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De Alba A, Britigan DH, Lyden E, Johansson P. Assessing the Prevalence and Association of Acculturation and Health Literacy Levels in Spanish-Speaking Hispanic Patients at Midwestern Community Health Centers in the USA. J Racial Ethn Health Disparities 2019; 6:701-706. [PMID: 30756258 DOI: 10.1007/s40615-019-00568-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 01/17/2019] [Accepted: 01/25/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Predictions from the US census indicate that by 2060 one of every three individuals living in the nation will be of Hispanic origin. Hispanics experience health disparities manifested with higher rates of chronic conditions such as hypertension and diabetes in contrast with other US population groups. Health literacy and acculturation have been well identified as key contributors for this issue. However, very few studies have examined the association between health literacy and levels of acculturation in Spanish-speaking Hispanics living in rural and urban areas of the USA. OBJECTIVE To assess the prevalence and association of acculturation with low levels of health literacy and demographic variables in Spanish-speaking Hispanics in the US Midwest. METHODS We measured levels of acculturation in Spanish-speaking adult Hispanics (N = 401) accessing community health centers in rural and urban Nebraska. We used a survey that included the Bidimensional Acculturation Scale for Hispanics/Linguistic Proficiency Subscale (BAS/LP) and the Short Assessment of Health Literacy in Spanish (SAHL-S). RESULTS We observed similar acculturation levels with rural and urban status participants. A total of 85% of the total participants had low levels of acculturation to US culture. Of the 15% of the participants who showed themselves to be bicultural, 81% reported adequate levels of health literacy in Spanish. CONCLUSIONS Our findings are consistent with previous studies that report the associations between acculturation and health literacy levels are significant. This study underscores the importance of considering the cultural aspects of the Hispanic community for the development of health literacy interventions and education programs.
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Affiliation(s)
- Armando De Alba
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, 68198-4373, USA.
| | - Denise H Britigan
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, 68198-4373, USA
| | - Elizabeth Lyden
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Patrik Johansson
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, 68198-4373, USA
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Abstract
PURPOSE OF REVIEW Pervasive disparities in T2DM among minority adults are well-documented, and scholars have recently focused on the role of social determinants of health (SDOH) in disparities. Yet, no research has summarized what is known about racial/ethnic disparities in youth-onset T2DM. This review summarizes the current literature on racial/ethnic disparities in youth-onset T2DM, discusses SDOH that are common among youth with T2DM, and introduces a conceptual model on the possible role of SDOH in youth-onset T2DM disparities. RECENT FINDINGS Minority youth have disparities in the onset of T2DM, quality of life, and family burden. Low family income and parental education and high youth stress are common negative SDOH among families of youth with T2DM. No studies have examined the role of SDOH in racial/ethnic disparities in youth-onset T2DM. Future research should examine whether SDOH contribute to disparities in T2DM prevalence and psychosocial outcomes among minority youth.
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Affiliation(s)
- Ashley M Butler
- Baylor College of Medicine, 1102 Bates Street, Suite 940, Houston, TX, 77030, USA.
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Johnson JA, Cavanagh S, Jacelon CS, Chasan-Taber L. The Diabetes Disparity and Puerto Rican Identified Individuals. DIABETES EDUCATOR 2017; 43:153-162. [DOI: 10.1177/0145721716687662] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this systematic review was to describe what is known about the diabetes disparity affecting Puerto Rican identified adults living in the continental United States as well as illuminate areas that merit further investigation. Methods The CINAHL and PubMed databases were searched using the keywords Hispanic, Puerto Rican, and type 2 diabetes. Search limits included < 10-year-old, peer-reviewed, systematic reviews, available in the English language. The abstracts of 124 articles were reviewed, and 7 articles were reviewed in depth. Results The Puerto Rican identified Hispanic subgroup is disproportionately affected by diabetes—the diabetes disparity. Puerto Rican identified Hispanic adults are less affected by citizenship status, may be less affected by English proficiency, use health care services differently, and have contextually different fatalistic views of diabetes compared with other Hispanic identified people. Spiritual/religious influences, associated mental health problems, and general cultural practices related to diabetes self-care are understudied in this group. Conclusion Ambiguous use of the term Hispanic should be avoided when describing Hispanic subgroups. Stronger, more robust studies are needed to understand the unique cultural forces influencing the poor diabetes outcomes and individual behaviors that contribute to generally suboptimal diabetes self-care for Puerto Rican adults with type 2 diabetes.
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Affiliation(s)
- Jalil A. Johnson
- College of Nursing, University of Massachusetts, Amherst, MA, USA (Mr Johnson, Dr Cavanagh, Dr Jacelon, Dr Chasan-Taber)
| | - Stephen Cavanagh
- College of Nursing, University of Massachusetts, Amherst, MA, USA (Mr Johnson, Dr Cavanagh, Dr Jacelon, Dr Chasan-Taber)
| | - Cynthia S. Jacelon
- College of Nursing, University of Massachusetts, Amherst, MA, USA (Mr Johnson, Dr Cavanagh, Dr Jacelon, Dr Chasan-Taber)
| | - Lisa Chasan-Taber
- College of Nursing, University of Massachusetts, Amherst, MA, USA (Mr Johnson, Dr Cavanagh, Dr Jacelon, Dr Chasan-Taber)
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Leung LB, Vargas-Bustamante A, Martinez AE, Chen X, Rodriguez HP. Disparities in Diabetes Care Quality by English Language Preference in Community Health Centers. Health Serv Res 2016; 53:509-531. [PMID: 27767205 DOI: 10.1111/1475-6773.12590] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To conduct a parallel analysis of disparities in diabetes care quality among Latino and Asian community health center (CHC) patients by English language preference. STUDY SETTING/DATA COLLECTION Clinical outcomes (2011) and patient survey data (2012) for Type 2 diabetes adults from 14 CHCs (n = 1,053). STUDY DESIGN We estimated separate regression models for Latino and Asian patients by English language preference for Clinician & Group-Consumer Assessment of Healthcare Providers and System, Patient Assessment of Chronic Illness Care, hemoglobin A1c, and self-reported hypoglycemic events. We used the Blinder-Oaxaca decomposition method to parse out observed and unobserved differences in outcomes between English versus non-English language groups. PRINCIPAL FINDINGS After adjusting for socioeconomic and health characteristics, disparities in patient experiences by English language preference were found only among Asian patients. Unobserved factors largely accounted for linguistic disparities for most patient experience measures. There were no significant differences in glycemic control by language for either Latino or Asian patients. CONCLUSIONS Given the importance of patient retention in CHCs, our findings indicate opportunities to improve CHC patients' experiences of care and to reduce disparities in patient experience by English preference for Asian diabetes patients.
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Affiliation(s)
- Lucinda B Leung
- VA Quality Scholars Program, Greater Los Angeles VA, Los Angeles, CA.,Division of General Internal Medicine and Health Services Research, UCLA, Los Angeles, CA
| | - Arturo Vargas-Bustamante
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA
| | - Ana E Martinez
- Center for Health Policy Research, UCLA, Los Angeles, CA
| | - Xiao Chen
- Center for Health Policy Research, UCLA, Los Angeles, CA
| | - Hector P Rodriguez
- Division of Health Policy and Management, UC Berkeley School of Public Health, Berkeley, CA
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Adams WE, Todorova ILG, Guzzardo MT, Falcon LM. 'The problem here is that they want to solve everything with pills': medication use and identity among Mainland Puerto Ricans. SOCIOLOGY OF HEALTH & ILLNESS 2015; 37:904-919. [PMID: 25720591 PMCID: PMC4521983 DOI: 10.1111/1467-9566.12240] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Taking medications are complex symbolic acts, infused with diverse meanings regarding body and identity. This article focuses on the meanings of medications for older Puerto Ricans living on the United States mainland, a population experiencing stark health disparities. We aim to gain an understanding of the way multiple cultural and personal meanings of medications are related to and integrated in identity, and to understand how they are situated within Puerto Rican culture, history and circumstance on the US mainland. Data is drawn from thirty qualitative interviews, transcribed and translated, with older Puerto Ricans living on mainland United States. Thematic Analysis indicated four prevalent themes: embodiment of medication use; medications redefining self through the fabric of daily life; healthcare experience defined through medication; and medicine dividing the island and the mainland. While identity is impacted by experience of chronic illness, the experience of medication prescription and consumption is further related to the construction of the sense of self in distinct ways. For these individuals, medication use captures the dilemma of immigration. While cultural belonging and well-being remains on the island of Puerto Rico, the mainland hosts both easier access to and excess reliance on medication.
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Walker EA, Silver LD, Chamany S, Schechter CB, Gonzalez JS, Carrasco J, Powell D, Berger D, Basch CE. Baseline characteristics and Latino versus non-Latino contrasts among Bronx A1C study participants. West J Nurs Res 2014; 36:1030-51. [PMID: 24407771 DOI: 10.1177/0193945913517947] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We describe baseline demographic and psychosocial characteristics of low-income, diverse diabetes adults enrolled in a telephonic intervention trial. Environment for the study was New York City (NYC) A1C Registry program. Baseline data were analyzed from 941 participants randomized to either telephonic/print or print-only intervention to improve glycemic control. Summary statistics for key variables were calculated; we highlight baseline contrasts between Latino and non-Latino participants. There were high proportions of Latino (67.7%) and non-Latino Black (28.0%) participants from South Bronx. Mean age was 56.3 years, almost 70.0% were foreign born, and 55.8% preferred Spanish language. Mean A1C was 9.2% and mean body mass index (BMI) 32.1 kg/m(2). There were significant contrasts between Latino and non-Latino participants for behavioral and psychosocial variables. This telephonic intervention study succeeded in randomizing a large number of low-income, diverse participants with poor diabetes control who are under-represented in studies. Latino versus non-Latino differences at baseline were striking.
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Affiliation(s)
| | - Lynn D Silver
- New York City Department of Health & Mental Hygiene, New York, NY, USA
| | - Shadi Chamany
- New York City Department of Health & Mental Hygiene, New York, NY, USA
| | | | | | - Jeidy Carrasco
- New York City Department of Health & Mental Hygiene, New York, NY, USA
| | - Danielle Powell
- New York City Department of Health & Mental Hygiene, New York, NY, USA
| | - Diana Berger
- New York City Department of Health & Mental Hygiene, New York, NY, USA
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Diabetes self-management activities for Latinos living in non-metropolitan rural communities: a snapshot of an underserved rural state. J Immigr Minor Health 2013; 14:990-8. [PMID: 22447175 DOI: 10.1007/s10903-012-9602-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The Latino community continues to grow in the rural Midwest, and diabetes is a pertinent disease for research in this demographic. Patient self-management is an important aspect of comprehensive care for diabetes and may mitigate complications. A cross-sectional survey assessed various activities including self-monitoring of blood glucose, personal foot inspection, diet adherence, and diabetes self-management education. Less than half of the sample performed self-monitoring of blood glucose daily (40 %), adhered strictly to special diabetes diet recommendations (44 %), or attended a diabetes self-management education class (48 %). Participants advised on personal foot inspection were three times more likely to perform the self-care activity. Improvements are indicated in these self-management activities. Further research is needed to discern disparities and barriers in self-monitoring of blood glucose among this target population. An increased emphasis on enrollment in diabetes self-management classes should target foreign-born Latinos with lower levels of education.
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Osborn CY, Amico KR, Cruz N, Perez-Escamilla R, Kalichman SC, O'Connell AA, Wolf SA, Fisher JD. Development and Implementation of a Culturally Tailored Diabetes Intervention in Primary Care. Transl Behav Med 2011; 1:568-479. [PMID: 23412908 DOI: 10.1007/s13142-011-0064-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Diabetes education for ethnic minorities should address variations in values underlying motivations, preferences, and behaviors of individuals within an ethnic group. This paper describes the development and implementation of a culturally tailored diabetes intervention for Puerto Rican Americans that can be delivered by a health care paraprofessional and implemented in routine clinical care. We describe a formative process, including interviews with providers, focus groups with patients and a series of multidisciplinary collaborative workshops used to inform intervention content. We highlight the intervention components and link them to a well-validated health behavior change model. Finally, we present support for the intervention's clinical effects, feasibility, and acceptability and conclude with implications and recommendations for practice. Lessons learned from this process should guide future educational efforts in routine clinical care.
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Affiliation(s)
- Chandra Y Osborn
- Division of General Internal Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN ; Diabetes Research and Training Center, Vanderbilt Eskind Diabetes Center, Vanderbilt University, Nashville, TN
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Osborn CY, Amico KR, Cruz N, O'Connell AA, Perez-Escamilla R, Kalichman SC, Wolf SA, Fisher JD. A brief culturally tailored intervention for Puerto Ricans with type 2 diabetes. HEALTH EDUCATION & BEHAVIOR 2010; 37:849-62. [PMID: 21076128 DOI: 10.1177/1090198110366004] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED The information-motivation-behavioral skills (IMB) model of health behavior change informed the design of a brief, culturally tailored diabetes self-care intervention for Puerto Ricans with type 2 diabetes. Participants (n = 118) were recruited from an outpatient, primary care clinic at an urban hospital in the northeast United States. ANCOVA models evaluated intervention effects on food label reading, diet adherence, physical activity, and glycemic control (HbA1c). At follow-up, the intervention group was reading food labels and adhering to diet recommendations significantly more than the control group. Although the mean HbA1c values decreased in both groups ( INTERVENTION 0.48% vs. CONTROL 0.27% absolute decrease), only the intervention group showed a significant improvement from baseline to follow-up (p < .008), corroborating improvements in diabetes self-care behaviors. Findings support the use of the IMB model to culturally tailor diabetes interventions and to enhance patients' knowledge, motivation, and behavior skills needed for self-care.
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Affiliation(s)
- Chandra Y Osborn
- Vanderbilt University Medical Center, Nashville, Tennessee, USA.
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Conwell LJ, Boult C. The Effects of Complications and Comorbidities on the Quality of Preventive Diabetes Care: A Literature Review. Popul Health Manag 2008; 11:217-28. [DOI: 10.1089/pop.2007.0017] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Chad Boult
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Bell RA, Arcury TA, Stafford JM, Golden SL, Snively BM, Quandt SA. Ethnic and sex differences in ownership of preventive health equipment among rural older adults with diabetes. J Rural Health 2007; 23:332-8. [PMID: 17868240 PMCID: PMC2612629 DOI: 10.1111/j.1748-0361.2007.00111.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Diabetes self-management is important for achieving successful health outcomes. Different levels of self-management have been reported among various populations, though little is known about ownership of equipment that can enhance accomplishment of these tasks. PURPOSE This study examined diabetes self-management equipment ownership among rural older adults. METHODS Participants included African American, American Indian, and white men and women 65 years of age and older. Data included equipment ownership overall and by ethnicity and sex across diabetes self-management domains (glucose monitoring, foot care, medication adherence, exercise, and diet). Associations between equipment ownership and demographic and health characteristics were assessed using logistic regression. FINDINGS Equipment ownership ranged from 85.0% for blood glucose meters to less than 11% for special socks, modified dishes, and various forms of home exercise equipment. Equipment ownership was associated with ethnicity, living arrangements, mobility, poverty status, and formal education. CONCLUSIONS Rural older adults with diabetes are at risk because they lack equipment to perform some self-management tasks. Providers should be sensitive to and assist patients in overcoming this barrier.
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Affiliation(s)
- Ronny A Bell
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1063, USA.
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Peek ME, Cargill A, Huang ES. Diabetes health disparities: a systematic review of health care interventions. Med Care Res Rev 2007. [PMID: 17881626 DOI: 10.1177/1077558707305409; 17881626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Racial and ethnic minorities bear a disproportionate burden of the diabetes epidemic; they have higher prevalence rates, worse diabetes control, and higher rates of complications. This article reviews the effectiveness of health care interventions at improving health outcomes and/or reducing diabetes health disparities among racial/ethnic minorities with diabetes. Forty-two studies met inclusion criteria. On average, these health care interventions improved the quality of care for racial/ethnic minorities, improved health outcomes (such as diabetes control and reduced diabetes complications), and possibly reduced health disparities in quality of care. There is evidence supporting the use of interventions that target patients (primarily through culturally tailored programs), providers (especially through one-on-one feedback and education), and health systems (particularly with nurse case managers and nurse clinicians). More research is needed in the areas of racial/ethnic minorities other than African Americans and Latinos, health disparity reductions, long-term diabetes-related outcomes, and the sustainability of health care interventions over time.
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Affiliation(s)
- Monica E Peek
- Section of General Internal Medicine, The University of Chicago, Chicago, IL 60637, USA.
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Peek ME, Cargill A, Huang ES. Diabetes health disparities: a systematic review of health care interventions. Med Care Res Rev 2007; 64:101S-56S. [PMID: 17881626 PMCID: PMC2367214 DOI: 10.1177/1077558707305409] [Citation(s) in RCA: 317] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Racial and ethnic minorities bear a disproportionate burden of the diabetes epidemic; they have higher prevalence rates, worse diabetes control, and higher rates of complications. This article reviews the effectiveness of health care interventions at improving health outcomes and/or reducing diabetes health disparities among racial/ethnic minorities with diabetes. Forty-two studies met inclusion criteria. On average, these health care interventions improved the quality of care for racial/ethnic minorities, improved health outcomes (such as diabetes control and reduced diabetes complications), and possibly reduced health disparities in quality of care. There is evidence supporting the use of interventions that target patients (primarily through culturally tailored programs), providers (especially through one-on-one feedback and education), and health systems (particularly with nurse case managers and nurse clinicians). More research is needed in the areas of racial/ethnic minorities other than African Americans and Latinos, health disparity reductions, long-term diabetes-related outcomes, and the sustainability of health care interventions over time.
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Affiliation(s)
- Monica E Peek
- Section of General Internal Medicine, The University of Chicago, Chicago, IL 60637, USA.
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Abstract
This review of the literature on vulnerable populations with diabetes identifies trends, summarizes major findings, and recommends strategies to fill gaps in the state of the science. For the purposes of this article "vulnerable populations" refers to members of diverse racial and ethnic groups, people of low-income, and those who live in rural and medically underserved areas.
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Affiliation(s)
- Alexandra A García
- School of Nursing, The University of Texas at Austin, TX 78701-1499, USA.
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