-randomised controlled trials of workplace health promotion interventions with a pedometer component in employed adults. The primary outcome was physical activity and was part of the eligibility criteria. We considered subsequent health outcomes, including adverse effects, as secondary outcomes.

DATA COLLECTION AND ANALYSIS

Two review authors undertook the screening of titles and abstracts and the full-text papers independently. Two review authors (RFP and MC) independently completed data extraction and risk of bias assessment. We contacted authors to obtain additional data and clarification.

MAIN RESULTS

We found four relevant studies providing data for 1809 employees, 60% of whom were allocated to the intervention group. All studies assessed outcomes immediately after the intervention had finished and the intervention duration varied between three to six months. All studies had usual treatment control conditions; however one study's usual treatment was an alternative physical activity programme while the other three had minimally active controls. In general, there was high risk of bias mainly due to lack of blinding, self reported outcome measurement, incomplete outcome data due to attrition, and most of the studies had not published protocols, which increases the likelihood of selective reporting.Three studies compared the pedometer programme to a minimally active control group, but the results for physical activity could not be combined because each study used a different measure of activity. One study observed an increase in physical activity under a pedometer programme, but the other two did not find a significant difference. For secondary outcomes we found improvements in body mass index, waist circumference, fasting plasma glucose, the quality of life mental component and worksite injury associated with the pedometer programmes, but these results were based on limited data from one or two small studies. There were no differences between the pedometer programme and the control group for blood pressure, a number of biochemical outcomes and the quality of life physical component. Sedentary behaviour and disease risk scores were not measured by any of the included studies.One study compared a pedometer programme and an alternative physical activity programme, but baseline imbalances made it difficult to distinguish the true improvements associated with either programme.Overall, there was insufficient evidence to assess the effectiveness of pedometer interventions in the workplace.There is a need for more high quality randomised controlled trials to assess the effectiveness of pedometer interventions in the workplace for increasing physical activity and improving subsequent health outcomes. To improve the quality of the evidence available, future studies should be registered in an online trials register, publish a protocol, allocate time and financial support to reducing attrition, and try to blind personnel (especially those who undertake measurement). To better identify the effects of pedometer interventions, future studies should report a core set of outcomes (total physical activity in METs, total time sitting in hours and minutes, objectively measured cardiovascular disease and type II diabetes risk factors, quality of life and injury), assess outcomes in the long term and undertake subgroup analyses based upon demographic subgroups (e.g. age, gender, educational status). Future studies should also compare different types of active intervention to test specific intervention components (eligibility, duration, step goal, step diary, settings), and settings (occupation, intervention provider).

AUTHORS' CONCLUSIONS

There was limited and low quality data providing insufficient evidence to assess the effectiveness of pedometer interventions in the workplace for increasing physical activity and improving subsequent health outcomes.

Challenges and success of recruiting and retention for a culturally tailored diabetes prevention program for adults of Mexican descent

PURPOSE

The purpose of this article is to describe methods used to recruit and retain high-risk, Spanish-speaking adults of Mexican origin in a randomized clinical trial that adapts Diabetes Prevention Program (DPP) content into a community-based, culturally tailored intervention.

METHODS

Multiple passive and active recruitment strategies were analyzed for effectiveness in reaching the recruitment goal. Of 91 potential participants assessed for eligibility, 58 participated in the study, with 38 in the intervention and 20 in the attention control group. The American diabetes association risk assessment questionnaire, body mass index, and casual capillary blood glucose measures were used to determine eligibility.

RESULTS

The recruitment goal of 50 individuals was met. Healthy living diabetes prevention presentations conducted at churches were the most successful recruiting strategy. The retention goal of 20 individuals was met for the intervention group. Weekly reminder calls were made by the promotora to each intervention participant, and homework assignments were successful in facilitating participant engagement.

CONCLUSIONS

A community advisory board made significant and crucial contributions to the recruitment strategies and refinement of the intervention.

RESULTS

support the feasibility of adapting the DPP into a community-based intervention for reaching adults of Mexican origin at high risk for developing diabetes.

Effectiveness of multicultural health workers in chronic disease prevention and self-management in culturally and linguistically diverse populations: a systematic literature review

With a large and increasing culturally and linguistically diverse (CALD) population, the Australian health care system faces challenges in the provision of accessible culturally competent health care. Communities at higher risk of chronic disease include CALD communities. Overseas, multicultural health workers (MHWs) have been increasingly integrated in the delivery of culturally relevant primary health care to CALD communities. The objective of this systematic review was to examine the effectiveness of MHW interventions in chronic disease prevention and self-management in CALD populations with the aim to inform policy development of effective health care in CALD communities in Australia. A systematic review protocol was developed and computerised searches were conducted of multiple electronic databases from 1 January 1995 until 1 November 2010. Thirty-nine studies were identified including 31 randomised controlled trials. Many of the studies focussed on poor and underserved ethnic minorities. Several studies reported significant improvements in participants’ chronic disease prevention and self-management outcomes and meta-analyses identified a positive trend associated with MHW intervention. Australian Government policies express the need for targeted inventions for CALD communities. The broader systemic application of MHWs in Australian primary health care may provide one of the most useful targeted interventions for CALD communities.

Increasing physical activity in Belgian type 2 diabetes patients: a three-arm randomized controlled trial

BACKGROUND

Pedometer-based physical activity programs have been typically delivered in a group format by a behavioral expert. An alternative strategy that builds on existing interactions is delivery through individual consultation by a general practitioner (GP). These two delivery strategies have not been directly compared.

PURPOSE

To compare effectiveness of a 12-week physical activity (PA) intervention for type 2 diabetes patients delivered by a trained GP via an individual consultation or as group delivery by a behavioral expert.

METHOD

Sixty-seven primary care participants (mean age = 67.4 years, 70% male) from three Belgian general practices were randomized into three different treatment arms: (1) individual consultation (n = 22) with three PA contacts with the patient's GP; (2) group counseling (n = 21) with three PA group sessions delivered by a behavioral expert; and (3) a control arm (n = 24) receiving no intervention. Participant inclusion criteria were ≤80 years; 25-35 kg/m²; ≤12% HbA1c and reporting no PA limitations. Outcome measures were pedometer-determined steps/day, self-reported PA, and health parameters (weight, body mass index, waist circumference, total cholesterol, fasting glucose, and HbA1c).

RESULTS

Group counseling participants increased 1,706 steps/day over baseline significantly (p ≤ 0.05) more than other treatment arms. Moreover, they increased their self-reported PA (+82 min/day), while control arm participants showed a decrease in PA (p ≤ 0.05). Participants of the individual consultation had a decrease in waist circumference (-1.4 cm) and HbA1c (-0.32%) and a lower increase in total cholesterol (+7.2 mg/dl) compared to the other treatment arms (all p ≤ 0.05).

CONCLUSION

Group counseling in type 2 diabetes patients improved PA, whereas individual consultations had an impact on some health outcomes on the short-term.

How many steps/day are enough? For older adults and special populations

Older adults and special populations (living with disability and/or chronic illness that may limit mobility and/or physical endurance) can benefit from practicing a more physically active lifestyle, typically by increasing ambulatory activity. Step counting devices (accelerometers and pedometers) offer an opportunity to monitor daily ambulatory activity; however, an appropriate translation of public health guidelines in terms of steps/day is unknown. Therefore this review was conducted to translate public health recommendations in terms of steps/day. Normative data indicates that 1) healthy older adults average 2,000-9,000 steps/day, and 2) special populations average 1,200-8,800 steps/day. Pedometer-based interventions in older adults and special populations elicit a weighted increase of approximately 775 steps/day (or an effect size of 0.26) and 2,215 steps/day (or an effect size of 0.67), respectively. There is no evidence to inform a moderate intensity cadence (i.e., steps/minute) in older adults at this time. However, using the adult cadence of 100 steps/minute to demark the lower end of an absolutely-defined moderate intensity (i.e., 3 METs), and multiplying this by 30 minutes produces a reasonable heuristic (i.e., guiding) value of 3,000 steps. However, this cadence may be unattainable in some frail/diseased populations. Regardless, to truly translate public health guidelines, these steps should be taken over and above activities performed in the course of daily living, be of at least moderate intensity accumulated in minimally 10 minute bouts, and add up to at least 150 minutes over the week. Considering a daily background of 5,000 steps/day (which may actually be too high for some older adults and/or special populations), a computed translation approximates 8,000 steps on days that include a target of achieving 30 minutes of moderate-to-vigorous physical activity (MVPA), and approximately 7,100 steps/day if averaged over a week. Measured directly and including these background activities, the evidence suggests that 30 minutes of daily MVPA accumulated in addition to habitual daily activities in healthy older adults is equivalent to taking approximately 7,000-10,000 steps/day. Those living with disability and/or chronic illness (that limits mobility and or/physical endurance) display lower levels of background daily activity, and this will affect whole-day estimates of recommended physical activity.

Pushing the envelope for cultural appropriateness: does evidence support cultural tailoring in type 2 diabetes interventions for Mexican American adults?

PURPOSE

This study explores the potential utility of a culturally tailored diabetes management intervention approach by testing associations between acculturation and diabetes-related beliefs among Mexican-American adults with type 2 diabetes.

METHODS

Data from 288 Mexican-American adults with type 2 diabetes were obtained via a bilingual, telephone-administered survey. Participants were drawn from a stratified, random sample designed to obtain maximum variability in acculturation. The survey assessed diabetes-related beliefs, intervention preferences, and the following three acculturation constructs from the Hazuda acculturation and assimilation scales: Spanish use, value for preserving Mexican culture, and interaction with Mexican Americans.

RESULTS

Only one outcome-preference for a program for Mexican Americans-was associated with all three acculturation variables. Spanish use was positively associated with belief in susto as a cause of diabetes, preference for expert-driven health guidance, and involvement of others in taking care of diabetes. Value for preserving Mexican culture was related to a more holistic view of health, as evidenced by an increased likelihood of consulting a curandero, use of prayer, and interest in a diabetes program with religious content. Value for cultural preservation was also related to higher suspicion of free diabetes programs. Interaction with Mexican Americans was associated with a belief that insulin causes blindness.

CONCLUSION

Findings from this study suggest distinct relationships between acculturation constructs and diabetes-related beliefs and preferences, thus arguing against the use of a single acculturation construct to determine diabetes intervention design. Cultural tailoring may enhance the cultural appropriateness and ultimate effectiveness of diabetes interventions for Mexican American adults.