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Nsobundu C, Nmadu YW, Wagle NS, Foster MJ, McKyer ELJ, Sherman L, Ory MG, Burdine J(JN. Process Evaluations of Diabetes Self-Management Programs: A Systematic Review of the Literature. Am J Health Promot 2024; 38:1048-1067. [PMID: 38648265 PMCID: PMC11348640 DOI: 10.1177/08901171241238554] [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: 04/25/2024]
Abstract
OBJECTIVE To conduct a systematic review of process evaluations (PEs) of diabetes self-management programs (DSMPs). DATA SOURCE An electronic search using Medline (Ovid), Embase (Ovid), CINAHL (Ensco), Academic Search (Ebsco), and APA PsycInfo (Ebsco). STUDY INCLUSION AND EXCLUSION CRITERIA Peer-reviewed, empirical quantitative, qualitative, or mixed-method studies were included if they (1) were a traditional, group-based DSMP, (2) involved adults at least 18 years with T1DM or T2DM, (3) were a stand-alone or embedded PE, and (4) published in English. DATA EXTRACTION The following process evaluation outcomes were extracted: fidelity, dose delivered, dose received, reach, recruitment, retention, and context. Additional items were extracted, (eg, process evaluation type, data collection methods; theories; frameworks or conceptual models used to guide the process evaluation, and etc). DATA SYNTHESIS Due to heterogeneity across studies, studies were synthesized qualitatively (narratively). RESULTS Sixty-eight studies (k) in 78 articles (n) (k = 68; n = 78) were included. Most were mixed methods of low quality. Studies were typically integrated into outcome evaluations vs being stand-alone, lacked theoretical approaches to guide them, and incorporated limited outcomes such as dose received, reach, and retention. CONCLUSION Future research should 1) implement stand-alone theoretically grounded PE studies and 2) provide a shared understanding of standardized guidelines to conduct PEs. This will allow public health practitioners and researchers to assess and compare the quality of different programs to be implemented.
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Affiliation(s)
- Chinelo Nsobundu
- Center for Community Health & Aging, School of Public Health, Texas A&M University, College Station, TX, USA
- School of Medicine, St George’s University, St George’s, Grenada
| | - Yeka W. Nmadu
- Department of Pediatrics, University of Florida College of Medicine- Jacksonville, Jacksonville, FL, USA
| | - Nikita Sandeep Wagle
- Population Informatics Lab, Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Margaret J. Foster
- Department of Medical Education, Texas A&M College of Medicine, College Station, TX, USA
| | - Ellisa Lisako Jones McKyer
- Vice Dean Faculty Affairs & Diversity, Equity, and Inclusion, Alice L. Walton School of Medicine, Bentonville, AR, USA
| | - Ledric Sherman
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Marcia G. Ory
- Department of Environmental & Occupational Health, School of Public Health, Texas A&M University, College Station, TX, USA
| | - James (Jim) N. Burdine
- Department of Health Behavior, Director of the Center for Community Health & Aging, School of Public Health, Texas A&M University, College Station, TX, USA
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Tidwell Torres M, Bailey A, Riscia PM, Kang AW. A Systematic Narrative Review of Recent Obesity Interventions with Black Women in the United States. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02026-9. [PMID: 38771451 DOI: 10.1007/s40615-024-02026-9] [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: 02/04/2024] [Revised: 04/06/2024] [Accepted: 05/08/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVES This study is to comprehensively review recent obesity interventions for Black women in the United States. METHODS We searched PubMed and EBSCOhost for articles published between 2013 and 2022 using a comprehensive search strategy. Two reviewers screened titles, abstracts, and full texts. Data from the included articles were extracted. Qualitative themes related to the intervention designs were identified across studies. RESULTS Fifty-two studies were included in the review. Interventions typically aimed to reduce weight by targeting diet and/or physical activity. Intervention activities were delivered virtually and in-person via several formats including didactic content and interactive sessions. Outcomes were assessed through a variety of research designs. Across papers, we identified six key themes of intervention design: integration of technology, centering community and culture, personalization of content, use of social support, skill-building through intervention activities, and addressing comorbid health conditions. CONCLUSIONS To address the obesity epidemic, future research can build upon key lessons learned from recent interventions tailored to Black women.
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Affiliation(s)
- Melina Tidwell Torres
- Department of Behavioral and Social Science, Brown School of Public Health, Providence, RI, USA
| | - Amelia Bailey
- Department of Behavioral and Social Science, Brown School of Public Health, Providence, RI, USA
- Center for Alcohol and Addiction Studies, Brown School of Public Health, Providence, RI, USA
| | - Patricia Markham Riscia
- Department of Behavioral and Social Science, Brown School of Public Health, Providence, RI, USA
- Center for Health Promotion and Health Equity, Brown School of Public Health, Providence, RI, USA
- Department of Epidemiology, Brown School of Public Health, Providence, RI, USA
| | - Augustine W Kang
- Center for Alcohol and Addiction Studies, Brown School of Public Health, Providence, RI, USA.
- Stanford University School of Medicine, Stanford, CA, USA.
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Miller ST, Akohoue SA, Murry VM, Tabatabai M, Wilus D, Foxx A. SISTER (Sisters Inspiring Sisters to Engage in Relevant Diabetes Self-Care) Diabetes Study: Protocol for diabetes medical nutrition therapy randomized clinical trial among African American women. Contemp Clin Trials 2023; 125:107052. [PMID: 36526256 DOI: 10.1016/j.cct.2022.107052] [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: 07/08/2022] [Revised: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND African American (AA) women with type 2 diabetes (T2D) carry disproportionate diabetes-related morbidity and mortality burdens. Diabetes medical nutrition therapy (MNT) improves glycemic, blood pressure, and cholesterol control, all critical in preventing and reducing diabetes complications. Yet, MNT does not address low motivation for dietary intake management, which is frequently reported among AA women with T2D living in the Southeastern US. METHODS A randomized controlled trial will be used to test the central hypothesis that diabetes MNT plus culturally-tailored motivational interviewing (MI) (diabetes MNT plus MI) is more effective than diabetes MNT alone (diabetes MNT). Two hundred ninety-one Southeastern AA women who are at risk for development and/or progression of T2D complications will be randomized to diabetes MNT plus MI or diabetes MNT. Both groups will include: 1) a 3-month active intervention period, consisting of group-based, nutritionist-facilitated MNT sessions; 2) a 3-month maintenance intervention period, including one group-based, nutritionist-facilitated maintenance support session; and 3) a 6-month inactive period. Culturally-adapted MI exercises will be integrated into the diabetes MNT plus MI group only. Primary (HbA1c) and secondary (systolic blood pressure, LDL cholesterol) outcomes will be assessed at baseline and 3, 6, and 12 months following the active intervention period. DISCUSSION The results from this study, called the SISTER (Sisters Inspiring Sisters to Engage in Relevant Diabetes Self-Care) Diabetes Study, are vital to the adoption and uptake of rigorously-tested MNT interventions that address motivation among AA women with T2D as a way to reduce their risk and/or progression of diabetes-related complications.
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Affiliation(s)
- Stephania T Miller
- Department of Surgery, School of Medicine, Meharry Medical College, 1005 Dr. D.B. Todd, Jr. Blvd, Nashville, TN 37208-3599, USA.
| | - Sylvie A Akohoue
- Department of Family and Community Medicine, School of Medicine, Meharry Medical College, 1005 Dr. D.B. Todd, Jr. Blvd, Nashville, TN 37208-3599, USA
| | - Velma M Murry
- Departments of Health Policy & Human & Organizational Development, Vanderbilt University, 2525 West End, Ave., Nashville, TN 37203, USA
| | - Mohammad Tabatabai
- School of Graduate Studies and Research, Meharry Medical College, 1005 Dr. D.B. Todd, Jr. Blvd, Nashville, TN 37208-3599, USA
| | - Derek Wilus
- School of Graduate Studies and Research, Meharry Medical College, 1005 Dr. D.B. Todd, Jr. Blvd, Nashville, TN 37208-3599, USA
| | - Ardana Foxx
- Patient Advisory Group, SISTER Diabetes Study, Nashville, TN, USA
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Villalona S, Ortiz V, Castillo WJ, Garcia Laumbach S. Cultural Relevancy of Culinary and Nutritional Medicine Interventions: A Scoping Review. Am J Lifestyle Med 2022; 16:663-671. [PMID: 36389044 PMCID: PMC9644144 DOI: 10.1177/15598276211006342] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 02/14/2021] [Accepted: 03/11/2021] [Indexed: 10/15/2023] Open
Abstract
Background. Taking into account the disproportionate impacts of disease burden from chronic conditions by racial and ethnic group, this scoping review sought to examine the extent to which nutritional interventions incorporated culturally relevant topics into their design and analyses. Methods. A literature search of 5 databases was conducted for any peer-reviewed studies on nutritional and culinary medicine interventions published between 2000 and 2019. Results. Studies were divided into 2 categories, medical education interventions (n = 12) and clinical/community interventions (n = 20). The majority of medical education interventions were not culturally tailored and focused on obesity/weight management within the Northeast and Southeast United States. In contrast, clinical/community interventions were primarily culturally tailored for Latinos/Hispanics and African American/Black populations residing in the Northeast and diagnosed with prediabetes/diabetes mellitus or hypertension/cardiovascular disease. Conclusions. This review identified an existent gap and need for inclusive studies that consider the culturally relevant topics into the design and implementation of nutritional intervention studies. Studies within medical education appeared to be the area where these changes can be most beneficial. There may be some value among clinic and communal-based studies in stratifying heterogeneous subgroups because of the missed cultural nuances missed when grouping larger racial cohorts.
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Affiliation(s)
| | - Vanessa Ortiz
- Rutgers Robert Wood Johnson Medical School,
Piscataway, New Jersey
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Freshwater M, Christensen S, Oshman L, Bays HE. Behavior, motivational interviewing, eating disorders, and obesity management technologies: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022. OBESITY PILLARS (ONLINE) 2022; 2:100014. [PMID: 37990715 PMCID: PMC10661888 DOI: 10.1016/j.obpill.2022.100014] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 03/19/2022] [Indexed: 11/23/2023]
Abstract
Background This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) is intended to provide clinicians an overview of "Behavior, Motivational Interviewing, Eating Disorders, and Obesity Management Technologies." Methods The scientific information for this CPS is based upon published scientific citations, clinical perspectives of OMA authors, and peer review by the Obesity Medicine Association leadership. Results This CPS outlines important components of behavior, motivational interviewing, eating disorders, and obesity management technologies as they relate to pre-obesity and obesity. Topics include eating behavior disorder evaluation, the motivations behind eating and physical activity behaviors (including underlying neurophysiology, eating disorders, environmental factors, and personal prioritization), motivational interviewing techniques, and technologies that may assist with pre-obesity/obesity management. Conclusions This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) on "Behavior, Motivational Interviewing, Eating Disorders, and Obesity Management Technologies" is one of a series of OMA CPSs designed to assist clinicians in the care of patients with the disease of pre-obesity/obesity. Implementation of appropriate clinical practices in these areas may improve the health of patients, especially those with adverse fat mass and adiposopathic metabolic consequences.
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Affiliation(s)
- Michelle Freshwater
- Diplomate of American Board of Obesity Medicine, Idaho Weight Loss, 801 N Stilson Road, Boise, ID, 83703, USA
| | - Sandra Christensen
- Certificate of Advanced Education in Obesity Medicine, Integrative Medical Weight Management, 2611 NE 125th St, Suite 100B, Seattle, WA, 98125, USA
| | - Lauren Oshman
- Diplomate of American Board of Obesity Medicine, University of Michigan Medical School, 14700 E Old US Hwy 12, Chelsea, MI, 48118, USA
| | - Harold Edward Bays
- Diplomate of American Board of Obesity Medicine, Medical Director/President Louisville Metabolic and Atherosclerosis Research Center, Clinical Associate Professor/University of Louisville Medical School, 3288 Illinois Avenue, Louisville, KY, 40213, USA
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Opoku-Addai K, Korsah KA, Mensah GP. Nutritional self-care practices and skills of patients with diabetes mellitus: A study at a tertiary hospital in Ghana. PLoS One 2022; 17:e0265608. [PMID: 35320308 PMCID: PMC8942245 DOI: 10.1371/journal.pone.0265608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 03/04/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction
Nutritional management decreases and/or prevents the complications and deaths associated with diabetes mellitus. However, the majority of patients living with diabetes do not engage in optimal nutritional management of diabetes because they see it as the most difficult aspect of managing the condition. This study aimed to explore and describe the practices and skills on nutritional management of diabetes mellitus among patients living with diabetes attending a Ghanaian hospital.
Materials and methods
This study employed an exploratory, descriptive qualitative research design. Fifteen participants were recruited using purposive sampling, and interviewed with a semi-structured interview guide. Content analysis was performed on the data gathered, following which three main themes emerged.
Results
More than two-thirds of the participants of this study had adequate meal planning skills, ate the right quantity of foods, engaged in healthy eating habits, and consumed healthy sources of carbohydrates, fats and protein when eating. However, more than half of the participants had insufficient knowledge and skills in the reading and usage of food labels.
Conclusions
The participants of this study largely engaged in optimal nutritional management of diabetes due to their healthy dietary practices and preferences. It is recommended that health care professionals in Ghana find practical and robust ways to factor the reading and usage of food labels into the care and management of patients with diabetes.
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Affiliation(s)
- Kwabena Opoku-Addai
- School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
- Faculty of Health and Medical Sciences, Department of Nursing and Midwifery, Presbyterian University College, Asante Akyem, Agogo, Ghana
| | - Kwadwo Ameyaw Korsah
- School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Gwendolyn Patience Mensah
- School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
- * E-mail:
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Razaz JM, Rahmani J, Varkaneh HK, Thompson J, Clark C, Abdulazeem HM. The health effects of medical nutrition therapy by dietitians in patients with diabetes: A systematic review and meta-analysis: Nutrition therapy and diabetes. Prim Care Diabetes 2019; 13:399-408. [PMID: 31186171 DOI: 10.1016/j.pcd.2019.05.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 04/29/2019] [Accepted: 05/12/2019] [Indexed: 11/15/2022]
Abstract
AIMS Intensive lifestyle, dietary interventions and patient education have been recommended as key milestones in to facilitate the management of Diabetes and contain the growing incidence. We performed a systematic review and meta-analysis to assess the health benefits of medical nutrition therapy among patients with diabetes. DESIGN A systematic search was performed in MEDLINE/PubMed, SCOPUS, and Cochrane library from onset up to February 2019 to identify trials investigating the health effect of Medical nutrition (MNT) in patients with diabetes. Random-effects models were used to calculate the effect sizes as weighted mean difference (WMD) and 95% confidence intervals (CI). RESULTS Eleven studies containing 1227 participants were included in the meta-analysis. Pooled results showed a significant reduction in Fasting blood sugar (FBS) (WMD= -8.85mg/dl, 95% CI: -14.41, -3.28), HbA1c (WMD: -0.43%, 95% CI: -0.69, -0.17), weight (WMD: -1.54kg, 95% CI: -2.44, -0.64), Body mass index (BMI) (WMD: -0.34 Kg/m2, 95% CI: -0.52, -0.17), waist circumference (WMD: -2.16cm, 95% CI: -4.09, -0.23), cholesterol (WMD: -4.06mg/dl, 95% CI: -7.31, -0.81), Systolic blood pressure (SBP) (WMD: -7.90mmHg, 95% CI: -13.03, -2.77). Results of meta-regression analysis based on age of participants and duration of intervention were not significant. CONCLUSIONS Patients with diabetes who received medical nutrition therapy showed significant improvements in outcome measures of FBS, HbA1c, weight, BMI, waist circumference, cholesterol, and SBP.
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Affiliation(s)
- Jalaledin Mirzay Razaz
- Department of Community Nutrition, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Jamal Rahmani
- Department of Community Nutrition, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamed Kord Varkaneh
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jacqueline Thompson
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, United Kingdom
| | - Cain Clark
- School of Life Sciences, Coventry University, Coventry, CV1 5FB, United Kingdom
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Egede LE, Williams JS, Voronca DC, Gebregziabher M, Lynch CP. Telephone-Delivered Behavioral Skills Intervention for African American Adults with Type 2 Diabetes: A Randomized Controlled Trial. J Gen Intern Med 2017; 32:775-782. [PMID: 28337686 PMCID: PMC5481234 DOI: 10.1007/s11606-017-4023-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 02/01/2017] [Accepted: 02/16/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Diabetes disproportionately affects African Americans and is associated with poorer outcomes. Self-management is important for glycemic control; however, evidence in African Americans is limited. OBJECTIVE To assess the efficacy of a combined telephone-delivered education and behavioral skills intervention (TBSI) in reducing hemoglobin A1c (HbA1c) levels in African Americans with type 2 diabetes, using a factorial design. DESIGN This is a four-year randomized clinical trial, using a 2 x 2 factorial design.: Participants: African American adults ≥18 years) with poorly controlled type 2 diabetes (HbA1c ≥9%) were randomly assigned to one of four groups: 1) knowledge only, 2) skills only, 3) combined knowledge and skills (TBSI), or 4) control group. INTERVENTION All participants received 12 telephone-delivered 30-min intervention sessions specific to their assigned group. Participants were assessed at baseline and 3, 6, and 12 months. MAIN MEASURE The primary outcome was HbA1c at 12 months post-randomization in the intent-to-treat (ITT) population. KEY RESULTS Two hundred fifty-five participants were randomly assigned to the four groups. Based on the ITT population after multiple imputation, the analysis of covariance with baseline HbA1c as the covariate showed that HbA1c at 12 months for the intervention groups did not differ significantly from that of the control group (knowledge: 0.49, p = 0.123; skills: 0.23, p = 0.456; combined: 0.48, p = 0.105). Absolute change from baseline at 12 months for all treatment arms was 0.6. Longitudinal mixed effects analysis showed that, on average, there was a significant decline in HbA1c over time for all treatment groups (-0.07, p < 0.001). However, the rates of decline for the intervention groups were not significantly different from that of the control group (knowledge: 0.06, p = 0.052; skills: 0.02, p = 0.448; combined: 0.05, p = 0.062). Results from per-protocol populations were similar. CONCLUSIONS For African Americans with poorly controlled type 2 diabetes, combined education and skills training did not achieve greater reductions in glycemic control (i.e., HbA1c levels) at 12 months compared to the control group, education alone, or skills training alone. This trial is registered with ClinicalTrials.gov, identifier no. NCT00929838.
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Affiliation(s)
- Leonard E Egede
- Department of Medicine, Froedtert and Medical College of Wisconsin, Milwaukee, WI, USA. .,Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI, USA. .,Division of General Internal Medicine, Froedtert and Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Joni S Williams
- Department of Medicine, Froedtert and Medical College of Wisconsin, Milwaukee, WI, USA.,Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of General Internal Medicine, Froedtert and Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Mulugeta Gebregziabher
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Cheryl P Lynch
- Center for Health Disparities Research, Medical University of South Carolina, Charleston, SC, USA.,Department of Medicine, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, Charleston, SC, USA.,Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
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Easton JF, Stephens CR, Román Sicilia H. The effect of a medical opinion on self-perceptions of weight for Mexican adults: perception of change and cognitive biases. BMC OBESITY 2017; 4:16. [PMID: 28469931 PMCID: PMC5414120 DOI: 10.1186/s40608-017-0152-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 03/17/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND This study analysed the relationship between perceived and actual Body Mass Index (BMI) and the effect of a prior identification of obesity by a medical professional for adults using difference in response for two distinct BMI self-perception questions. Typically, self-perception studies only investigate the relation with current weight, whereas here the focus is on the self-perception of weight differences. METHODS A statistical approach was used to assess responses to the Mexican ENSANUT 2006 survey. Adults in the range of BMI from 13 to 60 were tested on responses to a categorical question and a figure rating scale self-perception question. Differences in response by gender and identification of obesity by a medical professional were analysed using linear regression. RESULTS Results indicated that regardless of current BMI and gender, a verbal intervention by a medical professional will increase perceived BMI independently of actual BMI but does not necessarily make the identified obese more accurate in their BMI estimates. A shift in the average self-perception was seen with a higher response for the identified obese. A linear increase in perceived BMI as a function of actual BMI was observed in the range BMI < 35 but with a rate of increase much less than expected if weight differences were perceived accurately. CONCLUSIONS Obese and overweight Mexican adults not only underestimated their weight, but also, could not accurately judge changes in weight. For example, an increase of 5 kg is imagined, in terms of self-image, to be considerably less. It was seen that an identification of obesity by a health care professional did not improve ability to judge weight but, rather, served as a new anchor from which the identified obese judge their weight, suggesting that even those identified obese who have lost weight, perceive their weight to be greater than it actually is. We believe that these results can be explained in terms of two cognitive biases; the self-serving bias and the anchoring bias.
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Affiliation(s)
- Jonathan F Easton
- C3-Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Circuito Centro Cultural s/n, Ciudad Universitaria, Col. Universidad Nacional Autónoma de México, Del. Coyoacán, C.P. 04510 Ciudad de México, Mexico
| | - Christopher R Stephens
- C3-Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Circuito Centro Cultural s/n, Ciudad Universitaria, Col. Universidad Nacional Autónoma de México, Del. Coyoacán, C.P. 04510 Ciudad de México, Mexico.,Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, Circuito Exterior s/n, Ciudad Universitaria, Col. Universidad Nacional Autónoma de México, Del. Coyoacán, A. P. 70-543, C.P. 04510 Ciudad de México, Mexico
| | - Heriberto Román Sicilia
- C3-Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Circuito Centro Cultural s/n, Ciudad Universitaria, Col. Universidad Nacional Autónoma de México, Del. Coyoacán, C.P. 04510 Ciudad de México, Mexico
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Miller ST, Akohoue SA. Two-year follow-up study of a group-based diabetes medical nutrition therapy and motivational interviewing intervention among African American women. PATIENT-RELATED OUTCOME MEASURES 2017; 8:57-61. [PMID: 28450793 PMCID: PMC5399984 DOI: 10.2147/prom.s125884] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To assess the 2-year efficacy of a combined medical nutrition therapy and motivational interviewing (MI) pilot study intervention and factors that influenced long-term dietary self-care. RESEARCH DESIGN AND METHODS Pilot study participants, African American women with type 2 diabetes, completed a 2-year follow-up study visit, including clinical assessments and completion of a dietary self-care questionnaire and a semi-structured interview. Wilcoxon signed-rank tests were used to evaluate differences between baseline and 2-year follow-up clinical and dietary self-care outcomes. Hierarchical coding was used to analyze semi-structured interviews and categorize facilitator and barrier themes into subthemes. Subthemes were quantified based on the number of subtheme-related comments. RESULTS Among the 12 participants (mean age 57.1±5.7 years), improvements were observed for HbA1c (baseline: 10.25%; interquartile range [IQR]: 8.10, 11.72 and follow-up: 8.8%; IQR: 7.48,10.22), systolic blood pressure (baseline: 142 mm Hg; IQR: 134.25, 157.25 and follow-up: 127 mm Hg; IQR: 113.5, 143.25), frequency of eating high-fat foods (baseline: 3.5 days; IQR: 2.75, 4.25 and follow-up: 3 days; IQR: 2.5, 4.5), and of spacing carbohydrates throughout the day (baseline: 3 days; IQR: 3.0, 4.0 and follow-up: 4 days; IQR: 1.5, 4.5). There was a statistically significant decrease (p=0.04) in the frequency of fruit and vegetable intake (baseline: 4 days; IQR: 3.75, 7.0 and follow-up: 3.5 days; IQR: 2.75, 4.0). Dietary self-care barriers and facilitators included internal (eg, motivation) and external factors (eg, social support). Motivation (70 comments) and lack of motivation (67 comments) were the most pervasive facilitator and barrier subthemes, respectively. CONCLUSION Overall, diabetes-related clinical and dietary self-care outcomes were improved following a combined medical nutritional therapy/MI intervention, and motivation played an important role in dietary self-care engagement. Future research is needed to assess the added benefit of MI in improving clinical and dietary self-care outcomes and to identify best strategies to support post-intervention dietary self-care engagement.
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Affiliation(s)
| | - Sylvie A Akohoue
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN, USA
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Li Z, Jin H, Chen W, Sun Z, Jing L, Zhao X, Zhu S, Guo X, Study Group CNEED. Influencing Factors of Knowledge, Attitude, and Practice regarding Medical Nutrition Therapy in Patients with Diabetes: A National Cross-Sectional Study in Urban China. J Diabetes Res 2017; 2017:8948452. [PMID: 28948173 PMCID: PMC5602617 DOI: 10.1155/2017/8948452] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 03/05/2017] [Indexed: 01/19/2023] Open
Abstract
To investigate the knowledge-attitude-practice (KAP) score in diabetes patients living in urban China regarding Medical Nutrition Therapy (MNT) and explore the influencing factors, this national survey recruited diabetes and prediabetes patients in 40 hospitals across 26 provinces in China. A self-designed questionnaire was used to collect the data and assess the knowledge, attitude, and practice regarding MNT. Logistic regression was used to explore the factor influencing KAP scores. A total of 6441 diabetes patients (mean age: 60.02 ± 13.14 years) completed this survey. The mean glycosylated hemoglobin (HbA1c) level was 8.12 ± 2.12%, and the control rate of HbA1c (HbA1c < 7.0%) was 38.92%. Of the total, 53.56% had received MNT education. Over half of the patients had a poor total KAP score as well as poor K, A, and P scores. Patients with higher KAP scores had higher control rate of HbA1c (P < 0.05) but lower levels of fasting plasma glucose (FPG) and 2-hour postprandial blood glucose (2h-PG). Gender, occupation, residence, education level, and MNT education could influence the KAP scores (P < 0.05). This study showed that diabetes patients in urban China generally had poor understandings and practices related to MNT. Patients with higher KAP scores exhibited better control of blood glucose.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- China
- Cross-Sectional Studies
- Diabetes Mellitus, Type 1/blood
- Diabetes Mellitus, Type 1/diet therapy
- Diabetes Mellitus, Type 1/prevention & control
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/diet therapy
- Diabetes Mellitus, Type 2/prevention & control
- Female
- Glycated Hemoglobin/analysis
- Health Knowledge, Attitudes, Practice
- Hospitals, Urban
- Humans
- Male
- Middle Aged
- Needs Assessment
- Nutrition Surveys
- Nutrition Therapy
- Patient Compliance
- Patient Education as Topic
- Prediabetic State/blood
- Prediabetic State/diet therapy
- Retrospective Studies
- Urban Health
- Young Adult
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Affiliation(s)
- Zijian Li
- Department of Parenteral and Enteral Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Haimin Jin
- Department of Clinical Nutrition, Affiliated Hospital of Taishan Medical University, Taian, Shandong, China
| | - Wei Chen
- Department of Parenteral and Enteral Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- *Wei Chen: and
| | - Zilin Sun
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, Medical School, Southeast University, Nanjing, Jiangsu, China
| | - Lulu Jing
- Department of Clinical Nutrition, Peking University First Hospital, Beijing, China
| | - Xiaohui Zhao
- Abbott Nutrition Research & Development, Shanghai, China
| | - Sainan Zhu
- Statistics Office, Peking University First Hospital, Beijing, China
| | - Xiaohui Guo
- Department of Clinical Nutrition, Peking University First Hospital, Beijing, China
- Department of Endocrinology, Peking University First Hospital, Beijing, China
- *Xiaohui Guo:
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13
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Winkler LL, Christensen U, Glümer C, Bloch P, Mikkelsen BE, Wansink B, Toft U. Substituting sugar confectionery with fruit and healthy snacks at checkout - a win-win strategy for consumers and food stores? a study on consumer attitudes and sales effects of a healthy supermarket intervention. BMC Public Health 2016; 16:1184. [PMID: 27876025 PMCID: PMC5120526 DOI: 10.1186/s12889-016-3849-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 11/16/2016] [Indexed: 11/29/2022] Open
Abstract
Background The widespread use of in-store marketing strategies to induce unhealthy impulsive purchases has implications for shopping experience, food choice and possibly adverse health outcomes. The aim of this study was to examine consumer attitudes and evaluate sales effects of a healthy checkout supermarket intervention. The study was part of Project Sundhed & Lokalsamfund (Project SoL); a Danish participatory community-based health promotion intervention. Methods Consumer attitudes towards unhealthy snack exposure in supermarkets were examined in a qualitative pre-intervention study (29 short in-store interviews, 11 semi-structured interviews and three focus group interviews). Findings were presented to food retailers and informed the decision to test a healthy checkout intervention. Sugar confectionery at one checkout counter was substituted with fruit and healthy snacking items in four stores for 4 weeks. The intervention was evaluated by 48 short exit interviews on consumer perceptions of the intervention and by linear mixed model analyses of supermarket sales data from the intervention area and a matched control area. Results The qualitative pre-intervention study identified consumer concern and annoyance with placement and promotion of unhealthy snacks in local stores. Store managers were willing to respond to local consumer concern and a healthy checkout intervention was therefore implemented. Exit interviews found positive attitudes towards the intervention, while intervention awareness was modest. Most participants believed that the intervention could help other consumers make healthier choices, while fewer expected to be influenced by the intervention themselves. Statistical analyses suggested an intervention effect on sales of carrot snack packs when compared with sales before the intervention in Bornholm control stores (P < 0.05). No significant intervention effect on sales of other intervention items or sugar confectionery was found. Conclusions The present study finds that the healthy checkout intervention was positively evaluated by consumers and provided a ‘responsible’ branding opportunity for supermarkets, thus representing a win-win strategy for store managers and consumers in the short term. However, the intervention was too modest to draw conclusions on long-term sales and health implications of this initiative. More research is needed to assess whether retailer-researcher collaborations on health promotion can be a winning strategy for public health.
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Affiliation(s)
- Lise L Winkler
- Research Centre for Prevention and Health, Centre for Health, Capital Region of Denmark, Rigshospitalet-Glostrup, Ndr. Ringvej 57, Building 84/85, 2600, Glostrup, Denmark.
| | - Ulla Christensen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Glümer
- Research Centre for Prevention and Health, Centre for Health, Capital Region of Denmark, Rigshospitalet-Glostrup, Ndr. Ringvej 57, Building 84/85, 2600, Glostrup, Denmark
| | - Paul Bloch
- Steno Health Promotion Research, Steno Diabetes Center, Niels Steensens Vej 8, 2820, Gentofte, Denmark
| | - Bent E Mikkelsen
- Department of Clinical Medicine, Aalborg University, Frederikskaj 10, Building B, B2,, 2450, Copenhagen, SV, Denmark
| | - Brian Wansink
- Marketing in the Department of Applied Economics, Management at Cornell University, 114 Warren Hall, Ithaca, NY, 14853, USA
| | - Ulla Toft
- Research Centre for Prevention and Health, Centre for Health, Capital Region of Denmark, Rigshospitalet-Glostrup, Ndr. Ringvej 57, Building 84/85, 2600, Glostrup, Denmark
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14
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Duncan S, Goodyear-Smith F, McPhee J, Zinn C, Grøntved A, Schofield G. Family-centered brief intervention for reducing obesity and cardiovascular disease risk: A randomized controlled trial. Obesity (Silver Spring) 2016; 24:2311-2318. [PMID: 27616217 DOI: 10.1002/oby.21602] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 06/06/2016] [Accepted: 06/07/2016] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To assess the effects of a family-centered, physical activity and nutrition "brief" intervention (time-limited contact) on body weight and related health outcomes in primary health care patients with an elevated 5-year cardiovascular disease (CVD) risk. METHODS This study implemented a cluster randomized controlled trial design with two treatment conditions: a CVD risk assessment and one-time consultation ("usual care" control) and a CVD risk assessment and up to five home sessions that aimed to reduce obesity by encouraging physical activity and healthy eating (intervention). Three hundred and twenty patients aged 35 to 65 years from 16 primary health care clinics in Auckland, New Zealand, participated in the study. Intervention effects on BMI, waist circumference, blood pressure, blood cholesterol, triglycerides, 5-year CVD risk, physical activity, and dietary patterns were assessed using generalized linear mixed models. RESULTS When compared with the control group, the intervention resulted in a significant but relatively modest decrease in BMI between baseline and the 12-month follow-up (-0.633 kg m-2 , Padj = 0.048). Significant decreases were also observed for total cholesterol at 4 and 12 months, the total cholesterol to high-density lipoprotein cholesterol ratio at 4 months, 5-year CVD risk at 4 months, and fast food consumption at 12 months. CONCLUSIONS Our findings show that a family-centered brief intervention targeting physical activity and nutrition can generate slightly better obesity-related health outcomes than usual care alone.
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Affiliation(s)
- Scott Duncan
- Human Potential Centre, School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand.
| | - Felicity Goodyear-Smith
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Julia McPhee
- Human Potential Centre, School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
| | - Caryn Zinn
- Human Potential Centre, School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
| | - Anders Grøntved
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Copenhagen, Denmark
| | - Grant Schofield
- Human Potential Centre, School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
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15
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Miller ST, Cunningham-Erves J, Akohoue SA. Diabetes Education, Specialty Care, and Self-Care Advice among Obese African American Women with Type 2 Diabetes. Ethn Dis 2016; 26:229-34. [PMID: 27103774 DOI: 10.18865/ed.26.2.229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Healthy People 2020 (HP2020) includes benchmarks for diabetes management. The objective of our study was to describe diabetes management among African American women, a patient group that carries a disproportionate diabetes burden. PARTICIPANTS African American women with type 2 diabetes enrolled in dietary and weight management interventions. MAIN OUTCOME MEASURES Self-report assessments of diabetes education, specialty care, self-care behaviors and advice. Associations between diabetes self-care behaviors and diabetes advice using Chi-square tests. RESULTS Among 96 participants (age = 53 ± 9.4; BMI = 37.9 ± 7.3 kg/m(2)), reported diabetes education and foot exams were lower than HP2020 benchmarks, 48.9% vs 62.5% and 35.1% vs 74.8%, respectively and higher for dilated eye exams (70.1% vs 58.7%). The most frequently reported dietary advice was to increase fruit/vegetable intake (58%) and approximately 50% reported physical activity advice. Receiving no exercise advice was associated with greater odds of little or no physical activity (OR = 3.38) and planned exercises (OR = 2.65). CONCLUSIONS Receipt of diabetes education and some specialty care were below national benchmarks while health care provider advice influenced patient self-care behaviors. Increasing diabetes education and specialty care should be included within existing efforts to address the excess diabetes burden experienced by African American women. Longitudinal studies exploring the relationship between health care provider advice and self-care behaviors are needed.
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Affiliation(s)
| | | | - Sylvie A Akohoue
- Department of Family and Community Medicine, Meharry Medical College
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